A very well reasoned and put together piece Paul. Nothing at all like the rant I was expecting when I read the title! In my experience things very often work in spite of ‘the system’, not as a result of it. I’m at a loss how a machine with the scale, complexity and inertia of the NHS can be tuned to run more effectively. From what you’ve said, the work you and others have already done, if fully realised, could have already improved matters significantly. A missed opportunity… I fear the unfortunate thing about healthcare is that on the whole it isn’t an altruistic endeavour. For staff at the sharp end (sometimes literally!) it can a vocation borne of wanting to help, but elsewhere for a great many suppliers of equipment, consumables, pharmaceuticals and systems the shareholder’s dividend is the main driving force behind innovation.
Hiya Matt, I've spent most of today responding to comments and thankfully yours is the last mate! Stupid me for putting out two videos in a week and people writing great comments which deserve more than just thanks 👍. Well you are right any caring profession will be exploited by the employers such that they battle on despite the shortcomings whereas in commercial work you would say f-this and just go and get another job. There is sooo much scope for removing duplication by things being repeated - well intentioned but unknowing because data is not shared. Often the patient is the one saying "but I've already had that test?". Also sometimes a referral takes on a life of its own and runs on and on "I'll see you again in 3 weeks" and "I refer you to somebody else" without somebody saying enough this is nonsense - often it's the patient making that judgement too. Regards Paul
I think I have a little bit of insight here from a different perspective. I am an IT professional and, like you, geek out a bit over technology. 😂 By and large, hospitals here in the US are private entities, as are the insurance companies. There's government regulation, of course, but for the most part, or at least for the sake of this comment, they are 100% private businesses. Where I live, there are two major hospital systems. Both of which are utilizing a third party system cal ed "MyChart" that is used for all of the things your IT project was hoping to implement. The reason, I believe, these systems are bing used, as you aptly point out, is cost savings, or more accurately, increased profits. These systems aren't integrated because they are nice people, they are trying to reduce costs, both underlying costs and costs passed on to consumer, and to also increase, or at least stabilize, profits. There needs to be an incentive. And if it's not government forcing it on them, it has to be some other mechanism. I would surmise that in many case, much of what you helped build is not being utilized is not due to a cultural issue, or a British issue, but because of a human issue - "what is in it for ME."
Hi Greg, I do think public organisations sometimes lose sight of their customers and do things for 'internal reasons'. My knowledge is well out of date so I looked up MyChart and see that it is basically the patient front end to EPIC. They seem to be a the main alternative(?) to Cerner, which I do remember was one of the systems available under the National Programme for IT. So it's quite possible that by now EPIC interfaces to the NHS digital architecture for data interchange etc. I see that quite a few NHS public hospitals in the UK use MyChart/EPIC. Cheers Paul
Well done. Very informative and I am still here. My wife’s GP uses the NHS App but the London hospital that she is under uses My Chart app. So to see information she has to open 2 apps! They don’t talk to each other either.
Hi Rob, going back 20 years since I was involved, it was only intended to interchange demographic data and a care record summary. Also there was a data transfer service so that records could be transferred electronically between GP surgeries if a patient moved to a different surgery. I see that MyChart is the patient front end to EPIC, which is one of the big providers of patient record systems. I think maybe Cerner is the other big one(?). The idea of the NHS single smartcard logon was to be universal so that ultimately all users were verified and all actions auditable, and would be a fundamental enabler for 'one record'. Without going into too much detail, when the NHS smartcards were first introduced there were some problems with proof of ID - read into that what you like. The e-prescriptions service flushed out some naughty practice between a few GPs and Pharmacists. Cheers
We are very lucky to have our NHS Mark. The problem is it needs reform to make it more efficient and affordable. £200Bn divided by 64m people = £3125 per citizen per year (about US$4000). But not everybody gets sick every year so perhaps it's £6250 a year for the ones that do (using half the population, 32m patients a year guess). Well here you can get a lot of medical insurance for £6250 a year (about US$8000). Cheers
Thanks for this video, probably the best and most succinct explanation of the NPfIT I have ever seen (and as you know I was there with you!). IN Australia we too have had a less than successful go at an electronic record system with some issues around contract management as significant hurdles. The heart of the issue you raise though seems to be around change and training. I have long lost my passion for big change programs, but it seems to me that the nurse who couldn’t use her smart card was not aware of how much easier her job would be if she fully used the system ( how long was she winging it without using it). And she clearly didn’t know how to use it, so needs training. On the patient side, people need to know the system is available and how to use it. With more patients (like you with your father) demanding to use it, the providers will have to acquiesce. Am I right though in thinking you must go to certain hospitals or GPs - with little choice? If you had the choice, you would probably go where the systems work better.
Hi Bronwyn great to hear from you in sunny Australia (although I know you are in Winter😁now). We can only register with one GP but we do have a choice of hospitals if we ask. However if we choose something 'out of area' it can cause complications because hospitals tend have a 'preferred partner' on complex things. So for example we are in York (UK) and for complex surgery we are referred to Hull. Leeds is nearer and at least as good but then if post surgery follow-up is needed (say an infection) there can be push and shove between York and Leeds where York insist the consultant from Leeds must come back onto the case but Leeds might say "we've done our bit", the follow-up can be dealt with locally in York. Where personal relationships exist between York and Hull there might not be these NHS boundary disputes. (This is not theoretical - I speak from experience). 20 years ago when we both worked on NPfIT the public was suspicious of computer systems but now Apps are central to our everyday lives and everything is so quick and easy. Citizens are asking, "if I can do everything online from my phone in all other areas then why is Health still so manual and disjointed"? I think we will see increasing dissatisfaction and pressure from the public for joined up digital health services, as we are paying record levels of tax and people now know what efficient looks like. Cheers
Hi Paul. A very interesting and timely discussion. Over the last 13 months my wife has had regular interactions with not only her GP but also various clinics and hospital departments. To our amazement there has been umpteen methods of communication ranging from the NHS App to letters, emails and phone calls, as well as a few alternative on line portals. At times we have lost track of where to find appointments, results and other information. When undertaking a complex and detailed ongoing course of treatment the patient needs a single point of reference. The current disjointed system we have faced has been painful and frustrating. Your video has served to explain why this chaos exists. But where is the will to put matters right. 🤔🥴
Hi Andrew, I think to begin with they need to put the end to end patient experience front and centre, not just in a single care setting (at best unconnected islands of excellence). A nurse in resident mental health care I just spoke to said his NHS smart card does not work any more and they have all gone back to just passwords. He said it takes up to 10 minutes to load a record and sometimes it does not work at all. The meds records are digital so no logon = no record. Frankly I find this absolutely appalling and indefensible, that anyone in authority could think that was acceptable. Cheers
Hi Paul, interesting and very topical. I will send you an email with my thoughts as I am living a very different but remarkably similar existence in my current job, therefore am analysing the same behaviour daily. Cheers, Jon
Hi Paul, thanks for this discussion. I don't have any recent direct experience with the NHS but I know my sisters have had to really work hard to get things done on behalf of my mum. Two of them were nurses previously so they understand the medical side of things To provide a slightly different perspective. The health system in Spain is similarly funded as the NHS but it is managed by the autonomous regional authorities, all 17 of them. So you guessed it 17 different IT systems that don't talk to each other. When I moved from the Murcia region to Andalucia I got a printed copy of my medical records, some of which were manually entered into the Andalusian system. The medication records do worry me we have seen this go wrong recently with my mum and as you say can have serious consequences. I hope the systems that you helped introduce can be improved and made to work efficiently. All the best
David, the increasing cost of the NHS as we live longer is unsustainable. Eventually there will be a survival imperative to join things up, or start charging us which will be politically dynamite and won't fix the efficiency problem anyway. Cheers
Is it a case of you cant fix a problem until you fully understand what's needed. It does seem that IT people design systems for other IT people to appreciate and sometimes ignore the people who will need to use it, and not just the user interfaces.
Well yes that definitely happens Chris. These days you can't really separate people, process and tools. On 'Enterprise systems' you can't change any one without the others. In one simple case I was involved in rolling out EPOS in shops. The shop staff loved it but the HQ staff really did not grasp the real benefits of all the management information and opportunities it gave them. All the reports they could get, and real-time decisions they would permit/support, were seen as a something on the side. EPOS was seen as something for the shops but not a new way of working at all levels - which is what it was. Cheers
The ultimate owner is always the User. If you don’t design for Users, a lot of the system and coding is wasted effort. Of course there will be some Users who should really unplug and find another job.
Thanks for the insight Paul. Our experience from our sons births (Epsom hospital) to GP and local hospital (Ripon and Harrogate) has been exemplary. My first computer was an Elliot 803 then scientific double precision through working life, including a 32kb mainframe. Now l use a 64Gb flash drive for storage instead of a disc the size of a large dinner plate.
Hi Geoff, I'm constantly amazed what we know (as a community) and how varied our experiences are. Many of my regular subscribers can contribute experience on such a range of subjects. My earliest experience of computers (maybe a bit later than yours) was a mainframe in a computer building running a bespoke o/s called George. Later I saw a Ferranti with core memory (ferrite beads). In 1987 I cashed in my pension fund from Plessey (just 2 years' service) to buy an Amstrad 1512 DD colour for about £700 (I think) and so our adventure with a home PC began. Since then I've never been without one. Cheers
@@HaxbyShed I do enjoy reading about the experience of others, everyone has an interesting story to tell, except probably politicians. The Elliot 803, wasn't on the syllabus but l heard there was a computing lab so decided to investigate. Paper tape feed, a few console buttons and a computer-tune - never got it to work. George and Jean were on an ICL 1902, 16k memory, with a card reader feed. Took 2-3 days to add 2+2 due mainly to formatting issues. My last memory of ICL was a 1904s but that was probably ex degree. Early 70s brought reverse polish HP desktops plus a Datapoint 2200. The latter was really a business networking machine for 8 users, but with no square root, so l had to write one in assembler and reverse engineer the operating system. There were box girder bridges to design and Morison checks later which needed frequent visits to Londons (Euston Road) bureaux. Dartmouth Basic was about the only software we had in house plus some ICL packages. Remote links to Bracknell were 30cps so many visits to the computing centre were needed. The experience of computing systems took me into a lifelong interest in electronics by reading Sinclair's booklets and ETI. In the 1980s there were many offshore structures to design and we moved onto running the floating point high precision parts remotely in Sunneyvale, Ca. Later, it was Silicon Graphics machines on UWA machines in Perth, WA. This was about the time that CAD was becoming mainstream. FE, nonlinear, dynamics and software like Nastran were also mainstream. Then a gap as computing itself became mainstream and l started managing larger international engineering projects. Now l’m back, using Fusion 360 and Windows 11 - the learning and fun never stops, until it ends😊
Oh my goodness Geoff we could write a book between us all. At school I had a calculator with reverse polish notation. I did a bit of Intel 8080 machine code and assembler at college. When was on Windows 3.1 (home PC) I used to download updates from bulleting boards when 4.8kb/s was blistering. We could go on, and on, and on couldn't we. Cheers
Very interesting to hear the perspective of an insider. My feeling is that for any of these large systems, it is nearly impossible for any one person to understand the full picture, especially if they are in a position to effect the course of events, i.e. a manager. Without the full picture, it is almost inevitable that decisions will be made that leave gaps in the implementation. In this case it seems like the gap was in deployment. The assumption was made that getting a free tool to improve efficiency would be all the motivation that was needed to get any establishment to adopt it. Somehow a motivation greater than "But that is the way we've always done it" is required. In any case, it sounds like you are way ahead of us here in Canada. In Ontario, 16% of the population doesn't even have access to a GP, let alone one that can communicate effectively with other health care entities.
Hi Mark, I think some mistakes were made in the customer's commercial strategy. The standard products needed a lot of investment to connect to the NHS Spine. Big integrator companies were chosen to lead for each of 5 areas across England, and put up the cash for the product changes and deployment (integrators were only paid on installation and acceptance). It meant one integrator would team with only one GP records product provider and one hospital records product provider. This meant some product suppliers were excluded and GPs and hospitals in each area only had a choice of one product. Eventually the customer contracting authority had to relent and allow more choices for GPs and hospitals but that meant the big integrators could not get their investment back. It would have been better to create a catalogue of compliant products that the hospitals could choose from but then who would pay for all the product development? The Government wanted the integrators to take all the risk on the understanding of exclusive contracts for each area, which proved to be not exclusive at all. This caused serious tensions in the programme - not technical issues but rather commercial. Cheers
A lot of hospitals by me use XP based machines, or even ones that run on MSDOS, or even NT3.0 or OS2/Warp on others, simply because the actual vendors of the machines, generally things that are large, heavy, and have hospital wings built around them, including lots of copper plate and lead sheet for protection, have decided for business reasons that this 10 year old machine is now obsolete, even though it was designed and specified for a 40 year operational life, and thus they will not upgrade the OS or the control program for it past a certain point. Machines they will still service, but software you have to never update the actual computer running it, because it needs XYZ function that is different (mostly more secure, or fixed known bugs and race conditions) on later ones. So the solution I see is those machines are still in use, but isolated from the main ERP systems, only getting to interface with them through a gateway appliance that does sanity checking, validates inputs, and absolutely blocks anything other than exact paths, image types and expected structures in the data. Plus gives you a CD with the data on request, because it is your data, and they will only share it with you and the requesting doctor, so long as they have your assent as patient, or carer of patient Went for MRI, machine doing it runs XP, then went to have the surgery in a CT scanner, and there that is older, and runs NT, easy to see from the default desktop icons they have. the reception computer however was running Win7, as 10 was still in opt in mode, and I got a CD with a useless to me viewer program, which is using a Java runtime and this loads a Dicom viewer. My GP now also has a computer, no more paper files, though I still get a paper script, though he also teleconsults, so sends you a photo of the script instead after the phone call. I expect this will be around for a while, till the consulting rooms can communicate directly with the pharmacy of your choice and send the script electronically, but there are still regulatory hurdles that will need changing because they call for paper only.
Hi Sean, thanks for the detail and insight. DOS and XP still run in millions of embedded controllers in industrial machines but, as you say, the key thing is they are not connected to networks, or at least not IP networks. Cheers
This sounds familiar and we have similar issues here in NZ. I retired recently, having worked in IT since 1997, not in the health sector, but my wife, (who is a midwife) described many problems similar to those you highlighted; disparate information systems that are non-integrated, don't talk to one another etc. One of the bigger problems stemmed from the reluctance of different departments to adopt/adapt to newer technologies, integrated systems and the like. Things have improved over time but there is still long way to go!!!
Having spent the last 4 years through various family and personal issues dealing with the NHS I know what you mean. With my wife's cancer the treatment took over twice as long as it should, but interestingly we occasionally found when it worked well, especially during the initial stages it was because the staff were working around the system, not with it. On more than one occasion the nurse would disappear and come back 5 mins later having got on the phone to her opposite number in another hospital having arranged the necessary appointment and handed it to us on a post it note. So not all staff are oblivious to the problems. There is a huge cultural problem with the NHS, as they don't want change especially where they perceive that jobs are at risk whether they are or not. And yes, the unions are to blame for a lot of it, not that the management seem to be accountable either. And if the staff and the management don't want change, and the politicians of any colour are afraid they will lose votes if they meddle too much it is hard to see things ever improving very much.
Hi Tim, objectively I can say the new Government are off to a good start with their 'admissions' that things are broken and some tough decisions need to be made. Let's see how tough they will be in tackling the deep seated problems. They will have to be willing to be very unpopular with certain stakeholder groups. Cheers
Well said. May wife and I currently have seen different apps that are required to monitor our health services. None of them completely communicates with each other.
Hi Graham, at a patient level I don't think we care about the tech implementation choices so long as outwardly it works as one record. Just today I encountered a case where an MRI has been booked, when subject already had one just 3 months ago somewhere else for the very same issue. The people ordering the new MRI had no idea. How does it work for patients with dementia who can't say "don't you know I've just had one of those?". What a waste of resources!! Cheers
Great insight on typical, but albeit very large scale documentation and communication upgrade, with regard to GP surgery, a doctor would have a bulging manila index pouch with the patients history of treatment, my late father was ill for many years, I remember his hospital history being a very thick folder, which would on many occasions be couriered to the hospital he was in; it was quite regular for treatment to be delayed until that hospital had received his folder. Accessible digital information is a fantastic improvement, same with all areas of industry, the change from hard copy only to digital is highly time heavy, and expensive of course during the transition. We employed several people over 2 to 3 years to scan microfiche drawings ( having previously been photographed of original large engineering drawings some 30 years before) into an image format namely *.TIFF format and databased. The original drawings on 00, 0, A1, A2, & A3 plastic film took hundreds of square feet to store in big heavy vertical cabinets, and to obtain a copy to issue for manufacturing would require someone to retrieve the drawing transparency and print from it, the process used Ammonia, it was horrible to work in that office, the operators, mainly women would have a grey/white. pallor. Today, the digital drawing is sent to the plotter, and/or emailed Document storage is highly risky, fire is the biggest threat, allowing for flood being eliminated, we had a fire at my previous company, destroyed all drawings, parts lists, contract folders, but having been scanned and digitally stored, the impact was minimal, not to property of course; some 15 years earlier would have been disastrous losing parrt drawings etc. I think a complete UK census was destroyed in or around 2nd world war? Interesting to hear on one of your previous work contacts, and how we as people are resistant to change, it wasn't until 1993 I used a PC (IBM clone), and learning at home was difficult, and expensive. On the whole, the government at the time were positive in getting this done, though it could have touted previously. Thanks for sharing Paul.
Hi John, as you say digitising records makes them safe against fire or theft, quite apart from all the other benefits. Last week I saw a records trolley being pulled along the main corridor at York General Hospital - I could not believe it still happens. I bought an Amstrad 1512 in 1987 DD colour monitor and it was a very steep learning curve. I reckon I was on it weeks before the 'breakthrough' came. But wow it gave me access to a hole new world. Microsoft Encata Encyclopaedia on a CD - I could not believe the power of it. Cheers
Part of the problem is it's capital expenditure and that gets screwed back preferentially whenever money is short (which is pretty much all the time). I was wondering what happened to Choose & Book as I've never encountered it. Last year my GP suspected cancer and I was seen very quickly by a consultant on the very day consultants were supposed to be covering for junior doctors on strike. This started a long sequence of tests: blood, X-ray, CT scan, PET scan, lung function test, endobrachial ultrasound-guided transbronchial needle aspiration (don't ask), and finally an operation done on a Saturday and seen by a consultant on the ward on the Sunday (so they are working flat-out already). Result: I don't have cancer. But the whole process took 19 weeks, which if I had had cancer would have been too long. A lot of the delay was caused, I think, by snail mail communications. Apparently they are working to adopt emails next year.
Hi Samuel, I'm glad all is ok. Going through process and waiting for results can be very stressful and worrying (I know). I totally agree that Governments just cannot resist cutting costs (but without corresponding automation/modernisation) because it seems like a 'no victim' decision. To all Governments public services just look like costs with no upside so long as voters just suck it up. As we know there are also downsides to the private sector too but with Government run services generally you can be sure that opex budgets will get squeezed without the compensating investment to maintain/improve customer service. Some Government Departments can't even perform their most basic functions now. Cheers
You did well Sir. We get no letters here in Denmark, we get it in a kind of safe mail system. it has been that way some years now. One of the down points is, that we get no letter, no letter, no job for the postman, but that is my opinen. Cheers from Denmark
Hi Henrik, thank you for watching. It is good to hear how it works in Denmark. Talking about postal services, the Royal Mail service here is now private under Government regulation. Letters have been in decline and the company is losing money. There is a big political question whether letter deliveries will reduce from 6 days a week to something less often. Cheers Paul
Excellent video Paul and very informative. With regard to your complaint I suggest cognitive dissonance may be the reason and could also explain why the hospitals were reluctant to take up the new system.
William I think that is true. For change to be really successful there has to be a common overriding imperative that everyone supports (by nature, encouragement, fear, force or whatever). As they say "lead, follow or get out of the way". Cheers
Like you, I was associated with one of the large integrators in the 1980s, and my role included monitoring 'customer' responses to the evolving systems and facilities, within the various wings of NHS. It seems to me that uptake across GPs was high because, by and large, the people to be convinced were GPs and their practice managers: not IT professionals, and without entrenched views about their own legacy systems (if any). But in some other areas of NHS, the new solutions came up against IT professionals and idiosyncratic legacy complexity, and all too often the response to innovation from outside was slow, partial and begrudging. I'm saddened that the potential for the new functionailies has still not been grasped. Two other small points: my copy of the NHS app allows acees to records, but only those held by the GP - so there's nothing from hospitals except their GP communications; and the presentation of those records allows no search facility, so they can't be interrogated, they have to be read in their entirety (which is plain daft when you're 70 like I am). Great video, and most unexpected. Thanks!
Hi SloopyJohnG, you flag a good point that commoning/rationalising/streamlining/clouding disparate disjointed IT solutions often leads to job cuts in IT local departments. There is a very strong incentive for IT people to keep things as they are, local and complex. Maybe I oversold the NHS app. I agree with your comments about features and usability but it's still a very big step forward to put that information directly into the hands of patients. Cheers Paul
I work in a different Government department and feel your frustration. Is it culture? Possibly. I find that what tends to happen is that various parts of a department want different things. Someone has a good idea, genuinely, the requirements are captured and the job starts. Either the requirement grows beyond the budget or sometimes beyond the technical know how. So the systems, when delivered don't quite meet anyone's needs or only one section of a department and so are not taken up, much like you say. It's hard to please all of the people all of the time and when you run a company that employs 1.3 million people, FTE, it becomes extremely difficult!
Hi Stephen, quite often major change programmes need to be sponsored top down with an agreed vision of what the new world looks like, after transformation. In my experience, within the public service, many of the good ideas come from the middle layers and so by definition tend to be in islands. In big companies I've see objectives like "reduce headcount by 15% within 3 years", or "increase profitability by x%" or "improve customer service by x%" with no specific limitations as to how, and often supervised directly by a member of the main board. Cheers Paul
Hi Jay, I think these topics are global and universal. Public services are complex and don't have the simplicity of just making money. But still I do think they can lose sight of their basic purpose and who they serve. Do you know our national Land Registry service (the Government org that keeps the register of property titles) can only take payment by cheque or postal order. Well, most people these days don't have a cheque book (outdated form of payment) and I was surprised to discover that Postal Orders even still existed - like a bank cheque issued by the Post Office bought for cash over the counter. That's pretty appalling and inefficient. Cheers
I sorely wish the US would prioritize the provision of health care as a social provision but alas that’s unlikely. To your point and as others have said, everyone uses their own stuff here. I have been 2 months trying to get a call to schedule a couple MRI’s but the doctor has been faxing the wrong number or the right department of the hospital isn’t getting it. After a call to both hospital and doctor, I don’t feel any closer to a date for answers about ongoing pain. Between insurance, hospitals, and providers, I believe I have 4 different apps on my phone and as others have said, zero inter-communication….. ah well - enjoyed the video and hopefully someday all the healthcare industry will grow and adopt good IT integration for the benefit of the patient and the system!
@@shandylynn1 I think the thing to emphasise here is that in the UK, for all our systems faults, you would simply get those MRI scans, no questions asked, as many as you needed, for as long as you needed them.
Hiya, Shandylynn, it sounds very difficult. As Carl says, for all its quirks the NHS does provide free care (paid from general taxation) so in principle you just need to show up and it will take care of you. But the cost is enormous and increasing steeply as we get older (as a population) and it could be more efficient. Cheers
Wasn’t the NHS National Programme for IT scrapped by the government after just a few years? I can’t remember the reason why they decided to scrap it though. Also, I’d be very surprised if there are any NHS Trusts that are still using Windows XP, after the NHS cyber attack that happened a few years ago (approx 2017 or 2018?)
Hello Tony, I had left the programme well before the National Programme for IT was wound up but a quick Google says it ended in September 2011 and I suppose that's when the funding was withdrawn. Commentators have made many suggestions why the programme did not complete but I can quote one here "The project was marred by resistance due to the inappropriateness of a centralized authority making top-down decisions on behalf of local organizations." I hope you can read between the lines, but also the Conservatives came to power in 2010 and that was probably a factor also. I agree the XP quote is a bit dated now but Microsoft Windows XP security and technical support ended in April 2014 and Google tells me the NHS XP cyber-attack happened in May 2017 so more than three years after Microsoft stopped releasing new security patches. Cheers
I think Dickens was on to it with the Circumlocution Office.......Little Dorrit I think........That has to be written 200 years ago so it certainly is not new in the UK , sadly of course , it is everywhere else as well.
Hi Bob, no I'm not suggesting anything like that. The NHS is a very large federated organisation so at worst I'm suggesting it is so busy getting through the day to day stuff it's unable to take the benefits of joined up information systems which to a large degree already exist. Cheers
Hi there sorry that was meant to be tongue in cheek. I worked closely with the local health board as a copier repair enginer and installer. I say the way things worked on a day to day basis. Strangely enough the local health board IT was run by (yes you guessed it) Fujitsu.
frustrating that things haven't been standardised just because "its too hard" or "we have always done it this way". In Australia, we have the "MY GOV" app that combines all government services together in one place, but they don't seem to talk to each other so you get several notifications from different departments asking for the same information 🤨
Hi Peter, we are getting better there at Government level. We all (can) have a Government logon that covers many government services including personal tax. Once your photo ID is on the system you can apply for passports and driving licences, pay car tax etc online. Local Councils have similar systems for reporting local problems, paying bills, etc. So long as you can stay on the digital (automated) track it can be very easy and quick. Get off the digital track and need to talk to human then it becomes difficult in many cases. Cheers
Hiya, Scotland has a lot of open space. Just taking England, where most of the people are, it is 56m people in 50,000 sq mile = 1120 per square mile. We are pretty dense 😁
Hi Rusti, great progress has been made but the model still assumes that people stay in one place and only visit one GP and one Hospital. Don't get proper sick on holiday! Cheers
Sean, I think the computer is never to blame (apart from the occasional bug), it's how organisations conceive them and use them. Horizon itself did not send people to prison. It was the culture at the top of the organisation surely? Cheers
@@HaxbyShed Yes but they knew the software was buggy, and was very prone to losing transactions, yet never admitted it or fixed it at all, instead blaming all the errors on the assorted postmasters and then deliberately hiding the evidence of errors.
It's a process and people problem. IT systems are only as good as the processes and people maintaining and championing them. Coming from a family of health professionals, I can say they're terribly time poor (my brother worked in the NHS system for a decade) and the hospital management do not do enough to allocate training resources and time which is finally a result of budget constraints.
The problem is a lot of people just want to fill their pockets full of money rather than getting the job done. Its the same with any government contracts. NHS, HS2, Carillion, Water, Energy etc etc. Shall I go on ?
You are right Richard, because they are spending other people's money and there is no self-limit but don't you think it's because the ultimate customer is absent? Would you let a day-rate builder work for you unsupervised? Too often the customer chair at the top is empty or filled by an ineffective body (like the regulators). Government contracts eh? There are some notable successes but only with very strong management by the customer. Cheers
@@HaxbyShed We need politicians( legalized criminals) etc to be accountable not just do what they like. Plus they should do what the people what not what they think we should have.
Many of your concerns are likely attributable to inherent security issues for large databases with sensitive information. With so many people having access to NHS data, administrators have to limit and monitor access to prevent people from misusing the data. An even bigger issue is controlling who can edit and amend the data. Accordingly, it's imperative to limit access to justifiable need. The nurse who inquired about your father's medication may have lacked the credentials to access that information, and because she was neither a doctor or pharmacist, she probably shouldn't have even ask you for the info.
Hi EDesigns, I agree managing role-based access control is a big challenge day to day as staff join/move/temp/leave etc. Some of the information is medically sensitive but much is not. Names, addresses, NHS number, next of kin, - are these hyper sensitive really? My wife went to a sleep clinic and they did some basic tests. Did not tell us anything so she went to another clinic at another hospital that claimed to be more specialised. They wanted to repeat the very same tests. When she said I've already had those they said "ah but that was at a different hospital we don't know about that" and she said I'm telling you .... and they said "do you want it or not?" Cheers
@@HaxbyShed Because of prevalence of identity theft, even seemingly innocuous information, such as the examples that you cited, can be very valuable to bad actors. So yes, access to this data has to be monitored and constrained to minimize abuses, and, unfortunately, this can create some inconveniences.
I under stand what you are saying but what happens when you come against who are not connected to the internet in any way do not have a smart phone are not interested and prefer to communicate by letter my wife refuses to have a mobile phone, she says she as lived to 76 with out one and is not starting now
Hi Roger, I think I am tech savvy but for the really important stuff I still prefer letters. I worry greatly about older person exclusion but it's not only them. I was a trustee of a charity for visually impaired. A constant problem - how does one do on-line banking when blind? The charity was asked to provide volunteer helpers but we could not agree to that due to safeguarding concerns. No branch to visit, no family to help - what do they do? Cheers
Personally, I have for most of my life thought the NHS was an outstanding example of how public health should be done. We have a similar system here in New Zealand, and sadly many of the same issues exist as well. As an aside, blockchain (which is not just for cryptocurrency) offers huge promise for securely and safely handling private data such as patient records, not only in terms of security, but also in terms of the control that patients have over their own data. In the future I expect that many large, centrally managed databases, controlled by one government agency or another, will be transformed into distributed blockchain databases accessible to government and private institutions, and the individuals whose data is stored, yet without any central controlling entity. I'm sure it sounds like a dystopian nightmare to some, but it is secure and proven technology, that in the long run will be far better than the proliferation of siloed systems and interoperability and data-sharing problems that have today become the norm.
Hiya Paul. I think the problem is not so much security/technical as it is human issues. The NHS is loved and appreciated here, but we all know it is struggling with resources and demand. Cheers
Hiya RB, I agree. In business there is usually one primary objective and everyone supports it (one way or another) because it puts food on the table. In public organisations where there are no direct and immediate consequences that focus can gets lost and other proto-objectives creep in. I know in several Government organisations saving money and becoming more efficient and providing better service to citizens are not primary considerations (I have personal experience to back up those comments). Cheers
Hi Sam, I would not want to say too much without hard data to compare but I will say that the public services tend to lack the razor sharp focus on costs and efficiency (that much I do know from first hand experience). Cheers
Thank you, long time viewer and lurker, it's good to hear from your perspective. It at times doesn't help that hospitals are in competition with each other, the so called internal market, and have operated like that so long that is ingrained to think of trying to hold on and not loose business to other hospitals to a degree. As you said there's so many layers to the IT nhs infrastructure within a local service and more layers nationally. It's like layers in a onion, and everyone has their own onions and trying to get it all to merge and interact is more difficult than it should be. There needs to be much more longer term vision and planning rather than the 4 or 5 year cycle of who ever in power and their own ideas of how it should be. A longer term group that could set a vision and common ideas and see them through over long term might be a step in the right direction. Was a nice video to think about and i hope things will move and get better
Funny thing is that most internal departments in a hospital are now run by external companies, not actually by the hospital. Went to 2 diffewrent hospitals, one for a MRI, another for a CT assisted surgery, and in both the actual provider of the CT and MRI was the same company, and the surgery was done by a contracted surgeon. Only the hospital was doing the billing for part of both, and providing the actual room. I was in a third hospital as well, where the doctor was based as well. From the one you could see the other 2, each owned by separate holding companies. Unlike the UK here government hospitals I would still be waiting for the first appointment, if you want state funded optical or dental the waiting period is now around 10 years, and for many others it is up to 5 years, yet there are hundreds of GP positions open and unfilled, and hundreds of newly qualified student doctors to fill them, but the state is unable to actually fit them into the positions and get low cost doctors who need the practical training to complete the degree
Hi AmiPurple, I like the idea of lurker suggests somebody in the shadows - covert watcher. Ah yes payment by results, money follows the patient etc. I agree the internal market model does not lend itself easily to collaboration. And likewise having independent Trusts might not lend itself to common standards for information exchange, but then having everything centrally command and controlled top down is not good either. There needs to be something in it for everyone as a common cause. But which ever way you look at it the NHS has to become more efficient - you can only slice a salami so thin else it falls apart (bad metaphor but you get the idea). Cheers
Hi @hrxy, thanks for the comment. I don't claim my view is any more right than anyone else's but I did work on the programme directly for 3 years so it's not all hot air and armchair commentating. I talk about it because I care about it, but I'll be back to my normal hobby shop machining topics in the next vid. Cheers
@@HaxbyShed it will not work I remember in the 69 the great thing was microfishe, was going to revolution health care, where is it now? people are sicker now with so many new diseases, where are they coming from, answer, doctors, do you think some nurses in Nigeria or doctors from Pakistan give a fck bout the hippocratic oath, when they havoc no running water sewage, or food, you dolt. especially when they see fat waddling wetesteners in hospital with overindugent diseases. what do you think they think when every weekend they see people rolling in the street pissed. do you really think they don't think something. no, no, no 3 years is not enough to understand, stick to nuts and bolts not health care your not qualified
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A very well reasoned and put together piece Paul. Nothing at all like the rant I was expecting when I read the title!
In my experience things very often work in spite of ‘the system’, not as a result of it. I’m at a loss how a machine with the scale, complexity and inertia of the NHS can be tuned to run more effectively. From what you’ve said, the work you and others have already done, if fully realised, could have already improved matters significantly. A missed opportunity…
I fear the unfortunate thing about healthcare is that on the whole it isn’t an altruistic endeavour. For staff at the sharp end (sometimes literally!) it can a vocation borne of wanting to help, but elsewhere for a great many suppliers of equipment, consumables, pharmaceuticals and systems the shareholder’s dividend is the main driving force behind innovation.
Hiya Matt, I've spent most of today responding to comments and thankfully yours is the last mate! Stupid me for putting out two videos in a week and people writing great comments which deserve more than just thanks 👍. Well you are right any caring profession will be exploited by the employers such that they battle on despite the shortcomings whereas in commercial work you would say f-this and just go and get another job. There is sooo much scope for removing duplication by things being repeated - well intentioned but unknowing because data is not shared. Often the patient is the one saying "but I've already had that test?". Also sometimes a referral takes on a life of its own and runs on and on "I'll see you again in 3 weeks" and "I refer you to somebody else" without somebody saying enough this is nonsense - often it's the patient making that judgement too. Regards Paul
I think I have a little bit of insight here from a different perspective. I am an IT professional and, like you, geek out a bit over technology. 😂 By and large, hospitals here in the US are private entities, as are the insurance companies. There's government regulation, of course, but for the most part, or at least for the sake of this comment, they are 100% private businesses. Where I live, there are two major hospital systems. Both of which are utilizing a third party system cal ed "MyChart" that is used for all of the things your IT project was hoping to implement. The reason, I believe, these systems are bing used, as you aptly point out, is cost savings, or more accurately, increased profits. These systems aren't integrated because they are nice people, they are trying to reduce costs, both underlying costs and costs passed on to consumer, and to also increase, or at least stabilize, profits. There needs to be an incentive. And if it's not government forcing it on them, it has to be some other mechanism. I would surmise that in many case, much of what you helped build is not being utilized is not due to a cultural issue, or a British issue, but because of a human issue - "what is in it for ME."
Hi Greg, I do think public organisations sometimes lose sight of their customers and do things for 'internal reasons'. My knowledge is well out of date so I looked up MyChart and see that it is basically the patient front end to EPIC. They seem to be a the main alternative(?) to Cerner, which I do remember was one of the systems available under the National Programme for IT. So it's quite possible that by now EPIC interfaces to the NHS digital architecture for data interchange etc. I see that quite a few NHS public hospitals in the UK use MyChart/EPIC. Cheers Paul
Well done. Very informative and I am still here. My wife’s GP uses the NHS App but the London hospital that she is under uses My Chart app. So to see information she has to open 2 apps! They don’t talk to each other either.
Hi Rob, going back 20 years since I was involved, it was only intended to interchange demographic data and a care record summary. Also there was a data transfer service so that records could be transferred electronically between GP surgeries if a patient moved to a different surgery. I see that MyChart is the patient front end to EPIC, which is one of the big providers of patient record systems. I think maybe Cerner is the other big one(?). The idea of the NHS single smartcard logon was to be universal so that ultimately all users were verified and all actions auditable, and would be a fundamental enabler for 'one record'. Without going into too much detail, when the NHS smartcards were first introduced there were some problems with proof of ID - read into that what you like. The e-prescriptions service flushed out some naughty practice between a few GPs and Pharmacists. Cheers
Thank you for sharing your insights! I am very envious of the NHS. Maybe things could be better, but it sounds much fairer than the US system.
We are very lucky to have our NHS Mark. The problem is it needs reform to make it more efficient and affordable. £200Bn divided by 64m people = £3125 per citizen per year (about US$4000). But not everybody gets sick every year so perhaps it's £6250 a year for the ones that do (using half the population, 32m patients a year guess). Well here you can get a lot of medical insurance for £6250 a year (about US$8000). Cheers
Thanks for this video, probably the best and most succinct explanation of the NPfIT I have ever seen (and as you know I was there with you!). IN Australia we too have had a less than successful go at an electronic record system with some issues around contract management as significant hurdles. The heart of the issue you raise though seems to be around change and training. I have long lost my passion for big change programs, but it seems to me that the nurse who couldn’t use her smart card was not aware of how much easier her job would be if she fully used the system ( how long was she winging it without using it). And she clearly didn’t know how to use it, so needs training. On the patient side, people need to know the system is available and how to use it. With more patients (like you with your father) demanding to use it, the providers will have to acquiesce. Am I right though in thinking you must go to certain hospitals or GPs - with little choice? If you had the choice, you would probably go where the systems work better.
Hi Bronwyn great to hear from you in sunny Australia (although I know you are in Winter😁now). We can only register with one GP but we do have a choice of hospitals if we ask. However if we choose something 'out of area' it can cause complications because hospitals tend have a 'preferred partner' on complex things. So for example we are in York (UK) and for complex surgery we are referred to Hull. Leeds is nearer and at least as good but then if post surgery follow-up is needed (say an infection) there can be push and shove between York and Leeds where York insist the consultant from Leeds must come back onto the case but Leeds might say "we've done our bit", the follow-up can be dealt with locally in York. Where personal relationships exist between York and Hull there might not be these NHS boundary disputes. (This is not theoretical - I speak from experience). 20 years ago when we both worked on NPfIT the public was suspicious of computer systems but now Apps are central to our everyday lives and everything is so quick and easy. Citizens are asking, "if I can do everything online from my phone in all other areas then why is Health still so manual and disjointed"? I think we will see increasing dissatisfaction and pressure from the public for joined up digital health services, as we are paying record levels of tax and people now know what efficient looks like. Cheers
Hi Paul. A very interesting and timely discussion. Over the last 13 months my wife has had regular interactions with not only her GP but also various clinics and hospital departments. To our amazement there has been umpteen methods of communication ranging from the NHS App to letters, emails and phone calls, as well as a few alternative on line portals. At times we have lost track of where to find appointments, results and other information.
When undertaking a complex and detailed ongoing course of treatment the patient needs a single point of reference. The current disjointed system we have faced has been painful and frustrating.
Your video has served to explain why this chaos exists. But where is the will to put matters right. 🤔🥴
Hi Andrew, I think to begin with they need to put the end to end patient experience front and centre, not just in a single care setting (at best unconnected islands of excellence). A nurse in resident mental health care I just spoke to said his NHS smart card does not work any more and they have all gone back to just passwords. He said it takes up to 10 minutes to load a record and sometimes it does not work at all. The meds records are digital so no logon = no record. Frankly I find this absolutely appalling and indefensible, that anyone in authority could think that was acceptable. Cheers
Hi Paul, interesting and very topical. I will send you an email with my thoughts as I am living a very different but remarkably similar existence in my current job, therefore am analysing the same behaviour daily. Cheers, Jon
Well as the say Jon every org is staffed by the same people, it's only the names that are different 😁. Got the email thanks. Cheers
Hi Paul, thanks for this discussion.
I don't have any recent direct experience with the NHS but I know my sisters have had to really work hard to get things done on behalf of my mum. Two of them were nurses previously so they understand the medical side of things
To provide a slightly different perspective. The health system in Spain is similarly funded as the NHS but it is managed by the autonomous regional authorities, all 17 of them. So you guessed it 17 different IT systems that don't talk to each other.
When I moved from the Murcia region to Andalucia I got a printed copy of my medical records, some of which were manually entered into the Andalusian system.
The medication records do worry me we have seen this go wrong recently with my mum and as you say can have serious consequences.
I hope the systems that you helped introduce can be improved and made to work efficiently.
All the best
David, the increasing cost of the NHS as we live longer is unsustainable. Eventually there will be a survival imperative to join things up, or start charging us which will be politically dynamite and won't fix the efficiency problem anyway. Cheers
Excellent peice Paul!
Thank you Phil. Just something I care about. Cheers
Is it a case of you cant fix a problem until you fully understand what's needed. It does seem that IT people design systems for other IT people to appreciate and sometimes ignore the people who will need to use it, and not just the user interfaces.
Well yes that definitely happens Chris. These days you can't really separate people, process and tools. On 'Enterprise systems' you can't change any one without the others. In one simple case I was involved in rolling out EPOS in shops. The shop staff loved it but the HQ staff really did not grasp the real benefits of all the management information and opportunities it gave them. All the reports they could get, and real-time decisions they would permit/support, were seen as a something on the side. EPOS was seen as something for the shops but not a new way of working at all levels - which is what it was. Cheers
The ultimate owner is always the User. If you don’t design for Users, a lot of the system and coding is wasted effort. Of course there will be some Users who should really unplug and find another job.
Thanks for the insight Paul. Our experience from our sons births (Epsom hospital) to GP and local hospital (Ripon and Harrogate) has been exemplary. My first computer was an Elliot 803 then scientific double precision through working life, including a 32kb mainframe. Now l use a 64Gb flash drive for storage instead of a disc the size of a large dinner plate.
Hi Geoff, I'm constantly amazed what we know (as a community) and how varied our experiences are. Many of my regular subscribers can contribute experience on such a range of subjects. My earliest experience of computers (maybe a bit later than yours) was a mainframe in a computer building running a bespoke o/s called George. Later I saw a Ferranti with core memory (ferrite beads). In 1987 I cashed in my pension fund from Plessey (just 2 years' service) to buy an Amstrad 1512 DD colour for about £700 (I think) and so our adventure with a home PC began. Since then I've never been without one. Cheers
@@HaxbyShed I do enjoy reading about the experience of others, everyone has an interesting story to tell, except probably politicians.
The Elliot 803, wasn't on the syllabus but l heard there was a computing lab so decided to investigate. Paper tape feed, a few console buttons and a computer-tune - never got it to work. George and Jean were on an ICL 1902, 16k memory, with a card reader feed. Took 2-3 days to add 2+2 due mainly to formatting issues. My last memory of ICL was a 1904s but that was probably ex degree.
Early 70s brought reverse polish HP desktops plus a Datapoint 2200. The latter was really a business networking machine for 8 users, but with no square root, so l had to write one in assembler and reverse engineer the operating system. There were box girder bridges to design and Morison checks later which needed frequent visits to Londons (Euston Road) bureaux. Dartmouth Basic was about the only software we had in house plus some ICL packages. Remote links to Bracknell were 30cps so many visits to the computing centre were needed.
The experience of computing systems took me into a lifelong interest in electronics by reading Sinclair's booklets and ETI.
In the 1980s there were many offshore structures to design and we moved onto running the floating point high precision parts remotely in Sunneyvale, Ca. Later, it was Silicon Graphics machines on UWA machines in Perth, WA. This was about the time that CAD was becoming mainstream. FE, nonlinear, dynamics and software like Nastran were also mainstream.
Then a gap as computing itself became mainstream and l started managing larger international engineering projects. Now l’m back, using Fusion 360 and Windows 11 - the learning and fun never stops, until it ends😊
Oh my goodness Geoff we could write a book between us all. At school I had a calculator with reverse polish notation. I did a bit of Intel 8080 machine code and assembler at college. When was on Windows 3.1 (home PC) I used to download updates from bulleting boards when 4.8kb/s was blistering. We could go on, and on, and on couldn't we. Cheers
Very interesting to hear the perspective of an insider. My feeling is that for any of these large systems, it is nearly impossible for any one person to understand the full picture, especially if they are in a position to effect the course of events, i.e. a manager. Without the full picture, it is almost inevitable that decisions will be made that leave gaps in the implementation. In this case it seems like the gap was in deployment. The assumption was made that getting a free tool to improve efficiency would be all the motivation that was needed to get any establishment to adopt it. Somehow a motivation greater than "But that is the way we've always done it" is required.
In any case, it sounds like you are way ahead of us here in Canada. In Ontario, 16% of the population doesn't even have access to a GP, let alone one that can communicate effectively with other health care entities.
Hi Mark, I think some mistakes were made in the customer's commercial strategy. The standard products needed a lot of investment to connect to the NHS Spine. Big integrator companies were chosen to lead for each of 5 areas across England, and put up the cash for the product changes and deployment (integrators were only paid on installation and acceptance). It meant one integrator would team with only one GP records product provider and one hospital records product provider. This meant some product suppliers were excluded and GPs and hospitals in each area only had a choice of one product. Eventually the customer contracting authority had to relent and allow more choices for GPs and hospitals but that meant the big integrators could not get their investment back. It would have been better to create a catalogue of compliant products that the hospitals could choose from but then who would pay for all the product development? The Government wanted the integrators to take all the risk on the understanding of exclusive contracts for each area, which proved to be not exclusive at all. This caused serious tensions in the programme - not technical issues but rather commercial. Cheers
A lot of hospitals by me use XP based machines, or even ones that run on MSDOS, or even NT3.0 or OS2/Warp on others, simply because the actual vendors of the machines, generally things that are large, heavy, and have hospital wings built around them, including lots of copper plate and lead sheet for protection, have decided for business reasons that this 10 year old machine is now obsolete, even though it was designed and specified for a 40 year operational life, and thus they will not upgrade the OS or the control program for it past a certain point. Machines they will still service, but software you have to never update the actual computer running it, because it needs XYZ function that is different (mostly more secure, or fixed known bugs and race conditions) on later ones.
So the solution I see is those machines are still in use, but isolated from the main ERP systems, only getting to interface with them through a gateway appliance that does sanity checking, validates inputs, and absolutely blocks anything other than exact paths, image types and expected structures in the data. Plus gives you a CD with the data on request, because it is your data, and they will only share it with you and the requesting doctor, so long as they have your assent as patient, or carer of patient
Went for MRI, machine doing it runs XP, then went to have the surgery in a CT scanner, and there that is older, and runs NT, easy to see from the default desktop icons they have. the reception computer however was running Win7, as 10 was still in opt in mode, and I got a CD with a useless to me viewer program, which is using a Java runtime and this loads a Dicom viewer.
My GP now also has a computer, no more paper files, though I still get a paper script, though he also teleconsults, so sends you a photo of the script instead after the phone call. I expect this will be around for a while, till the consulting rooms can communicate directly with the pharmacy of your choice and send the script electronically, but there are still regulatory hurdles that will need changing because they call for paper only.
Hi Sean, thanks for the detail and insight. DOS and XP still run in millions of embedded controllers in industrial machines but, as you say, the key thing is they are not connected to networks, or at least not IP networks. Cheers
This sounds familiar and we have similar issues here in NZ. I retired recently, having worked in IT since 1997, not in the health sector, but my wife, (who is a midwife) described many problems similar to those you highlighted; disparate information systems that are non-integrated, don't talk to one another etc. One of the bigger problems stemmed from the reluctance of different departments to adopt/adapt to newer technologies, integrated systems and the like. Things have improved over time but there is still long way to go!!!
It all sounds familiar Dave. It's like hundreds of organisations all working to achieve the best but not cohesive as a system. Cheers
Having spent the last 4 years through various family and personal issues dealing with the NHS I know what you mean. With my wife's cancer the treatment took over twice as long as it should, but interestingly we occasionally found when it worked well, especially during the initial stages it was because the staff were working around the system, not with it. On more than one occasion the nurse would disappear and come back 5 mins later having got on the phone to her opposite number in another hospital having arranged the necessary appointment and handed it to us on a post it note. So not all staff are oblivious to the problems. There is a huge cultural problem with the NHS, as they don't want change especially where they perceive that jobs are at risk whether they are or not. And yes, the unions are to blame for a lot of it, not that the management seem to be accountable either. And if the staff and the management don't want change, and the politicians of any colour are afraid they will lose votes if they meddle too much it is hard to see things ever improving very much.
Hi Tim, objectively I can say the new Government are off to a good start with their 'admissions' that things are broken and some tough decisions need to be made. Let's see how tough they will be in tackling the deep seated problems. They will have to be willing to be very unpopular with certain stakeholder groups. Cheers
Well said. May wife and I currently have seen different apps that are required to monitor our health services. None of them completely communicates with each other.
Good to know we are not alone RG. 😁
Same background as me. I was in Scarborough doing the same thing. Also I'm told that York is getting rid of CPD which didn't work well with the spine.
Hi Graham, at a patient level I don't think we care about the tech implementation choices so long as outwardly it works as one record. Just today I encountered a case where an MRI has been booked, when subject already had one just 3 months ago somewhere else for the very same issue. The people ordering the new MRI had no idea. How does it work for patients with dementia who can't say "don't you know I've just had one of those?". What a waste of resources!! Cheers
Great insight on typical, but albeit very large scale documentation and communication upgrade, with regard to GP surgery, a doctor would have a bulging manila index pouch with the patients history of treatment, my late father was ill for many years, I remember his hospital history being a very thick folder, which would on many occasions be couriered to the hospital he was in; it was quite regular for treatment to be delayed until that hospital had received his folder.
Accessible digital information is a fantastic improvement, same with all areas of industry, the change from hard copy only to digital is highly time heavy, and expensive of course during the transition. We employed several people over 2 to 3 years to scan microfiche drawings ( having previously been photographed of original large engineering drawings some 30 years before) into an image format namely *.TIFF format and databased.
The original drawings on 00, 0, A1, A2, & A3 plastic film took hundreds of square feet to store in big heavy vertical cabinets, and to obtain a copy to issue for manufacturing would require someone to retrieve the drawing transparency and print from it, the process used Ammonia, it was horrible to work in that office, the operators, mainly women would have a grey/white.
pallor.
Today, the digital drawing is sent to the plotter, and/or emailed
Document storage is highly risky, fire is the biggest threat, allowing for flood being eliminated, we had a fire at my previous company, destroyed all drawings, parts lists, contract folders, but having been scanned and digitally stored, the impact was minimal, not to property of course; some 15 years earlier would have been disastrous losing parrt drawings etc.
I think a complete UK census was destroyed in or around 2nd world war?
Interesting to hear on one of your previous work contacts, and how we as people are resistant to change, it wasn't until 1993 I used a PC (IBM clone), and learning at home was difficult, and expensive.
On the whole, the government at the time were positive in getting this done, though it could have touted previously.
Thanks for sharing Paul.
Hi John, as you say digitising records makes them safe against fire or theft, quite apart from all the other benefits. Last week I saw a records trolley being pulled along the main corridor at York General Hospital - I could not believe it still happens. I bought an Amstrad 1512 in 1987 DD colour monitor and it was a very steep learning curve. I reckon I was on it weeks before the 'breakthrough' came. But wow it gave me access to a hole new world. Microsoft Encata Encyclopaedia on a CD - I could not believe the power of it. Cheers
Part of the problem is it's capital expenditure and that gets screwed back preferentially whenever money is short (which is pretty much all the time). I was wondering what happened to Choose & Book as I've never encountered it. Last year my GP suspected cancer and I was seen very quickly by a consultant on the very day consultants were supposed to be covering for junior doctors on strike. This started a long sequence of tests: blood, X-ray, CT scan, PET scan, lung function test, endobrachial ultrasound-guided transbronchial needle aspiration (don't ask), and finally an operation done on a Saturday and seen by a consultant on the ward on the Sunday (so they are working flat-out already). Result: I don't have cancer. But the whole process took 19 weeks, which if I had had cancer would have been too long. A lot of the delay was caused, I think, by snail mail communications. Apparently they are working to adopt emails next year.
Hi Samuel, I'm glad all is ok. Going through process and waiting for results can be very stressful and worrying (I know). I totally agree that Governments just cannot resist cutting costs (but without corresponding automation/modernisation) because it seems like a 'no victim' decision. To all Governments public services just look like costs with no upside so long as voters just suck it up. As we know there are also downsides to the private sector too but with Government run services generally you can be sure that opex budgets will get squeezed without the compensating investment to maintain/improve customer service. Some Government Departments can't even perform their most basic functions now. Cheers
You did well Sir. We get no letters here in Denmark, we get it in a kind of safe mail system. it has been that way some years now. One of the down points is, that we get no letter, no letter, no job for the postman, but that is my opinen. Cheers from Denmark
Hi Henrik, thank you for watching. It is good to hear how it works in Denmark. Talking about postal services, the Royal Mail service here is now private under Government regulation. Letters have been in decline and the company is losing money. There is a big political question whether letter deliveries will reduce from 6 days a week to something less often. Cheers Paul
Excellent video Paul and very informative. With regard to your complaint I suggest cognitive dissonance may be the reason and could also explain why the hospitals were reluctant to take up the new system.
William I think that is true. For change to be really successful there has to be a common overriding imperative that everyone supports (by nature, encouragement, fear, force or whatever). As they say "lead, follow or get out of the way". Cheers
Like you, I was associated with one of the large integrators in the 1980s, and my role included monitoring 'customer' responses to the evolving systems and facilities, within the various wings of NHS. It seems to me that uptake across GPs was high because, by and large, the people to be convinced were GPs and their practice managers: not IT professionals, and without entrenched views about their own legacy systems (if any). But in some other areas of NHS, the new solutions came up against IT professionals and idiosyncratic legacy complexity, and all too often the response to innovation from outside was slow, partial and begrudging. I'm saddened that the potential for the new functionailies has still not been grasped.
Two other small points: my copy of the NHS app allows acees to records, but only those held by the GP - so there's nothing from hospitals except their GP communications; and the presentation of those records allows no search facility, so they can't be interrogated, they have to be read in their entirety (which is plain daft when you're 70 like I am).
Great video, and most unexpected. Thanks!
Hi SloopyJohnG, you flag a good point that commoning/rationalising/streamlining/clouding disparate disjointed IT solutions often leads to job cuts in IT local departments. There is a very strong incentive for IT people to keep things as they are, local and complex. Maybe I oversold the NHS app. I agree with your comments about features and usability but it's still a very big step forward to put that information directly into the hands of patients. Cheers Paul
I work in a different Government department and feel your frustration. Is it culture? Possibly. I find that what tends to happen is that various parts of a department want different things. Someone has a good idea, genuinely, the requirements are captured and the job starts. Either the requirement grows beyond the budget or sometimes beyond the technical know how. So the systems, when delivered don't quite meet anyone's needs or only one section of a department and so are not taken up, much like you say. It's hard to please all of the people all of the time and when you run a company that employs 1.3 million people, FTE, it becomes extremely difficult!
Hi Stephen, quite often major change programmes need to be sponsored top down with an agreed vision of what the new world looks like, after transformation. In my experience, within the public service, many of the good ideas come from the middle layers and so by definition tend to be in islands. In big companies I've see objectives like "reduce headcount by 15% within 3 years", or "increase profitability by x%" or "improve customer service by x%" with no specific limitations as to how, and often supervised directly by a member of the main board. Cheers Paul
You would be shocked by the similarities here in Canada !!!
Hi Jay, I think these topics are global and universal. Public services are complex and don't have the simplicity of just making money. But still I do think they can lose sight of their basic purpose and who they serve. Do you know our national Land Registry service (the Government org that keeps the register of property titles) can only take payment by cheque or postal order. Well, most people these days don't have a cheque book (outdated form of payment) and I was surprised to discover that Postal Orders even still existed - like a bank cheque issued by the Post Office bought for cash over the counter. That's pretty appalling and inefficient. Cheers
I sorely wish the US would prioritize the provision of health care as a social provision but alas that’s unlikely. To your point and as others have said, everyone uses their own stuff here. I have been 2 months trying to get a call to schedule a couple MRI’s but the doctor has been faxing the wrong number or the right department of the hospital isn’t getting it. After a call to both hospital and doctor, I don’t feel any closer to a date for answers about ongoing pain. Between insurance, hospitals, and providers, I believe I have 4 different apps on my phone and as others have said, zero inter-communication….. ah well - enjoyed the video and hopefully someday all the healthcare industry will grow and adopt good IT integration for the benefit of the patient and the system!
@@shandylynn1 I think the thing to emphasise here is that in the UK, for all our systems faults, you would simply get those MRI scans, no questions asked, as many as you needed, for as long as you needed them.
@@carlwilson1772 💯 % yes. I’ll be waiting on pre-authorizations from insurance for weeks I’m sure. If I can even get a call back.
Hiya, Shandylynn, it sounds very difficult. As Carl says, for all its quirks the NHS does provide free care (paid from general taxation) so in principle you just need to show up and it will take care of you. But the cost is enormous and increasing steeply as we get older (as a population) and it could be more efficient. Cheers
Wasn’t the NHS National Programme for IT scrapped by the government after just a few years? I can’t remember the reason why they decided to scrap it though. Also, I’d be very surprised if there are any NHS Trusts that are still using Windows XP, after the NHS cyber attack that happened a few years ago (approx 2017 or 2018?)
Hello Tony, I had left the programme well before the National Programme for IT was wound up but a quick Google says it ended in September 2011 and I suppose that's when the funding was withdrawn. Commentators have made many suggestions why the programme did not complete but I can quote one here "The project was marred by resistance due to the inappropriateness of a centralized authority making top-down decisions on behalf of local organizations." I hope you can read between the lines, but also the Conservatives came to power in 2010 and that was probably a factor also. I agree the XP quote is a bit dated now but Microsoft Windows XP security and technical support ended in April 2014 and Google tells me the NHS XP cyber-attack happened in May 2017 so more than three years after Microsoft stopped releasing new security patches. Cheers
I think Dickens was on to it with the Circumlocution Office.......Little Dorrit I think........That has to be written 200 years ago so it certainly is not new in the UK , sadly of course , it is everywhere else as well.
Well human nature evolved in caves and it's not changed much in a million years. We should not be surprised really. Cheers
Should we be thinking of Fujitsu and the Post Office
Hi Bob, no I'm not suggesting anything like that. The NHS is a very large federated organisation so at worst I'm suggesting it is so busy getting through the day to day stuff it's unable to take the benefits of joined up information systems which to a large degree already exist. Cheers
Hi there sorry that was meant to be tongue in cheek. I worked closely with the local health board as a copier repair enginer and installer. I say the way things worked on a day to day basis. Strangely enough the local health board IT was run by (yes you guessed it) Fujitsu.
frustrating that things haven't been standardised just because "its too hard" or "we have always done it this way". In Australia, we have the "MY GOV" app that combines all government services together in one place, but they don't seem to talk to each other so you get several notifications from different departments asking for the same information 🤨
Hi Peter, we are getting better there at Government level. We all (can) have a Government logon that covers many government services including personal tax. Once your photo ID is on the system you can apply for passports and driving licences, pay car tax etc online. Local Councils have similar systems for reporting local problems, paying bills, etc. So long as you can stay on the digital (automated) track it can be very easy and quick. Get off the digital track and need to talk to human then it becomes difficult in many cases. Cheers
725 person per square mile if I got that right? Wow!
Hiya, Scotland has a lot of open space. Just taking England, where most of the people are, it is 56m people in 50,000 sq mile = 1120 per square mile. We are pretty dense 😁
Very interesting. The NHS frustrates me a little. He he.
Hi Rusti, great progress has been made but the model still assumes that people stay in one place and only visit one GP and one Hospital. Don't get proper sick on holiday! Cheers
You mean something actually got learnt from Horizon, or is it still being told that the computer never makes a mistiake.
Sean, I think the computer is never to blame (apart from the occasional bug), it's how organisations conceive them and use them. Horizon itself did not send people to prison. It was the culture at the top of the organisation surely? Cheers
@@HaxbyShed Yes but they knew the software was buggy, and was very prone to losing transactions, yet never admitted it or fixed it at all, instead blaming all the errors on the assorted postmasters and then deliberately hiding the evidence of errors.
It's a process and people problem. IT systems are only as good as the processes and people maintaining and championing them. Coming from a family of health professionals, I can say they're terribly time poor (my brother worked in the NHS system for a decade) and the hospital management do not do enough to allocate training resources and time which is finally a result of budget constraints.
Hi HM-P I agree. Cheers
The problem is a lot of people just want to fill their pockets full of money rather than getting the job done. Its the same with any government contracts. NHS, HS2, Carillion, Water, Energy etc etc. Shall I go on ?
You are right Richard, because they are spending other people's money and there is no self-limit but don't you think it's because the ultimate customer is absent? Would you let a day-rate builder work for you unsupervised? Too often the customer chair at the top is empty or filled by an ineffective body (like the regulators). Government contracts eh? There are some notable successes but only with very strong management by the customer. Cheers
@@HaxbyShed We need politicians( legalized criminals) etc to be accountable not just do what they like. Plus they should do what the people what not what they think we should have.
Many of your concerns are likely attributable to inherent security issues for large databases with sensitive information. With so many people having access to NHS data, administrators have to limit and monitor access to prevent people from misusing the data. An even bigger issue is controlling who can edit and amend the data. Accordingly, it's imperative to limit access to justifiable need. The nurse who inquired about your father's medication may have lacked the credentials to access that information, and because she was neither a doctor or pharmacist, she probably shouldn't have even ask you for the info.
Hi EDesigns, I agree managing role-based access control is a big challenge day to day as staff join/move/temp/leave etc. Some of the information is medically sensitive but much is not. Names, addresses, NHS number, next of kin, - are these hyper sensitive really? My wife went to a sleep clinic and they did some basic tests. Did not tell us anything so she went to another clinic at another hospital that claimed to be more specialised. They wanted to repeat the very same tests. When she said I've already had those they said "ah but that was at a different hospital we don't know about that" and she said I'm telling you .... and they said "do you want it or not?" Cheers
@@HaxbyShed Because of prevalence of identity theft, even seemingly innocuous information, such as the examples that you cited, can be very valuable to bad actors. So yes, access to this data has to be monitored and constrained to minimize abuses, and, unfortunately, this can create some inconveniences.
I under stand what you are saying but what happens when you come against who are not connected to the internet in any way do not have a smart phone are not interested and prefer to communicate by letter my wife refuses to have a mobile phone, she says she as lived to 76 with out one and is not starting now
Hi Roger, I think I am tech savvy but for the really important stuff I still prefer letters. I worry greatly about older person exclusion but it's not only them. I was a trustee of a charity for visually impaired. A constant problem - how does one do on-line banking when blind? The charity was asked to provide volunteer helpers but we could not agree to that due to safeguarding concerns. No branch to visit, no family to help - what do they do? Cheers
Personally, I have for most of my life thought the NHS was an outstanding example of how public health should be done. We have a similar system here in New Zealand, and sadly many of the same issues exist as well.
As an aside, blockchain (which is not just for cryptocurrency) offers huge promise for securely and safely handling private data such as patient records, not only in terms of security, but also in terms of the control that patients have over their own data. In the future I expect that many large, centrally managed databases, controlled by one government agency or another, will be transformed into distributed blockchain databases accessible to government and private institutions, and the individuals whose data is stored, yet without any central controlling entity.
I'm sure it sounds like a dystopian nightmare to some, but it is secure and proven technology, that in the long run will be far better than the proliferation of siloed systems and interoperability and data-sharing problems that have today become the norm.
Hiya Paul. I think the problem is not so much security/technical as it is human issues. The NHS is loved and appreciated here, but we all know it is struggling with resources and demand. Cheers
One reason systems are never updated is managers do not understand why it's needed and I can save money as the system works why replace it
Hiya RB, I agree. In business there is usually one primary objective and everyone supports it (one way or another) because it puts food on the table. In public organisations where there are no direct and immediate consequences that focus can gets lost and other proto-objectives creep in. I know in several Government organisations saving money and becoming more efficient and providing better service to citizens are not primary considerations (I have personal experience to back up those comments). Cheers
Job preservation
Hi Sam, I would not want to say too much without hard data to compare but I will say that the public services tend to lack the razor sharp focus on costs and efficiency (that much I do know from first hand experience). Cheers
stick in the mud comes to mind.
Hiya Paul, me or the system ? 🤣
@@HaxbyShed the system. I know from 1st hand experience what it is like and the absurd amount of money that is wasted.
Thank you, long time viewer and lurker, it's good to hear from your perspective.
It at times doesn't help that hospitals are in competition with each other, the so called internal market, and have operated like that so long that is ingrained to think of trying to hold on and not loose business to other hospitals to a degree.
As you said there's so many layers to the IT nhs infrastructure within a local service and more layers nationally.
It's like layers in a onion, and everyone has their own onions and trying to get it all to merge and interact is more difficult than it should be.
There needs to be much more longer term vision and planning rather than the 4 or 5 year cycle of who ever in power and their own ideas of how it should be.
A longer term group that could set a vision and common ideas and see them through over long term might be a step in the right direction.
Was a nice video to think about and i hope things will move and get better
Funny thing is that most internal departments in a hospital are now run by external companies, not actually by the hospital. Went to 2 diffewrent hospitals, one for a MRI, another for a CT assisted surgery, and in both the actual provider of the CT and MRI was the same company, and the surgery was done by a contracted surgeon. Only the hospital was doing the billing for part of both, and providing the actual room. I was in a third hospital as well, where the doctor was based as well. From the one you could see the other 2, each owned by separate holding companies. Unlike the UK here government hospitals I would still be waiting for the first appointment, if you want state funded optical or dental the waiting period is now around 10 years, and for many others it is up to 5 years, yet there are hundreds of GP positions open and unfilled, and hundreds of newly qualified student doctors to fill them, but the state is unable to actually fit them into the positions and get low cost doctors who need the practical training to complete the degree
Hi AmiPurple, I like the idea of lurker suggests somebody in the shadows - covert watcher. Ah yes payment by results, money follows the patient etc. I agree the internal market model does not lend itself easily to collaboration. And likewise having independent Trusts might not lend itself to common standards for information exchange, but then having everything centrally command and controlled top down is not good either. There needs to be something in it for everyone as a common cause. But which ever way you look at it the NHS has to become more efficient - you can only slice a salami so thin else it falls apart (bad metaphor but you get the idea). Cheers
or shared values.
this will. not work.
this waffle is simply one man's waffle, and someone else has another waffle, on and on.
Hi @hrxy, thanks for the comment. I don't claim my view is any more right than anyone else's but I did work on the programme directly for 3 years so it's not all hot air and armchair commentating. I talk about it because I care about it, but I'll be back to my normal hobby shop machining topics in the next vid. Cheers
@@HaxbyShed it will not work I remember in the 69 the great thing was microfishe, was going to revolution health care, where is it now?
people are sicker now with so many new diseases, where are they coming from, answer, doctors, do you think some nurses in Nigeria or doctors from Pakistan give a fck bout the hippocratic oath, when they havoc no running water sewage, or food, you dolt. especially when they see fat waddling wetesteners in hospital with overindugent diseases.
what do you think they think when every weekend they see people rolling in the street pissed.
do you really think they don't think something.
no, no, no 3 years is not enough to understand, stick to nuts and bolts not health care your not qualified