The NHS

[SilverFox2]

I doubt there are any (large) countrywide fully and completely integrated systems hooking up patient data and every piece of equipment in hospitals anywhere.
Blair’s NPfIT was a great idea, but hopelessly managed and leeched to death by IT and management consultants, which left the NHS with more IT software... but even more unintegrated kit.
Getting a system to talk 2 ways to a different system, is the issue. Unless it’s stipulated in the contract that the supplier needs to provide ongoing integration support (cheaply) then nowt will change

Thanks for reply.
I ask because I live in Spain where there is a functional computer system that works.
I agree that our Andalucian system is not nationwide because medical areas are individual cost centres by large geographical areas our own as big as England.
The result is that blood tests are available to GPs within 2 days, xrays at hospital on computer within 30 mins, colonoscopy procedures followed and visual findings given to patient in written form complete with several photos within 30 mins..
Medical appointments for GP within 2 days, prescriptions only available via a card entitlement that pharmacists must use with repeats for definite maximum periods.Local Medical Centre has no receptionists so mobiles used for appointment times that both Doctor and Nurse observe and simply call your name. Blood tests done on wednesdays from 8 until 11am by Nurse again by appointment times. Anything urgent direct to blood test area at local hospital with printoff of requirements in patients hand which is also procedure for wednesday blood tests.
Printouts of say blood test results a patient entitlement with for instance psa results maxing at a low 3. Above that figure automatic referal to hospital for usual check then biopsy then surgery or radiotherapy then usual 6 month appointments with full blood tests.
As a pensioner I pay for prescriptions but get a massive discount which also applies to my wife who is younger than me.

Can only relay my own experiences, perhaps I have been lucky but no need for waiting for letters for results, there is almost immediate computer posting of results and hospital appointment times via sms or telephone. Dare I say.any delay from any department is immediately obvious so all are made accountable.

Current European Card allows emergency treatment for free with same entitlement as Spanish but they strictly insist that if diagnosis needs further treatment then payment must be made or return to country of origin with the usual treatment records and findings handed to the patient.

No idea what the rest of Spain is like but I am very impressed by the Andalucian model which gets things done efficiently.
I'm sure the actual treatment is no better or worse than UK but it seems to serve the patient rather than allow its own internal possibly inefficient procedures to define its ability to cope.

 

[inbetween]

Surely there are systems elsewhere in the world that actually work?

Many systems work far better but that is because there is a will to make them better and change them. The NHS doesn't work because it hasn't changed since it was formed and the political climate means no-one can change it.

I think it is time to introduce a new public healthcare insurance that sits alongside NI. It would harm peoples pay and increase employers costs but it doesn't have to be radical. It certainly isn't as radical as Labour's plans which will inject a lot of money but then it would need even more in a few years.

If everyone had to pay 1% of salary towards healthcare then the NHS would be fixed overnight and it would scale with the population and inflation.

 

[blueinsa]

Many systems work far better but that is because there is a will to make them better and change them. The NHS doesn't work because it hasn't changed since it was formed and the political climate means no-one can change it.

I think it is time to introduce a new public healthcare insurance that sits alongside NI. It would harm peoples pay and increase employers costs but it doesn't have to be radical. It certainly isn't as radical as Labour's plans which will inject a lot of money but then it would need even more in a few years.

If everyone had to pay 1% of salary towards healthcare then the NHS would be fixed overnight and it would scale with the population and inflation.

Money is in the system at greater levels than its ever been.

PFI payments are crippling and still we have trusts signing up for more of the same to then claim they are being underfunded.

Ive no objection to a separate NHS tax but the NHS has to be ran properly and be taken out of politics and politicians hands completely going forwards.

 

[Bluemanc100]

Has the nhs managed to get a much needed integrated computer system yet?

The NHS are a little like the MOD used to be in my experience.. they avoid proven off the shelf solutions because some salesman convinces them that a bespoke solution is what they really need... That generally leads to a poorer product or service which costs millions to service because it's "special"

 

[TheRemainsOfTheDave]

The NHS are a little like the MOD used to be in my experience.. they avoid proven off the shelf solutions because some salesman convinces them that a bespoke solution is what they really need... That generally leads to a poorer product or service which costs millions to service because it's "special"

Not every hospital uses the software in the same way so there is no one size fits all. Most solutions come from a bespoke product originally that have been tweaked to suit the needs as defined. The problem is not usually in the software but the communication skills or level of expertise in purchasing IT services by the trusts. It really is sometimes guesswork as to how long a project to deliver a solution will take because some trusts think you just install software and it is finished, when in reality the job has only just begun. If they think relying on software support is the way forward, then deep pockets are needed and the support is only for the software working as intended, it won't resolve issues regarding how the hospital want the system to interact with other systems or when further changes are required. As an example, imagine a computer system recording the sex of a patient, it used to be just M or F. The software company can change it easily to give other options (and that's all that they need to do) but the big problem is all the extra bits of interacting software that read this information and have to be checked. It could very well be that a programmer has written somewhere that if Sex is not Male assume Female, but that is now wrong. Changes like this happen all the time so it is special skills responsible for outside of the software that are needed.

The ability to purchase said skills have been made harder in recent years by changes to tax rules for consultants in the public sector (this also affects medical staff and is one of the reasons why there are staffing shortages there too) and this is down to government policy. Unfortunately Labour have almost exactly the same approach with regard to taxation. Both parties want to treat temporary staff the same as employees for tax purposes. That's fine, but when there are limits to earnings in the public sector compared to the private sector you're going to see a brain drain.

 

[JASR]

Thanks for reply.
I ask because I live in Spain where there is a functional computer system that works.
I agree that our Andalucian system is not nationwide because medical areas are individual cost centres by large geographical areas our own as big as England.
The result is that blood tests are available to GPs within 2 days, xrays at hospital on computer within 30 mins, colonoscopy procedures followed and visual findings given to patient in written form complete with several photos within 30 mins..
Medical appointments for GP within 2 days, prescriptions only available via a card entitlement that pharmacists must use with repeats for definite maximum periods.Local Medical Centre has no receptionists so mobiles used for appointment times that both Doctor and Nurse observe and simply call your name. Blood tests done on wednesdays from 8 until 11am by Nurse again by appointment times. Anything urgent direct to blood test area at local hospital with printoff of requirements in patients hand which is also procedure for wednesday blood tests.
Printouts of say blood test results a patient entitlement with for instance psa results maxing at a low 3. Above that figure automatic referal to hospital for usual check then biopsy then surgery or radiotherapy then usual 6 month appointments with full blood tests.
As a pensioner I pay for prescriptions but get a massive discount which also applies to my wife who is younger than me.

Can only relay my own experiences, perhaps I have been lucky but no need for waiting for letters for results, there is almost immediate computer posting of results and hospital appointment times via sms or telephone. Dare I say.any delay from any department is immediately obvious so all are made accountable.

Current European Card allows emergency treatment for free with same entitlement as Spanish but they strictly insist that if diagnosis needs further treatment then payment must be made or return to country of origin with the usual treatment records and findings handed to the patient.

No idea what the rest of Spain is like but I am very impressed by the Andalucian model which gets things done efficiently.
I'm sure the actual treatment is no better or worse than UK but it seems to serve the patient rather than allow its own internal possibly inefficient procedures to define its ability to cope.

In general these days, a hospital in the UK will have the basics all joined up (hopefully). It's when you want an overall picture of a patient, that is where it's not integrated fully. Be it a Unit outside of the main hospitals, small GP Health centres, privatized sections of Healthcare, different Health Authority areas, brand new super-duper kit.

Mrs JASR works in the NHS - one Hospital she worked out, involved having at least 10 different systems (to get patient data, request analysis, check results, check medical info etc), all requiring different usernames (in different formats) and passwords (with different rules on passwords) that she would need to be in/out of constantly during a shift.- Not really what a critical patient needs - their health worker spending inordinate time fighting with the systems...
For patient privacy and security, they are meant to logout when they finished looking at.
For health and safety they are meant to clean hands after touching IT equipment used by others.
The above items were tried to be followed, but when you're working in a failing underfunded overloaded and backed up system, something has to give...

 

[SilverFox2]

Many systems work far better but that is because there is a will to make them better and change them. The NHS doesn't work because it hasn't changed since it was formed and the political climate means no-one can change it.

I think it is time to introduce a new public healthcare insurance that sits alongside NI. It would harm peoples pay and increase employers costs but it doesn't have to be radical. It certainly isn't as radical as Labour's plans which will inject a lot of money but then it would need even more in a few years.

If everyone had to pay 1% of salary towards healthcare then the NHS would be fixed overnight and it would scale with the population and inflation.

Having a look at a working system in any sector of business is surely how purchasing should operate? How can a judgement be made about other systems if its capabilities have not been assessed?
Is it possible that too many people make a living from keeping the nhs a special case.

I remember a saying from the business sector that was "If you've got a person who is great in a crisis well get fid of them because they have a vested interest in keeping you in that crisis"

I believe that the nhs may very well be a special case, not because of its medical function but mainly because of its reluctance to change to a digital world for its basic information processing.

 

[TheRemainsOfTheDave]

I believe that the nhs may very well be a special case, not because of its medical function but mainly because of its reluctance to change to a digital world for its basic information processing.

Not sure I agree with you on this.

 

[inbetween]

Having a look at a working system in any sector of business is surely how purchasing should operate? How can a judgement be made about other systems if its capabilities have not been assessed?

Is it possible that too many people make a living from keeping the nhs a special case.

I remember a saying from the business sector that was "If you've got a person who is great in a crisis well get fid of them because they have a vested interest in keeping you in that crisis"

I believe that the nhs may very well be a special case, not because of its medical function but mainly because of its reluctance to change to a digital world for its basic information processing.

Like many government organisations, healthcare is just a sideshow in some bits of the NHS rather than the sole reason it is there.

I worked in the NHS in an admin role briefly around 10 years ago. I was in a team of 5 people with a team leader and a manager. Our manager didn't do the work and was never anywhere to be seen because she was always at meetings.

So of a team of 7 people, 6 were doing work, 1 was leading the team and doing work, and 1 of them managed the person who was leading the team..... We were on great salaries too, I was on £18k as the lowest of the low and that was 10 years ago.

If you wanted a fancy rising desk costing thousands, you got it. If you wanted a nice new keyboard, new stationary, whatever, you got it. We had prayer rooms, chill out rooms, free tea and coffee and a subsidised canteen.

All of this added up to expenditure that contributed nothing whatsoever to healthcare.

Actually providing a public service is an afterthought for most of these organisations unless you are the poor soul who is stuck in the hospital doing the work....

 

[Bluemanc100]

Money is in the system at greater levels than its ever been.

PFI payments are crippling and still we have trusts signing up for more of the same to then claim they are being underfunded.

Ive no objection to a separate NHS tax but the NHS has to be ran properly and be taken out of politics and politicians hands completely going forwards.

If somebody could guarantee that the extra tax would land in the NHS which would be free as you said from political influence than I'd be more than happy to pay more... I'm sure most would