Keir Starmer's techno-fix for the NHS: Déjà vu disaster or brave new blunder? Around 20 years after the largest public sector technology disaster in UK history began a £12 billion contracting escapade, they're at it again. "They" being the Labour Party, and "it" a promise to fix the NHS with the magic of "technology." In an opinion piece in The Guardian, the leader of the opposition bemoaned the state …
"it will have politically limited options in raising taxes to pay for one of the world's largest healthcare providers,"
Well of course it would, when Labour is modelling itself as just a slightly less racist/bigoted version of the Conservatives.
One of Sir Beer Korma's biggest donors right now is John Armitage, who is an investor of a private health care company who have huge interests in privatising the NHS. It's in Beer Korma's interests to appease these bastards, and floating the idea of technology doubles down on it. Because the data used will, more likely than not, also fall in to the hands of Plantir as by the time 2025 rolls around agreements in the background will have been made. The decision will become entrenched.
The NHS will continue to exist for as long as people want to fight for it. It will not continue to exist if self serving/interested people like the current cabal of Nu Labour are allowed to continue neo liberal policies that have sunk the UK in to the mire it finds itself in now. The Tories are no better, but we all deserve a better solution to the Tory problem rather than something a little less bad but ultimately the same as we'll get with Starmer's party.
Wolfie, Does this sum up your take :)
https://www.youtube.com/watch?v=230GPwqel0Y
As a cynical old git I think Keir needs more practise being ‘a normal chap’ just like Blair used to do with his mug during 'informal' interviews.
As he was hanging around the governing party for the 2000's he'll have no excuse for repeating the errors bound up in trying to create an all encompassing streamlined IT system, unless of course the plan IS just to splash the cash...
You may or may not have made some good points. But you completely lost my attention when you used the stupid Beer Korma joke, not once, but twice.
It's as clever and funny as New Liebour, Bliar, Camoron, and others of those ilk. It's just peurile and irritating, and it completely undermines your claim to have a reasonable argument.
Downvote administered.
Have a word with yourself.
He's a liar. He's a fraud. And he's turning Labour in to just a little less shit version of the Tories.
But your problem is that I call him Sir Beer Korma? Mate it's a fucking compliment to the boring cunt.
Downvote handed back in kindness.
A little less $hit version of the Tories is probably more likely to get voted in, than a more left version. We can look to history to see that, going back to Tony Blair and New Labour, it was if it was still a conserative government. And when the Jeremy Corbyn's hard left tried, he failed miserably. In current times, the country is no longer a blue collar workers country and traditional labour values of the working class are no longer relevant. Sure, everyone is upset with the current Tory government, due to costs spiralling out of control - in part due to Ukraine, leaving the the EU, which is a disaster. Recovering from Covid - though I think Labour would have struggled to be any more generous that the Conseratives were during the pandemic and lockdowns.
Anyway - Its a good time for a switch, Tories have been in too long, and it needs to switch every now and again for balance. In 4 or 8 years it will switch back - out of 28 General Elections in the last 100 years, Conseratives won 28 and Labour just 9.
Like wow - your dripping bile is showing between the lines of what you write.
Considering what the fucking Tories are about to do with Peter Thiel and Palantir your comment is laughable/classic Pro-Tory whataboutism distraction.
‘Sir Beer Korma’… not persecuted by the Police for COVID breaches … until a pile of Tory Government ministers - inc BoJo and current Prime Minister R!sh!
Why would the OBVIOUSLY required IT integration of our biggest national spend (NHS) be impossible?! The problem is NOT the political parties - WE elect them, right or wrong!
The question is why their manifestos are not enacted? How come the changes they want take so long to come into force and are delivered so badly?
We know the answer from all of the previous disastrous failings. Repeated utter incompetence in the outdated structure of our civil service - slow, incompetent, top heavy, over-protected, insecure, outdated, luddite, politically biased ...
What chance does anybody have as an elected politician to get great / new ideas enacted??
> How come the changes they want take so long to come into force and are delivered so badly?
Politicians want their moment of glory and be associated with a new shiny - hence why we have HS2 (which was the brain wave of a politician wanting to improve their image)and not capital investment in the existing network.
The level of change required in both the NHS and its IT, will take longer than the five year term in office and the attention span of the typical politician and media.
So as history teaches us, a new government come into office, start with big announcements etc., appoint a minister who starts the ball rolling, however, things don’t get better immediately (natural because of delivery lead times) and so in the inevitable cabinet shuffle, a new minister is appointed. They need to be seen to do something and so tinker or even totally overrule the project started by their predecessor…
The evidence is change in something as big and complex as the NHS, will need to be incremental and paced over time, plus the politicians once they have set the ball rolling, will need to step back…
--The evidence is change in something as big and complex as the NHS, will need to be incremental and paced over time, plus the politicians once they have set the ball rolling, will need to step back…--
So near.
The evidence is change in something as big and complex as the NHS is impossible.
It is to big, there is to much inertia, to many vested interests. Unless your "over time" is measured in centuries the only way to do it is piecemeal. Take one hospital - detach from the NHS, sort it out (which may mean creating smaller units), keep it out of the NHS, move onto the next.
> Take one hospital - detach from the NHS
Don’t disagree with a prototyping approach, although with supposedly 30 new hospitals on the cards, there is an opportunity to start with a “greenfield” hospital.
The art will be keeping people’s expectations in check, as can foresee media, politicians and public getting upset if large service improvements are seen, as everyone will be clamouring for immediate deployment across the entire NHS…
> The evidence is change in something as big and complex as the NHS is impossible.
Depends on what you mean by change, in the last decade I suggest the NHS has become wholly dependent on IT to function…
Remember the division of the NHS into independent trusts, supposedly to introduce competition, has just added to the complexity. So a big part of the problem is down to politically motivated organisational structure…
It's impossible because the contracts will be handed to cretins.
Trouble is, in our industry "big" is often conflated with "complicated"...which couldn't be further from the truth...just because something is big in scale, doesn't necessarily mean it is technically complicated.
From what I've seen of NHS systems over the years working at various trusts is that almost 100% of the software in use is basically a skin for a database...badly designed skins, that look like they were designed in someone's bedroom in the 90's in an ancient version of Games Factory.
I was at an NHS appointment the other day for a scan with the missus, and I noticed that in the particular front end the radiographer was using, there was no email field...in our case, they used "Telephone 2" as the email field...when I asked the radiographer if that was standard practice, she told me that they use whatever field is free on a given record to store an email address. It's not even a system I look after and I felt physically annoyed by it. On the way back to the car, the missus noted my newly frustrated body language which resulted in her getting angry as well.
Her: You look frustated, are you ok? The scan went well, nothing wrong with the baby...all good.
Me: Yeah, I know, very pleased...but that fucking UI she was using. I'm vexxed.
Her: Oh for fuck sake, don't get started on that.
Me: Did you see it? What a mess...email in a telephone field?
Her: *rolling eyes*
Me: What a load of shit, that probably cost millions. I could have done that in a weekend for a tenner in VB6.
Her: Oh Jesus, shut up...every fucking time.
Me: You don't get it...if there was ever a problem with that database, it'd be an absolute nightmare to reconcile the data and check it for errors...shit in random fields!
Her: SHUT UP!
Me: The poor bastards that have to support that.
I mean I googled him and Wikipedia is not very informative but it's not clear how he is linked to any private healthcare company or companies. Do you have a source?
His giving to Labour, Sir Keir and Wes "Shadow Health" Streeting is provocative but if I'm going to make trouble with this information I'd like it to be detailed and specific trouble, you know?
Meanwhile you acknowledge that Labour are a somewhat less shite version of the Tories and that we deserve better - well, guess what? In this brave new world "slightly less shite" is the new "better" and since there isn't a perfect answer we'd better start incrementally, right? Or are you arguing that "somewhat worse than Labour" Tories are a better alternative than Labour? What we really need is an end to FPTP electoral systems and some proper PR so we get grown-up government that is suddenly a real job that takes work and skill, as that will weed out the current large crop of narcissistic buffoons and self-stuffing lawyers, neither of which groups really appreciates either compromise or hard work. We might even end up with an effective government that takes practical and pragmatic steps to improve the country in achievable ways - now wouldn't *that* be something?
We would likely have more variety if a large swathe of the country didn't vote for people because their dad did, and their grandad did etc.
Voting in this country has become more like being a football fan than a rational debate.
On that note...
THEY STICK THEIR DICKS IN PIGS, STICK THEIR DICKS IN PIGS...FUCK THE TORIES, FUCK THE TORIES, STICK THEIR DICKS IN PIGS!
On the other hand...
THEY SOLD OFF ALL OUR GOLD, SOLD OFF ALL OUR GOLD...FUCKING LABOUR, FUCKING LABOUR...SOLD OFF ALL OUR GOLD!
WUUAAAAAAAAAY!!!
we all deserve a better solution to the Tory problem rather than something a little less bad but ultimately the same as we'll get with Starmer's party.
Can’t agree more, I really can’t see myself voting for any of the 4 main parties.
I’ll be eyeing up the independents in hopes they at least care about my local area.
"Well of course it would, when Labour is modelling itself as just a slightly less racist/bigoted version of the Conservatives."
How is labour less racist? They talk as though they are not racist and the conservatives are, but I see nothing in their actions other than condescending white saviour attitudes.
It is also telling which major party has had more non-white people in senior positions.
I just corrected a typo: I typed "non-white" as "non-shite". Of course no party seems to have any of the latter.
Remove private firms from teh NHS, such as Accenture, KPMG and all those "value added morons" who charge you £1000/person/day whose being paid £100
This whole thing stinks of a chat to Mckinsey or similar!
Hire more Doctors, Hire more nurses, pay them more! Bring all the cleaning services and things like that back in house" The NHS has the expertise to run these things AND you'll be giving those staff a pay rise as you won't be forking out money to outsourcers and shysters like Carillion!
Force NHS Management to learn the phrase "take responsibility for your actions"
If you removed all the outsourcers, you could probably increase money going to ACTUAL PATIENTS without paying a penny more into the budget!
Oh yes....make parking free for staff
@Roland6
"That will because they believe nursing is an unskilled job and thus lower pay…"
Why does a lack of degree mean unskilled? This is the insane grade inflation. If we need nurses we need people to be trained to be nurses. If we need brickies we need people to be trained as brickies. This does not require a degree it requires training. As with a lot of non-academic jobs they need training.
As for pay, what is with the pay scales? Get a job, earn some pay and if you 'believe' you are worth more go get another job that pays you more. Forget this public sector secure job, pay scales based on seniority and pension benefits but earn the money just like the rest of us do. I know this will get downvotes because criticism against the religion isnt allowed even if some people started to realise problems over covid.
This does not require a degree it requires training
One doesn't need a degree for IT either, is that one's case too, Hmm? Sounds like sour grapes.
I know this will get downvotes
The one correct bit in the whole post. Have an upvote for getting something right... Ah. Erm.
@AC
"Nurses. And bricklayers."
Whatever you are reading into my comment is not what my comment says. It says the jobs dont need a degree. I never said anything about banning them and if someone wants to take some academic course in it, whatever. But it is not necessary. The job requires training.
> Why does a lack of degree mean unskilled?
Tory mindset.
Remember we are dealing with people who think a PPE degree is worth more than a STEM degree and somehow qualifies them to run a country…
In the case of nurses, the degree puts constraints on the sourcing of overseas nurses, requiring them to have gained some internationally recognised level of training; you might find that reassuring when a foreign nurse is taking your blood samples…
As to grade inflation, don’t disagree as we still need the vocational courses which are now “degree” courses.
@Roland6
"Tory mindset."
Eh? Not defending the tories but it was labour who pushed jobs to requiring degrees. Wanting 50% of students to go to uni and wrecking apprenticeships.
"In the case of nurses, the degree puts constraints on the sourcing of overseas nurses, requiring them to have gained some internationally recognised level of training; you might find that reassuring when a foreign nurse is taking your blood samples…"
Aka make it harder and more expensive to become a nurse then to fill the void import based on qualifications? Noting that in some countries cheating is the norm. Not reassured at all.
"As to grade inflation, don’t disagree as we still need the vocational courses which are now “degree” courses."
Sure. Instead of being paid to train on the job you can pay to get a degree, and then when you get a job need to be trained.
Just remember - Labour destroyed education in this country by introducing "Comprehensive" Schools, ensuring that the best and brightest students would be held back by the dullards. Labour also presided over the bizarre grade inflation that means that "nobody loses" - today's GCSEs are virtually worthless when compared to the REAL examinations back in the 1960s. Back then, three UK A-Levels were roughly equivalent to an American MA / MSc! We had the very best education system in the world, then Labour decided that the last thing that would ever get them elected was an educated populace.....
Labour always bankrupt the country - each time they've been in power, they've destroyed the UK economy within 3 years by squandering borrowed money like a drunken sailor. As Thatcher said all those years ago "Labour always runs out of other people's money to spend".
Unfortunately, we're now beset by an ill-educated and rather stupid "political class" none of whom have the slightest idea about anything even vaguely scientific - which is why they're always in awe of any charlatan with some spurious "degree" in some subject they just can't understand. That's why they've been so easily fooled by the idiocies of "St" Greta and the IPCC, so now we're condemned to the "Net Zero" stupidity...
The UK is in a hole - neither of the political parties that could win the next General Election have a clue between them. It really is time to find somewhere nice abroad to live out the rest of my days....
For my entire school and university life the Conservatives were in power.
AlbertH ' "Comprehensive" Schools, ensuring that the best and brightest students would be held back by the dullards '
Dullards? I went to a comprehensive. I got 2 degrees and have a 6 figure salary in an engineering field. Suck it up, Buttercup.
Unfortunately the "hire more ..." section comes down to "don't start from here".
It takes "quite a few years" to train a doctor, so if you open up the taps now, you'll get more doctors in something like a 5-10 year timescale (depending on desired state of training). So to have more doctors now or in the near future, you need to not start from here, but start doing something 10 years ago.
Of course, you could look at the other end of the spectrum and incentivise senior doctors not to retire early. But Labour have shot themselves in both feet by promising to reverse a recent pension rules change - and again, make it not worth staying in work when the tax charges on your pension mean you would be better of just retiring. Of course, those incapable of seeing past their envy have labelled the recent change as being a gift for the top 1% - but in reality a lot of those it affects are senior medical people in the NHS (thanks to the way their defined benefit pensions are valued for tax purposes).
> It takes "quite a few years" to train a doctor, so if you open up the taps now, you'll get more doctors in something like a 5-10 year timescale (depending on desired state of training). So to have more doctors now or in the near future, you need to not start from here, but start doing something 10 years ago.
To have more doctors now or in the near future, one just needs to offer them better salary and conditions than they get in their home countries.
Doctors are being trained, but then finding there are no NHS jobs available so they all decamp overseas to Australia, New Zealand, Canada & the US.
At the local hospital here in Palmerston in the Northern Territory, there are a huge number of British staff. Almost every doctor, plus some of the nursing & support staff. One doctor joked that it was an NHS refugee zone.
If only 5-10 years ago - when we had no shortage of Doctors/Nurses/Other-healthcare staff - something has been done about this…… ROFLMAO.
<Note.. George Osborne - Tory Chancellor of Exchequer) ditched the Nurses Bursary exacerbating this.
*partially restored by current Tory Govt in 2021.>
Removing the 250+ separate NHS Trusts in England would help. Regional teams yes, but all operating to a consistent national set of guidelines (which already exist).
250+ CEO’s, FD’s, People Leaders, Finance Teams, HR Teams, Procurement Teams, Estates Teams, IT Teams, Training Teams, DE&I Teams etc….. (loooong list).
Yes some has core NHS Systems and Resources underneath…. but as an NHS Worker for 2 NHS Trusts … I don’t need to do 2 sets of mandatory training on the normal IT, Data Protection, Fire Safety, Safeguarding, Safe Lifting, Diversity/Equality/Inclusion all washed over with ‘local guidelines’… running on 2 incompatible Training Systems with a mundane local mission statement.
Unnecessary duplication of effort, and faux-localisation.
I think that is exactly wrong. The NHS is just too big an organisation.
We need to look at successful medical systems, with similar or lower costs. None of them, from Sweden to France to Japan to Singapore have anything like the NHS,
Of course the good thing about the NHS is that it is not like the American system - it could be worse.
>Hire more Doctors, Hire more nurses, pay them more! Bring all the cleaning services and things like that back in house" The NHS has the expertise to run these things AND you'll be giving those staff a pay rise as you won't be forking out money to outsourcers and shysters like Carillion!
Roughly 1/10 of the NHS employees are doctors. 3/10 are nurses. The rest are the support staff ranging from receptionists, through IT support, payroll, maintenance, etc. to physiotherapists and other support professionals. If you want to say double the number of direct medical staff employed, it will probably also need a large increase in the other 60% employed by the NHS.
A few common mistakes made in large systems:
The other approach, where it is anyone for themselves results is a myriad of incompatible systems without real inter-system communication. It too is a nightmare and not a real solution.
However, there is a way, slow but steady, to make a large system work. You need to have a bottom-up approach where the same traits are handled in (relative) compatible ways. Not one system but local systems made for and by the locals. These systems need to evolve and coordination about communication syntax and the semantics of what is communicated must be (gradually) agreed upon. Each system should think about forward compatibility. There are many ways to achieve the same goal. Trying to make or even forcing a too-big-to-fail system is a sure recipe for failure; see current state of affairs. You need slow incremental changes. Get the locals (the nurses, doctors, patients and family) to appreciate a system made for them and then build upon that success. Do all of this while you merge and migrate systems where it makes sense and still leave place for new specialized local systems to be created and used.
> Design by committee
It’s a large complex system(s), committees are going to be involved, yes someone has to make a decision and get the various architects etc. to agree etc..
>Top-down design
It’s the only way to design stuff. Obviously, you can go to extremes such as full stepwise waterfall, but most large systems design methodologies incorporate elements of agile.
> Dwelling at OSI layers 8, 9 and 10
There is much that is needed at these layers, as they are directly applicable to healthcare.
The IT systems approach needed is a combined top down and bottom up injection of technology.
I suspect a big part of the NHS IT problem is is the size of systems and the expanding rich data files; many of which I suspect are proprietary and can only read by applications running on specific OS platforms.
Just that you know...
Design by committee describes a group making decisions who has no clue what the real users need, often in endless meetings with no or extremely little content and relevance. Things are decided by persons or groups without a sense of user's realities.
Top-down design describes the forceful demands from people up in the hierarchy to use specific technologies or implement specific features which often are incompatible, outdated or irrelevant.
OSI layers 8, 9 and 10 are Friends, Money and Politics (order may be variable) and describe meddling in the decisions within a corrupt system.
IT - particularly at senior levels and with the big consultancies - can get focussed on solutions. If you don't start by finding out what the actual problems are then your multi-billion pound solution is worth fuck-all. By looking at real-world problems with real-world users and working out how to solve those (as you say, bottom-up) you could actually start delivering something useful. IIRC, when the NPfIT debacle was happening, someone pointed out that in Sweden (?) clinicians and devs got together and delivered a working national system for around £20m (that's an 'm' not a 'b').
I suspect that many of us will have delivered systems which follow senior management's grand vision only to find out that the actual users have completely different problems
There is no national system in Sweden, every region runs its own healthcare and chooses their own patient records system. There's been some gradual standardisation as more and more regions switch to Cambio's Cosmic system and away from ones that are even worse. Unfortunately they're all heavily customised and moving records from region to region is usually still done on paper.
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It should not matter. Read what I wrote:
These systems need to evolve and coordination about communication syntax and the semantics of what is communicated must be (gradually) agreed upon.
There is a requirement that they can talk to each other in one or another way. Even if it only is an electronic paper. But, we know, because of internationalisation and standardisation, what matters in the content of the communication. And that can be sent and received quite easily by any system. Maybe not all data perfectly to begin with, but therefore it must evolve over time.
There's zero percent chance that either party can solve the current ills with the NHS. Labour brought in armies of consultants who sucked off cash and delivered SFA. Then the Tories have tried to clean up the mess Labour wrought and are damned for trying to balance the books to know where to invest.
Frankly, the terms cluster and fluck are so obvious it is stunning that Sir Stammer now thinks his silver tongued wibble can fix it.
It's what made me jump to this side of the pond.
Was doing interesting, if slightly underpaid, work at a little tech company oop north.
The receptionist had a boyfriend, a PFY who could barely string a sentence together but had a company 5series and I found out, was paid twice what I made as chief R&D.
He sold software to the NHS, he didn't understand what the software did, or why they needed it - but it was the only approved solution and the local NHS had to buy it. But somehow he was paid to 'sell' it
Designed to be secure by default, run in house for NHS. Can build connectors/convert to legacy systems and bring them on board to remove legacy shite. Stop paying MS billions for licencing and forced upgrade paths.
Software for the NHS by the NHS and not external consultant companies wanting some of the pork.
Support THAT and you might help Kier. It'll take time but it'll make a huge difference. With modern builds of Linux the users 9 out of 10 times don't even need to know they are not on MS
No idea what it is about Register commentators and Linux..obsessed is the word.
It's not just desktop it's the whole shebang. 1.5 million staff, 7000 organisations that come under the NHS Banner. Pharmacies, Dr Surgeries, CQC's etc. Many that won't have in house IT.
NHS Digital actually gets quite the good price on Microsoft software, just a shame about the Cloud First strategy and that b*llocks.
The trick is use the NHS Digital model. Create a centralised DB of patient data, it probably already exists and create API's that can provide access to it. Have a stand piece of software that can be used by Pharmacies and Doctors Surgeries and allow the big Trusts who have the cash and DON'T want to be bullied into using something like Palantir to develop their own front ends which are usable by their staff that can access the data.
Every Trust is different, Every trust has it's own challenges. Digital should be providing a platform, the foundations to the Trusts and then let them do their own thing based on how that particular trust works and how it's staff work.
"Create a centralised DB of patient data" - at that point you lost my vote. No way do you get to put my data into something centralised until you've earned my trust. And that does have to be earned incrementally. So start your plan again.
I'll happily support the Linux idea, BTW, especially for back office systems.
To be fair, your data is already there.
I don't assume I'll only need medical help in the area that I live. I would like a system where a Doctor or A & E Department country wide can call up my details and get my medical history and medication etc, ideally without paying Palantir money.
Every time you go to your Dr or if you have been to A & E, your data is there. It doesn't have to be huge amounts of data, but stuff that would be helpful in an emergency and something where not having to call your emergency contacts, or even FIND your emergency contacts is needed.
As to getting more doctors and nurses and porters and cleaners etc. It's a very British problem where the thikning is...."it'll take 10 years to do job X, so instead of starting it now and making sure we're in a good position in 10 years time, we'll just kick the can down the road and hope no one notices and some kind of miracle will fix the issue"
It doesn't need to be centralised to be honest - the HL7 specifications are perfectly capable of dealing with any data that may need to be transferred from one location to another ... any healthcare application worth the name should understand it already.
Some Trusts do use their own applications (and - more importantly - maintain themselves) ... that's my day job.
"NHS Digital actually gets quite the good price on Microsoft software"
It's still a cost.
Yes, Linux will bring an admin cost. So do MS products. I know from my own experience how much less admin time is spent in keeping Linux up to date so that would be another cost reduction. And the NHS has learned the cost of not keeping Windows up to date.
I know from my own experience how much less admin time is spent in keeping Linux up to date
Basic out-of-the-box Linux alone, perhaps. As soon as you add complex applications with different dependencies on libraries and other packages it's very easy for a "simple" update to drop you into dependency hell, where package A needs Vn of package B, but updated package C now needs Vn+1, and you can't install both, etc. I'm no MS fanboi, but although both Windows and Linux updates can be straightforward, when they do go wrong it can be much harder to fix the Linux mess. There's a reason why these sorts of systems used to specify commercial systems, like Solaris.
The difference on Linux is that somebody with a sales target to reach doesn't get to decide that if you need access to
certain data you also need to pay for PowerPoint aswell as Onedrive, and then decide that your bulk license has to count every employee from canteen to gardening as 'users'
However, with “NHS Linux”, the release cadence can be internally managed as can the dependencies.
With this target suppliers can build packages. From the experience of manufacturing, I suspect the minimum period of release stability is 7 years and probably needs to be more like 10~15 years…
Whilst some may laugh at say using W7 today, we need to remember the fundamental problem isn’t that W7 is unable to run todays workloads, it is because MS stop supporting it and so stop doing security patches and driver updates to support new technology. They did this because it was better commercially to deliver a “new” OS than to charge for support. Interestingly, the subscription model encourages release longevity..
my misses works for a healthcare company who provide specialist kit to the NHS. OMG the tales she can tell of utter housery and incompetence I get weekly rants! Number one issue is utter morons who work in admin for the NHS, lazy and downright stupid. she'll rock up to run a clinic for which a few days before kit would have been delivered to the hospital which need to be given to patients, the lazy twats won't even have brought the kit up to the clinic room or unboxed it! They are incapable of following REALLY basic processes, everything is run on multiple spread sheets despite the fact the bits of kit have their own software to manage them. In one hospital they were even pulling the shipping labels off boxes that kit shipped in and sellotaping the ripped of labels to bits of paper with the patients details on! The kit is designed to upload the patients particular readings in realtime so that clinicians can monitor the patient remotely, the hospital did't want to do that so they get the patients to send an SD card with the data to the hospital in the POST!!!!! Thousands of devices and patients many of the patients are DEAD but the lazy twats haven't kept patient systems up to date. It is utter incompetence at all levels. And this is just a small number of hospitals in the UK in a fairly small medical field that she is responsible for. Its so bad she is nearly broken.
They really need to think about how a Victorian system does not work in a modern world.
Today's medicine is all about tests and scans. Yet you have to make an appointment with a GP who cannot carry out even the simplest blood and urine tests and has zero scanning equipment.
Why can't I just make an appointment with the appropriate specialist at a hospital with a fully equipped lab and a full set of scanning kit.
Up to a point. GPs are independent businesses so can make decisions how they work within the limits of what they can afford. Some equipment such as ECG and ultrasound will be within the budget of a reasonable sized practice.
But the way our GP works, if a doctor decides a blood test is necessary they don't take a sample there and then, they offload it to a phlebotomist. That might be sensible if the patient were simply send down the corridor for that to be done, but no, it means another appointment and a delay in diagnosis.
"sensible": Oursources who charge bonkers money for a light to be changed - get rid of them, employee a couple of porters / handymen at each hospital.
"Beancounter": Sorry, no can do, Salaries come out of this pot, and there is no budget left.
"Sensible": But is is the same people and you are being charged x time as much for the same work, but now it takes longer to get done and wastes so much more money.
"Beancounter": But we have budget in pot x for this extra cost
"Sensible": Fuck the pots, the only pot I am interested in is the overall pot and you are fucking it royally by making us pay over the top.
"Sensible": Lets get a good team of devs in to write what we need
"Beancounter": Capita
"Sensible": Really ?
"Beancounter": Fujitsu
"Sensible": Awww, come on
"Beancoutner": Infosys
"Sensible":. I give up. Let me just clap instead
I used to commute into Marylebone. Over a few months I witnessed an amazing arse-first sequence of events which I'm sure was due to different budgets.
1. The station was painted. The painters were thorough. One of them even picked out in lovely detail the frieze above the magazine kiosk between platforms. It was, BTW, one of those 3-sided stalls where you could pick up the latest copy of whatever paper or magazine you wanted and hand over the money and hardly break step while doing so.
2. The brickwork was cleaned by sandblasting. The new paintwork was dulled by being covered in dust.
3. The forecourt was reorganised. The newly painted kiosk was demolished and replaced by a shop you had to walk into rather than past, much less convenient.
4. One set of tracks was removed by filling it up with rubble, covering part of one of the newly sandblasted walls. A replacement was made by excavating a very wide platform which had provided potential functionality of allowing vehicles to drive in to deliver whatever might be needed to trains.
I stopped using it before discovering the purpose of this last bit but I suspect it was to demolish the entire sandblasted wall, erect a new one and sell off a bit of the footprint as real estate. I'm quite sure this appalling project planning* was due to different budgets whose holders never shared their plans.
* I exaggerate. There clearly was nothing worth calling a plan.
The NHS is not underfunded, it gets about OECD average with below average results.
The statement that the UK NHS is not underfunded and receives funding at about the OECD average, but achieves below-average results, can be criticized on several grounds. Here are some key points to note:
Comparing funding levels: While the statement mentions that the NHS receives funding at about the OECD average, it fails to consider the unique challenges and demands faced by the UK healthcare system. Simply comparing funding levels without accounting for specific contextual factors can be misleading. The population size, demographics, and healthcare needs vary across countries, making direct funding comparisons less meaningful.
Comparative performance measurement: Assessing healthcare system performance solely based on average results, without defining what those results entail, can oversimplify the evaluation process. Health outcomes and performance are complex and multifaceted, encompassing factors such as access to care, patient satisfaction, efficiency, and equity. Without specifying which specific indicators or measures are being used, it is difficult to determine whether the UK NHS is indeed underperforming in comparison to other countries.
Funding adequacy: While the statement suggests that the NHS is adequately funded, it overlooks the widespread concerns and evidence indicating that the NHS is facing funding challenges. Many healthcare professionals, patient advocacy groups, and independent studies have highlighted funding shortages as a significant obstacle to providing high-quality care. Long waiting times, staff shortages, and a lack of investment in infrastructure are just a few examples of the issues that can arise from underfunding.
Rising healthcare costs: Healthcare costs tend to increase over time due to factors such as medical advancements, population aging, and the introduction of new treatments and technologies. While the NHS may receive funding at the OECD average currently, it's important to consider whether this level of funding is sufficient to meet the evolving healthcare needs of the population. Failing to account for increasing costs and adjusting funding accordingly could lead to a scenario where the NHS becomes relatively underfunded in the future.
In summary, the statement's oversimplification of the complex issues surrounding NHS funding and performance makes it susceptible to criticism. Evaluating healthcare systems requires a nuanced understanding of various factors beyond funding levels, and it is crucial to consider specific indicators, contextual factors, and evolving healthcare needs to form an accurate assessment.
The NHS budget is substantially less than our peers in France and Germany, if you include private spending ie NHS surgeons working overtime it's still substantially less. If you want to see how privatised systems work in this country take a look at social care, the NHS was pretty good a decade ago but we've not really had a government since then and either they don't care or are incapable but still the problems pile up!
@airbrush
"the NHS was pretty good a decade ago but we've not really had a government since then and either they don't care or are incapable but still the problems pile up!"
A decade ago the NHS was riding high on labour spending like drunken sailors beyond what we can sustain. The tories have continued to spend even more than Brown even in the years they claimed 'austerity'. The problems always pile up. Throwing money at the issue doesnt resolve the problems, targeted spending can do. But this is where people trying to bribe votes out of people might not be best placed for deciding the care of people.
... is not the doctors, or primary care in general, but the secondary care system in the UK.
.
For instance take my GP daughter:
Every day for months she has had to see 3 individual patients for extended consultations - basically taking up 3 slots each. She has to see them because they have complex mental health issues, and each of them has been on the waiting list for secondary care for between 5 and 9 months! If one of them took their own life, which they regularly threaten, my daughter (as the last person to see them) would be under suspicion and have to nervously wait for months before the Coroner's Inquest. (Not the secondary care system that should be looking after them.)
Or the people that regularly come in begging for stronger medication for pain, while they wait over a year for surgery. When my daughter cannot prescribe most strong painkillers as they are only for short term use.
.
She can see that on average 1/3 of her time is spent dealing with the regulars who should be under the care of the secondary care system.
Then nearly 1/2 of the other patients she sees complain of the difficulty in getting an appointment or the time in the waiting room while she has to deal with the difficult patients.
She is threatened with physical abuse at least twice a week, and yet she has to be kind and compassionate.
.
Doctors are your first line of investigation and diagnosis.
Secondary care is then supposed to take over with detailed tests and scans. Followed with intervention, be that an operation, or long term care and support.
The secondary care is not happening and the Doctors are having to take the brunt of this.
.
All for a £65K - £80K debt when leaving Medical School and a relatively low wage (starting at £14/hour).
</rant>
Well ultimately it's all a matter of perspective - in secondary care there are very similar arguments about how the caseloads are clogged up with patients who should be managed in primary care but the GPs refuse to take them back! This is a particular problem with mental health services where there are a lot of individuals who have chronic problematic behaviour of one sort or another but who do not actually have any kind of of mental illness / mental disorder. However and unfortunately they end up getting stuck in healthcare.
The main problem with modern medicine is that most people have no good grasp of their processes and simply don't understand their own work or what their service should be delivering. It's very hard to 'digitise' services like this - believe me, I've tried. If we could just get people to get to grips with this, and make sure their staff were performing properly then we'd have a much more efficient service. Too often I've seen managers who are ineffective, and refuse to manage their staff properly because they are afraid of allegations of bullying, racism etc.
It's like deja vu all over again hearing this from Keir Starmer... the poor man obviously believes it but it needs a lot more than some IT systems, it needs proper examination from ground up of what our staff are doing and why, with systems employed to support their work. Putting systems in and thinking that as if by magic everything will change is naivety, and it is what led us to the ruinous waste of the National Programme.
"clogged up with patients who should be managed in primary care but the GPs refuse to take them back!"
GPs have no say in the matter. They even have a name for it "_____-dumping".
One of my Aunts was in and out of hospital for the last 3 months of her life. Dr says that she is too ill to be looked after in the community, and she gets an Ambulance ride to Hospital. After a week or so the Hospital discharge saying that she is much better now. Dr sees her at home the next week, there is no improvement on last time he saw her (or worse) and the cycle repeats. Eventually NHS agreed on palliative care for her last couple of weeks.
Completely agree about performing properly, especially the sub-contracted people. (Of course, there are some who go above and beyond, but generally you get what you pay for. The NHS pays through the nose (and many times more than their own staff would cost) for the sub-contracted people, who themselves only receive minimum wage and are duly disinterested.)
> One of my Aunts was in and out of hospital for the last 3 months of her life.
The hospital-home cycle; all too common with the elderly, made worse by the lack of joined up health and social care, with as you saw the inevitable outcome.
I hope you didn’t get screwed by social services wanting payment for the live in carer etc. (whilst end of life health care is free, ie. The NHS will pay for district nurse visits, they don’t pay for a career to make meals, dress a person etc.; social services don’t pay for a person to go shopping etc. and are bemused when asked how they expect a bed ridden person get out to a bank/shops).
Condolences, we went through a similar experience with an aunt; in her case it was 8 months from first hospital admission to death. Fortunately, she was never out of hospital for more than 6 weeks so the social services free 6 weeks of post hospital support service kept getting reset.
-- Too often I've seen managers who are ineffective, and refuse to manage their staff properly because they are afraid of allegations of bullying, racism etc --
Your name is Dominic Raab and I claim my £5
More seriously he was right about the bar being to low for these allegations, especially when they are made for an event that happened many years ago.
All for a £65K - £80K debt when leaving Medical School and a relatively low wage (starting at £14/hour).
Every student leaves university with horrendous debt these days, however very few have the career earning potential of medical doctors. I see you've gone with the "they're on less than a Costa barista!" line. Well, guess what, in 5-10 years' time a barista will still be on the equivalent of near minimum wage while your daughter will be inline to receive the thick end of £100k+/year! Not bad considering the UK average salary is £33k (junior docs start on £29k). I happen to live in a pretty deprived part of the UK where you're doing well for yourself if you're earning £30k/year. A cursory glance of the websites of four local GP surgeries and every one lists average salaries north of £100k.
The fact of the matter is that freshly minted doctors are not much use to anyone - they need a lot of guidance. Sure they work long hours, but that should really be considered an apprenticeship which will lead to absolute job security and almost limitless rewards, if they choose to pursue them. For example, one reason it's so hard to see a doctor is that huge swathes of GPs choose not to work full time, simply because they're so richly rewarded.
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The NHS app is brilliant - I can get repeat prescriptions without having to but the doctor every month. It would appear straightforward for that to also have a chat function with a 111-type operator, and/or a zoom function for remote Dr appts to make things more flexible and reduce non-attendance at GPs or indeed some follow-up outpatient care.
There was also an emphasis on prevention to avoid the cost of cure, which would seem a good idea - just today the tories appear yet again to have not gon through with adding information about calories to drink bottles (in case you are wondering, a pint of beer has the same calories as a mars bar).
Actually building some more hospitals would be a help too.
Your GP or local healthcare group have to subscribe to all those features.
Mine just has the electronic repeat prescriptions.
Medical history - NO
Chat - NO
Zoom appointments - NO
Appointment booking - YES - for 1 week and then withdrawn
If you want to build something, then build many Old Peoples Homes. That would get rid of the bed blocking that has filled over 50% of beds in some hospitals at some times. However, it will not work as OPH come out of the Local Authorities Social Care budget and that is even more seriously underfunded than the NHS!
Old Peoples Homes should be brought into the NHS, then Hospitals and OPH can cooperate.
> If you want to build something, then build many Old Peoples Homes.
Unstandardised the sentiment, but what is actually needed are convalescence homes/cruises.
With the advances in medicine, a patient is medically fit to be discharged from hospital (ie. They no longer need intensive or on-hand sophisticated medical care) but not be in fit state to resume normal life (*1) especially, if that is living on their own without support. So getting these people out of scarce and expensive hospital beds into lower cost convalescence facilities where the focus can be on recovery and rehabilitation, whilst longer term social care arrangements can be put in place.
(*1) I’m a reasonably fit working adult am due to have key hole surgery. The operation is a couple of hours outpatient appointment, the recovery period is 48 hours post-op (painkillers etc.) followed by up to 2 weeks rest, gentle exercise and not do anything strenuous including driving. The expectation is my family and friends will collect me from the hospital and then look after me.
just today the tories appear yet again to have not gon through with adding information about calories to drink bottles
Which serves no useful purpose:
- the people who have problems don't read or pay attention to those labels anyway.
- it encourages the manufacturers to stuff their products full of artificial chemicals (sweetners instead of sugar, start instead of fat, etc.) to keep the magic number down, and as a result the product is far less healthy in every other way.
When the National Programme for IT (NPfIT) launched, three different tech giants consulted me. They had got the bid packs and it made sense to them to do so. After all I was working in the leadership team of a British software startup but had spent five years in a leadership role in the social and health care care sector. They probably figured if anyone knows how to win this he will. I told all three No Bid. Their sales leaders told me that wasn't an option. So I asked them to show me the model of the domain - the operating model they were going to be building their solutions for - and they searched inside the envelopes and alas found that was missing. Instead, the procurement team had included some wonderful National Service Framework Standards. I think they were the National Service Framework for Diabetes complete with a black and white picture of a roguish Alan Milburn Secretary of State for Health. The triumphant sales team declared "here is the domain model" and so we sat down with the developers, the engineers, and a couple, of hours later they No Bid. Three consultations and three No Bids. Some years later one of them thanked me for avoiding the write-downs that some of the winners had to make.
Some of the confidence I felt in doing this was because I knew a secret. One of the 'authors' of the National Programme for IT (NPfIT) had previous form. He had helped the Major of London tender for a Congestion Charging System. The winning tech firm reached out for help several weeks after winning the bid. Their many programmers writing code had a problem - no one had built a congestion charging system before - this was a creative first. And the consultant who had prepared the 'requirements' well lets just say there were some holes. Luckily, it was solvable. We had helped them create an evolutionary solution, helped them figure out how to build it iteratively, to learn and add (on a 24 hour cycle) to the model, then to build new IT services to handle what they had discovered and was now in the operating model. The grew slowly and successfully.
Every software Product Manager will find this a familiar journey and the approach was what I had told a group of NHS leaders several years before the National Programme for IT. We had proved the approach with a Local Authority who avoided the trap of buying an old an antiquated IT solution for social care. The LA instead commissioned their own evolutionary approach. They accepted the need to change how social care was delivered and managed, and developed their IT system, slowly, to help enable this operating model change. No big bang. No secret magic solution. Just careful learning and change. As I say, I shared this approach with the NHS leaders (including the future National CEO) years before the NPfIT: Divide up the problem into different health domains; Focus on working out how you want to deliver say diabetes services; get that defined well enough to begin working on that (which means the experts and patients are the key design partners; have multiple local owners iterate it; make this early adopter solution more widely available to others when done and share the transformation journey the people may need to travel along; create some enabling platform services that enable this and solve for some of the data challenges, but remember this is primarily about transforming how the health and social care system should and could work in future, not about how to do todays hospital admin more quickly. I saw no evidence that they listened or understood. Perhaps they di but were not empowered. But I would give the next Government the same advice today.
Digital tooling allows standardisation of process within specialities and the simplified sharing of data across specialities and individuals (including the patient) who when working together can improve health outcomes across an entire economy.
It does not
Identify the ethics of sharing information
The legality of information sharing
The information consumption needs of the individual or their wish add to the pool of information
Human resistance to change when standardising process
The lack of trust between individuals and national governments who wish to monetise health information
It can
Help with ethics and legality
Identify existing digital data flows
Simplify and improve the speed of process
However we never really invest in the above, we invest in bright and shiny short term tooling which often does not have the long term investment behind it. We invest where we are desperate. We invest if we think it will save money.
Why is IT not the "Golden Bullet" that keeps on getting thrown about and why have so many IT initiatives failed?
From what I have experienced and been told by friends in the NHS is that it is not an NHS in that routine nursing practices vary by Trust and that you have to "be re-certified" when you work for a different Trust.
I used to have regular blood tests when on blood thinners and these were conducted either by my GP Surgery or remotely when on foreign assignment, with the results going to my local hospital to "manage" my condition. I then had an assignment which had me working at the company HQ in Hampshire and tried to setup the same arrangement. The local super surgery was in shock and denial when I tried asking them to arrange my blood testing and said I had to have a local GP to manage my condition as otherwise how would my local GP be able to do that for me. When I told them that my GP had no part in the process already, as managed by the local hospital they at first thought I was lying, but after my insistence and checking with my Surgery, they reluctantly agreed to my request.
I am sure that their must be many other similar examples of simple procedural differences that must be overcome before a standard IT system could be introduced, let alone for such differences in specialised units or when a patient receives both private and NHS treatment (from the same consultants).
I am sure that the process of making "One NHS" could provide tremendous advantages and also have some disadvantages, but it would be a massive task and take decades to evaluate and complete. However my personal feeling is that without that "throwing" IT at the NHS would be a largely wasted opportunity.
A statement of 'we can fix it all if we get in' from a politician in opposition. I'm not taking sides here but it's not like we don't hear that kind of thing in the daily exchanges in the House or in regular opinion-pieces in their favourite media outlets.
Said with the best intentions, I'm sure, but if/when the speaker does finally get the keys to power, they realise everyone else in the party has committed to spending the same money elsewhere, plus there's limited time to make an impact if they want to get re-elected. Priorities change; low hanging fruit becomes the focus and the grand plans that could make a long-term difference are quietly put out to grass - and there's no assurance they would be implemented correctly with clearly defined goals and milestone (both questionable concepts in huge, centrally-managed government projects).
219 NHS Trusts, with independent management, administration, procurement and duplication of overheads.
If the objective of the NHS is to be a job creation and money printing scheme, then, carry on. If the objective is to be a cost-efficient and effective public health service? The fundamental organisation simply has to be addressed. Deal with the organisation first and then consider the IT requirements on a common basis.
To balance out the anti-Starmer rhetoric of the article. Remind me again who's been in charge since 2010? 13 years of rot, inaction and cronyism that's seen NHS capability, capacity and decline through a period where the country collectively needed it more than ever? Record numbers of people off work sick because they can't get treatment?
There is also the not inconsiderable risk that if left under the current incumbents it will be deliberately fragmented into a US-style private system, further disadvantaging the less well off and handing even more cash to shareholders.
Having worked on two parts of npfit over several years, I could see not only that it was going badly, but why.
Basically the core "spine" and database part was terribly badly designed simply because it was based in a 'quick and dirty' demo setup that wasn't designed for scaling to production, but 'the authority' insisted in using that.
They also insisted on regular version releases so close together that there were two separate development streams leapfrogging each other. An utter and complete waste of resources.
The implimentation of the system at endpoints was mostly a matter of integrating it with one of a handful of existing systems.
The sensible approach would have been for a given contractor to integrate all instances of one system no matter what the location.
Instead it was done regionally, so each contractor had to cope with all the systems as well as accommodating varied (and contradictory) requirements for each trust - and sometimes for each hospital!
It could have been excellent. It should have worked, but it was crippled by inappropriate administrative restrictions.
Since then, technology has moved on, but political incompetence is still the same problem
Simple, sell off all the hospitals, make all GP surgeries private if not already and then let market forces take control, those that provide god service, meet targets at a competitive prices to the NHS, get the patients, thus the health companies make a nice profit, become bigger, invest in their facilities and build even better hospitals or go under, works for the hotel industry as a slightly wide example. No to private medical insurance to cover costs, as this will always deprive the poorest in the community.
The problem with this arrangement is that while the private operator WILL be able to undercut the inefficient management of the NHS, "dependence" on the private operator means that the cost of using it at end point (e.g. if the bill is sent to government) will exceed that of the current operators.
See how PFI worked out on the roads for examples. A Tory invention, but adopted hastily by Labour and at scale, disastrously.
No love for either of the two big parties here. Cue usual comments about FPTP needing to go.
None of this means technology cannot help the NHS. The technology can be improved, and it might even produce efficiencies if correctly specified. But hoping you can use technology to magic away deep-seated and complex organizational problems is a fool's errand. And you could make it worse. ®
The NHS is its own problem, it’s too weirdly in its operation and not willing to change for huge numbers of excuses.
The quoted last paragraph sums up the mess the NHS is extremely well.
Meanwhile, in the southern end of Europe... I can log into my public healthcare website using a password or a certificate, get my vaccination history, get a list of known allergies, get a list of previous visits to the doctor and their outcomes, get test results that can be shown as text, get a list of my prescribed medicines, send a message to the doctor if there's an ongoing case and they'll reply, book a visit at the doctors. I go to the chemist, they swipe my healthcare card and tell me what's prescribed and ask me if I want to buy everything or just some of the prescription. They can also print out a receipt which has future prescription dates if I ask for it.
During the pandemic online services were repurposed to send SMS messages to everyone in stages depending on their age or if they had an immunological condition, deal with a huge amount of bookings, videocalls with doctors, and generate vaccination certificates.
A few years ago there were problems if you were outside your region but now you can get prescriptions if you're in another region and doctors in other regions can access your medical records from your home region (i.e. the equivalent of the gaps between NHS England trusts or the great divide between NHS England and Scotland or is more or less solved). It doesn't interface well with private healthcare, in that case I need to take the test results from the private healthcare practise to the public health service and vice-versa. There can be downtimes for certain services but in the main it's all there and it works.
In the meantime the NHS seems like it's had something like more of a decade of the same bunch of consultancies that promise the moon and end up delivering abject failure. Nobody seems to be able to deliver improvements service by service and build up on what came before and the NHS doesn't appear to have any great interest in that either.
Starmer obviously has a magic IT bullet in his pistol.
As someone who has 3 close family members working within the NHS I can tell you that it has a kludge of IT systems, some of which still run on XP, and will be a complete b'stard to integrate. Whilst there are some relatively modern systems, such as being able to view X-rays and scans digitally, things like patient records and booking systems are still in the dark ages in many hospital trusts.
Add into the mix an excess of managers shoving useless bits of paper round desks, initiative overload and crumbling infrastructure, plus the utter failure of the social care system ...
E.g. our local hospital has Autoclaved Aerated Concrete beams which are having to be replaced at enormous cost and inconvenience. My wife worked in social services for many years and I can't describe how badly underfunded and disorganised this sector is. The best thing that Starmer et al could do is to sort the social care system to prevent bed blocking - which is endemic to the tune of 13,000 beds as of last month.
I guess he could always use Crapita to solve this.... or maybe not.
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