As if to prove that it is not only technology projects under the NHS National Programme for IT (NPfIT) that go wrong, October saw another hospital crippled by IT problems – and the company at the centre of it is also the most controversial participant in the National Programme. New technology is supposed to improve operational efficiencies and save money. So it is a tad embarrassing that serious problems with one of iSoft’s most complex hospital computer system installations are threatening to wipe more than £16 million off the expected income for University Hospital of North Staffordshire, a figure described by finance director Mark Mansfield as “pretty scary”.

North Staffordshire is in a difficult enough position already. It is wrestling with having to claw back debts from last year of £15m and the axing 1,000 staff. To add to its woes it is also having problems getting basic information on patient treatments out of its IT systems in order to send bills out to the primary care trusts.
ISoft software packages iCM and iPM – the so called “new heartbeat of the hospital” – were finally installed at the start of July, more than two years behind schedule. Six weeks later IT staff were encountering what was described as “significant difficulties” as a result of “problems with the software”.

These were said to be being addressed but in mid October hospital staff were told by the IT department that: “Due to technical difficulties, trust departments/wards will be unable to view results via iCM until further notice. We are working closely... to resolve this issue as a matter of priority.”

Trust issues

According to the trust board papers the problem stems from the new datawarehouse associated with the electronic patient records. Activity reports needed for billing have been impossible to generate due to “the failure so far of the system to collate appropriate identifiers to the work”, and the “high level of coding backlog” that has built up. The October board paper states: “While significant effort is being put into resolving these issues, little meaningful progress has yet been made. These issues must be resolved as a matter of urgency if the trust is not to suffer a major loss of income, impacting materially on the 2006/7 out-turn.”

iSoft’s North Staffordshire installations do not form part of the NPfIT. But the ageing joint iSoft iCM/iPM solution is the software being offered by CSC to 60 per cent of NHS trusts as part of the £12 billion NHS IT programme.

CSC is currently being forced to offer the older software as versions of iSoft’s new Lorenzo system, originally due in 2004, are now not expected until 2008 at the earliest.

In May the trust and iSoft said in a joint statement that there had been a number of reasons for the delays: “Data migration on this scale and complexity is something that is outside the scope of many NPfIT projects. iSoft is transferring 10 years’ of clinical data from multiple, disparate sources.”

Mike Brereton, trust chairman at North Staffordshire, told The Guardian: “It is too early to say” if the trust is happy with the progress to date.

It might be thought that self-declared “grumpy git” Richard Granger would be keen to win over certain constituencies but it seems not. The NHS IT boss has sparked a new row by comparing the British Medical Association (BMA) to the National Union of Mineworkers.

According to Granger, the influential doctors’ trades union is a barrier to change in the NHS. “There are some blocks to radical structural change,” he said in a roundtable debate on IT and modernisation hosted by the New Statesman magazine.

“I have encountered an incredibly powerful union – comparable to the National Union of Mineworkers – and that is the British Medical Association. We have had very complex demarcation disputes that govern who can order what, who can do what and they get into price per job negotiations... It really is a rate-limiting factor on change in the public sector.”

A BMA spokesman said: “It is a completely unfair criticism. Obviously we have been raising doctors’ concerns about the NPfIT but to suggest that we are being somehow obstructive is completely unfair.” In a subsequent statement, NPfIT said the IT director general’s remarks were not taken from a verbatim transcript and “the full context is therefore missing”. Quite what the missing context is was not offered as evidence.

A MORI poll for the NHS found in January that enthusiasm for the NPfIT had fallen sharply among many health service staff, particularly managers and IT executives. The survey suggested this was in part down to project delays.

Granger also returned to a familiar theme of blaming the media for reporting only bad news, this time claiming that it would reduce wider governmental willingness to take risks.

“Our appetite for doing things that are transformational and taking large amounts of risk is going to reduce and we will end up buying in things as commodities after other countries have got them in first.”