The NHS's troubled relationship with technology

A man uses his smartphone The public are used to having most aspects of their life just a click away. But in the NHS it is a different matter

When you think how technology has reshaped everything from the way we shop to how we communicate with friends, the lack of progress made by the NHS is astonishing.

While booking holidays and doing the weekly shop online has become routine for many, making appointments to see a GP in such as way has not.

And in an era when companies hold a host of personal information, the fact remains an ambulance can still respond to an emergency call, ferry a patient to hospital but doctors will still have little knowledge of their medical history.

Since the 1990s report after report has called for more innovation.

But time and time again the NHS has failed to live up to expectations - at least in the way the health service interacts with patients and shares information (a much stronger case can be made for its use of technology in areas of medicine, such as robotic surgery).

The £12bn NHS IT project is a case in point. Launched in 2002, it was meant to revolutionise the way technology was used in the health service by paving the way for electronic records, digital scanning and integrated IT systems across hospitals and community care.

But more than a decade on it the national programme has effectively been disbanded with many of its ambitions yet to be realised.

Local parts of the health service - hospitals and the new GP-led groups - have now been asked to push ahead with the changes and the speech by Health Secretary Jeremy Hunt on Wednesday is an attempt chivvy that along.

Some progress

Admittedly, progress is being made in some areas.

Telehealth and telecare, which covers everything from specialist equipment to help a patient monitor their condition to sensors in the home to detect falls, has been piloted quite successfully in several areas.

But the number of people benefiting is still limited to the tens of thousands.

Meanwhile, online appointment booking is at least two years away and some of the most innovative ideas deployed in other countries are but a distant dream.

For example, in the US electronic bracelets are in use that can be scanned by doctors enabling them immediate and easy access to the patient's medical history.

And as the NHS plays catch up, other sectors continue to push the boundaries of what is possible.

It poses the question: Why?

Julia Manning, chief executive of the 2020health think-tank, says the lack of success in embracing technology is "crazy".

She believes the barriers are related to culture more than anything else.

Indeed, the private sector has often complained that the commissioning and purchasing systems in the NHS have proved too complex to encourage innovation.

The NHS IT project was the government's attempt to apply some central control.

But after that struggled the NHS is back to devolving responsibility down to a local level.

Everyone will be hoping the health service is more successful from now on.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 94.

    I need large print due to visual impairment, and I never cease to be shocked at how the NHS fails to handle this simple task.

    1. They can't put a note on my file saying I need large print, so the info isn't passed along to the next doctor.
    2. Appointment letters can't be in large print as "it's an automated process and our computers can't handle it".
    3. Leaflets or forms to fill out - forget it.

  • rate this

    Comment number 93.

    I remember arranging surgery with an oncologist. He got out his diary and pencil and I thought "I love that". This man was the best placed on the globe to save my loved ones life. I wanted him to be an expert on cancer, oncology and surgery. I did not want him wasting his time fiddling with a piece of IT that needs him to be trained. That mans brain has a higher purpose than mastering IT.

  • rate this

    Comment number 92.

    Big business also makes a mess of major IT projects. Too many pressures, leaders not having the guts to say "no, we have our remit" when in-flight changes are requested. Also we don't need 'business managers' in the NHS, this is not a business, it's a very different organisation with different goals and objectives. Keep business and the 'free market' far away from the NHS and we have some hope.

  • rate this

    Comment number 91.

    As an IT professional who did a stint as an NHS Head of IT, there are several reasons for the troubled relationship. Many of the people in IT arent IT professionals they're people who've moved into IT from within so lack experience. Senior Management lack an understanding of the application of Technology. Big decisions are committee driven with many committee members having differing agendas.

  • rate this

    Comment number 90.

    Its not just the NHS - the government goes blindly into massive IT projects in all areas (benefits, immigration, pay), and there have been massive failures in all areas costing billions of pounds a pop. We just cant seem to get it right, ever.

  • rate this

    Comment number 89.

    Having an inside track on this, I can tell you that the problems are largely political. There are many areas where improvements could be made but NHS staff resist it:

    1. Having people correct problems manually makes a manager's empire bigger
    2. It keeps their community in work
    3. They're not competent enough to understand what is possible

    With no real pressures on costs, we cannot expect better.

  • rate this

    Comment number 88.

    I speak truthfully from what I typed previously from real conversations from frustrated NHS IT and Medical staff I know well. It's frustrating for me as I work on the front line for a company that implements "Electronic Document Records Management" and I cannot understand from my own profession why the NHS can't get it right.

  • rate this

    Comment number 87.

    83. Newsmaxout
    "Most people don't appreciate just how pedantic computers are. They do what you tell them to, no more, no less."

    Computer systems are meant to do what they are programmed to do. What is required is to design the systems properly in the first place by ascretaining what is actually required and allowing the systems to be maintainable and easy to upgrade for any new functionality.

  • rate this

    Comment number 86.

    An interesting challenge - but bound to be problematic. NHS as a whole and down to individual hospitals is lacking any decent management. Fiefdoms rule and consultants can be petty and argumentive. Totally unclear lines of responsibility and authority. Costs of any work done under contract for NHS are routinely & massively inflated- lack of strong management means little challenging of costs.

  • rate this

    Comment number 85.

    A management team much higher up from the real engineering teams on the ground will make the decision on what solution will be put in place. Without the core IT staff on the frontline being consulted. Then pull the plug 6 months into the implementation when finally they concede that what looks good on paper does not work on the floor from not just a user perspective, but operationally.

  • rate this

    Comment number 84.

    I have worked in a hospital that was entirely computerised. In 3 years, there was a total of 5 minutes when I could not access the electronic notes. I compare this with probably 5% -10% of patient paper notes not being available when needed. There is simply no comparison.
    A centralised service will never work though, and I hope there is no more attempts to bring that one out again.

  • rate this

    Comment number 83.

    Most people don't appreciate just how pedantic computers are. They do what you tell them to, no more, no less.

    However, in most situations there is the "documented" process and then there is "real" process actually used by the people on the ground.

    Add some layers of management & consultants to get a Chinese whispers effect & you have no chance of getting a computer to do what's needed!

  • rate this

    Comment number 82.

    There was no obstacle in the NHS for adopting a new computerised system, the problem was too many consultants milking the government's funding leading to excessive costs.

  • rate this

    Comment number 81.

    The NHS national programme for IT has failed because none of the providers communicated fundamental system requirements with the end users - either clinical or admin. It was an entirely top-down project from a "we will give you this" rather than a "what do you need" perspective. This is one of the main reasons why large scale IT projects fail time and time again. The waste must stop.

  • rate this

    Comment number 80.

    I found one of the major obstacles to IT in the NHS were senior nursing staff and more especially the surgeons. Neither group want to be monitored or be responsible for computer data. The surgeons as a whole refuse to consider anything new unless it is financially worthwhile to their private practise. Both groups do anything to prevent new systems which might indicate how they spend their time.

  • rate this

    Comment number 79.

    Having worked in NHS IT and left to return to the private sector I echo all those comments on poor management, lack of direction, poor outsourcing contracts , badly trained staff, incompetent procurement and no post implementation planning. NHS IT is a complete shambles but some companies have got very rich on it.The amount of hardware bought and never used is incredible. NHS & IT - no chance

  • rate this

    Comment number 78.

    "65. Shaun the Faun
    Whilst there's a lot of truth in some of what's been said, the fundamental problem in the NHS is the doctors."

    Very sadly Shaun is right.

    Some GPs fought hard to kill the single patient record .. Why?

  • rate this

    Comment number 77.

    This isn't unique to the UK. Ontario had the same issues with its"eHealth" plans.

  • rate this

    Comment number 76.

    Over blown aims, over complex rules and untested jumping on band wagons

    NPFIT one system for all a poor fit for most
    Fax is safer than e-mail ... the NHS still prints and faxes rather than e-mailing to secure account
    Telehealth - Telemedicine trendy but the results (up to a year ago) were far from convincing.
    Laptops need keyboard covers can't be used within 6 foot of a patient .. on it goes

  • rate this

    Comment number 75.

    Or, as in the case of the Trust I work in; No leadership, a decentralised budget (giving each Department the money, worst idea ever!!!) and a complete lack of understanding of what was needed as no one talked as a group and Trust. Just mini fiefdoms, empires and kingdoms the end result being that to bring the Trust back up to speed with decent technology is going to cost the taxpayer £200m


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