The chief executive of Worthing and Southlands Hospitals NHS Trust has said the Cerner Millennium care records system is still suffering from ‘inferior functionality’, leading to ‘significant level of discontent among clinicians’.

Attempts to install manual and electronic workarounds – where possible – have already cost over £2m of extra spending, with a further £1m now required by the trust. The Cerner CRS system was provided by Fujitsu as part of the £12.7 billion NHS IT programme.

Workarounds have had to be installed for nurse handover reports, establishing a separate patient database for A&E and a data warehouse to allow statutory reporting.

As a result, Worthing – which had been hailed by Fujitsu as a flagship site – has already had to borrow £2m from West Sussex PCT to cover ‘extra expenditure incurred as a result of the Cerner implementation’, on extra staff and software, straining the relationship with its main customer.

Despite these extra investments Worthing’s chief executive has said the trust is “still unable to satisfactorily capture, record and bill all activity”, which was “contributing to contractual difficulties” with the PCT.

On 1 May, Stephen Cass, chief executive at Worthing, wrote to Candy Morris, chief executive of the South East Coast Strategic Health Authority, asking for support “in order to mitigate the predicted high financial costs arising directly from this deployment.”

He bluntly tells Morris: “It is evident that the trust continues to experience significant difficulties due to inferior functionality and ongoing usability issues of the system which has led to a significant level of discontent amongst clinicians and users of the system.”

With the problems of Cerner Millennium unresolved, the trust says it will need an extra £1m in the coming year to hire 42 new administrative staff to check and manually process data meant to have been handled by the Fujitsu provided computer system.

Cass told Morris: “The [trust] estimates the ongoing need for an additional 42 WTE [whole time equivalent] staff, which equates to a financial cost in the region of circa £1m in excess of the previous patient administration system.”

The trust has now prepared a detailed impact assessment for 2008/09, which identifies 18 different issues to do with the Fujitsu provided CRS system.

Problems with the system include: staff being unable to effectively locate and track patients or case notes, no facility to record A&E procedures or provide fit for purpose discharge summaries, no capability to track and monitor 18-week waits, serious problems with correspondence, no provision for printing and annotating patient lists, and no ability to print off specimen labels.

Cass added that whilst Fujitsu’s year-long contract re-set has been underway, the trust has yet to receive necessary fixes and upgrades, including Choose and Book and 18-week tracking.

In his letter to Morris Cass says: “The lack of clarity regarding timescales for the deployment of future releases, which will address existing limitations such as tracking the 18-week pathway, the need to move to direct booking and the provision of an effective order communications solution, is of particular concern.

“This position has been exacerbated by the lack of progress in delivering local enhancements to the system as envisaged by NLOP, and the continuing delays surrounding the provision of fixes/upgrades to improve the usability of the system.”

Connecting for Health (CfH) says it is working with the trust to fix problems. A spokesperson told EHI: “WASH is receiving planned upgrades and maintenance fixes in line with agreed plans. Many of the concerns raised during early stages of implementation have now been resolved and there is a robust escalation process in place for trusts to raise issues unable to be resolved at a local level.

On the extra unplanned costs incurred by the trust the spokesperson said: “Deployment plans have always had an element of both central and local funding for implementation.”

A Fujitsu spokesperson added: “Fujitsu Services endeavours to work with NHS CfH to deal with the evolving needs of all trusts as well as those specific to Worthing.”

Two months ago Morris wrote to local MP, Peter Bottomley two months ago, saying functionality ‘deficiencies’ have resulted in CfH asking Fujitsu to explain why implementation dates continue to slip for trusts in the South.

“You may be aware that NHS Connecting for Health with the support of the three SHA chief executives in the South of England has escalated the issue with Fujitsu in relation to their failure to deliver key implementation milestones in their work for the Southern Programme for IT. Negotiations continue, and there are no rose-tinted glasses. We await Fujitsu’s remediation plan,” she told the MP at the time.

Bottomley challenged health minister, Ben Bradshaw, on this issue and last week, Bradshaw published a written response, stating: “We are aware of the concerns expressed by clinicians at Worthing and Southlands NHS Trust about the Cerner IT system that has been installed at that trust.

The minister said CfH boss Gordon Hextall will now be visiting the trust “I have arranged for the department’s director of informatics and interim director of programme and systems delivery to visit Worthing hospital at the earliest opportunity to address with clinicians locally the concerns that have been raised by the honourable member. I will also write to him shortly to explain the plans that are in place to further develop and improve the Cerner Millennium product, its functionality, and its ease of use.”

The problems and visits from Department of Health senior officials echo the problems at Milton Keynes last year, where CfH’s then chief executive, Richard Granger, and the NHS chief executive, Sir David Nicholson went to address disgruntled users of Cerner and pledged support in making the system more usable.