Health secretary Matt Hancock assembles brains trust: OK, guys. Let's cure NHS IT Health secretary Matt Hancock's tech brains trust met for the first time today as the UK government revealed the people it hopes will come up with workable ideas to fix the NHS's creaking IT systems. The so-called Healthtech Advisory Board's goal is to help Hancock and the various public servants tasked with overhauling the …
Indeed, he spoke in favor of HSCIC data sharing, on the basis that sharing genuinely anonymised data could lead to improved research and health incomes, then found out it was more a system for selling poorly anonymised data to all and sundry and started campaigning against it.
I've only had a little bit of experience with IT in the NHS but got a little bit of exposure to both ends - the very simple kit on the ground and the unfathomably complex systems in the background. For me the only way is for the NHS to grow a pair and start developing in house. It will take strong management... ah, there's the problem, OK forget I spoke.
If they want a decent team rather than what's left-over by the private sector, they are going to have to work out how to pay a them something like market rate and benefits rather than offering poorly remunerated jobs with good pensions from which it's difficult to get sacked, and mediocrity flourishes. The senior end of such a team will be commanding similar salaries to senior doctors.
I suspect, that increasingly, software will be a major part of how heath-care will be delivered - as important as clinical staff. Recognising this, rather than treating it as a business service, will be necessary.
For me the only way is for the NHS to grow a pair and start developing in house
That would be nice, I just don't see it happening. There is a world of difference between how the private sector operates and the public sector.
Just pushing a working product to market of significant complexity requires a lot of money, risk of failure, not to mention how the staff end up working crazy hours to get something out the door and of course receiving 'incentives'to work like that. Of course there are NHS staff that put a huge number of hours in but that's generally to help people on the frontline, not build some IT solution, to give away to other NHS trusts.
"It will take strong management... ah, there's the problem, OK forget I spoke."
You're right though. The only thing that will sort the issue is someone in charge who knows what they are doing and is given the power to get on and do it, without political interference.
Oh, and yes, since you ask, the sky is green on my planet :-)
According to her website, Nicola Blackwood has the medical trifecta of Postural Orthostatic Tachycardia Syndrome, Myalgic Encephalitis and Ehlers Danlos syndrome.
These are uncommon diseases so it seems very unfortunate that one person could have so many.
She was chair of the Commons Science select committe which is a disgrace - surely with 650 MPs they could have found someone with a credible scientific background.
More proprietary vendors dropping in incompatible boxen with ripoff support needs built-in. >sigh<
I know, how about starting with a schema/framework standard for the secure storage and interchange of personal health data. Then any fool can buy any box as long as it implements the standard properly. Why, you could even >sharp intake of breath< "publish" the schema in the public domain and >catch that bureaucrat as he faints< solicit comment.
"I had a dream last night" — John B. Sebastian
Great, that's much less work. Now "all" you need to do is set up a data exchange hub, and publish a list of standards it will accept. (The choice of standards would be mostly dictated by "file formats that can be securely and reliably validated".) Make it available, and this is the killer, for free to all licensed medical practitioners and centres.
It will probably become evident quite quickly that there are requirement gaps that the open standards can't cover, and then the body may turn its attention to sponsoring the development of new standards to cover those. But there's no reason why it can't start right now with what is already available.
We've got open standards coming out of our ears already (HL7, FHIR, openEHR to name but a few) - a few less standards would be a good start.
Having worked in the NHS IT arena, and specifically with data, this 'lighter touch' is a good move, as long as it progresses properly.
From what I'm seeing, it's more that there will be enforced open standards of interoperability (so results from one system will be guaranteed acceptable to the inputs of another, with the guaranteed existence of mandatory fields).
This, if mandated, will really help avoid lock in to proprietary systems (especially suites of systems, where you buy one, then have to stay with the vendor for the rest, and have no idea how to get data out of it apart from a clunky web interface with no simple export).
All for leaving local IT to do what the local Trust needs, but setting some standards in stone across all Trusts for data exchange sets the groundwork for joining things up properly, while allowing each place the flexibility to optimise for local conditions.
Wouldn't say I'm sold on it all, but it's an interesting development, and far from the "Bang the head repeatedly on the desk because of sanity overflow due to listening to the sheer stupidity being spouted" condition that was prevalent when the NPfIT of old was proposed (with its timescales).
Having worked in the NHS IT arena, and specifically with data, this 'lighter touch' is a good move, as long as it progresses properly.
Having some considerable visibility of how CCGs and "provider trusts" work, I would expect giving them greater freedom to result in nothing but problems, due to poor management with low transparency and accountability, mixed with poor management knowledge of IT (and often of all things medical), and too often either political appointees or golf club networkers.
In the NHS we have an unfortunate half-breed system that brings out the worst of localism and centralised management (the police are similar in this respect). I really can't see any fixes, other than completing the original half-job of nationalisation and making GP's salaried, managed and accountable employees, and the entire NHS managed centrally, identifying local needs on a data-led basis (thus excluding the malign influence of local government interferers and all the snout in the trough CCG and trust directors). And even then we still have the problem that central government can't run ANYTHING properly.
> clunky web interface with no simple export
There’s a reason for that. The suppliers know NHS IT procurement is naive so they only sell a web front. They can charge more for “integration” with other systems.
The main reason NHS IT is a mess is because patient data is under control of primary healthcare providers; the general practitioners. Until patient data is wholly owned and controlled by patients themselves we can never have multiple operating models, such as gp->consultant, independent service provision, hospital@home.
Anyway, hospitals are just hotels with attending physicians. Best to separate out the services.
It's the usual sort of self serving well remunerated execs who can spout the usual mission statement bullshit that loosens the purse strings held by clueless politicians. Until they get truly independent tech experts with no agenda of self promotion other than wanting a fair reward for having led real world successful projects in the driving seat, and being given enough freedom to do the same for government projects without interference from narcissistic politicians, continual failure and waste are inevitable.
But every time I see a new Tory Health Minister trying to come up with another great plan to 'save' the NHS, I am reminded of this cartoon from Steve Bell.
It'll never happen, unless its going to benefit the Hospital PR (where I had experience) it won't get the backing. It had PR backing until it actually came to putting £££ where the boards mouth were, then it died a death it seems...... So until then data theft is still a major risk to patients and their data by swiftly removing paper notes from the hand push trolleys!
I rate Goldacre. Brilliant author, if you've not read bad science stick it on your Christmas list. But getting him involved seems more of a PR exercise based on his twitter posts than anything else.
Seriously tho... what the f*ck is this? No real IT experience. Goldacre would probably make a decent chair... i bet he'll ask awkward questions and cut thru the BS. But have any of these people had any experience in running IT services? Anywhere? Let alone in the NHS? Any proper operational experience?
Agreed. This committee (they might call it something else but it will just be the usual talking shop) will be the usual waste of NHS time/money as they don't seem to have realised that the NHS is still stuck in the 20th century as the world's biggest buyer of fax machines, they hate people sending them e-mails (my wife has just been given a 65 character e-mail address to respond to re. an appointment), they still can't send notes electronically from one surgery/hospital to the next on a reliable basis and they're still running XP all over the place (saw an example of this on a laptop at Kings College Hospital in London a few months back).
There are simple and relatively cheap solutions to the above (and other similar NHS IT problems) that will be ignored because they're not "sexy" like apps so the culture of continued failure will continue because actually resolving the real problems is not as exciting as Matt Hancock getting his own app.
Re Ben Goldacre, he's very pro establishment when it comes to certain areas (e.g. nobody must question the results of papers if they're published in a suitably auspicious journal, see the NICE/PACE farrago that he refuses to even acknowledge as a problem) so I wouldn't hold out much hope there, especially as he's got no expertise I'm aware of in real-world IT.
Number of things.
Now bear in mind the NHS is one of he biggest orgs in the world. The fact that these are an issue is dammning for the people working in the NHS. No excuses.
Ome there are import technicla aspects that need looking at, namely interoperation./standards. The NHS centre should not be stipulating which application of what not to use. It *mus* be saying yo they interwork.
A lot of the problems with the boave have been mainly fixed with HL7. How Labours digital NHS failed when the bulk of the stuff was available, which the NHS pays money for is damming of the NHS as an organisation.
The other one problem, which is less technivcal and more orgnaisation - there's no point trying to automate a dysfunctional org where people ignore or are unwilling to use prcedures. No ammount of IT will fix that.
And before people star syaing 'O hhe Drs n Nurses are there to help pepole get better ..' They are. The bulk falls on the non clinician staff, which make up 50%+ of the NS employees. And the clinican staff have their part to play - NHS operates like a wierd ,expensive feudal system.
Consultnats are not Kings. They are paid employees of the NHS.
Publish open free standards, requirements (like data storage location and big data analytics management) expectations etc...
Make some data sources publicly available (obviously not patient sensitive data), more along the lines of the bus tracking information, or police crime hotspot information, which allowed bored keen coders to knock together websites in a matter of days that out performed those paid through the nose for by the government.
Create an app store for health organisations to buy from (maybe link into apple/ google for some help with this bit and the code review/ reputation management aspects, which i imagine would be a massive factor in launching the system)
Sit back and watch as everyone from kiddie coders to multinationals compete to sell you their apps on a per user or whatever basis...
and then let the healthcare providers buy the ones that fit their requirements the best... it wouldn't work for all of the NHS IT problems, but it would for some, and would definitely shake things up at the top of the market...
They were called that until the Government decided they should change their name due to the inclusion of the letters N H and S. They did a lot of good work before they closed down. However, MPs memories are short...
https://www.openhealthhub.org/t/nhos-closedown-the-final-straw/1385 and https://www.digitalhealth.net/2018/01/nhos-project-ending-after-legal-challenge
Some time ago, my company was supplying an expensive team of software engineers to a firm of management consultants ( who shall remain nameless) to install a real-time bed booking system in a London hospital. A real-time system was costing far, far more than an online service seemingly for no benefit to anyone and it's purpose was a constant cause of speculation amongst the team and was a complete mystery to all involved. As time went by, more and more engineers were thrown at the project to the point additional office space had to be found.
Eventually, our company became seriously concerned at the sheer size of the monthly cost of running the contract and our financial director was having to seek larger and larger amounts of working capital just to keep the show on the road.
Just why it had to be real-time and not online was never explained officially but it became increasingly obvious that some senior manager didn't actually appreciate the difference between real-time and online. Vast amounts of money were thrown at an increasingly vain attempt to implement the system, and at no time was any money spent on disaster recovery or even a robust backup system.. Towards the end, it had become obvious to everyone involved that what was required of them was impossible to achieve, and several representations were made to the management that the plug should be pulled, however these were ignored, possibly because everyone involved was making more and more money from the doomed project.
Eventually, the whole thing collapsed leaving absolutely nothing in usable code and a small mountain of unusable hardware. The strange thing was the seemingly inexhaustible budget.
Just as an aside, at the same time we had people working with London Transport to developed the London Underground train arrival boards that are positioned on the platforms to provide information for customers on the next train arrival time. This was not going well for all sorts of seemingly unsolvable ireasons until one of the team (who's name I believe was Maureen) had the somewhat genius idea of making a London Underground minute 90 seconds long, thus removing all the grief instantly. This is why to this day "two minutes until arrival" notice seems to take far longer than two minutes, especially as back then the 90 seconds was not fixed and could change according to circumstances.
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