Only a small fraction of medical devices are specifically designed for the NHS. A high proportion of them are off the shelf products primarily designed for the US healthcare market.

• ''An internationally recognised way of tracking capital spending is the spend per head of the workforce. This estimates the amount of additional resources that are available per worker, which may lead to a more productive workforce. With the number of whole-time-equivalent (WTE) staff employed rising by 6% between 2013/14 and 2016/17, capital spending per WTE fell by 23% – an average of 9% a year. 

• Data from the Organisation for Economic Co-operation and Development (OECD) show that capital spending for health care, such as for hospitals and equipment, in the UK is low compared with other OECD countries, at 0.3% of GDP compared with an average of 0.5%. Increasing spending to the OECD average would mean an additional £3bn would be available for investment in health capital across the UK.

• Falling capital spending impacts provider finances and service delivery. It limits the ability of NHS trusts to purchase new equipment, and to make repairs and maintenance to current facilities. In 2016/17, there was an estimated maintenance backlog of £5.6bn, up from £5.2bn in 2015/16. This was greater than the total capital budget."

Simon Barker:

What would a medical device designed for the NHS look like? 

The only likely difference I can see is that it might be cheaper and shoddier to make it more affordable.

Legh Richardson:

Interesting...

There appears to be a very large budget for capital investment but not revenue expenditure.

Therefore its likely to be a lack of investment in the people structure, because there's a policy of removal of the weakest links in the system that can bring the machine to its knees.

The money is there and available but is not being invested appropriately.


Legh

It's well known that sports and music do not follow the usual conventional laws of economics but I'm beginning to wonder if healthcare is also an exception. It's impossible to deny that the NHS is a labour intensive organisation. At the time when it was founded in the 1940s there were many other labour intensive organisations in Britain. Large factories and shipyards employed thousands of workers. Large offices employed thousands of clerks and typists. In the intervening decades technology has slashed the workforce in the commercial and industrial world. Despite the introduction of masses of new technology into the NHS it has done very little to reduce the number of staff employed. This raises the question whether healthcare is largely immune to automation in a way that many other commercial and industrial processes are not. If this is generally true then a situation arises where the NHS ends up simultaneously paying for more new technology and the salaries of a comparable (or even greater) number of staff as each year goes by. A nasty combination for the taxpayer.


If technology could be developed where an NHS hospital can provide exactly the same services with only 50% of the nurses and 75% of the doctors it employs then it creates a moral dilemma. It could be the solution to a funding crisis and save the taxpayer billions but there is also the issue of whether nurses and doctors deserve to be thrown onto the scrapheap of unemployment. Are nurses and doctors any more special than factory and office workers who have lost their jobs due to automation, or should they go down the same avenue?

Maurice Dixon:

Perhaps poor understanding of what technology is actually needed by properly engaging with staff (not just buying what industry wants to sell the NHS or nice-to-have 'wants' by ill-informed NHS buyers), better procurement (stop overpaying for things by using NHS's huge buying power to negotiate better prices), spend money to train staff to use it to maximum effect (ensure those you buy the equipment for can use it properly) and support it properly through life (keep it serviceable and to latest version) is the real problem, and not the 'technology' itself?

A valid point. A theory I have is the 'command and control' style of management and organisation of the NHS is a relic from the 1940s when technology was much simpler that is incapable of effectively embracing modern technology used in medicine and using it to its greatest benefit. An analogy is that it's like trying to govern a country with modern technology under the same system of government as ancient Egypt or the feudal system from the middle ages.


Trade unions probably have their part to play as they can help to perpetuate archaic and obsolescent but popular practices, and can create conflicts between the interests of nurses and those reponsible for implementing and servicing medical devices and IT systems.

The fundamental problem and what you are all eluding to is that the NHS doesn’t have a Research & development department so it is at the mercy of private companies that are all chasing profits. The worst being the drug companies that offer new drugs as new technology to prolong life on their drugs without site of a cure. If the electronics industry had the lack of progress that medicine has had over the last one hundred years we would still be using sparks to transmit radio signals and never have invented the valve let alone digital technology. Medicine is a closed shop with no mechanism for making progress and hence no mechanism for dealing with new technology. I posted a bit about Electrotherapy in the medical networking area here

communities.theiet.org/.../23737

that speaks volumes from the silence it received.

If you look at the history one can see medical progress has come from engineers whether it be mechanical engineers for the joints, heart valves or externals machines to assist the body, electrical engineers for the radio therapy and scanners or chemical engineers for drugs. We all know what happens to species that don’t make progress, they go extinct. It has to be down to government to create an R & D sections that goes in pursuit of cures not profits. Profit has no place in medicine since it ultimately puts the pursuit of money above the health of people. I know from my own investigations that any pathogen can be killed using Electrotherapy that includes the cure of cancers, HIV and Malaria. What could that do for the NHS budget in terms of emptying beds and eliminating the drugs bill for long term treatments?

Paul Gruszka:

The fundamental problem and what you are all eluding to is that the NHS doesn’t have a Research & development department so it is at the mercy of private companies that are all chasing profits. The worst being the drug companies that offer new drugs as new technology to prolong life on their drugs without site of a cure. If the electronics industry had the lack of progress that medicine has had over the last one hundred years we would still be using sparks to transmit radio signals and never have invented the valve let alone digital technology. Medicine is a closed shop with no mechanism for making progress and hence no mechanism for dealing with new technology. I posted a bit about Electrotherapy in the medical networking area here

communities.theiet.org/.../23737

that speaks volumes from the silence it received.

If you look at the history one can see medical progress has come from engineers whether it be mechanical engineers for the joints, heart valves or externals machines to assist the body, electrical engineers for the radio therapy and scanners or chemical engineers for drugs. We all know what happens to species that don’t make progress, they go extinct. It has to be down to government to create an R & D sections that goes in pursuit of cures not profits. Profit has no place in medicine since it ultimately puts the pursuit of money above the health of people. I know from my own investigations that any pathogen can be killed using Electrotherapy that includes the cure of cancers, HIV and Malaria. What could that do for the NHS budget in terms of emptying beds and eliminating the drugs bill for long term treatments?

Excellent post.


The NHS does carry out R&D but it's a tiny fraction of what they do. Part of the problem is that we don't really have a national health service because the NHS is subdivided into regional Trusts which are largely independent of each other and rarely collaborate with each other in shared projects. Another problem is popular opinion - if an NHS trust is given an extra £1m of funding then the majority of the public believe that it should be spent on frontline services rather than R&D. Employ more doctors and nurses as opposed to scientists and engineers.


You are correct that most progress in medicine has come from engineers rather than doctors. There are times when I think that the NHS can only survive the 21st century if it is vertically integrated where it designs and manufactures its own medical devices and pharmaceuticals in order to ensure that they meet the requirements of the patients and to prevent private companies from ripping off the NHS, and ultimately the taxpayer. In one hospital the medical engineering department used to design and fabricate its own bespoke surgical instruments - even for operations on specific patients - but had to cease because of legislation where all surgical instruments had to be formally approved and CE marked.