[akersten]

The notion that it should take 40 million pounds to fix this is just so reflective of the disconnect between the bureaucracy and the people that actually get work done that I probably couldn't think of a better example if I tried.

I can think of a couple ways to make that faster for free. Many dozens more for a lot less than a million pounds, forget 40. Arguments about "but corporate / compliance / vendor contracts / red tape" be damned. (Edit: Most of the replies to this comment are exactly this sort of thinking - It's too complicated, there's too many vendors, we can't do it, it's too hard, no one will do it for free. This is the exact kind of lack of political will to get anything done that I'm talking about. It's someone's existing job to do IT, task them with making it better - plugging in the computers to the wired network is a good free first step. Cleaning up the GPOs so Windows login doesn't take 60 seconds (!) is another freebie. Yes, these systems are complicated. That's not an excuse for them to be garbage).

The decadence of IT spend is horrifying. I suspect most of it winds up lining someone's pocket.

[frereubu]

This is a pretty simplistic comment that seriously underestimates how complex this stuff is. (Are you Dominic Cummings by any chance?) IT systems like the one in the NHS are huge, have grown organically over time and are mission-critical. You can't just trash one system and start from scratch (witness the Universal Credit debacle in the UK). It's like repairing a ship while it's sailing. Yes, there's quite a bit of money involved, but I can only imagine someone who writes a comment along the lines of "it's easy, just do X" has never touched a system like this, or had to write budgets for it.

I'd also like to see you walk into a situation like this, no matter how much power you had, and see how far 'Arguments about "but corporate / compliance / vendor contracts / red tape" be damned.' gets you.

[txdv]

I was like "40 million won't be enough to make a dent" :D

[heavenlyblue]

Ah no, you clearly misunderstand that NHS doesn’t actually use a single system f or everything. What IT systems are used depends on the hospital discussed, and thus 40M isn’t really about the complexity of a single system - it’s simply a paycheck to pay for upgrades of many systems running in parallel and barely having any interop whatsoever.

[dangus]

It's free? Does that mean you'll work for free until it's done?

The idea that anything is free is ludicrous. You are either spending time (wages) or money (buying solutions).

Why would £40 million be a lot of money for the IT systems of the entire public healthcare system in the UK? The NHS has a yearly budget of £114 billion, so this particular IT spend is only 0.03% the size of their yearly budget.

There's nothing decadent about this. It's essentially deferred maintenance that is long overdue, probably overdue because the government had to wade through people like you who can't help but complain every time a government organization wants to invest in modernizing.

[zamadatix]

> The NHS has a yearly budget of £114 billion, so IT spend is only 0.02% the size of their yearly budget.

You might want to double check you math.

But yes, it's such a small amount of the overall IT budget I almost wonder why it's being given separately.

[dangus]

My original calculation added in an unintended currency conversion (Google assumed that "40 million" meant "40 million US Dollars), and I also meant to clarify that I was talking about this single initiative, not the overall IT budget. I've since edited my number (0.03 instead of 0.02%)

[toast0]

> plugging in the computers to the wired network is a good free first step

Plugging into wired ethernet is only free if you have a wired port near the computer and it connects (properly) to an available port on a network switch and you have patch cables onsite and free labor to connect them (including labor that can access the network closet if needed) and free labor to configure the computer to prefer the wired over the wireless, if necessary.

Ideally, it's not a lot of labor, and there's likely to be some switch ports available and some patch cables available, but there's also probably a reason the computers are using wifi if they are.

You can argue this is probably part of someone's job already, but if they aren't doing it because they have too much other stuff to do, you'll need to pay someone else to do it.

[DanBC]

> It's someone's existing job to do IT,

That would be Simon Eccles at NHSX. https://twitter.com/NHSCCIO

NHSX is reasonably new. https://www.nhsx.nhs.uk/

They've been having some trouble recruiting and retaining staff. https://www.healthcareitnews.com/news/europe/nhsx-reviews-st...

I do feel that you haven't understood the complexity of the landscape. Not of the vendors, because in theory we could just impose standards of interoperability upon them with RFC like documents. But the complexity of NHS providers. There are thousands of GPs, hundreds of NHS trusts, and they've all got to talk to each other while providing strong access controls and audits.

EDIT: I don't normally ask about downvotes, but I'm curious about the votes in this post, and I'd be grateful for any explanation about downvoting.

[arpinum]

Their pay is 30% below market, so they wind up blowing even more money on contractors. I’m pretty sure increasing pay will save them a chunk of change, but the NHS ties itself up in knots to prevent sensible changes.

[MrMorden]

If they're only 30% below market, the NHS is in a lot better shape than many government organizations.

[inferiorhuman]

They've been having some trouble recruiting and retaining staff.

And yet I didn't see any obvious job openings. I didn't see an obvious way of checking civilservicejobs.service.gov.uk as neither NHSX nor National Health… turned up any results when plugging them into the organization filter. It's an interesting mission, but if they're not hiring then I can only imagine they're starved for funding or they've successfully retained enough folks.

[toyg]

> if they're not hiring then I can only imagine they're starved for funding

The overall context is a government that has been openly antagonistic to the NHS for at least a decade, pushed for disastrously expensive "privatisation by stealth" efforts [0][1][2], and is now effectively trying to outsource the digital side of NHS operations to private companies [3]. Strategically starving certain departments is par for the course.

[0] https://www.theguardian.com/society/2014/apr/04/gp-local-nhs...

[1] https://the-probe.co.uk/blog/2019/12/hancock-urged-to-halt-n...

[2] https://www.bmj.com/content/346/bmj.f1322

[3] https://en.wikipedia.org/wiki/Babylon_Health#Matthew_Hancock

(and many, many more sources if you really need them...)

[inferiorhuman]

The overall context is a government that has been openly antagonistic to the NHS for at least a decade, pushed for disastrously expensive "privatisation by stealth" efforts [0][1][2], and is now effectively trying to outsource the digital side of NHS operations to private companies [3]. Strategically starving certain departments is par for the course.

If the goal is to "starve the beast" NHSX isn't having trouble with retention then are they?

[DanBC]

I agree with everything you say, but GPs have always been private companies operating under NHS GP contracts, and Babylon Health isn't at all unusual in that regard.

They are a very large provider, and that's causing problems for their hosting CCG.

None of this detracts from your point: the NHS has been deliberately under-funded for years, and the Conservatives are pushing for non-NHS providers to provide services.

[jlg23]

You are dealing with multiple vendors, who all bring their layers of customer support and sales people before you even get an estimate of the required change.

Contracts might include processes that must be followed for any modification so nobody gets sued afterwards.

The developers who implemented the software might not even be with the contractor anymore. So you pay for training someone else, too.

[teddyuk]

I personally think £40million is outrageous but how much does a system that cannot go down cost?

[DanBC]

Previous attempts to fix this cost huge amounts, and none of them worked properly.

care.data (about 10 million) https://en.wikipedia.org/wiki/Care.data

Connecting for Health: (over 10 billion!!!) https://en.wikipedia.org/wiki/NHS_Connecting_for_Health

[jen20]

This is an unwarranted slight on CfH, which _did_ produce lots of useful work.

Unfortunately it was far too ambitious and effectively killed private development of healthcare software for the U.K. market in the process, making (for an example relevant to one area of my expertise) dose-based eprescribing a pipe dream despite having produced a ton of useful standards.

[TomGullen]

> I can think of a couple ways to make that faster for free.

Such as?

[fsargent]

Auth0

[dangus]

And who will set that up for £0/hour?

[petepete]

Taking a lead from GDS and starting to create user-friendly, predictable applications with a shared design language and reusable components (like SSO, email/SMS/letter sending) would be a step in the right direction.

They've already stated but it will take a long long time.

https://beta.nhs.uk/service-manual/

[simonh]

That isn't free, and won't solve the same problem - logging in to existing applications being used today and for a long time into the future.

[petepete]

Nothing's free. You can't really deny that taking that approach is more sensible than the current, fragmented mish mash of propriety systems.

The fact that they've already started down that path is a good sign.

[simonh]

Of course nothing is free, that’s the point. Yes it’s a good approach but as I said its solving a different problem.