Barts in special measures

Barts Health NHS Trust has been placed in special measures as it deals with a major deficit, problems meeting national waiting time standards and a damning Care Quality Commission report into one of its hospitals.

The trust announced yesterday that it has been put into special measures by the NHS Trust Development Authority as it stares down the barrel of an expected £93 million deficit and addresses issues in meeting national waiting time standards.

The decision to put the trust into special measures has been hastened by the publication of the CQC report into Whipps Cross University Hospital, one of the hospitals that the trust took over as part of a 2012 merger.

As part of that merger, Barts Health embarked on an ambitious IT strategy to implement the Cerner Millennium electronic patient record system across all of its hospitals to deliver more integrated care.

The CQC inspection report on Whipps Cross, released today, says a £13 million increase in the trust’s expected deficit was due in part to £2 million of additional costs for the IT systems deployment at the hospital.

The costs were due to an unsuccessful deployment and the need to invest “significant resources” to address problems with outpatients booking and scheduling.

CQC inspectors visited Whipps Cross last November, with their report noting that “the implementation of IT systems had impacted on patient safety and care” and meant patients were struggling to get appointments.

Staff across departments reported problems with patients receiving letters for the wrong treatment and being booked into the wrong area, leading the operations being cancelled and delays in treatment.

A patients’ panel said the new system had booked appointments with doctors who no longer worked at the hospital, while patients were coming in for clinics that did not take place on the day of their visit.

Whipps Cross also had problems with issuing patient letters after one of the servers stopped working in June 2014 for more than two weeks, leading to an extensive backlog of over 40,000 letters and patients missing appointments.

Problems with the system in the maternity department had led to some women complaining that their appointments had been delayed or mixed up, while others had faced long waits to see reception staff on their arrival.

Staff confirmed that there had been problems with appointments for scans and clinics during the implementation of the new system, with temporary measures including the replacement of some electronic booking with manual booking and the introduction of a waiting number dispenser for women to see the receptionist.

IT issues are also reported to have caused delays with pathology results for renal patients, leading to delayed treatment.

A lack of computers for emergency and urgent care staff was also noted, with the report stating that some data such as a patient’s blood pressure or heart rate were sometimes recorded on paper and then transferred into the electronic patient record when a computer was available.

“Transferring the information from paper to computer increases the risk of incorrect information being recorded or it not being recorded at all. If a computer was not immediately free, it was also possible the member of staff may forget to update the patient’s record, we were told.”

The report notes that IT problems were a factor in what it describes as “a serious incident…which resulted in a patient death”.

“Although the investigation had not been fully completed at the time of our inspection, one of the contributing factors referred to the computers not working and as a direct result information was not readily available about the patient.”

The CQC also observed problems with smart cards given to staff to access the EPR, with some staff sharing cards when theirs did not work and breaching information governance requirements. The organisation was told during a re-inspection that new cards had been reissued to staff following the problems.

There were also complaints about a lack of IT support, with access for new staff taking up to eight weeks and employees chosen as “champions” for the new system given no extra training.

“They did not feel fully competent and well supported by the trust to fulfil this role,” the report says.

EHI News reported last December that Barts Health had suspended reporting of its referral to treatment waiting time data to address “significant” IT problems.

In a statement announcing the special measures, Barts Health chief executive Peter Morris said the trust “is committed to ensuring the safety and welfare of every one of its patients”.

“This report describes services that fall a long way short of what we aspire to. We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the trust has a big challenge ahead.”

Morris said the trust will take all the necessary steps to raise standards at Whipps Cross, and is confident that being placed into special measures will “provide help and support where it is most needed”.

“It has worked well with NHS organisations in other parts of the country and I am confident it will work here.”

EHI News has asked the trust a number of questions about the problems with its IT systems, and is awaiting a response.