back to article Open source and the NHS: Two huge disorganised entities without central control

To outsiders, Britain’s National Health Service must look like a monolith, with more than a million staff marching under one three letter acronym to provide healthcare free at the point of delivery, paid for by the taxes. But the NHS is actually an assortment of several hundred organisations. Each UK nation runs its own health …

  1. Keef

    Close all the golf courses.

    Without the distraction of Golf consultants and GPs will have more time to do their jobs.

    Of course a few greasy handshakes would dry up, free holidays would be lost and some power would be transferred from an elite arrogant overclass to the people who should be making the decisions.

    Not that NHS managers are the Gold Standard, but with an overpaid. overprotected and often incompetent elite ruling the organisation it ain't going to work.

    1. Anonymous Coward
      Anonymous Coward

      Re: Close all the golf courses.

      Of all professions in the world, I'm surprised you think doctors are the feckless lazy ones. You have no idea how much continuous training and learning is required to stay proficient/progress as a registrar or consultant, which comes on top of your regular work week.

      1. Warm Braw Silver badge

        Re: Close all the golf courses.

        It does seem that being a senior hospital medic comes with a sense of entitlement - that the work they've put in to get the position means they have a free pass to ignore all the rules that apply to the paeons. The biggest objections to the swipe card access system at our local hospital came from the consultants because their actual arrival and departure times would become traceable. No other members of hospital staff expect a certain amount of flexibility in their working day to accommodate their private patients. Or to avoid working at weekends (except, perhaps, being technically "on call").

        And a surprising amount of that continuous training and learning is paid for by medical equipment suppliers and takes place at plush hotels with all expenses paid for.

        Doctors may not be lazy, but they like their perks and they've been a powerful impediment to change over the years. It's even taken them an inordinately long time to accept the premise of "evidence-based" treatment.

        Whatever their talents, effectively managing health-care provision is not one of them and they'd actually be much better employed on the golf course than in clinical management where they're all too status-conscious and susceptible to generous hospitality (which, to return to our sheep, they're not likely to get from Open Source solutions).

        1. Anonymous Coward
          Anonymous Coward

          Re: Close all the golf courses.

          And a surprising amount of that continuous training and learning is paid for by medical equipment suppliers and takes place at plush hotels with all expenses paid for.

          Most of that continuous training is reading the Lancet (and ten other journals) and keeping fully up to date with developments in your speciality. This does not take place in plush hotels by "equipment suppliers" (very little equipment required for many disciplines, eg endocrinolog), it takes place in your dingy office that you share with 3 other consultants, or in your home office that you provide at your expense.

          Much better would be to cut out a lot of the bullshit and move to a US style way of managing doctors. For example, in the UK a consultant anaesthetist will spend around a quarter to half of their hospital time in an ER, with the rest admin, where as in the US, the role of an anaesthetist attending is to be in surgery, and will spend 80 to 90% of their hospital time in surgery, and they have enough medical secretaries to do the admin.

          The biggest objections to the swipe card access system at our local hospital came from the consultants because their actual arrival and departure times would become traceable. No other members of hospital staff expect a certain amount of flexibility in their working day to accommodate their private patients.

          First off, most consultants don't have private patients - it tends to be cutters and gas men who do private work. Secondly, even consultants with private patients have contracted hours and set clinics/lists and having them turn up at 9 and go at 5 is not a good way of utilising their contracted hours. You turn up in time to get your paperwork done before running your clinic or surgical list, you leave once that is all done. Some serious clock punching envy here..

          I'm from a medical family, my dad was a consultant, both my sisters are consultants, both their husbands are consultants and all their friends are either consultants, GPs or registrars. The amount of work required just to get that to point is unbelievable, and doesn't stop just because you reach the top step. 'technically "on call"', give me a break…

      2. 96percentchimp

        Re: Close all the golf courses.

        I wouldn't worry about it. That's the kind of cliched knee-jerk comment that's become common on El Reg as it turns into a tech-savvy Daily Mail.

  2. Dr Who

    The possibilities are endless

    Accident and Emergency : OpenWound

    Geriatrics : OpenGrave

    Maternity : OpenLegs

    Maternity (for the the executive with a meeting to get to) : OpenSunroof

    Plastic Surgery : OpenChequebook

    Pharmacy : OpenAllHours

    1. Magnus_Pym

      Re: The possibilities are endless

      Brain Surgery : OpenMind

      Haematology : OpenVein

      Proctology : Hello

      1. Anonymous Coward
        Anonymous Coward

        Re: The possibilities are endless

        Gynaecology: OpenSeseme

    2. frank ly Silver badge
      Thumb Up

      Re: The possibilities are endless

      It took me a while to figure out 'OpenSunroof'.

      @Magnus Pym - Or maybe 'Halo'.

  3. graeme leggett

    they've been 'suggesting' using NHS number for years

    from 2008 http://npsa.nhs.uk/corporate/news/nhsnumber/

    1. matthew bennion

      Re: they've been 'suggesting' using NHS number for years

      The majority of the systems I wrote supported the NHS number. Given the growing desire for anonymity it could easily be used as a key identifier in pseudonymisation.

      1. graeme leggett

        Re: they've been 'suggesting' using NHS number for years

        The Scottish NHS has a different number, the " Community Health Index " CHI number, but it - a bit like a driving licence - has the patient's date of birth in it. In clear.

  4. Alfred

    The ridiculous power of doctors

    Absolutely right. The ridiculous power of doctors is astonishing to people from other walks of life. Educated, specialised body-mechanics are just that; the idea that they inherently have a superior opinion (compared to every other hospital employee and associated personnel) on broad aspects of running a hospital is ludicrous, but hard to dislodge (although, to be fair, hard to dislodge only from their minds).

    Reminds me of the (thankfully, now fading) attitude of surgeons in the operating theatre. The surgeon doing the actual cutting is one of the worst choices of people in the room to be in charge, but so often is (even if not officially).

    1. Doctor Syntax Silver badge

      Re: The ridiculous power of doctors

      The whole point of the NHS (pace Sir Humphrey) is to provide medical treatment to patients. The providers are the doctors, nurses, physios, dentists, etc. The jobs of the rest of the staff, every last one of them, have no logical justification other than to support to that function.

      To put it another way, if you're admitted to hospital with severe abdominal pain who do you want to decide on your treatment - a doctor or a bean-counter?

  5. The last doughnut

    Arrgh that be a roight shambles that be, arrggghhh.

    Save a whole lot of money and abolish all the beauracracy. Return it to what is was always meant to be, a national health service for all, free at the point of use, paid for through taxation. Abolish all the pointless levels of management, the accounting, the trusts, the profit centres, the management comitees, the accountants, the accountants (double entry, y'see, arrghhh). Pass me that rum there would you boy - me wooden legs playing up again. Arrrggghhhh.

  6. Anonymous Coward
    Anonymous Coward

    Open source FTW

    Have just spent the best part of 2 hours writing to my local commissioning group imploring them to adopt open-source first attitude. Two clicks later and here I am!

    We have a large number of crap websites dotted all over the place on various platforms. All could be much better delivered on WordPress and we could actually become moderately competent on just one platform. Even NHS England uses WordPress for their site...see what happens

    Regarding "the ridiculous power" of doctors, you would like to sit in my chair for a day.

    If you were a mechanic and had to listen to someones batshit idea regarding how their car works on positive crystals rather than diesel, you might start to get self important too.

    A common example is obesity. While many have come to terms with the idea that they eat and drink too much, many more are absolutely shocked at the suggestion that these are related factors.

    1. John Brown (no body) Silver badge

      Re: Open source FTW

      "A common example is obesity. While many have come to terms with the idea that they eat and drink too much, many more are absolutely shocked at the suggestion that these are related factors."

      In that particular example, I think people are more shocked at being called obese by a doctor for being a little overweight as the "common" usage of non-medical people of the word obese is to mean someone who is humongously fat and can barely walk without waddling.

      1. Anonymous Coward
        Anonymous Coward

        Re: Open source FTW

        "humongously fat and can barely walk without waddling."

        Ah, the 'morbidly obese'

        But for the middling sort comes down to some sort of disjunct between ideal and practice - person sees fit individual on telly, and thinks "I'd like to look like that" but has - for a hundred and one valid reasons - difficulty in turning it from "I don't want to look like this" into motivation to change.

        I know that I am a case in point. I know I'm getting bigger round the waist. But I like meaty (fatty) savoury stuff. So far my motivation is a vow not to buy a pair of trousers with a bigger waist and so accommodate any further increase. On the other hand it's not yet 10 o'clock and I topped up my breakfast with an M&S mini sausage roll.

  7. keithpeter
    Windows

    About [expletive] time

    That is all.

    (NHS could lead the world in this)

  8. Anonymous Coward
    Anonymous Coward

    I think I missed a point...

    But I thought I already had a ID number that NHS uses?

    Anyone lacking a National Insurance number? Is it missing from any medical notes?

    Why do we need another?

    Wife's a nurse.

    Doctors tend to shirk responsibilities and pass the buck an awful lot. In any other career a lot of these "professionals" would be facing disaplinaries or the sack for gross misconduct. Since there is a culture of protecting the doctors they don't seen to get any comeback.

    There are a few doctors that are respectful, but it is sad that these doctors are notable for being the exception. By respectful I mean not elbowing others off a phone (my wife was informing a family that their grandmother died), snatching equipment while in use (nurse was treating a patient, F1 wanted to answer her leads question), consultant publicly belittling a HCA for calling him in (patient crashed later that night)... etc.

    Something is wrong with the current culture of the NHS.

    1. J.G.Harston Silver badge

      Re: I think I missed a point...

      NHS number is issued at birth. NI number is issued at age 16. How would under-16s use their NI number to access medical services?

  9. Adrian Midgley 1

    NPfIT failed for other reasons mainly

    Including being not very good.

    This was partly because it was run by managers who had limited understanding of IT and less of the business; and specified by clueless people from clueless firms.

    Talking about medical re odd (what is one of those BTW) rather than automation is tending to be an index of being behind; and a major failure mode is seeing computers as devices with which people can be programmed.

    GPs inventented this stuff, put it into operation in their Practices, in several cases actually wrote it, and have now lost control of it to the elements above.

    I did play golf, once, in 1974 IIRC which by coincidence was about the time The London Hospital implemented a computer system that was useful on the wards. I have a picture somewhere of the 10 MByte hard drive being craned from its lorry into the building.

    The example of the bankers may not be entirely good, but consider the idea that if you want to help someone clever, knowledgeable and hard working to do something they are good at a bit better faster or cheaper you should probably be sitting near them watching and listening, and building software in conversations which occasionally include "make this script work fast and reliably"

    You'd better also reflect that much of medicine is nonlinear.

  10. Adrian Midgley 1

    unmemorable numeric string as foreign key

    asked of people and typed in to recall records.

    The new NHS Number is a 9 digit string + modulo 11 check digit.

    It isn't very useful for quick selection from a list. Feel free to work on that.

    Most of my patients can have their record called up with 2 letters of surname and 2 of forename.

    The NHS number has some odd rules baked in - gender is locked for instance so have a gender change and your identity fails. Clearly this is a business rule somewhere since the number doesn't encode the gender of indeed anything else - unlike the CHI string.

    Neither is even slightly useful for effective pseudonymisation.

    But one of the more obvious reasons it lsaks in slowly is that these systems are not mostly new ones.

    1. Anonymous Coward
      Anonymous Coward

      Re: unmemorable numeric string as foreign key

      I find that busy doctors, nurses, healthcare assistants, and pharmacists can write 10 digits (as a 3,3,4 pattern) out clearly (enough) on the bits of paper I get sent that I can decipher them and put them into our systems. Far too often I have to take an educated guess at handwritten names, and from time to time I get dates of birth where the current year has been used instead of the birth year, or perhaps Britain's ageing population includes more centenarians....

      So I prefer to have three identifying pieces of information when asked by a surgery if they can supply me with a copy of a report that we sent them weeks ago.

  11. Sam Haine

    Have any TCOs been published for these systems?

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