Outdated IT system puts patients in Wales at risk

The way patient records are kept in Wales is outdated and worryingly prone to crashing, placing patients at risk, a new report has found.

The NHS Wales Informatics Service (NWIS) is supposed to integrate IT systems across Wales’ health boards using new ways to speed up red tape, save money and improve patient treatment. However, WalesOnline reports the Assembly’s Public Accounts Committee found that since NWIS was first envisioned in 2003, other technology products have been launched and improved while medical staff in Wales are still struggling with “archaic and fragile” IT systems which don’t deliver on their promises.

In 2016 the total cost of developing and rolling out the new systems across all Welsh health boards was estimated at £484m. But the committee could find little evidence of where the money would come from and whether it would be additional NHS funding or found within existing resources.

NWIS also spends only 10% of its budget on innovation while allocating considerably more to repairing and maintaining systems long past their sell by date. The committee was particularly concerned at the fragility of CaNISC, the system used to track the treatment and wellbeing of cancer patients in Wales. CaNISC is based on software not supported by Microsoft since 2014. Despite the software effectively being obsolete and at risk of cyber attacks, a replacement still hasn’t been found. Cardiff and Vale University Health Board reported that the system was down for three days during August of this year.

Velindre Cancer Centre reported “One patient did not receive chemotherapy treatment, as blood results were unavailable; there was also a delay in radiotherapy treatment for eight patients.”

Richard Pugh, head of services for Macmillan in Wales, said “The concerns outlined in this report reflect what many professionals working in cancer care already know – that there are serious question marks about the IT systems used to hold patient records and manage patient care. Failings within the CaNISC IT system mean vital treatments like chemotherapy or radiotherapy may not be prepared on time, patients may attend for treatment only to experience delays in it going ahead, and health professionals are left unable to access patient records to plan their care. Continuing with the current ‘patch-and-mend’ approach on an obsolete IT system will not only heap additional pressure on our hard-working cancer care workforce, it runs the risk of putting cancer patients in Wales at risk and creating unnecessary stress for those going through treatment. We fully support the committee’s recommendation that the CaNISC IT system should be replaced as soon as practicably possible. People with cancer need a reliable system to manage their care effectively and they need that system now – this will only be achieved by strong leadership across NHS Wales as a whole and a firm commitment to providing the investment that is so urgently required.”

In total, systems across NHS Wales failed on average once every nine days in the first six months of 2018. The committee was given assurances no patients were at risk during the outages. But NWIS’s own serious incident log stated “There was an increased risk to patients with GP consultations, creating anxiety for clinicians and patients as a result of the inability to view all patient records, as well as an increase in the delays in patient flows within outpatients, emergency department, endoscopy, and theatres. Some patients required repeat diagnostics as a result of the inability to process some pathology samples.”

The committee was also concerned at the “overly positive” reports of progress from senior managers with the chief executive responsible for hosting NWIS describing its ambitions as “world leading.” This is despite projects either running well behind schedule, or in some cases, only on schedule because the schedule had been changed.

Nick Ramsay AM, chairman of the Public Accounts Committee, said “In 2003 the iPhone was yet to be invented and Gmail and Skype were yet to take off. It was in this same year that the Informing Healthcare strategy was launched, with an electronic patient record for in Wales at its heart. The other technological innovations of that year have not only been realised, but leapfrogged several times, and yet NHS Wales remains far away from a seamless electronic portal for patient records. Our inquiry has raised serious question marks about the competence, capability and capacity across the health system to deliver a digital transformation in Welsh healthcare. And yet we discovered a culture of self-censorship and denial amongst those charged with taking the agenda forward – in NWIS itself, as well as its partners in the health boards and the Welsh Government.”

Some of the recommendations made by the committee:

  • The committee was very concerned by the evidence heard on system outages, infrastructure and resilience. Given recent evidence of further outages since it took evidence, the committee would like further assurance from Welsh Government that the systems are resilient. It recommends the Welsh Government sets out a clear timetable for putting the digital infrastructure of NHS Wales on a stable footing
  • In the discussions on the use of Cloud computing and the impact of recent outages, the committee said it was deeply concerning that, when many consumer systems appear to have very robust performance and up-time, the NHS in Wales is struggling to run its own data centres with 21 outages in the first six months of 2018 – one outage every nine days. The Committee recommends a review of the senior leadership capacity in terms of skillset and governance within both NWIS and the wider NHS Digital Team
  • NWIS is currently overstretched and improvement requires far more than simply pouring more money into the existing organisation, which is unlikely to achieve significantly different results. The committee recommends that any additional funding apportioned to NWIS needs to be tied to reorganisation to achieve the improvements that are required

The Welsh Government said it will now consider this report. A spokesman said “We acknowledge the number of concerns raised within the report from the Public Accounts Committee. We now need to review its findings in detail before providing a considered response to the committee.”

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