Incident: Welsh NHS IT System Failure Causing Chaos and Delays

Published Date: 2018-01-24

Postmortem Analysis
Timeline 1. The software failure incident affecting the Welsh NHS systems happened on a Wednesday, as mentioned in the article [66961]. 2. The article was published on 2018-01-24. 3. Estimating the date of the incident: - The article does not provide a specific month or year for the incident. - Therefore, based on the published date of the article (2018-01-24) and the fact that the incident occurred on a Wednesday, we can estimate that the software failure incident happened in January 2018.
System 1. Welsh NHS computer systems [66961]
Responsible Organization 1. Technical issues were responsible for causing the software failure incident affecting the Welsh NHS systems [66961].
Impacted Organization 1. Doctors and hospital staff in the Welsh NHS [66961] 2. Patients like Philip Young who were awaiting biopsy results [66961] 3. Aneurin Bevan University Health Board complaints line [66961] 4. GP services in Wales [66961] 5. Primary care providers like Dr. Alan Woodall [66961] 6. Consultants at Morriston Hospital in Swansea [66961]
Software Causes 1. Technical issues causing a widespread failure in computer systems affecting the Welsh NHS [66961] 2. Problems related to national firewalls affecting nationally hosted systems across NHS Wales [66961]
Non-software Causes 1. The failure incident affecting the Welsh NHS systems was caused by technical issues, as confirmed by the National Cyber Security Centre [66961].
Impacts 1. Doctors and hospital staff were unable to access patient details, blood, and X-Ray results, causing frustration and danger [66961]. 2. GP services were affected, with at least half of GP services experiencing issues [66961]. 3. Patients faced delays in receiving important medical results, such as biopsy results, leading to concerns about potential health implications [66961]. 4. Staff were unable to access patient records, hindering their ability to provide proper patient care [66961]. 5. The inability to access phone numbers of patients led to difficulties in contacting them to cancel appointments [66961]. 6. Notes from appointments could not be typed up and saved, resulting in a backlog of work [66961]. 7. The incident raised concerns about data security and patient care, especially in the aftermath of previous cyber attacks on the NHS [66961].
Preventions 1. Regular system maintenance and updates to ensure the stability and security of the IT infrastructure could have prevented the software failure incident [66961]. 2. Implementation of robust backup and recovery systems to quickly restore services in case of a failure could have mitigated the impact of the incident [66961]. 3. Enhanced cybersecurity measures to protect against technical issues and potential cyber attacks could have prevented the disruption in the Welsh NHS systems [66961].
Fixes 1. Implementing more robust backup systems to ensure continuity of service during technical failures [66961]. 2. Conducting a thorough investigation into the root cause of the technical issues affecting the national firewalls and nationally hosted systems across NHS Wales [66961]. 3. Enhancing cybersecurity measures to prevent future incidents and ensure data security [66961].
References 1. Doctors and hospital staff affected by the software failure incident, including statements from Bangor GP Dr Catrin Elis Williams, Philip Young, and various other healthcare professionals [66961]. 2. The British Medical Association (BMA) in Wales, representing doctors, providing insights into the impact on GP services [66961]. 3. The Welsh Government, confirming the restoration of systems and addressing potential backlogs [66961]. 4. The National Cyber Security Centre, clarifying that the issues were due to technical problems and not a cyber attack [66961]. 5. Powys NHS IT department, acknowledging a major incident affecting nationally hosted systems and attributing it to national firewalls [66961]. 6. Assembly's opposition health spokesman Angela Burns, expressing concerns and emphasizing the need for swift resolution to ensure patient data security and care continuity [66961].

Software Taxonomy of Faults

Category Option Rationale
Recurring one_organization, multiple_organization (a) The software failure incident at the Welsh NHS systems had happened before within the same organization. Dr. Alan Woodall, chairman of GP Survival UK, mentioned that the system had gone down before but only for short periods [66961]. (b) The software failure incident at the Welsh NHS systems affected multiple organizations. The article mentions that at least half of GP services in Wales were affected by the IT failure, indicating a widespread impact across various healthcare organizations [66961].
Phase (Design/Operation) design, operation (a) The software failure incident in the Welsh NHS systems was attributed to technical issues and not a cyber attack, according to the National Cyber Security Centre [66961]. This suggests that the failure was due to contributing factors introduced during the system development or system updates rather than an operational issue. (b) Doctors and hospital staff were unable to access patient details, blood, and X-Ray results due to the internal portal being down, leading to chaos and frustration among healthcare professionals [66961]. This indicates that the failure was also influenced by the operation or misuse of the system, as it directly impacted the daily operations and functionality of the healthcare services.
Boundary (Internal/External) within_system (a) within_system: The software failure incident affecting the Welsh NHS systems was caused by technical issues within the system itself, as confirmed by the National Cyber Security Centre. The Welsh Government's department of health and social services also stated that the problems did not lead to any data security issues, indicating that the failure was primarily due to internal technical issues rather than external factors like a cyber attack [66961].
Nature (Human/Non-human) non-human_actions, human_actions (a) The software failure incident in the Welsh NHS systems was attributed to technical issues and not a cyber attack, as confirmed by the National Cyber Security Centre and the Welsh Government's department of health and social services [66961]. The Powys NHS IT department mentioned that the issue appeared to be related to national firewalls and was under investigation [66961]. (b) Human actions also played a role in the incident. Dr. Catrin Elis Williams, a Bangor GP, described the situation as frustrating and dangerous, highlighting the impact on patient care due to the inability to access crucial information [66961]. Additionally, the British Medical Association in Wales reported that at least half of GP services were affected, emphasizing the human impact of the software failure on healthcare professionals and patients [66961].
Dimension (Hardware/Software) software (a) The software failure incident reported in Article 66961 was not attributed to hardware issues. The National Cyber Security Centre mentioned that the problems were caused by technical issues and were not the result of a cyber attack, indicating that the root cause did not originate in hardware [66961]. (b) The software failure incident in Article 66961 was primarily attributed to software issues. Doctors and hospital staff were unable to access patient details, blood, and X-Ray results due to a widespread failure in computer systems. The Welsh Government confirmed that all systems were back up and running after facing technical issues, emphasizing that the problems did not lead to any data security issues. Additionally, the British Medical Association in Wales mentioned that at least half of GP services were affected by the software failure incident, highlighting the impact on healthcare services [66961].
Objective (Malicious/Non-malicious) non-malicious (a) The software failure incident reported in Article 66961 was non-malicious. The National Cyber Security Centre confirmed that the problems were caused by technical issues and were not the result of a cyber attack. Additionally, the Welsh Government's department of health and social services stated that the problems did not lead to any data security issues. The incident was attributed to technical issues rather than any malicious intent [66961].
Intent (Poor/Accidental Decisions) unknown (a) The software failure incident reported in Article 66961 was not due to poor decisions but rather technical issues. The National Cyber Security Centre confirmed that the problems were caused by technical issues and were not the result of a cyber attack. Additionally, the Welsh Government's department of health and social services stated that the problems did not lead to any data security issues, indicating that the failure was not a result of poor decisions [66961]. (b) The software failure incident reported in Article 66961 was not attributed to accidental decisions but rather technical issues. The Welsh Government confirmed that the problems were caused by technical issues and were not the result of a cyber attack. The incident was described as a major incident affecting nationally hosted systems across NHS Wales, with investigations ongoing to determine the root cause [66961].
Capability (Incompetence/Accidental) accidental (a) The software failure incident reported in Article 66961 was not attributed to development incompetence. The National Cyber Security Centre mentioned that the problems were caused by technical issues and were not the result of a cyber attack. Additionally, the Welsh Government's department of health and social services stated that the problems did not lead to any data security issues, indicating that the failure was not due to incompetence in the development process. (b) The software failure incident in Article 66961 was described as causing chaos and frustration among doctors and hospital staff. One GP mentioned that the system going down caused significant problems in accessing patient information, results, and past medical histories, leading to a backlog of work. Patients were unable to receive their test results promptly, and appointments had to be rescheduled, causing concerns about delays in critical medical information. This accidental failure disrupted healthcare services and patient care, highlighting the impact of unexpected technical issues on the system's functionality.
Duration temporary (a) The software failure incident described in the articles was temporary. The Welsh NHS systems were affected by a widespread failure in computer systems, leading to doctors and hospital staff being unable to access patient details, blood and X-Ray results, and other essential information. However, the Welsh Government confirmed that all systems are now back up and running, indicating that the failure was not permanent [66961].
Behaviour crash, omission, value, other (a) crash: The software failure incident in the Welsh NHS systems resulted in a crash where doctors and hospital staff were unable to access patient details, blood, and X-Ray results due to the internal portal being down [66961]. (b) omission: The system failure led to omission as doctors and staff could not access patient information, results, and past medical histories, causing delays in patient care and appointments [66961]. (c) timing: The timing of the system failure was critical as it occurred during the day, affecting patient care and causing frustration among healthcare professionals who needed the system for various tasks [66961]. (d) value: The software failure incident did not involve the system performing its intended functions incorrectly but rather failing to perform them at all, leading to disruptions in accessing critical patient information and results [66961]. (e) byzantine: The software failure incident did not exhibit byzantine behavior as the problems were attributed to technical issues and not a cyber attack, and there were no data security issues reported [66961]. (f) other: The software failure incident also resulted in the inability of staff to access phone numbers of patients to contact them and cancel appointments, notes from appointments could not be typed up and saved, and there was a backlog of tasks due to the system being down [66961].

IoT System Layer

Layer Option Rationale
Perception None None
Communication None None
Application None None

Other Details

Category Option Rationale
Consequence unknown (a) death: People lost their lives due to the software failure - No information in the provided article suggests that people lost their lives due to the software failure incident. [66961]
Domain health (a) The software failure incident affected the healthcare industry, specifically the Welsh NHS system, causing disruptions in accessing patient details, blood and X-Ray results, past medical histories, and appointment information [66961].

Sources

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