

Abandoned UK NHS IT system has cost £10bn so far - dodyg
http://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn

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Toenex
As someone with a little first hand experience in the NHS IT (I develop
medical imaging software) I saw how at the mercy of the vendors the NHS became
in the world of PACS (the systems used to store and retrieve medical images).
Not only where they being charged vast amounts but the level of capability
delivered was embarrassingly poor. I worked with many clinicians as a
university researcher and again when I was working in clinical trials for a
pharmaceutical company and they were continually amazed by what we could do
with images; I heard the phrase "why can't we do that in the clinic" so often
it was one of the reasons I moved into a medical imaging startup. I thought
the limitations might be regulatory but after developing and successfully
marketing an FDA cleared, CE marked piece of software we came to realise that
the biggest obstacle in the UK NHS were the PACS vendors. Essentially they own
connectivity to the images and made it almost impossible to integrate into
their systems in a way that really addresses the clinical need. It doesn't
help that the NHS seems to be filled with people only to eager to encounter a
reason NOT to do something (in part I'm sure because everyone is too busy to
add more to their plate). The technical competence of the senior folk was also
often poor, they were usually senior clinical folk who relied on consultants
for advice, often consultants provided by the vendors. The result was it got
itself lumbered with long, expensive contracts that tied them into particular
vendors which prohibited access to the wider ecosystem of solutions.
Thankfully the NHS started to realise this and began rolling down many of
these contracts. Hopefully a fresh start this year particularly with the
cessation of the problematic Connecting for Health
[[http://www.connectingforhealth.nhs.uk/](http://www.connectingforhealth.nhs.uk/)]
program.

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dodyg
Is there any well run IT system for a comparable national health system
anywhere else in the world?

~~~
beagle3
Israel has a single-payer-multiple-competitor system. It's national in the
sense that everyone is covered. It is not national in the sense that there are
several (5 or 6) competing HMOs, each with their own IT / management /
procedures etc.

3 HMOs cover about 85% percent of the population, and of those at least the
3rd and 2nd largest have decent IT. Significant parts of which still run on a
mainframe....

I've heard horror stories about the biggest years ago - but they might have
upped their game since.

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dodyg
This is a related news [http://www.theguardian.com/society/2013/sep/18/csc-
courts-si...](http://www.theguardian.com/society/2013/sep/18/csc-courts-sign-
off-payment-shareholders)

It looks like all around fiasco.

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tonyedgecombe
I'm pretty sure anybody with industry experience cringed when the government
first launched this project. It strikes me the government would be better off
devolving purchasing decisions to a local level where individual units can
choose something off the shelf.

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linker3000
I'm pretty sure every member of the public with half a brain cringed when the
government first launched this project. The woeful reputation earned over the
years by (UK) government-led, data-driven IT initiatives speaks for itself.

It would seem that the two primary skills prized by the IT consultants is
extremely short term memory and the ability to stick one's fingers in one's
ears and go 'la la la - I can't hear you..oh, and here's my bill'.

Devolving the purchasing in itself would not necessarily be a good idea, but
I'm all for a six-pronged approach:

1) Develop or adopt robust data handling standards and a certification
strategy 2) Develop a common/compliant platform standard and a certification
strategy 3) Issue RFQs and proposals to competitive tenderers with the clear
understanding that there will be no sole supplier 4) Evaluate and certify the
offerings from winning tenderers 5) Allow competitive purchasing decisions at
a local level from the certified/approved hardware and software vendors. 6)
Implement a rolling auditing, performance re-assessment and certification
renewal scheme for all vendors

Time and time again the 'one shoe fits all', single vendor solutions from one
of the big consulting organisations have proven to be a disaster, yet back
they come when the next future-fiasco is in the planning stages. Cynical me
smells something fishy about the whole cosy club.

~~~
arethuza
Your points 1 through 6 sound pretty sensible to me - except that when it came
to actually doing any of that it would all be handed across to the very same
consulting companies and vendors that are, in my opinion, largely responsible
for the mess in the first place.

~~~
linker3000
Quite likely - although any vendor assessment programme would include
reference to performance/deliverables in previous projects.

(Actually, if I had my way, certain vendors and consulting groups would be
told to fuck off and not bother tendering!)

~~~
arethuza
And that's presumably why you wouldn't be allowed anywhere near making such a
decision. You would be trying to get the right thing done (a failing many of
us have) whereas the goal of these consulting groups is to make as much money
as possible and who cares about delivering anything!

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dodyg
I would love to hear the inside stories on this.

~~~
arethuza
David Craig's book "Plundering the Public Sector" is a bit old, but it gives
some details of how these projects were run and for whose benefit (there is a
hint in the title):

[http://www.amazon.co.uk/Plundering-Public-Sector-David-
Craig...](http://www.amazon.co.uk/Plundering-Public-Sector-David-
Craig/dp/1845293746)

~~~
rurounijones
If you can get your hands on it

[http://en.wikipedia.org/wiki/Lions,_Donkeys_and_Dinosaurs](http://en.wikipedia.org/wiki/Lions,_Donkeys_and_Dinosaurs)

written by Lewis Page (Of theregister.co.uk fame) has more stories related to
the MoD

