Mary Wakefield

I used to back Jeremy Hunt’s digital NHS plan. Now I know it’s a disaster

A month of disconnected tests with my new baby has brought home to me just how complex health records can be

7 May 2016

9:00 AM

7 May 2016

9:00 AM

My baby and I excel at blood tests. He (tiny, jaundiced) stretches out naked under the hospital’s hot cot-lamps like a Saint-Tropez lothario. The nurse rubs his foot to bring blood to his veins, and I lean over the cot to feed the greedy midget, who squawks just once as he’s stabbed.

I watch the drops bulge and drip and I puzzle over the NHS and its mysteries. Why do nurses collect baby blood in glass straws with an opening no wider than a pin? It’s like an impossible task set by a whimsical tyrant.

Even more surreal is the way the NHS handles patient records. Because the midget and I have visited so many parts of the NHS — maternity wards, A&E, GP surgeries, neonatal units — we’ve become a crack two-man investigative team. Did you know that every hospital keeps separate records for the same patient, and that they don’t, often can’t, share them, even in an emergency? I had no idea.

My boy was born in a different hospital from this one, on the other side of town. He has already had various tests but my local hospital has no access to the results. To find out his blood type, for instance, they simply test again. More heel-warming, more squawks. Hospitals are meant to communicate with a patient’s GP, but it’s been a month since the baby’s first jaundice test (we were admitted via A&E) and his registered doctor is yet to be told he’s being treated. Hospital records have to be handwritten by doctors, explains the GP when I ask, then posted or faxed over. They’ll get round to it eventually.

Why handwritten? Why faxed? No patient under 20 would even recognise the word. Our everyday data is now updated and uploaded whether we like it or not. Work meetings appear by dismal magic on my internet calendar; unwanted photos upload endlessly to clouds. So why doesn’t every patient have an NHS iCloud into which every treatment by every doctor is instantly uploaded?

This has been Jeremy Hunt’s big crusade — a digital, paper-free NHS with integrated electronic patient records. It was also, under Labour, the aim of the world’s biggest government IT failure, which has cost us more than £10 billion so far. But that was ‘one size fits all’, said Hunt. His approach, he says, is decentralised — and initially I was all for it.

But as we’ve hung around in waiting rooms, the midget and I, talking to nurses and GPs, to my surprise I’ve found my mind quite changed. Far from being straightforward and sensible, project ‘paper-free’ — however decentralised — is deeply unpopular and largely unworkable. It has all the hallmarks of another billion-pound digital turkey.

One of Jeremy Hunt’s great bugbears has been the lack of data available to frontline medics. ‘It’s crazy that paramedics cannot access a full medical history of someone they are picking up in an emergency,’ he’s said. The only time I’ve met Mr Hunt, in his vast, sunlit corner office, he repeated this refrain: ‘We need an iPad for every paramedic.’

I asked several paramedics what they thought, and back came a general sigh of despair: ‘Oh God. Not this again.’ Hunt’s iPads, they say, would endanger lives. It’s a critical, lethal waste of time to have to access a patient’s medical records in an emergency. It’s a waste of time to input data electronically, too. Until the technology radically improves, it takes longer than handwriting.

Back in 2011, the brilliant Dr Max Pemberton wrote a piece for the Telegraph about the dangers of swapping notepads for screens. Max had been doing the rounds in a ward when he noticed that the place was chock-a bloc with chunky-looking touchscreen tablets, turned off and unused. They were meant for recording patients’ data, explained a nurse, but no one bothered with them. If dropped, they broke, game over; the software didn’t sync properly with the central database; and anyway the Wi-Fi was often down. It took twice as long as handwriting, the nurse said.

Dr Max put me on to an excellent piece in the British Medical Journal this month by a GP called Margaret McCartney, which makes a chilling point about Hunt’s digital drive. Perhaps because they seem so sensible to any layman with an iPhone, there’s been no testing of the measures in this great electronic leap forward. None of these innovations have been subject to the usual scrutiny, she says. Anything new introduced to the NHS should, as a matter of course, have been rigorously tested, but this is not evidence-based.

The plan is to spend £30 million on ‘releasing time to care’ and ‘acceleration towards a paper-free environment’. But: ‘Where’s the evidence on time-saving?’ asks Dr McCartney. ‘I used to spend four to five minutes completing death certificates in my neatest writing. Now it takes me much longer. My secretary used to type referrals; now I have to do them electronically, eating into time needed for direct patient care.’ As I look back over the past month of sunbeds and scans, baroque as the system seems, I can’t imagine how electronic note-taking and storing would have worked. When the midget and I next visit A&E for a break or bump, what use will endless screens of his bilirubin levels be? What I failed to think about when I cheered for project ‘paper-free’ is that to be useful, data needs curating, sorting and tailoring. And who in the NHS has the time for that?

The first ‘progress report’ into project ‘paper-free’ was, as it happens, released just a few weeks ago, with an introduction by a Mr Paul Rice, ‘head of technical strategy’, and the upshot of the report is that there’s been, no surprise, almost no progress. Paul begins with a joke about an Irishman, then ends with a little burst of desperate lyricism. ‘I grew up in a landscape of rolling drumlins, vertiginous cliff edges and apparently endless sandy strands,’ he writes. ‘For local communities, the route to paper-free may well share these characteristics: a reasonable map. Sturdy boots. Companions. A sense of purpose. Best foot forward.’ What Paul means, I think, is that though billions have been pledged and millions spent, his boots have already sunk into a sandy strand, the map is drenched and unreadable, and his companions, quite sensibly, have fled.

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  • davidofkent

    The NHS is an impending disaster. Thanks to a misguided funding system, it will eat up every penny of our taxes and NI in about ten years’ time.

    • Malcolm Knott

      I just got back from A&E, Ipswich Hospital. Here’s the dialogue.

      ‘We need to book you into the Fracture Clinic next week.’
      ‘OK, I’m free any day but Monday.’
      ‘If there is a free appointment on Monday we have to give you that. Then if you can’t make it you have to cancel.’
      ‘I know now I can’t make it. I’m working on Monday.’
      ‘I am afraid we have to give you a Monday appointment, even if you can’t make it.’

      Symptomatic, I am afraid of an organisation which has been captured by its employees: a small but irritating inefficiency which could be remedied overnight if the patients’ interests were prioritized.

      • Ingmar Blessing

        Ever tried a bribe? Works well when a specialist is needed. They should make it legal: You get “some” appointment for free and if it has to be on a specific day or within the next two weeks you pay extra.

      • Leon Wolfeson

        No, an organization which has had it’s budget cut over and over. You wanted it, you got it. As you seem to think magically that if what? Nobody in the NHS was paid?

        • Malcolm Knott

          The little lunacy I mentioned has nothing whatever to do with the budget.

          • Leon Wolfeson

            The Tories top-down disorganisation?

    • Leon Wolfeson

      Ah yes, the evils of treating the poor.

  • Margot5000

    Some 12 years ago I had treatment which involved attending some 4 different hospitals – part necessity, part for my convenience. It all went without a hitch. NOW I would not risk attending even two different ones. Part of the problem is the marketisation whereby patients are cash cows and hospitals have to part with some of the payments if they go elsewhere.

  • This is an astonishingly naive article. It’s clearly the case that dishing out loads of iPads is never going to make the NHS more efficient. However, it beggars belief to think that delivery of health services is uniquely unable to benefit from the introduction of new technology.

    The reason that no headway has been made in this is the same as the reason that technology has made no impact on the price of legal services. It is because the producer interest is too strong.

    • Malcolm Knott

      Lawyers’ offices are knee-deep in IT.

    • Leon Wolfeson

      “It’s clearly the case that dishing out loads of iPads is never going to make the NHS more efficient”

      That heavily depends on the apps and infrastructure. And the Tory central NHS IT has been a disaster zone (again. Labour were little better.).

  • Tom M

    “……Until the technology radically improves…….” My God it takes some nerve or a complete lack of understanding about how everybody else in Europe runs their patients records to make stupid comments like that.
    Here in rural France I turn up at the GP’s surgery. He puts my carte vitale (like a bank card) into his computer. All my records are visible to him. He writes a prescription onto the computer and I take myself off to any chemist’s in France where they can access the prescription when I put my carte vitale into their computer. At the same time any costs that have been incurred that are recoverable by my insurance company are sent to their computer which processes the data and credits my bank account. If I go to hospital, dentists, physiotherapists etc etc exactly the same system is used there. All seamlessly done and has been so for over twenty five years.
    The “professionals” who talk this rubbish as the same ones who tell us that:
    Recovering medical costs from tourists is not cost effective.
    Recovering walking sticks, crutches after the patient is finished with them is not cost effective.
    Checking out the qualifications of foreign trained medical staff is not cost effective.

    • Malcolm Knott

      … and booking you an appointment for a day when you’re free to attend is not cost effective. (See my post above.)

    • That’s why the first person in the UK who bought the Patient held paper record was someone who lived in France and knew that not everything digital word as well as you imagine. Anyone with any sense, keeps their own paper record, and wherever they travel it works! On holiday in France and in my car is a full copy ON PAPER of all important letters ./ test results etc

  • Ingmar Blessing

    They should keep the paperwork but simply take a picture from the result and put it on a USB stick and into the cloud. That would be the best of both worlds.

    Not properly working wifi is incompetence at its best. Must not happen like the lights shouldn’t go out during surgery. What use does a system have if it (or the IT guy) fails you?

    On the technology end: Why not using those pads with a pen (probably attached with a string)? And for paramedics it surely can’t be wrong to give them data glasses which display all the live physical parameters of the patient. Additional information only makes sense when needed in action, like a info about drug allergies or transmittable diseases. Or organ donor information..

    Bottom line: Sounds like a lot of incompetence..

    • Leon Wolfeson

      “And for paramedics it surely can’t be wrong to give them data glasses
      which display all he live physical parameters of the patient”

      We’re still 3-4 years away from reliable technology to do that. Oh, the current MS Hololense can display the data, but the technology needs a rugged, medical-use suitable version and some other improvements.

      • Ingmar Blessing

        It’s at least ready for a test run:

        • Leon Wolfeson

          That’s a device designed for a fairly friendly work environment (and consumers), though, not a medical-certified one.

          Then people need to start working with the software etc. – this stuff is brand new and it takes time to come up with properly working models of UI/UX, especially for emergency service usage.

          The wireless standard I expect the medical ones to use (can’t remember the name offhand, but it’s designed for high-reliability) isn’t even standardized until late this year or early next.

          The first use is going to be in other fields – certainly paramedic and ambulance usage is one thing they could be used for… but that’s for the future. Also, how exactly are they going to pull this additional data? Off Some sort of local smartcard?

          (I’m exploring this stuff from the interactive media side, and all the hardware’s pretty fragile right now, not to mention dependent on carting around a full-scale PC for most uses)

          • Ingmar Blessing

            So, you do have a brain after all. Chapeau!

            Those glasses are actually quite robust (like other industry equipment) and they are technologically very simple. Small display + battery + cpu = done, 200 Euro for good hardware is almost too much. One might think these glasses must be very complex, but in fact, their main/only task is to display information like a screen.

            I’ve now seen producers on several industry trade fairs and they all look good. The link was just an example. If you’re in the field, you should probably invest into one and see where it gets you. (and also test this I believe, at one point, glasses and armband will fuse into one product; it’s going to be awesome!)

            When it comes to first applications, I’d say ambulances are very well suited for field testing, because the environment is tough, it’s limited in complexity and it could actually make a difference. Other areas would be rally car racing, other sports, firefighting and as usually the military.

            Overall in the case of ambulances, the glasses only have to be synced with the apparatus of the vehicle. Maybe a simple smart phone app can handle the patient files. I can imagine putting on there some of my vital information without government pressure, because in the case of an emergency the knowledge about my blood type and allergies can make the difference (or I could get a tattoo on my upper arm..). Data protection is an issue, but I’m not an expert on that, tough my hunch is, if necessary they will find something suitable.

          • Leon Wolfeson

            So you spew bigotry, deny the facts and try and get people killed. Well, that’s you. removing the mistake of talking to you as if you were interested in discussion, or had any knowledge of the hardware.

            As for your plan of tattoos…

          • Ingmar Blessing

            I will take that as a compliment, Leon, Schatzi!

          • Leon Wolfeson

            Yes, of course you see trying to wreck entire technologies before they can take off as a good thing, Mr. Schatzi!

            Were you a major pusher of the “glasshole” nonsense?

          • Ingmar Blessing

            Why, Schatzi, should testing a technology be the same as wrecking it?

            Have you checked out myo? I’m thinking about putting some money into a pot together with a couple of friends and then ask someone with the necessary skills to see what and how far you can get with the combination of both. Maybe it becomes a product. Interested?

          • Leon Wolfeson

            So you talk to yourself, Mr. Schatzi, as you try and scam some people or whatever.

          • Ingmar Blessing

            No, I’m serious and you are an expert on media integration. That could work! What do you charge per hour and do you have references, Schatzi?

          • Leon Wolfeson

            Mr. Schatzi;

            Your seriously talking to yourself, as you mention your so-called profession…

          • Ingmar Blessing

            I love it how we’re bonding here. So, what’s your professional qualification?

          • Leon Wolfeson

            You are creepy.

          • Ingmar Blessing

            Don’t be shy, Schatzi.

          • Itinerant

            Oh the irony.

          • Leon Wolfeson

            So, no, hitting people in the knee with a 4-iron? Is not irony.

  • Can I suggest that many more people need to read my April 2013 BMJ article “Paperless records are not in the best interest of every patient”

    and look at some of the other publications by myself and colleagues trying over and again to point out the “this EPR Emperor has no clothes!”

  • Carrying your own paper record works. Try taking a USB stick and from fear of viruses the hospital will not let it connect to their system

  • Marvin

    This dope insists that he can get two pints of beer in one pint glass. Him and his government have destroyed the NHS and just will not go anywhere near the real problems caused by real issues. Free NHS treatment for the whole world, no question asked.

  • Bristol_Boy

    The political parasites are trying to get a shift system running using only day workers and no extra personnel. 24/7 only works when a fully funded, fully manned shift system is employed, but this would need many more trained personnel from Doctors, Nurses and all ancillary staff.
    This would be a problem when the said political parasites have ruined an education system, from child education through to the medical education and it’s backbreaking costs, so we have to endure an endless invasion of overseas personnel to prop up our overburdened and abused NHS.

    • John Carins

      They have ruined the Armed Forces as well. They have ruined our Defence contractors normally as an EU sacrifice. All sold to French, German and Italian rivals. You couldn’t make it up.

  • P Garfjeld Roberts 7040647

    “Why do nurses collect baby blood in glass straws with an opening no wider than a pin? It’s like an impossible task set by a whimsical tyrant.”

    The pin-sized opening actually makes it very easy: the blood is literally sucked up the tube by ‘capillary action’. Coincidentally, the type of blood collected is also called ‘capillary blood’, not for reasons related to the size of the collecting tube, rather the calibre of the vessels breached to get the sample.

    The alternative methods (needle and syringe) is tremendously more difficult in young children (both technically, and in terms of the pain caused), and can actually impair the quality of the result by damaging the blood as it is drawn up, though this may be necessary in some circumstances (e.g. arterial blood sampling).