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back to article NHS delivers swift kick to Microsoft's wallet over fee demands

Microsoft is finding out that it doesn't always pay to play nasty with large government customers: NHS procurement bosses are telling authorities and bodies to hold firm against a wave of licensing compliance threats. As exclusively revealed by The Channel last week, Microsoft wrote to all 160 healthcare bodies across England in …

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Unhappy

OK

Dyke said "...will allow us to work together with Microsoft to deliver best value to the NHS".

The only way that will work is if the NHS persuades MS to help it migrate to Linux or another FOSS O/S, and that ain't going to happen.

So keep spending chaps, it's not your money you are wasting anyway!

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Anonymous Coward

Re: OK

If the French police can do it so can the NHS

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Holmes

Re: OK - "If the French police can do it so can the NHS"

Ah! Methinks you underestimate the abilities of the Gallic Fuzz and/or overrate the abilities of our third world hell health service.

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Anonymous Coward

@rm -rf / - Re: OK

No, because NHS must grow a pair of balls before they can do that.

It's the same in this part of the world where I currently live. Provincial government is cutting spends left and right but they've just sent the usual long line of trucks filled with tax payers money to Microsoft, it's the only sector where no spending cuts are being considered.

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Anonymous Coward

...and moving everything off the Windows environment to Linux would work out to be the cheapest option? Just trying to work out how much the PM costs for the proposal would have you whining about another stupid amount of money being wasted by another failed I.T project. Get back in your ivory tower and close the curtains.

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Anonymous Coward

"and moving everything off the Windows environment to Linux would work out to be the cheapest option"

It seems very unlikely - almost everything the NHS does is based around applications that run on Microsoft OSs They are also well down the road of ditching a stack of legacy UNIX based solutions - I'm sure it doesnt make sense to open a new Zoo...

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Ransom

The best way to prevent being held to ransom is to move away from M$' effective monopoly.

The cost of porting over to FOSS would be made back from not paying M$.

Can anyone say if the NHS has even considered using Linux?

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Re: Ransom

Sorry but your post highlights your lack of knowledge about the NHS. Many of the products used within the NHS are niche, designed for a specific purpose and crucial to saving lives. I am not saying that the NHS does not use standard Microsoft products since they do but, Sourceforge and the general FOSS community do not produce applications that can be used to manage the millions of x-ray images that are generated every year, nor do they supply the pharmacetical patient records that are required to ensure people don't get the wrong medication. The cost of replacing these applications with FOSS based products would not only wide out any licence savings in respect of MS products but would also take some considerable time to produce. In the meantime people would die.

People who see the move to FOSS as the cure all for technology woes and Microsoft dominance do so through their own rose tinted glasses. The problem is that when you get down to it any migration of the Microsoft product set is beset by difficulties and additional costs to the organisation going that route.

An example from my own experience can be found in moving to Open Office since that product was unable to deal with tracking changes to the documents I authored which meant undertaking reviews was slow and complex when compared to the simple (if flawed) Microsoft track changes functionality.

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Re: Ransom

Negociating a good price for specialized software from Microsoft or any other source is one thing but the perennial 'Win n+1' and 'Office n+x' shenannigens do have the smell of a licence to print money. Nothing a tough negociator with the clout of the NHS couldn't handle of course, (aided and abetted by the combined purchasing depts of the gummint one would hope).

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Facepalm

Re: Ransom

Excellent idea guys!

First lets move all the servers, desktops, tablets, laptops, shared and virtual desktops to an OS that 95% of the applications cannot run on. Repurchase and redevelop all critical applications (often from vendors who don't even exist anymore!) so they now run on the new OS.

Then lets retrain thousands of IT staff across the country to use the new operating systems and applications.

Then lets re-write the thousands of macro and VBA based spreadsheets and applications as well as all the Access databases that are spread throughout the NHS to an "open source" solution.

Then there is the cost to retrain the users to use the new OS and applications, new devices that are supported under the new OS, the cost to remove and wipe the non supported hardware, support contracts with "open source" vendors (if they exist!).

<sarcasm> Excellent idea and should save a fortune! </sarcasm>

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Anonymous Coward

Re: Ransom

If the NHS start making moves towards a FLOSS environment:

1. They don't NEED to migrate EVERYTHING

2. They don't NEED to migrate everything ALL AT ONCE

3. Suppliers would start moving to support the new environment. A sane company doesn't let the largest healthcare customer in the country get away from them, simply because "muh Windows"

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Re: Ransom

1) libreoffice

2) tracking changes works fine. You may need to turn it on.

Are you telling me, you could not get ANY help to your problem?

3) "community do not produce applications that can be used to manage the millions of x-ray images that are generated every year, nor do they supply the pharmacetical patient records that are required to ensure people don't get the wrong medication. "

So these applications sprang into life on their own? No. Someone PAID to have them developed, and therefore someone can PAY to have them ported, rather than paying for the status quo. You did keep the source code, right?

Noone is saying they cannot coexist, but the sooner that public money is not used to prop up big multinational business, the better for all of us.

Libreoffice is not perfect, but no software is, and it is FOSS. Fix it yourself. Pay someone ELSE to fix it. How about one of those small biz contractors rather than megacorps?

Once you have done the work to adapt to FOSS tools, it stays that way. Because no external entity can force you to upgrade based solely upon their desire to make you pay, again.

P.

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@ Bluenose

Sorry as well, but your own post indicates lack of knowledge about software.

...designed for a specific purpose and crucial to saving lives

And what are those, in particular? I highly doubt that MS Windows based software is indispensable there. AMOF, more so, there have been a lot of instances where MS Windows lags behind other systems (including GNU/Linux) in reliability, speed, ease of deployment and development. To name just a few: top 500 fastest supercomputers, London Stock Exchange and many more examples.

applications that can be used to manage the millions of x-ray images that are generated every year

"Managed" how exactly? Stored and kept in the database? Are you trying to make my shoes laugh at this? :)

Using your analogy of "seeing things through the rose-tinted glasses", I'd say that people that see Microsoft-made and based software as irreplaceable don't use any glasses at all since they just shut their own eyes entirely.

...is beset by difficulties and additional costs to the organisation going that route.

is it the sedative medication costs you're talking about, that help people go through the stress of seeing something new? This would also apply to the constant changes MS have a habit throwing at their loyal users. Have you hear d about UI (r)evolution in MS Office or Windows 8?

Your example reveals that you must have held it ... I mean used this option wrong. What were your specific shortcomings of it?

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at AC, post #2232775

You're using the sarcasm operator twice, that is effectively negating its action.

...to an OS that 95% of the applications cannot run on

Are you trying to run Windows applications on GNU/Linux or other platform without an emulator or a virtual machine? Well, let me state this, binaries built for two separate systems are incompatible, sometimes they are not even compatible to run on similar systems. I suggest to discover for yourself analogous to those applications that are either the same ones but built for the system in question, or can be used as a substitute for it.

Then there is the cost to retrain the users to use the new OS and applications

This cost should always be accounted for even with new iterations of MSO and Windows 8.

new devices that are supported under the new OS, the cost to remove and wipe the non supported hardware

Are you talking about Windows Vista, 7 or 8?

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Anonymous Coward

Re: Ransom

Use Open Office and need to track changes? Switch to Libre Office.. there, fixed that for ya.

To make a serious stab ar managing x-rays and pharma records for the NHS the end-user requirements need to be made available. Sounds like it would be an interesting project, not so much from a technical standpoint but rather from working to overcome the roadblocks amd FID that would get thrown in by those who benefit from it staying proprietary.

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Anonymous Coward

Re: you moved to open office

And then found it lacked a function that was critical for your use (which it doesn't actually lack).

I don't know what your role is in NHS IT but it seems to me your comment tells us more than you perhaps intended about why the NHS has gotten into the mess of having patient care dependent upon obsolete and unsupported software.

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Re: Ransom

@ Bluenose

I call crap on your comment:

>Sorry but your post highlights your lack of knowledge about the NHS.

Mainly because I work for a supplier of healthcare products, it is a patient record and Xray/CT/whatever scanner images management solution. It supports ie and firefox, so you can connect to it from FreeBSD or OpenIndiana if you so wish.

The only systems that need windows are those that are directly connected to the specialized hardware. All secretary's, doctor's, nurse's, backoffice systems can of course run whatever you want. I am not saying replace the Windows box that controls the CT scanner, for example, however, all the other systems can be Linux/FreeBSD/Whatever.

We are really big in the US with our healthcare products, I assume we are too multiplatform for the NHS. We have the biggest medical institutions in the US as customers .... go figure.

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Re: Ransom

@Phil:

"You did keep the source code, right?"

Yes, but the company that kept the code went bust...

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Re: Ransom

"The best way to prevent being held to ransom is to move away from M$' effective monopoly."

The best way to avoid being held ransom is to be the 5th largest employer in the world and to tell anyone who tries to go and fuck themselves. As the title of the article notes, the NHS is capable of kicking Microsoft in the wallet far harder than MS can kick the NHS. MS can threaten all they like, but they will never risk losing that amount of business if the NHS just refuses to bend over.

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Re: Ransom

"1. They don't NEED to migrate EVERYTHING

2. They don't NEED to migrate everything ALL AT ONCE

3. Suppliers would start moving to support the new environment."

Sorry, but the NHS *CAN'T* migrate until the suppliers of *EVERYTHING* have. I've been doing NHS IT upgrades, and the complexity is astounding. You can't just migrate a little bit of a GP surgery and tell them: you've got office tools, but you'll have to wait for the suppliers to get around to writing a non-Windows heart monitor, sphignomometry system, dictation software, medical records system, x-ray scanner, x-ray reader, blood pressure reader/charter, blood tester, etc. You do need to migrate EVERYTHING and you do have to do it ALL AT ONCE and it is impossible to do until AFTER the suppliers have migrated.

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Re: Ransom @Bluenose

"the general FOSS community do not produce applications that can be used to manage the millions of x-ray images that are generated every year"

That's funny - the last time I looked at the back end system that manages the millions of x-ray images that the NHS generates per year, it was a collection of bespoke applications running on Solaris and JBOSS hooked up to an Oracle database. Not a hint of MS anywhere till you get to the local Trusts themselves.

You make a valid point that there are always going to be a few scenarios where a MS solution is much easier and therefore possibly cheaper. However, it's the mindset that MS is the panacea that fixes all problems and must be used that can and does give them the near monopoly they enjoy, which in turn allows them to be the money grabbing gits they can be if they think they can get away with it.

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@J.G.Harston - Re: Ransom

Wrote :- "You can't just migrate a little bit of a GP surgery and tell them: you've got office tools, but you'll have to wait for .. a non-Windows heart monitor, ... You do need to migrate EVERYTHING and you do have to do it ALL AT ONCE"

So the surgery uses the same PC to do both heart monitoring and type memos? The more I hear about NHS computer systems the worse it gets.

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A better way for the NHS to save money and reduce licence (and labour) costs would be to stop typing out so many internal letters and notes and to move to electronic document storage which most of their equipment suppliers already offer. (Printing out x-rays that have been emailed from the scanner just to go into a notes pile for example)

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Anonymous Coward

The reason X-rays are printed out is this:

It was decided that the job of moving from wet film to digital X-ray would be competed.

Some authorities went with a Fuji solution, others went with Kodak. Nobody specified that the two digital formats had to be compatible - so they're not.

If you have an accident and end up in a hospital that uses Fuji system but get follow up treatment by your local authority that uses a Kodak system, then your X-ray will be printed out so you can move it around with you because it can't be done electronically...

add to this that there was supposed to be an NHS wide IT/Patient Record system that would move all patient records to a digital scanned format - but it's been screwed up by various IT companies - various large Trusts were allowed to opt out of the restructuring and so their systems remain incompatible with the overall plan and building in allowances/conversions has provide to be difficult/costly/time-consuming - and of course - every so often various bits of the UK media with their own anti-NHS agenda whip up a storm about Patient data not being secure - or being sold to insurance companies - etc. So the chances of a national digital patient system ever happening is currently practically zero.

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Vic
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Some authorities went with a Fuji solution, others went with Kodak. Nobody specified that the two digital formats had to be compatible - so they're not.

Does mogrify support both formats? What would be the cost to make it so that it does?

Vic.

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Anonymous Coward

Both Fuji and Kodak were paid substantive fees for the delivery of the x-ray equipment a visualisation/rendering system, they also have a maintenance contract to support the machines - although of course that's a touchy subject if you got a Kodak system given the current state of Kodak as a company - but I suspect one or both companies would need new contracts to also output/input the hi-res X-ray data in a suitably common format.

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No Sympathy

I have little sympathy with companies who are locked into a price escalator by a monopoly they bought into. What the hell did they think would happen to the price ! The first hit of crack is free etc. It's just esp galling that in this case it's tax payer money. But they probably saw no real alternative to crack at the time, without work.

I'm a massive Linux fan, and have Linux desktops plugged into a MS corporate environment (AD joined, Exchange, Sharepoint, Lync erc). It all works and pretty well, but we had to work pretty hard to make it smooth and hide the cracks from our users.

This is hardly Linux's fault that it doesn't work with propitiatory software, but most users (and to their shame most corp IT people) don't see it that way. For Linux to fit in here a distro would have to basically have all these connection tools and techniques ready to go (this would be things like SSSD for AD, Thunderbird/Lightning /DAVMAIL for Exchange, we are trying Wync for Lync, maybe CrossOver for MS Office docs etc etc). It's all possible just takes work to make it go smoothly and deploy to 100's of users. This is beyond most IT depts that have worked largely only with MS technology for maybe 20 years. Either someone will make Linux do all this cleanly or (probably more likely) the world will move on to things like Chromebooks etc

The reason my sympathy is limited is that these guys (like most people) didn't exactly help themselves. They could have piloted open source software and Linux desktops (to get the level of expertise and see what they could and couldn't do). Yes that would have taken investment but it would have saved in the long run. Even the presence of this project would have been leverage. It is the NHS, they would have had the resources.

Even a start would have been (hopefully as the cabinet office might belatedly do) insist on open document formats. They would then at least have now been able to have a choice of office suite, even on Windows. And a lever on a vendor....

To the people saying they have Windows specific programs they need. True, but you have to start from somewhere. Even in a Linux desktop environment they could have Citrix or Windows PC's where required etc not hard....

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Re: No Sympathy

" This is beyond most IT depts that have worked largely only with MS technology for maybe 20 years"

You conveniently forgot to mention that 20 years ago Linux was a baby OS written by someone who didn't want to pay for a unix licence. I used to boot it and run it off a floppy disk because I needed to write COBOL code for a first year assignment. There was no easy GUI. Fiddling with FWM and slackware with XConfig was a nightmare! Dos and windows 3.x and office 4.2 was a lifesaver for the rest of my assignments. There are a lot of people with rose tinted glasses around these days.

Posted anonymously because I don't have the energy to play ping pong with a bunch of blinkered linux fanbois who can't be bothered to sit back and think about the bigger picture. Linux may be great now but it was crap in the real world back when the NHS signed up M$.

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Re: No Sympathy

20 years ago Windows was a baby OS (3.1) that came on three floppy disks. There was no TCP/IP stack and fiddling with autoexec.bat to try and get winsock + one other application running was a nightmare!

Posted anonymously because I don't have the energy to play ping pong with a bunch of blinkered MS fanbois who can't be bothered to sit back and think about the bigger picture.

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Re: No Sympathy

Ermm I'm not sure I said they should have been working on Linux for 20 years, I simply said that they had 20 years of MS experience, which made/makes changing or innovation in this area hard (out of comfort zone) even now. Maybe they could have looked at this in the 5 - 10 year ago time frame. And maybe not Linux desktop is what I'm suggesting. A procurements of HM Government and NHS size could have insisted on an open document format (even with a time frame placed on this). Or maybe Linux servers for certain purposes etc.

I have some (okay a large) amount of sympathy with the difficulty of integrating a Open Source let alone a full Linux desktop solution into such an environment.

But my main point is my sympathy violin starts shrinking rapidly when they have done nothing, when they had/have massive leverage as a large customer (unlike most people) to do something to tame this tiger "a bit" even. But they didn't, and now get royally screwed.

They could have done more to avoid total lock in.

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Re: No Sympathy

"20 years ago Windows was a baby OS (3.1)"

IIRC 20 years ago Windows wasn't even an OS, it was a GUI that ran on top of DOS.

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Meh

Re: No Sympathy

"IIRC 20 years ago Windows wasn't even an OS, it was a GUI that ran on top of DOS."

Not every Windows of that era. Windows NT 3.1 is just coming up to its 21st birthday - that wasn't just a GUI on top of DOS.

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Re: No Sympathy

> You conveniently forgot to mention that 20 years ago Linux was a baby OS

Totally irrelevant in this case because the NHS used to use Novell. They only signed up to the total Microsoft monopoly relatively recently.

Having two competing suppliers is fine. Having one is not.

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Facepalm

@Peshman - Re: No Sympathy

Wrote :- "Linux may be great now but it was crap in the real world back when the NHS signed up M$."

That is debatable, but the main criticism here is that the NHS got themselves bound into contracts, badly written ones at that, with little or no provision to escape to alternatives. We are hearing that now from insider posts here, like the loss of bespoke source code, and like x-ray data formats being incompatible between Kodak and Fuji machines. Nothing to do with how good Linux was 20 years ago.

Clearly there were/are administrators at the NHS who needed arse-kickings.

"Posted anonymously"

No you didn't. You are Peshman and I claim my £5.

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Good defensive negotiating stance by Peter Dyke!

What it seems MS are trying to do is to get NHS healthcare bodies to make purchases now, under current rules before the new rules are finalised. Peter's response is to remind the healthcare bodies that a new agreement (and potentially more favourable?) is being negotiated and will be completed 'soon' and hence hold fire.

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Anonymous Coward

Win XP

I visited a hospital last week. Wall to wall Windows XP. Of course running lots of native windows apps.

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What Does Microsoft Have To Offer

What do government bureaucratic robots need that Microsoft Windows offers over and above Linux or FreeBSD? Irrespective of bugs, viruses, and other malevolent code?

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Re: What Does Microsoft Have To Offer

@David Kelly

I upvoted, but all software has bugs ... the rest of your comment is OK, though ;-)

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One less thing to worry about. ..

I currently manage the archival of paper based patient records for a major A&E department, over 100k scans per month. We do all the hard work of getting it into a searchable format and installed on the server back end at the customer site (1 x modest vm running Windows server).

The past 10 plus years of records can be searched on any text contained in the database within a few seconds eg NHS number, name, address etc using a Windows based application. The best part it that the server can provide the same service via a Web page. In this case moving the user's to a non MS OS Is not an issue.

I'm covered if they ever come asking :)

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Good points on both sides.

Getting technology into the hands of the clinician and subsequently getting them to use it is hard enough with systems they know; the vast majority know Windows, a minority know Mac, very few know Linux. it's all very well and good saying "use FOSS" (horrible acronym) but the training costs would be phenomenal; IT training departments would have to be expanded/inflated with contractors.

Some systems are so widely used that you can't do it in a phased approach. Using a previous example, how do you integrate your [big corporate brand] PACS (digital xray) system and you new "free" PACS systems with bi-directional messaging so that windows users see what the Linux users see? You simply *cannot* have clinicians looking at the same diagnostic image/information and seeing 2 completely different versions of the information because it syncs over night.

A consultant struggling to use, for the sake of argument, Linux based IT systems would waste more cash in a single day than the cost of a single windows license+CALs. I say waste because they will give up, refuse to use it and potentially cancel their clinic.

The majority of NHS England applications (SPINE) require IE to work. Granted, you could use something like Citrix to deliver an IE environment to the user on a Linux desktop but there again, you need a CAL and a Citrix license per user (recurring cost), potentially platinum level if you want to used advanced features; this is all costly. The same could be said of any application that "requires windows" so you get better ROI but you need separate server pools for your applications which have different requirements.

Fact is, no single organisation can pay a development company to create all the applications it needs to run on Linux (again, for the sake of argument). NHS England/Government could as a whole potentially. Please tell me of an EPR Supplier that is "FOSS" compliant? I know of 1 EPR supplier who is potentially making their code base open source, but it runs on windows with SQL server.

I think at the end of the day, the costs are roughly the same.

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I call crap ... spine was developed by BT, kick them in the balls and request a version compatible with firefox and you are done.

I assume spine supports ie6 only, right ? If not, I am sure you can get it to work properly in chrome with user agent extension.

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Anonymous Coward

I work in a GP surgery. It's an unusual GP surgery in that it employs someone who can handle IT beyond the point of "have you turned it off and on again". On the whole GP surgeries all use the same windows user account because nobody knows how to create new ones. Many of you seem to think it's appropriate to put these people onto a linux environment and in all honesty most of the staff would never be able to tell the difference, they don't know what "operating system" means anyway.

Their hands are tied by the applications, most external applications struggle to run properly in anything other than ie6, but the real crunch is the main clinical system. We're currently moving from EMIS Web to SystmOne, this means that we need to upgrade from XP to 7 because SystmOne only runs in 7. Would we have done this otherwise? Eventually, but not for some time yet. It's important to note that our move is unusual, both clinical systems are current. A lot of practices are planning their move from EMIS LV, I believe this was first released in 1981.

If one of you wants to write a clinical system that only runs in linux then, then yes perhaps, in 20 or 30 years you'll get the nhs using linux, but changing clinical system is a once in a career event.

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> most external applications struggle to run properly in anything other than ie6

Well, since that is no longer supported, I wonder how they do it ... I mean XP is dead, is it not ?

Crap, I forgot, NHS still has not managed to migrate all to newer systems ... time to switch to linux where possible and switch to LibreOffice.

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Ah yes, SystmOne. When logged in as an Admin you can't actually configure it. You have to go searching for the user and drag them back and get them to log on just so that you can tell it what f*****g printer to use.

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All of this "License Talk" has me wondering...

How much does it cost just to keep all these licenses in order? From the looks of it, it is a daunting task, that nobody really know how it works. This MUST be a cost involved, and I suspect that it isn't a small one.

Given that, how much does this add to "Total Cost of Ownership" that everyone talks about? From the looks of it it isn't even considered, but the compliance keeps popping up as necessary to do. Then consider the "overbuying" of licenses just to keep from not having the proper ones. All of these items add cost to the compliance.

Might be worth looking into!

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Well...

Yep, I'm a .NET dev with a background focussed on MS.

With that said:

The NHS would be fucking insane not to consider Linux in appropriate and possible locations. Things like secretarial machines could surely be migrated? What's the "NHS Patient Database" client front-end look like? Desktop app or 'intranet-based'? If it's a desktop app, pay someone to do a intranet 'web-front-end' for it, and THEN move secretaries over to Linux. Nice and slow - no rush, we've been paying a fortune in licenses thus far - but at least moving in that direction will 'eventually' lead to massive long-term savings for the NHS.

As more machines went over to Linux, the NHS would be in a better position to require / demand / pay for specialist medical software to be written for Linux. This would help move the 'one-off, specialist' PC's from Windows to Linux.

This kind of slow, incremental program would surely save a fortune in the long run?

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Paris Hilton

Hmmm?

Whitehall = fiddling fcuks?

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Anonymous Coward

The reasons given for why the NHS

can't move away from Microsoft, that it is dependent upon programmes and applications that in turn are dependent on ie6 and/or XP, that there are 'critical' applications used every day that run in XP and the vendor is out of business, seem to me like exactly the reasons why the NHS should look to move away from Microsoft, possibly to Linux, certainly to FOSS. Those arguing to stay as is, you do know the thing about XP and ie6?

It strikes me that the stay as we are sort of thinking comes from the old mainframers, where the OS and hardware could be decades old, but 'it's too expensive to change'. Then one day it all falls over.

I don't think proponents of a move to FOSS are saying, switch off everything on Sunday, and Monday is Linux.

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50% FOSS

I'm an NHS hospital doctor. My specialist work uses custom software on Windoze PCs with extra knobs on (literally) - ultimately supplied by faceless US companies who may well have heard of Europe. That work is probably locked into Microsoft for years.

The rest of the time I use email, word processors, simple spreadsheets and networked database applications of various sorts supplied by the hospital - all of that could be done on a linux platform. Moving from old versions of Microsoft Office to LibreOffice would be much easier than moving to Microsoft's latest versions with their changing interfaces and bloated features. It might also stop the overworked, idiotic spreadsheets that come my way. Of course we could start with LibreOffice on Windows, which works just fine. And its native format, ODF is apparently what the UK Gov wants. I have not seen any manifestation of that desire yet. Even US Corps might have to take notice of that.

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Re: 50% FOSS

"ultimately supplied by faceless US companies who may well have heard of Europe"

Or a faceless Austrian company where the telephone support goes home at 5pm.

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