When discussing NHS reforms big issues like markets, accounting, accountability and so on come to the fore.
But it's important to remember that the vast majority of people are happy with the NHS, its services and accountability. Lansley may wish to deny it, but that's the reality. And the popular narrative about admin inefficiency (even if it has a basis in truth) was not created popularly, but by the right wing press.
That means that NHS reform should concentrate as much in ensuring that there really is progress in ensuring front line services get to people at least reasonable cost. So the next reform I have to proposes has this goal in mind.
IT reform in the NHS has concentrated on big data issues, the NHS spine, and such issues. Well, that was the land of Tony Blair fantasy (he who had never touched an email). The truth is that there is need for IT reform in the NHS still — and a lot of it. But the most basic IT reforms are what are needed.
Many hospitals still keep hand written notes. And I can assure you it's true what they say about Doctor's handwriting (I'm married to one).
And many hospitals and other NHS services still use fax machines (when did you last send a fax?). Quite often they fax illegible hand written notes. Which results in high risk of medical non-communication.
Mind you — when email is sent the NHS email system is dire. Surely they can do better than an appalling version of something that looks like Outlook from a decade or more ago? It's steam driven, at best.
And there's plenty of other evidence of IT uselessness. A recent article in one medical paper recounted the tale of the trainee doctor who spent 10% of his time writing out blood sample request forms because the hospital he worked in had not invested in label printers at about £60 a shot. I know that GPs all over the country do exactly the same thing — the most basic of tasks that IT could automate to massive advantage are simply not being done.
And as far as I can see almost standard consultations are being done by medics time and time again all over the country and being written up in notes retyping (at best) the same stuff over and over again when simple macro driven automated entries into much of the standard software in use could save vast amounts of time when doing so. A few moments writing the macro (it's a doddle — macro writing software for use across platforms costs less than £15 a machine on PCs) and an hours training and the time saving yield would be enormous.
But there's no central direction in the NHS to demand this.
That's the price of the absurd policy of local decision-making — it leads to massive local inefficiency as best practice is not shared and has to be re-learned locally, time after time again.
Start a basic IT revolution in the NHS, I say, and do it nationally, now.
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I agree – if systems were upgraded to (e.g.) an NHS-specific Linux installation (which could probably be designed by any competent software engineer, supplied with a list of requirements, for a few thousand pounds) it could be rolled out on all existing hardware and the software wouldn’t even cost anything (because it’s all open source). The system could be maintained either by small in-house teams at hospitals etc or by outside (locally based) IT contractors. Instead they went for the monolithic approach of behemoths like Capita, EDS etc and it has cost billions of pounds and been a disaster.
I know at least a dozen different people working in the IT industry who could set up a workable framework for the entire NHS IT system within a few months – at probably 2% of the costs we are paying at the moment. But it won’t happen because it doesn’t fit with the big business outsourcing model of Serco etc. The Tories did make some sensible noises about open source in opposition but of course once in power, they forget all about it. I’ll probably raise this with Jesse Norman at the NPEN meeting this coming Monday.
As a computer semi-literate at best, neverthelss I keep my own update medical record on file. Just the necessary detail (numbers etc.) and succinct summary of what when. Then when need it I just hand a copy of over. They can read it in a couple of minutes and know it is all there. The amount of time trouble and issues it saves are immense. The format is very basic and layout clear.
Re the information I have provided in response to your Osborne item,
They must be rubbing their hands at the points you are making here.
Because what you are suggesting will open the door to outsourcing contracts, with the labour supplied from overseas, cheap, with the big Indian outsourcing multinationals raking it in, while workers are diplaced broadscale here.
BTW – re the ubiquitous confusion between outsourcing, and offhsoring
Outsorucing – a firm/org’n putting part of its function, like its IT over to an outsourcing firm is a different thing to sending work offshore – having work done overseas either by own firm. like RBS oeprations in India, or by an outsourcing firm.
What we are looking at is an explosion in cheap onshore outsourcing – but of course once contracts are fixed, those firms can utilise their home country operations as much as possible, to increase profits.