Lack of leadership blamed for delays over new electronic records system

A series of criticisms have been made in an investigation ordered by bosses at Rotherham NHS Foundation Trust into the project – although key details have been censored in a public version of a report by internal auditors PwC.

The system went live in June last year but quickly ran into problems which have yet to be sorted out and is likely to be at least £10m over budget once it is in place.

The problems meant around 5,000 fewer outpatient appointments were booked than expected between June and August last year, leaving the trust £1.4m out of pocket, while significant numbers of patients also turned up for clinics unexpectedly and the crucial two-week target for cancer treatment was compromised.

The electronic patient record (EPR) system took four years to launch. NHS chiefs decided to buy it from US firm Meditech but the report found the chosen version had not been deployed before in the UK. As a result, the trust had to make it suitable for the NHS – leading to long delays despite expectations it would be in place within 18 months.

“It is now evident that this timescale was unrealistic and there is now a view that if the trust had key personnel who had the right level of experience and expertise of implementing these types of projects that it would have alerted the trust to the fact the timetable was unrealistic,” said the report.

It found there was a lack of leadership on the project, and a strong reliance on external consultants. The contract did not include key milestone or performance targets and penalties.

One staff member told the review team: “Anything relating to EPR basically went and the money was approved regardless.” Another said: “EPR appeared to be developing like a child on its own.”

The report said financial procedures and controls on the project “appear to have been inadequate”. It added: “We identified that external consultants were given authority to approve expenditure, in some cases for their own organisations, which was against the trust’s standing financial instructions...”.

It recommended where external contractors are used, the trust “must ensure appropriate safeguards are put in place”. “This should include checking for any potential conflicts of interest, secondary authorisation and approval for transactions on behalf of the trust and/or regular independent review of the expenditure authorised and approved by the individual concerned.”

The audit said clinicians had raised concerns over patient safety linked to the system but managers still went ahead, prompting criticism “regarding the culture and the ‘tone at the top’ from the executive management team in place at the time when EPR was being implemented”. “It was commented on numerous occasions that executive management did not listen or respond well when challenged and in particular the clinical staff interviewed did not feel that they were taken seriously or that their professional opinion was valued,” it said.

Full details of the audit have been withheld by hospital chiefs who said it would damage their ability to respond “fully and appropriately” to its findings, claiming they needed a “safe space” to resolve issues raised.