Future of the three NHS bodies managing health tech in doubt after £2.1bn cash injection UK health secretary Sajid Javid has strongly indicated that the individual health bodies responsible for IT spending in the NHS will be reorganised. IT strategy across England's unwieldy public-sector health system rests on the shoulders of three organisations: NHS England & NHS Improvement, NHS Digital, and NHSX. While …
The other day I found this article by a psychiatric worker that highlghts a serious downside to 'health digitisation'. It makes troubling reading.
There have always been articles extending current actions along infinite trend lines. The NHS is extremely sensitive to patient safety, and changes move very slowly. I would argue that clinicians have been so intransigent that other types have had to come in to modernise. Pre-Covid, how many doctors (who are the ones setting a lot of policy) would say "actually, I can pretty much do this job with a patient on a video call"?
That the availability of technology actually makes for the ability to manage large numbers of people as cohorts in ways that the personal touch cannot. It's about time that healthcare became truly proactive rather than reactive. We absolutely should be grabbing as much data as possible and asking qualitative questions to determine context.
Yes, people need personal attention from doctors who think for themselves but there absolutely is a place for collecting large amounts of legitimate telemetry data from people to identify potential issues before they would normally become a problem.
It would be very nice, however, if that data wasn't being processed by Microsoft Viva (indirectly), Deepmind and a bunch of other private sector shovelware but instead by computers and software fully owned and open for use by the taxpayer. Of course, the moment politicians get involved, you get multiple failed attempts and dodgy deals between friends soon after...
At the (high) risk of being flamed here, I'll share my experience.
There is little hope for holistic IT reform across the UK because each silo insists on working in their own way and many are not only computer literate but seemingly very anti-technology. Please understand I don't want to knock the hard working staff and the things they do daily that are far more than I could ever do in such circumstances. Plus I don't look to tar all staff with the same brush.
That being said one of the worst ever projects I undertook was the roll out of a new telephony platform for a NHS site. Simply attempting to roll out like-for-like was repeatedly thwarted with complaints that were escalated to the highest level and backed with the full weight of the top-of-the-senior-leadership including but not limited to: the ringtone of the new devices not exactly matching the old devices; no longer having a pause between transfer from one extension to another; having to endure new, similar handsets; and (as it was going in to a wider phone system), *existing* phone numbers being preceded by the number 2.
Whilst I'm very wary that input is important and a system needs to work for everyone, it was evident that there was no desire to push back on the more frivolous elements for the sake of keeping a system consistent across a wider organisation. In actuality, the reverse is demanded at every stage as everyone wants to continue as they always have done and in some ways may simply refuse to move to a new platform to do so (be that moving paper to IT).
I saw many colleagues stumble at the same hurdle with their projects in that environment and am convinced the prevailing attitude is that of legal IT or similar whereby you couldn't possibly understand what they're doing so you couldn't possibly ask them to do it any differently and either how-dare-you-try or "we're too busy to interact with you".
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Hmm, I love the smell of UK Gov IT failure in the morning.
A £300 million budget and nothing to show for it yet ? I can do nothing for that kind of money as well.
And everyone knows it won't become an issue before the spending hits £600 million, but then, with minimal effort shown, it'll hit a billion and that's when the project will really take off.
In almost all of these cases it seems that there is a pattern of poor planning by a committee of bureaucrats who know something has to be done and all have their own agendas about what that something should be. But don't actually listen to anybody. And above them are a bunch of even better paid bureaucrats who set up the project but don't bother to listen to other sections who also have a stake.
And no one listens to the staff who are actually going to use the bloody stuff.
NHSX was the passion project of Matt Hancock, just as NHS Digital was the passion project of Jeremy Hunt. From day 1 NHSX had significant overlap with both NHS D and NHS E&I and didn't make much sense existing. None of the agencies have a particularly good track record with NHS Trusts even if Digital have managed a couple big wins (Free Windows 10 being the main one that comes to mind!). So all I expect to happen now is that all 3 will be consumed into a new agency with a flashy name and run by the pals of Javid and no lessons will be learnt!
What amazes me is that having just looked it up, NHS Digital employs 6000 people and they can't seem to come up with a working digital plan, perhaps they are underfunded and understaffed?
Or perhaps there isn't a single boss who has any fecking idea of how to choose and use the staff.
I'll bet there are a few good people in that crowd but who are unable to do their jobs due to PHBs all the way up.
>What amazes me is that having just looked it up, NHS Digital employs 6000 people and they can't seem to come up with a working digital plan, perhaps they are underfunded and understaffed?
NHSD largely do lots of boring-but-essential work on the themes of intra-NHS information exchange and statistics processing and publication. Hence their more formal name of the Health and Social Care Information Centre. They were rebadged NHS Digital to make the minister happy.
NHSD got pruned back in 2018 and is now boring but competent, more often than not their apparent deficiencies are as a result of being hamstrung by policy they did not create.
NHSX was created to be an internal consultancy, not bound to any other part of the organisation, but has turned out to be a cesspit of weapons-grade incompetence, staffed by ignorant strutting wastrels, many of whom were refugees from the original CfH train wreck. It makes the Covid PPE procurement look like a paragon of public-spirited transparency,
NHSE thinks it knows what it wants, but doesn't. There are a lot of people in charge who want shiny stuff to show ministers and don't care about whether it is actually true or not. So we have glossy Tableaus coming out of our ears, fed by random rancid data that is months old. And people are wondering why the whole thing has fallen over in a chaotic heap.
The root cause of this is that when the NHS created its payscale, IT folk were put on the administration/ clerical paypoints, rather than the professional / technical ones, and as a result anyone remotely competent has left for a proper salary, bar a few true believers.
>The root cause of this is that when the NHS created its payscale
Could not be more true. I'm in Leeds and a senior data architect at a large, data-centric software firm. I love the public sector and have deep experience doing large scale data systems and processes for complex, highly regulated organisations. So, assuming I'm any good at what I do, I'm exactly the kind of guy NHSD in the city centre should want. Unfortunately on a good day the best they can offer me is exactly half what I earn today, and they are regularly trumped by the similarly-named-but-not-constrained-by-payscales DWP Digital just up the road. Worst of all worlds really.
Half? Senior data architect sounds like it would be "Lead Architect" which is generally an 8b role, i.e. £54,764 - £63,862, but NHSD / NHSX like to up roles by one band so it would be an 8c role and so £65,664 - £75,874. If you are making 2x either of those in Leeds then bloody hell, are there vacancies going?
>... bloody hell, are there vacancies going?
Loads. Look towards the software vendor market where everyone is paying near-London salaries but doesn't give a monkeys where you live. That'll increasingly be the new norm. People hoping to snag senior architects for £45k and a gym membership are going to be in bother in the coming year.
"So all I expect to happen now is that all 3 will be consumed into a new agency with a flashy name and run by the pals of Javid and no lessons will be learnt!"
I expect a new body to be created with the project aim of bringing the other three bodies under it's wing into a single, all encompassing body. Eventually. Maybe. Or we'll just end up with four bodies. It all sounds a bit like creating a new standard, so I won't bother linking the obvious XKCD :-)
There were always people in IT at the NHS that saw themselves as gods. I'm glad I had a run at the NHS but had to leave after 3 years not due to choice but my contract ended and they decided not to renew it. Probably because I say it how it is and no management likes to admit their fuck ups.
I went back after 7 years for 2 months. Nothing had fucking changed, this time I made the choice to leave.
Our IT manager on my first tour of duty was good and nice. Its just the people above him were useless cunts. Treat your engineers like shit, you end up with shit engineers that don't give a fuck.
Say to a room full of band 5 engineers that you don't realise are band 5 engineers cause you're out of touch that "I'm gonna replace all band 5 engineers with box monkeys" shows you're a cunt of a director and out of touch.
Ignore the reports of "Isn't that classed as a bribe?" when you get flown to silicon valley by HP and then given their new tablets/laptop as free gifts shows you're a bent director. Especially when HP then magically win the tender for new kit.
You wonder why your 2nd line do the bare minimum when they get told shit such as "I no longer want any of you to pick the quick win tickets. I want you to concentrate on other tickets and the low hanging fruit tickets" at which point I'd had enough and argued they are the same thing, quick win and lower hanging fruit are the same "No they are not" yes they are "no, they are different". That argument between me and a manger lasted over a min with me just ending it. Couldn't carry on arguing with an idiot.
Then, being a contractor, you get moved to the PC roll out team but told you'll now be paid £2 less than the shit wage you were already on is sole destroying. And knowing you have no confidence so are resigned to staying as you need the money doesn't help with your confidence any more (but thats my own fault).
Eventually you get out when they decide to try to stitch you up over some netbooks that appeared on the network that you warned them about 3 months before. When a Trust was going it alone and doing their own thing. Only for 3 months later they actually notice them, ask and I'm the only one that responds so they then tried to discipline me for them not fucking listening to my warning 3 months before (No story short. The Trust hated the main IT department. Wanted to test them out, asked me to help get them on the network. I did to make sure they were done properly and encrypted. Then warned IT. Got ignored till they spotted them then it all kicked off. They knew due to being a temp I had no rights so couldn't take them to a court for unfair dismissal where I'd have won)
Roll on 7 years later when you just need a job so force yourself to go back only to find nothing has changed. The contract engineers get stuck in a shit office that surely breaks health and safety and mental health well-being. Then you have a director or head of service abusing his position again. With his daughter working in the department. Which isn't a problem at all. Yet it turns out she can do whatever the fuck she wants cause "her dad is the boss" (not come from her, comes from other engineers).
So she comes and asks us temps late on Friday about a ticket could we do? (That never existed as she was the only one allowed to do jobs without tickets as her dad let it slide) We ask where the full time, paid more engineers are, this isn't what we were hired to do "Oh they've all gone home" (Its Friday, they've actually all fucked off to the pub). We agree only to find the kit we are to pick up is massive and over at another building down a steep hill with only a trolley for company. We get to the building only to find, despite being IT, they have limited our fucking ID cards to certain areas so we can't get in. We call her up as she said they were expecting us and that "Jim" at the main building was expecting the kit. We inform her we can't get in the building so she comes over. Oh look, not even her ID works. We eventually flag a nurse down walking past who lets us in. We find the room with the kit in with 2 nurses. Its not large at all whats the problem. We load it on the trolley to move and asking where the rest of it is, are then informed by the nurses "Oh the other engineers were here earlier but they only took the lite stuff". So turns out the full time engineers just couldn't be bothered to finish the job so got it palmed off to "the temps".
We push the kit up the steep hill into the next building, get to the x-ray department and "Jim" knows nothing about it. Oh FFS. Eventually we find someone who does, hand it over and leave. It just summed up the NHS IT for me. Showed that nothing had changed. I never went back after that day and found a perm job elsewhere.
But from all the time I worked at the NHS and it doesn't appear to have changed, in IT there is a culture of fear. The temps and lower down engineers get treated like shit. There are to many managers and managers that abuse their position. Attempt to question their choices and you'll be on the shit list with an attempt to push you out.
Why do I always bang on about this now and then. Because its kinda a form of theorpy talking about it.
Well, you've launched into this through the wrong optic haven't you? Its clear to infer from your post about a dalliance with 'NHS IT' that you worked at Trust level... this is around National level strategy and the organisations responsible for defining the strategy and implementing it. So, yes your points may be valid at provider level but you're missed the point by about fourteen hectares.
I wish these idiots would stop their IT spend wanking...........
That amount of money could have been spent on more doctors in the GP surgeries and Health Centres, so that when you need a prescription for antibiotics say, you don't need to embark on a 20 mile drive to your nearest A&E because you cannot get an appointment sooner than two weeks time at your local health centre.
That amount of money could be spent chaparoning all those really ill people who turn up at the health centre at 7:30am so they can hope to get an appointment to see a doctor for their health that er, needs them to see a doctor........................, so they can be allowed to sit down inside the atrium instead of being forced to stand outside in February's rain - whilst they await the receptionist telling them, "computer says no" there arent' any appointments left for today.
The problem is twats wasting public money of funky IT projects that fill the pockets of their mates without ever delivering anything besides bad news.
IT, it isn't IT, it's financial corruption, none of these fucking projects will ever be delivered for the public good, it wouldn't make fiscal sense to do so...........
ALF
.....but in my experience, you always end up with an IT f**k up when the focus is on IT!!!
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It helps if the organisation has well designed business processes BEFORE any of the IT anoraks set to work. So where's the commentary here about "standard repeatable processes"....you know, Capability Maturity Model.....even Level 2 would be a start.
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Oh......note that I'm talking about NHS business processes.....long, long ways away from IT development processes.....which would be another interesting topic!!
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So.....do the umty-ump NHS Trusts all use the same business processes? And if they don't have common processes, I guess any talk about "national IT strategy" is moot before you start!!
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Please......don't bore me with talk about IT.......if there's a problem, the root cause is a million miles away from the technology!!!
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