Few trusts are prepared for dealing with the year 2000 bug. And most want more resources and more guidance from the centre. Peter Mitchell reports

It is not going to be all right on the night. Public service minister David Clark told the Commons last week that the year 2000 bug was now the NHS's number one non-clinical priority.

But according to two reports - one by the Audit Commission, the other by the NHS Confederation - there is little chance the NHS will get its critical electronic systems through the dreaded midnight hour without mishap.

Worse, few hospital or ambulance trusts have sorted out plans to deal with the inevitable failures. Both organisations have been asking trusts and health authorities how far they have got in putting last-ditch safeguards into place - and both are worried by the replies.

The Audit Commission's A Stitch In Time, published yesterday, reviewed bug-busting progress up to March at 174 NHS bodies and 145 local authorities.

Not only did it find year 2000 problems already happening - with one patient-booking system refusing to make appointments into the new century - but almost everyone is behind schedule with their bug-fix projects.

Fewer than 10 per cent of trusts even claim to have full 'contingency plans' to deal with their residual failures - partly because lack of central guidance means they do not know where to begin.

At the same time, the costs of replacing suspect equipment could soar. A trust starting its year 2000 project today will end up paying three times as much as a similar trust that began in 1996 - partly because it won't have time to implement the cheaper fixes, and partly because the human resources needed to crack the problem become more expensive as the deadline approaches.

The NHS Confederation survey - conducted in April and May - found even more evidence of floundering.

Almost half the 249 trusts which replied admitted they had either only just got moving on their contingency plans, or had not even started. Fewer than 10 per cent of trusts were close to finishing their contingency planning.

The real figures are highly likely to be worse than this; at least some of the 50 per cent of non-respondents probably didn't want to admit how far behind they were.

HAs - which have less urgent problems to solve than the trusts - have done a little better, though still well short of the targets.

One worrying factor, says the confederation, is just how little consultation between potentially interdependent bodies there has yet been. Many acute and ambulance trusts in industrial areas face the possible 'nightmare scenario' of large numbers of emergency admissions caused by a year 2000 failure at (say) a local chemical plant - just as medical equipment fails within the trust, and perhaps even telephones or electricity stop.

Trust managers have to talk to their local partners - emergency planning offices, fire and police

services, local authorities, and neighbouring trusts - about how to handle this. Yet only 31 of the 249 trusts had done so.

Most had either discussed their plans with just one other body, or none at all.

This might be because it is still early days, says confederation policy manager Tim Jones - but 'other data from the survey suggests that trusts and HAs are lacking the essential expertise and support to undertake thoroughly this unprecedented task'.

So what is to be done? According to the confederation's survey, most trusts feel unable to handle suppliers on their own, and are becoming desperate for more support from the centre.

They want more resources and perhaps some central guidance on contingency planning.

Most urgently, year 2000 project managers need the NHS Executive to help them get the most valuable commodity of all: information on what machines will work and what won't.

Wider co-operation between trusts may help share expertise. Most appear to be developing contingency plans from scratch without even trying to swap ideas with their neighbours, says the Confederation. Simple measures being considered by some hospitals - such as switching staff shifts at midnight on 31 December 1999 instead of 10pm, to ensure double staffing at the critical hour - can easily be passed around without loss of effectiveness.

The most striking admission is that nobody yet has any real idea how much it will all cost - not even the Audit Commission.

But David Clark's statement didn't mention anything about that. 'Departments still expect to meet the costs from their existing IT budgets,' he said, while warning of the hidden dangers from faulty embedded chips and urging departments to pressurise suppliers. More constructively, he instructed all public bodies - including trusts - to keep customers informed of their year 2000 progress. That, he says, will reassure the public by demonstrating the NHS is taking the issue seriously.

Perhaps. But most IT managers think a bit more money would have been even more reassuring.

Audit Commission. A Stitch in Time. pounds15. Audit Commission Publications, Bookpoint Ltd, 39 Milton Park, Abingdon, Oxon OX14 4TD. 0800-502030.

NHS Confederation.

Meeting the Year 2000 Challenge. Free from Matt Hageney, NHS Confederation, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ. 0121-471 4444.