University Hospitals of Morecambe Bay NHS Foundation Trust is working through a backlog of 14,000 patients who failed to receive follow-up outpatient appointments because of administrative and IT problems.
The report of an investigation into the backlog paints a damning picture of failures at the trust, which became the first to introduce the Lorenzo electronic patient record system as part of the National Programme for IT in the NHS.
The report says the problems go back many years and have their roots in a ‘mismatch’ between demand and capacity at Morecambe Bay, as well poor management and risk practices and a culture of avoiding blame.
However, it also says the trust missed a big opportunity to identify and tackle the problems when it introduced Lorenzo in June 2010, and that staff work-arounds contributed to the ultimate size of the backlog.
Eventually, there were 37,000 access plans on the Lorenzo system for which a guaranteed access date had been missed. Many of these plans were duplicates or had not been closed.
However, 14,000 patients needed to be seen and were divided into cohorts so the trust could deal with them. All these patients should have been seen by the end of March.
For the future, the report says the trust needs to establish better systems, find ways to make sure that the board knows what is going on, encourage staff to take responsibility for dealing with problems, and curb the “mal-use” of Lorenzo by imposing “sanctions” on staff if necessary.
It also says the findings of the report, and the importance of “electronic, standardised and systematic management of outpatient follow-ups” should be shared with all providers, in case others are suffering the same problems on a smaller scale.
University Hospitals of Morecambe Bay NHS Foundation Trust has come under increasing scrutiny in recent weeks.
Foundation trust regulator Monitor declared that it was in breach of some of its requirements in October, and raised concerns about its governance and leadership.
The regulator has now used its powers of intervention to install a new interim chair – Sir David Henshaw, chair of Alder Hey Children’s NHS Foundation Trust – and to demand the appointment of a new chief operating officer and a turnaround director.
At the same time, investigations have been launched into the trust’s maternity and emergency care services.
At one point, Morecambe Bay was hoping to take over the neighbouring Cumberland Infirmary and West Cumberland Hospital. But they have now been merged with North Cumbria University Hospitals NHS Trust.
The investigation into the outpatients backlog says the problems can be traced back to 1998, when the-then Morecambe Bay NHS Trust was formed out of three organisations.
It says the trust always struggled to manage patients effectively across divisions spread over three sites; and that things were so bad at one point that the local primary care trust took over outpatient booking.
When this function was returned to the trust in 2009, the report says it failed to centralise booking in one place and to put it under one management.
Then, when a backlog was identified during the data cleansing process for the introduction of Lorenzo, the trust failed to recognise it as a clinical problem.
Instead, to try and solve another administrative problem – the constant cancellation of clinics – the trust introduced a ‘partial booking’ system.
Patients who needed a follow-up in more than six weeks were asked to call for an appointment.
“No arrangements were made to account for the 1,000 or so calls that the clinical clerks would receive per week, whilst still trying to man the reception desk and administer the clinics,” the report says. “This created chaos and confusion for patients and staff alike.”
Patients were often offered late appointments – “some of which arrived with the patient only after the clinic had taken place.”
All of this caused patient and GP complaints, but because they seemed to relate to administrative problems, their real, clinical nature was overlooked.
In the middle of all this, outpatient staff complained that Lorenzo was slow – although the report says there is no evidence that it was slower than the system it replaced – and that it was more complicated to complete a booking.
As a result, “many staff found ways around that were quicker, but these were responsible for patients having multiple access plans, which helped to label the problem as administrative.”
Floor walkers initially monitored such “inappropriate” use, but this stopped once Lorenzo had stabilised.
Morecambe Bay is the first and most prominent of the ‘early adopter’ sites for Lorenzo, which was due to be implemented in the North, Midlands and East by CSC as local service provider.
The problems at the trust, CSC’s failure to complete the ‘early adopter’ programme, and critical reports from watchdogs and MPs on progress, have thrown a new LSP deal into doubt.
CSC announced last week that it was going to lay off 500 staff, including 46 from iSoft, which developed Lorenzo, and which CSC bought last year.