We're all doomed (again)
Ah well, having skillfully avoided all NHS contracts last time round, I'll be doing the same again. Most of the people I know who worked on the last round are now clients of the NHS - the psychiatry wing of it.
Given the track record of project failures in NHS IT, some might say that Matt Hancock - former Minister for Fun who now runs the Department of Health - is marching with ill-founded confidence towards what he describes as a “tech revolution”. NHS hosptial photo, by Marbury via Shutterstock It is 2018 and the NHS is still …
Or more importantly, get the stakeholders to buy in to the programme changes, and get those stakeholders to make the end user groups, consultants, and little old ladies manning receptions in surgeries all over the land less resistant to those changes also simply because they don't understand modern IT and prefer to work work with and abacus... "because that's what we've always done".
With actual first hand experience of the last debacle I can confirm that that was a key lesson that needed to be learnt by the NHS. I doubt it has been.
Buyin? Good luck with that.
Hospitals are in a perpetual 3-way fight for resources and status between Management, Doctors and Everyone Else (eg admin, nurses, radiographers and other "lesser" trades.)
Doctors are generally very clever people, as you'd expect. They've been taught they are superior beings and experts in everything. And they are the most deserving. So somebody comes with lots of money and they naturally want a piece of that. And will do everything possible to get that piece, but also keep the other two in their rightful place.
Despite popular myth, the Management are often clever people too and are doing the best they can to mediate the war between the Doctors and Everyone Else. They can see the IT stuff is going to make a big difference, but they also know the Doctors will want all of the pie and that Everyone Else will have tools to get on with the job and get Ideas Above Their Station. So they are immediately on the defensive.
The Everyone Else have been pissed on by the other two for years. Finally they have a chance to stop having to pay obeisance to Doctos and Management every few minutes and get some respect as medical specialists in their own right and some decent tools to work with. Since the other two are playing silly beggars and this is really all about them dammit, then why should they sit quietly and hope there's some crumbs left for them once the big boys have finished fighting?
About the only thing that every unites the three is when a Health Minister threatens to upset the apple cart and he must be portrayed as Totally Evil Sub-human and a Threat to the NHS and destroyed for the good of everyone. Which of course means them and not the poor patients who just want to get their kid to be seen by a nurse/speech therapist/physio. Or even - gasp - a consultant.
About the only thing that every unites the three is when a Health Minister threatens to upset the
With good reason given the motivation and behaviour of most ministers in the public and the NHS' collective memory - o competence or motivations or 'hidden agendas' and the need for a lucrative career when they are booted out all play their insidious parts.
The fact that Microsoft do not Bear the Costs of Free Provision of Ultra Modern Systems to Services which are provided them*, by government or administrative board decision, is that which effectively halts any and all Rapid Electronic Progress in Patient Programs.
RePayment via Savings and Profit Accrued in Ultra Modern Systems Services would be a Great Win Win for a System Enabled to Guarantee Success for its Components/Utilising Entities.
And enable the likes of a Microsoft to Establish a Healthy Almighty Lead in the Field.
* I have only assumed and presumed that to be the case.
If I'm wiped up off the road following an accident, I'd quite like the A&E clinicians to be able to access my record and fast. If I see my GP, likewise - these authorisations are very obvious and even implicit. But I'd also really like to be able to know after the event, who in the NHS has accessed my record and when and why they did so. If my data has been anonymised to make this available for research I'd also very much like to know to whom and under what terms and for what purpose access was given, and also to be able to know exactly how my data was processed in order to anonymise it, so I can know if this anonymisation was likely to be effective.
This is because the best policing and prevention of misuse of this highly sensitive, personal and confidential data is likely to be similar to how the banks are policed - we check for unauthorised payments if and when we go through our own bank statements line by line. For much the same reasons we should be able to know who has accessed our medical record, how and why.
Hear hear - I'd be delighted if a govmt organisation could come up with a secure and connected syetem that allowed medical professionals to get the relevant information for you when they needed it. Unfortunately, a prerequisite for that is the govmt minister & associated flunkies having a scooby as to what they were dealing with - otherwise we're back in the hole dug for the previous incarnation of an NHS IT system.
Good luck with that one. NHS facilities are always short on computers and staff are too short on time to wait for a PC to log off one person and log on another. What that's going to mean is one person will log in to the system and leave it open for any staff in that area (or any doctor that passess by and wants to look something up) to use. It also won't show that your case was shown to half a dozen medical students that were following a doctor around, or that staff will gossip about it if it's an interesting case and show it to each other.
All your records and data are on computers any way. The paper medical notes are just a printout or a copy of something that has already existed or still does exist on a computer/server/cloud system (barring legacy notes).
So a centralised secure system (that is actually secure) is a better option than random semi secure systems that have some of your information on. It already happens in the police where the PNC have a trove of information on you and the security services no doubt have even more. So it can be done.
Logging on/off is generally pretty good and even if a PC is left logged on there is still a requirement to log in to the application to get access. Once again similar to the Police.
As for medical students, they see a massive amount of interesting cases with their own eyes and can easily chat about them, they no doubt do, however patient confidentiality is probably higher in the medical field than it is in most other sectors (replacing with client/customer/public confidentiality as appropriate for that sector). Medical people also, generally, are just not that interested in things that you may think is an interesting case (e.g. embarrassing for you) as they have seen similar or worse many times before. An interesting case to a medic is more likely to be highly boring to the lay person.
The only people who could have issues would be celebrities who might have a low grade medical person looking at their notes, but to be honest they could do that at the moment anyway and it is surprisingly rare that information ever gets leaked or that the media would publish it if it was.
too short on time to wait for a PC to log off one person and log on another
The printer at work is capable of recording the ID from my card whenever I go to pick up a printout. I would certainly hope that (a modern application on) an NHS PC doesn't require a separate Windows login for each user but that the app requires an ID card to be presented to a reader each time a transaction occurs and records it in the access log. It would take no more time than using your card to open a door.
1) It will be late
2) It won't work
3) It won't do the job it was designed to do because of feature creep
4) HMRC/IR-35 will make all the above triply so because they can. "We can't get the staff..."
5) All the above will be true even is Crapita are not involved.
And Finally (unless you know otherwise)
6) The Minister who kick this off will not be around long enough to have to stand up in Parliament to explain why it has gone so badly wrong. This applies to both main political parties btw.
Business as usual then... :)
Perhaps the most significant thing we know is that overstretched public services are largely overstretched because of the deterioration of other public services. Last night's Ambulance on BBC 1 was a case in point - emergency vehicles dealing largely with failures in social care for the elderly and the consequences of homelessness. A large part of police time is now spent dealing with mental health problems - and the proportion goes up as the number of police officers goes down.
None of this is going to be solved by technology and any suggestion that it might is just a case of "look over there".
Any Politician who announces he has a 'vision' needs to be escorted out of the building and dumped in a secure wing somewhere permanently or until NHS mental health get around to his case (which is much the same).
We're in enough danger of replaying the early 20th century again at the moment, we don't need another nut.
What the NHS needs is a capable system to deal with it's current and near future workload, not dreams of an NHs Uber system to last a thousand years.
Smoking peyote? He's been sitting breathing deeply from his own BO, which is probably worse.
There is loads of room for scepticism here BUT hidden beneath it all is a crucial change of direction. In the past, and including NPfIT, the strategy has been to build a monolithic, centralised system to which every corner of the vast and disparate NHS would have to mould its operational practices. That, as we all know, is impossible even in a much smaller organisation and is a key reason for the failure of NPfIT.
Now we hear mutterings of data interchange standards, enforced use of the existing unique ID number, allowing local units to build IT systems that suit their operations, yet still be able to speak to other systems on the network.
This is how the internet was built. The "fathers" did not instruct us how to build an email server, they merely defined SMTP and told us that if we want to build an email server, this is how it's going to send messages to other mail servers. This model works and it scales well beyond the size of the NHS.
Ironically, given my example, most people on the planet now just use two monolithic email services, but don't get me started on that - it might lead to violence.
Hancock is clearly not someone who can deliver this, but parts of his plan are a very welcome change in emphasis.
Maybe that is the problem, that the organisation is varied and inconsistent. There's no good excuse for the NHS to have so little commonality. It is supposed (broadly speaking) to fix people's health problems. There's established protocols for treatment, there's no reason for the lack of standardisation in organisation, management and governance (or in procurement, systems, buildings, hardware and technology).
Take the not-too-contentious example of hospitals. Every time the NHS builds a new one, (a) they fuck up capacity planning, location, car parking and other easily resolved elements, and (b) they do so each time to a brand new from the ground up design, leading to delays, cost-overruns, and plenty of costly work for untalented architects. All this could be resolved centrally with a portfolio of perhaps five basic designs with some modularity according to the scale and services needed (and also allowing for low cost expansion if needed). Architecture-by-Lego.
So bringing this back to NHS IT, you're quite right that standards based models have worked elsewhere, but really only where failure didn't matter. Look at all the early email clients or servers that have long since vanished - when these folded, a few devs had to find new jobs, and a few loyal customers were pissed off, but nobody died. To my mind the NHS needs common systems, they could be commercially provided (albeit on a regulated asset payment basis to avoid monopoly power), and the NHS needs to be able to have access to the IP (maybe just escrow code) to avoid supplier risk. Of course, that suggests one system to rule them all and in the darkness bind them, and there's a difficulty that NHS Digital is the Sauron of this age - evil, malignant despoilers the lot of them. They all need to go.
A few other things Hancock could do for healthcare would be to unwind all the PFI deals that are leaching money out of the NHS, stop local authorities from charging the NHS rates. And sack all the useless, over-paid, talent free wankers who seem to make up most NHS Trust boards, and replace them with accountable NHS employed managers (who could be and should be sacked if they're crap). And stop the public sector merry-go-round where whenever some overpaid useless twat fucks up, they get paid off, and then land a juicy role elsewhere in the NHS or related bodies.
Here endeth the rant.
My understanding of the process for building new hospitals under the Public Private Partnerships (PPP) framework is:
1. Developer selected from various bids submitted and given contract to build hospital.
2. Developer buys land and builds hospital.
3. NHS Trust enters into a contract to rent the hospital from the Developer for a period of between 50 to 100 years i.e. the Developer becomes the NHS Trust landlord and the Trust doesn't own either the land, the hospital or any other buildings built on that land.
4. NHS Trust goes into deficit because it cannot afford to pay the rent and run the hospital as well.
I daresay that buried in the lease contract there will also be a provision somewhere that if the hospital is in arrears to the landlord and certain Government legislation has been enacted the landlord can take back possession of the hospital and assign it to a privately run organisation more likely to be able to pay its debts. Such as an American healthcare provider. After a hard Brexit. Probably.
Having trudged through all the comments to this piece, can I thank this correspondent for reading what was said and understanding the implications (unlike nearly every other comment in this thread).
If this set of policies gets anywhere near reality, then this is the first time (that I can recall) that Government is seriously contemplating setting out (or nailing their colours to the mast of) a set of data interchange standards - rather than mandating this company or that software.
This is, of course, what they should have done this the first time around. By defining data interchange formats and the data to be transferred, it really could open up competition and innovation. This is what Government should be doing, not picking and choosing software for the clinical users.
Existing players will be dragged (probably kicking and screaming) into compliance and they will have to shape up or go under. Having seen the lack of capabilities and UX design of some of the "market leaders" in this space, I can only hope that some enterprising SMEs will take the incumbents on and show them how it should be done.
P.S. NHS number as a unique key - who'd have thunk it?
All trusts and Clinical Commissioning Groups will have the “freedom” to buy whatever they like,
They can buy whatever they like?!?! Strange decision, I would have thought standardising on the same kit would be better from a support and development point of view. Unless they want trusts to think they have at least some freedom.
...But not IT driven by alpha-medicos. Systems experts can do a really wonderful job spotting the diligence bottlenecks, opportunities for auditing and so on, but that is dismissed by expert doctors trying to carve out a simplistic niche for themselves. I don't go to a programmer to have my gonads stretched so why do lead clinicians think they are fit to design IT systems.
Medical mistakes run at about 25 a day, that's just the fatal ones, and there's lots of information in the IT system to show where the hotspots are... except the model for clinical goverance in the NHS is not fit for purpose so using it is a non-starter. The model for 'management' in primary and secondary care is also crap, so good luck there.
Just follow Canada with their recent legalisation thing.
Then no one would be particularly bothered about brexit or anything for a couple of decades.
Granted, whoevers left will probably be cripply paranoid, but upcoming generation boring might disdain weed as they allegedly disdain alcohol, so maybe they can take over in a decade and a bit.
From what I remember of it last time the biggest issues to me seemed to be:
The various GP/hospitals weren’t forced to buy into it. As it wasn’t mandated they weren’t interested in signing up.
The software companies making the healthcare systems needed to make complete rewrites that couldn’t happen in any realistic timescales.
There were multiple software vendors used by different GPS/hospitals, which was great for competition, but was a nightmare to integrate into something that large.
I remember working on it and being proud of what we were trying to achieve and dismayed how bad it became.
Based on UK government track record in (mis)management of this "grand plan, Stan", I'd say:
1. 10 years behind schedule;
2. £25 mil over the budget;
3. 80% won't work; and
4. 90% of what is required isn't there
I have one important question: Where is the UK government pulling all this found from? I mean wasting money is one thing. Wasting more money for the same project which wasted previous money is just too darn stupid.
Yet another "Cunning plan."
The fail is strong in this one.
You'd think that with an impending Brexit training more nurses and doctors in the UK might be quite useful. Y'know, reducing dependency on foreign nationals (I seem to recall that was one of the wishes that (some) Leave voters thought it was all about*)
*Instead of keeping the parliamentary Conservative party together and smoking the kippers,
I am ashamed to say this 'what rhymes with Prat, Matt?' is my constituency MP. I can't say he represents me, or the constituency, because he doesn't. He was parachuted into a safe seat by Tory Party grandees, and given this ministry to cut is milk teeth on.
He is a dork of the first order. A full bloded dyed in the wool lesser spotted Oxford PPE career politician who cares nothing about the country, only about virtue signalling his way to high office, a secure income stream and the ability to send his kids to expensive schools to be part of the next generation of elitists.
But as Theresa May's disastrous career* proves being a dork and an outright pill of the first order and utterly incompetent is in fact exactly the sort of qualities that will get you appointed to the top job, because in the end you job is not to be a visionary, a leader or to formulate policy, your job is to stumble along and make such a mess of it that people will cease to bother and the deep state can do what it does without being bothered by little details like democracy.
Matt will make a total pigs (r)ear of it, if he for one moment believes that implementing it is actually his job.
But he will emerge unscathed and go on to Lead The Country - probably into a sinkhole.
*Career: Verb, To move swiftly in an uncontrolled way.
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