back to article No fax given: Blighty's health service bods told to ban snail mail, too

The NHS, in England at least, will email patients directly rather than rely on snail mail, and organisations will be free to look beyond Accenture's NHSmail to send e-missives, under proposals from health secretary Matt Hancock. "The rest of the world runs on email – and the NHS should too," Hancock said today at the NHS …

  1. Dr Who

    Hancock's half hour

    Once again, encouraging messages from Hancock. Open standards for interoperability of disparate local systems. Nice if it really happens. No more multi-billion failed attempts at monolithic NHS wide systems.

    BUT - email for sensitive patient communications. That's got to be taking the piss (if you'll excuse the pun). If you need secure communications with guaranteed delivery then email is absolutely the last tool for the job. A smartphone app with end-to-end encryption giving access to a secure document store - that could work.

    1. Anonymous Coward
      Anonymous Coward

      Re: Hancock's half hour

      It depends..

      NHSMail has a secure function which requires recipients to login to a portal (linked to their e-mail account) to retrieve the contents. Think it's based on egress or something similar. Doesn't help if the recipients e-mail address is compromised or insecure though.

      Then again if consent is given then the onus is on the patient to ensure it's secure to a degree. BUT one of the problems will be that the NHS typically doesn't not use consent as a legal basis under Data Protection Legislation.

      It's still better than letters though, although I can guarantee phishing using NHS letters will go through the roof, there's already a problem with private companies pretending to be the NHS and calling up vulnerable people to try to flog them specialist beds etc.

    2. This post has been deleted by its author

    3. Anonymous Coward
      Anonymous Coward

      Re: Hancock's half hour

      " If you need secure communications with guaranteed delivery then email is absolutely the last tool for the job. A smartphone app with end-to-end encryption giving access to a secure document store - that could work."

      You are joking, I hope.

      Email can be made secure, and with work, desktops or laptops can be made reasonably secure. The tools to do so are relatively common, and can be packaged for end users as secure bootable live systems.

      Smartphones, on the other hand...

      1. Are easily lost, misplaced, or broken.

      2. Not everyone has one.

      3. Unlike email, the specific device matters. You need access to that one device, not another compatible device that can easily replace the lost/stolen/broken/failed device, with a bit of software and a key or two..

      4. They are among the most privacy compromised devices on the planet, and that probably cannot be fixed without replacing the OS.

      5. They are hard to secure, and it is difficult to be sure they have been secured... and given the way updates are done, and apps work, there is considerable room to doubt they can be kept that way.

      6. They require expensive communications plans.

      7, They may be difficult to use for the sick, elderly, or merely technologically disinclined.

      I have yet to find a readily available smartphone that I would trust with any part of my private life, let alone things touching on very private health matters, or my life.

      1. AMBxx Silver badge

        Re: Hancock's half hour

        Email works well enough in private health. When WPA need to send something confidential, I just receive a notification email. Then I login to their site to retrieve the document. It's annoying to go through two steps when it's something trivial, but reassuring when it's something more private.

        Problem will be passwords etc for the old and infirm. There are still plenty of people with no Internet access and they tend to be old and ill.

      2. CrazyOldCatMan Silver badge

        Re: Hancock's half hour

        Email can be made secure

        But no-one outside of commercial organisations does. Do the most popular email clients do secure email? Most of them claim to, but setting up PGP/SMIME et. al. isn't a task for a novice (and even security professionals say probably isn't worth it).

        And a lot of your complaints about smartphones also apply to email - not everyone has it, it's easily compromised and hard to secure and hard to use for elderly or techophobes.

        In short, there isn't a solution that works for everybody. And I (for one) won't be giving my local hospital my email details (given that the last time I did so, the address used ended up on all the spam lists in short order).

      3. pmb00cs

        Re: Hancock's half hour

        Email can be made to be secure, but not within the control of the sender, and at the cost of reliable delivery.

        You can enforce transport encryption, but then what happens when none of the receiving servers for a domain support it? Don't send to that domain?

        Assume they do, your email is securely transferred to the next hop. Now you have to trust that infrastructure is secure, there could be a dozen more hops, and you have no control over the security practises of any of them.

        If everyone secures their email infrastructure then everything is coming up roses. But it's 2019 and my ISP doesn't even offer TLS on imap or pop3 ports for email collection. What hope do the rest of us have that the SMTP transport across the internet both supports TLS, and has it enforced?

        Or do you mean end to end encryption like PGP or SMIME? because they require everyone to have keys, and know how to communicate them.

      4. Canna

        Re: Hancock's half hour

        Well said. Agree completely.

      5. Anonymous Coward
        Anonymous Coward

        Re: Hancock's half hour

        "Email can be made secure, and with work, desktops or laptops can be made reasonably secure. The tools to do so are relatively common, and can be packaged for end users as secure bootable live systems."

        You are joking, I hope.

        Mrs Miggins at the retirement home isn't going to know how to secure her own desktop or laptop. She also isn't going to be firing up a Linux boot disk just so she can check the results of her blood pressure test from last week, nor will the NHS be able to support a client image for use by the general public.

        All of your points about smartphone problems are also relevant to consumer PCs, in some cases more so than smartphones (items 2, 4, 5 and 7). The readership from this site may be used to working with and securing consumer PC kit but that's getting increasingly rarer in the general population, where most have access to smartphones but PCs are getting less common.

        The NHS has to cater to the whole population, not just the middle aged IT guys of the world.

    4. Rich 11 Silver badge

      Re: Guaranteed delivery

      "A letter lost in the post could be the difference between life and death," he said – which is perhaps a reference to various incidents where clinical correspondence went missing.

      An email lost to a patient's Gmail spam filter could be the difference between life and death too.

    5. John Brown (no body) Silver badge

      Re: Hancock's half hour

      "A smartphone app with end-to-end encryption giving access to a secure document store - that could work."

      Not forgetting the government mandated back doors.

  2. Ol'Peculier

    'ow much?

    12 million quid a year to support 1.2 million users? How do companies get these kind of gigs?

    1. Irongut

      Re: 'ow much?

      Brown envelopes stuffed with cash do wonders if you know who to give them to.

      1. Aladdin Sane Silver badge

        Re: 'ow much?

        Secure e-mail for £10/user/year? Not bad for an NHS contract.

        1. dentedness

          Re: 'ow much?

          Tutanota costs £10.50 a year for individual accounts. A 50p discount for a 1.2 million volume account sucks.

      2. Doctor Syntax Silver badge

        Re: 'ow much?

        "Brown envelopes"

        Can't do that. Can't use snail mail.

        1. Anonymous Coward
          Anonymous Coward

          Re: 'ow much?

          "Brown envelopes - Can't do that. Can't use snail mail."

          I'm sure hand delivery in the car park of a very nice golf course isn't termed snail mail...

          1. eldakka Silver badge

            Re: 'ow much?

            Sneakernet.

  3. Irongut
    Thumb Down

    What about pensioners, the unemployed, people on low income or people in homeless shelters and the like who have no internet access? These people need medical treatment too.

    And, that's before we consider the implications of sending medical information to a patient whose email address is with Gmail or similar.

    1. Anonymous Coward
      Anonymous Coward

      I think you will find that most pensioners are very well connected but I agree with the point made. Both the NHS Blood & Transplant Service and my NHS Dentist use SMS Text messaging to contact me.

    2. Anonymous Coward
      Anonymous Coward

      NHSMail to Gmail is probably more secure than you'd expect to be honest.

      But doesn't mean the gmail account is secure and it means Google get their hands on sensitive information - bit like a backdoor way of getting access to NHS data this..

      1. Doctor Syntax Silver badge

        "NHSMail to Gmail is probably more secure than you'd expect to be honest....Google get their hands on sensitive information"

        Which is exactly the level of security we expect. So no.

    3. smudge Silver badge

      What about pensioners, the unemployed, people on low income or people in homeless shelters and the like who have no internet access? These people need medical treatment too.

      My first thought, too. In fact, I am sure that the groups that you have mentioned, through no fault of their own, probably require more medical help than the average Joe or Joan Public.

  4. Locky Silver badge

    2FA

    Secure web-based mail with a SMS access code to access would work for 95% of the communications, not difficult to implement or particularly groundbreaking

    The challenge is how to keep the 5% who can't or won't fit the model

    1. Mike 137

      Re: 2FA

      Not everyone has a "smart phone" (even if that were to provide secure communication, but it doesn't), and for almost everyone email is the equivalent of a postcard written in pencil - it can be read and modified in transit. Indeed those who use "free" web mail" may have their messages trawled for advertisement targeting as a matter of course.

      The challenge is not "how to keep the 5% who can't or won't fit the model", it's to ensure that the "model" is fit for purpose and protects the vulnerable, not just created for the convenience of the least affected party regardless of consequences should the transaction miscarry.

      1. Dan 55 Silver badge

        Re: 2FA

        SMS doesn't need a smartphone, they'll work with dumbphones. You can send them to landlines too.

        TOTP would be better though. By which I don't mean the BBC programme.

        1. phuzz Silver badge

          Re: 2FA

          Wait, what else does TOTP stand for is not Top of the Pops?

          "Time-based One-time Password"?! Aside from that being a really ugly sentence, surely the acronym would be TBOTP? Or if you are only taking the first letter of hyphenated words then it would be TOP. Honestly, who came up with that acronym?

          1. Anonymous Coward
            Anonymous Coward

            Re: 2FA

            "Time-based One-time Password"

            That certainly sounds like a stupid idea looking for a purpose.

            Now you have to implement, maintain, pay for and secure two communications channels, and keep them both operative in order to do anything.

            1. Dan 55 Silver badge

              Re: 2FA

              Now you have to implement, maintain, pay for and secure two communications channels, and keep them both operative in order to do anything.

              So the same as SMS then. Only SMS is more easily got round (a bit of social engineering with the operator's call centre droid or someone on the inside and you've got a duplicate SIM).

            2. eldakka Silver badge

              Re: 2FA

              Now you have to implement, maintain, pay for and secure two communications channels, and keep them both operative in order to do anything.

              TOTP doesn't require a communication channel, let alone a separate communication channel. It's software, a token based system where you open the software, and it gives you a token, a temporary password.

              It is available as 'installable' software for computers, smartphones and other computer-type devices. Software such as Digipass, Google Authenticator, and many others. Or can be provided as a fixed-purpose token generator, a little device with a LCD screen and an on button, such as some banks offer if you want more secure banking accounts (some banks have them mandatory for business accounts) and other institutions. e.g. RSA SecurID device as seen in the wikipedia article linked. Some secure password storage devices, e.g. Yubikeys, can also function as TOTP generators.

              It does, of course, introduce its own problems/complexities - needing a device to install it on (computer, smartphone), or providing a hardware appliance which has monetary costs. Although banks often provide them for free, so in bulk they must be cheap as chips.

              1. HelpfulJohn

                Re: 2FA

                Oh, *that*! Yes, that does work quite well. I've been using token micro-boxes for multi-factor secure banking for years and those RSA things even longer. So far, no issues.

                Losing the extra bit is a bit of a problem for those who lose things but I don't seem to be able to do this very often; even were one to, getting a replacement is a matter of a couple of days at most. Usually through snail-mail, which might be irony.

            3. This post has been deleted by its author

        2. Anonymous Coward
          Anonymous Coward

          Re: 2FA

          SMS messages on a landline are horrible. They rattle of the security code at such a rate of knots it's almost impossible to jot it down even when you have a pen and paper to hand. Unfortunately it's something I have to endure quite frequently as my mobile signal is so poor (and variable) inside I sometimes have to go to end of the garden even to get text messages.

        3. Anonymous Coward
          Anonymous Coward

          Re: 2FA

          In a lot of cases SMS just doesn't work. Both my smart phone and my smarter simple phone lose them regularly in the bowels of the phone... and the last time I looked, SMS delivery was not guaranteed.

          Furthermore, some of us regularly misplace our smartphones for up to a month or two at a time, which makes them useless for any type of priority communication. I've never had it hide for more than six or seven consecutive months, but I really don't know what happens to SMS messages when it's been powered off for that long.

        4. jelabarre59 Silver badge

          Re: 2FA

          SMS doesn't need a smartphone, they'll work with dumbphones. You can send them to landlines too.

          Sure, and just how do you **RETRIEVE** those SMS messages sent to your landline, especially as I have yet to see a SMS-enabled house phone.

          Took me ages to get it through Crapcast's thick skull that SMS on my house phone was useless, and I wanted my landline set to *reject* SMS.

          1. Dan 55 Silver badge

            Re: 2FA

            You don't get a call and a robot voice speaking the message to you when you answer?

    2. Anonymous Coward
      Anonymous Coward

      Re: 2FA

      "Secure web-based mail with a SMS access code to access would work for 95% of the communications, not difficult to implement or particularly groundbreaking"

      Let's see...

      So you want to make receiving important health information dependent on not one but two different devices? Using two different types of network? That the end user has to pay for? One of them being a highly insecure portable device?

      Surely nothing could go wrong with that....

  5. msknight Silver badge

    He doesn't get it.

    I actually use fax to correspond with my GP when planning non-urgent things. It's quicker than writing a letter and I can write it, and my GP can read it, at times that suit us, independently of each other. I don't waste a GP appointment... and when I do have an appointment, we've got a good grounding on what's going on, as we've had "discussion" already, so the appointment is shorter and everyone's happy.

    Fax, I believe, is better than e-mail because e-mail is just too easy and liable to lead to the GP surgery being inundated.

    1. Halfmad

      Re: He doesn't get it.

      No idea why you are being down voted, as a patient you're allowed to give your information out to the GP like this especially if is suits you (not everyone can speak after all and call in).

      e-mail is also useful but most GPs are sensitive about patients contacting them direction purely because they may be on holiday etc and miss something. GP workflow is surprisingly complicated and I'd suspect that in this instance fax is easier for them to handle than e-mail..

      1. Anonymous Coward
        Anonymous Coward

        Re: He doesn't get it.

        I try to use carrier pigeon to contact my GP. It's not going to well. A chap in the next road keeps intercepting my messages. I don't really mind him accessing my personal media information, but I hate him eating the bandwidth.

        1. BebopWeBop Silver badge

          Re: He doesn't get it.

          Eddie the Eagle lives near you?

    2. Richard Jones 1
      Happy

      Re: He doesn't get it.

      I log onto our GP surgery and enter the details of what is needed. Recently my wife needed replacement anti allergy substances. I used the 'free form' data entry option and when my wife rang a few days later, she was told it had already been processed and sent to the pharmacy.

      I wrote a snail mail letter to a bank only for them to e-mail a reply advising that had been actioned.

      The world is improving its use and understanding of how to use technology. Having been a victim of the NHS snail mail losing appointment letters, I applaud the use of better methods.

      As a pensioner who retired in 2002, I find electronic communications extremely useful, though the NHS mobile application has so far been a bit of a curate's egg. The delay in getting the 2AF code has been measured in numbers of hours at times, it is not clear if this was a general issue with the poor idea of using the mobile as the authentication side channel or a specific NHS app issue. Other times it has worked OK.

      1. Doctor Syntax Silver badge

        Re: He doesn't get it.

        "As a pensioner who retired in 2002, I find electronic communications extremely useful"

        So it works for your use case. Fine It would work for mine. It wouldn't work for everyone. Even here it wouldn't work for SWMBO because she very rarely looks at email. She also very rarely turns on her mobile so SMS wouldn't work either. Snail mail and POTS work very well.

        Thinking that because something that works for oneself works for everyone is a trap into which tech enthusiasts are liable to fall. Hancock is so entrapped into it that he doesn't realise it and, frankly, I doubt he'd believe, or maybe not even understand, anyone who tried to tell him.

  6. Anonymous Coward
    Anonymous Coward

    Secure, private, encrypted two-way messaging is needed, email possibly not

    Secure, private, encrypted two-way messaging is needed, email possibly not (as the majority of email is transmitted unencrypted, and setting up email encryption is too fiddly for almost everyone, especially for not particularly IT-technically-minded people (probably at least 90% of the population)).

    Physical postal letters don't work very effectively for a substantial proportion of the population these days, and a secure and convenient alternative is long overdue for the NHS.

    Our banks do secure messaging, our online shops do secure messaging, but the NHS still requres you to phone, and have a non-asynchronous conversation (in other words, in real time, there and then, usually after several dialling attempts to finally get through after several attempts with the engaged tone), in order to book a doctor's appointment (rather than just loading up a web form at any time of day - or night - convenient to you, and picking an available appointment time that suits you (just like you would when using an online travel ticket booking service)). Likewise for arranging repeat prescriptions. It's primitive, inefficient, and a poor use of time and resources all round.

    Of course telephone booking should still be available for those who really need or want it, but for many of us, it's no longer convenient. Which reminds me, I really do need to write back to the hospital to re-arrange the follow-up review appointment they attempted to arrange for me by allocating me an appointment by letter (at a time I couldn't manage). Like many people nowadays, I either do not have the time available to make personal phone calls during working hours, or lack the privacy in my shared office to be able to do so. Secure electronic communication with the NHS can't come soon enough, in my opinion.

    I just hope (hah) that it won't turn out to be a ludicrously expensive and ultimately half-baked system contracted out, via brown envelope, to someone's favourite buddy/outsourcing company... :-(

    1. Anonymous Coward
      Anonymous Coward

      Re: Secure, private, encrypted two-way messaging is needed, email possibly not

      One reason the NHS doesn't want to do two way conversations is they'd rather consultants were.. consulting than sitting replying to endless e-mail.

      While most people would send in the odd question, there are people who are fixated on their health and would send in dozens of messages a day. I know - as I deal with several of these people at the moment.

      We also have problems with patients stalking staff.. it's a tiny, tiny minority but happens constantly.

      Two way conversations are great in theory - but only if it's worthwhile and actually beneficial to the patient, most of the time it's not a good use of clinical time.

      1. Anonymous Coward
        Anonymous Coward

        Re: Secure, private, encrypted two-way messaging is needed, email possibly not

        "One reason the NHS doesn't want to do two way conversations is they'd rather consultants were.. consulting than sitting replying to endless e-mail."

        Yet another example of the false economy of doing away with secretaries, admin assistants, receptionists, and the like.

        Nobody being paid more than about 80,000 a year in the local currency of your choice should be doing their own typing, report formatting, calendar updates, expense forms, and similar clerical and administrative tasks.

    2. Doctor Syntax Silver badge

      Re: Secure, private, encrypted two-way messaging is needed, email possibly not

      "in order to book a doctor's appointment (rather than just loading up a web form at any time of day - or night - convenient to you, and picking an available appointment time that suits you (just like you would when using an online travel ticket booking service)). Likewise for arranging repeat prescriptions. It's primitive, inefficient, and a poor use of time and resources all round."

      Change your GP.

      With our GP we can book appointments and order repeat prescriptions online. We can also do that by phone. What we don't get to do is ring a doctor direct and why should we expect to do that? If you were in a consultation with your doctor you wouldn't be happy to have them break off a few times to answer the phone and then try to pick up where they left off. Nor do we get to pick the exact time we want. After all the doctors do have other patients to see so it's a matter of picking the best slot left.

      1. Anonymous Coward
        Anonymous Coward

        Re: Secure, private, encrypted two-way messaging is needed, email possibly not

        There is quite a severe shortage of GP places in my city, so changing GP isn't really an option. If your GP's surgery has a useful web presence, you are very lucky, as that's still far rarer than it should be.

        It took me several months to find a GP with spaces available in/near my neighbourhood the last time I moved to a different part of the city, and my previous GP's surgery was getting increasingly desperate to get me off their books as I no longer lived in their catchment area.

        But why should different GP surgeries have different levels of technical competence? It's almost as if they were a shambolic collection of small businesses rather than a National Health Service (with all the economies of scale that that really ought to entail). Oh, hang on, that's exactly what they are, and so each surgery has to re-invent the same wheel (or stick with that roughly hewn log roller, depending on their inclination). To coin a phrase, that's no way to run a "business". There ought to be a high quality, efficient, patient-focused and patient-friendly national NHS communications and IT infrastructure, but there isn't.

  7. Anonymous Coward
    Anonymous Coward

    WTF.....

    "A letter lost in the post could be the difference between life and death," he said –"

    And an email which goes into a spam folder, gets lost in transit, or gets buried in amongst 100+ other emails each day is just as likely to be the differenrce between life and death.

    Not to mention that an email address is not exactly a fixed identity, given how temporary short-term, or just plain quantity some of us have of them.

    I like a letter from the doctor as I can stick it to my fridge with a magnet. Simples, and it works...

    Then consider how many tw@ts in places like the public service send out emails with meaningless sending address or subjects, such as "reception desk" or "appointments" or something.

    Or is this another attempt at government departments to harvest everyones personal details?

    1. m0rt Silver badge

      Re: WTF.....

      Came on to say the very same thing. This is lunacy and a bloody good reason why politicians shouldn't run vital services.

    2. Anonymous Coward
      Anonymous Coward

      Re: WTF.....

      "I like a letter from the doctor as I can stick it to my fridge with a magnet. Simples, and it works..."

      Another solution that works for some and not for others.

      Many people - perhaps 15% of the population ( a guess, I know it is about 8% for one particular issue alone) have problems with paper organization.

      Some of us would lose the letter before it got to the fridge, and quite possible before It actually got opened and read.

      There is pretty much nothing we can do to make sure that does not happen.

      So... email is good. It doesn't get lost, like letters and smartphones, and can be replicated, backed up, and accessed in many places and ways.

      If you have end to end encryption (and a desktop computer, which is hard to lose) then you're done.

      If you don't have a secure email, then a regular email saying 'call this number at your earliest convenience' citing a number reserved for important medical communication should do the trick.

      Even better, make it a number that works from anywhere in the world and goes to a switchboard that can connect you to any doctor, hospital, clinic, lab, or other medical facility... which is just a problem in compiling and searching a good, detailed phone directory.

      Again, this can be accessed from any phone and does not depend on one technology or one device.

  8. TRT Silver badge

    "The rest of the world runs on email"

    Not really. No.

    It's useful, I'll give you that, but far more of my "official" stuff comes via the post. Electoral cards, DVLA stuff (OK, I get e-Reminders, but not parking tickets or traffic fines - OK I wouldn't know, I don't get those, but I've never heard of anyone getting a parking ticket by email that wasn't a scam), tax notices, council tax (the number of dead trees I get explaining WHY the police are getting 3p a day from me. As if I cared about it. Just do the flipping job!)...

    No, I think you're barking up the wrong tree there, matey. Enhance, not replace.

  9. revenant Bronze badge
    Thumb Down

    "A letter lost in the post could be the difference between life and death"

    Indeed, Mr Hancock. But have you never experienced the problems of e-mail communication, which opens up possibilities for a whole lot more ways for communications to be lost, mis-directed, spied on etc.?

    Reliable and (reasonably) confidential delivery of information via e-mail requires NHS staff and their clients to be totally clued-in on best-practice. I just can't see that happening for quite a few years, if ever.

    By all means have e-mail communication as an opt-in service, but for the sake of those who can't grasp the technology well-enough, keep the old methods as well.

    1. John Robson Silver badge

      Re: "A letter lost in the post could be the difference between life and death"

      "By all means have e-mail communication as an opt-in service, but for the sake of those who can't grasp the technology well-enough, keep the old methods as well."

      And for those who can grasp the technology, and want nothing to do with it.

      I can see a 'there's something in your GP portal to look at' email/sms/letter being a reasonable way of getting digital comms out - but that only deals with the people who can use digital comms..

  10. Blockchain commentard Silver badge
    Facepalm

    VFEmail have a number of servers available I believe and could do with a cash injection to beef up security and backup procedures.

  11. Blockchain commentard Silver badge

    Look what was first registered last October....

    nhs.email

    I wonder if something is already in the pipeline but needs a 'public' presence to justify an OTT yearly charge the NHS will end up paying.

  12. Daedalus Silver badge

    Yes, but....

    Real world happening from Reddit:

    Business owner: I don't get my e-mails until late in the afternoon.

    Tech: Show me what you do.

    Owner: I come in in the afternoon, start Outlook, and that's when I see my e-mails. Why don't I see them earlier?

    *collapse of tech party*

    In the face of this kind of brilliance from someone who, one assumes, has enough brains to stay in business, how can you justify using e-mail to contact everybody from the members of Mensa to the famous Eccles?

    Definitely H-H-Hancock's half-wittedness.

  13. Gene Cash Silver badge

    "An email sent to the wrong address could be the difference between life and death"

    I've seen so many people put my email as jeancash, genekash, etc... DESPITE my pains taken to spell it out slowly.

    1. CrazyOldCatMan Silver badge

      Re: "An email sent to the wrong address could be the difference between life and death"

      DESPITE my pains taken to spell it out slowly.

      Try having a relatively long and unusual surname. That gets to be even more fun..

      (Despite the fact that it's, unusually, spelt exactly how it's pronounced..)

  14. MisterHappy

    Maybe offer a choice

    So watching my dad using email well into his 8th decade is painful but he can do letters just fine.

    My wife's mum is fine with email but likes letters for "important things".

    How about asking the patient how they would prefer to be contacted?

  15. TechDrone
    Megaphone

    About time email was offered as an option

    Years ago one of our local hospitals made you wait months for an appointment. They will then send you a single postcard with your appointment date on. If that doesn't arrive and you subsequently miss the appointment they cancelled the referral and you have to start all over again. To add insult to injury, they refuse to discuss appointments over the phone on the grounds of patient confidentiality.

    I have regular contact with NHS & school staff with reports going back and forth. When we go to appointments now we take printouts of every letter and report from all parties with us due to the number of times we've turned up, only to have to rebook due to the consultant not have all (or even any) all the bits of paper in their case notes. We even take 2nd copies of recent reports for them to keep.

    Email as an option is fine for many. Post works for many. SMS also works for many. These are not mutually exclusive, and it's about time the NHS administrivals got their act together.

    1. The Pi Man

      Re: About time email was offered as an option

      You realise that this common sense approach of “one size doesn’t fit everyone” will never catch on?

    2. CrazyOldCatMan Silver badge

      Re: About time email was offered as an option

      and you subsequently miss the appointment

      Which brings up my current pet peeve - my local hospital. So, I have a hospital outpatient appointment at 9am on 5th February. Since that's the day after the Superbowl (and I won't have got to bed until 4am and my blood alcohol level certainly won't permit me to drive by 9am) I tried to reschedule it.

      Foolishly, I called the outpatients line for the department, as written in bold on the top of the appointment letter. The phone call bounces between several phones then disconnects. I try 3-4 more times, at different times of the day, over several days - same result.

      I discover that the hospital has an automated on-line form for re-doing appointments so I try and use it. I then re-try after diabling Noscript, privacy badger and Ghostery and this time the form seems to work.

      I still (4 days before the appointment) get the SMS reminding me of the appointment so, follwing the instruction in the SMS, I reply with CHANGE (which should trigger a reschedule.

      I then watch the Superbowl and wake up at around 1pm the follwing day, secure that I won't have missed my appointment.

      Two weeks later, I get a scolding letter telling me I'm naught for not attending and setting up another appointment.

      So, at that appointment, I plan to (politely) make the point that the hospital procedures and contact methods are woefully inadequate and, if they advertise a number et. al. IT SHOULD DAMN WELL WORK!

      (pant, pant).

  16. 89724102172714182892114I7551670349743096734346773478647892349863592355648544996312855148587659264921

    Will Hanc*ck have more stay in power than Mike C*nt?

  17. Harry Stottle

    ProtonMail

    Protonmail is already up and running and easily the best combination of security and user friendliness currently available. It's certainly easier than using gmail nowadays.

    Two ways it could work. First option, anyone wishing to sign up for email contact should be encouraged to go and get their free PM account and make that their default email address (if advising novices, include advice on strong passwords). GPs could do the same but would be kicking against the bosses official line. Those few with the cojones to place patient trust and confidentiality ahead of "just following orders" will proceed regardless. Result: patchy adoption and plenty of friction.

    Best would be if NHS signed a contract with PM to provide the service. That would send such an amazingly positive message to the world in general that the long term consequences are impossible to estimate. And PM would get a solid funding boost which would enable their operation to spread further and faster. Of course this won't happen. The spooks won't permit such a dangerous publicly endorsed precedent. But it makes for a good daydream.

    Option 1 remains available.

  18. Alan Ferris

    Who are the big users of the NHS?

    In 30 years as a GP, I found that the big users of the NHS fell into a number of groups, the elderly being one of the biggest groups. My father (in his 90s) can cope with email, but many of the elderly can't, or don't even have a computer or smartphone. Many of those who do have a mobile phone keep it in the cast in case of vehicle breakdown and don't otherwise turn it on.

    Our current health secretary seems obsessed with computers, but hasn't worked out how a GP can use Skype to examine a patient, check a blood pressure, or measure a temperature. In other words, he hasn't a clue about how doctors work. We are all doomed.

    1. Tim Almond

      Re: Who are the big users of the NHS?

      80% of 65-74 year olds use the internet.

      But even if you only get 25% of users opting for letters, that's 25m saved on postage per year.

      I get the feeling a lot of people in the health service just don't want any sort of improvement to administration.

  19. Anonymous Coward
    Anonymous Coward

    Given the state of NHS IT - no no and thrice NO

    Apart from the very pertinent comments about not everyone in the main users of the NHS having email and/or smart phones (internet access is not universal amongst the long term sick, elderly and children), email is not secure or guaranteed delivery. I know snail mail is not perfect but email is way worse, even if you use some form of encrypted system - which would only confuse many of those that are actually able to receive them, making the system almost useless.

    Add the very poor state of NHS IT and their insecurity (I recently started receiving very specific SPAM after being referred to on NHS clinic due multiple virus' on their computers - which they only found after I spent a few hours on the phone to their IT department) and you actually have a recipe for making the NHS massively more inefficient that it already is and you might as well just publish patient details on public websites.

    I hate to say it but IT is not always the best solution even when it is the cheapest. I know I should ashamed of such thoughts and now need some counselling from the BoFH but.........

  20. aelfheld

    "The rest of the world runs on email [...]"

    If the Health Secretary supposes that, the Health Secretary law is a ass - a idiot.

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