Cambridge put in special measures

Cambridge University Hospitals NHS Foundation Trust has been put into special measures by Monitor, which says the trust's e-hospital programme has caused "significant cost increases", while benefits have not been realised.

The CQC’s chief inspector of hospitals, Professor Sir Mike Richards, recommended the intervention following the publication of an inspection report, which highlights serious safety and quality issues at the trust, including several related to the introduction of its ten year, £200 million eHospital programme.

Monitor announced today that it has responded by deciding to put the trust in special measures. The regulatory body for foundation trusts in England said Cambridge is predicting at least a £64 million deficit this year, due to an average overspend of £1.2 million a week.

Monitor's own investigation into the trust's finances has concluded that the trust lacks the adequate financial control it requires.

"The trust also underestimated the scale and challenges of implementing its new electronic patient record system, eHospital, and the impact this would have on its provision of healthcare for its patients," a statement from the regulatory body says. "These issues led to significant cost increases and a failure to realise the benefits the system could provide."

The news comes a week after the Cambridge University Hospitals’ chief executive Dr Keith McNeil resigned his post, referencing the trust’s “growing financial deficit”, which stood at £20.6 million at the end of July.

The introduction of the eHospital programme, which included a major infrastructure upgrade by HP, and the first implementation of the Epic electronic patient record system in the UK, may have contributed to the deficit, but the CQC report shows it may have impacted patient care as well.

In its key findings, the CQC says that the introduction of Epic, which is in common use in the US, has “affected the trust’s ability to report, highlight and take action on data collected on the system.”

This includes the ability to access information from diagnostics tests such as electrocardiographs, while agency staff are not always able to access information about patients they are supporting.

The problems in data collection have meant that staff have been unable to complete audits effectively, according to the Health and Social Care Information Centre.

“Staff were competent and understood the guidelines they were required to follow, however, lack of staffing and problems with the computer system (Epic) made this difficult,” the report says.

The report adds that the EPR is “beginning to be embedded into practice” but is “still having an impact on patient care and relationships with external professionals.”

The CQC also mentions that medicines were not always prescribed correctly during the inspection due to “limitations of Epic”, although the CQC said it has been assured this is being addressed. Specific recommendations from the CQC include that medicines must be “managed in line with national guidance and the law”.

Cambridge remains the only trust in the UK to have installed the EPR, although the board of Royal Devon and Exeter NHS Foundation Trust recently approved a business case for the system.

Papworth Hospital NHS Foundation Trust, which neighbours Cambridge University Hospitals, had also intended to go with Epic but last month decided not to take the system citing concerns about value for money.

The CQC report also highlights more general problems at Cambridge University Hospitals, which comprises the two main sites Addenbrooke’s Hospital and the Rosie Hospital.

The most pressing of these is a shortage in staff in a number of areas, which has led to staff working in services where they lacked proper skills and training, “presenting a risk to patient safety”.

Routine operations have also been frequently cancelled and there have been long delays in getting appointments.

Despite the serious technological issues at the trust, the CQC also highlighted some areas where digital tools were part of “outstanding practice.”

Examples include the use of virtual clinics involving multidisciplinary teams and the online educational resources developed by the trust’s neurological critical care team.

Sir Mike also commended the commitment of the trust’s staff, with the CQC rating the trust’s caring as “outstanding.”

Trust chair Jane Ramsey said: “We are determined to put this right as quickly as possible, to make sure our processes are robust and transparent, so every step of a patient’s journey can be effectively monitored from the ward to the board. 

"We will be working with the CQC, Monitor, our partners and staff to develop further action plans to rapidly address the rest of the concerns and we are confident we will have them in place quickly."