Airedale Shows Candour Can Carry an EPR to Go-Live
This weekend, clinicians at Airedale NHS Foundation Trust will open a patient record system they have spent months learning. Patients have already been handed a leaflet that says something hospitals rarely admit in writing: expect small delays in the recording of notes while staff adjust. Appointments will go ahead as normal. The trust has told people what the first few days will feel like before they feel it.
The go-live of the Oracle Health Millennium electronic patient record is set for 17 and 18 October. It follows a difficult passage. Earlier this year the board recorded additional capital and revenue pressures against the original business case and gave the programme an amber rating in its assurance framework. That rating was published, discussed and acted on. Governance was tightened, process mapping continued and the programme was reported as stabilising. The trust made its trouble visible and then did the work.
That sequence matters because EPR programmes in England have a mixed record, and boards have too often learned of difficulty late, when the options had narrowed to expensive rescue or quiet slippage. An amber rating that leads to firmer controls is the system working as intended. It deserves more recognition than the green dashboards that precede many a troubled implementation.
Guernsey offers a useful comparison. The island sits outside the NHS, but its health committee has just announced it will move towards closing its EPR programme in favour of rolling improvements, with its president saying the problems had been recognised and that pushing ahead regardless would have made them worse. Stopping can be a sound decision. Airedale reached the opposite conclusion from a similar discipline of honest assessment, and the assessment is what the rest of the service should copy.
The national setting makes this pressing. Government ambitions for a single patient record and a shift from paper-era processes to digital ones depend on hundreds of local implementations succeeding in organisations with little spare capital. When a business case overruns, the trust usually absorbs the difference from a budget already stretched by waiting list recovery and productivity targets. If the consequence of reporting an overrun is scrutiny and blame, boards will report it later. Policymakers who want accurate early warning need funding and assurance rules that reward the trust for raising its hand.
Workforce strain sits underneath all of it. Training staff on a new record takes them away from patients at a time when rotas are already tight, and the first weeks after go-live typically slow clinicians down. Airedale has promised extra support during the changeover, which is where programmes of this kind are won or lost. Clinical goodwill is finite. If the system saves staff from re-entering the same information, as the trust expects, that goodwill grows. If it does not, the cost lands on morale.
Other organisations are watching. BSW Hospitals Group is moving towards a shared EPR go-live and has just named a senior responsible officer, with benefits realisation and process mapping already under way. Those leaders will look at Airedale's early weeks for evidence on how much disruption to plan for and how much support to fund. Suppliers will be watching too. Their standing with NHS buyers is built on how quickly faults are fixed in the first month, when a trust has no patience for delay.
Patients are the quiet beneficiaries of the trust's approach. A leaflet that sets modest expectations earns more trust than a promise of seamless transformation, and public confidence in digital reform is hard to rebuild once lost. The stated benefits are sensible ones: better communication between care teams, less repetition of information and a base for later digital services.
None of this guarantees a smooth launch. The real test comes in the weeks after 18 October, when queues, workarounds and fixes will show whether the preparation was sufficient. But Airedale has already done something the service needs more of. It told the truth about its risks, kept its governance in view and went live with its patients informed. That is a standard worth setting for every trust that follows.
