back to article For fax's sake: Medic chaos as e-Referrals system goes offline

Hospitals and GPs across England are resorting to fax machines in order to refer patients this morning thanks to IT problems resulting in the new e-Referrals system being pulled offline. The system is critical for GPs referring patients to hospitals and was supposed to replace the previous Choose and Book system. The new e- …

  1. Trollslayer Silver badge
    Thumb Down

    Can they NOT cock something up?

    No, you're right.

    1. John Robson Silver badge

      Re: Can they NOT cock something up?

      Viagra?

      It's the one cock-up they would inevitably avoid

  2. This post has been deleted by its author

  3. WaveyDavey

    Was never un-cocked before.

    Don't get me started on the referrals to hospital - it has been an utter shambles in Wakefield for a number of years.

    I have 2 kids with chronic, managed ear conditions, under an amazing consultant.

    So kid presents at scheduled audiology appt for hearing test. Audiologist says: Hmm, gunked up, possible infection, need to see consultant next door. But you cannot just do that:

    So, go home, ring GP, get appointment. Persuade GP *not* to treat (outside there expertise, consultant is a million miles ahead of them). Then persuade GP to request referral. Hospital *maybe* deigns to grant one, and if you are really lucky, it will be with the consultant who has been managing the case for the past umpteen years. If you are lucky. And then wait the 6-10 weeks for the referral appointment to come round.

    Meanwhile, child (with hearing aids) can't hear their fucking teacher in class for ten weeks. Great outcome, Pinderfields, really great.

    1. Lamont Cranston

      Re: Was never un-cocked before.

      That's awful. I understand why you can't just drop in to see the consultant next door, but what is stopping the current consultant referring you on to his colleague (tertiary referring, as it's known)? Have you complained to the hospital/CCG?

      1. Warm Braw Silver badge

        Re: Was never un-cocked before.

        It's no longer allowed. All referals have to come from a GP because it's their budget that pays for it.

        Madness.

        1. Immenseness
          Flame

          Re: Was never un-cocked before.

          "It's no longer allowed. All referals have to come from a GP because it's their budget that pays for it."

          I think it is worse than that, it is a side effect of the target culture. There are guarantees for minimum wait to see a specialist, say n weeks. Having the target is meant to improve service, but instead of making the wait shorter, it tends to make the wait to a see a specialist more uniformly just under n weeks for everyone. No one wants to bust their figures, so they insist on going back to the start (GP) each time, where, coincidentally, the clock gets reset.

          That way, if you need to see 3 specialists, it magically takes 3 * n weeks, and hey presto, all targets are met, and the politicians can crow about success, yet the patient waits 3 times as long. The law of unintended consequences once again.

          1. Kane Silver badge
            Thumb Up

            Re: Was never un-cocked before.

            @Immenseness

            Sounds like a perfect example of perverse incentive to me!

        2. Lamont Cranston
          Unhappy

          Re: It's no longer allowed.

          Decent commissioning should see it classed as Follow Up activity, but I'll eat my hat if tertiary referring really has been stopped just because CCGs don't want to pay for it!

    2. Anonymous Coward
      Anonymous Coward

      Re: Was never un-cocked before.

      Did you try waving a credit card under the conslutants nose? I've heard it can work wonders in some parts of the Health Service. When my wife was having a severely limiting back problem looked into, she was told "6months wait on the NHS, or the same people in the same place next week, if you pay up front". You're going to have to get used to it soon enough anyway now Cameron's back in.

      Basingstoke Hospital, but I don't suppose anywhere else is much different.

  4. Destroy All Monsters Silver badge
    Holmes

    Hmm... socialized and centralized healthcare

    Permanent trainwrecks we can believe in!

    Amazingly I have never had my plumber refer me to my glazer (though even so both are under the privacy-and-trust-eroding regime of "VAT" taxation). How is that?

    1. Doctor Syntax Silver badge

      Re: Hmm... socialized and centralized healthcare

      "I have never had my plumber refer me to my glazer"

      OTOH I have had my joiner refer me to my painter.

      1. launcap Silver badge
        Happy

        Re: Hmm... socialized and centralized healthcare

        > OTOH I have had my joiner refer me to my painter.

        "Twas on the Monday moring that the plumber came to call.."

        1. Anonymous Coward
          Anonymous Coward

          Re: Twas on the Monday morning the GASman came to call.

          Option 1: As designed:

          https://www.youtube.com/watch?v=zyeMFSzPgGc

          Option 2:

          Upraded with extra Playmobil: https://www.youtube.com/watch?v=mOA_SUKEZRE

          Option 3: both of the above.

          301507181612

  5. Sir Sham Cad

    Pure speculation but...

    From past experience with system migrations such as this, yes the demand would be well known. However it almost certainly also involves a change of platform so the translation of demand to back-end load isn't so well known. The usual method of back-end compute provision in my experience from these 3rd parties is they'll under resource, hope they get away with it and add more grunt if necessary later.

    No, I don't know why full load testing wasn't done either.

    Glad I'm not on the phones.

  6. Uberseehandel

    Entirely Predictable Outcome

    Some years ago I considered releasing an application for use by clinicians in Britain. I have developed a number of health systems in the past, both at the national level and at the (large) hospital level. But none of this prior experience was in Britain.

    Having ascertained that there was both need and demand for the application, it was still prudent to check what was going wrong with Information Systems in the NHS, before spending any real money.

    In a nutshell what I found was that several key projects were in process, but the working parties were predominantly staffed by all the doctors, nurses, surgeons, pharmacists, librarians, administrators, midwives, academics (you get the idea, this list could fill several pages), who were so terminally useless that their involvement in an IS project would have no impact on current healthcare operations.

    The respective project managers were of the passive process variety, going through the motions and not differentiating between those notions which were batsh1t eatingly stupid, complex and off the wall. and the needed sensible, useful and simple applications that could be augmented in the future. At no stage were the participants shepherded back to the real world.

    So a an application to handle prescriptions became a medical order system (sensible), and then somehow metamorphosed into a knowledge based best practices behemoth, which would never, ever work, for very obvious reasons. When it came to prescribing drugs, the processes described were more involved than those involved in getting approval for the drugs in the first place. But somehow there was no alert system considered to pick up on potential prescription drug interactions.........

    All the other systems I examined were equalling discouraging. The health record system was designed to "leak", and appeared to have been sketched out by a group with a background in .public safety and a taste for data matching.

    I actually attended a "summit" that was discussing health systems in the NHS, and was horrified when in a general session, the response to my tongue in cheek remark "a billion pounds isn't what it used to be", was a great deal of sage head nodding from all on the platform.

    As I contemplated the differences between what was, and continues to occur in Britain with what I had experienced elsewhere, I decided not to continue the project. Had it been developed, it would also have handled the current failing referrals project.

    I know I am not alone in fleeing abroad when presented with the need to see a doctor for anything more serious than a signature on a piece of paper.

    1. Anonymous Coward
      Anonymous Coward

      re: The health record system was designed to "leak"

      Please do tell us more about this, in as much detail as you can get away with?

      1. Uberseehandel

        Re: re: The health record system was designed to "leak"

        Well, as far as the"individuals module" was concerned (that wasn't its actual name), one of the tables was set up to store VAT numbers, passport numbers, individual tax numbers, National Insurance numbers, and a host of other information used by the PNC and useful when setting up mammoth data matching projects, and it was all structured in a way that would be very convenient for outside access. This made me feel very uneasy,

        All the data models and project documents were in the public domain. I applied for an account and received access by return. They were seeking to record information that I, as a long term non-resident, was unaware even existed.

        When setting up a National Master Patient Index in another country, it became apparent that in order to maintain the integrity of Public Health, and Public Health information, all data had to remain confidential, even when illegal immigrants and overstayers were being treated. I think we ended up agreeing that exceptions would be made in the event of people presenting with gunshot wounds, otherwise all requests for information from outside the medical sphere would be stonewalled. Without this we never would have kept on top of some nasty TB problems. In Britain today, both TB and AIDS/HIV are concerns in some recent immigrant groups, if these people do not trust the health service, these issues will become significant problems.

  7. Christoph

    "We will continue to update users regularly, and are sorry for the inconvenience this has caused"

    Could we please have just a trifle more than the standard utterly meaningless managementspeak when it is peoples' health and lives that are affected?

  8. Anonymous Coward
    Anonymous Coward

    HSCIC this could be interesting....

    HSCIC the same people messing up Care.Data.

    I have an explicit letter in my file at GP and Hospital that NO records are to be shared with HSCIC this is due to the Care.Data sharing issues. and liking my illusion of privacy.

    so now they wont be able to do a refferal as doing so will be in breach of my specified data protection rights.

    so now cant get a refferal, Cant be sent details of cancer screening ( http://www.theregister.co.uk/2015/01/28/caredata_optouts_mean_no_cancer_screening_invites_nhs/ )

    slowly so much will be handled by the HSCIC and their external contractors that you wont have the ability to use the NHS unless you agree to have your data shared on page 1 of a national red top tabloid :-(

  9. damingo
    FAIL

    System offline message....

    Firstly the website for making appointments has a failed SSL Cert. But more entertainingly if you take a look at the source code for the "Sorry were offline" message (https://www.ebs.ncrs.nhs.uk/) you can see that it was written using Microsoft Office!!! I bet they charged the NHS £££ for a "specialist message displaying system".

    FAIL.

    1. Simon Crowe
      FAIL

      Re: System offline message....

      Who does their testing ?

      1. Surely not beyond the whit of man to have an alpha test site on line and purchase load testing services or even rent time on AWS ?

      2. Click on the language link on the first page on the page above

      shameful

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