Royal Free says £7.2m deficit due to Cerner

The Royal Free Hampstead NHS Trust has reported a £7.2 m deficit due mainly to problems with the Cerner Millennium Care Records System installed by BT under the NHS National Programme for IT.

The trust had a loss of £3.2m in the last three months alone, attributed to severe ongoing problems with the CRS system installed in June. Royal Free was the first organisation to take the London cluster version of Millennium.

Implementation costs have been far higher than planned, and problems with the system have left the trust without reliable data. This has led to under-utilisation of key resources such as theatre time, resulting in reduced levels of activity and clinical efficiency leading to lower income.

Board papers say that of the £7.2m losses, lost activity accounts for £1.3m, potentially correctable data entry £3.789m – of which £2m is at risk unless required software fixes are delivered on time, and additional staffing costs of £1.2m. A Royal Free spokesperson said the losses represented about 6% of the trust’s total budget.

November trust board papers state: “The committee was informed that the majority of the adverse variance to budget was due to the implementation of Cerner. The shortfall comprises a number of issues where costs and losses have been incurred over the implementation plan.”

The financial problems experienced by the Royal Free appear to closely mirror those reported at Barts and the London. In September E-Health Insider reported the trust was projecting a £3m shortfall in income this year due to the data problems.

In August the Royal Free initially reported that the deployment of the London Millennium CRS software had proved “demanding”, with delays in some of its busiest clinics. But, overall, said implementation had gone well.

The new board papers, however, lay bare the issues the trust has been struggling with since implementation. Problems that have led to increased implementation costs, data issues, reliability, reduced levels of clinical efficiency and reporting problems leading to financial deficit.

Extra staff had to be recruited to fix problems with data entry and reliability “to maintain normal activity levels”. Reliability is also reported as a problem: “Issues with the stability of the system and the clunky workflows causing the previous levels of clinical efficiency to fall…”

The report also reports, “Activity shortfalls attributable to the system not supporting the trust in managing the patient pathway, meaning many clinic and admission slots were not used (lost activity)”.

The paper adds: “Data entered on the system incorrectly or not entered at all, in part due to the clunky workflows and, in part, to the lack of experience of our staff in using the actual Royal Free build, as the system supplied was different to the system supplied for training, and there were no operating or procedure manuals for the system.”

Unsurprisingly the paper reports the situation “has resulted in a great deal of uncertainty surrounding the potential full year outcome for the trust”. It says that most performance measures showed good performance by the trust “but a significant number of patients are approaching the 18 week target.”

“Arrangements are being put in place to ensure that this target is achieved, although uncertainties about the quality of data within the Cerner system hampers some of the detailed operational arrangements that have underpinned the trust’s previous success.”

Asked whether the losses were under control or expected to continue, the trust spokesperson told E-Health Insider: “We expect some degree of losses to continue, although not at the rate which affected Quarter 2, while we work to resolve issues with the system. The extent of these losses still needs to be identified.”

A spokesperson for BT, the local service provider for London, said: We cannot comment on the finances of individual NHS trusts. However, some additional costs are to be expected when implementing a system in an environment as complex as a large London teaching hospital.

“The NHS London Programme for IT, BT and Cerner are working together with the trust to quickly resolve outstanding issues. Progress is beginning to be made in identifying much of the missing activity and steps are being taken to recover the costs related to data entry problems. All parties are working hard to minimise the impact of these issues.”