1. Issue
The Cyber Attack on 12th May 2017 on Barts Health impacted not only on access to PACS (imaging), Pathology and ARIA Chemotherapy Prescribing, but also access to all Trust computers, affecting all staff. This was declared as a major incident on 12 May and stood down on 24 May, with daily command and control meetings until stability was reached.
The Trust worked diligently to check and verify PCs to ensure the safe delivery of care for patients. Throughout this period, Hospitals have remained open for emergency care and majority of appointments went ahead.
Alongside the processes already described since 20/4, the impact of the 12/5 cyber attack affecting communication and additional delays to diagnostic requesting will be specifically reviewed for clinical harm:-
This includes:
Breast cancer screening The prolonged impact on Cancer MDT Impact on 52 week breaches Assess whether any impact on maternity
Backlog of complaint ( e-forms)
Establishing safety netting alongside datix reporting

2. Progress update The clinical harm process has already been introduced following the IT Equipment failure in April The first priority is ensuring that any patient who has encountered delay is placed back on a care pathway, with particular emphasis on cancelled operations. For Cancer there were 3 cancelled operations, which have all been re-booked and the RTT target for re-booking cancelled operations is within 28 days.
NB: The cancelled operation unvalidated data will continue to fluctuate as initial cancelled patients are re-booked.

3. Breast Screening
A dedicated harm review process has been implemented as below.
Backlog Numbers
Progress Update
Outcome
980 screening mammograms
980 reported
5 cancers diagnosed
300 surveillance mammograms
All reported initially without access to archive
Subtle changes brought back for clinical review and ultrasound scan +/- further mammogram
No cancers to date and films for second reporting as historic archives are restored
3000 screening patients with delayed appointments
All are being re-booked
New cancers will be assessed for clinical harm reviews. Anticipated to be low numbers.

4. Maternity
The Clinical Harm Team undertook a review to assess any clinical harm impact on Maternity Services. There is no evidence to date, having interviewed the site ADOMs. A specific focus was on any delays to Foetal anomaly screening. To date, none have been identified.

5. Radiological Safety Netting
Alongside clinician Datixes regarding individual patients, a radiology safety netting process has been put in place.
To date, 1,100 MRIs and 600 CT Scans have been recovered from the recent archives since the IT events and are being reported. Further imaging recovery is on-going. A log kept within Radiology for all patients from this period are being monitored for new diagnoses and/or repeat ionising radiation. A clinical harm review will be undertaken for all these patients, many of whom will be duplicated via the Datix process. Thus this ensures robust safety netting for the clinical harm review processes outlined.

6. Overarching Safety Netting
Individual Clinician datix reporting as a “catch all”
Tracking and reviewing complaints
Tabling impact of ICT failure as an agenda item in governance meetings with vigilance for incidence triggers.