Instead of paying through the nose or consultancys
That money could have paid for a lot of hookers
The end result would have been slightly better if not too dissimilar
MPs doubt that the Health Secretary's plans to make the NHS paperless by 2018 will be on time and budget, based on Whitehall's shambolic handling of the abandoned electronic health care record system. The widely derided National Programme for IT (NPfIT) was first signed off by ministers in 2002 under the previous Labour …
These reports are always the same, they go on about the whole system being a failure and just point to it being an electronic records system.
There's a lot more to it than that:
Having seen the imaging system in use when I took my mother to A&E it is a lot better than waiting ages for film developing. The images can be retrieved quickly from anywhere.
"Having seen the imaging system in use when I took my mother to A&E it is a lot better than waiting ages for film developing. The images can be retrieved quickly from anywhere."
You can have digital imagery without spunking £10bn on a centralized storage/sharing system.
As many other countries in the world do.....
As a sysadmin that makes a living building networks for "digital imagery", it is not remotely as simple as you might think. Even a small setup for a dentist with two locations is stupidly expensive. Trying to get enough capacity, bandwidth, redundancy, metadata sorting, automation, security, etc for all of the medical imaging in a country of 60M? Including the text records?
Yeah, you know what? I can see getting into the billions.
Isn't the capacity and bandwidth issue really a reflection on the available infrastructure; not the imaging technology?
From an outside perspective it looks like a shitload of money has been wasted on a system which never materialized when that money could have gone a long way to providing decent infrastructure, that everyone benefits from directly as well as reducing the cost and complexity of the imaging system.
Big spend to compensate for poor foundations is a really, really bad idea. No matter what field your're in. I guess it doesn't really matter in this case though since they can't get the infrastructure expansion programs right either.
Visited a hospital while abroad (in the EU) and they had a good imaging system which had cost them a lot, lot less than 10bn, in fact less than 10 million. The images were on the doctors screen by the time I saw him which was about 5 minutes after I was on the scanner.
I got a free copy on CD and the copy included software to help me look through them and understand them..... all pretty cool for a geek!
Hell, my dogs and horses get complimentary non-proprietary digital copies of their internal images. I'm absolutely certain my vets didn't pay millions, much less billions, for that.
The technology is very common in the equine veterinary field and I would venture to say, even higher quality than that used on Humans. The big whole animal machines are certainly quieter than the big thumping, whirring things they make people use. Lots of vets can view the imaging in real time over IP so your trusted vet can make a diagnoses if the animal is far away. It's a nice setup...
It only costs so much for Humans because somebody (customer/taxpayer) is getting fucked.
>"Hell, my dogs and horses get complimentary non-proprietary digital copies of their internal images. I'm absolutely certain my vets didn't pay millions, much less billions, for that."
This is true, but I doubt your vet has access to petabytes of image storage that is replicated in real time to a separate data centre in case of disaster, with storage infrastructure that won't allow accidental deletion of patient data because you would need the correct physical key from the storage manufacturer / vendor to do so. It's the redundancy and resilience that costs an arm and a leg unfortunately.
I should add that I don't think this article is referring to the imaging system (that's just one small part of the NPfIT that was actually delivered and mostly works) - it seems to be more about the steaming pile of cluster-fuck that the patient record system turned out to be.
@AC; were those images available to any doctor that took up your file across the entire country? What level of privacy and security controls existed?
Because if they managed that on $10M for 60M people, I'd be mightily impressed. (And did that figure include the construction of the datacenters, costs of bandwidth, what level of redundancy, non-imagery data, etc.)
I'd love to know who implemented such a system for $10M!
It didn't include sharing across the entire county as you don't really need to do that. Copies are available for the rare occasions where that's necessary (you get a CD or DVD which you take to the other hospital). The images were only shared within the hospital and a few outlying clinics. The kit went into the existing datacenters.
It's really not that complicated.
"Copies are available for the rare occasions where that's necessary (you get a CD or DVD which you take to the other hospital)."
This is an excellent idea that needs to be explored more. Allow the data subject to control their own data! The costs are small, compliance issues are minimised, and people actually control their own data and who has access and when!!
Of course, that is why it will never be considered ...
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My group will perform the work for 50% lower than the original price and build in no impact zero accountability for everyone involved. Other providers may offer you a less expensive price; but someone is going to have to fall on their sword when it is all over.
You don't want that to be you do you?
I'd have fucked it up for half that amount.
Remember to choose a really inappropriate framework for the bulk of it - something like PHP for example. Then you can charge a massive amount for extra work until the client finally gives up. The client of course got your friends in other consultancies to write the contracts, so despite failing to deliver you can still walk away with all your cash.
That's how it worked. And as I know someone who worked on the project, I can assure you that PHP was the framework of choice. That someone was also one of the most slapdash and lazy programmers I've ever had the misfortune to work with, but the (large telecoms) company he was working for on the NHS contract didn't seem to care.
Very true !
I manage the transfer of paper records to digital searchable format for a large department / over 150000 pages a month. We employ just 3 people to make it happen and all records are searchable within a few seconds on name, patient number etc
It's not rocket science but then we are not charging enough to duck it up.
However the issues with the NHS is one of arrogance, convenience and luddites.
After all we have been talking about the paperless office for deacdes and no commercial business has acheived it; so why would a Public Service with no commercial incentive to do so trail blaze this issue. Especially one that has a history of having Change forced on it resulting it a concerted effort to undermine and resist the necessary Change.
It simply wont happen and we will look at another £10bn wasted and more public sector halfwits and government types walking away shrugging their shoulders saying "nowt to do with me mate".....not my fault.
Quite simply without hard Acoountability these guys should not allowed to have access to such funding at all; they cannot be trusted with just pocket money.
Whether its Government and Civil Service spending £millions with 1000's of suppliers of paper clips, pens, printer paper, light bulbs.
MOD buying choppers that cannot fly in clouds and fog, attack helicopters when they have not ticked the box for pilot training, building the SA80 rifle instead of buying the AR15.
Police forces this week being called to accoiunt for why the dont consolidate their purchasing power for simple equipment like boots, stab vests, handcuffs, cars etc.
Quiet simply Public Sector offers poor value for money and that is the principle reason Taxes go up to pay for their poor performance and value for money.
Bin the lot and start again...................
I agree with almost every part of what you're saying except the poor Public Sector value part. The private sector in every country (if there is a private sector) has a looooong history of 'maximizing' the value of the Public Sectors ignorance.
The way the Public Sector is positioned by leadership as the 'Great All Knowing Oz' makes it ripe for plunder. They talk big but don't have a high level of internal technical expertise, the Private Sector knows it. They also know the Public Sector can't come out and say "we don't know what we're doing", the citizens would hang them all.
A lot of this could be mitigated by having a strong internal technical competence that knows the business. Instead governments sailed their internal experts down the river and it is costing Billions to accomplish nothing. The outsourcing and contracting of key systems by States really needs to be reassessed. It isn't working well for anyone.
The NHS is a load of good doctors and nurses strung up by the beast of the NHS. I have no idea if hunt is a good man for the job or not but either way he can not win.
If we assume he is competent and determined to make a good system. And we assume he has a good/workable plan which would bring benefits to the NHS. And we assume he is not being shafted at every step by the public sector system how can he win? The gov was left no money but the NHS was left with a lame duck system. Tied to bad contracts he is in the pit dug by the last lot. And if he improves anything his party will likely be voted out and the next lot will claim credit (whoever that may be).
I dont see any good way for the NHS to improve because nobody seems to care where anything can be done. The front line can work as hard as they want but cant change anything and the people who can change things dont care because they got it cushy.
And we get to pay for it.
Isn't that the way of any massive institution? Doubly so for State institutions? Those in charge are inevitably assimilated into the machine, regardless of their initial intent or capabilities. The higher up a person goes within those institutions, the further they are removed from the purpose of the institution. The, pardon the phrase, 1% problems that apply only to them and their direct peer group become the focus of their efforts.
Another CEO, Director, Minister &c has an agenda and 'you' are part of that. You've got to support them or risk falling out of favor within your peer group. They don't have to worry about the mission of the institution, somebody below them is taking care of that. Your job is to 'keep the complex wheels of (x) turning smoothly', even if it may not be the most ideal solution for the mission.
Leadership is crucial but when things grow too large the individual, possibly good, leaders at that level have their own mission which, more often than not, does not mesh especially well with the mission of the institution. I prefer short term, issue specific leadership with public accountability for large institutions. It's when people have to base their decisions on a peer group to keep their job and not on the mission that things go to hell. That's how institutionalization happens :)
Not such a good idea. Then the civil servant gets a good bonus if the budget was overestimated and non at all if it was underestimated. So their negotiating skills wouldn't come into it.
I suspect that you'll find in this case that the contract is exactly what the then Labour government asked for.
It would have probably been better to let each health authority do it's own thing and give up on the idea of one system to rule them all.
"It would have probably been better to let each health authority do it's own thing and give up on the idea of one system to rule them all."
I was an "Engineer at the coalface" on this project. One of my jobs was to interface with the patient record systems at the individual trusts.
Some trusts had excellent IT departments, and I have little doubt they would have found a good solution locally. Others were absolutely wretched (We're probably talking about 25% being at each end of this spectrum, it certainly wasn't a small number in the awful list), there were a number that made very poor purchasing decisions and bought from small local companies. One in particular hard-coded the address they needed to connect to into the application, then lost the source code.
Would local have been better? I don't know, but I do think they'd have spunked just as much money up the wall - they'd just have done it individually.
I too was at the Coalface as you put it.
The primary cause of the contract failure could be put down to a NPfIT vision that was not fully supported by the SHA's let alone the Trusts.
When we started to engage the Trusts they were in the dark regarding the Vision, contract and the impact on them. we had to sell the Vision all over again to those Trusts; many of which had already made investments of commitments to local suppliers or some of the big players.
Then the "individual" who headed the negotiations for NPfIT left and the rest is history........
Big bang solution rather than implement and iterrate
Poor contract management on both sides
Scope creep of monumental proportions
Software solutions unproven and delayed in development
Trusts undermining the Vision and Contract as they had already made a local decision for a solution
Delays driving Trusts to dis-engage with the NPfIT programme
The lord god that is Clint Eastwood had a term for this "CLUSTERFUCK"
But hey, no harm...... no one died.........no accountability.......... wait for the dust to settle and try again next decade......
Government buyers tend to rely on a small pool of very large consultancies and accountancy firms to draw up contracts. The same consultancies and accountants that then bid for the work the contract's for. As a result, there are rarely any penalties in the contracts for f*cking up or walking away from an incomplete project.
If the contract and project managers in a commercial organisation had screwed a major project up as badly as those in the Department of Health have done, they'd have been fired. The same should apply in this case. The department's project sponsors don't appear to have known what the NHS needed, talked to the Trusts or considered patient requirements (medical privacy), so they should be on the exit queue as well..
Why should the NHS become paperless?
The paperless office has been touted since the 70s (maybe before) yet we all still buy printers and use paper every day. You can't tell patients that they will recieve appointments by email because some of them do not have, do not want or would be unable to use email even if you gave them it for free.
Some things like digital x-rays make sense but for other things it makes sense to use a hard copy.
All fine until you are taken suddenly ill on business at the other end of the country and the Paramedics and A&E docs treating the now unconscious you are unaware that you're allergic to some common medications and that your condition is ongoing, is chronic, and responds only to one of the less common protocols.
Lost your anti-psychotic medication on holiday? Good luck with getting a pharmacist to hand over some more without seeing your history of prescriptions.
It may sound far-fetched, but people can and do die from inappropriate treatment. It would be lovely if people only became poorly at home and the people with existing conditions never strayed more than ten miles from their GP's clinic, but the real world is a little more complicated.
The trick in all of this is to make sure that the right people can see your medical history at the right time without anyone else being able to see it.
My understanding of one of the key issues is that the government decided to go nuclear and build something completely brand-spanking new to be used nationally instead of the cheaper alternative of using some middleware to glue the wide array of already existing electronic record systems together, allowing practitioners to view 'foreign' records in a browser and providing an audit trail and ability to send updates back to the 'local' surgery for non-real time or even offline updating depending on the system.
Once a middleware solution was in place it would then have been an easier task - if it was even needed - to replace legacy local systems when convenient.
@Anonymous Coward - Wednesday 18th September 2013 15:28 GMT
"All fine until you are taken suddenly ill on business at the other end of the country and the Paramedics and A&E docs treating the now unconscious you are unaware that you're allergic to some common medications and that your condition is ongoing, is chronic, and responds only to one of the less common protocols."
...all fine so long as said paramedic/A&E actually know definitively who you are, which might not be possible it you are unconscious under the back of a bus! If you are highly allergic to something or have a serious medical condition, some sort of medical bracelet/tag would be far better (and also will work in other countries).
"The trick in all of this is to make sure that the right people can see your medical history at the right time without anyone else being able to see it."
But this will never happen - you medical record will be sold to the highest bidder (with the plan already in place) and PCs/fondleslabs will be left with default/open passwords allowing anyone access.
Once you let the (electronic medical record) genie out of the bottle you will never get it back!
a couple of billion here, what's the big deal?
and, by the time they've got an accurate figure (naively assuming they will EVER get a remotely accurate figure), the 10 billion will have mushroomed to 25 billion. Oh, well, like I said, pocket change.
And on a different note - it must be applauded, as remarkable effort to to keep it in line with just about every major (multi-billion) gov project with a "digital" label - a failure. Well done!
Anyone been to the new QE hospital in Birmingham. Billions spent - at one point it was the largest civil engineering project in Europe. Less than 3 years old ...
1) No step-free access from the car park* to the hospital. Wheelchair users (of which there are a lot, considering ITS A FUCKING HOSPITAL) have to use lifts.
2) In most wards you can't completely pull the curtains round, as the rooms seems to be 4cm too small. The tracks have to be bent around one another
3) Most corridors where the consultants work are too narrow to get a wheelchair past the chairs in the corridor if anyone is sitting in them
4) Several sets of symmetrical doors which a wheelchair user needs to open *both* simultaneously (if only someone had an idea of *a*symmetric doors with the wider half being big enough for a wheelchair.
5) Most checkin desks are full height. Anyone using a wheelchair is unable to be seen, or have space to write
Hardly little niggles. And that's what I have seen in 3 visits. God forbid I got a chance to go backstage !
*The car park layout is the pinnacle of fuckwittery. For reasons known only unto God, they appear to have permanently closed the exit to one side, forcing all traffic to exit through an exit the other side where the approach to the exit cuts the main route to circle the car park. The result at peak times is traffic simply can't move.
Everything you wrote re the QE is right, and more, It's the ultimate in brochure-based design, as far as I can tell.
Mind you the NHS didn't design or build it and whichever NHS person signed off the design was probably told just to sign it and shut up. Many of the snags were known in advance.
" it cost £627 million to build, taxpayers will foot a total bill of £2.581 billion – four times the actual cost of the hospital.
Gareth Duggan, University Hospitals Birmingham Foundation Trust spokesman, said: “The full unitary payment for the new hospital announced by the Trust in 2006 was £40.8 million.
“The cost in 2011/12, when the new hospital is completed, is projected to be £48.2 million. The difference is due to the application of inflation.”
Private firms nationwide are expected to earn £60 billion from NHS hospital PFI schemes over the next three decades, the Conservatives have said."
No I made that quote up but seriously that is effectively what he's pitching, isn't it?
Here's a notion, radical as it may sound.
Let's not have yet another reorganization/massive IT project/nationwide circle jerk for at least a decade
Let's find out why UK hospital death rates are the worst in the G7 and why that data is so sensitive that only the US is named on the list (perhaps because they have the best and are happy to be at #1) and find out how the UK system can not be the worst, especially for things like pneumonia for elderly patients for example.
I know, absurdly radical, not doing anything. ???
BTW NfIT supports keep mentioning the digital imaging system. It's meant to be a success story as it does allow "filmless" (to coin a term) viewing of various sensors, XRay, MI, Ultrasound, PET etc.
Note For these applications do you really want a "lossy" compression algorith that throws away high frequency (IE lone or small pixel cluster) data as "irrelevant" ?
That could be your only shot of a treatable condition before it grows too big to be operable or just tries to kill you.
That said I can believe that suppliers do make it balls achingly difficult to get an image out of their system, despite ever fairly simple algorithms giving 50% compression (BTW an X-ray image is roughly 2048x2048 at 12 bits, about 6MB uncompressed. Multiply by a 1000 beds and 1 year and the numbers do start to stack up).
The UK Gov will always fuck up IT projects when they go with closed source solutions,
really the UK gov needs to mandate Open Source where possible, at least then systems wont become obsolete easily...
it is not that hard or expensive to hire a few geeks to maintain a code base, as long as you have the code!
I'm quite sure it is just as possible to royally fuck up an Open Source solution as it is to bugger a Closed Source one.
Open Source is not the issue, the issue is in proper specifications, proper oversight and proper responsability. Apperently, there was none of that in this project - or any other for that matter.
Open Source is not a magic wand that solves all IT woes.
Just go to East Surrey Hospital. It is filthy, badly designed and a good few people I know won't go anywhere near it.
I was involved in an RTA last year near Dorking. I had the option of East Surrey, Epsom or Guildford hospitals. I chose Guildford.
I've seen enough of the inside of hospitals over the past few years because I have Leukaemia.
Some places are really well run. Others need wiping off the face of the planet. This is all down to the local management and not the NHS dictats coming down from central government.
Well, I think we all knew it was heading that way years ago. The nail in the coffin was Richard Granger's hardline approach to NHS contracts with stiff penalties.
It is also ridiculous to think that it was possible to integrate all of the disparate clinical systems for which the government allowed the NHS to 'go their own way' and procure their own systems in the name of decentralisation, empowerment and choice/competition. It's a disgrace that a national service of such importance has never had mandated software solutions that are used nationally and that are interoperable with each other from day 1. It is the government and the NHS that have failed, not IT.
The ridiculousness continued with the way the implementation was allowed to be derailed by politics and the top medical consultants (General Medical Council?) who refused to back any sort of integrated national IT system because it threatened their fiefdoms.
It failed because the government insisted on allowing the NHS trusts and clinics to do their own thing when they were clearly incapable and giving the job of trying to impose a national IT system to the NPFIT who themselves were also clearly incapable of running a project of such scale to any sort of good practice, efficiency and constraint.
The broadband project (BDUK) is going the same way. Councils have spent months/years and millions in just the tender process and signing a contract mostly with BT because their stipulation in the contract for companies that have a history of providing national network infrastructure really excluded everyone but 2 or 3 companies from bidding. Why we didn't just give the money to BT is beyond me. We would have more money to extend the reach to more homes and also be ahead of the curve. Instead, the budget is soaring and already it is now being estimated as finished in 2017 rather than 2015. Yet another failed public sector led programme.
Yet the blame for it all always rests with the 'overpaid' consultants and contractors as they are very convenient scapegoats. After all, surely the poor "low paid" public sector workers could never be blamed for any of it.
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