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Plenty of column inches have been dedicated to the urgent need for investment in the NHS’ crumbling buildings in recent months.

Equally important, but often less visible, is the need for many IT systems to be overhauled and upgraded.

Pennine Acute Hospitals Trust – which is set to be acquired by Salford Royal Foundation Trust to create the Northern Care Alliance – requires major investment on both fronts.

North Manchester General Hospital has perhaps the worst estate in the north west, while the Royal Oldham is also crying out for substantial investment.

But the frailty and complexity of the IT infrastructure and networks across the Pennine sites is an even more pressing concern.

A recent paper to the NCA committee referred to “frequent outages” becoming longer in duration and harder to fix, including an incident in June which meant a third of all trust staff were unable to access any system for four days.

It added: “Situations like these can easily lead to clinical risk given the duration of time staff have to work on paper and re-key information back into numerous clinical systems.”

It’s unclear whether this incident resulted in appointments being cancelled, but apparently no patient harm occurred.

Legacy systems

The situation at Pennine – which has a ridiculously complicated IT landscape including around 650 physical and virtual servers and more than 30 clinical systems deemed to be mission critical – is largely a legacy of bringing several different organisations together.

These past mergers left the trust having to patch together multiple clinical systems without funding ever being available to do a wholesale redesign.

What the trust really needs is a complete overhaul and a single electronic patient record.

The EPR business case has now been rolled into negotiations around the formal acquisition of Pennine by Salford Royal, in which it will try to squeeze as much capital as possible from government, in return for taking over its neighbour.

These negotiations have been devilishly complicated, though, as they also involve the transfer of NMGH to Manchester University FT, as well as bids for major building works.

Stopgap solutions for Pennine’s IT will be needed in the meantime.

The paper suggests good progress has been made over the last few months to understand the risks and weaknesses, and significant management attention now appears to be dedicated to stabilising the current systems as much as possible. This includes five new senior appointments to the IMT team, which had previously been hollowed out to make cost savings.

Clinicians have apparently started seeing some improvements over the summer, while a recent briefing to staff reckoned the situation would have been “much worse” without the support from Salford.

Record keeping

Another trust in need of IT investment is Blackpool Teaching Hospitals, where investigations into patient deaths have repeatedly raised concerns around care records and information sharing.

Over the last three years, the FT has received warnings from coroners about poor record keeping in at least five separate inquests.

The trust currently has an electronic patient record in its emergency department, provided by IMS Maxims, and is “finalising plans to deploy this solution to the rest of the organisation”.

It also wants to procure an electronic document management system to replace paper notes, but has struggled to generate funding for it. A revised business case is due to go to the board next month.

Missing a trick?

Providers in the north west must look on in envy at the private patient income that gets generated by specialist trusts in London.

Great Ormond Street received £62m from private patients last year, compared to the £200,000 made by Alder Hey. Should the gap between the two children’s hospitals really be that large? Or is Alder Hey missing a trick here?

The Royal Marsden FT, a specialist cancer trust in London, made even more, generating an income of £121m from private cancer patients in 2018-19.

In a response to HSJ, the Marsden had a pop at other trusts, such as The Christie in Manchester, which run their private clinics in partnership with a commercial company and share the profits. It stated: “The integrated model at The Royal Marsden allows us to reinvest all of the income from private care into the hospital. Many other NHS trusts use a private company (part-privatisation) to run their private services and this company will share in the profits.”

The Christie’s joint venture with American firm HCA Healthcare generated revenues of £25m in the latest accounts – far less than the Marsden, but far more than Alder Hey.

 

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