Only half of trusts’ staff were trained ahead of troubled IT go-live

The implementation of Oracle Cerner’s EPR at Royal Surrey Foundation Trust and Ashford and St Peter’s Hospitals FT was carried out, despite the trusts not having achieved their target of 80 per cent of staff having completed the necessary training, newly disclosed documents show.

HSJ has also seen an internal report by the Royal Surrey’s informatics team which warned of risks to patient safety and data problems, unless preparations improved in the three months leading up to go-live. 

The two acute trusts implemented the EPR in May last year under a programme called Surrey Safe Care, but there have been multiple problems ever since – including some of the issues that the internal report warned of.  

The trusts acknowledged the process had been “challenging” but said they had trained a higher proportion of the staff who were working in the two weeks after go-live, with Royal Surrey describing the findings of the internal informatics report as an “inaccurate representation” of readiness.

Training numbers

According to the trusts’ training plan (obtained by HSJ through a Freedom of Information request – see below), 80 per cent of “end users” (relevant staff) would be trained in use of the EPR prior to go-live.

The training was carried out during the final three months leading up to implementation, which took place on 17 May last year.

However, by 11 May only 49 and 47 per cent of staff had completed training at ASPFT and RSFT respectively, according to an internal update, also released to HSJ under FOI (see below).

Another 22 per cent of staff at both trusts had started training, while around 30 per cent of staff across the organisations had not started. 

A spokeswoman for the two trusts told HSJ they prioritised training staff who were due to work over the two-week period after go-live. At the point of go-live the trusts had trained more than 80 per cent of that staff cohort. 

She said the 50 per cent figure included all bank and temporary staff, “many of whom were not scheduled to work during the first two weeks of go-live”. 

“Multiple additional resources were in place to support with any issues, such as super users in clinical and operational areas and over 130 experts ‘floor walking’ across both sites on an average day to troubleshoot,” she added.

Three weeks of “mop-up training” was offered to staff after go-live, and both trusts set up “resource centres on their intranets, with quick reference guides to help navigate various parts of the system”.

Commenting from a general point of view, not specific to Surrey Safe Care, Geoff Broome – director at EPR support firm Apira – said it can be difficult to train staff who are busy with frontline care. 

He said there is a tendency for staff to leave training until “the last minute”, and therefore giving them more time doesn’t always help. Having floorwalking, telephone support, local champions, online help, and other support available can “mitigate lack of attendance at formal training to quite a large degree”. 

But he added: “Overall though, a low level of engagement on training is a sign of weak overall clinical engagement and therefore is a concern, notwithstanding the perennial operational pressures.”

Data concerns

HSJ has also obtained a leaked update from the Royal Surrey’s informatics team three months prior to implementation, which warned of several issues with the new system that were damaging its preparations.

The issues included:

• A potential to lose patients requiring follow-up care due to the different process of booking follow-ups, which posed a safety risk;
• A potential financial impact caused by problems recording activity in certain areas, such as ophthalmology, oncology and audiology; and
• An inability to meet minimum go-live reporting requirements.

Technical problems, along with the pandemic, had already caused the implementation to be delayed twice prior to May 2022.

Trust leaders met that month to discuss whether to implement the EPR, and they were told none of the 45 workstreams that formed part of the project were reported as “red”, compared to 12 in January 2022.

This, along with “assurances from the programme team and external NHS England trust system support model assurance review”, meant go-live was approved – the trusts told HSJ.

The problems emerge

However, less than two months after implementation, a string of data problems were reported to a meeting of Surrey Heartlands Integrated Care Board – such as “challenges” with the booking and administration of elements of follow-up patients, and an inability for the trusts to be performance-managed due to poor data quality.

Additionally, the then-NHSE transformation director Tim Ferris visited the Royal Surrey “to learn lessons from the roll-out to inform future roll-outs across the country”, according to ICB minutes.

The following month, chiefs at Ashford and St Peter’s Hospitals FT warned the new EPR would affect cancer performance for the rest of 2022, and earlier this autumn it emerged the IT issues were linked with one patient death and 30 incidents of harm at the Royal Surrey.

Board papers from Royal Surrey’s November meeting reveal another four incidents of harm have been logged since October. Two were “low” harm and two were “moderate” harm.

The papers also noted “stabilisation” of the EPR implementation remained a key factor in directors’ current concerns about staff morale and engagement, and there are still risks of the new system losing sight of follow-up patients – according to minutes from the trust’s quality committee meeting in October.

In response, the trusts said three of the four harm incidents were not directly due to the problems with the EPR, but they had highlighted that improvements could be made.

The fourth incident was caused by the EPR and consisted of a an issue with diagnostic reporting from July 2022 – which has been resolved, the trusts said.

Addressing the concerns raised in the internal informatics update, the trusts said these painted an inaccurate representation of the readiness for go-live, as the issues had evolved from February to May 2022.

“By May 2022, many of the technical issues that had delayed implementation had been addressed,” the spokeswoman said.

“This was a complex project across two organisations and there have been challenges throughout implementation. We continue to develop it to be as safe, efficient and user friendly as possible and are committed to capturing and sharing our lessons learnt for the benefit of the wider NHS.”

Many NHS trusts are either implementing new EPRs or optimising their existing EPRs to achieve standards set by NHSE by 2026, as part of the health service’s attempts to become more digitally mature. 

Oracle Cerner declined to comment.

• Story updated at 9.29am to correct an error. The trust had trained more than 80 per cent of staff who were due to work during the first two weeks of implementation by day one of go-live, and not by the end of the two-week period - as previously reported.