NHS executives at PCTs in London are asking how it was possible for Imperial College Healthcare NHS Trust to lose track of hundreds of patients who were referred for urgent appointments with specialists to discuss possible cancer.
The Department of Health requires that patients who go to their GP with symptoms that may indicate cancer are seen by a specialist within a maximum of two weeks.
But Imperial College Healthcare NHS Trust has found that 900 of its patient records are incomplete, and that some patients might not have been seen for treatment or investigation under the two-week rule, Pulse has reported.
Imperial has asked GP organisations to help track down patients, their carers or their representatives to ‘ascertain whether the patient has received treatment or still requires treatment'. Some of the patients will have been called by staff at GP practices, some of whom have systems that track patients under the two-week rule.
But others might have slipped through the net and not been alerted by Imperial to their urgent appointments. Imperial has no clear idea how many.
NHS North West London, which comprises a group of eight PCTs, has expressed “substantial concern”. In addition to the problem reporting its two-week cancer waits, the Trust is trying to clear a backlog of patients who have waited more than 18 weeks from referral to consultant-led treatment.
Deloitte has carried out an external audit and “concerns remain about record keeping at Imperial”. The executives say that “systematic failings” have been identified which will take time to resolve. A clinical review is underway to see whether patients have not experienced harm due to an elongated wait.
Simon Weldon, Director of Commissioning and Performance, North West London Cluster Board, has asked the North West London Board to be aware of the “enormity of the organisational challenge facing Imperial and that remedial actions would take time to take effect”.
A spokeswoman for Imperial told me last month
“The safety of our patients is our absolute priority. At present we are in the process of clinically validating all records that indicate that a patient may have been waiting longer than two weeks.
“To date our investigations have found no suggestion that any delay in treatment has caused a patient to come to serious harm.”
This week the Trust said in a statement “The safety of patients is our absolute priority. Our Trust is taking the issues involved in the current situation very seriously and at all times the well-being of the patients we serve is foremost in our minds.
“We acknowledge that some patients may have been caused additional pain and anxiety associated with a prolonged wait for diagnosis and treatment and worked to address the problem as robustly and quickly as possible.”
It appears that Imperial staff have not entered onto IT systems some details of patients who have been referred under the two-week rule - and where they have, data has been incorrect, entered into duplicate records, or not followed up to check appointments were kept, or the patient seen for treatment and investigations.
Eye off the ball?
For nearly a year the problem was not spotted, which has left some North West London executives wondering how it could have happened. It is known the Trust has devoted time and attention of senior management to a replacement of existing systems with Cerner, under the National Programme for IT. Has the Trust taken its eye off the ball while making plans for Cerner?
The Trust says the problem is administrative and unrelated to IT systems. But should the Trust separate its earnest work on new Cerner systems from failures in its organisation, processes and administration, and poor quality data? Is this the time for Imperial to be planning a big switch to Cerner, and under the allegedly defunct NPfIT?