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Is technology killing the NHS?

Arran Cameron
I'm sorry if this comes across as pessimistic but I believe that the NHS will die unless seriously intelligent reforms are made to it. These reforms will probably not be possible because of inertia in the system. What happened to Stafford Hospital is a snapshot of what will come to other NHS trusts.


When the NHS was established in the 1940s, technology in hospitals was far simpler. In many cases medical procedures were carried out using simple hand tools. The most complicated piece of equipment in a hospital was probably an X-Ray machine. A modern hospital contains tens of thousands of pieces of advanced machinery.


This costs a large amount of money to buy.

This costs a large amount of money to maintain and service.

This costs a large amount of money to provide staff training.


The amount of money spent by hospitals on advanced medical devices and IT equipment keeps increasing year after year and is a substantial part of the NHS budget.


If this isn't bad enough in itself, the NHS is not very good when it comes to using and deploying technology due to its cumbersome and antiquated management structure along with the mentality of a high proportion of its staff. The NHS is clearly not a visionary and progressive organisation.


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.


The situation is marginally better with software although NHS IT projects are known to have been expensive disasters.


Therefore, is technology killing the NHS?
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    Maurice Dixon:


    Telemedicine, GP appointments by Skype, personal body-worn medical monitoring, auto-blood condition monitoring and treatment, MRI scanners, keyhole surgery, etc, etc are all part of the adoption of technology. However, these are all stovepipe approaches, not within a system-of-systems strategy and technology architecture. Thus, perhaps technologists need to better understand the requirements and needs of their customers before offering and designing systems without user input, and using a spiral evolution approach starting with small quick wins to bud confidence then evolving based on increasing confidence and evidence of value added and cost benefit.



    Telemedicine is a relatively recent development and very much a brave new world for the hospital centric NHS. A sea change in the attitude of NHS managers will be required to implement telemedicine which will take many years of overcoming opposition and bureaucracy.


    Large hospitals contain thousands of medical devices but most are standalone rather than networked. The concept of networking medical devices in the NHS has been confined to only a few isolated areas, such as critical care suites or neonatal wards, until a few years ago. One reason why most devices are standalone is because they are portable so they can only be networked using a wireless interface. The NHS has always used wired networking for computers and fixed medical devices, so wireless networking is very much a new game.


    Networking medical devices outside of a hospital campus – such as hospital at home – is venturing into uncharted territory for the NHS. There are a number of questions that need to be answered:


    1. Who provides, and pays for, the communication links between the medical devices used at home and the central controller in the hospital?


    2. If a patient dies as a result of a communication link failing, or data being corrupted, then who takes the blame?


    3. Some implementations of telemedicine are being provided by medical device manufacturers rather than the NHS. If the NHS chooses to outsource telemedicine to medical device manufacturers (or other private companies) rather than offer telemedicine services directly then is this a case of privatising the NHS via stealth and technology? It is possible that the cost of outsourcing telemedicine to private companies is more expensive than the NHS providing it directly, but if the private company will take the legal responsibility when a patient dies as a result of failure of the equipment or the communication link, leaving the NHS scot free, then the NHS may have no choice but to outsource or potentially be sued for millions.
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    My provider of health services does not require an individual to obtain a referral from his/her Primary Care Provider (PCP) to see a specialist within network. One just calls up and gets an appointment.


    However if one urgently needs to see a specialist then the PCP makes the appointment.


    Peter Brooks MIET

    Palm Bay Florida USA


  • 0
    we are talking about the NHS Peter - not the US Private Heathcare System which of course works differently
  • 0
    The point that I am making about only PCP's being allowed to make referrals for patients to see Specialists is to raise the question of why it has to be that way under the NHS!


    Peter Brooks MIET

    Palm Bay Florida USA 

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    I have received a bit of inside information about medical engineering departments in hospitals.


    Back in the 1980s most cars only had rudimentary electrical systems – such as lights and windscreen wipers – so they could be repaired by mechanics with only hand tools and a multimeter. Modern cars have advanced electronic systems and require the use of advanced test equipment or computer software to identify faults or reconfigure electronic modules. Therefore a modern day car mechanic must have an understanding of the electronic systems on cars and the hardware and software tools required for servicing, fault diagnosis, and reconfiguration.


    Medical devices have also advanced in the same way since the 1980s and many now require specialised hardware and software tools for servicing, fault diagnosis, and reconfiguration, but a sizeable fraction of techs today still have the 1980s mindset and have not advanced beyond hand tools and a multimeter. The situation is often more acute amongst medical engineering managers than techs, as most of them generally aren't very computer or software savvy. Conflicts of interests may break out between certain techs who want to seriously embrace specialist hardware and software tools and managers who do not understand them or the benefits they provide.


    To further complicate the matter is where medical devices are networked or used in conjunction with PCs, as this requires IT and software knowledge in addition to medical device hardware knowledge. Hospital IT departments predominantly deal with computer hardware and software used in office type settings, so their IT techs have limited knowledge of medical devices and their associated software. It's not uncommon for 'finger pointing' to take place between medical engineering techs / managers and IT techs / managers over who has the responsibility for issues surrounding networked medical devices or PCs used in conjunction with medical devices.
  • Former Community Member
    0 Former Community Member
    When buying specialist medical equipment, buy the Contract Logistics Support appropriate performance/availability based package/contract from the provider, don't expect NHS technical staff to take it on initially without proper training and OEM back up. If you buy the Mon-Fri 08:00 to 17:00 (excluding Bank Holidays) support package to keep costs down, don't expect any faulty kit to be fixed and available from Fri 12:00 to Mon 12:00 at least - 24 hr hospitals require 24 hr technical support - you get what you pay for.
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    From my experience volunteering in US hospitals for over 15 years there are three groups of "internal" techs. 


    Group A deals with maintenance of internal plumbing (sinks,toilets and air/heat ducts) and electric lamp replacements.


    Group B deals with simple maintenance of support medical equipment (IV pumps and non complex electronics equipment). It should be noted that equipment that can not be fixed on site are sent back to the external equipment manufacture's service departments. They also clean pumps that have been contaminated with blood products that gets inside the equipment 


    Group C deals with IT related items (replacement of local computers, servers software, security, the main computer plus related telecommunication equipment, pulling cables etc.)


    Items like major air-conditioning/heat  external electrical supply and really complex medical equipment (X-Ray, PET etc) are fixed by outside vendor approved service providers.


    Peter Brooks MIET

    Palm Bay Florida USA 


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    Regarding electronic equipment that is inserted into the body (examples pacemakers and ICU) a representative of the equipment manufacture supports the creation  of the kits used in the operating area (during the tool sterilization process) and later actually working in the operating area with the surgical team and validating that the system works before the patient is closed up.


    The following day the same equipment representative visits the patient in the hospital to actually fine tune the unit.


    Peter Brooks MIET

    Palm Bay Florida USA


  • Former Community Member
    0 Former Community Member

    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.




    Agree with you. 

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    The inability to communicate the patients data from an eye doctor (we have different medical terms here in the US) to a hospital facility or primary care doctor, is also a problem here in the US. 


    Generally primary US hospitals to not do eye surgery with the exception for eye problems involving major accidents (traffic accidents for example).


    Eye Surgery is usually done in a "Same Day Surgery" stand alone facilities owned and operated by group of eye doctors.


    Some of these doctors are also eye surgeons, so that all the patient information (including photographs) is available to them during the surgery.  There are a couple of problems with this however in that sometimes they need additional medical information such as recent EKG results (for patients with heart problems) or latest A1C results (for patients with Diabetes) and they have to contact the Primary Care Physician to obtain the data.


    Peter Brooks MIET

    Palm Bay Florida

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