back to article Tories would decentralise NHS IT

An incoming Conservative government would decentralise health service computing and extend competition between suppliers, according to a plan released at its party conference. The party's NHS Improvement Plan, released on 29 September 2008 by shadow health secretary Andrew Lansley, says the party will replace "Labour's …


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  1. Anonymous Coward
    Anonymous Coward

    Serve the Clinicians

    There was me thinking it should aid the clinicians in the service offered to the patients.

    What is this fascination with identity databases, surely money would be better spent, in researching actual diseases and their cures.

    It is very simple, if the medical profession is meant to help rather than monitor, then people will be quite happy holding their own data.

    Government systems have proven themselves to be insecure time and time again, and we all know why, the wrong people are running the show when it comes to government software.

  2. Martin
    Thumb Down

    Hokey Cokey

    You put your IT Systems in.

    You pull your IT Systems out.

    In, Out, In, Out,

    ....until everybody feels sick.

  3. Anonymous Coward

    i got news for them.

    From my experience of the nits I been sent in to consult, (can you set up this exchange 2003 cluster we have just been sold by a major computer vendor. Sorry no, because you don’t have any Active directory set up I can’t.) the NHS already has a decentralized It.

    I have been on locations were there is a handful off staff, with there own separate network, firewall, mail system buying and purchasing what ever they like. That what needs sorting out, that waste. Identify application that should be central controlled (email a good point) and manage it instead of letting each building spend and waste money doing what they want for 100 or so staff.

  4. b


    This sounds dangerously sensible...

  5. Anonymous Coward

    So more incompatible systems all round then?

    Ahhh showing their true colours again with soundbites to suit the usual paper readers, decentralise - a different system for each health board area, none of which will be compatible, leading to patients suffering and dying before "we couldnt have foreseen this, its all the previous party's fault, mummy mummy tell the bad proles to leave me alone"

    the Tories are worse than labour, anyone still remember "torynomics" -> tax less and spend more, thus running up our national debt whilst cutting services all round.

    I dislike David Cameron a lot, he is a sleazy insincere toff who cant accept his party dont have a clue....if you want an idea of how childish politics would be (more so than now) look at Canada where PM Stephen Harper managed to fix dates of elections, but then decided to cry like a baby that "you mean opposition types are hindering my ideas.....I'm calling an election, stuff the law"

    Im not keen on New Labour...too much power for too long, perhaps we should change to a reality style vote....with a vote every 3 months, any unpopular idea...poof your gone...I think it would focus the mind of the government on doing what WE want, not what THEY want

  6. Chris
    Thumb Up


    All they need to do is decentralise democracy too, then I'll be happy.

  7. John Robson Silver badge


    Add some VPN and decentralise it all you want, just make sure that there are some well defined standards for data interchange (note, not storage - interchange) probably XML with a certain number of required fields for any consult etc.

    I do want my records held locally, but when I get airlifted to a distant hospital because some idiot in a car can't wait 20 seconds to overtake me on my bike then I damned well want them to be able to access that data in a comfortable format.

    It should be possible to determine where my records are kept (and where they have been sent to when I moved)

  8. michael

    extend competition between suppliers

    "extend competition between suppliers"

    I do not want the local hospertitals competing with each other I want them treating me when I am run over by a bendy buss I want to go quickley to the nerest place not be offered a chouice with 4 diffrent forms and choices before I am driven 2h ot the nerest one that has not been shut down

    OMG I just relised I sound like I shoudl be in the letters section of a tabliod I will go and hang my self on some cat5 cable

  9. Anonymous Coward
    Anonymous Coward

    USB sticks for all?

    Why not just issue everyone with a USB stick with their records on? "You are now responsible for your own records". Private companies will start to offer a back up service. Why do the NHS feel the need to keep their own records? All the NHS need to keep is a signature of the data to verify it hasn't been changed.

  10. Shakje

    Re: Interesting...

    No, it sounds reasonably sensible. There are two potential problems, however:

    1) They probably won't do it.

    2) Since they haven't suggested exactly how they'd do it, they'll do it even worse, like everything else they touch.

  11. Meg

    It is already decentrilized!

    I worked in a hospital I.T. department for 3 years and I can tell you without a shadow of a doubt unless its changed in the last 12 months it is already decentralized. The internal I.T. where I worked was shockingly bad and most of the 1st / 2nd line agents knew alot more about pretty much anything I.T. than the people who actually installed and managed the network.

    It needs centralizing not the opposite...

  12. Anonymous Coward

    Rename required

    the NHS should now become the National Service for Health, then you can have NSH IT.

    Mine's the labcoat with the brown stains.

  13. Sword
    Thumb Down

    Centralization is what we need!

    I am an NHS doctor and we are currently crippled by the lack of centralization in the NHS IT service.

    In hospital, there is little IT anyway - medical records are primarily on paper. It can take hours for the paper notes to reach me when I admit a patient to hospital - mostly I just have what the patient remembers and the GP computer print-out of their record summary.

    If a patient has something done at another hospital, their local hospital may not have any record.

    The X-Ray IT system is fragmented - there are arrangements for some hospital to access other hospitals systems, but this is variable at best. Blood results are the same. GP blood results and hospital blood results are kept seperatley and may be held on different, inaccesible systems

    In general practice, all the notes are computerised but only within that surgery. When you move GPs, your data is printed and someone is employed to retype it in to your new surgery's computer system. Letters from the hospital are typed, printed, posted and the scanned into the GP system!

    This occurs even with practices in the same shared building - if a patient moves between practices, the notes are printed, the retypes.

    If a confused or unconcious patient comes into A&E, we generally have no information unless they have a relative with them.

    Patients do not realise this - many times they say to me 'its all on my record'. That may be, but the record may be miles away.

    We DESPERATELY need a central record system that can be accessed from anywhere. I understand the privacy concerns but if you collapse in the street, wouldn't you want the receiving doctor to know a bit of background, what you are allergic to, etc? Without a central database of medical information, or even patients carrying it on a smart card that can be read by a nationally agreed system, lives are at put at risk frighteningly regularly.

  14. Anonymous Coward
    Anonymous Coward

    Gone to France anyone?

    Now I'll be the first one to say the French system isn't perfect (I'm from over there, so I know), but when it comes to healthcare it's pretty good.

    I'm not sure who runs the health IT system, but I know that everyone with a "Securite Sociale" number gets a "carte vitale". This is a chip card like a bank card, but with no magnetic strip. It contains basic information about you, and a key. When you go to the doctor's, he can insert it into a terminal and get access to your files. If he gives you a prescription, it is automatically added to your file. When you then go to the pharmacist, you give them the card and/or the printout, and they dispense the drugs. What drugs are dispensed are added to your profile, but it is limited so the pharmacist cannot access all your history, only the relevant bit. If you're among the people who do not pay for drugs (e.g. pregnant, unemployed etc) the system tells the pharmacist that.

    Then if you go to hospital because of e.g. car accident, they'll look in your wallet to see if you have your card with you, because that would give them all your history, recent medicines prescribed, conditions, allergies etc. One drawback is that there is a huge database somewhere with everyone's details in. To avoid abuses, it is illegal for a government agency to share their data with another. So if the tax office is looking for you, they can't go to the health office to get your address. This means that when the tax office decides that you don't need to pay for prescriptions, they sent YOU a paper that you then pass on to the health office. There is never a direct link between those databases.

    Obviously there is a risk that the database cold be hacked in, or an insurance company might want to get their greedy paws in there. I hope the UK could look to continental Europe every now and then, as there are systems there that work really well ( and others are crap, obviously). Also, if anyone in there knows more about the French system or can spot errors in what I've written, please speak up!

    PS. can I have a snail or frog icon? or garlic?

  15. RW

    The meaning of "to decentralize"

    If they mean each local chunk of your NHS can do their own thing, it's a recipe for disaster. Not only because of the incompatibilities that will arise, but because there aren't that many good IT people around to design, construct, maintain, and administer all those different systems. Decentralize all that, and you can be guaranteed that the systems that result will be (already are?) abysmally poor.

    John Robson's proposal that there be standards for data interchange has a seductive quality to it, but I'm afraid that it's not enough.

    I used to work for an organization that was created from the corresponding chunks of some 150 or so independent municipalities, and when we started up, we spent years merging all those independent systems into one system -- which still had traces of localized features 25 years later. So you do NOT want to go down the route of each authority having its own system. Decentralization must mean nothing more than physical decentralization, but with each chunk of the NHS using precisely the same software.

    But then the objection remains that there aren't enough good admins to do the work, so your centrally constructed, locally hosted solution will still end up fucked in the head (as the phrase goes).

    No, the only viable solution is a single central database, though it's conceivable it can be divvied up into geographic pieces to lower network costs and reduce the all-eggs-in-one-basket problem.

    Even then, who's going to design this monster? You'll have everyone wanting it to do things their favorite way and playing politics to achieve that end, so you'll end up with a single system that is actually twenty or more systems hiding under one roof.

    The cherry on top of this sundae is the inability of UK government to stay out of arguments they have no expertise in. The Jacquis and Gordons will be unable to resist the urge to impose their own uninformed ideas on things.

    Conclusion (for those who've stayed with this tedious argument): no matter what you do, decentralize or centralize, it simply won't work. I think I want to cry!

  16. Anonymous Coward

    Andrew Lansley and crap IT

    If you want an idea about safe anything IT is in rthe hands of Andrew Lansley

    Try posing your views here

    I got a script error every time

  17. Phil Hannent

    Decentralize is the wrong word

    Standardise would be better. If central NHS IT just defined a data interchange format (in the same way that HTTP and HTML are) is then ISV would rush to create software (like Netscape and MS did) to sell to all the different NHS trusts, competition would ensure the software worked with the standard and that they didn't fail.

    Hospital software would talk to other hospital software to ask about patients, a distributed decentralised network with built in redundancy, now there is an idea.

    The problem is that any decision such as this is made on the golf course not by the people actually who know the best course of action.

  18. Anonymous Coward

    Oh great, just what we wanted

    For years I have been working to get systems to talk together, having to untangle the spaghetti that is/was the current set up, getting applications with different data standars to be understand each other, stop boards/trusts etc from buying off the shelf because the salesman was good.

    Oh well at least it means I have a job in another 10 years to untangle it again when they centralise it again

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