Keir Starmer's techno-fix for the NHS: Déjà vu disaster or brave new blunder?
- Reference: 1684840745
- News link: https://www.theregister.co.uk/2023/05/23/starmer_nhs_it/
- Source link:
"They" being the Labour Party, and "it" a promise to fix the NHS with the magic of "technology."
In an [1]opinion piece in The Guardian , the leader of the opposition bemoaned the state of the NHS following the ravages of the pandemic and years of arguable underfunding.
[2]
But Labour is in a tight spot. Though hotly tipped to win the next general election, likely to be in 2024, it will have politically limited options in raising taxes to pay for one of the world's largest healthcare providers, which already soaks up an annual budget of [3]£160.4 billion in England and suffers a chronic shortage of doctors and nurses.
[4]
[5]
"There is another change that could totally reframe the NHS and how it operates, and save money," the opposition leader opined, as if staring dreamily into the distance, consumed by a vision of a better future he alone could see.
That change, you ask? "Moving from an analogue system to a fully digital NHS. The NHS is in pole position to take advantage of advances in science and technology, if only ministers realised it," Sir Keir said.
[6]
Yes, yes. If only some minister had – in the 25 years since the dotcom boom brought the elixir of IT bubbling to the top of the business and political agenda – thought that the NHS could be made more efficient using tech investment.
The problem is they have. Several times. And it has not ended well.
The National Programme for IT (NPfIT), which began contracting under the Labour government in 2003 with a budget estimated at £12.7 billion, fell dramatically short of its ambition to offer electronic health records throughout the NHS.
[7]
In 2011, the National Audit Office (NAO) found that £2.7 billion spent up to that date did not represent value for money. "Based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different," it said.
In the wake of the NPfIT failures – there were many among a few successes – the coalition and Conservative governments were more modest in their ambition for NHS IT yet still managed to come up short.
In 2020, the NAO warned that [8]the lack of systematic learning from past failures means there remain "significant risks to successful implementation… in all areas" of the government's "Digital Transformation Portfolio" launched in 2014.
[9]NHS England spends £8M to extend Microsoft deals by a month
[10]NHS England considered using Palantir tech to manage strike disruption
[11]UK consortium bid for NHS data platform falls at first hurdle
[12]NHS Highland 'reprimanded' by data watchdog for BCC blunder with HIV patients
Since then, there have been more efforts. In early 2022, the UK health secretary looked to [13]"the latest technology" to clear a 6-million-strong waiting list in England caused by the COVID-19 pandemic. Then in June that year, the NHS committed to [14]implementing electronic health records for all hospitals and community practices by 2025, backed by £2 billion in funding.
Despite more than 20 years of initiatives, the shortcomings are manifest. In December last year, a study by the British Medical Association revealed that [15]more than 13.5 million working hours are lost yearly in England's health service alone due to inadequate IT systems and equipment .
To home in on just one dramatic example, a catastrophic failure of electronic health systems at Guy's and St Thomas' hospitals during the summer heatwave of 2022 [16]took two months to completely rectify because of the complexity associated with 371 legacy IT systems.
As if none of this is apparent, Starmer ploughed on promising "more choices for patients and the ability for us to better manage our own health."
The pledge has a history dating back to before even the National Programme for IT. First planned in 2000, Choose and Book was funded in 2003 via a five-year, £64.5 million contract to the commercial supplier Atos. It promised patients choice in booking hospital appointments in consultation with family doctors using an electronic booking system. In 2014, it was scrapped.
The problem was, in practice, there was no choice. [17]A study from 2014 showed that in GP consultations, the "choice of hospital was either not offered at all or was presented to the patient as an external requirement (something the GP 'had' to do), with GPs often highlighting the perceived absurdity of the situation by expressing humour or exasperation."
The study did not encounter a single example of any patient choosing to go anywhere except their local hospital, and only one example of a member of staff who recalled (on a single occasion) such a choice being made.
None of this means technology cannot help the NHS. The technology can be improved, and it might even produce efficiencies if correctly specified. But hoping you can use technology to magic away deep-seated and complex organizational problems is a fool's errand. And you could make it worse. ®
Get our [18]Tech Resources
[1] https://www.theguardian.com/commentisfree/2023/may/22/digital-nhs-technology-health-service-keir-starmer
[2] https://pubads.g.doubleclick.net/gampad/jump?co=1&iu=/6978/reg_offprem/front&sz=300x50%7C300x100%7C300x250%7C300x251%7C300x252%7C300x600%7C300x601&tile=2&c=2ZGzjKIAgr0sm-SXO8FMI7gAAABg&t=ct%3Dns%26unitnum%3D2%26raptor%3Dcondor%26pos%3Dtop%26test%3D0
[3] https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/funding/health-funding-data-analysis#:~:text=NHS%20England%20budget&text=For%20this%20financial%20year%20(2023,on%20directly%20to%20the%20NHS
[4] https://pubads.g.doubleclick.net/gampad/jump?co=1&iu=/6978/reg_offprem/front&sz=300x50%7C300x100%7C300x250%7C300x251%7C300x252%7C300x600%7C300x601&tile=4&c=44ZGzjKIAgr0sm-SXO8FMI7gAAABg&t=ct%3Dns%26unitnum%3D4%26raptor%3Dfalcon%26pos%3Dmid%26test%3D0
[5] https://pubads.g.doubleclick.net/gampad/jump?co=1&iu=/6978/reg_offprem/front&sz=300x50%7C300x100%7C300x250%7C300x251%7C300x252%7C300x600%7C300x601&tile=3&c=33ZGzjKIAgr0sm-SXO8FMI7gAAABg&t=ct%3Dns%26unitnum%3D3%26raptor%3Deagle%26pos%3Dmid%26test%3D0
[6] https://pubads.g.doubleclick.net/gampad/jump?co=1&iu=/6978/reg_offprem/front&sz=300x50%7C300x100%7C300x250%7C300x251%7C300x252%7C300x600%7C300x601&tile=4&c=44ZGzjKIAgr0sm-SXO8FMI7gAAABg&t=ct%3Dns%26unitnum%3D4%26raptor%3Dfalcon%26pos%3Dmid%26test%3D0
[7] https://pubads.g.doubleclick.net/gampad/jump?co=1&iu=/6978/reg_offprem/front&sz=300x50%7C300x100%7C300x250%7C300x251%7C300x252%7C300x600%7C300x601&tile=3&c=33ZGzjKIAgr0sm-SXO8FMI7gAAABg&t=ct%3Dns%26unitnum%3D3%26raptor%3Deagle%26pos%3Dmid%26test%3D0
[8] https://www.theregister.com/2020/05/18/latest_nhs_it_revolution_is/
[9] https://www.theregister.com/2023/05/18/nhs_england_extends_microsoft_deals/
[10] https://www.theregister.com/2023/04/17/nhs_england_palantir_tech_optout/
[11] https://www.theregister.com/2023/04/17/uk_consortium_bid_for_nhs/
[12] https://www.theregister.com/2023/03/31/nhs_highland_reprimanded_by_data/
[13] https://www.theregister.com/2022/02/09/nhs_tech_consultancy_procurement/
[14] https://www.theregister.com/2022/06/30/uk_electronic_health_records/
[15] https://www.theregister.com/2022/12/09/inadequate_it_systems_contribute_to/
[16] https://www.theregister.com/2023/01/30/hospital_legacy_systems_recovery/
[17] https://www.sciencedirect.com/science/article/pii/S0277953613006904
[18] https://whitepapers.theregister.com/
version of the Conservatives
Sir Keir Starmer has already said his Labour party are the *real* conservatives.
Wolfie, Does this sum up your take :)
https://www.youtube.com/watch?v=230GPwqel0Y
As a cynical old git I think Keir needs more practise being ‘a normal chap’ just like Blair used to do with his mug during 'informal' interviews.
As he was hanging around the governing party for the 2000's he'll have no excuse for repeating the errors bound up in trying to create an all encompassing streamlined IT system, unless of course the plan IS just to splash the cash...
More or less yeah - except Keir also wants to make painfully clear that he's not a boring bastard and that everyone should stop calling him one otherwise so help him God etc.
> I think Keir needs more practise being ‘a normal chap’ just like Blair used to do
It's in the next service pack.
It's not THAT hard!
Remove private firms from teh NHS, such as Accenture, KPMG and all those "value added morons" who charge you £1000/person/day whose being paid £100
This whole thing stinks of a chat to Mckinsey or similar!
Hire more Doctors, Hire more nurses, pay them more! Bring all the cleaning services and things like that back in house" The NHS has the expertise to run these things AND you'll be giving those staff a pay rise as you won't be forking out money to outsourcers and shysters like Carillion!
Force NHS Management to learn the phrase "take responsibility for your actions"
If you removed all the outsourcers, you could probably increase money going to ACTUAL PATIENTS without paying a penny more into the budget!
Oh yes....make parking free for staff
Re: It's not THAT hard!
"Hire more Doctors, Hire more nurses, pay them more!"
Ultimately saving money as they won't need to work shifts for agencies (at two, three, or more times the cost) doing the exact same jobs, in the exact same locations...
Re: It's not THAT hard!
Unfortunately the "hire more ..." section comes down to "don't start from here".
It takes "quite a few years" to train a doctor, so if you open up the taps now, you'll get more doctors in something like a 5-10 year timescale (depending on desired state of training). So to have more doctors now or in the near future, you need to not start from here, but start doing something 10 years ago.
Of course, you could look at the other end of the spectrum and incentivise senior doctors not to retire early. But Labour have shot themselves in both feet by promising to reverse a recent pension rules change - and again, make it not worth staying in work when the tax charges on your pension mean you would be better of just retiring. Of course, those incapable of seeing past their envy have labelled the recent change as being a gift for the top 1% - but in reality a lot of those it affects are senior medical people in the NHS (thanks to the way their defined benefit pensions are valued for tax purposes).
Re: It's not THAT hard!
> It takes "quite a few years" to train a doctor, so if you open up the taps now, you'll get more doctors in something like a 5-10 year timescale (depending on desired state of training). So to have more doctors now or in the near future, you need to not start from here, but start doing something 10 years ago.
To have more doctors now or in the near future, one just needs to offer them better salary and conditions than they get in their home countries.
Re: It's not THAT hard!
>takes "quite a few years" to train a doctor, so if you open up the taps now, you'll get more doctors in something like a 5-10 year
If only foreign doctors were trained on how to work on the unique British physique
Sounds like developers in a planning session.
Requirements? What are those? Look at all these toys!
A few common mistakes made in large systems:
Design by committee
Top-down design
Dwelling at OSI layers 8, 9 and 10 Needless to say, the costs of such system are huge and the results are, well, rather small.
The other approach, where it is anyone for themselves results is a myriad of incompatible systems without real inter-system communication. It too is a nightmare and not a real solution.
However, there is a way, slow but steady, to make a large system work. You need to have a bottom-up approach where the same traits are handled in (relative) compatible ways. Not one system but local systems made for and by the locals. These systems need to evolve and coordination about communication syntax and the semantics of what is communicated must be (gradually) agreed upon. Each system should think about forward compatibility. There are many ways to achieve the same goal. Trying to make or even forcing a too-big-to-fail system is a sure recipe for failure; see current state of affairs. You need slow incremental changes. Get the locals (the nurses, doctors, patients and family) to appreciate a system made for them and then build upon that success. Do all of this while you merge and migrate systems where it makes sense and still leave place for new specialized local systems to be created and used.
And don't use the likes of ATOS, Capita, Deloitte, etc in to do it. The company I work for sees so many opportunities to make postive changes at local level, but we don't get a look in as it's all, as you say, top down change run by consultants and comittees.
Stammering his way to another disaster
There's zero percent chance that either party can solve the current ills with the NHS. Labour brought in armies of consultants who sucked off cash and delivered SFA. Then the Tories have tried to clean up the mess Labour wrought and are damned for trying to balance the books to know where to invest.
Frankly, the terms cluster and fluck are so obvious it is stunning that Sir Stammer now thinks his silver tongued wibble can fix it.
Re: Stammering his way to another disaster
It goes back further than that ... try the 80s/90s and the "Internal Market" - basically departments charging each other for their services, and thus requiring a layer of bureaucracy to handle the paperwork.
Big government big disaster
Government controls the training of staff. Controls the resources to the NHS. Sets the rules for the NHS. This isnt a technology problem, it is a government problem.
I owe NHS IT a lot
It's what made me jump to this side of the pond.
Was doing interesting, if slightly underpaid, work at a little tech company oop north.
The receptionist had a boyfriend, a PFY who could barely string a sentence together but had a company 5series and I found out, was paid twice what I made as chief R&D.
He sold software to the NHS, he didn't understand what the software did, or why they needed it - but it was the only approved solution and the local NHS had to buy it. But somehow he was paid to 'sell' it
NHS Linux
Designed to be secure by default, run in house for NHS. Can build connectors/convert to legacy systems and bring them on board to remove legacy shite. Stop paying MS billions for licencing and forced upgrade paths.
Software for the NHS by the NHS and not external consultant companies wanting some of the pork.
Support THAT and you might help Kier. It'll take time but it'll make a huge difference. With modern builds of Linux the users 9 out of 10 times don't even need to know they are not on MS
Re: NHS Linux
No idea what it is about Register commentators and Linux..obsessed is the word.
It's not just desktop it's the whole shebang. 1.5 million staff, 7000 organisations that come under the NHS Banner. Pharmacies, Dr Surgeries, CQC's etc. Many that won't have in house IT.
NHS Digital actually gets quite the good price on Microsoft software, just a shame about the Cloud First strategy and that b*llocks.
The trick is use the NHS Digital model. Create a centralised DB of patient data, it probably already exists and create API's that can provide access to it. Have a stand piece of software that can be used by Pharmacies and Doctors Surgeries and allow the big Trusts who have the cash and DON'T want to be bullied into using something like Palantir to develop their own front ends which are usable by their staff that can access the data.
Every Trust is different, Every trust has it's own challenges. Digital should be providing a platform, the foundations to the Trusts and then let them do their own thing based on how that particular trust works and how it's staff work.
Re: NHS Linux
"Create a centralised DB of patient data" - at that point you lost my vote. No way do you get to put my data into something centralised until you've earned my trust. And that does have to be earned incrementally. So start your plan again.
I'll happily support the Linux idea, BTW, especially for back office systems.
Re: NHS Linux
It doesn't need to be centralised to be honest - the HL7 specifications are perfectly capable of dealing with any data that may need to be transferred from one location to another ... any healthcare application worth the name should understand it already.
Some Trusts do use their own applications (and - more importantly - maintain themselves) ... that's my day job.
Tech is not the solution.
They really need to think about how a Victorian system does not work in a modern world.
Today's medicine is all about tests and scans. Yet you have to make an appointment with a GP who cannot carry out even the simplest blood and urine tests and has zero scanning equipment.
Why can't I just make an appointment with the appropriate specialist at a hospital with a fully equipped lab and a full set of scanning kit.
Get rid of the bean counters and other blood suckers
"sensible": Oursources who charge bonkers money for a light to be changed - get rid of them, employee a couple of porters / handymen at each hospital.
"Beancounter": Sorry, no can do, Salaries come out of this pot, and there is no budget left.
"Sensible": But is is the same people and you are being charged x time as much for the same work, but now it takes longer to get done and wastes so much more money.
"Beancounter": But we have budget in pot x for this extra cost
"Sensible": Fuck the pots, the only pot I am interested in is the overall pot and you are fucking it royally by making us pay over the top.
"Sensible": Lets get a good team of devs in to write what we need
"Beancounter": Capita
"Sensible": Really ?
"Beancounter": Fujitsu
"Sensible": Awww, come on
"Beancoutner": Infosys
"Sensible":. I give up. Let me just clap instead
"years of arguable underfunding2
It is not in the smallest bit arguable.
Real problem with Doctors ...
... is not the doctors, or primary care in general, but the secondary care system in the UK.
.
For instance take my GP daughter:
Every day for months she has had to see 3 individual patients for extended consultations - basically taking up 3 slots each. She has to see them because they have complex mental health issues, and each of them has been on the waiting list for secondary care for between 5 and 9 months! If one of them took their own life, which they regularly threaten, my daughter (as the last person to see them) would be under suspicion and have to nervously wait for months before the Coroner's Inquest. (Not the secondary care system that should be looking after them.)
Or the people that regularly come in begging for stronger medication for pain, while they wait over a year for surgery. When my daughter cannot prescribe most strong painkillers as they are only for short term use.
.
She can see that on average 1/3 of her time is spent dealing with the regulars who should be under the care of the secondary care system.
Then nearly 1/2 of the other patients she sees complain of the difficulty in getting an appointment or the time in the waiting room while she has to deal with the difficult patients.
She is threatened with physical abuse at least twice a week, and yet she has to be kind and compassionate.
.
Doctors are your first line of investigation and diagnosis.
Secondary care is then supposed to take over with detailed tests and scans. Followed with intervention, be that an operation, or long term care and support.
The secondary care is not happening and the Doctors are having to take the brunt of this.
.
All for a £65K - £80K debt when leaving Medical School and a relatively low wage (starting at £14/hour).
Re: Real problem with Doctors ...
Well ultimately it's all a matter of perspective - in secondary care there are very similar arguments about how the caseloads are clogged up with patients who should be managed in primary care but the GPs refuse to take them back! This is a particular problem with mental health services where there are a lot of individuals who have chronic problematic behaviour of one sort or another but who do not actually have any kind of of mental illness / mental disorder. However and unfortunately they end up getting stuck in healthcare.
The main problem with modern medicine is that most people have no good grasp of their processes and simply don't understand their own work or what their service should be delivering. It's very hard to 'digitise' services like this - believe me, I've tried. If we could just get people to get to grips with this, and make sure their staff were performing properly then we'd have a much more efficient service. Too often I've seen managers who are ineffective, and refuse to manage their staff properly because they are afraid of allegations of bullying, racism etc.
It's like deja vu all over again hearing this from Keir Starmer... the poor man obviously believes it but it needs a lot more than some IT systems, it needs proper examination from ground up of what our staff are doing and why, with systems employed to support their work. Putting systems in and thinking that as if by magic everything will change is naivety, and it is what led us to the ruinous waste of the National Programme.
" it will have politically limited options in raising taxes to pay for one of the world's largest healthcare providers, "
Well of course it would, when Labour is modelling itself as just a slightly less racist/bigoted version of the Conservatives.
One of Sir Beer Korma's biggest donors right now is John Armitage, who is an investor of a private health care company who have huge interests in privatising the NHS. It's in Beer Korma's interests to appease these bastards, and floating the idea of technology doubles down on it. Because the data used will, more likely than not, also fall in to the hands of Plantir as by the time 2025 rolls around agreements in the background will have been made. The decision will become entrenched.
The NHS will continue to exist for as long as people want to fight for it. It will not continue to exist if self serving/interested people like the current cabal of Nu Labour are allowed to continue neo liberal policies that have sunk the UK in to the mire it finds itself in now. The Tories are no better, but we all deserve a better solution to the Tory problem rather than something a little less bad but ultimately the same as we'll get with Starmer's party.