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back to article NHS needs to catch up on technology

The NHS is failing to make effective use of simple technology now commonly used by its patients, such as the internet and email. Other industries like financial services and travel have been much quicker to adopt new technology, according to thinktank the King's Fund. Allowing patients to talk to doctors via email, use of video …

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Stop

The basics

My partner works in the Royal Surrey Hospital in Guildford, and they don't even have VOICEMAIL in her department!!!

There are many people there who openly resist any change, let alone something that may make everyone's jobs easier and let them treat patients more effectively...

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It's a people problem, not a tech problem

When you start a small business, it's quite easy to gather a team that is highly motivated and focussed on the goals of delivering service. You can communicate effectively with your staff and ensure everyone's making their contribution.

However as organisations grow, the goals get diluted. The needs of the staff increase in importance and the needs of the customers become more distant, as fewer and fewer of your people find themselves at the revenue-earning sharp end of the biz. Ultimately you get to organisations like the NHS, taken as a whole, one of the largest employers in the world. Almost no strategic decisions in this set-up are made primarily for the benefit of the patients. They'll be made for reasons of cost, CYA, expediency but primarily for the convenience and benefit of the staff themselves. This is why it's next to impossible to book doctor's appointments. It's why waiting rooms ban the use of mobie phones (even though they're permitted on heart wards - first hand experience here, guys) and with relevance to this topic - it's why NHS people don't like to learn new technologies. Apart from the sheer bother of old dogs and new tricks, most tech today is used to reduce headcounts or to empower users. Areas that NHS staff, themselves, have a vested interest in eliminating.

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Anonymous Coward

Confidential Government Memo.

Government Project Funding Process.

1) Do no preliminary research whatsoever. It's best if you have absolutely no understanding of whats involved in the project at all. Ideally, you should fail to grasp even the most basic aspects of it, such as whether or not completing the project is possible or not.

2) Announce Project, seek contractors. Let anyone bid, even if everything they've ever touched has failed catastrophically.

3) Award contract to lowest bidder, even if there is no way, including slave labor, to deliver at the quoted price.

4) Don't enforce their budget at all. Keep throwing money at the problem. It'll totally go away.

5) Don't set any deadlines. It takes as long as it takes. In relation to point 4, ensure absolutely no financial incentives are provided for finishing on time.

Bonus Stage: Make sure absolutely nobody is answerable when the project is finally delivered a decade late, 1000% over budget and doesn't work.

Bonus Stage 2: After 2 months of trying to force everyone to use your new project, scrap the whole thing and buy a prebuilt solution from France at half the price.

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Stop

12.7bn FFS.

Why is it when ever "NHS" and "IT project" are mentioned it always followed by the word "Disaster" so this thinktank must be a group of *Very* brave people to start making suggestions like this.

Oh great, you should be able to email the doctor. So now every hypochondriac will now be able to email his doctor from the comfort of their living room? Whenever I go to my doctors his surgery is always full, how is he going to get time to read emails as well?

And of course video conferencing is *Such* as good idea. I have worked for two companies now who spent a fortune setting up video conferrence systems and ive never seen them used apart from on special occasions when they wish to show off to a client.

Sorry, im ranting, but it appears they dont have a clue what they are talking about, more money down the drain, as suggested by the King's Fund, what the *uck is that name all about? I need to look this quango up.

More unwanted suggestions by an unwanted quango for more unwanted projects.

*Sigh*

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Flame

Sterling work! Thanks King's Fund...

In other news - "Think tanks nearly 100% effective at stating the bleedin' obvious". Anyone who has visited a hospital or surgery in the last few years could have come to the same conclusion.

Despite some superficial trappings of having joined the 21st century (flat screen monitors, woohoo!) the NHS's systems remain resolutely un-joined up, forcing you to restate every little detail of your life whenever you have need of their services. It's frankly embarrassing.

Come to think of it, given all the intimate personal details forced out of us at A&E desks, they would be good places to do some identity theft harvesting....

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NHS low-tech

Well, I'm glad of that- it gives them a chance to have a stable system. I'm especially glad they're low-tech if NICE gets more in on the act.

"Treat Mrs Jones' cancer? No, the drugs are far too expensive- especially with all this videoconferencing equipment we've just bought."

Long may they not waste money on high-tech fads like VC equipment (what's wrong with MSN / Office Communicator and a webcam?!) and instead spend it prolonging the lives of me and my family.

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Flame

Better leadership?

Unless "better leadership" means getting rid of some of the useless pen-pushers, those suits you find wandering around your local NHS trust with empty foolscap files trying to look important to justify their existence, and redirecting the funding to more worthy causes such as actually healing people, regardless of whether they're over 65 or not, I find it hard to agree with that conclusion.

You can tell when one of these suits walks past. Without fail, every single doctor, nurse and consultant watches it walk past and shakes their collective heads wishing they had the eight hour day and pay scale of the useless moron that just passed through their domain.

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Gates Halo

May not be this simple...

But... surely the best way to run something like this is to create a centralised system that just stores the data securely and develop a couple of secure API's to send and retrieve data to this system.

Then just invite software companies to create the client software which can then be certified centrally. Then these software companies can sell their client software solutions to doctors surgeries, hospitals, care home etc (obviously fix a maximum budget they can spend on the software per user or something).

This means the government is only paying for a central data system and some middle-tier API's up front. They can even make some money on the certification program of the client software to stop 1000's of applications by bedroom programmers flooding the market. Then, the client software is only paid for when it's ready to use, and there will actually be a choice of solutions, created in a competetive market.

In my opinion this type of model is the only way to create system the size the government is planning these days. Giving the whole contract to a single company is just going to limit the options available in the system and ensure it overruns and goes over budget.

Icon? Well, we need a new one for Balmer.. but it's obvious.... Developers developers developers developers!

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IT Angle

More technology?

What a crock of sh*t.

What the NHS need is to stop investing in ridiculuous multi-billion pound EDS failures that expensively reinvent the wheel (webmail as an example) and go firmly back to basics.

Clean wards please, a team to crack down on MRSA please, an A&E bed not covered in faeces, cancer drugs when I need them, not HD, 3D, 5.1 surround sound x-ray machines that help in a minority of cases.

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Paris Hilton

call me picky

... but isn't the job assigned to all those wonderful doctors and nurses supposed to be orientated around this thing called "a patient" and why then should they need the added complication of access to email (and 3-day training course on how to write their password on a post-it) except possibly to be informed by some phukwit in management that they logged in to their computer 5 minutes late this morning and will have 2.5p deducted from their wage this week. (yes, that works out at about £3.00 per hour).

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Stop

With the FT down ~10% in the first 3 hours today

it would seem particularly inappropriate to put the financial services sector forward as an example of anything much except lies, greed and organisational incompetence.

And who exactly wants confidential medical info flying backward and forward using legacy internet email technologies, which are inherently neither reliable nor secure.

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Anonymous Coward

@May not be this simple...

Hear Hear. Exactly what I've been thinking all along.

Make the solution a matter of interfacing. Allow the GPs, trusts, etc buy their own software as long as it conforms to a minimum standard for communicating to a central database. Not this massive one-size-fits-all, all-things-to-all-people bs "solutions" like iSOFT's LORENZO turd is pretending to try to be and will forever fail.

Luckily I recently got out of the Health IT game after 10 years of hitting my head against brick walls and issues with what our offshore 'colleagues' keep delivering.

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Email from banks

Anon 09:58 hits the nail on the head. Email is already a dying technology for communicating with customers. In fact it's already all but dead for the banks because of the widespread bank related email scams. It's unreliable, untrustworthy, and insecure.

Appointment reminders by text message with a fifty quid fine if you don't turn up - now that would be a grand idea.

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Flame

Crap ideas!

There's no way on Earth that doctors would accept getting emails from their patients, let alone teleconferences...

Who the hell is the Kings Fund anyway? Are they supported by EDS or MS?

I'm all for technology, but only if it's appropriate to the need. The NHS needs to spend money on the basics and life-saving equipment first before wasting billions on stupid procurement projects. My wife works for the NHS and she only got a networked desktop PC (shared between 3/4 people) this summer!!!!

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Boffin

Allowing patients to talk to doctors via email...

... That would, of course, be secure e-mail so private information wasn't broacast to any nosy parker out there...

... wouldn't it?

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Anonymous Coward

Pete makes sense

those are the reasons, it is just too big, it exists for itself not to achieve any goal.

Technology could be very well used in health field, but they appear to want to use it to slip in ID systems through the backdoor, great way to give your IT that cracker feel to it.

IT is meant to be used to solve problems, not create more of them, I have always preached that if you can do it cheaper and faster without a computer system then that is what you should do, you won't find many in IT that will say that.

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Anonymous Coward

Do you actually work in the NHS?

I wonder how many actually work in the NHS, particularly in connection with IT and understand the problems faced by the people that work within it?

A typical organisation like a trust hospital is in actuality a conglomeration of various autonomous medical and non-medical units ranging from builders and electricians through to specialist doctors and surgeons. Each unit is virtually its own business and it is not uncommon for them to have their own IT departments and networks, all operating under the banner of the hospital, and not necessarily within the same site.

Added to that, the hospital takes in patients from clinics and doctors who may be located anywhere in the country who in turn, will have their own systems. Now multiply this scenario across the various organisations across the UK and you will have a rough idea of what the NHS is. It is probably more accurate to define the NHS as a mechanism for payment of healthcare in Britain and not think of it as an organisation per se.

To talk about a seamless, centrally driven National Programme is nonsense. It is like saying all cities, towns and villages in the UK will only use one homogenised system dictated by central government. A clear non-starter unless you live in a country like the ex-Soviet Union.

Some organisations do employ cutting-edge technology. We do, for example (no names mentioned as I am posting this as an AC) but at the end of the day, like any other business, upgrading depends on income. The bulk of our income goes to patient care, which after all is our core business.

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Linux

Better Way

As Britain's biggest employer, the NHS must invest the time and effort in building a pure Free Software solution for their needs. This will:

* Avoid haemhorraging money to foreign software vendors. Local programmers shop in local shops, pay local taxes, drink in local bars, eat in local restaurants, watch shows in local theatres and take their families to visit local tourist attractions, thus keeping money in the local economy.

* Ensure genuine data security. If anyone can inspect and modify the Source Code, then vulnerabilities can be repaired as they are spotted; since "good guys" outnumber "bad guys", any given vulnerability is more likely to be spotted by a "good guy" than a "bad guy".

* Provide necessary "future proofing" against both changes in data format (if ever an unavoidable, radical change in data formats means migration tools are necessary, they can at least be created directly from the *actual* data loading and saving routines) and suppliers going out of business leaving unmaintainable software (because the Source Code will be out in the open, and any sufficiently competent programmer can maintain it).

The NHS IT services department can always contract itself out to other firms at a later date, once a fairly stable system is established.

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IT Angle

This time it is not EDS!

I hate to contradict David Wray, but (AFAIK) NHS IT is an area where EDS has not been involved. Seems that almost all computer services companies can screw up given the opportunity?

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Anonymous Coward

No suprise

The profession of all the 9 members of the Polit Beaureau which run China are....wait for it..let me say this again so you don't miss it....the profession of ALL 9 members of the officials that run China are ENGINEERS.

Perhaps, just perhaps there's a connection there as to why China is growing, developing so rapidly.

In the UK, how many engineers are there in Government? I bet you'd be hard pressed to count 1 or 2.

The people that run this country do NOT understand technology and have very little interest in it, Tony Blair can testify to that. He freely admitted he didn't know know what a mouse was.

People in this country make fun of people who understand computers and technology, they are proud to boast they they can't do maths.

No wonder this country is so backwards with tech.

If you want IT to be a success in the NHS, get rid of some of the managers and start putting some qualified engineers, MIET, and or MBCS qualified people in the management of these organisations, give them some power, allow them some flexibility and then you'll see the problems, the mess sorted out.

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Coat

@May not be this simple... AC

I was just beginning to type something similar. Good point.

I suggest we form Company. Call it something ludicrous like 'AllRegCommentards' or 'BollocksRus plc'. Then, and here is the cunning part, use your comment as the digest and fill out to 500+ pages with lorem 'ipsum text (nobody actually reads these things so it doesn't matter) and offer it to the government as a 'new IT strategy consultation document' at the knockdown price of £10 million. That aught to be enough when spread around all reg readers. So...

...everyone down the pub. Pass my coat will you, it's the one with the £10 million IOU in the pocket.

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@Do you actually work in the NHS?

> Each unit is virtually its own business and it is not uncommon for them to have their own IT departments and networks .... To talk about a seamless, centrally driven National Programme is nonsense.

Au contraire, my friend. This is precisely why standardisation is a good thing. It's why every doctor, when presented with the same medical condition (and obviously, patient situation) should prescribe the same treatment. It's why every nurse should do the same things to the same patients, the same meals served and the same administrative practices carried out in every hospital, surgery and walk-in centre everywhere.The thing that makes the NHS so inefficient, (as shown up in the league tables that have been forced on them) and therefore indirectly kills countless people each year is the phrase "oh, here we do it differently ..."

It's because of all the different ways of doing things, the idiosyncracies of the staff, the personal feuds and biases, the "I know better" attitudes and the sheer arrogance of the senior staff that the whole setup is such a mess. What the NHS needs is for someone with the authority and personality to say "do it this way or get out." Only then will we be able to have an NHS that spends money and effort on the patients, not the staff and can respond in a consistent and timely fashion to changing needs and expectations.

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IT Angle

Stop Stealing My Golden Eggs

Not happy this matter has been brought to the publics attention - again!!!!

Having made a good living from the NHS (as a consultant) I feel I should add some balance to the arguement for us third parties.

1) Senior management are very upfront and honest - you are informed at the earliest possible stage that your services are being employed so that if a project fails it is because of your incompedence and not the fact the idea was bad in the first place. Ultimately you will be fired and the manager gets browny points for taking decisive action.

2) All the talented staff have left - such as myself as compensation is diabolical for skilled jobs. Why should I work for 25K a year doing my job when I can leave then come back in as a consultant - doing the same work for £25\hour (50K\year) - you know it makes sense.

3) For the inherantly tricky issues I require to pay a third party for these - ultimately they will get the sack if something goes wrong - I have my cut on top of theirs for protecting myself - an ethos the senior staff fully support.

4) I also save the NHS the hassle of writing my contract - I do this for them. This way I am perfectly positioned to find loopholes to allow me to overcharge for time in case things are quiet. For some reason no one in the NHS wants to verify my contract terms and conditions - may imply a level of liability if they did then they would get penalised.

5) Most competent staff who used to be with the NHS either work for me or with others like me. They don't seem to have realised that its the key personnel we're interested in which forces them to employ my services as I now have their key staff with the skills to progress.

6) This leads us to 'The Maintenance Contract'.

All components - hardware\operating system\environment\administration\updating are usually handled by different parties. This allows all parties to stall for time while 'discussing' who is actually to blame. Usual outcome is one of us gets a nice £50-£100\hour (depending on the system) to find and fix the problem - average time to resolve - 1 week. (you would do it too)

7) Latest developments: The Fully Managed Service

Great earnier - the third party providing the service has a license to make money - the NHS are so reliant on the provider they have to go with what they say & don't wish to rock the boat by asking why they are being charged say an extra 100K for a mistake that looked like the third parties - again coming back to liability - we pay you then you take the rap. The key staff skilled enough to have them fix the problem for free now work for the third party - outstanding.

8) The National Framework:

250 laptops costing £1000\unit get a limited £0 (yes zero) discount for the bulk order - even although the exact same model is in PC world for £600 - no oversight and the person from the NHS got a free mousemat and matching mouse for their effort - not bad for a 250K order.

If it was my business - have NHS internal project managers (you tried MS Frame) who are responsible from concept to handover & pay them accordingly. 30K for someone managing a £5,000,000 project of which £2,000,000 is scope creep is pants. Pay them for the job they do & you might keep your staff instead of them going elsewhere.

Think that about covers it.

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Anonymous Coward

Title.

quote - "But... surely the best way to run something like this is to create a centralised system that just stores the data securely and develop a couple of secure API's to send and retrieve data to this system.

Then just invite software companies to create the client software which can then be certified centrally. Then these software companies can sell their client software solutions to doctors surgeries, hospitals, care home etc (obviously fix a maximum budget they can spend on the software per user or something)." /quote

So, basically you mean things should be exactly as they are with System One, Synergy and EMIS all just acting as clients accessing the NHS Spine with authentication done via a Smart Card provided by the PCT?

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Anonymous Coward

@AC 21:48

Indeed. Shame none of these run for standard users without hacking the things around, isn't it? Should never have been signed off. Only Thursday I spent ten minutes on the phone with a software vendor totally bemused that we don't give our users admin rights on the machine. "but that's a permissions error! The user needs full read/write access to C:\Windows!

Over my dead body.

But I digress. My hobby horse. I could tell some horror stories.

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Linux

Read/write access to c:\windows?

"but that's a permissions error! The user needs full read/write access to C:\Windows!"

LOL...Running Synergy were they?

Quality product that...

...sarcasm mode off.

Penguin. 'Cos it doesn't require its users run as Admin.

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Anonymous Coward

Syngergy?

No. Actually not a spine app but another widely used item.

Believe it or not, I had one system where the provider wanted me to do this on a TERMINAL SERVER.

Erm. No thanks. I really want to spend every other weekend rebuilding it and every afternoon weeding out the malware.

Linux apps generally indeed don't require the user to be root. This is because the developers have always known that's bad and naughty. Too many Windows developers are still living in a Win98 (or at best NT 4.0) world. It's not so much that they require admin, but they do tend to require write access to places where only admins get write access. Most of these things will run for Power Users, but I have to have exhausted every other avenue and have actual patient impact bearing down on me before I do that.

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Joke

"but that's a permissions error!"

Another outstanding example of how little the providers think of the NHS.

No doubt the guy who knows enough to tell to the provider how to do their job probably works for them now.

Why don't the NHS managers realise that the providers NEED their business - send an install with the relevant permissions built in to the install (10 minute job) or plan to phase out the provider. Again no top level support for the guys in the field.

First question has to be "who signed off on the purchase & how was it tested". As an end user support engineer you are completely entitled to ask for this information. Again with no NHS employed project manager probably to oversee this process it perfectly positions the provider to give you the run around.

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Anonymous Coward

@The Sceptic

Questions I know the answers to I don't need to ask. It will have been tested by being shown off by a smiling idiot from the vendor on a PC configured to work. If it's had any end user testing, it will have been by end users who are already admins because their IT dept. has given up the unequal struggle of getting their stuff to work any other way.

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Anonymous Coward

@ Email from banks

Only if we can fine the NHS when they miss our appointments.

Yes sir the doctor will see you at midday, ensure you are here then, if you miss it we will refuse to treat you any more. So you turn up at 11:45 just to be on the safe side, about 2 to 3 hours later you get to see the doctor. hardly the stated appointment time. Yet if you kept the appointment like this they would be arsey with you.

Now i like the NHS, they (Nurses and doctors) work hard and deserve our respect, but its the buearacy and targets which are ruining it

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Fine the NHS when they miss our appointments.

Excellent idea

and make sure that patients who miss their appointments are fined too.

Patients £10 per missed appt

Health visitors, nurses, etc £50

GPs £100

Hospitals £1k

AC since I work for the NHS

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