back to article A fifth of England's NHS trusts are mostly paper-based as they grapple with COVID backlog, warn MPs

A group of MPs in the UK Parliament have called on NHS leadership to end an approach to health service IT that allows a fifth of NHS trust to remain largely paper-based. Reporting on efforts to clear the backlog in care caused by the pandemic, the House of Commons Health and Social Care Committee said NHS England, the …

  1. JassMan Silver badge

    So much for the Billions already wasted

    "The MPs also called for new levels to encourage the adoption of new computer systems in healthcare. It said the independent watchdog the Care Quality Commission should include an assessment of the integration of information technology between primary care, secondary care, and the social care sector in its assessment of NHS Integrated Care Boards — organisations with responsibility for NHS functions and budgets."

    If they hadn't decided they were going sell off all the patient data thus creating a public backlash, they could have implemented this twice already. Mind you, both attempts were probably so badly designed that only big business would have been able to extract data in bulk rather than doctors being able to see data for their current patient.

    1. GioCiampa

      Re: So much for the Billions already wasted

      Perhaps... just perhaps...

      ...if (successive) "Governments" hadn't wasted inordinate amounts rearranging (usually meaning adding to) the bureaucracy involved in running the NHS, we might have been able to get something workable sorted out. But no... just a giant game of (political) football...

      (Disclaimer - I work in a NHS IT department - so have seen the "reorganisations" first-hand)

      1. codejunky Silver badge
        Pint

        Re: So much for the Billions already wasted

        @GioCiampa

        "But no... just a giant game of (political) football..."

        I feel bad for you. I have family working in the NHS and it never seems to get better but they do find ways of making it worse. A new patient record system being the current problem being inflicted on the staff.

        1. Anonymous Coward
          Anonymous Coward

          Re: So much for the Billions already wasted

          Manchester by any chance? We’re “going live” with a new EPR later this year, still 80% paper based.

          The new EPR even has provision for paper record management to replace the existing HP-UX mainframe.

      2. LybsterRoy Silver badge

        Re: So much for the Billions already wasted

        There was an article on the beeb recently about the NHS and its !we can't cope - giz us some cash" mantra but it only went back to (I think) 2016. I'd love to see a study from before the introduction of management consultants to the present day. Having been a management consultant I think we'd see a steady decline after their introduction.

  2. Doctor Syntax Silver badge

    Ward-Grey and the committee seem to have forgotten that this is a government department and hence a government IT project they're talking about. Those looked after by paper-based trusts ATM are probably the lucky ones.

    1. Charlie Clark Silver badge

      That's only part of the story. The NHS, as such, doesn't exist. It refers to a collection of service providers (hospitals, doctors, dentists, etc.) and a central budget. For years, various governments have tried to impose IT from the top but this has usually met with resistance because the "IT" didn't solve problems. Covid 19 has shown just how well various parts can work together when the government doesn't interfere. NICE is another example of letting the professionals decide what's best.

      I've only seen things at great distance but any kind of centralised system has to been conceived and delivered as a service to the NHS and not the other way round. However, the usual suspects (consulting agencies, manufacturers, drug companies) have the better lobbying apparatus and usually win out.

      1. John Brown (no body) Silver badge

        "For years, various governments have tried to impose IT from the top but this has usually met with resistance because the "IT" didn't solve problems."

        As an employee in an IT company, I have sympathy with that. We also have top down management in relation to IT "improvements" that generally make our lives more difficult. So long as the big bosses get their pretty graphs and reports, and they are "better" than the ones they used to get, then that must be win for the company, yes?

        1. 43300 Bronze badge

          A lot of the "innovations" in IT now are primarily intended to increase the bottom line of major IT companies - especially via subscription services which it's increasingly difficult to avoid.

          I'm sure many of us on here are involved with administering a hybrid cloudy mess involving Microsoft's products. Is this an improvement on the on-prem systems, really? Can the staff actually work more effectively as a result of this? IT has become one masive gravy train for a few mega-companies.

    2. Rich 11

      Or probably not. I was in hospital just three days ago, an event which involved going from A&E to Radiology, back to A&E for treatment, then to Radiology for verification, and finally back to A&E for monitoring and discharge. At every stage either the department receptionist, a department nurse, the radiographer or the A&E doctor checked me in or checked my details on their computers. They knew they had the right record for the person in front of them because they asked a confirmation question such as my postcode, and if I hadn't been capable of giving that or my name they could have looked at my wristband. Compare that with the last time I was at A&E, fifteen years ago for a near-identical injury: then I had to carry several forms around with me at a time (and eventually a prescription), which quickly got disordered and crumpled, and the only things which were shared electronically were the x-rays.

      1. Yet Another Anonymous coward Silver badge

        Because that's one hospital.

        When the Hospital is in a different Health Service Group Service from the IT's Health Group Service Group and your GP and the specialists are in a different Service Group Health Group

        And all this is deliberate so it can be gradually sold off.

      2. sad_loser

        thanks for posting this

        It's good to hear that some things are going in the right direction.

        A lot of what you experienced is the result of good practice at a local level that the IT supports by enforcing good practice - doing the boring stuff well prevents major cock-ups e.g. checklist manifesto by Gawande.

        One barrier to progress that most people do not understand is that all the IT contracts are held by individual organisations, not the NHS, and this means that individual hospitals each pay the system supplier to do the same work (which is outsourced to low-income countries)

        1. Rich 11

          Re: thanks for posting this

          A lot of what you experienced is the result of good practice at a local level that the IT supports by enforcing good practice

          It is, and that's why I took umbrage at Doctor Syntax's piece of cynical ignorance, "Those looked after by paper-based trusts ATM are probably the lucky ones.". No-one thinks the broader NHS doesn't have problems, but most of those arise from the fractured structure imposed by politicians who think markets solve everything, and they are the blind ideologues and architects of disorder I hold in utter contempt.

          1. Doctor Syntax Silver badge

            Re: thanks for posting this

            I once, as part of a contract, did some work on an NHS project. It was clear that the data they held was properly structured. It was all to be passed to my client as flat records with several of the fields out of order concatenated into a single field which we then had to rearrange back into order. I pointed out to them that because some of their fields sometimes contained spaces we couldn't take spaces as implied record separators. After a bit of humming and harring they conceded the point. Getting the data in a sensible format seemed out of the question but they would add a flag to hint how it should be rearranged. The flag ended up with 4 values one of which, used in exceptional cases, indicated we didn't need to rearrange it because they hadn't deranged it.

            The project covered England and Wales. Part of the fun depended on deciding which national body contained the definitive version at any one time.

  3. Scott Broukell

    Dear NHS - Get well soon

    Once the envy of developing nations, now it appears the NHS has been put on an end-of-life pathway for some decades. I was once acquainted with a post-grad in the 1970s who was part of a team tasked with examining every last detail of it's structure in order to bring about massive changes, supposedly for the good, he once said to me (and I quote): "You won't recognise the NHS in ten years time".

    Well what I do recognise is that over a much longer time billions of public money has continuously been pissed away, by various administrations, without bringing about any tangible good and which appear to have only served "chums" and overpaid external consultants etc.

    As difficult as it is to accept, I take the view that a high class public health system, such as our dear old NHS, requires a continuous and quite significant level of public taxation in order to both fund it sustainably and to develop the staff and systems (IT etc.) in an effective manner going forwards.

    All that would appear to have taken place is an endless waste of significant public monies on successive 'sticking plaster' measures which just cannot be expected to hold the whole thing together, but which successive administrations parade as splendid fixes.

    And who is left to actually hold the thing together, day in day out, the beleaguered staff! (on all levels), who soldier on and who continuously have to find workarounds in order to keep the ship from sinking!

    I feel that the repairs need to be driven from the inside out, properly costed and transparently examined by experienced auditors and with tangible, meaningful, input from staff who have worked at all levels of the NHS coal face, not from top-down directives fed by highly paid external consultants.

    So going back to that post-grad with whom I was once acquainted, I mean he appeared diligent in his work and honestly dedicated to the idea of making things better, but I do have to wonder about the quality of the data he submitted and about the quality of the decisions that were based upon that data.

    1. Rich 11

      Re: Dear NHS - Get well soon

      We all know that politicians don't make decisions based primarily upon data.

    2. tin 2

      Re: Dear NHS - Get well soon

      I agree with you entirely. A fact I was introduced to a couple of years ago, and have had cause to check again recently that I wasn't horribly mistaken is that the NHS costs, from the public purse, per person, LESS than healthcare in the US.

      Again: from public funds in both cases. That's before any insurance, deductibles, bankrupcies, gofundmes and ofc loads of people actually not being entitled to treatment in the states.

      They're paying more per capita in taxation for healthcare than we are, and ours is ostensibly "free" at the point of use.

      If one sits and thinks about that and what it means is going on, it's utterly mind boggling.

      1. John Brown (no body) Silver badge

        Re: Dear NHS - Get well soon

        On the other hand, so long as your health insurance is up to date and full cover (expensive!) then you can walk into your doctors, be diagnosed, have a CAT scan same day, and be booked in for surgery, possibly also same day.

        In general, in the UK, unless they happen to spot something that is a matter of life or death, you just get added to the ever lengthening waiting lists. But at least that applies to everyone (unless you "go private") whereas in the US, if you don't have insurance, you may be lucky to get treated at all.

        1. Eclectic Man Silver badge

          Re: Dear NHS - Get well soon

          Yes, sort of. In the UK you only start to worry when the NHS tells you that if you haven't heard from them in two weeks, you MUST get in touch to find out what is going on.

      2. Eclectic Man Silver badge

        Re: Dear NHS - Get well soon

        Regarding UK vs USA spending on health. I recall that the USA spends vastly more ( about twice, perhaps ) than the UK, and has an average life expectancy of around 5 years less. And yet many USA politicians claim an NHS style health service in the USA would be too expensive and cost lives. One politician even claimed that had Stephen Hawking been born in the UK he would have died because the NHS wold not have treated him. Hawking corrected him on both counts.

    3. Anonymous Coward
      Anonymous Coward

      Re: Dear NHS - Get well soon

      If the NHS was as good as we like to kid ourselves it is, it would have been copied around the world. It hasn't, because it's generally seen as a model of now not to implement single payer healthcare. Ask any NHS employee and they'll tell you stories of waste, inefficiency, greed, endemic poor management and corruption.

      1. Rich 11

        Re: Dear NHS - Get well soon

        Ask any NHS employee and they'll tell you stories of waste, inefficiency, greed, endemic poor management and corruption.

        Show me a large organisation which doesn't have that.

        1. codejunky Silver badge

          Re: Dear NHS - Get well soon

          @Rich 11

          "Show me a large organisation which doesn't have that."

          Being such a large organisation might be the problem the AC is pointing out. The NHS being one of the largest employers in the world, the largest employer in Europe and it still complains about staff shortages and uses fax machines.

          Its so world beating we look down on the US healthcare (that looks down on us) but no other developed country. Such an envy of the world that other countries have no interest in copying it.

  4. Pascal Monett Silver badge

    "improve productivity in an organisation severely short of staff"

    Well maybe one of the first things to do would be hiring more staff ?

    Once you have enough people to deal with the day-to-day, you can start thinking about optimizing.

    As usual, government is dealing with things ass-backwards.

    1. localzuk Silver badge

      Re: "improve productivity in an organisation severely short of staff"

      Problem is, it takes years to train all those staff up. So, it isn't so easy hiring new ones - you've gotta get them to do the right courses first.

    2. Cederic Silver badge

      Re: "improve productivity in an organisation severely short of staff"

      The world's eighth largest employer is not short of staff, severely or otherwise.

      https://en.wikipedia.org/wiki/List_of_largest_employers

      Whether those staff are competent, productive and needed is a far more relevant question, the answer to which is only ever occasionally 'yes'.

      Perhaps addressing the 47.2% of the NHS workforce that aren't in a clinical role might free some of the ever increasing NHS funding to better support healthcare outcomes. Seriously, we really don't need (yet another) £90k/year Head of Diversity and Inclusion (to cite just one vacancy currently being advertised).

      1. Yet Another Anonymous coward Silver badge

        Re: "improve productivity in an organisation severely short of staff"

        >Perhaps addressing the 47.2% of the NHS workforce that aren't in a clinical role

        Yes outsource cleaning , building services, IT, HR, training etc to profit making companies - ideally the same monopoly supplier to the government.

      2. John 110
        Coat

        Re: "improve productivity in an organisation severely short of staff"

        @Cederic

        Two things stick out from your post.

        First, it is impossible to run anything with just the specialist staff. The NHS NEEDS cleaners, porters, secretaries IT staff, Lab support workers etc. These are the lowest paid of the staff budget and either have a high turnover, or rely on the dedication and good will of the workers (which is not any less from ancillary staff than clinically facing staff)

        Second, I agree about the cost of high-level administrators, but the sad truth is that good administrators cost money, and the best ones we had were wooed away to industry or other NHS Trusts for a higher salary than they were currently getting. The catchphrase is "if you want industry-quality administration, you have to pay industry salaries"

        Everyone else (except Doctors, who opted out), are on standard payscales (used to be Agenda For Change, don't know what they are now.)

        --> me putting on my Howie (https://www.workinstyle.com/howie-lab-coat.html) coat (in the days when I wore one...)

      3. Anonymous Coward
        Anonymous Coward

        Re: "improve productivity in an organisation severely short of staff"

        > The world's eighth largest employer is not short of staff, severely or otherwise.

        That old chestnut - there is no single "NHS" - there are 4 separate organisations for England, Scotland, Wales, and Northern Ireland - in NI it is called "HSC NI".

        Trusts and other (local) regional bodies are also organisations in their own right with their own employees. Then there is NHS Digital, NHS-X, HSCB, BSO, etc with their own employees.

        GP Practices are commercial organisations, the majority of which are Partnerships (though there may be some as Limited Companies) - so individual GPs are either Partners in, or employees of, their Practice.

        It's like saying the "Auto Industry" is the Xth largest employer in the world, or the "Armed Forces of the World" are the Xth largest employer.

      4. midgepad Bronze badge

        Wild guess here...

        Male, white.

        1. Cederic Silver badge

          Re: Wild guess here...

          Well, yes, those would be the under represented communities that a diversity officer should be seeking to understand and address.

          Men are 53% of the workforce yet only 27% of NHS employees are male.

          White people are 83% of the workforce yet only 77% of NHS employees are identified as white.

          Still, we can I'm sure look forward to the extra funding, training and target advertising seek to boost those numbers.

      5. localzuk Silver badge

        Re: "improve productivity in an organisation severely short of staff"

        Why do people think the NHS is full of managers? It has fewer managers per employee than the economy as a whole. https://www.kingsfund.org.uk/projects/health-and-social-care-bill/mythbusters/nhs-managers

        Most of those non-clinical role people are admin staff, porters, cleaners, site staff, IT staff, etc... Are you saying the NHS should do without these?

        1. LybsterRoy Silver badge

          Re: "improve productivity in an organisation severely short of staff"

          There was also a study by Nufield Trust

          https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers#1-what-kinds-of-staff-make-up-the-nhs-workforce

    3. John Brown (no body) Silver badge

      Re: "improve productivity in an organisation severely short of staff"

      I'd have thought the best thing to do with regard to "digitalising" the NHS would be not to build some huge monolithic system and drop it onto the entire NHS all at once, but the spend a few years getting it right at a single Trust. Spend whatever it takes to make it work and demonstrate it working effectively to the rest of the NHS such that they are clamouring to implement it. They could even take two best (note: not cheapest) bidders, and give them a Trust each to work with and see what comes out best/quickest/most efficient.

      Or better yet, buy in the talent at market rates and build it in-house, specifically for the UK as a whole such that maybe later they could sell systems to other health agencies around the world. That way, they'd not even be tied to a specific OS if they choose.

      1. J.G.Harston Silver badge

        Re: "improve productivity in an organisation severely short of staff"

        Or, go down the route that GP surgeries do. GP practices are all individual private businesses, each of them choses how to function and what equipment to use. Individually they chose their own clinical software systems, and a healthy *working* ecosystem has developed to provide that clinical software, often written by GPs for GPs, so they know what they want and what to provide. None of it imposed from on high by some ivory tower dwellers.

        1. Yet Another Anonymous coward Silver badge

          Re: "improve productivity in an organisation severely short of staff"

          >often written by GPs for GPs

          That's a relief, I always choose medical professionals for their expertise in cyber security rather than Ivory Tower types.

          I also prefer to get my vaccine made by the local village pharmacy rather than those Oxford college dwellers.

          1. midgepad Bronze badge

            Re: "improve productivity in an organisation severely short of staff"

            The initial ones were written by various people.

            Academics interested in how (GP) medicine is done, buyers of pharmaceutical information (and one use area for gp systems was for dispensing practices, who needed something like a pharmacy ststem)

            And then jobbing GPs with an interest in solving particular problems in their work.

            While the records were on a drive in the building, alongside similar information jn larger volumes in paper packets, the threat and security models were fine, thanks.

            Moving ask the records for half the country onto two systems at four data centres, and linking that to Dominic Cummings, Tufton St et Al, a little different.

            The computer industry has given us its thoughts rather later than Hipocrates wrote down his, and we've been developing them since then, thanks.

        2. gw0udm

          Re: "improve productivity in an organisation severely short of staff"

          Sadly this is no longer true. The GP system market is basically a duopoly, and the systems are old, clumsy and monolithic. They are also built from a small business mindset and do not scale. The market is stagnant and there is very little innovation. It is what happens when there is a lack of competition snd investment and suppliers rest on their laurels.

          1. TimMaher Silver badge
            Windows

            Re: “The GP system market”

            Too true.

            A few years ago, our surgery got rid of their old system and replaced it with one from a different supplier.

            It did things like complain about hyphens in you last name and added unwanted capitals, all in a very ‘70s DB/4GL kind of way.

            I don’t use it.

      2. LybsterRoy Silver badge

        Re: "improve productivity in an organisation severely short of staff"

        --Or better yet, buy in the talent at market rates --

        That worked so well for the Civil Service as a whole - didn't it?

    4. LybsterRoy Silver badge

      Re: "improve productivity in an organisation severely short of staff"

      I think you have a slight problem with your recommendation. The last thing the NHS needs is more bureaucrats!

      First thing that should be done is to replace the overpaid and non-performing managers with people who can do the job.

  5. Anonymous Coward
    Anonymous Coward

    Cui Bono?

    Quote: "...The select committee urged NHS England to respond to the Wade-Gery report on putting data, digital and tech at the heart of transforming the NHS..."

    But compare this with these two reports:

    1. Complete Disregard for GDPR by Royal Free

    Link: https://www.theregister.com/2021/09/30/royal_free_deepmind_representative_action_uk/

    2 The Police, Crime, Sentencing and Courts Bill -- Warrant-free Access to All Medical Records

    Link: https://www.theregister.com/2021/10/11/data_guardian_police_bill/

    So....about "transforming the NHS"....who is this transformation supposed to benefit....Google? DeepMind? the Police? GCHQ?.....

    .....or perhaps ordinary citizens who need decent health care?

    It would seem (see above) that the needs of taxpayers and citizens ALREADY take a back seat!!!!

    1. DevOpsTimothyC Bronze badge
      Thumb Down

      GPDPR & WannaCry

      Add the GPDPR data sell off fiasco and WannaCry...

      Can we just get a list of those 20% of NHS trusts so those of us who want medical treatment without our medical data leaked know where to go ?

      It seems to me that a paper based NHS trust is probably more reliable and secure

    2. Eclectic Man Silver badge
      Unhappy

      Re: Cui Bono?

      "2 The Police, Crime, Sentencing and Courts Bill -- Warrant-free Access to All Medical Records

      Link: https://www.theregister.com/2021/10/11/data_guardian_police_bill/"

      So, hang on, if I have DNA test for some inherited disease, that would mean the Police have no need to sample my DNA if I'm in the vicinity of a crime, they can just get the details from my NHS record?

  6. johnnyblaze

    NHS is screwed anyway

    I admire what the NHS stands for, and I admire the staff on the front line who work there, but everything else about the NHS these days is totally f*cked, as has been shown first hand by the pandemic. An organization so inefficient and badly run it doesn't matter how much money you throw at it, it won't make any difference. The NHS is no longer fit for purpose, and is one of the main reasons were in this C19 mess (it was all about protecting the NHS, not about stopping people dying). Honestly, it needs rebuilding from the ground up, but I don't think any government has got the guts to do it.

    1. Doctor Syntax Silver badge

      Re: NHS is screwed anyway

      "it was all about protecting the NHS, not about stopping people dying"

      The two are not incompatible. AIUI the protection bit was to keep infection levels down to a point where there were sufficient resources available to treat patients (remember a few hospitals having to declare emergencies because the demands for oxygen exceeded the capacity of the plumbing) and to avoid losing too many staff to Covid and not having enough available to treat patients.

      Since the back end of last year we now have policy effectively being dictated by the Tory rebels after the last vote. So we don't have sufficiently strong protections in place and there are the consequent reports of mounting staff shortages due to sickness. ISTM that the actions of some MPs can only explained by them thinking they're playing Minecraft or something and their actions don't have consequences in the real world.

      1. Anonymous Coward
        Anonymous Coward

        Re: NHS is screwed anyway

        But, but, but we've had Brexit. Life must get better. They said so.

    2. AndrueC Silver badge
      Stop

      Re: NHS is screwed anyway

      it was all about protecting the NHS, not about stopping people dying)

      We were always going to have that problem. The only way to avoid it would be to have the NHS permanently funded and staffed to meet the needs of a global pandemic. That would be ruinously expensive and disgustingly wasteful of resources. It would result in thousands of qualified medical professionals spending their entire career sitting around waiting to be needed. No government will ever or should ever resource a national health service at such a high level.

      If one day your entire neighbourhood drops by for tea and biscuits you will struggle to meet demand. Does that therefore mean you should have always had enough milk, tea and biscuits in your house ready for such an event? Of course not. It would be ridiculous.

      What C19 has actually shown is that we've been resourcing the NHS quite adequately(*). Despite enormous pressures it has managed - so far - to weather the storm. Yes it's required help from the general public but this is a global pandemic. A once in a century event. You can't operate a health service year after year, decade after decade on the basis that once every hundred years there will be a five-fold increase in admissions.

      (*)Not well (could be better) but adequate.

    3. midgepad Bronze badge

      Re: NHS is screwed anyway

      Balls.

  7. Scott Broukell

    NHS Efficiency

    (Sorry, me again) There is only one sure way that you can, at the very least, increase some efficiency in the NHS and that requires the full-time services of a regiment of trained snipers using high velocity, hollow-tipped rounds with 100% head-shots guaranteed. At least that way you can get rid of the old and demented, the druggies and highly dependant alcoholics etc.

    One size does not fit all in a public health service. Imagine you ran a car plant producing a range of five family saloon cars. Then one day you get a letter from the department of transport insisting that you also produce; buses, tractors, tanks, fire engines, diggers and HGVs all from the same single manufacturing plant that you use for your saloon cars. Oh, and you won't be told in advance how many of each type are needed each week either. That's what the NHS is like - there is no way on earth that you can tell what size, shape and age the problems are going to be and yet they continue to walk in through the door 24/7!

    You can't just say oh look demand on the renal unit is down 40% in the last month, well then, we can shift half of the ward and equipment over to maternity, they seem to be constantly dealing with babies over there! There is very little if any predictability to work with.

    The NHS is a bit like a prism - the white light of constant patient demand that streams in through the front door is then separated out into a broad spectrum of complaints and dealt with accordingly. So what looks like a single line of uniform customers actually represents a whole gamut of things that need fixing.

    Of course if you want to increase efficiency further down the line, in the output stage, you could provide well funded, well staffed and well trained NHS community outreach services for say drug and alcohol dependency units. Success in that area would almost certainly release some resources in other public facing areas, such as policing, probation and the courts etc. Those released resources could then be re-directed to more urgent policing matters etc.

    So it is an almost impossible task to achieve efficiency in general. That's not to say that you can't spend resources carefully, with hindsight and juggle rotas/be flexible with agency staffing etc., but in the main the demands still require constant flexibility and there is always a cost to that. Then again, you can push that flexibilty too far and, guess what, it breaks!

    1. ShortLegs

      Re: NHS Efficiency

      "(Sorry, me again) There is only one sure way that you can, at the very least, increase some efficiency in the NHS and that requires the full-time services of a regiment of trained snipers.... get rid of the old and demented, the druggies and highly dependant alcoholics etc."

      Euthanasia for the old. Why? After a lifetime of work they should be shot?

      Define old. You'll change your mind if when you parents hit that age. Or you.

      The "etc" Does that include people who require very high dependency requirements, such as the VSI casualties from Iraq and Afghan? Make that suggestion at your nearest barracks or Veterans point. You might find several of those trained snipers taking shots at you.

      You cockwomble.

      1. Anonymous Coward
        Anonymous Coward

        Re: NHS Efficiency

        "Euthanasia for the old. Why? After a lifetime of work they should be shot?"

        Well Brexit. But not to worry, it looks like they have frightened off all the EU staff, and at the same time frightened off those EU staff that worked in care homes. So now the old are basically bed blockers, preventing other old people from using the NHS. That means these others will be unable to be treated and die sooner. Perhaps Brexit was a godsend after all.

        BTW, what's a cockwomble?

        1. Doctor Syntax Silver badge

          Re: NHS Efficiency

          "BTW, what's a cockwomble?"

          If you need to ask...

          Maybe you're new here.

  8. SundogUK Silver badge

    "...The select committee urged NHS England to respond to the Wade-Gery report on putting data, digital and tech at the heart of transforming the NHS..."

    God help us.

    We need Doctors and Nurses "at the heart of transforming the NHS" not IT. Clear out all the useless admin types, provide the simplest and most efficient IT tools they need, off the shelf and let the medical people get on with it.

  9. ColinPa Silver badge

    left and right hands

    My sister who was a nurse complained that she had to spend half an hour each day entering data about which patients she was planning on visiting. Name, address etc.

    She then went to see the patients.

    The system thought it took 5 minutes to drive from Taunton to Bristol!.

    At the end of the day she had to spend an hour enter name, address, treatment, notes etc for the patients she visited - on a different computer. She could not cut and paste because it was a different computer.

    She didn't think anyone actually used the information - but it was there for legal protection in case she got sued.

    She asked me - was there an easy way to get the systems to talk to each other!

    1. RegGuy1 Silver badge

      Re: left and right hands

      Sounds like teachers.

  10. Twanky Silver badge

    ...to ensure technology helps improve productivity...

    Does this mean that only technological improvements should be considered? It sounds like introducing tech is seen as the goal, not just a tool.

    The next question is: whose productivity? Helping to stop medics wasting their time and enabling them to concentrate on patients' needs would be a good start.

    Of course, what we'll end up with is a new method of measuring productivity with which the management consultants will show that 'the new system' has increased performance ten-fold against metrics that have never been measured before.

    Power to the medics!

  11. Anonymous Coward
    Anonymous Coward

    I'm Sticking to Paper

    I trust the NHS less than almost anyone else with my personal information.

    Until they can give meaningful guarantees about what they do with my private data and improve their security I will stay completely paper based.

    I do not give any of my other data to google, why should I help the NHS donate it for free?

  12. Dante Alighieri
    Boffin

    plus ca change

    the new EPR we are getting is enter once, use data in many places, automated forms, pathways etc. confirm details once on any admission.

    Except if you want to request any sort of diagnostics where all the data sits stubbornly elsewhere.

    On a separate note, Scotland did a thing back in the 2000's where they specified 4 or 5 systems for each area of work in a hospital, which were all guaranteed to work with the other 2 or 3 systems like radiology and with the 1 or 2 supported Gp systems. No monolithic solution but a known set of compatible systems allowing any area the impression of choice.

    Then they offered 50% central funding for system replacements for this kit, or any healthcare provider could buy anything elese they liked - but with no funding.

    Interoperability between different providers nationally massively improved.

    and for fun - the NHS public wifi link - stripped of an ID code has a really cool programmers landing page https://www.nhs.uk/captive-wifi-portal/

  13. RegGuy1 Silver badge
    Coat

    NHS England, the organisation that manages the health service

    Just to be clear "NHS England, the organisation that manages the health service" in England. I know of some to whom this matters a lot -- they are not English, as you would expect. :-)

    Health is a devolved matter.

  14. Boris the Cockroach Silver badge
    Megaphone

    A lot of you are nearly

    there with the solution to the NHS's IT woes

    It does need a top down approach to IT... however the approach should be in "Defining the data stored by the NHS"

    eg Patient name, address DoB, GP details etc etc etc

    Then specify that for example a consultant needs to pull up a patients GP record, the system can then see the GP's system and recall the data from there

    I've had experience of the NHS systems not being able to do a simple thing like that when needing treatment.. the local hospital did a whole series of tests (including a psyche test....the 'professional' doing that ran out of the room screaming about the darkness after 15 mins...)

    Then I got transferred to another hospital who wanted to spend another week doing exactly the same tests because they could'nt talk to my local one...(loud protests from the patient about people too lazy to pick up a fucking phone sorted that :) )

    having got the data definition , its upto the hospitals and GPs to buy/rent/make the best implementation of that standard.

    As for the other problem with the NHS , the lack of staff , that one is even easier..... TRAIN SOME jeez (and cover their costs while in training too )

  15. Eclectic Man Silver badge

    Fax machines

    As far as I know, the local NHS hospital still uses fax machines. About 5 years ago I needed a minor operation (basal cell carcinoma removal) but as it was a bit tricky and required plastic surgery there needed to be co-operation between dermatology and 'plastics'. So they faxed each other, and no I don't mean 'computer fax' I mean genuine paper-based faxed.

    The problem, one of the many problems, the NHS has, is that the staff are all trying to do a good job (Harold Shipman and Ian Paterson excepted) and every time they get almost used to the latest re-organisation, another Secretary of State decides to re-organise the re-organisation. One issue is political dogma. The Capitalists consider everything in terms of the market, and have tried to impose market based ideologies on the NHS, whereas the Socialists see the NHS and other government as a Service, and seek to avoid competition. So when the next lot get into power in Westminster they try to undo whatever that previous lot did. The biggest round of applause a Secretary fo State for Health ever got at an NHS conference was when he was introduced as the only one who had not instigated a major re-organisation.

    I suspect the only solution would be a genuine cross-party consensus lasting a decade or more on what the NHS is for and how to get it*, but I won't hold my breath.

    *(Don't ask me, I only live here and haven't got a clue.)

  16. Abominator

    My dog can get a same day MRI and/or CT scan, and gets overall better care for a fraction of the cost we allocate per capita for the NHS.

    On the NHS you are typically waiting months and for some years for an MRI or CT scan.

    1. Anonymous Coward
      Anonymous Coward

      How much does your dog pay for a CAT scan?

    2. codejunky Silver badge

      @Abominator

      "On the NHS you are typically waiting months and for some years for an MRI or CT scan."

      That is the problem of costs. The NHS is 'free' but it costs us with long wait times and terrible service. On the other hand if your paying for treatment and the health providers actually have to care to get paid then the quality of service is a lot better and I have found actually useful. Unfortunately that idea scares people because they automatically think of the US even though the rest of the developed world have found other ways to do it.

  17. Alan Hope

    Well Google NPfIT and read about what happened. As both a keen amateur computer coder and clinician I was fascinated to follow the progress of this mind-bogglingly expensive digitalisation of my profession in the early 2000s. I attended presentations from the IT teams, and had hands-on demos of their interfaces (in weird, expensive, air-conditioned coaches specifically adapted for the purpose).

    And it was the most disappointing, half-baked, badly thought-out computerisation of anything I have ever seen. It was clear after even a few minutes experience that the major IT companies involved had failed to grasp any of the subtleties of clinical management and interactions. I just remember an awful sinking feeling that the whole thing was going to fail ... and it did. Spectacularly.

    We perhaps got PACS (a useful sort of Youtube for X-rays), although the idea and the initial development of that pre-dated NPfIT. And a global database of names and addresses. And that was pretty much it for 6.2 billion UKP.

  18. Paul 87

    It'd be brilliant if this time around, someone started by asking the staff what they *need*, things that they need to save time on. Don't even start with asking them to think about what's possible for "technology" to do, find out what takes the time and then analyse what can actually be streamlined with off the shelf solutions, and what may need custom solutions.

    There's lots of *ideas* on what may help, but until you talk to the people doing the work, and test whether your solution actually saves time, then you don't know what'd work.

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