Kingston Hospital NHS Foundation Trust did not go-live with Cerner e-prescribing and clinical documentation last year after BT failed to deliver a “workable system” on time, trust board papers reveal.
Plans to implement the clinical functionality later in 2013 were thwarted by the Department of Health’s refusal to pay the £2m in estimated extra costs associated with the delay.
“This left the trust with no option but to cancel the deployment. In order to minimise losses, the trust took the upgrade to the functionality (so BT have been paid) but is not able to utilise the functionality so has gained no benefit to patient care,” a report to the board in September 2013 says.
The experience has prompted Kingston to begin exiting its National Programme for IT contract, under which it received Cerner Millennium from BT in 2009.
The board report says the trust was due to go-live with an upgrade to Millennium in June 2013. This included enhancements to the Cerner functionality, a new reporting warehouse and the deployment of e-prescribing and clinical documentation.
Kingston invested £2.8m last year in preparing for the upgrade and would have been the first in London to take the new clinical functionality under NPfiT.
However, the implementation was cancelled when BT was unable to deliver a “workable system” on time due to problems with reporting aspects of the functionality.
Once the problems were resolved, a new date was set for September, but the new modules were not deployed because the DH would not support the additional costs of the delay.
These were estimated at £2m because of the need to double the size of the intensive support team. The DH offered only £200,000.
An email from senior responsible owner for local service provider programmes at the DH, Tim Donohoe, said: “Having thought about this carefully and also having spoken to Ian Dalton at BT, I can confirm that we would find it impossible to justify and to source the additional funding.”
The board paper says the DH’s decision was a surprise, but because the trust had no visibility of the details of the contract it had “no ability to apply leverage”. Attempts to work with the DH to reduce costs were refused.
Escalation within the DH, to the Trust Development Authority and to NHS England were also unsuccessful as “changes to the governance of the national programme means there is no longer any ownership of difficulties caused by legacy contracts within the NHS”.
“The trust is working under a legacy contract for its IT systems over which it has no leverage if there is a failure.
"This includes deployment failures but also service failure. If the service went down for any period of time it would cause significantly increased costs to the trust and there are no mechanisms to secure compensation for that loss,” the board papers say.
In response, the trust has started the process for exiting the contract. The report says it is the second foundation trust in London to do this, after Royal Free London NHS Foundation Trust.
A Kingston spokesperson told EHI it had agreed a new plan with BT and the Health and Social Care Information Centre to go live with e-prescribing and clinical documentation in the next few months.
“However, BT again let us down on the plan as they had not had formal contract documentation exchanged with HSCIC. They then redeployed the resource, which has once again delayed the planned go live," the spokesperson said.
“At this stage we do not yet have a confirmed and agreed plan for when we might deploy e-prescribing and clinical documentation and in the meantime the trust is working as quickly as it can to exit the programme.
“We understand that an element of the payment has been withheld pending full deployment of e-prescribing and clinical documentation.”
A BT spokesperson said the company has “maintained a close working relationship with Kingston over the past few months whilst ensuring we also meet the commitments of implementations at other acute trusts in London and the South.”
Enhancements to the patient administration system, A&E and information management went ahead in September last year.
However, a November update to the board says Kingston experienced “a significant number of issues” following the September upgrade, which affected both front-end users and reporting.
“The major front-end issues were resolved within the first two weeks, however, significant data clean-up has been required in order to ensure the data would be accepted by SUS and the trust receive the related income,” it says.
A Cerner spokesperson said the company has a very positive relationship with Kingston and “remain ready to support the deployment of the additional functionality."