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back to article MPs: This paperless health service plan isn't worth the paper it isn't written on

MPs doubt that the Health Secretary's plans to make the NHS paperless by 2018 will be on time and budget, based on Whitehall's shambolic handling of the abandoned electronic health care record system. The widely derided National Programme for IT (NPfIT) was first signed off by ministers in 2002 under the previous Labour …

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Instead of paying through the nose or consultancys

That money could have paid for a lot of hookers

The end result would have been slightly better if not too dissimilar

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Anonymous Coward

Re: Instead of paying through the nose or consultancys

Or better yet a load of nurses...

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Re: Instead of paying through the nose or consultancys

As a nurse myself I strongly objectto the suggestion that the money should have been spent on nurses instead of hookers - we could have had a hooker each by now !

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Re: Instead of paying through the nose or consultancys

how abut we compromise and pay hookers to work in hospitails

"hello nurse" indeed

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Re: Instead of paying through the nose or consultancys

OK, I'm in.

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Anonymous Coward

These reports are always the same, they go on about the whole system being a failure and just point to it being an electronic records system.

There's a lot more to it than that:

http://en.wikipedia.org/wiki/NHS_Connecting_for_Health#Deliverables

Having seen the imaging system in use when I took my mother to A&E it is a lot better than waiting ages for film developing. The images can be retrieved quickly from anywhere.

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Ah yes

those images stored in proprietary systems, as I discovered when I asked for a copy.

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"Having seen the imaging system in use when I took my mother to A&E it is a lot better than waiting ages for film developing. The images can be retrieved quickly from anywhere."

You can have digital imagery without spunking £10bn on a centralized storage/sharing system.

As many other countries in the world do.....

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Correct me if I'm wrong but I think that PACS (digital imaging) was begun before NPfIT. It was subsumed and then credit was taken.

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Anonymous Coward

Visited a hospital while abroad (in the EU) and they had a good imaging system which had cost them a lot, lot less than 10bn, in fact less than 10 million. The images were on the doctors screen by the time I saw him which was about 5 minutes after I was on the scanner.

I got a free copy on CD and the copy included software to help me look through them and understand them..... all pretty cool for a geek!

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WTF?

Hell, my dogs and horses get complimentary non-proprietary digital copies of their internal images. I'm absolutely certain my vets didn't pay millions, much less billions, for that.

The technology is very common in the equine veterinary field and I would venture to say, even higher quality than that used on Humans. The big whole animal machines are certainly quieter than the big thumping, whirring things they make people use. Lots of vets can view the imaging in real time over IP so your trusted vet can make a diagnoses if the animal is far away. It's a nice setup...

It only costs so much for Humans because somebody (customer/taxpayer) is getting fucked.

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As a sysadmin that makes a living building networks for "digital imagery", it is not remotely as simple as you might think. Even a small setup for a dentist with two locations is stupidly expensive. Trying to get enough capacity, bandwidth, redundancy, metadata sorting, automation, security, etc for all of the medical imaging in a country of 60M? Including the text records?

Yeah, you know what? I can see getting into the billions.

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@AC; were those images available to any doctor that took up your file across the entire country? What level of privacy and security controls existed?

Because if they managed that on $10M for 60M people, I'd be mightily impressed. (And did that figure include the construction of the datacenters, costs of bandwidth, what level of redundancy, non-imagery data, etc.)

I'd love to know who implemented such a system for $10M!

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Anonymous Coward

It didn't include sharing across the entire county as you don't really need to do that. Copies are available for the rare occasions where that's necessary (you get a CD or DVD which you take to the other hospital). The images were only shared within the hospital and a few outlying clinics. The kit went into the existing datacenters.

It's really not that complicated.

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"Copies are available for the rare occasions where that's necessary (you get a CD or DVD which you take to the other hospital)."

This is an excellent idea that needs to be explored more. Allow the data subject to control their own data! The costs are small, compliance issues are minimised, and people actually control their own data and who has access and when!!

Of course, that is why it will never be considered ...

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Isn't the capacity and bandwidth issue really a reflection on the available infrastructure; not the imaging technology?

From an outside perspective it looks like a shitload of money has been wasted on a system which never materialized when that money could have gone a long way to providing decent infrastructure, that everyone benefits from directly as well as reducing the cost and complexity of the imaging system.

Big spend to compensate for poor foundations is a really, really bad idea. No matter what field your're in. I guess it doesn't really matter in this case though since they can't get the infrastructure expansion programs right either.

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>"Hell, my dogs and horses get complimentary non-proprietary digital copies of their internal images. I'm absolutely certain my vets didn't pay millions, much less billions, for that."

This is true, but I doubt your vet has access to petabytes of image storage that is replicated in real time to a separate data centre in case of disaster, with storage infrastructure that won't allow accidental deletion of patient data because you would need the correct physical key from the storage manufacturer / vendor to do so. It's the redundancy and resilience that costs an arm and a leg unfortunately.

I should add that I don't think this article is referring to the imaging system (that's just one small part of the NPfIT that was actually delivered and mostly works) - it seems to be more about the steaming pile of cluster-fuck that the patient record system turned out to be.

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I'd be willing to bet another £10 billion

That there are a lot of people that have made a lot of money out of this failure.

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Anonymous Coward

Not being greedy, I'd have fucked it up for half that amount.

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Sorry, you wouldn't have stood a chance. The scale of a project like this is so massive that it takes a really big company to fuck it up.

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This post has been deleted by its author

I'll fuck it up for a 10th of that! Your move! ;)

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For an extra 5 billion, I could fuck it up in ways that no one has ever thought of before.

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Stop

My group will perform the work for 50% lower than the original price and build in no impact zero accountability for everyone involved. Other providers may offer you a less expensive price; but someone is going to have to fall on their sword when it is all over.

You don't want that to be you do you?

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Devil

@Dave Fox

I'll fuck it up for double that.

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I'd have fucked it up for half that amount.

Remember to choose a really inappropriate framework for the bulk of it - something like PHP for example. Then you can charge a massive amount for extra work until the client finally gives up. The client of course got your friends in other consultancies to write the contracts, so despite failing to deliver you can still walk away with all your cash.

That's how it worked. And as I know someone who worked on the project, I can assure you that PHP was the framework of choice. That someone was also one of the most slapdash and lazy programmers I've ever had the misfortune to work with, but the (large telecoms) company he was working for on the NHS contract didn't seem to care.

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A lot of paper ...

... for context, there is probably upwards of fifty thousand tonnes of medical records in the UK. We are talking about a project that dwarfs Google books or any of the worlds major scanning projects. It's not impossible, but the logistics are harder than the technology.

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Anonymous Coward

Re: A lot of paper ...

Very true !

I manage the transfer of paper records to digital searchable format for a large department / over 150000 pages a month. We employ just 3 people to make it happen and all records are searchable within a few seconds on name, patient number etc

It's not rocket science but then we are not charging enough to duck it up.

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Re: A lot of paper ...

However the issues with the NHS is one of arrogance, convenience and luddites.

After all we have been talking about the paperless office for deacdes and no commercial business has acheived it; so why would a Public Service with no commercial incentive to do so trail blaze this issue. Especially one that has a history of having Change forced on it resulting it a concerted effort to undermine and resist the necessary Change.

It simply wont happen and we will look at another £10bn wasted and more public sector halfwits and government types walking away shrugging their shoulders saying "nowt to do with me mate".....not my fault.

Quite simply without hard Acoountability these guys should not allowed to have access to such funding at all; they cannot be trusted with just pocket money.

Whether its Government and Civil Service spending £millions with 1000's of suppliers of paper clips, pens, printer paper, light bulbs.

MOD buying choppers that cannot fly in clouds and fog, attack helicopters when they have not ticked the box for pilot training, building the SA80 rifle instead of buying the AR15.

Police forces this week being called to accoiunt for why the dont consolidate their purchasing power for simple equipment like boots, stab vests, handcuffs, cars etc.

Quiet simply Public Sector offers poor value for money and that is the principle reason Taxes go up to pay for their poor performance and value for money.

Bin the lot and start again...................

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Re: A lot of paper ...

I agree with almost every part of what you're saying except the poor Public Sector value part. The private sector in every country (if there is a private sector) has a looooong history of 'maximizing' the value of the Public Sectors ignorance.

The way the Public Sector is positioned by leadership as the 'Great All Knowing Oz' makes it ripe for plunder. They talk big but don't have a high level of internal technical expertise, the Private Sector knows it. They also know the Public Sector can't come out and say "we don't know what we're doing", the citizens would hang them all.

A lot of this could be mitigated by having a strong internal technical competence that knows the business. Instead governments sailed their internal experts down the river and it is costing Billions to accomplish nothing. The outsourcing and contracting of key systems by States really needs to be reassessed. It isn't working well for anyone.

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No win

The NHS is a load of good doctors and nurses strung up by the beast of the NHS. I have no idea if hunt is a good man for the job or not but either way he can not win.

If we assume he is competent and determined to make a good system. And we assume he has a good/workable plan which would bring benefits to the NHS. And we assume he is not being shafted at every step by the public sector system how can he win? The gov was left no money but the NHS was left with a lame duck system. Tied to bad contracts he is in the pit dug by the last lot. And if he improves anything his party will likely be voted out and the next lot will claim credit (whoever that may be).

I dont see any good way for the NHS to improve because nobody seems to care where anything can be done. The front line can work as hard as they want but cant change anything and the people who can change things dont care because they got it cushy.

And we get to pay for it.

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Re: No win

Isn't that the way of any massive institution? Doubly so for State institutions? Those in charge are inevitably assimilated into the machine, regardless of their initial intent or capabilities. The higher up a person goes within those institutions, the further they are removed from the purpose of the institution. The, pardon the phrase, 1% problems that apply only to them and their direct peer group become the focus of their efforts.

Another CEO, Director, Minister &c has an agenda and 'you' are part of that. You've got to support them or risk falling out of favor within your peer group. They don't have to worry about the mission of the institution, somebody below them is taking care of that. Your job is to 'keep the complex wheels of (x) turning smoothly', even if it may not be the most ideal solution for the mission.

Leadership is crucial but when things grow too large the individual, possibly good, leaders at that level have their own mission which, more often than not, does not mesh especially well with the mission of the institution. I prefer short term, issue specific leadership with public accountability for large institutions. It's when people have to base their decisions on a peer group to keep their job and not on the mission that things go to hell. That's how institutionalization happens :)

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"poor negotiating capability"

No kidding. Government buyers are inherently poor negotiators, because unlike the seller, the buying civil servant isn't on commission and doesn't have his career on the line. There's no obvious solution to this issue.

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Re: "poor negotiating capability"

"There's no obvious solution to this issue."

Er . . .put the civil servant buyers on a bonus system - they get to keep a percentage of everything under budget.

Not popular maybe, but sure would focus the mind.

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Re: "poor negotiating capability"

Not such a good idea. Then the civil servant gets a good bonus if the budget was overestimated and non at all if it was underestimated. So their negotiating skills wouldn't come into it.

I suspect that you'll find in this case that the contract is exactly what the then Labour government asked for.

It would have probably been better to let each health authority do it's own thing and give up on the idea of one system to rule them all.

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Boffin

Re: Er . . .put the civil servant buyers on a bonus system

You've not seen Yes Minister have you?

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Re: Er . . .put the civil servant buyers on a bonus system

Yes Minister was brilliant, and I maybe wasn't being completely serious.

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Anonymous Coward

mandate protocols and standards, not specific implementations

"It would have probably been better to let each health authority do it's own thing and give up on the idea of one system to rule them all."

BT, Microsoft, CSC, Accenture etc. What could possibly go right?

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Anonymous Coward

Re: "poor negotiating capability"

"It would have probably been better to let each health authority do it's own thing and give up on the idea of one system to rule them all."

I was an "Engineer at the coalface" on this project. One of my jobs was to interface with the patient record systems at the individual trusts.

Some trusts had excellent IT departments, and I have little doubt they would have found a good solution locally. Others were absolutely wretched (We're probably talking about 25% being at each end of this spectrum, it certainly wasn't a small number in the awful list), there were a number that made very poor purchasing decisions and bought from small local companies. One in particular hard-coded the address they needed to connect to into the application, then lost the source code.

Would local have been better? I don't know, but I do think they'd have spunked just as much money up the wall - they'd just have done it individually.

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Re: "poor negotiating capability"

I too was at the Coalface as you put it.

The primary cause of the contract failure could be put down to a NPfIT vision that was not fully supported by the SHA's let alone the Trusts.

When we started to engage the Trusts they were in the dark regarding the Vision, contract and the impact on them. we had to sell the Vision all over again to those Trusts; many of which had already made investments of commitments to local suppliers or some of the big players.

Then the "individual" who headed the negotiations for NPfIT left and the rest is history........

Big bang solution rather than implement and iterrate

Poor contract management on both sides

Scope creep of monumental proportions

Software solutions unproven and delayed in development

Trusts undermining the Vision and Contract as they had already made a local decision for a solution

Delays driving Trusts to dis-engage with the NPfIT programme

The lord god that is Clint Eastwood had a term for this "CLUSTERFUCK"

But hey, no harm...... no one died.........no accountability.......... wait for the dust to settle and try again next decade......

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Re: "poor negotiating capability"

Government buyers tend to rely on a small pool of very large consultancies and accountancy firms to draw up contracts. The same consultancies and accountants that then bid for the work the contract's for. As a result, there are rarely any penalties in the contracts for f*cking up or walking away from an incomplete project.

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Blame where blame's due

If the contract and project managers in a commercial organisation had screwed a major project up as badly as those in the Department of Health have done, they'd have been fired. The same should apply in this case. The department's project sponsors don't appear to have known what the NHS needed, talked to the Trusts or considered patient requirements (medical privacy), so they should be on the exit queue as well..

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Re: Blame where blame's due

I've seen a lot of projects screw up this badly in the private sector and the person or people to blame didn't get fired. In some cases they actually got promoted!

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Re: Blame where blame's due

Hahahaha! Managers being fired for screwing up! Hahahaha! Will you be staying in this universe, or are you just visiting?

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Why?

Why should the NHS become paperless?

The paperless office has been touted since the 70s (maybe before) yet we all still buy printers and use paper every day. You can't tell patients that they will recieve appointments by email because some of them do not have, do not want or would be unable to use email even if you gave them it for free.

Some things like digital x-rays make sense but for other things it makes sense to use a hard copy.

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Re: Why?

The only people that print anything in our office are dinosaurs who will not learn new ways of doing things.

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Anonymous Coward

Re: Why?

All fine until you are taken suddenly ill on business at the other end of the country and the Paramedics and A&E docs treating the now unconscious you are unaware that you're allergic to some common medications and that your condition is ongoing, is chronic, and responds only to one of the less common protocols.

Lost your anti-psychotic medication on holiday? Good luck with getting a pharmacist to hand over some more without seeing your history of prescriptions.

It may sound far-fetched, but people can and do die from inappropriate treatment. It would be lovely if people only became poorly at home and the people with existing conditions never strayed more than ten miles from their GP's clinic, but the real world is a little more complicated.

The trick in all of this is to make sure that the right people can see your medical history at the right time without anyone else being able to see it.

My understanding of one of the key issues is that the government decided to go nuclear and build something completely brand-spanking new to be used nationally instead of the cheaper alternative of using some middleware to glue the wide array of already existing electronic record systems together, allowing practitioners to view 'foreign' records in a browser and providing an audit trail and ability to send updates back to the 'local' surgery for non-real time or even offline updating depending on the system.

Once a middleware solution was in place it would then have been an easier task - if it was even needed - to replace legacy local systems when convenient.

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Re: Why?

@Anonymous Coward - Wednesday 18th September 2013 15:28 GMT

"All fine until you are taken suddenly ill on business at the other end of the country and the Paramedics and A&E docs treating the now unconscious you are unaware that you're allergic to some common medications and that your condition is ongoing, is chronic, and responds only to one of the less common protocols."

...all fine so long as said paramedic/A&E actually know definitively who you are, which might not be possible it you are unconscious under the back of a bus! If you are highly allergic to something or have a serious medical condition, some sort of medical bracelet/tag would be far better (and also will work in other countries).

"The trick in all of this is to make sure that the right people can see your medical history at the right time without anyone else being able to see it."

But this will never happen - you medical record will be sold to the highest bidder (with the plan already in place) and PCs/fondleslabs will be left with default/open passwords allowing anyone access.

Once you let the (electronic medical record) genie out of the bottle you will never get it back!

mb

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Anonymous Coward

10 billion here

a couple of billion here, what's the big deal?

and, by the time they've got an accurate figure (naively assuming they will EVER get a remotely accurate figure), the 10 billion will have mushroomed to 25 billion. Oh, well, like I said, pocket change.

And on a different note - it must be applauded, as remarkable effort to to keep it in line with just about every major (multi-billion) gov project with a "digital" label - a failure. Well done!

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What's the problem?

Wouldn't an NHS private label version of FaceBook have been better?

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