Thanks

The NHS was always going down hill due to no R & D but I think a recap of history for those that were born after the corrupt 1980’s is required. The NHS at the start was set up correctly in that nursing staff controlled and ran the hospital. You only have to look at the success of Japanese engineering companies that have a policy of promoting from within the engineering ranks because those people know the industry best and know which way the technology is heading. In the 80’s money became the be all and end all of companies that were only interested in making the share price go up in the short term regardless of the long term. It was a mad period where companies were shutting down R & D departments because they were seen as high cost and lowering the share price. The smart companies renamed their departments so the idiot accountants could not see them. The NHS was starting to cost more due to drug prices and its own success then Thatcher did a job on it and brought in masses of administration staff, that we still suffer today, under the guise of streamlining it to reduce costs. Anybody with any sense could see it was a bad idea especially when administration was not the problem it just added a big cost load on the NHS that did not improve patient care. My view is Thatcher was lobbied by private medicine to destroy the NHS and she wanted to get rid of the cost from the government pockets. She didn’t bargain for the public reaction and that is probably the reason the Conservatives booted her out for giving them a bad name. She created the housing crisis of today by preventing councils from building houses so that private builders could supply the houses and reap the vast profits. Strange Thatcher went from a small semi in Wimbeldon to a half million pound Barratt home. The NHS administrators get far more money than the medical people and are just parasites. One CEO was given £225K to quit it is just obscene. If the NHS cost less and ran perfectly well before administrators were added what is the point in having them?

If I was in control of the NHS I would implement your vertical integration by giving all the administration the boot, put the nursing staff back in control, get GCHQ to set up a secure IT system under the direction of the nursing staff and of course set up a government R & D department that was not a closed shop to alternative treatments other than drugs. It will never happen so it is down to engineers to create the Electrotherapy devices that I know can cure any pathogen based disease and shake up the whole system up.

Paul Gruszka:

Anybody with any sense could see it was a bad idea especially when administration was not the problem it just added a big cost load on the NHS that did not improve patient care.

My view is Thatcher was lobbied by private medicine to destroy the NHS and she wanted to get rid of the cost from the government pockets.

If I was in control of the NHS I would implement your vertical integration by giving all the administration the boot, put the nursing staff back in control, get GCHQ to set up a secure IT system under the direction of the nursing staff and of course set up a government R & D department that was not a closed shop to alternative treatments other than drugs.

It will never happen so it is down to engineers to create the Electrotherapy devices that I know can cure any pathogen based disease and shake up the whole system up.

Maurice Dixon:

Technology could most definitely make the NHS more efficient. Having spent many hours in an eye A&E department for a serious condition this weekend it is obvious how inefficient current NHS patient processing is. Having been sent by an optician who had studied a series of digital photos of the eye over. a few weeks, it was decided priority investigation and and treatment was needed for a potential blindness-inducing condition. Whilst the eye department processes and staff that eventually did the eye operation were very proficient, the A&E process and the 'arrival information, triage and detailed assessment, treatment, post-op processes and emergency review' yesterday and today completely ignored basic digital imagery technology that could make the whole process far more efficient and effective. The optician has a time lapse trail of the eye condition with numerous very high definition digital photos of the eye in question. The NHS would not accept these photos, even as background information. When at the A&E, that had been pre-warned of arrival, the initial reception admin process was quite efficient, and the initial triage quite efficient (within 15 mins?), thereafter the 'your wait is determined by priority not time of arrival', didn't function. After 3 hours of sitting in line with a potentially life changing condition, others who had been waiting many hours were seen by doctors and many discharged with eye drops (thus, perhaps not quite such a priority) - why couldn't these be processed by nurse practitioners? Once on the 'being seen to' list, everything was done manually, no digital photos taken of the eye and its deteriorating condition from initial triage to, detailed assessment (by at least 2 doctors), pre-op, during op, post op, to discharge and having to been reviewed again today. Each doctor made manual sketches on scraps of paper, hand written notes (some not as legible as perhaps necessary), and no digital photos were taken or reviewed for consistency of trail eye condition changes. each doctor had their 'snap shot' of the eye condition. Fortunately, the doctor that had to do an emergency review this morning, due to concerns about eye deterioration overnight, was the same one on duty yesterday who signed the discharge papers - that was the only continuity - a doctors memory of what the eye looked like yesterday and what it looked like today. The use of very effective high-res digital photos/videos from the optician to the hospital and through the whole process would have been far more efficient and provided a factual 'digital trend trail' of the pre-op eye condition, what was done during the operation, what was the status post op and at discharge and hopefully provide evidence of eye condition improvement over the next few months. If a high street optician chain can have a digital library of its clients eye condition over years, why can't the NHS specialist eye departments, and why can't they all use each others images if the patient consents? Why can't the optician now be provided with post-op and hopefully after treatment has been completed, so that at the next annual eye review/check, the condition can continued to be reviewed by professional opticians, but not take up valuable NHS resource and time?


This must be one of 100s of examples where properly applied use of technology could significantly improve the NHS. Technology could save the NHS if applied to improve processes, not just 'digitise' bad paperwork and manual processes, provide better access to patient information and records, and provide factual evidence trail of medical conditions across the value chain.

What a fantastic story!


This is far from the first time when the NHS has refused to accept medical information originating from a third party source (your optician). I am well aware of NHS psychologists and paediatric consultants refusing to accept reports from teachers or local authority educational psychologists and SEN officials for cases involving Asperger Syndrome or autistic spectrum disorders.


It is deeply questionable why the NHS is refusing (or possibly cannot legally accept) information from other medical practitioners, such as opticians, and then update records following treatment. Your story is an indication of how the NHS is lagging behind the private sector when it comes to storing and using medical records - a library of high-res photos vs handwritten notes - and the disconnectness it has with other medical practitioners.

Arran Cameron:

Whenever I have mentioned the concept of vertical integration in order to reduce costs (ultimately to the taxpayer) and ensure that medical devices meed the requirements of the NHS and its patients I have been accused of socialism.

Also, why should nursing staff be put back into control? Why not have engineers in control instead?

There is a problem whether it would be legal to sell certain medical devices to the public for home / self treatment.

I'm in favour of genetic modification of humans as this will add a completely new dimension into medicine.

Maurice Dixon:

Technology needs to be applied with caution for the benefit of the specialists and patients, with the intelligent and empathetic support of the technologists, not just for the sake of technology. This is one issue the NHS needs to learn from having been driven to over prescription of drugs for the sake of the Pharma companies who just want the NHS to buy evermore quantities, and evermore expense drugs.


Technologists must not peddle the 'emperor's clothes'  (De)illusions that new technology is always best and will always improve things, many technologies make things far worse if not designed and implemented properly - see many NHS IT systems. However, here seems to be an example of where technology can support training and refreshing of surgeon skills and developing new surgery techniques, pre-op practice and dry runs, etc, without putting patients lives at risk, thus, has a 'value chain enhancement' for surgeons and patients.
https://www.computerworlduk.com/applications/newcastle-hospital-turns-osso-vr-train-surgeons-3695729/?no1x1&utm_source=Daily&utm_medium=email&utm_term=image&utm_content=image&utm_campaign=Daily2904&elqTrack=true&bt_ee=A4rqAc%2FwqFvgeKV5mlG8TjvZrixgUNN8lAfw%2FgTuWWkJwG%2FKEnCuDeKz%2FKxnk9l3&bt_ts=1556549747127  


As with all things new stuff, introduce slowly and with moderation, not just for the sake of new stuff, must be introduced properly with concepts, training, procedures, through-life support, proper budgets and resources, etc, etc, and it must 'add value' not just be the next 'must have' technology in the medical sector. 

There is the overarching question whether the NHS can successfully keep up with developments in technology (in the real world) and successfully embrace it, or whether its structure and organisation, along with the mindsets of its staff, severely inhibit both aspects?


A scenario has stuck in my mind that in the early 1990s the medical staff in Russian hospitals were just as good (or even better) when it came to medical matters as their counterparts in Britain and western Europe, but Russian hospitals were technological timewarps barely any more advanced than those from the 1930s. The NHS is nowhere as extreme as this but a danger exists that medics will be unable to keep pace with developments in medicine unless they also keep pace with developments in technology.


I agree with you that technologists must not peddle the 'emperor's clothes' or just introduce technology for the sake of it without it achieving any benefits to the patients. However, will a situation arise in the future where the private healthcare sector will be better at keeping up with developments in technology; embracing technology in a way that results in the greatest benefit for the patient; and even leads in the R&D of developing new technology than the NHS does?


There is some evidence that before computer science was introduced as a National Curriculum subject, independent schools generally had more up to date computers than state schools did and were also better at deploying them for educational use than state schools were - even in subjects like music or design & technology. I do not think that it was purely difference in financial resources for independent schools vs state schools, but staff with better knowledge of how to use computers as an educational resource along with a structure and organisation of the school that enabled ideas to be implemented in practice.  

Maurice Dixon:

I believe many NHS staff still see technology as a potential threat to jobs including, taking away status as technology levels knowledge and reducing status by allowing more to be down further down the chain.

I harbour the same suspicions. As I previously stated, the NHS is a labour intensive organisation; technology has not reduces the number of staff employed in the NHS; and that healthcare may even be immune to automation and therefore does not follow the usual conventional laws of economics which apply to most other commercial and industrial processes.


The NHS is also a heavily unionised sector of the economy. I have long believed that both the political left and the trade unions are movements that are very good at demanding change but they are also movements who struggle to understand change, especially change as a result of technology. They are wary of developments in technology because of fears that it transfers more powers to the financial and corporate elite as well as destroying jobs for workers. I can remember a conversation with a left leaning individual about how internet shopping is killing bricks and mortar shops, and causing retail workers to lose their jobs. He said it's very bad although I tried to explain that internet retailing could possibly help British manufacturing that has been treated badly by bricks and mortar retailers since the 1970s.

 

However, taking on more responsibility must be reflected with more pay for those taking on more responsibility.

Technology also is a threat as it can de-mystify the medical 'knowledge is power' status of some, and also expose the inefficiencies in current processes and departments. However, if technology can leverage more productivity, provide better work satisfaction, standardise medical interventions, deliver quicker medical treatment times, reduce waste in costs and resources, and automation of routine activity this will make staff, and thus the NHS, more effective and efficient. Technology should allow more nurse practitioners/paramedics to do more, and be rewarded for taking on more, to release consultants and surgeons to focus on the more demanding medical work, delivering more front line 'bang for buck', reducing bed blocking, reduce drug use, and getting people home quicker. We must find the win win scenario technology could deliver.

However, too big a reliance on technology can be a high risk, as when technology fails and is not repaired quickly, staff can find it hard to fallback to basic non/low-technology working during a failure. Back-up processes, and resilient system design, need to be in place and practiced to reduce the loss of technology risk to delivery the NHS output.