NHS: Remember those patient records we didn't deliver? Well, we found another 162,000 NHS leaders have admitted that the biggest ever loss of patient documents is worse than initially thought, as another 162,000 undelivered documents have been discovered. The scandal was first revealed back in February, when the UK's national health service was forced to admit that 709,000 items of correspondence – which …
> Filing presumably means "put them in a box". If they are in a box already then not much left to do really.
Filing means putting them somewhere where they can be found again in the future. (Preferably by following an existing process for requesting those records, rather than opening every box and looking through.)
When I briefly did some NHS work around x-rays, back in the days when they were on film, consultants removing files and then leaving them in their car boot was the bane of the filing staff's lives.
"Oh, they're in the car boot - I can't possibly go out and collect them now."
"And will you say the same thing to me tomorrow?"
"Oh, they're in the car boot - I can't possibly go out and collect them now."
Best response:
"No worries, I have a crowbar here, be right back."
"... Yours is the Blue Fiat, right?"
Probably would've had them handed to you before you reached the door.☺
Last year I visited a doctor in my local death camp and as things were closing he 'reminded me' about an appointment I had for an MRI at 10:00 the next morning that I had not been told about. When I arrived home my wife told me that the hospital had rung to ask why she had not been for an urgent scan. At the scheduled time of the scan she had been asking the GP where her urgent appointment was.. no letter had arrived.
I played hell with them via a formal complaint while both my wife and I sorted out our appointments.
The explanation, a money saving venture using a new warehouse, oops sorry a new postal system was said to be the cause, a move I understand they decided to change.
The staff in the relevant test centres wondered why no had come for their tests so at 8 per day for a couple of weeks at a cost somewhere north of £500 a pop that was some saving, NOT!
My personal experiences with the NHS have been uniformally excellent and the staff friendly, helpful and competent (also underpaid, overworked and harrassed but that is a different discussion).
So, I am a massive supporter of the NHS. But sometimes they do make that difficult - oddly, frequently when forced into ill-thought-out "money-saving" ventures with for-profit companies with little or no understanding of the NHS core business.
Experience varies from trust to trust and GP to GP.
Te problem the NHS has is that modern healthcare involves a lot more than genile old GP listening to your chest with a stethoscope.
The 'easy' stuff in healthcare are sort of done - antibiotics, procedures, whatevers.
The hard stuff is coordinating it all - making sure appointments are correct and timely and well known, making sure resources are scheduled on time and use correctly, making sure patient X on dru X is not given drug Y, making sure a a a patient is tracked.
The latter stuff is where the NHS falls down massively, mainly as those skills and people are not 'clinical' so are paid like a typist.
NHS could have the best sugeical care in the world but it is pointless if the patient has not been told.
"The hard stuff is coordinating it all - making sure appointments are correct and timely and well known, making sure resources are scheduled on time and use correctly, making sure patient X on dru X is not given drug Y, making sure a a a patient is tracked.
The latter stuff is where the NHS falls down massively, mainly as those skills and people are not 'clinical' so are paid like a typist.
NHS could have the best sugeical care in the world but it is pointless if the patient has not been told."
It falls down because of chronic under investment, which has accelerated in real terms over the last 7 years. It falls down because gobshites in Government think they know best and decide to add layers and layers of management to the organisation to make it "efficient". Except, it doesn't run efficiently due to the management as nothing can happen until all those layers of management agree to it.
And then we have the "services" the NHS must put to tender to 3rd parties. Tell me again about the times a private healthcare company did something for the good of it's customers and not its shareholders?
@ wolfetone
"It falls down because of chronic under investment"
I struggle with that explanation. I keep getting told how the problems would be solved if they were showered with more money, except labour pissed money on them in great quantities that could not be sustained and yet they always demand more. Over the last 7 years the NHS has not got the ever increasing budget but has been kept with the investment from the greatest and longest boom in recent history.
However the NHS has money for a new IT system and training people months before it is deployed to ensure confusion and chaos. They also have the budget to hunt whistle blowers and PR about how wonderful it is. I am of course talking about the NHS and not the nurses and doctors who have to put up with this system.
"Except, it doesn't run efficiently due to the management as nothing can happen until all those layers of management agree to it."
Well said. Even under labour they were cutting nurses at the same time as hiring secretaries. The bureaucracy is a wonderful machine to slow everyone down. Such as the recent smart idea to ask our sexual orientation so they can track any discrimination issues. The same organisation I wouldnt trust to track a patients progress (they have failed a few times just for close relatives) wants to waste productive peoples time (nurses) with more paperwork.
"Tell me again about the times a private healthcare company did something for the good of it's customers and not its shareholders?"
Looked after my dad. Where the NHS failed and could have killed him because they dismissed him and his heart problem the private doctors saw him within reasonable time (within a week not in the next 2 month for a heart condition!) and gave him great care and performed the surgery before the NHS diagnostic appointment would have been possible to book. if you want to ask what they have done for their customers they kept my dad alive after the NHS failed him after his ride in by ambulance.
Here that's a perfect description of care from the Veterans Administration. I'm terminal & inoperable as a result of their care. Up in Seattle, the VA contracts out their health care for my Mom and sister and it's wonderful, so similar results government vice private care.
Tell me again about the times a private healthcare company did something for the good of it's customers and not its shareholders?
The only instances I can think of are where the company has gone bust due to massively misunderstanding the implications of its contract while trying to do it on the cheap (how else are shareholders going to maximise their return?). The service has then been taken back in-house by the NHS trust, usually (but not always) before they lost too much clinical expertise because junior surgeons no longer had any opportunity to learn their trade via the mundane knee and kidney ops before being able to advance to the more difficult stuff that wasn't outsourced.
No.
In terms of % GDP - if thats how you want to measure the NHS - then its middling or a development country.
In terms of outcome i.e. if they actually make you better then the NHS is poor, almost developing country level.
When you put in the unfunded pension cost than the cost of the NHS almost doubles.
The latter stuff is where the NHS falls down massively, mainly as those skills and people are not 'clinical' so are paid like a typist.
So, so, so very true. But try paying people who aren't "actually delivering patient care" a decent wage, or see the spend on that going up, and watch the howls of complaint from certain newspapers and every politician bar none about "wasted money on NHS bureaucracy"
"little or no understanding of the NHS core business"
In this particular case, however, delivering mail doesn't really need much understanding of NHS core business. It just needs an understanding of the words "deliver" and "mail". Even this seems to have been too much to achieve.
"or are not interested in doing so?"
Not to mention the basic security implications of trusting important things to easy electronic communications. From phishing emails pretending to be your doctor to the ease of which a patient could be bumped, whoops I mean rescheduled, by simply firing off an update email (as could fraudsters).
My basic policy is to disregard anything official looking that arrives by email. If it's important enough to matter, I expect to be duly notified on proper headed paper.
"Do IT professionals still need reminding that a significant proportion of the population are either not equipped to receive email and sms, or are not interested in doing so?"
I think you are looking down the wrong end of this problem. NHS staff shouldn't be using paper, all records she be entered into patient databases. If contact is needed to be made with a patient, their preference will be recorded in that database, be it email, SMS, or postal mail.
Short feedback of my experience with healthcare in Switzerland...
Everyone is obliged to buy private healthcare insurance, and gets issued an insurance card with a chip in. Every surgery, hospital , pharmacy etc can read that card and get some basic info off it. Every institution has its own records on each individual. There is no national patient record, and the system works excellently without needing this - the surgeries and hospitals send records to each other when needed, which is not that often that it create s alarge overhead, and certainly not enough to justify a massively complex, privacy-nightmare centralised system for all records.
Every surgery has at least one, usually many more medical secretaries who are extremely competent with all th epaperwork and IT systems without needing a lot of medical knowledge. Highly trained nurses and doctors are mostly doing nursing and doctoring, not too much paperwork (which is highly electronic anyway). Appointments etc are sent by post, test results may be copied to the patient and are sent to whoever needs to interpret the results. It all works pretty seamlessly.
Ah, I hear you say, but you have to pay for it and the NHS is free.... well, NHS is free at the point of delivery, but it's cost is raised form taxation. Here we pay for the cost ourslves (including copays) but the tax is lower and there are legal restrictions on insurance provision and cost that mean that poorer people or people with pre-existing conditions are covered without needing to spend too much.
NHS budget is 116.4 billion GBP, about 1800 per person per year or 150/mth, or about CHF200. Here the basic insurance is about CHF100 for kids and CHF300-400 for adults (women's more expensive than men's), around CHF225/person for a family of 4 - so not that much more expensive and (apparently, since I haven't experienced NHS first hand) considerably better.
Shock, horror, a properly regulated private market works better than a nationalised service (NHS) or an unregulated private market (whatever the US has)
@AC
I dont know why you are hiding behind AC when you have contributed such a good comment. In this country the NHS is a religion. The scary part is some people believe it is the best in the world and worse some people think it would be with just more money (not from them of course).
In this country anyone who questions the religion is told the alternative is the US. I keep pointing out that the only developed country in the world the UK looks down on for healthcare is the US.
Thumbs up from me.
"My personal experiences with the NHS have been uniformally excellent... etc etc"
So in other words, the frontline medical staff are good but their work is undermined by incompetent management / rubbish IT, and the powers-that-be seek to solve this by allowing the existing icompetent management to source more IT.
Hmmmm, I wonder if that will work?
As an NHS employee I completely agree, we need heads to start rolling for this sort of thing especially when I can investigate staff on junior grades who are then fired for misuse of computers etc.
Yet higher ups never, ever lose their jobs even when the mistakes are on a completely different scale.
*** He said that, as part of the work, the team had looked at whether clinicians had stuck to processes introduced in 2015 that intended to improve the transfer of NHS documents – and discovered that there were about 5 per cent of cases "where that hasn't been happening". ***
Ah, so once again it's all the clinicians' fault, and not the overpaid fuckwit MBAs at the top of the organisational chain?
Neither businesses nor public services can function when run by people who suppose that management is a portable skill requiring no knowledge of what's being managed. Failed businesses can sink, but services remain necessary. The NHS won't work again until it's run by people who understand healthcare.
It used to be said (and perhaps still is) that Rolls Royce (back when it was a car maker and an aero engine maker) went bust the first time because it was run by engineers who had no business skills or knowledge. And that it went bust the second time because it was run by businessmen who had no engineering skills or knowledge.
For all I know it might even be true. It certainly seems plausible enough.
"My personal experiences with the NHS have been uniformally excellent and the staff friendly, helpful and competent "
I've had good NHS experiences, medium ones, and awful NHS experiences. That's the trouble. You never know what you are going to get. Here is a very trivial example, three recent blood tests:
1. Nurse took a sample of blood so skilfully I felt no discomfort. Had I been asleep when she stuck the needle in, I probably wouldn't have woken up. She was also friendly and efficiant. Great.
2. Same surgery, different nurse. Talked non-stop about her holidays while wobbling the needle painfully in my arm. Afterwards I almost fainted, which might be unrelated.
3. Same surgery, third nurse. Friendly and efficient. Almost as good as (1). I noticed she ommited to wipe the injection area with alcohol beforehand, presumably slightly increasing my chances of an infection, but I didn't say anything.
Taking blood samples is trivial, but the same inconsistency happens in the most serious treatments. I could relate depressing stories of crappy "treatment" received by seriously ill relatives, but won't. Some will argue that poor NHS experiences are caused by lack of funding but I think that lack of responsibility and accountability plays a big part.
Put bluntly, the NHS, as a huge publicly funded body, lacks motivation to keep you alive, to treat you with compassion or to minimize your discomfort. Human nature dictates it. A private health company, on the other hand, is highly motivated to achieve all these things. But then, private health companies are also motivated by profit, which can lead to a whole different set of problems, equally as bad as the above.
Okay sorry about the lecture, I'll stop there.
> I noticed she omitted to wipe the injection area with alcohol beforehand, presumably slightly increasing my chances of an infection, but I didn't say anything.
I've done 'finger-prick' blood tests at least four times a day for the last 12½ years without pre-wiping the location with alcohol. Perhaps I am now dead?
"I've done 'finger-prick' blood tests at least four times a day for the last 12½ years without pre-wiping the location with alcohol."
The finger prick exudes blood which carries any micro-organisms out of the site which is protection measure that evolved a long time ago. Inserting a needle through the skin into a vein has the potential to carry anything on the skin into the bloodstream.
@Doctor Syntax
For most of my life, I too, thought it necessary to disinfect a site where an injection was given or phleb taken (it's taken by phlebotomists, so it must be phleb they're taking). I was told that it was necessary to kill commensal micro-organisms so they wouldn't get into the bloodstream. They might be OK when they're on the surface of your skin but they can be little buggers if they get into your blood.
However, for the past few years, when I've had a flu jab or phleb taken, they've not done this. Last year I asked why not and was told they don't do that any more because it causes some people discomfort.
Better to have your arm drop off than have an injection sting, eh?
"it's taken by phlebotomists, so it must be phleb they're taking"
I hope not. The "tom" is a bit of a clue that your phleb is being cut (The word atom was invented to name something that couldn't be cut any further) and a quick trip to whackypedia tells me that the phleb bit means blood vessels. I rather hope they don't take those.
I noticed she ommited to wipe the injection area with alcohol beforehand, presumably slightly increasing my chances of an infection, but I didn't say anything.
It used to be thought that was the case, but now it turns out that as long as the skin is visibly clean, disinfecting it doesn't make any difference for blood taking.
Every day hundreds of thousands of patients records, in paper-form, is transported around the country.
If you see a consultant, your paper records precede you.
Go into hospital?
They're there first!
They're not kept there either, after you get out, or die, they're transported to storage.
Complicating things now is the requirement that the same system has to provide the records to private healthcare companies outside the NHS.
And for those who think we're neck-deep in management, we're not.
Some 4.5% of NHS employees are primarily admin (1.3 million workforce (ish)), compared to a commercial company admin headcount of around 15%.
Lots of those are retiring...and getting new employees up to spec on a system heavily dependent on encyclopaedia sized volumes of paper records is hard work.
There are porters wheeling hundreds of KG of paper records around every hospital...every day....delivering them to wards and clinics. So got lost?
And you're surprised?
Wait 'til they're all digitised...then get lost in their entirety...
#hacking
Well, the current system is barely coping.
My other half had a private scan done on her neck, on referral, and the local NHS clinic manged to lose it. It was one neck scan and between two visits they could not track it. Oh well that's only 250 quid, so what.
The current system is archaic whichever way you slice it and only works because sheer of man/woman effort and knowledge which by what you say is disappearing.
Also why do you think humans are safer, a relative went through an agency with no real checks for a temp job and ended up in Tolworth having vast access to all kinds of NHS information, lots of Access databases, Excel sheets, the IT systems of the clueless.
It *is* possible to build software systems that are extremely difficult to hack and far safer than paper. Its just that vested medical interests are very strong and management keep trying to build large enterprise systems with people who have no experience building enterprise systems.
In a government operating healthcare system, people provide the government with all of their health information; arguably a lot more valuable and intrusive into one's life than many think. Yet, get absolutely mad upset about handing over a PIN to their phone.
Amazing.
Think of everything in your health records. Next of kin, employment, life choices, etc. Think about all the questions you get asked during a hospital or doctor visit. Sexual partners... the STDs you have, medication you take (which can say a lot), etc.
..yep, it's all in there, and available to your government when you have a health care system run by this government. Not only for them to abuse, but anyone else once it finds its way to Pastebin.
In the zone of a million? That's pocket change[1] for the Boris who still seems to think it'll be possible to throw nonexistent amounts of money at the NHS...
1 - £350M a week, divided by 24x7 hours, is a mite over £2M/hr, so dealing with the backlog will "cost" a mere half hour of imaginary finding.
Yep, it's definitely Still Broken.
Moved from North-West Kent to East Devon at beginning of July. Registered with local GP within a couple of weeks.
Old GP practice sent records off pretty much straight away.
New practice still to receive them. They're stuck with the 3rd party who does the transfer, apparently.
's alright though, since for my father in his nursing home (who has the same problem, compounded by his practice in SouthWest London closing at the same time he moved) I was able to correct them on the errors/missing info in his care plan.
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