North by North West: Not copying Salford

The 2017 merger of two big acute trusts in Manchester left the new organisation with a key decision to make over the supplier of its electronic patient record.

Two years later, Manchester University Foundation Trust has made a strange-looking choice of provider, naming US-firm Epic as its preferred bidder following a procurement process.

Its two predecessor FTs — Central Manchester based off Oxford Road in the centre of the city, and South Manchester, at Wythenshawe Hospital in the south — had each implemented different EPRs.

The Chameleon system used at, and partly built by, the Oxford Road trust wasn’t functioning as had been hoped, while Wythenshawe Hospital in the south of the city had only recently implemented a brand new EPR from Allscripts, another Midwestern US tech firm, following a major procurement decision made by its former leadership.

The most straightforward course of action, following the merger, appeared to be an expansion of the Allscripts system, to minimise any additional costs and upheaval from having to replace Wythenshawe’s system once more.

On top of that, Allscripts was also already up-and-running or set to be implemented across most of Greater Manchester. It had been used in neighbouring Salford for many years, while Wigan and Bolton were on their way to getting it. Hospitals in Rochdale, Oldham, and Bury are expected to follow (as they sit under the same management board as Salford).

With system integration the new name of the game for the NHS, and IT interoperability crucial to achieving this, expanding the Wythenshawe EPR appeared a no brainer.

This line of thinking was cemented in submissions to the government from MFT itself, in which it requested loan funding to initiate the project.

A document unearthed by HSJ at the time suggested expanding Allscripts “represents better value for money over 10 years than either the ‘do minimum’ or the option of implementing a new integrated EPR and patient administration system from another supplier (eg. Epic)”.

On top of this, earlier this year NHS England and NHSX published a list of “accredited” EPR suppliers, in which Allscripts was named as one of eight providers said to offer the “most robust systems” and which proved they could integrate well with other systems. Epic was not listed, which was surprising given it is already installed at a few big Shelford Group trusts.

More upheaval, achieving value for money, interoperability, and national assurance: on the surface, it all seemed to be working against Epic.

Yet that’s what the trust has gone for, while so far declining to explain its choice.

Some will think about the Epic decision in the context of MFT’s long-standing rivalry with Salford Royal. The Allscripts system has been heavily associated with Salford’s success, but surely “DON’T COPY SALFORD” can’t have been in the criteria?

Four in a row

Southport and Ormskirk’s inspection report from the Care Quality Commission came back as another “requires improvement” — its fourth in a row.

There was some modest improvement in the well-led domain, with leadership of surgery and urgent and emergency care both improving. But leadership remained “requires improvement” overall, due to medical care remaining “inadequate”.

Inspectors said the division had failed to remedy criticisms made after the last visit, such as a lack of staff trained in mandatory and basic life support, poor infection prevention, insecure storage of care records, and a lack of nurses that had received an annual appraisal.

It’s difficult to see the trust making significant steps forward until it sorts out its unusual clinical configuration (with paediatric emergency care and maternity provided at Ormskirk, and adult emergency care in Southport).

So, it was encouraging the CQC felt the trust had, since its last inspection, “developed a vision for what it wanted to achieve and a strategy to turn it into action”. More on that in the new year.