back to article Tech can do a lot, Prime Minister, but it can't save the NHS

Britain has a long-term health problem: Britons are living longer with conditions that would previously have killed them. This is obviously great for the people concerned, but not for the government, which is on the hook for most of the nation’s healthcare costs. This election has seen technology, along with new buildings, …

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  1. Mark 110

    Agree that GP capacity is the problem rather than being able to book online. I see a simple solution to that in increasing the prescribing powers of pharmacists. To take the pressure off General Practice.

    Just to take the GP bottleneck out of the equation where possible. I had a shoulder issue recently and needed physiotherapy. I couldn't see an NHS Physio without seeing a GP first - so, as I can afford to, I went private and got seen the next day. One further visit and issue resolved within the two weeks I would have had to wait for a GP appointment. If I couldn't afford to I would have wasted 30 mins of a GPs time getting a physiotherapy referral . . .

    Technology could help there.

    1. Anonymous Coward
      Anonymous Coward

      The bottleneck

      In IT this is called demand management, Make it difficult to do, and those that can will go elsewhere. Same approach taken with benefits etc. Besides, you would only get a 10 min consultation on a first visit to a GP and would likely get a referral to your local physio service in 6-8 weeks.

    2. Pen-y-gors

      Prescribing

      Agree about pharmacists and other variations. Our practice has revamped the diabetic care - previously you saw a diabetic nurse who did various checks and chat, but then you needed to see a doc for general review of prescriptions etc. Now they have a lower grade person who checks feet etc, then a Nurse Practitioner does the main review, who is allowed to prescribe, so doc's time saved. Pharmacists should be allowed to do repeats (within limits).

      Appointments are still a problem. Phone up in the morning and you'll get a same day appointment. With whichever doc is on duty. And you can't make an appointment a week or to in advance for a convenient time. It's same day or nothing - even for non-urgent things. Bit silly really.

      We'll just have to pay more taxes.

      1. James 51

        Re: Prescribing

        @Pen Perhaps multinations and the billionaires who own most of UK media could start paying theirs.

        1. Anonymous Coward
          Anonymous Coward

          Re: Prescribing

          You wait to see your GP, then you wait weeks for physio. Potentially you're off work or unable to work at 100% and taking prescription medicine. Sometimes you even hurt yourself more having, for example, to limp for 8 weeks can damage your back.

          I've found that where I'm living now (abroad), I see the physio within a few days meaning I'm back at 100% fit for work much quicker.

          It seems to me that the NHS is caught in an ever decreasing circle. They're underfunded so they don't treat people on tile, so people get sicker and cost more to treat, so they're underfunded...... etc.

          To give some other examples:

          My uncle was told he didn't need a hip replacement, despite it being obvious he did. The GP didn't want to do it as it would cost too much. My father managed to get him seen privately and it was obvious from the scan that the hip needed replacing and the GP even said so but only after he'd had it done privately!

          In another example my grandmother was forced to wait more than two years for a hip replacement and then denied it at the end as she wasn't active enough! Of course she wasn't active she'd been reduced to a cripple during the two years waiting and become unable to move. This then lead to heart problems and..... all I can say is "thanks" NHS!

    3. Charlie Clark Silver badge

      Here in Germany you can go straight to a specialist. However, this is considered one of the main reasons why healthcare is so expensive. And also, due to the way things are budgeted here, appointments with specialists for non-private patients quickly become very rare and Germany spends a lot more per person on health than the UK.

      On the whole I much prefer the referral by GP approach because a good GP should be able to refer to you the right specialist quickly. Digital records and more powerful practice nurses could also help here but at the end of the more resources: financial, personnel and technological are required. Won't stop the solutionists lobbying for purely virtual solutions though: you can get a free VR consultation which virtually solves your shoulder problem.

      For years the Tories have been chanting the mantra of greater efficiency (listening to Yes Minister from the early 1980s is eerily prescient) meaning more can be done with less. But it never can. Outcomes only really improved and waiting lists declined when Labour started spending heavily on health, though they also fell for the dreadful PPI scams.

  2. Anonymous Coward
    Anonymous Coward

    First of all

    I think the NHS needs to dissolve a lot of power from trusts and make things more centralised. It must be a huge waste of money for each trust to use different IT contractors and systems that then never work together. It's the same for GP's, all on different systems. Centralise IT at least and half these problems will go away, surely?

    1. Mark 110

      Re: First of all

      Some kind of SIAM model where Service Management, Architecture, Procurement and Integration were centralised for sure. I would not be in favour of too many huge monolithic IT contracts though - needs to competition between suppliers on service and price.

      1. Anonymous Coward
        Anonymous Coward

        Re: First of all

        The Services do it why not the NHS?

        1. CrazyOldCatMan Silver badge

          Re: First of all

          The Services do it why not the NHS?

          Differences in scale. And, in the services, if you get told to do something you don't have the option to say "no - I'll do it my way..".

          The NHS - no longer national, not really healthy and (in some cases[1]) not much of a service..

          [1] Amulance Trusts - I'm looking at you.

        2. therealmav

          Re: First of all

          must be a different 'services' to the ones I'm familiar with. Because every time I talk to someone about service IT, it's accompanied by a rolling of eyes and something like '<systemname>, what a fucking joke'

          Large scale it for an organisation spending way north of £100bn that's the biggest employer in Europe is just way hard

    2. Doctor Syntax Silver badge

      Re: First of all

      "Centralise IT at least and half these problems will go away, surely?"

      In theory, yes, so have an upvote. But given government's proven abilities [sic] to handle large IT projects I think there are some practical problems with that.

      1. TitterYeNot

        Re: First of all

        ""Centralise IT at least and half these problems will go away, surely?"

        In theory, yes, so have an upvote. But given government's proven abilities [sic] to handle large IT projects I think there are some practical problems with that."

        IMHO one of the (many) problems with the NHS NPfIT fuckup, especially the integration of GP's surgeries into the system, was a lack of centralisation. The early initial spec called for one centralised system used by all NHS Trusts and GP surgeries, which was abandoned in favour of design whereby individual Trusts and surgeries could choose different providers. Yes, in theory this allows a choice, encourages competition and reduces lock-in, but in reality the result was a bunch of different providers all trying to integrate different products and technologies into one monolithic system on a national scale. And guess what, it didn't work.

        So rather than giving Trusts and surgeries one system that would have worked, and worked reasonably well, and telling the Trusts and surgeries that moan, tough, it may be a slightly different to what you're used to doing but you're not stupid, you're just going to have to learn how to use it, instead we piss a few billion quid up the wall and get the abortion that is the Lorenzo patient records system...

    3. Flocke Kroes Silver badge

      Re: First of all

      My local hospital recognised the danger of getting locked in with a monopoly software supplier. Their solution: pick two incompatible solutions and let each member of staff pick one. The result is that they are locked in with two different suppliers. It is almost as if people outside the software industry do not understand that the most effective tool to break lock in is the GPL.

      1. Bronek Kozicki

        Re: First of all

        ... almost as if people outside the software industry do not understand that the most effective tool to break lock in is the GPL

        ... because they do not. The way GPL presents itself to the outside world, it is mostly about 1) free to use 2) free to change. With a generous dose of RMS inspired ideology. This is precisely what turns the business people off GPL. They get easily wooed by closed-software vendors, but there is no-one to try to convince them to open standards and open source, because the assumption is that if something is free and open, then obviously managers would choose it above pricey and closed. Hence no marketing effort to try to sell open source, after all it is supposed to sell itself, right? Which is very bad assumption to make, because closed source often comes with SLAs (never mind how effective these are in practice) and open source does not (unless there is vendor making money off it, like RedHat - for which it is hated in some GPL circles)

        1. Anonymous Coward
          Anonymous Coward

          Re: First of all

          I agree, so have an upvote.

          But I also think your analysis assumes more understanding of the GPL (and broadly, open source) than actually exists in the NHS.

          I work in the NHS, and with open source software on a daily basis, hence anon. My experience is that people tend to equate open source with one or more of the following things:

          1) Free as in beer

          2) Lack of "enterprise" support

          3) Difficulty of use/integration

          4) Difficulty of procurement (they have a point here - very many open source vendors are terrible at dealing with the NHS).

          Despite the fact it's probably one of the biggest benefits, free-as-in-freedom/free to change very seldom gets a look in, except with particularly informed people.

          There are people trying to improve understanding, both in the NHS and the wider public sector. But it's a slow process.

        2. Doctor Syntax Silver badge

          Re: First of all

          "This is precisely what turns the business people off GPL."

          That would include the non-business people running RedHat, I take it.

          I suspect that what precisely turns most business people off GPL is people saying that business people are turned off GPL.

    4. Anonymous Coward
      Anonymous Coward

      Re: First of all

      "I think the NHS needs to dissolve a lot of power from trusts and make things more centralised."

      Such as the central patient record?

    5. CrazyOldCatMan Silver badge

      Re: First of all

      Centralise IT at least and half these problems will go away, surely?

      Sadly not. Or at least, not unless you spend a hell of a lot more money moving Trusts of their current (and in most cases uniquely customised) software base and onto a centralised platform.

      Sure - it can be done but not easily. Best way would be to establish the centralised IT service and then gradually migrate Trusts over as their stuff becomes obsolescent. And that's not a short-term[1] process and won't be cheap.

      [1] Which means no politician will go for it - commit to long-term spending without some glory gain that the newspapers can report against their name? Forget it!

      1. GrapeBunch

        Re: First of all

        "Sure - it can be done but not easily. Best way would be to establish the centralised IT service and then gradually migrate Trusts over as their stuff becomes obsolescent. And that's not a short-term process and won't be cheap."

        As a disinterested and mostly uninformed outside observer, I'm wondering if the messy reality where each Trust has its own system, can't be harnessed using Darwin to make a better and more cohesive whole. There must be one Trust system that best reflects the ideal NHS system. Such a system already has elements of scalability, because it serves NHS facilities Trust-wide. Make it the default system. Other Trusts may continue with their own systems, but with their IT management budgets (by that I mean the amount paid to middle and upper managers, not capital or staffing by actual IT people) frozen. I imagine you'd want to start by incorporating one Trust (which need not be geographically contiguous) into the default Trust system.

        I won't talk about how you make the choice of best Trust system an objective rather than a political decision. Nor will I talk about resistance from empire-builders in each Trust. Rather, I'd like to talk about the possibilities of humour if the idea of going with proven competencies takes hold:

        "Mr. Trelawney, your operation is scheduled for 9 o'clock tomorrow morning."

        "Already? That's wonderful. So that's here at Truro Hospital, then? When should I arrive?"

        "No, Mr. Trelawney, your operation will be at Aberdeen Hospital. They have the best record for ingrown toenail procedures. And according to the Belfast Trust computer, which has the best timetables, if you leave now for Truro rail station, you will just make it to Aberdeen in time for the 7:30 a.m. check-in for your operation. And please don't eat anything for 12 hours before the operation."

        "Not that I'd want to."

        "Your surgeon is Dr. Ronald MacDonald."

        [pause] "Blimey."

    6. the spectacularly refined chap

      Re: First of all

      It's the same for GP's, all on different systems. Centralise IT at least and half these problems will go away, surely?

      GPs will be on one of four clinical systems. EMIS has over half the market. Add SystmOne and you are over 90%. The other two are fighting over the scraps. Regardless, that's hardly "all different systems" and yes, they all interoperate to a greater or lesser extent.

      Having seen this at health authority and at national level I concluded most of the problems are cultural rather than technological, in particular the obsession with confidentiality.

      GPs can't directly see the spine entries for their own patients, they can't even look up their NHS numbers for themselves but are instead dependant on the health authority or primary care support services.

      Even then, up until around the millennium NHS numbers were not national at all but allocated independently by each local health authority. Move between authorities and you'd get a new NHS number. Even now, with "national" NHS numbers and at the level of national administration, those within NHS England can't see the records of NHS Scotland and vice versa and so on.

      All this adds up to a lot of scope for data mismatches and duplicate accounts: it is a wonder systems like GP2GP (which transfers computer records between practices) work at all.

    7. macjules

      Re: First of all

      Not going to happen. Never.

      By now the NHS is very firmly entrenched into multiple level CYA management. When you have this level of bureaucracy you no longer have any service at all.

      Think Victoria Climbié and Haringey social services where the social services had such complex levels of intertwined management that the enquiry into mismanagement could not clearly identify who was responsible and actually ended up paying compensation to the one woman who was to blame.

      Ask any consulting surgeon about management procedure and they will tell you that that is what the problem with the NHS is, they simply can not operate because the managers do not understand that there are always risks with any procedure, and as a consequence they try to put off any surgery where at all possible.

      If it is going to happen it will be where BUPA takes over the NHS, something like PAX in Switzerland.

  3. annodomini2

    Real world underfunding

    In 2009-2010, the NHS budget was £111.7Bn

    In 2016-2017, it is £122.6Bn.

    Tory data manipulators state they are spending more money on the NHS.

    Between 2010 and 2017 compound inflation is about 18%.

    Therefore the 09-10 budget (relatively) was ~£131.8Bn.

    Or more fundamentally, a 7% reduction in funding.

    1. Flocke Kroes Silver badge

      Re: Real world underfunding

      May's £8 billion over five years is almost £31 million per week. What happened to the other £319 million?

      1. Gezza

        Re: Real world underfunding

        We haven't left yet.

        1. codejunky Silver badge

          Re: Real world underfunding

          @ Gezza

          Thanks for posting that. It is nice to see the remain stick being taken off them and hitting them back.

          1. James 51

            Re: Real world underfunding

            That is what they are planning to spend over the next five years including three years when we will be out of the EU so I'll take that stick back and see you:

            https://www.youtube.com/watch?v=A8yjNbcKkNY

        2. Anonymous Coward
          Anonymous Coward

          Re: Real world underfunding

          "We haven't left yet"

          May says we will be out in two years. That then leaves three more years of her five year NHS cash projection at the low level. So when exactly will the promised financial benefits be forthcoming? Farmers are asking the same question about their continuing subsidies.

          1. codejunky Silver badge

            Re: Real world underfunding

            @AC

            "So when exactly will the promised financial benefits be forthcoming?"

            and

            "Farmers are asking the same question about their continuing subsidies."

            Now why would farmers be thinking about subsidies if we leave? Would it be related to the EU being more expensive than the world so requiring subsidy? And without the subsidy the cheaper products are a benefit to??? Everyone!

            I just hope May doesnt screw this up. A good Brexit would have been assured if UKIP won last time.

      2. Anonymous Coward
        Anonymous Coward

        Re: Real world underfunding

        What happened to the other £319 million?

        Well, here's a thought for you. Hospitals, health centres, and GP practices are charged business rates, so the government gives and takes away. I'd stop that circular nonsense tomorrow, and that would provide over half a billion quid a year extra. Only 0.5% increase, but that's all extra money, and an additional £2.5bn over the next five years.

        The beards and sandals of local councils will weep that they need that money for social care, but mine still has money to piss up the wall on public fireworks displays, music and poetry festivals, "LGBT history month" and many other crappy "cultural" services so I'd happily cut their income.

        1. Doctor Syntax Silver badge

          Re: Real world underfunding

          mine still has money to piss up the wall on public fireworks displays, music and poetry festivals, "LGBT history month" and many other crappy "cultural" services

          Mine had several hundred thousand Euros to spend bringing the Tour de France to block the roads for several days plus more spent on various facilities around that. It must have totalled about £1m. Although they did mend a few roads as part of that so we got something back, even if they weren't the roads in greatest need.

          1. CrazyOldCatMan Silver badge

            Re: Real world underfunding

            Mine had several hundred thousand Euros to spend bringing the Tour de France to block the roads

            One of the best roads I ever rode my motorbike on was in Ireland - built (with EU money) specifically for one of the stages of the Tour Du France. Wide, smooth, lots of lovely curves and virtually no cars[1].

            [1] No - no cyclists either. It was about 3 years old when we rode on it. Quite a few times. It would have been perfect EXCEPT FOR THE DAMNED RAIN[2]!

            [2] Yes - I come from the UK. We have rain too. But not in the same quantities or on the same timescale. In 14 days, we had a whole 1/2 day when it wasn't raining. We spent a lot of time in pubs[3] on that tour.

            [3] Not a bad thing - but I can do that at home. When you go abroad on the bikes, it's to see all the wonderful countryside going past in a green blur[4] :-)

            [4] "What's France like?" "Green and blurry :-)"

          2. James 51

            Re: Real world underfunding

            @Syntax It cost £1m but how much tourism has it brought in?

        2. GrapeBunch

          Re: Real world underfunding

          "The beards and sandals of local councils will weep that they need that money for social care, but mine still has money to piss up the wall on public fireworks displays, music and poetry festivals, "LGBT history month" and many other crappy "cultural" services so I'd happily cut their income."

          Beard and circuses.

      3. veti Silver badge

        Re: Real world underfunding

        May, to give her credit (and there's a phrase I never thought I'd type), always denied the "£350 million" bollocks. So it's not exactly fair to try to hang that round her neck.

    2. Anonymous Coward
      Anonymous Coward

      Re: Real world underfunding

      "Tory data manipulators state they are spending more money on the NHS."

      I seem to remember New Labour data manipulators doing the same thing not so long ago. Or were you including them in your definition of "tory"?

  4. Zog_but_not_the_first
    Boffin

    The basics...

    If an advanced, rich industrial society can't afford to spend the proceeds of its real wealth generation on health and education, then what is it for?

    1. Anonymous Coward
      Anonymous Coward

      Re: The basics...

      To spend its money on nuclear deterrents and tax cuts for (already) rich people?

      1. RonWheeler

        Re: The basics...

        Which tax cuts for which already rich people? Facts might help your case.

    2. Captain Hogwash
      Mushroom

      Re: The basics...

      See icon. No, I'm not happy about it either.

    3. Snorlax Silver badge

      Re: The basics...

      Bringing democracy to parts of the world we have no business being in?

      Arming oil-rich countries like Saudi Arabia?

      Lining the pockets of your public school chums?

      Whether we'll be an advanced, rich industrial society for much longer is, of course, a matter for debate. As somebody has already said, furrin doctors might find somewhere better to go once brexit kicks in...

    4. Miss Lincolnshire

      Re: The basics...

      ...to hide away in the forests of magic money trees that the Tories are happy to see thrive in the Cayman Islands

    5. codejunky Silver badge

      Re: The basics...

      @Zog_but_not_the_first

      "then what is it for?"

      Health

      Education

      Welfare

      Law

      Borders

      Foreign aid/expenses (e.g. diplomatic, EU fee, etc)

      Infrastructure projects

      and many more

      Plus-

      Toys (millennium dome, olympics, etc)

      Bribing voters with more welfare

      Increased anti-terrorism/surveillance authoritarianism

      Hot topic of the day wastes of money (green bollocks, smart meters, etc)

      Add the waste of budgets where you must spend all of it to claim the same or more next time leading to it being splurged on anything at the end of the budget year, jobsworths and other parasitical activities and the money vanishes very quickly.

      1. CrazyOldCatMan Silver badge

        Re: The basics...

        Bribing voters with more welfare

        "Panem et circensis" still works quite nicely - human nature hasn't changed much in 2000 years. The mob still want their dole and amusements.

        1. Anonymous Coward
          Anonymous Coward

          Re: The basics...

          And that's why we can't have nice things nor have stable civilizations long-term. Eventually people get tempted by the bread and circuses, get turned off by anything inconvenient (who they would just vote out), and eventually something breaks, causing upheaval. I suppose Machiavelli had a point in that sometimes the only way to get something done (if it's unpopular but necessary) is to FORCE it, and an elected government has trouble doing that barring a crisis (and in their case, by the time the crisis hits, it'll be way too late).

    6. Anonymous Coward
      Anonymous Coward

      Re: The basics...

      If an advanced, rich industrial society can't afford to spend the proceeds of its real wealth generation on health and education....

      Any accurate assessment of real wealth generation (rather than massaged GDP accounts) will conclude that the ***real terms*** wealth of most western countries hasn't grown for almost a decade. Meanwhile the costs of healthcare continue to increase for the reasons stated, and the population are only happy with solutions like "everybody paid more than me gets a tax increase", and the sums for that don't add up.

      Fair enough, if everybody is happy with a significant tax increase. But to balance the Treasury books, tax revenues need to rise by about 30% in total, and with real terms tax increases every year. You won't squeeze more than about a fifth of that out of millionaires and US tech companies, so it means that the tax threshold has to drop dramatically so that the low income groups pay a lot more tax, and the tax paid by middle income groups needs to go up by at least 20%.

      Simple reality mate, is that free at point of issue health care is no longer affordable unless you start limiting what you're giving away, or dramatically increase the tax take. Vote Corbyn today, and then if he wins, see if he really can find all that extra money from the mythical rich. But no socialist before him has ever run a successful and sustainable welfare state economy, anywhere in the world.

    7. CrazyOldCatMan Silver badge

      Re: The basics...

      If an advanced, rich industrial society can't afford to spend the proceeds of its real wealth generation on health and education, then what is it for?

      You are obviously not a politician or a Captain of Industry..

  5. bradioactive

    Interested to see what El Reg makes of Labour's plans... i cant see any balance in the article...

    1. SA_Mathieson

      Labour plans to increase the annual NHS England budget by £11bn a year. Given three health think tanks reckon it needs £30bn extra in five years' time to stand still given the healthcare inflation problem (https://www.thetimes.co.uk/article/127abc06-4a19-11e7-a7b8-5e01acd01516) the same funding shortfall largely applies.

      1. Mark Dempster

        >Labour plans to increase the annual NHS England budget by £11bn a year. Given three health think tanks reckon it needs £30bn extra in five years' time to stand still given the healthcare inflation problem (https://www.thetimes.co.uk/article/127abc06-4a19-11e7-a7b8-5e01acd01516) the same funding shortfall largely applies.<

        They also plan to get rid of the far-more-expensive privatised services & bring them in-house again, freeing up more money. The extra funding for social care will also reduce current levels of bed-blocking, which is a major expense

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