Analysis: Life in the old systems yet?

A SMALL but significant minority of NHS trusts will not be able to complete their year 2000 fixes, according to government watchdog the National Audit Office (NAO). Does that mean the NHS as a whole is fast approaching a millennium crisis?

Computing has talked to NHS IT managers around the country. We uncovered a people who are concerned about the impact the bug is having on key IT initiatives within the NHS, and increasingly worried about the lack of information about the conformity of vital medical devices.

Charles Yeomanson, year 2000 project manager at Walsgrave Hospital NHS Trust in Coventry, said: ?We?ve budgeted for the year 2000 but there?s going to be a strain on other projects ? such as implementing the government?s recent NHS white paper and its emphasis on electronic patient records.?

But what?s keeping IT managers awake at night is the threat from embedded microchips in devices such as intensive-care monitoring equipment.

Private health provider Bupa has said that it is budgeting for a 30% failure rate in its medical devices ? although some IT managers believe this figure does overestimate the problem.

Clinical equipment regulator the Medical Devices Agency (MDA) published a bulletin last November instructing trusts to deal directly with suppliers, and only to pass serious prob-lems its way.

The result: very little real pressure on suppliers. In theory, according to the MDA?s November bulletin, suppliers should have provided a compliance assessment of their products by the ?beginning of 1998?. But IT managers complain that this still hasn?t happened.

Diane Milan, head of information and IT at Ealing, Hammersmith and Hounslow Health Authority, said: ?A lot of suppliers are not providing undertakings about compliance. They?re worried about legal liability.

?And the MDA and NHS Executive won?t do a big programme of testing because they?re also worried about liability, so the situation is very fragmented.?

Small wonder then that the NAO found that 15% of trusts ?were not confident? that their clinical equipment would function normally in the year 2000.

With information systems, what emerges is the amount of specialist medical software that needs upgrading or replacement. East Riding Health Authority discovered in an audit that all seven of its key suppliers provide systems that require upgrading or replacement. These upgrades will cost an average of #3,000 to #6,000 per GP practice ? a total cost of between #300,000 and #600,000.

If East Riding?s figures are typical ? and there are some 9,000 GP practices in the NHS ? then the national bill will range from #27 million to #54 million.

Nick Allan-Smith, East Riding?s director of information services, has no doubt that the GP bug fix can be completed within existing budgets, and largely by the NHS Executive?s deadline of the end of this year.

But he questions whether major suppliers will be able physically to update every practice: ?We are very reliant on our suppliers. I don?t know whether they?ve got the capacity to make wholesale changes across the NHS.?

A number of big-name vendors have dropped support for hospital patient administration systems. One in Coventry-based Walsgrave has had to spend ?a six-figure sum? to replace a non-compliant GTE system, sold by prime contractor IBM in 1991 before GTE pulled out of the health market.

Walsgrave expects to implement a replacement by November this year. Fortunately, Walsgrave was reviewing its IT infrastructure as part of its merger with neighbouring trust Rugby. Consequently, it was able to adopt Rugby?s system for its operation. If the merger hadn?t been taken place, it could have taken another six months in the tender and procurement process.

Most major suppliers have, reluctantly, upgraded systems which they would have preferred to see abandoned. Siemens charged about 60 trusts up to #30,000 each for upgrades to the NHS? most widely used patient administration system, the IRC-PAS package.

Total year 2000 budgets for hospital trusts range in Diane Milan?s west London area from #250,000 for a community trust to #1 million for a large hospital trust. Bridgend Hospital in Wales has budgeted #200,000. Walsgrave?s more complex millennium problem will cost ?in excess? of #1.2 million ? over 1% of the entire trust budget.

If these budgets are accurate, they suggest that NHS estimates totalling #320 million (#170 million for IT and #150 million contingency for medical devices) are thankfully in the right ballpark ? assuming the medical devices problem does not escalate.

With 400 trusts in the NHS in England, a conservative estimate of #500,000 per trust suggests a total trust bill of #200 million. With an average GP bill of #40.5 million, plus an average health authority bill of #3 million (based on #30,000 for each of the 100 authorities), a grand total of around #250 million emerges.

Overall, NHS IT managers seem confident that they can fix the bug in time ? as long as suppliers help them identify problem areas. And many are optimistic that the bug can be fixed within existing budgets. Whether that is the case or not remains to be seen.

Last week: The bitter millennium pill

• National Audit Office survey reveals 15% of trusts don?t think all their medical devices will be millennium compliant
• Liberal Democrats call for #750 million more government money to fix the bug
• Many hospital trusts are stuck with non-compliant patient administration systems abandoned by suppliers
• No strong central co-ordination for fixing millennium bugs in clinical equipment by regulator, the Medical Devices Agency (MDA)

Hitting government targets

Government timetables for cutting NHS waiting lists, bureaucracy and bad practice are in jeopardy because of the millennium computer bug, an investigation by Computing has revealed.

The decision to force individual NHS organisations to fix the problem locally from existing budgets has paralysed IT decision-making.

Among the victims are:

• The new NHS information management and technology strategy. This was due to be launched in March, to replace a previous strategy which had petered out by the end of 1997. It is now on hold while ministers work out how to foot the bill, and will be unveiled in July at the earliest.
• The national roll-out of electronic communications under the ?patients not paper? initiative. At the time of the scheme?s announcement in 1996, the government said that this should save the NHS #100 million a year.
• Upgrades in information systems needed to implement government reforms set out in last December?s white paper. These aim to replace the ?internal market? set up in 1991 with a market based on quality, not cost. However, this is not possible with current information technology.