Skeleton Service: Dense Bones and Digital Disasters

Today I received my test result, with the delightful news that my bone density is normal. It is a seasonal relief to know that I am not walking around on a skeleton that is on the point of snapping or dissolving. Phew. Hopefully, it is still OK for me to take the sensible precaution of eating lots of cheese. You know, just in case.

You may remember that this test was carried out on 6 December, twenty-four days ago. Even allowing for the season of goodwill and postal delays, that seems a long time to wait for a simple result of a simple test. Indeed, the letter shows that the result letter was generated on 18 December. Perhaps the ‘twelve days of Christmas’ refers to the time it takes to get a test result to the patient. The letter itself was a copy of a letter sent to my GP’s surgery, who had been unable to tell me the result when I phoned them the week before last. 

But hang on – isn’t this the twenty-first century? Why are medical test outcomes being notified by snail-mail anyway?! It appears that I am not the one person riled by this, as illustrated by the delightfully-named Dick Vinegar’s festive moan in the Guardian four years ago.

Although the impact on me on this occasion has not been of any great seriousness, it is not an isolated occurrence. Just before Christmas, I had a follow-up appointment with the cancer consultant at Bart’s and found that she had no idea that I had had a hysterectomy. Why? Because it had taken place in another hospital and the information had not been shared. It is surely not beyond our capacity as a society to facilitate our National Health Service to use digital communication and information-sharing. In fact, I expect that beyond the initial outlay, it would save money and resources for the perennially cash-starved NHS.

So, why has this not happened? As is usually the case, a dip into the history of the issue may help to explain. A report last year by the King’s Fund provides a useful summary (on page 3) of the background, which can be further distilled into a timeline looking something like this:

  • 1960s: computers first used in the NHS for administrative, financial and research purposes
  • 1970s: first Department of Health reviews into use of digital technology
  • 1992: first national information technology (IT) strategy for the NHS
  • 1998 and 2002: subsequent strategies, leading to the creation of the National Programme for IT (NPfIT), later called Connecting for Health.

The King’s Fund report explains that Connecting for Health aimed “to create a single electronic care record for patients, connect primary and secondary care IT systems, and provide a single IT platform for health professionals” and argued that “This multi-billion-pound programme of investment dominated the digital agenda under the Labour government” but that “it failed to achieve its main objectives – including establishing an integrated electronic health record system across secondary care – although it did establish some important national digital infrastructure and services”. It blames overly-centralised decision-making and a lack of local engagement, meaning that “users’ needs were poorly understood and providers were directed to implement at pace systems they had little say over”. Connecting for Health formally came to an end on 31 March 2013, three years after Labour had been replaced in government by the Tory-LibDem coalition.

There are plenty of technical explanations of the failure of Connecting for Health, but is there also a political explanation? Tony Blair’s ‘New Labour’ government had an evangelical belief in the all-round superiority of the private sector, and an equally evangelical determination to reject public provision as old-fashioned socialist baggage. So this programme, along with many others in the NHS and across the public sector, was hived off to private companies. And private companies, whatever their advertising says, are motivated by making money. That is the nature of the beast.

The programme divided England into five clusters, and gave them to private enterprises as follows:

  • Computer Sciences Corporation (CSC) – North, Midlands & Eastern (NME) cluster
  • BT Health London (formerly BT Capital Care Alliance) – London cluster
  • Accenture – North East and East/East Midlands clusters
  • Fujitsu – Southern cluster

However, by May 2008, only two main contractors remained – CSC and BT. Accenture gave up nearly all its involvement in January 2007, handing over its £2bn workload to CSC but keeping a small hand in Picture Archiving and Communication System (PACS) rollout only. Fujitsu messed up so badly that its contract was terminated in May 2008 .As so often happens, the private contractor had contacted-out large chunks of its work, in this case to software developers who apparently succeeded only in developing software that crashed.

In the interests of balance, let us note that some parts of the Connecting for Health programme did work quite well, such as digital storage of X-rays and IT installation in GP surgeries. But the national network was an expensive failure, one victim among many of New Labour’s obsession with inviting the private sector into the public. And even now it has been scrapped, the NHS remains tied into some of its contracts until the 2020s.

Now we have the Tories in power, and the appalling Health Secretary Jeremy Hunt has challenged the NHS to ‘go paperless’ by 2018. The target year starts the day after tomorrow, and the challenge is not lloking too likely to succeed.

Is it just me, or is there something rather odd about the person in charge of the NHS ‘challenging’ it to do something rather than resourcing it to do so? Or is this just the sleight-of-hand, target-and-tick-box culture that allows right-wing politicians to pretend that they support our NHS while they take it apart by stealth?

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