back to article Cambridge University Hospitals rated 'inadequate' due to £200m IT fail

Cambridge University Hospitals has been placed under special measures by the NHS regulator, after a failed £200m IT project plunged its finances into the red and left it unable to deliver key services. Health watchdog Monitor flagged the trust as "inadequate", following concerns about staffing levels, delays in outpatient …

  1. BenBell

    Am I the only one

    Who reads these stories and thinks "I could have done better" or wishes that they could have been in charge of these types of projects

    ...and then very quickly changes their minds??

    I genuinely feel for the poor techs like us who get stuck working their asses off on big projects like these only to end up taking (partial at least) blame for poor management choices - while the poor management go off onto other high paying contracts and we get left with scars on our records.

    1. This post has been deleted by its author

    2. Anonymous Coward
      Anonymous Coward

      Re: Am I the only one

      A chimpanzee could have done better!

      But then you know what they say, "pay peanuts, get monkeys"...

      1. Richard Taylor 2
        Joke

        Re: Am I the only one

        As you might regret in other worlds, be careful to distinguish areas from monkeys

      2. gw0udm

        Re: Am I the only one

        Funnily enough they certainly did not pay peanuts

        At £50m initial cost with a total of £200m over 10 years it is one of the most expensive hospital IT projects we've seen in the UK.

        Epic is a large American company and their way of working is entirely different and on a much grander scale than we are used to here.

        1. Anonymous Coward
          Anonymous Coward

          Re: Am I the only one

          I'm quite sure they paid peanuts where they should have paid real money, and funneled real money where they should have paid peanuts.

          There's no incentive in making a project right when you can always get away with a lot of cash. The percentage of this kind of projects failing miserably should have raised big red flags, but apparently nobody cares.

          1. Anonymous Coward
            Anonymous Coward

            Re: Am I the only one

            There's no incentive in making a project right when you can always get away with a lot of cash.

            You just summed up Government IT in the Blair era. Both in aims, and results.

      3. Hans 1
        Joke

        Re: Am I the only one

        200 million quid is quite a lot of peanuts, if you ask me.

    3. Anonymous Coward
      Anonymous Coward

      Re: Am I the only one

      No you are'nt Ben!

      I dont know about scars , but I'm sick of seeing our govt chuck millions away on failed projects that no doubt made the PM thousands per week , whilst im stuck earning pittance and would propbably have done a better job with near zero project management experience but i do at least have a brain and some common sense.

      The numbers in this case are staggering! I just read the story on Michigan suing HP over a $50m project that hasnt materialised - thats a whole state - this hospital trust eff up dwarfs that!

      1. Anonymous Coward
        Anonymous Coward

        Re: Am I the only one

        Actually, project management is not easily improvised. Improvisation in project management leads to these disasters.

        Patient records on handheld is something we already do, our software costs a 1000th of what they charged here, well, if it is a "really" big trust, it might end up costing 100th ... we have many implementations in "big" university hospitals, have had for years.

        Who can I call there, our solution is proven ... anon, for obvious reasons

        1. M7S

          Re: Am I the only one - gve us a clue

          I've an interest in purchasing a patient record system for handhelds, for a very very small care system.

          Any chance you could give us some pointers as to where to look as clearly these people missed your offering and I probably also would?

          Thanks

          1. Anonymous Coward
            Anonymous Coward

            Re: Am I the only one - gve us a clue

            Define very, very small ? We mostly do biggish guyz - how many end users (nurses, doctors, etc).

            >These people missed your offering and I probably also would...

            I guess our sales guyz are to blame, if anyone is to blame.

            Obviously, I am a tech, not sales...

            1. Anonymous Coward
              Anonymous Coward

              Re: Am I the only one - gve us a clue

              Take the name of Oracle's head quarters, remove "Shores" and you have a tree, now ask google. This is a Dutch company, not Oracle-related.

          2. Adrian Midgley 1

            Re: Am I the only one - gve us a clue

            Handhelds I don't know about, but you might look in general at Open Source offerings, and the modest infrastructure which is developing around them.

            Start with the US Veterans Health Administration system, (called Vista for a lot longer than anything else had been) which is released and maintained in a WorldVista GPL version.

            You might also look at the Canadian OSCAR McMaster, which is mainly GP software.

            There are various others, I'm not familiar with FreeMed and GnuMed.

    4. ecofeco Silver badge

      Re: Am I the only one

      No. You aren't the only one. Just like the rest of us, we don't know the right people and are terrible at selling snake oil.

  2. Bronek Kozicki
    Unhappy

    there are few examples when bad IT management causes loss of life, but this probably would be it. I doubt that companies and managers responsible even considered what will happen if the project continues to bleed money, but the most likely outcome (as unfortunately witnessed elsewhere in Britain) will have been cutting health services in the trust, including things like E&A , cancer treatment etc., which likely have led to some number of (avoidable or premature) deaths.

    What is making it even worse, it seems very unlikely that anyone will be brought to full responsibility (as opposed to shifting chairs) or that health department will learn anything from this failure.

    1. Hans 1

      I lived in a country where there was no such thing as a patient, you were a customer. Go to your GP or dentist, he would say to the secretary: "Would you mind fixing another appointment for this customer, please? Thanks." before closing the door.

      Of course, he would try and convince me I needed surgery that he would practice on me, on the back of healthcare. How many others believed this a.h. ?

      Private healthcare does not cut it, look at the US, even before Obama introduced Obamacare ... they were paying more per capita for healthcare than us in Europe, yet, hardly anybody (to summarize, the ultra wealthy) got/gets proper treatment, and even then ... case "superman" - his healthcare bill in Europe would have been $0, well, not quite, he would pay monthly fees for the system, lower than what he paid* in the US.

      In Europe, anybody can expect the same treatment superman got, for a MILLIONTH of the cost, how is that possible ? How come the American system only insured the middle and upper class, and still was way more expensive than European-style healthcare ? Why is the UK aiming for US style healthcare when we all know it does not work? Blame Europe, maybe, but are the British MEP's not pushing for this as hard as the other European "conservative " EMP's ? I do not make the distinction for British EMP's because, afaik, 100% of British EMP's push a neo-libral agenda (there might be one or two I have missed, excuses where due).

      *obviously excluding any moneys he coughed up for the actual treatment that was not covered by his plan.

      1. Hans 1

        >EMP

        I obviously mean MEP ... sorry ... too late to fix.

      2. Bronek Kozicki
        Coat

        From what I've read, they seem to have nailed it in Singapore, but I cannot be bothered to understand exactly how it works. Also, for any social issue there are bound to be many opposing views whether or not particular solution is "optimal" one.

        Heading for the door, because that's off topic.

  3. Anonymous Coward
    Anonymous Coward

    Diktat

    I spent an unexpected couple of days in Addenbrookes a month or two back. From what I could see as a patient, broadly speaking the eHospital system appeared to be functioning. That said, it seemed that the interface between some routine measurement systems (body temperature and blood-pressure) wasn't complete or wasn't practically workable.

    It was concerning however to find staff in A&E recording the temperature and blood-pressure measurements with a biro on *paper towel*. I asked the staff about this, suggesting a notepad (pen-and-paper notepad) would be much better - but was told that they'd have to provide their own as because the hospital is officially "paperless", they cannot be issued with notebooks.

    Sure, such a huge project will take time to bed down and have all the wrinkles ironed out, but this kind of dogma and lack of pragmatism is seriously worrying.

    1. Anonymous Coward
      Anonymous Coward

      Re: Diktat

      FWIW logging vital signs on the eHospital console things seemed to be working quite well in the Rosie Maternity unit earlier in the year. Having to write on paper towels is a bit concerning however...

    2. gw0udm

      Re: Diktat

      Unfortunately they weren't telling you the whole truth.

      For as long as I can remember in hospitals nurses have always done this. It seems to almost an ingrained part of the culture and I've never seen a nurse write anything in a notebook. However I have seen very many paper towels used for noting down obs. Probably because they are always to hand and they don't need to be ordered separately.

      It's not unsafe as such. Even if the system was working entirely properly they will probbaly still do this!

      1. DocJames

        Re: Diktat

        For as long as I can remember in hospitals nurses have always done this. It seems to almost an ingrained part of the culture and I've never seen a nurse write anything in a notebook. However I have seen very many paper towels used for noting down obs. Probably because they are always to hand and they don't need to be ordered separately.

        This.

        I think the explanation is a bit more complex though. If you have a notebook, you have a whole load of patient data. You probably want to make sure that when you transcribe it you input the correct patient's details. Which requires a patient identifier. You now have a notebook with identifiable patient information. If you have a paper towel, you know the info is from the last patient you saw. And then you bin it, and it is uninterpretable (well, BP is usually obvious, but pulse/O2 sats are not and occasionally RR too).

        Nurses work hard and quickly (phoar!), often carrying out practical tasks. Notebooks would be a pain and get lost. Doctors tend to do more talking/thinking than doing, so notebooks are better.

        I carry a notebook and live in fear of it going missing. It has 80 pages, all* of which probably contain information that would have newspaper worthy public complaints if it was handed to someone who wished to make my life unpleasant.

        * actually, some pages are blank still. The full notebooks are kept safely and not carried around.

        1. Intractable Potsherd

          Re: Diktat @ DocJames

          Exactly right! I used to be a nurse, and was told explicitly from day one of nursing school not to carry notebooks. In fact, taking any notes in handovers was frowned upon for exactly the reasons you mention. I once dropped my aide-memoir for the shift from my pocket - in one way, it was fortunate it was found by a member of staff, in another, after the chewing-out I got from the Charge Nurse, I almost wished it was a patient that had found it. I did stop writing notes that had more than very basic info, such as BP, pulse etc, though - the fact I can clearly remember the incident over thirty years later might give you some idea as to how that "educational opportunity" went ...

    3. Anonymous Coward
      Anonymous Coward

      Re: Diktat

      >Sure, such a huge project will take time to bed down and have all the wrinkles ironed out, but this kind of dogma and lack of pragmatism is seriously worrying.

      Exactly, you can never have 100% paperless, it is just not feasible, however, 97, 98 or even 99.9% is quite possible, depending on a multitude of factors. Most importantly. YOU ALWAYS NEED BACKUP PLAN B, for when shit hits the fan! Even if parts of the IT system go down the gutter for some reason, you must be able to continue, pen and paper as a last resort.

      You cannot imagine the cost reduction you see when you get rid of 50% of the paper - ask accountants how much your business spends on paper/printer maintenance yearly and you will understand. You might even end knocking on our door for a solution ... ;-)

  4. Anonymous Coward
    Anonymous Coward

    I was also a patient

    The new system is working, and quite well according to the staff. I was in on 'go live ' day and that as fun!

    But they got there.

    The big problem at Addies is individual centres of excellence that are separated by total lack of functional interdepartrmental communication and insulated by layers of management and bureaucracy that hasn't got a clue.

    1. Intractable Potsherd

      Re: I was also a patient

      Just like most hospitals then - though some manage not to have any centres of excellence. (Not generally digging at the staff here - though don't get me on the topic of modern nurse training - just the attitude of managers who want to silo everything, and never try anything new).

  5. Anonymous Coward
    Anonymous Coward

    how many times...

    the patient records debacle . again.

    Perhaps rather than letting the individual trusts all over the country each have a turn at losing hundreds of millions , they should just get it right once and then pass the knowledge on?. or do it nationally?

    or buy an off the shelf system?

    I really cant see whats so hard about this. Its a load of data that needs to be accessed.

    Its not a new idea! its not something never tried before!

    Maybe Oracle might be able to help, I heard they do some sort of package along that line...

    The NHS is literally laid out so that the right hand dosent know or care what the left hand is doing

    1. Allonymous Coward

      Re: how many times...

      I can't decide if you're being sarcastic.

      If you're not, Google "NPfIT" then spend a bit of time reading how Big Centralised IT projects in the NHS don't always work all that well.

      1. gw0udm

        Re: how many times...

        Also there is no such thing as an 'off the shelf' system. Addenbrookes is using Epic, but any system you buy needs a huge amount of configuration to suit the individal site. This is true for any large scale system implementation I would think.

      2. Anonymous Coward
        Anonymous Coward

        Re: how many times...

        "Big Centralised IT projects in the NHS don't always work all that well."

        Yeah we know that , the big question is why? same reason as this more local project in the article?

        I *do* know that the NHS national apps , aka Npffft! , require that IE8 is used. NOT "IE8 or later" , oh no - "IE8 Only"

        what does that say about planning and project management?

  6. Stevie

    Bah!

    "It's a hospital, Humphrey! Patients!"

    And here we see the inevitable result of putting highly-placed techies in a real-world problem. We have raised two generations of CS graduates to expect to have the latest and greatest instead of getting the job done with what is at hand. This translates into open-ended budgets implemented by people who never expect the money to run out, and wide-eyed bewilderment when it does.

    Systems of the sort described in the article need to be engineered firstly to get a deliverable product out of the gate before changes in law make upgrades and scope-creep push the delivery horizon into the land of imaginary dates, and secondly to describe a rich and immutable API so that modules can be bolted on to a visibly working useful core as time progresses. That way the customer gets to see and use something as soon as possible allowing mistakes and mis-specified actions to be rectified before it is all out-of-hand according to real-world needs as opposed to what some MBa in management thinks it should do.

    1. Arthur the cat Silver badge

      Re: Bah!

      "And here we see the inevitable result of putting highly-placed techies in a real-world problem. We have raised two generations of CS graduates to expect to have the latest and greatest instead of getting the job done with what is at hand. "

      No, the techies who actually do the implementation are at the bottom of the heap. I've not done medical IT (thank Dawkins) but I've done similar work. The spec is put together by senior management with MBAs and no practical shop floor experience, aided by expensive consultants who've taken to heart the Demotivator poster "If you're not part of the solution, there's good money to be made prolonging the problem". The wanted solution is usually a big bang switchover, rather than prototype roll out, testing and refinement, and if the implementers ever met the people who will actually be using the software then the universe would explode or something, so you can't officially ask anyone about the ambiguities and downright contradictions in the spec except for the idiot who created them in the first place.

      Oh, and the spec changes whenever someone has a bright idea or a change of mind, which is often, but the deadlines don't, so the testing period gets shorter and shorter.

      1. Anonymous Coward
        Anonymous Coward

        Re: Bah!

        At last, someone commenting who actually knows what they're talking about!

    2. Andy 73 Silver badge

      Re: Bah!

      I suspect you have misinterpreted the problems as being technical rather than political.

      Certainly you could envisage a centralised core service that provides data store for patient information in an efficient and timely manner. You could imagine APIs that provide access, and means to extend the data and access methods as the use cases build up. I would imagine even the greenest developer could draw that on a whiteboard somewhere.

      In practise though you discover that department A and department B want two different features delivered first, that department C wants to use a legacy system until they have the budget to replace it and department D will not sign off on anything until you can guarantee the system is a complete replacement for their entire patient record system. Not only that, but you must prove the entire project meets various bits of legislation around confidentiality and accuracy, but no-one knows which bits of legislation or can understand the legalese that they're written in. There are mutterings that new legislation is coming along shortly that will change things anyway. Worse still, that suits all the departments who have been relying on the vagueness of paper based records to 'work around' legal requirements. They will, of course expect your system to both meet the legal requirements and bend them to fit the existing processes at the same time.

      Whilst all of this has been going on, some clever soul signs a three million pound contract to replace all the blood pressure monitors in the hospital with something that is completely incompatible with your data collection hardware. Despite the fact that another company provides a similar device that would work, you cannot amend the order as the manager in question doesn't want to loose face. In the mean time, the heart rate monitors you have planned to incorporate will not be available for another six months and the current equipment won't support the minimum requirements laid down by someone you've never heard of and cannot contact.

      On top of all this, it turns out the provider of the tablets cannot support your APIs as they are, and due to restrictions on hardware procurement, you cannot simply go for a bog standard Android device and write your own client. You therefore have to write an entire translation layer that turns your realtime data collection into a series of web forms accessed through a third party database via SOAP calls. The project only takes a few weeks, but it's long enough for the company to go bust and the procurement process has to be restarted. When it is, the new requirement will be that the tablets must support the old manufacturer's obscure SOAP calls, preventing you from being able to ditch the unnecessary translation layer, and doubling the cost as the new manufacturer charges you to re-engineer their APIs.

      Finally, in every meeting with the end users, you discuss workflows and current practices regarding data collection. In every meeting, they think of three new use cases, and outright contradict two of their previous descriptions. Like a good techie, you decide to make it all data driven so things can change in future, and you are told to embark on an expensive side-project to provide access and control over this meta-data so that the various stakeholders can feel in control. After six months of development it emerges that none of the stakeholders actually understands a thing about this project and that you will be solely responsible for collecting and maintaining the metadata anyway. And the users still can't actually agree what their workflow is.

      Hell is other people.

      1. Steve 114

        Re: Bah!

        I wrote 'Canary Yellow' (below), while s/he was writing this excellent script. Just to endorse it wholeheartedly. For our next trick, what maxims should we advise to hapless 'government', to make any future difference at all, after so many generations of well-meaning, disappointingly unprofitable, impossibly committee-bound initiatives. But don't forget, the Utopian health systems of these islands still attract inward delegations of appreciative top-level foreigners from all over. British muddle (eventually) Rules OK.

    3. Doctor Syntax Silver badge

      Re: Bah!

      " describe a rich and immutable API"

      Can't do that because Agile.

      1. Anonymous Coward
        Anonymous Coward

        Re: Bah!

        Does the HL7 standard class as a "rich and immutable API"?

        Been around since early 1990s, in fairness probably more a set of protocol and messaging standards than strictly an API, but most folks wouldn't really care about the difference.

        If it's not relevant, why isn't it relevant, other than NIH?

        1. Andy 73 Silver badge

          Re: Bah!

          "Does the HL7 standard class as a "rich and immutable API"?"

          .. I think it classes as 'just enough rope'.

          Plus XML.

  7. Steve 114
    Happy

    Canary Yellow.

    Anyone here been exposed to NHS projects at high level? There are huge conflicts of vested interests, intersecting competing political ideas, and a spaghetti of wobbly-working and previously half-implemented systems. Plus, varying inconsistent theories of what 'Standards' and (gulp) 'data protection' should apply. The poor folk who actually have to specify and (perish the thought) implement are just 'the canary in the coalmine'

    1. <shakes head>

      Re: Canary Yellow.

      and every consultant and doctor believing that only they matter/are right.

  8. Uberseehandel

    Chaotic NHS IT Projects

    From time to time i have reviewed major NHS projects (it isn't difficult).

    Two factors stand out alarmingly

    Almost all those involved in drawing up project requirements appear to have been selected because they can be spared by their employer without being missed

    Also, almost all the project/program managers appear to be from the detached school of project management. They studiously avoid any involvement that is anything beyond the processes required to report what has been decided. The standard line of defence is "the project requirements reflect what the project members desire".

    No NHS IT projects will be successful until there is full and ongoing involvement from the busiest, most senior and influential clinical staff.

    1. DocJames
      Coat

      Re: Chaotic NHS IT Projects

      No NHS IT projects will be successful until there is full and ongoing involvement from the busiest, most senior and influential clinical staff.

      Can I suggest that often the senior and influential staff are not clinical?

      If you want involvement it'll have to be everyone who uses the system. Or who's job is influenced by it. That's (near as dammit) everyone. Good luck asking everyone in the NHS (or even just one hospital). Especially given someone's point above about doctors thinking they know everything (I'm a doctor too, but I do actually know everything. That's why I'm on an IT site ;-) And the corollary of doctors knowing everything is that nobody* dares to speak up if a doctor says something, even if self evidently wrong.

      * not quite nobody, but none of the junior doctors or ward level nurses. The ones who you need to tell you want is actually going on. And certainly not your accurately described project managers...

      It's the white one, and no longer in the UK...

  9. chris 17 Silver badge

    wr erase reload

    need to send a team in to 1 hospital with no preconceived ideas and build a new system from the ground up, digitally incorporating as many processes as possible, eliminating or automating as many processes as possible and allowing for those processes that just can't be automated or will take time to automate. They need top also recognise its an ongoing process which will never end, just have may iterations to fine tune the system.

    1. x 7

      Re: wr erase reload

      "need to send a team in to 1 hospital with no preconceived ideas and build a new system from the ground up"

      already been done, such products exist. Products that have evolved over years, within hospitals, and that work. However they're not expensive enough for the senior management to get the kudos (or backhanders) associated with mega-projects such as this

      1. ecofeco Silver badge

        Re: wr erase reload

        Exactly, x7.

  10. johnaaronrose

    Epic system

    Not sure if this is true or relevant. But I saw somewhere that Addenbrookes has bought a Patients Clinical Records system named Epic. Web search showed that EPIC is produced by a US company of that name. It is now being used by a Dutch hospital: that hospital is the third stage 7 hospital in Europe to use Epic.

    1. x 7

      Re: Epic system

      Epic is the name of the supplier.

      eHospital is the product that Addenbrokes and Papworth have jointly purchased from Epic. Not to be confused with an Indian company offering a similar product also called eHospital.

      Epic eHospital is the software which appears to be causing the problems - leading to reports in the local Cambridge press of "epic fails" and similar puns

      Epic home page is http://www.epic.com/

      Naturally there are UK tried and tested products available off the shelf which could have been used and worked - but weren't chosen. It appears someones ambition for a new shiny foreign product seems to have misled them. I wonder how many offshore bank accounts were involved....

  11. Anonymous Coward
    Anonymous Coward

    I was there

    and now I work for another large NHS Trust in special measures with a pisspoor ICT system. The ICT 'support' mouth breathers I deal with on a daily basis are always cheerfully unconcerned: Can't connect to the system for viewing a critically ill patient's blood test results? Try again tomorrow morning, guv. Printer for requesting blood test results broken, meaning each request has to be filled out by hand and a thirty second job takes five minutes (and I have to do dozens of these) while dramatically increasing the chances of a mistake being made? We'll fix it within three days, unless we forget, mate.

    It would be grossly unprofessional of me to hope that one of these sluggards falls seriously ill and then comes to harm because a doctor was hamstrung by an IT cockup. So of course I don't do that.

    I really want to know who I can blow the whistle to in the hospital IT hierarchy. Any ideas?

    1. Stern Fenster

      Re: I was there

      < I really want to know who I can blow the whistle to in the hospital IT hierarchy. Any ideas? >

      No point, except as a sacrifice. Almost all whistleblowers come to a bad end, despite comfy Trust regulations telling you how much your input will be valued. Here's one: http://www.surmise.org/choler_klng.html . I know for a fact it went to ministerial level. She had regs ostensibly protecting her. They didn't.

      1. Hans 1
        Coffee/keyboard

        Re: I was there

        >Here's one: http://www.surmise.org/choler_klng.html . I know for a fact it went to ministerial level. She had regs ostensibly protecting her. They didn't.

        I read that and it made me feel awful, then I read this:

        http://navigocare.co.uk/navigo-consultancy/navigos-consultants/

        Kevin Bond, chief executive, has led the transformation of mental health in North East Lincolnshire moving services from a large mental health trust, into a PCT and then a Care Trust Plus, ultimately into a successful Social Enterprise.

        During that time Kevin has empowered service users to aspire to better quality care and provided the leadership to create innovative services that deliver.

        ... and now I need a new keyboard.

        Still feeling sad for what happened at NE Lincs Trust (rip), though.

        1. Hans 1

          Re: I was there

          >Care Trust Plus

          Care Trust PlusDoubleGood would have been a better name, imho.

      2. cantankerous swineherd

        Re: I was there

        linked article pretty grim. unfortunately "universities" are turning out skip loads of these manager types.

    2. ecofeco Silver badge

      Re: I was there

      Don't even think about whistle blowing.

      Now copious notes and a book deal long after you've left would be a far better idea.

  12. msage

    HP....

    Good old HP and their outsource to us save money routine!

    The guys on the ground worked hard, but the lack of project management and EPIC buy in was amazing.

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