House of Commons - Public Accounts

Select Committee on Public Accounts Sixty-Sixth Report

MANAGING THE MILLENNIUM THREAT

PROGRESS MADE IN THE NHS IN ENGLAND

33. The NHS relies heavily on IT systems and electronic equipment for many patient services. It is impossible to predict the seriousness of malfunctions, but in extreme circumstances failure or malfunction of equipment could put patients lives at risk. The Chief Executive of the NHS has described the year 2000 problem as the highest nonclinical priority in the NHS. There could be serious disruption to the NHS in the year 2000 unless urgent preemptive action is taken.[29]

34. Initially in May 1996 the NHS Executive set up a small project to assess what action needed to be taken, and alerted Trusts and Health Authorities to the problem and issued information packs. The Executive first wrote directly to Chief Executives of Health Authorities and NHS Trusts on the potential problems of the year 2000 date change in September 1996. They did not set a specific timescale for action, although they told Chief Executives that they should know where they stood before the end of 1996. In October 1997, the NHS Executive instructed Chief Executives of NHS Trusts and Health Authorities to take personal responsibility for ensuring patient services were not compromised, and set timescales for action.[30]

35. The Committee asked the NHS Executive why they had set any deadlines in 1996. They told us that initially they had followed through with training events and information packs, and that they had monitored action in the early part of 1997. At that time, they found that the response had not been as good as they had wanted and this was one of the reasons why they had then set up the monitoring process against targets.[31]

36. The Comptroller and Auditor General reported that in October 1997, 10 per cent of NHS Trusts were not confident that their IT systems would be compliant by the end of 1999, and 15 per cent were not confident that their clinical equipment would continue functioning normally in the year 2000.[32] We asked the NHS Executive how they would ensure all trusts were ready in time. They said they had now set very clear deadlines:

a planning deadline of December 1998 when all critical systems should be fully ready and tested or, if they were not, there should be detailed plans to cope without those systems and equipment; and

a final check deadline of September 1999 to ensure all parts of the NHS were either fully prepared or in some cases had proper contingency plans in place.[33]

37. The NHS Executive added that all the returns they had suggested that the two deadlines would be met across the NHS. They were confident that everyone would meet their targets for fixing IT systems. However, they did not think everyone was confident of fixing their medical equipment, and this was one of the reasons why the NHS had set aside £150 million as a contingency sum.[34]

38. We asked if the deadline of September 1999 left them with enough time to sort out any problems, should difficulties emerge They were confident that good progress could be made during the period December 1998 to September 1999. They would be monitoring quarterly until the end of December 1999. They would also be receiving regular reports from their district auditors and samples of the quarterly reports would be sent to an independent reference group. And although the responsibility for meeting the deadlines lay with each Trust Board and each Health Authority, regional offices would, and indeed had already intervened.[35]

39. We had previously examined the NHS Executive on the development of hospital information support systems.[36] We asked whether these systems would be millennium compliant, and what this would cost. The Executive assured us that all patient administration systems were being actively investigated by the individual trusts who ran them in conjunction with suppliers, and they expected all of them to be resolved in terms of year 2000 compliance problems by the dates they had set.[37] As regards the cost, they told us that of the nine sites involved, seven had maintenance agreements with suppliers which covered the costs. Of the two sites that did not have maintenance agreements, Nottingham City Hospital NHS Trust estimated the cost at £61,000 while the Birmingham Heartlands Hospital NHS Trust put the cost at £501,000.[38]

40. Many of the more sophisticated diagnostic and treatment services which the NHS use rely extensively on electronic equipment and failure of those systems could have serious consequences for patients. Initially the Medical Devices Agency advised that while medical devices might show some year 2000 problems, these were unlikely to be serious and very unlikely to be life threatening. However, in October 1997 the NHS Executive instructed NHS organisations to draw up inventories of electronic equipment, prioritise equipment whose failures could have serious consequences, contact suppliers for advice, take corrective action if necessary and draw up contingency plans for equipment failure. The Medical Devices Agency issued a bulletin to all medical equipment manufacturers advising them to assess all their produces, identify any affected by the year 2000 problem and make this information available to users. They also emphasised the need to prioritise action, stating that resources did not exist to investigate every item of hardware and software in use, let alone to put right those affected by the problem.[39]

41. We asked the NHS Executive why the Medical Devices Agency was so late in recognising the potential threat. They agreed that it had taken some time for the whole question of embedded chips in electromedical equipment to be given the same emphasis that had been given to IT systems, but that the Medical Devices Agency was now providing proper support to the NHS. They recognised that there are some pieces of equipment that are so critical and could not be tested in time. As a result, they had set aside £150 million as a contingency sum to enable replacement or renewal of parts.[40]

42. We asked the NHS Executive how they planned to ensure that no patients were exposed to risk from equipment or systems failure. They told us that the each NHS Trust was having to tackle the supply industry almost on an item by item basis. With thousands of different items of equipment in use, the Executive were following all available lines of enquiry. They were trying to obtain compliance information. They were being clear about testing procedures where these were relevant. They had agreed with the Medical Devices Agency that the initial check on each bit of equipment would be made by the appropriate person holding the equipment in the NHS, and by the manufacturer. They had established a clearing house, a database on which people could exchange information. And manufacturers had sometimes exchanged information with them. Where they thought there might be problems, they were ensuring that they had contingency plans in place. [41]

43. They admitted, however, that they could not guarantee that nobody would die as a direct result of year 2000 problems. But they assured us they had systematically assessed all the risks and would continue to deal with them up to December 1999, and that patients' safety was the premium on all they were doing.[42]

44. The Comptroller and Auditor General reported that the information available on the state of readiness in General Practice suggested GPs were likely to have difficulty in achieving year 2000 compliance. And almost one third of Health Authorities did not have confidence that GP systems would be year 2000 compliant in time.[43] We therefore asked the NHS Executive how they would make sure that every GP would be ready. They took the view that the problems in GP surgeries were a lot less serious than in other parts of the NHS. This was partly because manufacturers of GP systems had been very good in pushing compliance. In addition, the latest returns showed that more than 80 per cent of GPs were well aware of the problems in store. And they assured us that systems for cervical screening had been made year 2000 compliant in 1995.[44]

45. They also pointed out that all GP systems were going to have to be upgraded to accommodate the Government's objective of having the facility to pass information freely and electronically between hospitals and GP settings. So the combination of improved software and in some cases improved hardware meant that the problem in general practice could be properly resolved. They added though, that GPs had good paper backup systems and these were an important safety net.[45]

46. The NHS Executive have told NHS organisations that they should plan to meet the cost of their year 2000 compliance programme from within existing budgets. The Comptroller and Auditor General reported that inadequate resourcing increased the risk of failure, and was the single largest area of concern identified by respondents to the NAO survey about the difficulties they faced in tackling the year 2000 problem. The Comptroller and Auditor General also reported that the cost of tackling the year 2000 issue in the NHS was estimated at £230 million but could be much higher.[46]

47. We therefore asked the NHS Executive about the cost, and how they planned to ensure that the NHS had adequate resources to complete the programme. They told us that on the basis of information from each individual NHS Trust, GP and Health Authority at the end of March 1998, the cost would be £320 million in England. This was made up of £170 million to deal with all of the IT issues and £150 million as a contingency against problems with medical devices.[47]

48. This figure needed to be put in the context of annual NHS expenditure on IT of £200 million and nearly £1 billion on medical and surgical equipment. They thought that the purchase of certain bits of equipment or upgrades of software might be brought forward from the normal replacement cycle but that any displacement activity would be under the capital budget and would not impact on recurrent monies that pay for staff and NHS activity.[48]

49. The Committee sought further reassurance from the NHS Executive that every Trust would be able to fund its year 2000 programme without loss of service to its patients. The Executive assured us that the money would be allocated on a nonrecurring basis, with £210 million of the £320 million being spent in 199899. They added that since May 1997, for the NHS in England, the Government had allocated an extra £1.7 billion and part of that was to deal with this pressure. Expenditure on year 2000 work would be insulated from the routine of Health Service spending and would not lead to any downgrading of patient care.[49]

Conclusions

50. In view of the potential impact of the year 2000 issue on NHS services and on patients, we are astonished that the NHS Executive got off to such a slow start in addressing the problem. The failure to set deadlines for action in September 1996 was a missed opportunity to ensure that all NHS bodies took the threat seriously. The action taken by the Executive subsequently means that they now have in place the elements of a well managed project.

51. We note that the NHS Executive are confident that all IT systems will be modified in time, and that medical equipment will either be modified or replaced where required. But we are concerned that the deadline of September 1999 for finally checking that all parts of the NHS are fully prepared, or if not have contingency plans in place, leaves them very little time to deal with problems that emerge. We look to the Executive to take strong and decisive action, including direct intervention where appropriate, to ensure that all NHS organisations and GPs are fully prepared.

52. Many of the more sophisticated diagnostic and treatment services which the NHS use rely extensively on electronic equipment, and failure of those systems could have serious consequences for patients. We are therefore appalled that the Medical Devices Agency did not realise the potential impact of failures until late 1997. In our view, this delay, and the misleading advice they gave the NHS in 1996 can only have increased the risks to patients and the costs of remedial action.

53. We welcome the action the NHS has now taken to tackle medical equipment, their assurance that they were putting a premium on patient safety and the fact that the NHS has set aside £150 million to help replace equipment or parts affected by the year 2000 problem. But we are disturbed that the NHS Executive could not give us a categorical assurance on the safety of patients. We expect the NHS Executive to monitor the position on medical equipment closely, and to take every step possible to ensure the safety of patients.

54. We note the NHS Executive confidence that the GP systems will be ready in time.

55. We note NHS Executive's assurance that expenditure on year 2000 work will not lead to any downgrading of patient care. However, we remain concerned about the possible impact on capital programmes of diverting money to year 2000 work; about the possible delay to other important projects; and about the added pressure on already stretched budgets. We expect the Executive to monitor closely the impact of the costs of tackling the year 2000 problem, and ensure that lack of resources do not result in the failure of systems and equipment that are critical to NHS services and patient care.

29 C&AG's report, (HC 724 of Session 1997-98) , paras 2.7-2.10 Back

30 C&AG's report, (HC 724 of Session 1997-98), paras 2.16-2.22 Back

31 Qs 67-68 Back

32 C&AG's report, (HC 724 of Session 1997-98), para 13 Back

33 Qs 10, and 41-46 Back

34 Qs 132-138 Back

35 Qs 56-57, 95 Back

36 7^th Report of the Committee of Public Accounts, Session 1996-97, (HC 97) Back

37 Qs 114-122 Back

38 Evidence, Appendix 2, p19 Back

39 C&AG's report, (HC 724 of Session 1997-98) , paras 2.10, 2.18, and 2.24-2.26 Back

40 Qs 131, 139-143 Back