The sad thing is, I am sure that if this had been properly managed, a system for booking appointments that was actually secure could be done for under 1 million. Heck, all you really need is properly constructed web forms over a secured intranet with a secured database backend!

The bigwigs have to pay for all the business dinners and the £500/hr contractors need to make their money somehow...

"under 1 million"

surely you have forgotten the obligatory back handers, punts, boosts (call them what you will) from your quote?

Of course you are quite correct.... but that wouldn't have made the billions for the people who did it!

Unfortunately this is true of many large IT projects these days where the simple, costs effective, solution is rejected simply because it IS simple and cost effective!

Microsoft, and many others, get accused of providing 'bloat ware' but try to say that about a project like this and you will be told....... I am sure you get the picture!

We recently had the misfortune to be involved with "Choose & Book". After three weeks of trying to "book" and being sent regular letters asking us to contact them to make an appointment (We'd tried every other day and got all manner of excuses from "They're busy we'll take a message", to "Someone else has your account open and I can't access it") we finally "booked".

The "booking" though wasn't a booking at all - we were just added onto a waiting list.

So instead of the old system where we would have gone straight on a waiting list we had to make phone calls every other day to finally get on a waiting list 3 weeks after being referred - absolutely ridiculous.

Rather than wait for the waiting list to pan out I've given up and gone private - really makes me wonder where all of my tax/NI goes each month ...

I've actually had to use Choose and Book and can honestly say that, as a patient, it seemed like a reasonably good system. I was given a number of hospitals and various appointments to choose from and was able to select the one most convenient to me. The biggest problem wasn't really with the system - it was the fact that all the appointment options were months away.

In response to Frank Bellavance - it's not just the technology that's at issue here.

I'm no expert on Choose and Book whatsoever - indeed I'd suggest that anyone who's commenting on how simple it should all be is just a backseat driver - but there are questions over whether the whole notion of Choose and Book is well conceived idea at all.

AIUI the basic concept is that a patient, when their GP advises them that they'll need a hospital proceedure, can choose (a) what hospital to be treated in and (b) specifically which surgeon or other specialist the patient will be trated with.

Needless to say in the majority of cases when the GP offers the patient this choice the patient then ends up asking the GP (a) which hospital they should choose and (b) which surgeon or specialist they should choose - and it all ends up taking much longer and introducing an element of worry and doubt into the patients mind over whether they've made the right choice.

I just tried to Choose and book an appointment online and guess what? It doesn't work with Firefox.

Doh!

I think Doctors should stick to medicine and STFU about technology they know absolutely nothing about.

Choose & Book implys booking appointments at clinics in hospitals from the comfort of your GPs office. The GPs website has to be served, as well as interfaced with every single hospital in the UK. There is not some magical database of bookings to select from on a website you morons. Bookings are created/cancelled/updated/moved constantly.

Do you know what HL7 is? Version 3 vs. 2.3? How every message of the same type can be different? Do you realize every hospital in the UK uses a different back-end booking system? Do you realize the NHS hires contractors (like me) because no one with any skills works for peanuts, which is what the NHS pays? Do you know what information security is, and that you can't just store patient data anywhere you like? That you can't even TEST with it?

Yes, a webapp serving 40,000 GPs and every hospital in the UK for under £1 million. Yep, that's going to happen you idiots.

Now hurry up fatty and brush the crumbs off your keyboard to write some pathetic drivel reaffirming you know jack nor squat about anything.

Correct me if I'm ignorant but I can't remember a single Government IT project that didn't suck. You shouldn't be shocked at this news, in fact, it doesn't even qualify as news - it was expected.

One thing this Government are really good at is bridging the gap between cynicism and realism.

Choose & Book doesn't even support Firefox...

"We are sorry, but the web browser you are using is not compatible with the online Choose and Book service.

We apologise unconditionally for any inconvenience caused by this problem and can assure that we are working to make sure that future versions of the Choose and Book online service work in as many types of browser as possible."

"There is not some magical database of bookings to select from on a website you morons. Bookings are created/cancelled/updated/moved constantly."

I may be a moron, but I know what a database is. If it can't cope with records being updated constantly, it isn't a database at all. So, please, stop insulting us and actually talk sense.

Ah, the classic reaction of a programmer (who almost certainly *does* have a horrifically impossible job) blaming the failure of a tool on the users, whose work he - to quote his own ewpression - knows "jack nor squatl about".

"Bookings are created/cancelled/updated/moved constantly." - yes, that's why a decently-run database system is required. If a national - hell, even a regional or county - IT system can't cope with this, then it's a white elephant. No-one says it's the fault of the code slaves; however the same cannot be said of those who decided the whole thing could and should be done, and are pouring taxpayers' money at something which according to your own description may never work because of the technical constraints.

I lve in a country where 14% of deaths among GPs are by suicide due to depression or burnout caused to a great extent by too much red tape and administrative pressure, plus being treated like dirt. Don't make doctors' lives worse.

"I lve in a country where 14% of deaths among GPs are by suicide due to depression"

Which country is that then?

The problem with Choose and Book, as with most of the NPFIT, is that it's a solution in search of a problem. There was very little wrong with the previous referral system, the problem was with the waiting list once you got referred. The Government though is obsessed with choice and IT. I don't want a choice of five hospitals and fifteen consultants, I want to be treated by a competent doctor, in a local hospital and after as short a waiting period as possible.

Hmm, if hotels and airlines have been managing to book online for many years now and interoperate between disparate systems, it shouldn't be so hard so yep, about a million quid sounds reasonable. HL7? Yep, another interoperability standard, good idea but not rocket science. Look at any travel website - how do you think they manage to book with all the different airlines and hotels? Hell, Amazon even publish their API.

Did someone get out of bed the wrong side this morning?

I doubt VERY much whether anyone is having a ‘jab’ at you or the many other ‘contractors’ who work, or have worked, on this system so why are YOU getting your knickers in a twist over something which you have NO control over – unless you actually designed and spec’d the system?

You have actually highlighted one of the issues with the system * every hospital in the UK uses a different back-end booking system *. But of course, someone somewhere somewhen decided that this was not a problem and a ‘work around’ could be devised.

OK, £1 million was quoted but probably more in jest than an accurate figure BUT if it were not for every hospital using a different system then a much simpler and cost effective solution could probably have been achieved.

Maybe, just maybe, if someone had got their act together a few years ago and come up with a ‘standard back end system’ then all the problems that you are facing, and the costs involved, would not have arisen.

By the way, I DO know that the NHS pays and from what you said “no one with any skills works for peanuts, which is what the NHS pays”, so assuming the NHS pays you (directly or indirectly) then what you are actually saying is that YOU have no skills! <BIG GRIN>

Hear !! Hear !! Well said !!

Between the pocket Hitlers appointed by the government and the "database-ignorant" code slaves, we have this wonderful system that even the poorest of airline and/or hotel booking systems will sneer at !!

As a GP in London, I used to do referrals by post or fax. Some of the hospitals, which cannot meet the demands, simply told the patients that they never received the referral. Some patients who got the appointment and did not attend for various reasons told me that they never received the appointments. Some departments lost the referral letters and ring us to fax it again on the day of the appointment.

We tried email referrals through secure NHSmail. Though the hospitals could not deny receipt of referral, patients could say that they never received the appointments.

CaB is a boon to me. Through CaB, I am able to book an appointment, confirm with the patient that they would attend, print out the appointment letter and then send the referral letter as an attachment at a later time. It takes an additional 2-3 minutes of my consultation time. I must say that CaB has cut down a large amount of administration time duplicating things. It may be bit slow but I have nothing but praise for the whole idea and how it is implemented.

I know the money that was spent was colossal. I am sure simple and cost effective ways could have been found. Then it is not possible for all concerned to make a buck. It is true that there are not much of choices. At least I know that my patient will get seen on a particular date and my responsibility is over. CaB works for me and I love it.

So is it just the IT side of NHS that's having problems or are they deeper problems? Michael Moore brags about the superior quality of medical care in the UK, but I hear many complain about different aspects of it. The US has its own problems, but I suspect that Mr. Moore has chosen to only see the negatives in the US and the positives in other countries.

Comments? Observations? Ass kickings?

Dillon Pyron asks about a how the US system compares to the UK's. Well, yes there are budget problems in the UK. Many schemes were brought in in the NHS to make things more efficient. Most resulted in change but many incentivised (accidentally, perhaps) the wrong things. Pick up a paper from a few years back and read about the old people who got discharged from hospital to unblock a bed only to die in a nursing home a short while later.

The IT projects are a nightmare because every hospital has different systems. Most of the systems in the hospitals are not directly compatible; most of them speak HL7 v2.x, but the problem with that messaging standard is that in the case of many messages it specifies only the structure of the messages, and doesn't define data dictionaries for field contents. There are many different and large data sets for describing overlapping but not identical things (e.g. two major versions of the Read codes, ICD10, SNOMED-CT). HL7 v3 is much more complex and has features that make some aspects of message handling interesting; for example many of the "low level" element types in HL7v3 are defined recursively (in that they can contain embedded instances of themselves). To give you a flavour of the problems of interoperability, take a simple case, gender. In HL7v3 there are if I recall correctly 12 or so different conventions for decribing gender. Some of them use 0 or 1, some use M or F. Well, a simple translation table shold take care of that right? Well, no. Not all the data sets have the same number of members. Many have two, but some have three and some have four (yes, four values for "gender"). Bidirectional transformation is not even possible in a lossless fashion. Nobody wants to be in a position where they have to say "we transfered your records to another system, but the inteface programs garbled them and so we <insert mistake here>".

One of the problems with the UK's healthcare system is that the medics don't work for the NHS itself. The GPs are self-employed and the surgeons work for the hospitals, which are autonomous. The NHS is hardly in a position to force anybody to do anything.

The technical difficulties posed by choose and book are non-trivial. The C+B system will need to interface with every outpatient appointment system in every hospital in England and Wales. Those systems maintain appointments in real-time, so the C+B system cannot assume an appointment is available just because it was told 10 minutes or 10 seconds ago that it was still free. Many hospiotals were (I heard) hopelessly behind in implementing the technical requirements of C+B. It's a bit of a mess.

Though we may look at the progress of the NHS's IT programmes and put our heads in our hands, we should remember that nobody in the world has ever done what they are doing before. (Was that "with good reason!" I hear from the audience?).

In terms of healthcare, I think it is possible to get better healthcare elsewhere. But not at the same price. Lots of other markets are distinctly bipolar; for example, in the USA you can probably get excellent healthcare which will probably exceed the quality of the care available in much of the UK. But many people in the US don't get that. They get the stuff at the other end of the spectrum. Like (iirc) the worst infant mortality rate in the western world, despite more healthcare spending per head than the UK. So I suppose whether you prefer the UK or the US system depends on whether you would be comfortable being at the top of the heap without worrying about those at the bottom.

Having been an IT worker in the NHS, I can personally attest that the private companies (mostly american) pretending to provide systems to the NHS were incompetent, disinterested and dishonest.

Their systems didn't work.

Their workers had no idea how they were supposed to work.

Their managers had no system for ensuring simple troubleshooting occurred, and simply reverted to a stock "We think the problem lies in the NHS network/systems".

Different "teams" refused to talk to each other to solve problems, which were always related to incompetence within the private company.

For example, we would identify a problem in their system and report it to them:

- their "firewall" team would ring us back, eventually, to say "nothing wrong with our firewall".

- we would say, "we told you we are guessing you have a name resolution problem internally when we logged the call"

- they would say,"we're the firewall team, we can't do anything about that"

- we would say, "pass it to someone who can"

- they would say, "we're the firewall team, we can't help you..."

etc...etc...etc...

We had years of this kind of stupidity.

This meant that the NHS IT workers were forced to solve a myriad problems by inference, ringing around various elements of the private company's "solution" to try to get somebody somewhere to do their job providing information and conducting troubleshooting.

To think that we were doing these contractors' jobs for them while they were the ones on big bucks was slightly galling, although we had the satisfaction of knowing we did our job very well and felt sorry for the pathetic muppets working for these private companies - they will carry their incompetence throughout their careers which won't be much fun.

As an Englishman living abroad in Europe I have to say it looks like this system is trying to solve a problem of the NHS's own making.

What happens here if I want to see a specialist. I ask my GP, or a friend for a name of a specialist. I phone the specialist and make an appointment, which is normally within a week of my request (the same day if it's cancer, for example).

That's it, no IT system, no unhelpful receptionist and no wait!

Being disabled and with several health problems I see my GP regularly. For some time now I have only been able to book an appointment with the GP on the day. I have to call at 8:00 am and hope that I am lucky enough to get a slot. I can get to see one of the practice GP's on the day but only my regular GP knows all the in's and out's of my conditions and treatment. Any other GP would need several hours to read up on all of my file. The only reason this has been introduced is so the practice. Trust and Government can say that waiting lists have been reduced or eliminated.

The same goes for consultant appointments. Instead of going on a waiting list to see a particular consultant I now go on a waiting list to receive a letter telling me to choose an appointment using C&B. This letter is promised a couple of weeks before the appointment date. So there is only a short waiting list to report as the other waiting list to receive the letter is not reported.

To Matthew Collaery,

Thank you very much for your post. It made my smile, and then weep with the amazing familiarity of it all.

How long have you been out of the NHS? Just to comfort you I can tell you that absolutely nothing has changed.

It doesn't matter if its a National System or a shoddy VB 4 App with an Access backend database. Hospitals seem to get all manner of programs in from companies that arn't interested in providing after sales support.

I myself am an IT worker in the NHS, and have had many a conversation with software providers due to problems experienced along the way. 99% of all calls have been met with the likes of "it's not my responsibility" "it's your proxy server" "it's your firewall" or the famous "it's a local networking issue".

Considering local support contracts are paid for the only word I can think of describing alot of support offered is "jobsworth".

These responses have left our department high and dry on many occasion. Essentially forcing us to have to figure out a solution ourselves. And more often than not provide one, for systems that are not ours, that we should have support for.

It is stressful but I must concur that it is satisfying in the sense that you are doing your job (and someone elses) very well. Not that this is recognised by the users as any piece of bizarre software used around the Trust is for us to fix and us alone.

May I also congratulate you on the past tense of "Having Been an IT worker in the NHS"

"Hmm, if hotels and airlines have been managing to book online for many years now and interoperate between disparate systems, it shouldn't be so hard so yep, about a million quid sounds reasonable."

Hahahaha - very amusing. The Global Distribution Systems may be archaic old green-screen dinosaurs, with a web gloss over the top, but they're far from simple. If you can build a system that does what SABRE, Amadeus, or even Expedia does for a million quid, forget the NHS, you'll make a fortune in the travel industry. Even bolting together an aggregation site to let you choose prices among e.g. low-cost carriers is not trivial.

Glen Williams : "...shoddy VB 4 App with an Access backend database... "

Gosh, that sounds amazingly familiar!!!!!

...and we won't even mention the security issues related to said crappy DB, or the web-based rubbish in use because so-called "developers" these days can only bodge together microsoft-related rubbish, instead of proper applications.

Having said that, these rubbish systems are what is being addressed (kinda sort-of) by EPR, etc...

"...or the famous "it's a local networking issue"..."

Gee, you got that one, too? Who would have guessed...

We had one where they'd sent a whle team over from america and their rubbish bit of web-based software didn't work and they spent 3 days pestering me about it - turned out they'd forgotten the time zones (duh) and somebody at the other end was switching it off (or something) just as the "team" in the UK was trying to use it.

But do you think it occurred to them to look into the problem themselves - quick phonecall to sort out the problem?

Nah, blame the NHS workers and say "it's a local networking issue".....

What got me though, is the very next time they had problems, it'd be straight to "it's a local networking issue" again without learning from their previous experiences.

What do you expect when you have too much manpower thrown at a project where time scales are simply stupid, budgets ridiculous, along with project managers (inexperienced?!), permanent staff and contractors who don’t, can’t or won’t talk to each other. When a problem crops up, everyone blames someone/anyone else or, the best one, blames the lack of communications between groups – and everyone ends up going round in ever decreasing circles.

Then when the project is completed and most, if not all, of the programmers/developers have moved on (lucky them) to other projects there is no one left who knows the system(s) to support it/them and so the support staff, who may not have a clue anyway, end up ‘fire fighting’ and trying to pass the buck in an attempt to buy some time.

Oh what a wonderful world we live in!