GETTING NHS OFF BACK TO HEALTH
INFORMATION TECHNOLOGY
Successive governments over the past 15 years have tried to create a national NHS electronic patient record and this has failed. On a local and sub regional level the data is not compatible.
GPS, hospitals, pharmacies, mental health and ambulances do not know what each other is doing. This leads to many mistakes, especially related to prescribing medicines.
Theoretically it’s very simple to do when you have numbers in thousands and tens of thousands.
However, when you have millions of patients with millions of pieces of information, it becomes much more difficult. These things are surmountable with money, and of course Google, Tesco and Amazon have done it.
However, the NHS has substandard systems. Many hospitals are bringing in mainly American IT systems now, including Cerner and EPIC.THESE are very expensive.
For a large hospital group even a cheaper system can cost £ 7million a year to maintain.
Once you start scaling it up, the cost is large (about £300million a year for England), even though this is tiny compared to the amount of money we spent on Covid.
Just the £16billion we spent on Covid in the first year for test and trace would have paid for surgical hubs, regional IT systems and gone a long way to solving waiting lists.
SOCIAL CARE
Twenty per cent of patients who leave hospital have complex needs. They are usually frail and elderly and need extra care, either at home or in care homes.
The social care system and health system does not connect between councils and hospitals. For example, if you have a frail and elderly person in a nursing home who fractures their neck or femur and is sent to hospital, they first take priority over planned operations.
Four weeks later when they are ready to go home they are stuck in hospital at £400 a day. Why won’t nursing homes take them back? It is because everyone gets paid.
The hospital is paid £400 a day to keep them there and the nursing home is paid for the bed even if no-one is in it. If everyone’s getting paid then there is no incentive to get people back.
Also social care, like health, largely works five days a week. So we cannot discharge these complex patients at weekends, further jamming hospitals and lengthening waiting lists.
The fact that the Department of Health and Social Care is called that is a misnomer. Health does not run social care in the UK. It is the
Department for Levelling Up, Housing and Communities (ie local government, the councils).
The budget for health is £139billion a year, versus £29billion for local government. The solution is to put social care into the NHS.
If health and social care really worked as one, hard decisions would have to be made shifting money towards social care.
PUBLIC HEALTH
Public health is also outside the NHS and this is wrong. We need to reinstate the Ministry of Public Health and a minister of Public Health should share an office with Sajid Javid and have equal status in the Cabinet.this is for prevention of disease and mitigation. Their first task should be to run a pandemic planning exercise week ever year. We need to be ready for the next one that could be worse than Covid.