Because NPfIT was such a success ..
National Health Secretary Jeremy Hunt has promised £4.2bn investment to "bring the NHS into the digital age," part of an attempt once again by the department to force the service to go paperless. Apparently the cash pile will allow patients to book services and order prescriptions online, access apps and digital tools and …
He is in every sense of the word, every thought, conscious belief and definition of the word stupid.
4.2 billion could clear the debt of the NHS, it could actually pay people what they need (nurses get a pay rise) it could allow Ambulance trusts to upgrade their fleet and not rely on auxilliarys.
It could allow a great deal considering we are the lowest investor of health care in the Western world.
But virgin Healthcare now run hospitals across the country, the great carve up has begun. There is a renationalise NHS bill being drafted under labour because the privisation has already cut too deep to just reverse it.
And now the moron in charge is trying to give us WIFI and more and ingenious ways to spend public money on private concerns.
The point here is that it's 4.2 billion, once. Rather than 4.2 billion each and every year.
Plus it probably also includes 3 billion already allocated for NHS funding, but 4 billion sounds so much more 'generous' than "Here's some cash you were already getting, but now you need to spend it on stuff through my mate's outsourcing company".
"The point here is that it's 4.2 billion, once."
Indeed, but as Avatar said, clear the debt. That would release cash from the current account which now goes to pay interest into actual health care. The situation at present is that those PFI debts are so expensive to service that A&E, e.g http://www.examiner.co.uk/news/west-yorkshire-news/huddersfield-royal-infirmary-shock-anger-10742794
I agree that this money, even if it a one-off (which it is supposed to be, but won't be) could be better placed elsewhere in the NHS. My local surgery is being taken over by Virgin: all the good doctors have gone, the standards are already slipping, and I know the costs will be driven down ('not so many referrals, please!') and the pressure for me to remove the lock on my data will go up.
Needless to say, I am moving.
I would rather have housing built for nurses with this 'digital' money.
>it could allow Ambulance trusts to upgrade their fleet and not rely on auxilliarys.
Thin end of the wedge - lack of skilled paramedics is more problematic - they're leaving at the rate of 1200-1500 a year and new entrants take ages to skill up. Vast amounts of time parked at A&E as they're being used for treatment, likewise.
Locally we've had fire engines turning to out to provide a first response on ambulance calls for several months now - mostly for serious incidents involving kids (eg last week for a young teenager who collapsed in a school with a suspected heart attack).
Sadly everything I said was thin end of the wedge. I started out with a rant on every aspect of the NHS as I used to work there but instead just covered the basics that a normal person sees, the ambulance and the nurses. No one wants me on a tirade of how you will miss the NHS when it has gone.
I could get really boring with how Privatisation has ruined it and how stupid Tory decisions since they took over have sneaked through, without mentioning Lincolnshire selling medical records or the Junior doctors strike.
Not even thinking about community first responders and their lack of skills, there only to meet targets for first on scene.
You can guess where I used to work. And can guess where I vote. (Not that Burnham was better)
I already request repeat prescriptions from my local surgery via the internet, which is then taken to the local pharmacy to be dispensed ready for me to collect at my convenience a few days later (not during the pharmacist's lunch hour though!) - it saves having to argue with the doctors' receptionists or spend time in the waiting room with all the plague vectors...
(Mine's the yellow one with the visor and HazMat written across the back.)
It's ridiculous that making or heaven forbid, changing an appointment is such a convoluted process. My partner teaches a specialist subject only on Wednesdays, she can visit healthcare appointments on any other day, but her practice insist on scheduling Wednesday's and is then shirty when she asks for an alternate day, even though the services she needs are available other days. It should be possible to go online and change the day or even offer to swap with someone else who might prefer her day.
NHS needs to catch up with the 21st century.
Actually where I live you can't. There are two GP practices but they share the same building and their receptionists sit side by side. Both use the same system to book appointments and a lot of stuff is done on paper (which is then suppose to be transcribed). There was a recently head count at the surrounding practices too to ensure that no one had moved outside of their catchment area and they were given a few months to get register with another GP before being taken off the books if they had.
Only really works in big towns and cities that have multiple practices, if you live in a rural area you get the doctor who's prepared to work out in the sticks and like it, or you get to travel 20 miles to the next surgery. My village doesn't have a doctor, so I have to drive to the nearest town anyway. Mind you I do have two towns to choose from.
"Your local Practice Manager != the NHS"
Yes as many people fail to comprehend, GP practices are mainly outsourced to GP's who are not directly employed by NHS but are effectively private companies fulfilling NHS contracts to provide GP services.
It's not always possible to change gp's either because of locality or popularity.
There is no reason why there can't be a centralised appointment system that all GP's and hospitals use. One place that everyone goes to to interface with the NHS would be a tremendous start to harmonising this mess of associated services and contracts that makes up the NHS that we all pay for.
'ooh had a bowl movement this morning....'
The only bowl movement in my household is from the breakfast table to the sink, where it lingers for days.
However I do try to get my bowel movements in or generally near a toilet, and tend not to leave them lingering for someone else to deal with.
It's certainly not wasted providing WiFi. My wife and son spent have spent several weeks seriously ill in hospital in the last year, I was able to be there for them throughout visiting hours everyday thanks to free fast WiFi, which allowed me to WFH(ospital), and thus paying the taxes which keeps the NHS going.
I agree entirely.
What puzzles me though, is that the NHS is so unique, that of the five billion programs that have been written over the last century or so, not one, can be taken off the shelf, tweaked and applied to the problem. No we have to pay another team, to write the wheel from scratch and what do we get? Something that isn't roundly capable of doing the job, at a cost of ten hospitals.
I do not believe for one minute that the UK is the only nation attempting to digitise its health system and I rather think many have already ticked that box, so why can't we just buy into their expertise and spend the savings on building some state owned infrastructure, instead of renting it from Cameron's hedge fund buddies?
4.2 billion could clear the debt of the NHS, it could actually pay people what they need (nurses get a pay rise) it could allow Ambulance trusts to upgrade their fleet and not rely on auxiliaries.
Whilst I agree with you main points, I'm afraid that 4.2billion is nothing like enough to get the NHS back to a fully functioning condition. Successive governments of all colours have systematically thrown away the assets needed to maintain the service in an effort to achieve "efficiency".
Unfortunately, efficiency and good patient care are not always compatible.
It may not be efficient to have lots of local hospitals with respite beds, but suddenly, when you get rid of them all, you find that the big central hospitals don't have anywhere to discharge their patients to.
It is not efficient to have lots of Ambulance stations around a rural county, but if you close them, you suddenly find it takes a long time for Ambulances to get to the patient, especially in bad weather, because the vehicles are having to travel 30 miles instead of 3.
It is not efficient to have A&E departments in local cottage hospitals, but the alternative is long journeys for every patient to distant central hospitals, and Ambulance vehicles tied up with one patient for over an hour or more, even for minor injuries.
Pah, I really shouldn't get involved in these threads, my blood pressure goes up too much.
There is the problem of increased expectations of the NHS to cater to our every desire above and beyond what it was put there for. The NHS nearly collapsed on conception when the money didnt exist to provide the actual level of care initially proposed and its budget has expanded like an all consuming monster in the process. With a budget that leaves growth behind year on year but also increasing demands in terms of patients and paperwork we have a system that must consume more while providing less. Something has to give.
Unfortunately the polarised debate and emotional arguments make actual reform practically impossible. And we also have a variable quality of hospital of brilliance and painful waste. Just as we have critical patients and people we have to wonder what planet they come from to waste a hospitals time/resources.
Indeed, if a new way of tackling a problem is found then what was once a long term live-with-it-until-you-die condition now becomes something the NHS can (possibly) do something about to improve your life. So the nation expects they ought to.
Now in theory the benefits should accrue somewhere else in society. And you'd hope that the savings in reduced long term care, preventing related illnesses etc could be added to the NHS bottom line - but they're hard to account for.
Their offices are little more than piles of patient files from floor to ceiling! I've seen them for myself so this is just more of Jeremy needing a C* on his last name. Completely bogus when they're still running Windows XP in wards I've recently been into in my local GP's surgery and seen at a NHS hospital!
*= Discriminating El Reg readers know how to move letters around!
The NHS CIO/CTO or EIEIO announcing that they will screw the IT suppliers into the ground to get teh best deal for the NHS.
The NHS CIO/CTO or EIEIO realising that actually digitising the paper based records going back n years for the 65+ million NHS Patients will more than take up the budget he has without introducing. It's a big number, but then that represents about £65 per patient.
My paper file which follows me around the various hospitals in my local trust contains my medical history and the reports that the consultants I see write, and the other consultants can read, unlike the on-line system where they can only see the reports written by them,
Don't so much have to worry about the warehouses full of old records, they're already accounted forward. It's not adding to them with the current and future work. Medical records need to be retained 10 years after the subject has died.
And parts of the NHS rely on photocopiers and faxes. Been given a handout by a hospital recently? Probably photocopied within an inch of its life, washed out greys and margins at an angle to the edge of the paper. I take phonecalls about our laboratories test results. "I'm chasing up a test result". Yes my records show it was reported to you last month. "Can you fax it to us?"
There must have been some serious lobbying going on from Craptia, Accenture or whoever is on the case. The out-source crowd must be wetting themselves with excitement and anticipation at the ££££
It will all go wrong, they can then bale out after a year or so and blame the Government. Then they will still get most of the money. Hunt (and probably Ozzi and Comedian will be long gone) then they can take the blame.
It all looks perfect to me.
'Paperless' has always been plain silly. Use IT wisely, but in the chaos of wards and GPs, some things WILL be written on scraps of paper, napkins, chart traces. And everyone (er?) can 'write', whereas not everyone can type, or find the things they want to say on kludgy drop-down menus and disease codes. Ask people how they work, and then decide how to handle reality. Else it's a forever cycle of 'won't happen'.
"By 2020, 25 per cent of all patients with long-term conditions such as hypertension, diabetes and cancer will be able to monitor their health remotely, said Hunt."
Now I can see how ones health might be monitored remotely by others, but for someone to montor their own health remotely surely needs some kind of astral projection app (or seriously trippy medication).
Seems about as likely as nothing going at all wrong with young
Berkley'sJeremy's latest utterances.
How I would tackle this problem...
Step 1: Decide on an operating system platform for the whole of the NHS. With the sort of money that is sloshing around for this project I'd be very inclined to roll my own Linux distribution (NHOS anyone?).
Step 2: Dictate that applications follow the Unix principal of doing one thing well with a clearly defined interface. Interface apps using a language neutral and open standards method such as web services where possible.
Step 3: Start migrating services over, ban (I hate that word) within 5 years the development of any new apps that aren't on the new platform. Insist that all new applications are either open source or the copyright is held by the NHS / UK government (would you believe this is often not the case which makes the tendering process a joke).
The NHS is big enough that providers would switch over and follow the new rules even if they did kick up a stink at first. I'm really surprised how much the NHS doesn't throw it's considerable weight around.
The NHS is big enough that providers would switch over and follow the new rules even if they did kick up a stink at first. I'm really surprised how much the NHS doesn't throw it's considerable weight around.
But that's the problem,the UK government (and not just the present one but all of them since Trusts were introduced) have insisted that NHS Trusts should be as far as possible autonomous, (but with Central Government oversight) and therefore they don't have a cohesive purchasing policy, there is no functional central purchasing authority for providers to deal with.
The NHS is not an single entity, it's a billing structure. This is how it started off post WW2 and it's basically how it remains with little in the way of changes. Nobody would design a system this way, but even proposing to change it will face masses of misinformed hystria such as "SAVE OUR NHS!!11!!11" and opposition to having any part of the the NHS in private ownership, despite the fact that GP's practices (which virtually everybody agrees is the best part of the NHS) are, have always been and will always be for profit businesses owned by the doctors.
When in a single county you might have half a dozen or more NHS trusts, plus several hundred individual GP practices all doing their own things IT wise then trying to standardise anything nationwide is really something of a pipe dream.
Even if starting a massive IT project to "save money" would be a sane idea when it is managed by government, which it isin't. The government made IT solutions for the NHS suck, frankly. That's why EMIS is so popular amongst anybody with any choice in using it!
In the case of a certain test for a certain condition, the NHS effectively relies on three commercial entities with their central laboratories. Because its cheaper than a hospital or ccg running their own service.
There's an alternative test for that same condition which GPs pay the local pathology labs at the hospitals for. Hospitals that are trusts.
I moved to Scotland when I retired 12 years ago and now come under NHS Orkney. I am a type 2 diabetic and I can access my diabetes-relevant data online at http://www.mydiabetesmyway.scot.nhs.uk. It's not perfect (e.g. the chiropody people use a different system to the rest of NHS Orkney) and there is sometimes confusion over what code is allocated to a particular symptom but I can see my results of blood pressure, HbA1c, height/weight and several other sets of clinical data. It is only available in Scotland at the moment.
> Apparently the cash pile will allow patients to book services and order prescriptions online
Here's a video explaining how the new efficient booking of appointments will work. It is, of course an old video -- more than a decade old, in fact -- but since we seem to be about to repeat ourselves, it bears a repeat in turn.
We've been able to book appointments online for a couple of years now.
Of course it helps if there are any available for the next 2 to 3 weeks covered by the system.
As an aside, at least they've been sensible enough to keep a proportion of the bookable time slots off the online system, for those who don't have internet access.
How many times do we get the "paperless" myth? Working in the NHS myself, hence Anon C posting, the only way we go "paperless" is when we run out. In other departments PO rules are so tight that they cannot buy more and staff bring their own in.
It also presupposes that all other (hate this word) "stakeholders" with which one interacts are paperless too which of course is never, ever the case. Lump into that, various legal obstacles such as faxes having a different legal status to scans, consent forms that need signing etc and you see that Mr Hunt is:
a: Detached from reality
b: An idiot
c: A c*nt
Not necessarily in that order.
To be honest all of this is just a tissue-thin veil to cover the backdoor privatisation of the NHS while drooling elites wait in the wings to divvy it up once it has been suitably defunded. Labour are as guilty as the Tories & Lib-Dems (remember the coalition) with that PFI scam.
But hey, paperless! Top plan!
I for one hope they don't spend the money on another attempt to solve the problem.
I hope they spend the money on an attempt to define the problem. With a clean understanding, and defined requirements, they could set up a decent staging post for the armies of order. They can then get competing implementations. Maybe work out if they need further staging posts. No way will this expedition work in one shot.
That and a sacrificial prototype implementation to find out how badly they collected the requirements...
While everyone bemoans the inefficiency of the Paper based Health record, many paper based Health records have 'efficiently' sat within a Doctors surgery somewhere for the last 20-30 years untouched gathering dust, for many patients between ages of 20-50 (excluding pregnancies).
As the BBC found out, digitising something (their programme archive) for the sake of digitising it, is expensive, has to be maintained, secured, backed up.
Just concentrate on digitising the subset of hypochondriacs, first.
...and even those records then have to be accessed and written up by a generation of techno-savvy Doctors for all this to all work. 'Garbage In - Garbage Out'. We're not there yet in this respect.
I know mine are held secure enough, because I can still remember my Doctor's handwriting, eligible!
They also don't require paying Microsoft blood money to keep Windows XP/7/8/8.1/10 secure (depending on what year in the future you are reading this), for them to be maintained in their paper form.
...who managed to piss junior doctors off enough to make them strike. That's quite an achievement, given the usual ability of doctors to agree on a course of action (minimal).
He's also managed to get the consultants, GPs, nurses, ambos and other healthcare professions united in support of the juniors. This is fucking unheard off.
I'm not sure that much of what goes on is actually related to what he thinks or is mainly his internal Tory party rivals setting him up to fail; what is clear is that he's made a massive error and has ruined his career. Every health secretary is described as "the worse ever"; it's rare that anyone does anything about it, let alone going on strike (ie losing pay) over it.
It's hard to know if point and laugh remains an appropriate response; I am now becoming slightly concerned about the moron's health.
A comment by one of the many failed suppliers to the NHS IT system when they heard that another bite of the apple was possible.
After he calmed down 5 minutes or so later, it was all he could do to control himself from cancelling that order for a cheap yacht and get a much bigger bugger !!
NHS IT Supremos are now busily preparing a seriously flawed specification, with at least a quarter of the NHS sticking plaster budget waiting to be gobbled up in just one go!
What do the the bookies reckon? 6 years and nothing to show for it....again...for £10bn
I say again YEEEEHAAAaaarrr!
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