Millennium doom

Edited by MF Smith and Chris Dowd

Sheffield Academic Press 235 pages pounds29.50

Forget the dome. If you run an NHS institution, especially a large acute hospital, the most interesting experience of the new millennium is likely to be your appearance in court to answer charges of killing patients through negligence in dealing with the year 2000 computer bug.

Mike Smith, a professor of general practice at St Bartholomew's and Royal London trust, has made a name for himself by saying publicly that up to 1,500 deaths might be attributed to the problem. This does not, he stresses, mean that computers will directly kill 1,500 patients. But for the NHS the consequences will be the same: billions of pounds down the drain in legal fees, on computer consultancy and to compensate litigants.

Not to mention the cost to individual careers. Remember the 1992 troubles at the London Ambulance Service? That was all about a claim of 20 additional deaths, at the most.

There is another twist: even if the millennium bug is eventually cleared of all charges of causing direct harm to patients, it will still be guilty of diverting money that would otherwise have gone into care. Result: more misery, pain and death.

Year 2000 and Healthcare Computing is a collection of papers, originally published in the Health Informatics Journal, to back up this thesis. It makes scary reading and should change the minds of anyone who thinks the millennium bug is a trivial data-processing issue blown out of all proportion by computer consultancies and journalists.

The real killers will not be multi-million pound integrated systems but tiny microchips hidden in the most unlikely equipment, from infusion pumps to car-park barriers. One chilling survey from Sweden found that an infusion pump did not function because the software mistakenly calculated that it had not been calibrated for six months; a defibrillator likewise calculated that too long a time had passed since its last maintenance. The NHS's equipment is almost certainly just as vulnerable.

One alarming contribution from Britain reveals that 28 per cent of GP computers are 'vulnerable', in that they were developed in obscure technology or by firms that later vanished from the market. Professor Smith estimates that the total cost to the NHS could be between pounds1bn and pounds3bn over the next few years.

And this is in a country with probably the best nationally guided millennium computer bug project in the world.

The NHS Executive has demanded that all organisations submit detailed plans by the end of this month. But even Quarry House has admitted that this is probably too late. There is neither the time nor the money to put these plans fully into effect. For most organisations, the only alternative is triage: fix the bits that might kill people and make contingency plans to deal with the rest.

As if all this isn't enough, the book concludes with a warning about another millennial phenomenon.

We can expect an epidemic of drunkenness, depression and perhaps even mass suicide. And we're not talking about NHS IT managers.

MICHAEL CROSS