Researchers warn NPfIT delays risking patient safety

Lack of effective communication and delivery delays are leaving trusts disenfranchised and weakening local commitment to rolling out the National Programme for IT creating risks to patient safety, leading academics have warned.

Competing priorities, lack of financial resources and repeated delays in the delivery of new systems are all said to be hindering efforts by senior NHS trust managers interviewed to sell the programme locally.

The study, published in the BMJ, warns of the risk to patients’ safety if Connecting for Health (CfH), the agency responsible for the NHS IT programme, continues to leave trusts in the dark. It says trusts are attempting to mitigate clinical risks by opting for interim systems, but warns that interim systems outside of the programme will be inefficient when the new national programme systems are eventually introduced.

The researchers say: “The lack of integration offered by interim applications has left senior trust staff questioning whether NHS-wide connectivity will ever be achieved and why trusts have had to wait several years for the new systems.”

The findings come from a qualitative study of progress on the NPfIT programme in acute trusts. The research, carried out by researchers from Imperial College, King’s College, the London School of Hygiene and Tropical Medicine and Bristol University, found that senior NHS managers interviewed supported the goals of the programme, but had several concerns.

The researchers interviewed 25 senior managers and clinicians responsible for implementing the programme in four NHS hospitals in England. Interviews were conducted in two stages, 18 months apart, to compare progress and perceived challenges over time.

The researchers found that the programme was still having an impact of financial deficits and managers were distracted from implementing the programme by other priorities. Communication between CfH and local managers was found to still be poor, and delays in patient administratio system implementations were still common, resulting in a growing risk to patient safety.

One of the researchers Jane Hendy, a research fellow at Imperial College, told E-Health Insider that the interviews demonstrated the lack of communication between the NHS agency and trusts.

“Managers need to be given a timetable for implementations and an idea of what to do whilst they are waiting. They need some guidance as to what to do meanwhile. Trusts haven’t been informed to the exact nature of the delays. They are given one timetable, then another and then another, and are left in the lurch with systems that need replacing.”

One chief executive is quoted as saying: “I wouldn’t go out and sell it to people because I don’t know when it’s going to arrive…getting people too enthusiastic on specific timetables would have been very dangerous.”

One medical director said: “Actually motivating people in this particular trust at this particular time to have the vision to get involved in a nationwide project, which isn’t delivery, is virtually impossible. The majority of my colleagues are surviving day to day with no beds, cuts…There are real immediate issues, there isn’t the luxury, I suppose, of people having the time and intellectual capacity to pursue a 10 year vision.”

An IM&T director said trusts wouldn’t worry about it because the local service providers work for CfH and not them: “The frustration is we’re not the customers, as far as the suppliers are concerned…CfH pull the strings, it’s their contract, we’re just the entity that takes the solution.”

Hendy told EHI: “There is a huge issue of financial commitments that senior trust officials are faced with week in-week out. The task of finding time to prioritise issues has meant that the national programme has been left on the backburner for a while, as they have a lot on their plate."

She added: “Targets are putting huge pressure on some trusts though, and so if a system needs to be replaced, we’re finding some will go out and spend the money necessary. What I think the main message of this report would be to CfH is that trusts need continual guidance, especially in light of all the delays, on how to get the benefits that they need.”

The paper warns: “The sheer size of the task has made progress slow. Effective communication and a shared commitment to the task across all health sectors have been difficult…even with changes, the issues raised in our study, particularly in regard to risks to patient safety, still need to be urgently addressed.”

The researchers conclude: “Connecting for Health needs to address the uncertainty experienced by trusts and take responsibility for advising about interim decisions. Trust managers urgently need concrete information about implementation timetables, long term goals of the programme, and value for money.

They also stress the need for better assistance to trusts to help them see the benefits of the NPfIT programme: “Finally, trusts need help to prioritise IT modernisation against other competing financial pressures.”

In a response the paper, CfH said patient safety was not an issue: “It is untrue to suggest patient safety is being compromised. NHS CfH is giving full priority to trusts with the oldest existing systems. In the past twelve months alone, we have installed 162 systems in the hospital sector including 15 hospital patient administration systems and 62 picture archiving and communication systems, which capture and store images electronically.

“Progress introducing systems in acute hospitals, like the four in this study, has been slower than expected and some of this has been dependent on legacy IT suppliers and ensuring trusts are fully prepared for the new systems. We and the local service providers work alongside trusts to fully support existing systems ahead of installation of national programme systems.”

The CfH statement added that the paper identified challenges which they take seriously and work hard to address.

“This research reveals some of the challenges and frustrations of introducing new IT into the hospital sector. We work with those challenges every day and are working hard in partnership with local NHS organisations to overcome them to make best use of these technologies. This study again shows the huge support for better health informatics in the NHS and the aims of the national programme.

“We take seriously the need to ensure our systems meet NHS needs and that staff are fully engaged with the national programme, which is why on 1 April 2007 strategic health authorities, in partnership with trusts and PCTs, took responsibility for local delivery and implementation of the national programme.”

The research was carried out by Jane Hendy, research fellow at Imperial College, Naomi Fulop, professor of health and health policy at King’s College, Barnaby Reeves, reader in epidemiology at Bristol University, Andrew Hutchings, lecturer at the London School of Hygiene and Tropical Medicine and Simon Collin, research associate at Bristol University.