Ah, the paperless office, like nuclear fusion ...
just around the corner.
Those El Reggers old enough (like me) to remember the PC boom of the early 80s will recall how the first peripheral that got purchased after the computer was a printer ....
Once again the NHS has unveiled grand plans to become paperless, with NHS England's national director for patients and information Tim Kelsey this time naming 2020 as the momentous date. In order to cut the scourge of paper, which costs trusts up to £1m each in storage per year, Kelsey wants to introduce patient barcodes. By …
The actual reason paper is still used is precisely because it is expensive to store.
As it's expensive to store, there is an accepted reason for destroying all records humanly possible after 6 years, and at the moment it is accepted that if all of the records have been destroyed you can't bring a claim against somebody.
This is not merely cynicism on my part- this was pointed out to me by the managing partner of a firm when attempting to push a paperless office. Completely technically feasible, but this is the issue. Friends in the NHS, Council etc have admitted off the record that this is a serious issue in their workplaces as well and a major reason behind remaining on paper based processes.
There speaks a man that's never priced up cloud storage providers.
And most NHS stuff, in terms of medical records, is kept for life. There's still letters in my medical notes from when I was a baby. I assure you. I've seen them. My GP receptionist used to hand you your envelope to take into the doctor and rarely was it ever a timely appointment, and given that they are MY records, I went through them several times.
However, you do have to ask - after 6 years, what are they going to have done that you haven't sued them for already? There's a reason financial dealings are rarely kept for more than 4 years, medical is longer, and anything "of note" (i.e. being sued over, or criminal record, tax record etc.) is kept for much longer.
The real reason is that the NHS is just shit at IT because it lets consultants run the show, who get paid whether or not it pans out. I'd be loathe to say on record that said consultancies are somehow related to higher-ups in the NHS, or even people like ministers, etc. *cough*. Go buy a single AA battery via the NHS procurement process (which you are forced to use if you work in the NHS) and it can cost upwards of £6. And, if you're lucky, may arrive and NOT be pinched by an unrelated department in the same building despite your department having paid for it. Multiply that out to the million-pound microscopes, scanners and lab equipment and it gets into silly money very quickly. Upgrade this 5-year-old microscope which runs from an XP-based PC and it'll cost £90k. Buy the new model with a 5-year-lease and it'll only cost £100k. Someone does the maths, and you end up paying through the nose for what should have been a decent piece of lab equipment with a long term support contract. But no.
Never attribute to malice that which can be perfectly explained through greed and stupidity.
Not a lot actually. The costs for scanning for a large trust are around £30k a year, around 100k images a month, 4GB of storage per month scanned.
One trust has around 11 years of records stored on their site and can search a selected month in less than a few seconds. Searching the whole lot takes about half hour but they should never need to do that. All browser capable but they prefer the client application.
If they bought the license now it would cost around £2M but upgrade rights are great in this case. .. they paid £50k for it with £3k a year for renewals.
Sounds like a bargain compared to what they'll be charged for storing it all digitally.
Indeed, and backing this is the crux of the problem - they'll try to keep everything.
What they should be doing is streamlining their data collection and its processing, looking to remove duplication of data & effort, with ALL of the associated cut backs to management and administration that implies.
The goal must be to digitise only what they need rather than what they have. And they should seek to do this not with scanned images of paper forms, but by eliminating the paper records in the first place.
> ...compared to what they'll be charged for storing it all digitally
Or fined for losing it all digitally. Advantage of a ton of paper in half a ton of filing cabinet: it can't be "exfiltrated" without heavy lifting equipment and massive incompetence on the part of the data owners. Oh, hold on...
Spot on, sir! The great thing with paper records is that, even in the event that security has failed, there is only so much information that can be taken. Electronic records have the weakness that, when security fails, the amount of information that can be spaffed is ... well, 800+ people's HIV status might be the snowflake on top of the bit of iceberg above the water-line. There is security in slowness of access.
More relevant than first appears.
At my local hospital medical staff routinely seem to do the online booking thing to arrange a follow-up appointment. Tell me it will be sent to me automatically, then I hear nothing. And if I phone to find out why I've heard nothing, they know nothing about it.
I've leant that it's best to get them to write a piece of paper, or simply tell the appointment desk that I'm coming,. then I go and wait there while they make the appointment manually and print me the letter there and then.
I, of, course, have no idea what your routine op is for. But let me tell you a little story.
I suffered a seizure that led to a posterior dislocated shoulder with reverse Hill-Sachs lesion and reverse Bankart lesion. Fractured head of humerus to you. And it ripped the capsule off the bone too. (yes, it was bloody painful. Ask the A&E nurse whose ear I screamed into. After shitloads of morphine). Unfortunately, this wasn't diagnosed until Orthopaedics reviewed the X-rays (a posterior shoulder dislocation is missed >50% of the time at initial presentation) and called me back to the OP clinic, at which point I was admitted. Surgeon tried an external reduction that night. Not surprisingly, it was far too unstable and came out again, pretty soon I think.
Much humming and hah-ing. Talk of transfer from Darent Valley to King's. Wait for MRI to get a good look at the soft tissue damage - and you ain't gonna get one of those on demand unless it's life-threatening. Theatre finally scheduled again after I'd been in the Day Case Unit for, errr, a week.
But it didn't go ahead. Why ?? The Orthopaedic surgeon was also on that day's trauma list. 3 urgent trauma cases came in that day. So I was cancelled. For 3 people who could well have died if they didn't receive immediate surgery. Mine could wait. And I'm glad it did, for the sake of those 3.
They made sure it happened the following week by doing it at QMH, Sidcup as a day case. No A&E there so no chance of this "semi-elective" surgery being cancelled for a more urgent case. I was up to the 3 weeks at which not fixing a shoulder fracture becomes dodgy anyway.
Annoymous: well that sounds a rather shit experience. Sorry to hear it.
Hope you're better now,
A doctor (in NZ, as in the UK the govt and media don't listen to doctors telling them There Is A Problem and instead claim that it's all self interest. When you hear in the media about docs whinging, it is rarely a problem for doctors that is being discussed, although it
may will be presented as such.)
I wonder what could possibly go wrong?
2016 - Project outsourced to multiple industry partners upon geographical basis
2017 - Government cutbacks force ringfenced NHS to make further savings; all projects topsliced
2018 - One industry partner withdraws due to, um, bad hair day or somesuch excuse
2019 - Regional development failure highlighted by Select Committee
2020 - Change of government. Second industry partner withdraws, taking IP with it
2021 - Select Committee warns of possible project failure
2022 - NHS England announces new project deadline
2023 - GPs complain they weren't consulted
2024 - Public claims it wasn't consulted
2025 - Change of government. Health Secretary 'resets' project
2026 - NHS England warns of underfunding
2027 - Project cancelled; lawyers rejoice
Doctor: Take a seat Mr Smith <swipe swipe> Right, i've got your results here on the screen. I have good news and bad news.....which would you like first?
Mr Smith: Oh, er...the bad news doctor.
Doctor: Well according to your test results <swipe> you have stage 4 small cell carcinoma of the lungs and brain.....there is no stage 5!
Mr Smith: Oh no! And whats the good news?
Doctor: Well <swipe swipe> Game of Thrones season 4 boxset has 25% off at the HMV sale!
I'm not a reactionary but after having spent a few hours in the waiting area of a day surgery unit last week (where patients did have a wrist band with a QR style code) and watching the activity I wonder if the managers have any idea about the non-obvious uses of paper files?
* Attaching a patient's locker key to her file to keep it safe during the op.
* Provision of files to different theatre teams based on where they were on the central circular desk.
* At a glance checking of a patients position in the queue by where there file was in the array.
* Ad-hoc note scribbling (and diagram drawing) in the files.
* The good old fashioned thumb flicking browsing of old notes in a very thick file by an anaesthetist (presumably visually scanning for related info rather than doing a keyword search)
* Detaching forms/pieces of paper to take away to another location (colour coded forms by what I observed)
And then there's the signing of patient consent forms; and the showing them to the patient in theatre and asking "is this your signature". They'll need something better than the things I sign for parcel delivery!
All these things *can* be supported with technology but I suspect it's not as simple as people think.
Yeah, right, because there is no real need in the NHS for absolutely secure, infallible, reliable passage of data between Departments, Hospitals, GP Surgeries, Care services etc.
Okay, so the written word can be misread, or even entered incorrectly, but once committed to paper it's all there in your notes, permanently, with little chance of being accessed by anybody malicious.
Yes, Notes do go missing, but it's a very rare occurrence compared to the incidence of data loss or corruption.
As an ex-blood runner, I can see how the idea of paperless sounds like a good idea. Probably half our calls were to go to some cottage hospital to pick up granny's notes when she's been rushed into A&E and no-one has access to her medical history.
As a S/W Engineer however, all I can say is oy vey!
No it isn't. Last paper I read on this (some 10 years ago I admit) was that at any given time, ~20% of (paper) medical records cannot be found. That number fell to ~10% for "never found again". There was no indication as the the merit of what a "record" was in this instance, so perhaps those number are misleading. The acceptance criteria for a new digital system was in the region of 0.0001%.
I worked in medical records and the problem of lost records is very very low indeed. Misplaced records, well that's another story.
There is nothing more empowering to a lowly office oik than the right to smash open any and all of a consultants drawers, desks, cabinets and as a last resort, the boot of their car, when searching for patient records. Yes, I witnessed a registrar's porche being crowbarred open on the off chance it contained OUR records.
Scenarios that would have BOFH flushed with admiration for dutifully tearing some pompous consultants office into hamster bedding were endless.
The pay was terrible, the conditions, terrible, moral, was terrible, but the power one could wield in the face of even the most over inflated egos was priceless.
Although, I have to admit, many of the consultants were actually quite decent folk who's unswerving cooperation guaranteed our compassionate side won out and kept things quite amicable.
If I learned anything from my experiences, worth passing on, is never, ever, have more than one medical complication at a time as the different departments will misplace your records as they go back and forth between the various disciplines.
Begging you to stay?? Don't be so silly pal - a vote in England would have seen you shown the door, and that was then. After all the Little Scotlander antics during the vote, and the tartan tails increasingly desperate attempts to wag the English dog, you must realise most of England doesn't actually want you in the Union?
It did seem to me that the Scots' antics handed the election to the Tories on a plate. Effectively telling the rest of the UK that a vote for Labour was a vote for the SNP.
But actually, I personally would like to see Britain stay as Britain, not a collection of little countries on a small island.
With an NHS that is truly national.
But no giant top down IT projects please.
Labour may beg you to stay, for without Scotland there can be no Labour governments, however they do not speak for England.
The Conservatives played a master stroke - Allowed the Tartan Mafia to put themselves into a position where EVEL becomes an absolute must with the electorate to fix the problem of two classes of MP we currently endure. In so doing, they hobble the worst excesses of any future Labour governments.
Any goodwill the English had towards Scotland vanished in the face of their racist, spiteful, and illogical rhetoric. They have few friends here now, even in the Northern cities, such as my home town, where once there had been nought but warmth for our neighbours over the wall.
Scotland couldn't afford independence back then, and you sure as shit can't afford it now. The central problem is that Scotland is the size of a large city by population, at best it may be considered a county, but it has never really been a proper country in the international sense. You need to adjust your expectations - Scotland has no right to a greater sway over England than does Birmingham.
Quite right, LucreLout - based on population, the south east of England is the equivalent of a nation. It certainly has far more than its fair share of influence. Let's have a referendum to divorce the rest of the UK from that corner*, so that Scotland, Manchester, Birmingham etc all have the same influence. Much of the anti-English sentiment up here** that has so rattled your cage is actually anti-London/SE England. I suspect common cause will easily be found, especially with the Welsh involved. Far more fruitful than well-meaning folks like you playing Westminster's game by getting upset that some people aren't as happy with the blissful Union as you are.
**Yorkshireman relocated to Fife - no signs of anti-Englishness that I have witnessed.
based on population, the south east of England is the equivalent of a nation. It certainly has far more than its fair share of influence.
I quite agree.
Let's have a referendum to divorce the rest of the UK from that corner
Loathe though I am to admit it, the rest of the UK being independent is no more fiscally achievable at the current time than an iScotland would be.
I suspect common cause will easily be found, especially with the Welsh involved
The last thing the Welsh want is independence. Even with a tonne of whatever the SNP use as rolling baccy, they couldn't make their numbers add up for five minutes. Credit to the Welsh, there's no pretence to the contrary.
Far more fruitful than well-meaning folks like you playing Westminster's game by getting upset that some people aren't as happy with the blissful Union as you are.
You misunderstand. Aside for the almost instant and unending poverty and hardship it'd cause the Scots, I'd quite like to see them floated off on their own, and not just because I'd quite like a cheap as chips holiday flat in Edinburgh. The reality is we'd end up propping them up financially, as having a basket case economy on your border makes national security difficult.
Independence will last a few years at most. Any second act of Union would rightly see Scotland rejoin as a county of England, which is really what it should always have been recognised as.
I worked for an office manager who printed off all, ALL!, of his internal email (this was the late 90's before proper email took off) and had the 'trainee' file them away in standard filing 4 drawer cabinets. I think he had six cabinets because, of course, the email was cross referenced something like this:
One copy for internal staff related matters.
One copy for agency staff related matters.
One copy for health and safety related matters.
One copy because it concerned an external supplier.
Someone getting a paper-cut from some Niceday printer paper could trigger an avalanche of nasty finger cutting paper memos.
The cabinets filled up in weeks.
Oh, he photocopied faxes and filed them too.
... approximately 4 container ships worth of patient notes in the current NHS Archives. It can be scanned, but it is a big project (bigger than Google Books or the Vatican Library). You cannot outsource the scanning to anyone - no-one is big enough.
It would be an exciting project, to be sure, but let nobody doubt how big it is. I reckon that dedicated scanner staff would probably need film badge dosimeters if handling that volume of material.
Source: at the risk of killing my 'anonymity' I did all the research and maths myself whilst on the NHS programme. Had to argue with people who thought we could discount 80% of it because only about 20% of people attend hospital frequently --- of course they didn't realize that these people also had the thickest wodges of notes!
After a recent visit to an NHS consultant I found it took six weeks for the consultant's letter to my GP to be typed up by the secretary. Going paperless isn't going to help here at all. A few copies of Mavis Beacon Teaches Typing might do the trick though.
I think you'll find it isn't the secretary that is the weakest link in this chain, but the doctor that saw you.
The consultant will invariably record his thoughts on a dictaphone, often referring to specific documents in your medical records and quite often not making complete sense.
The secretary will be constantly referring back to your records and the often illegible scrawls, looking up ridiculously contrived jargon in medical dictionaries and basically trying to forge something professional from a bag of pigs ears.
The consultant, meanwhile is probably in another hospital dealing with their private patients, while the typed up letters sit dutifully awaiting to be signed.
Obviously it's an hospital and emergencies come first, clinics fecund, in-patients and ward rounds turd, out-patients forth, training your underlings, filth, dealing with mangers sith, eating, sleeping and socialising, heaventh and lastly, having to do the paperwork.
A consultant probably sees their secretary for about an hour a week and in that time she has to cram a weeks worth of queries in.
Take it from me. Those women, and invariably they are women, work non-stop, often secluded away in some dismal space with little contact other than the patients that are constantly telephoning their anxieties through and expecting immediate attention.
Which is why, when speaking to any of the consultants' secretaries, my wife and I (!!) never, ever lose our rag. Always polite, 100% calm. Sarcasm turned down to, hopefully, 1 or less. We realise they're as frustrated with "the system" as we are at that point. Probably more so.
And it's why I 'phone on behalf of my 94-year-old father. I so know he'd piss them off......
I am thinking of little old lady taking her repeat prescription down to the chemist. A bit of paper she can handle but ask her to bring her phone will only cause confusion as she snips the cord of her rotary telephone receiver* from the hall passage and brings that in.
And, yes, they still use them.
My lovely spouse is a senior medical physics bod in the cancer treatment area, who sometimes works from home if she isn't feeling brilliant (long-term, usually manageable medical condition)
Now it turns out that the Trust Policy is that if your 'work from home laptop', hasn't been plugged into the office LAN (which is unlikely as you KEEP IT AT HOME), that the IT policies F'ing disable remote connections.... So to get your WORK FROM HOME laptop working you need to bring it in so that they can 'fix it'...
Her team and colleagues are ready and able to roll out new/faster/better cancer treatment, it has all been medically commissioned, all boxen are triple-ticked.
But the Department of Health won't allow it, even though they paid for the kit, the training, the whole shebang.
Now the NHS trust (and others I imagine) are being FINED for not treating patients fast enough...
So how does the trust respond? Rather than spending some clearly justified money on treatment kit, they up the hours of the current kit, and absurdly increase the hours of staff to (I quote) "maximise throughput"...
What do you think happened?
Loads of treatment staff then leave on a regular basis (who are then replaced at great expen£e), lots of expensive kit needs LOTS more maintenance.
Whenever I hear about "NHS Saving money", I almost literally piss myself laughing.
Now it turns out that the Trust Policy is that if your 'work from home laptop', hasn't been plugged into the office LAN (which is unlikely as you KEEP IT AT HOME), that the IT policies F'ing disable remote connections.... So to get your WORK FROM HOME laptop working you need to bring it
That will be something called NAC and end point protection which ensures that the machine is up to date with AV signatures etc so as to protect the NHS's data!!
Err no matey, it quite sensibly picksup all the relevant signatures via our interwebs first, then it fires up the Citrix remote-whizzyness.
Or it would do if it wasn't f'ing disabled....
Thanks for your comment anyway.
I was told that our local, new Tunbridge Wells Hospital didn’t even have integrated internal I T systems and a member of staff told me her job was boring because she had to enter the same information into 6 different systems! And that GPs are unable to share information about their patients and vice versa.
How is that going to go paperless?
I was given an appointment letter and told to scan it on arrival at Sevenoaks Hospital to speed entry. The reception staff laughed, they did not even have a scanner!
Paperless in 5 years, I’ll believe it when I see it.
OH They had better get RFIDs embedded in patients while they are about it so they can track patients when the loose them.
But when the NHS is privatised, it will be split into competing trusts who will never agree a single overarching system nor implement it reliably via the same practices and procedures across the board. A bit like what happens with commissioning at the moment, but to a greater degree.
Aha you aren't a Tory supporter, that's fine.
What is your view of the ongoing and contingent liabilities of the PFI contracts that Messrs Blair & Brown so enthusiastically spread throughout our green & pleasant land?
Cherry-picking bits of info to backup your worldview is fine around here, may I suggest thag you be a little more subtle?
FTR I'm not a Labour supporter either but how bad (or good) anyone else is, is irrelevant. Trying to go off topic is just a distraction.
Responsible discussion about the future of the NHS should not be a game of tit for tat.
I positively choose to get real paper prescriptions.
Having that piece of paper in my hand allows me to get my medicine dispensed at any pharmacy - something the electronic systems do not. If there are supply difficulties, I am free to search round pharmacies to try to find one that has some of my medicine. If I prefer to obtain a product not available in the UK, I can send my prescription to a pharmacy in another country.
(Many of us react differently to the various makes of some products. So freedom to get our preferred product, whether UK or import, is important.)
I dread the further imposition of electronic prescriptions.
I don't think anyone has said its a national solution, as far as I am aware it's every man for themselves as there is no national standard on what systems this all has to link into. If it was then a national solution then we would be looking at a public inquest in 2024 into how much money had been wasted and a big financial settlement with whichever third party had won the contract. Also going paperless is reliant on getting a bunch on Clinicians with their own egos and agendas to agree on anything, even something as simple as a form.
...if you hire _good_ people, which are not necessarily expensive, and motivate them. You need a solution that's lower overhead for those people involved than the current pen and paper systems while still being at least as safe.
For that you'd need to have people designing it who are involved in the actual processes. You have to have people who know what a doctor or a nurse does and what forms they have to fill out.
Unfortunately the NHS will probably just give this to some commercial company which will completely mess it up, spend huge amounts of money on consultancy work and expensive products that aren't suitable for the job. Outsourcing core tasks of any organisation simply does not work, no matter if it's private or public.
It's another, admittedly extreme, case of someone seeing a problem that can be adressed by new technology but being blind to the potentially greater problems that could be (and in this case have been) caused by the newer technology.
So far as I can see, the reason that paper has persisted for so long (it's more than 35 years since I first heard a manager say that we'd soon have paerless offices) is because of a combination of it being the appropriate technology for some usage cases, people just liking the stuff because it doesnt depend on technology of varying screen size and resolution and potentially intermittent power supply to read, and in some cases, a bit of Luddism.
It's the 'appropriate technology' bit that some seem to miss with paper. Security? Well, I'd like to see a foreign cracker try to access the notes I've written on the A4 pad in my bureau, they'd have much more luck trying to get at the data on my PC next to it (running Linux mint with full disk encryption, and apparmour installed - best a mere user like me can manage at the moment). Search is a big minus for paper, of course, particularly if a patients notes are extensive. But then how important that is depends on a whole lot of other factors. Simply throwing IT (and along with it, large amounts of taxpayers money) at the 'problem' of paper notes isn't going to magically solve the problem, particularly if the problem hasn;t been properly assessed, understood, and the limitations of the potential replacement assessed and understood by those that make decisions about these things.
My mother-in-law-to-be works as an NHS nurse and struggles with IT. She's far more comfortable, and quicker, writing out the notes that she needs to make and it can take her considerably longer to type these up to a computer. That's no negative reflection on her though, as when she was at school computers weren't even talked about.
But if this is a cost cutting measure, surely it'd be better to stop private health companies bidding to provide NHS services and when they deem a patient too expensive to treat they send them back in to the NHS system? Because you know, private companies are meant to turn a profit by either increasing the costs they charge or by cutting back on their own expenditure.
Anon because I know someone on the inside of the NHS, who along with their colleagues have told me the above.
Or perhaps the private sector could do something like, you know more efficiently than the NHS?
The private sector makes money by doing more with less, granted that may not necessarily happen with the NHS, if that were the case then I would take issue with whoever wrote the contract...
Talking of which, a number of years ago, my proudest achievement as a senior risk bod at a big outsourcer was to ensure that we wouldn't EVEN BID for a big NHS contract that HMG insisted we should bid on.
The senior sales muppet (apologies to Jim Henson), was amazed why I held this view, I asked him to explain to me under 30 seconds what the contract was meant to achieve.
Methinks if the NHS could do more with less, oh look there is a porcine squadron doing very good barrel-rolls.
"Or perhaps the private sector could do something like, you know more efficiently than the NHS?
The private sector makes money by doing more with less, granted that may not necessarily happen with the NHS, if that were the case then I would take issue with whoever wrote the contract..."
Same AC here.
You're quite right they make money by doing more with less. Less jobs, less services, and outsource the work back in to the NHS. With health care, savings can only be made through charging more for the service or cutting back on the cost of delivery. And ultimately, why should someone's wealth dictate what healthcare they receive when illness doesn't discriminate?
Methinks the NHS should be taken away from the Government, or the people with clear vested interests away from the NHS should be banned from touching it.
Couldn't agree with you more on that matey....
A few years ago I was between contracts, I offered to help wifeys team project manage their system changeover & citrix roll-out FOC.
My offer was refused, on the grounds that I had not been 'cleared', which apparently would take f'kng months. Pointing out X instances of moi having scribbled on the official secrets act, having SC clearance, CRB checkec by local a (previous) local authority didn't cut the mustarrd...
And to cap it all, in my work I wouldn't have had access to any digital records, BUT all live oncology patient records are kept in a corridor which the public have access to in an UNLOCKED CUPBOARD.
The final icing on the cake? None of the employees/consultants employed by the vendor had any recent clearances.
So progress in the NHS? There is a higher likelihood of my little lad becoming the next President of the United States...
surely it'd be better to stop private health companies bidding to provide NHS services and when they deem a patient too expensive to treat they send them back in to the NHS system?
Quite so. And what the outsourcing doesn't take into account is the loss of skills to the NHS. Surgeons hone their skills by doing simple ops. When knee and hip replacements were outsourced in some areas, the recruitment of juniors was cut because they were no longer needed. When the difficult cases were sent back in (because the company was only contracted to do certain types of cases, which did not include all complications arising from the ops they did do), the existing consultants had the skills to treat those cases. Their new juniors, however, had no basic experience to build upon, were of little help, and effectively had no way to attain the skills necessary for consultant status. No doubt some juniors ended up working for the outsource providers, but in conditions that were intended to maximise throughput of patients and not consider the training needs of potential consultants.
Someone once suggested that when one applies for a EHIC card, they also send you a NHS medical card with onboard chip, that could store basic information about the patient as well. This might include allergies, existing medical conditions, blood group type etc and new medical conditions could always be added when required. Obviously they will need thousands of card readers round the NHS to read them with, but the card could be the key component to a more integrated, paperless, IT based system. People with serious medical conditions could also carry these around with them in their wallets or purses, just in case they fall ill when out and about.
Or am I being just plain naive?
Maybe, but my understanding is that primarily folk that apparently aren't entitled to free NHS care arenthe only ones likely to apply for it.
Otherwise our 'leaders' would no doubt jumpon the idea of having ID, sorry 'healthcare entitlement' cards for the great re-unwashed....
Last century I worked out how to reduce paper use in the NHS...
For each organisation count the sheets of paper (as A4) bought last year.
Buy 10% less for this year.
About now the admin people would have used up all the improvement available from writing on both sides of each sheet.
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