Monitor blasts Rotherham’s EPR programme

The Rotherham NHS Foundation Trust has been found in significant breach of its terms of authorisation by Monitor, with its electronic patient record implementation identified as a key issue.

The trust this month admitted it was facing "persistant serious issues" with the deployment of its Meditech EPR including "clinician and staff acceptance and usability."

It has stopped all go-lives of the system and has hired an external consultant, Larry Blevins, to conduct an immediate review of the system.

A statement from Monitor said The Rotherham had significantly underperformed on its financial plans leading to concerns about the way it was governed.

Key concerns included the trust’s failure to successfully implement a new EPR which led to problems booking patient appointments and loss of income.

A letter from Monitor to The Rotherham says: “The trust has not managed EPR implementation in an effective way and significant operational and financial risks will remain until the trust has a robust and operationally effective EPR system."

“It is unclear whether the trust has sufficient visibility over operational performance and quality issues, including incidents of patient harm,” it adds.

“Data quality remains a significant risk. The trust is currently unable to rely on coding, case mix or activity data from the EPR system, significantly compromising the trust’s ability to manage performance effectively.”

Earlier this month, the trust issued a statement regarding the appointment of an interim chief executive. This said it had discovered “significant issues of operational and financial performance” which needed to be addressed urgently.

“The board will institute a strategy to correct or take other actions concerning the EPR system in such a way that it does not hinder or slow the work of clinicians, nurses, AHPs and others during their time caring for patients.

“We have engaged an independent external EPR expert, with experience in multiple types of implementations,” said the statement.

“His job will be to review and resolve the issues causing the EPR situation from an independent standpoint.”

The trust went live with its Meditech EPR last summer, two years after the original planned go-live, and has experienced difficulties with the system since.

Board minutes from the trust’s EPR programme board meeting in October last year, obtained by EHI via the Freedom of Information Act, revealed that the trust had stopped the phased go-live of the system.

“Until all current issues had been resolved there should be no further implementation of EPR phased go-lives,” the document says.

The following month’s EPR board minutes reference the non-executive director chair of the audit and assurance committee raising concerns that there may be financial pressures and risks related to the system.

“As such he suggested that the trust should consider allocation of a further financial contingency or reinvestment in EPR,” the minutes say.

Stephen Hay, managing director for provider regulation at Monitor, said it was concerned that the trust’s failure to address its financial issues was due to "the lack of adequate strength and capacity within the management team.”

The trust board has engaged a specialist healthcare management firm, Bolt Partners LLP, based in London, to lead the trust’s recovery.

Michael Morgan has replaced Matthew Lowry as interim chief executive after former chief executive, Brian James retired last year.

“Bolt Partners will provide three recovery and restructuring professionals on an interim basis, Michael [Morgan] will be engaged with immediate effect as the trust’s interim chief executive to lead the recovery and restructuring,” said a statement from the trust.

The trust has also taken out a full page advertisement in the local paper to reassure the public and staff that it has sufficient cash to meet all payroll and creditor obligations.

The Rotherham was one of the first trusts to go outside the National Programme for IT in the NHS for an EPR and was the first NHS trust to purchase the latest Meditech system. The value of the deal has been put at £40m over ten years.

In October last year, Unison claimed the trust planned to cut 750 jobs over the next three years to save £50m over four years from its £220m budget.