Sunday, 25 April 2010


I have realised that we don’t have a National Health Service. We have a regional one. Its only since I’ve been a locum and worked in 3 different counties that I’ve realised this. What do I mean? Well let’s take admitting a patient into hospital for a start. Each hospital has its own rules for admitting a patient. Some have a GP hotline, some have a switchboard may or may not answer and when they do they can’t find the doctor you are looking for, and some have their own team who negotiate on your behalf with the admitting doctor. I don’t get it. How hard can it be to have a common admission pathway to hospital? Very hard it seems. In the end you get fed up trying to work out what’s going on and the patient gets bounced to A+E with a letter.
What about paperwork? Each hospital has its own paperwork to be filled in, different colour schemes and boxes to be ticked. Is it too much to ask to have one set of universal notes? They would look the same for every hospital and could be easily read through, filled in and relevant section found? Far too sensible. Each hospital has to have its own identity so someone somewhere in an office can justify their salary. Universal notes would save on stationary costs, improve patient care (as everyone knows where everything is) and you could even audit things easier if you were so inclined. Hell, if every hospital stuck to this you could even begin to attempt to computerise it. There could even be a standardised admission letter that GPs could use so the admitting doctor could read our ineligible scrawls.
Mind you I can’t be too critical of different hospital records seeing as I have had to train in 5 different electronic record systems to be a GP locum. Some of the systems I’ve used a truly rubbish, God only knows why the GPs use them.
I could rant about postcode lotteries for health care but everyone knows about those. I’m talking about what goes on behind the scenes. Nurses needing to retrain when they move hospitals because one hospitals certificate aren’t valid in another hospital. New doctors not having the faintest idea how to fill in requests for tests as every hospital does it differently. TTO forms that vary from place to place with varying information filled in. Getting everyone to agree on all this would be a nightmare. But then that’s where politicians come in, so we can blame them if it all goes wrong.
I read that it’s the ambition of Labour and Conservative that every hospital becomes a Foundation trust (worked well for Mid Staffordshire?). With this of course it would mean a rebranding of each hospital. New signs, new letterheads, new everything. That will not be cheap, and surely some of that money could be better spent ensuring the smooth running of the hospitals and the staff that work there. You might even improve patient care, but that’s not my main concern, I just want an easy life.


  1. Back in the early 90's I was involved with a team commissioning a computerised Maternity Information System. The aim was to allow the input of one set of information about the mother, pregnancy, birth, baby and postnatal follow-up. Details that are duplicated many times by hand with needless hours wasted on endless, repetitious form filling and searching for information by everyone involved. The need for it to encompass Auditing tools was an essential. It was plagued with developmental difficulties. Even back then the expectations by NHS staff were not only for accessible patient information but the need for a structure to share the information within the hospital, community and the NHS as a whole.

    So here we are, 20 years on and it still hasn't happened universally within the NHS. Millions upon millions have been spent and lost on systems not up to the challenge.

    If NICE can sort out effective clinical treatments there should be an equivalent and answerable central team who guide and endorse the way forward on the core needs of any such information system. If such a knowledgeable team does exist, something is wrong that after 20 years a universal system does not exist.

    One can't help but put it all down to money. It was at a time when the efficiency and possibilities of computers were seen by clinicians and NHS staff who wanted to use the technology to its limit. Companies were vying for contracts and the millions they could make from getting in through the door of any NHS Trust. It would be a virtual guarantee of being paid what they asked. Another aspect to this situation was the lack of computer science knowledge amongst NHS staff. The need of being dually qualified to understand the information technology implications as well as the needs of the patient in a clinical setting is needful and those qualified for these roles now exist.

    I agree wholeheartedly with your despair at the lack of a universal system both for information and patient management through the NHS, it can be abysmal at best with regional variations. At the end of the day it is the patient who is losing out and those caring for them who are left utterly frustrated.

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