To be fair - healthcare IT infrastructure sucks everywhere, even in the country most well-known for remarkably expensive privatised healthcare. It's not really obvious at this point how to fix it. Have the Government Digital Service or similar work on it directly and ditch the contractors?
> Have the Government Digital Service or similar work on it directly and ditch the contractors?
Basically, yes. Bring it all in-house, ban the contractors/consultants/mercenaries/etc. Remove the profit motive and suddenly you don't have millions of dollars/pounds being siphoned off by vampiric consultancies and third-party vendors. Suddenly you can spend tax-payers money in a sane and rational way.
Hire a bunch of talented people who care about the wellbeing of their nation state, pay them well enough and task them with building the best systems possible in the most efficient way possible.
This is what should have happened instead of the disastrous NPfIT. It took years and none of the big players (Accenture, BT, Fujitsu, CSC) could even agree what a fucking medical record should look like because nobody was willing/able to concede anything.
If it had been an in-house project with actual experts employed in building/deploying on a smallish scale (say, a town or county) and then rolling out it could have been a thing of beauty.
> Hire a bunch of talented people who care about the wellbeing of their nation state, pay them well enough
This is impossible. Any large organization eventually resorts to using pay scales to combat corruption. When the right people will be 10+x more effective than the wrong people, pay scales are impossible.
Literally the entire reason why large organizations resort to hiring contractors is because they know it's impossible for them to hire good people directly.
I agree with your solutiom, but there is far, far less blood sucking going on than you might imagine and far, far more organizational incompetence. That is, organizations hire contractors and then dont know how to tell them what they want, but simultaneously refuse to let the contractor have initiative because they dont know how to set up a pay structure for it. Businesses screw themselves.
Yeah but the truth isn't as exciting as thinking you can write DJango app to save the NHS. It's far more fun to think you can knock something up with your friends in a few months.
Then requirements start coming in, the stakeholders, the politics. The multi faceted organizations, the disparate teams with never ending edge cases.
3 years later when it's past phase 2 and creaking at the seams, along comes the next upstart... DJango! Which idiot picked that?!!! Me n my friends could....
Without giving too much away, I've been involved in just such an initiative, and it was _awesome_.
However, in the context of an established organisation it's really hard to pull off, and so we eventually ran into serious pushback from other factions within the org, particularly the established IT Ops folk.
Still, it can be done, and it can be a raging success. Especially gratifying when you spend two days writing up a system in Python which replaces some 90's garbage that's costing the organisation 200k per year in licenses.
This. A million times this. I think at this point the tech community should be vocal about this issue.
Tech has improved ten-fold this last decade, and IT consulting services simply don't care because they profit hugely from it. What makes this issue even harder to solve is the fact that IT is so simple to hide because society does not understand it enough.
Similar to the Tech Pledge, we should stand and be very vocal about the fact that you CAN build strong, secure and relatively cheap systems. If we don't do this, who else will ?
We're stuck between a part of the industry which benefit from this (and especially the big bosses, they don't care about the developers either) and a society which doesn't see the value of homegrown (as in company/government-grown) tech talent and the tenfolds decreases in IT spending it could entail.
Can I ask, how did the employees fit in with the payment structure? My feeling has been that the NHS simply can't hire talented staff on the wages they expect because the pay grades don't go up that high. Hence hiring contractors.
How does it suck? Everywhere I look hospitals have dumb pc's connnected securely to cloud services for applications, primarily Citrix or web based portals hosted by a trusted contractor or the hospital themselves.
There's an awful lot of network-connected, really badly written, often unsupported software in healthcare, that uses proprietary formats. VDI doesn't save you if what's on the other end has to be Windows XP to run your shitty software that'd cost your IT department's entire budget for a year to replace and retrain users.
