Back to the future
Wes Streeting is a cheeky chappie and down in the NfN bunker the moles love him dearly, they really do. The problem is that Wes has provoked Julian Patterson, the Health Service Journal’s master of sarcasm. He – Wes, not Julian - has travelled back to 1997 to find experts to rebuild the NHS. According to Julian Patterson he -- Wes - has returned with an interesting selection. Here are some snippets.
Unexpectedly, “Wes has appointed Lord Ara Darzi to find out why the NHS is broken. Surgeon, conference speaker, and self-taught primary care expert Lord Dejavuzi is well-qualified to comment on things that don’t work” says Julian. “He is mainly known for the revolutionary “open all hours” health centres that bore his name and were closed all hours within two years”.
“Another illustrious passenger in Mr Streeting’s time machine is Alan Milburn. The former health secretary’s area of expertise is buying time. His advice to all new health secretaries is to come up with a 10-year plan, which allows a lot of long grass to grow and various cans to be kicked down the road”.
“One of the interesting discoveries on Mr Streeting’s time travels was something called the Private Finance Initiative. According to Mr Corrigan, another of the relics Mr Streeting brought back from his trip to the 20th century, PFI very nearly worked. More private money could be the answer to the “no more money” problem. What could possibly go wrong? The taxpayer will only find out much later when the prince of private-sector investment turns back into the frog of public-sector debt”.
Source: Julian Patterson Streeting goes back to the future HSJ 21/6/24
We are waiting to be informed
The first report from the Covid-19 Inquiry details multiple failures of the British state to adequately prepare for the pandemic. The overall picture for both the NHS and social care was one of funding not keeping pace with need, chronic short-termism and inadequate investment in measures that would have made the NHS and social care more resilient to the pandemic. The worrying reality is that, four years on, neither the NHS nor social care are in a much more resilient state to contain an epidemic. In some areas they are weaker.
Source: Nuffield Trust response to the first Covid Inquiry report 18/07/2024
Big kit little problem
Government ministers are promoting AI for the NHS and are also talking up the UK’s world beating role in boosting the AI economy. Matt Black, a regular critic of NHS development, points out that AI has not shown any concrete ability to solve hard, complex problem outside of very narrow, well defined issues (like identifying anomalies in radiology scans).
A recent insider note from the industry goes a step further. Jim Covello, Goldman Sachs' Head of Global Equity Research, argues that to earn an adequate return on the approximate $1 trillion estimated cost of developing and running AI technology it must be able to solve complex problems — which, he says, it isn't built to do. “We're a couple of years into this, and there's not a single thing that this is being used for that's cost-effective at this point,” he says. “I think there's an unbelievable misunderstanding of what the technology can do today. The problems that it can solve aren't big problems”.
Source: Ben Clover AI could solve ‘disgraceful’ structural problems, says minister Health Service Journal 9 July 2024
Spanner in the works
The Microsoft outage in July hit the NHS almost everywhere, but London was very badly affected because it has a disproportionate number of general practices using EMIS software. It appears to be the only NHS region that declared a critical incident. The disruptions originated from the cybersecurity firm CrowdStrike. An update to one of CrowdStrike’s software tools malfunctioned, disrupting computers running Windows.
One leading London practitioner told the Health Service Journal what happened “We completely lost access to the entire medical record. Repeat prescriptions, past medical history, allergies, test results, everything. Crippling”.
GP software has lots of built-in systems to check for allergies, medication contraindications, incompatible medications and so on. Practitioners had to resort to written records, which will need to be carefully transcribed when the system is restored. “All the practical business critical stuff went down too – appointment bookings, referrals, etc .”
News from Nowhere is worried. If this is what happens when a software upgrade misfires what will happen if a deliberate attack is launched against vulnerable software?
Sources: Ben Clover London Eye, Health Service Journal July 2024 Nick Robins, What is CrowdStrike, and how did it cause a global Windows outage? Guardian 19 July 2024
The more things change…
“As a NW London physician I see loads of folk stuck in beds who do not need hospitals. I also see a fair few referred in to hospital who do not have any medical emergency - two elderly people during the last Junior Doctor strike sent in because of safeguarding concerns (one by the police the other by a GP) - spring to mind. One is still in a hospital bed a month later. There seems no system in place for urgent social care for these situations.
A lot of the stuck patients are victims of the dissolution of social networks and lack of support in the community. Add to this a paucity of Nursing Home places, and an increasing tendency of nursing and residential homes to refuse return of their residents (thereby rendering them homeless), and it is no surprise that we have a problem with beds.
Source: anonymous commentary published in the Health Service Journal 25/7/24
….the more they stay the same.
No sooner is one medical workforce problem solved – trainee doctors’ pay – than another pops up – the crisis of profitability amongst general practitioners. The independent contractor status of many GPs might not last much longer .We are talking rodeos. Watch this space. Yee haa!
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/