So… I think I might have solved half of Mike’s problems

Probably not, but quickly to explain the title: it is simply that my old boss Mike Bracken has just been announced as government’s new exec  digital director. So he has quite a big job on his hands – and as it happens, I was driving back from the docs and trying to solve an annoyance when this was announced so – although I had a bit of an inkling, I did miss the actual announcement. However, that’s beside the point…

Whilst I was missing the big news of the day I was irritated because the doctor’s surgery I belong to finally scraped itself into this Internet era by having a website that *does something*: lets you book your appointments and manage hospital stuff etc etc. However, you have to go into the surgery to get a code in order to go home and then sign up. This code was one of many printed out in advance, and when I asked for it I was just handed it by a mouthingly apologetic secretary who was on the phone.

On my slightly irritated way home I was trying to work out why they had such an annoying system. Surely it’s not really necessary to make people come into the surgery to get this code, especially as they are not doing anything to check that I am a patient when they give me said code. This was the only possible reason I could think of for making people do such a thing.

Then I thought, well actually, they probably didn’t know what they wanted when they commissioned the new shiny website that actually *does* something. Without sounding horribly, horribly -ist, the practice managers are all ladies of a certain age and the docs are so massively busy I doubt they had anything to do with it. I suspect that they told a web company a version of what they wanted and were sold something that would have been acceptable in the 90s.

This lead me to think, perhaps the NHS should centrally design a booking system for all surgeries and roll this out – before quickly remembering my decade in the public sector and realising the enormity and insanity of that proposal.

So instead, would a very clever thing be that the NHS/some government body (er Mike?) instead take the time to write up a requirements doc for a surgery website? This would not cost the earth to produce, could be posted on a central site and whenever a surgery in the UK decides that the time has come to have an online booking service, they simply print off the requirements doc and then they can select their web builders of choice from local talent.

I mean, surely the requirements are always going to be the same? Every surgery has patients, doctors and nurses and a finite number of things that can be achieved online that are common across the piece. Of course, a clever requirements doc would be written so that the site can have plug-ins and widgets that can be addded at very little cost for those occasional anomalies.

This may well create a small slew of businesses who become adept at finding and delivering against these requirements, prices would vary naturally, but would settle at somewhere reasonable, so that businesses can make a little profit and the public purse is not swindled.

Then I thought, I wonder how many other common businesses across government could benefit from this.

It’s one way isn’t it? I can’t see the down side, can you?

PS Mike Bracken’s appointment is extremely good for government people and for the digital dreams of the public sector. I hope you all look after him.

19 responses

  1. Emma you are a tease !

    What would happen is this.:

    A specification would be written, probably by an over paid consultant like myself. It would be too costly to put to a Public Consultation, so a working group would look at the proposal and tweak it a bit. The NHS would then go to tender and procure a best value solution. (All done at the tax payers cost and probably costing more than an off the shelf booking tool).

    The winner of the procurement will have constructed their bid against the specification, hedging their bets on costs and hoping to win. They will start work as soon as they can to try and keep within budgets.

    In the meantime, the DOH will realise that DCMS has written an action plan for eAccessibility. It will also realise that it already has a contract in place for patient records (or some other seemingly unrelated project). This unrelated contract will have already specified a CMS and Data Warehousing Infrastructure.

    In the interest of cutting costs and satisfying eAccessibility, officials will have to modify the specification with the supplier…And so the fun begins.

    The supplier not wanting to walk away will try to accommodate the unrealistic changes and the Government will try not to kill off the project…Which is now spiralling out of control.

    In the meantime, you will book your holiday, order your food, by a book and do a whole range of things in a secure manner.

    Some existing sites, like visionhotels.co.uk, will also already allow an Inclusive booking experience, meeting DCMS’s accessibility plans…So you will be confused as to what the hell has happened.

    Government has created an accountability nightmare for itself whilst buying pencils, that it imposes upon technology. When it comes to technology and IT it seems stuck in about 1975.

    The NHS could implement an accessible booking system for less than the cost of procuring one…But who would pick who got the cash?

    One replacement missile + a tank + an NHS hospital building – the overspend on Nimrods = Best Value.

    Confused, you are supposed to be.

      • “Less Red Tape” sounds great, but will always be trumped by “Civil Service Accountability to the Tax-Payer” and other Euro-OJEC-Fairness -for-Sausage criteria.

        Thankfully, what we have in abundance in public sector procurement is Duck Tape. It can stick together the worst solutions, coalitions and keep departments well “joined up”.

        Have you noticed that nobody in Government procured Twitter?

        Yet all the minsters and parties now deploy it…You would think that it would give them a clue.

        I SAY MORE DUCK TAPE !

        Preferably, Green – a tasteful combination of Yellow and Blue. Better than nasty old red tape…

  2. Maybe the whole website and all the associated widgets could even be built to sit in the G-Cloud and surgeries can just buy access to their own instance of it when they want, without the entire thing needing to be built over and over again?

    • Yes, but the cynic in me gulps at how doing such a thing might baffle even the bravest practice manager – after the instance ahd been created natch (see John Laity’s comment ;)). The simple solution of printing off a requirements doc seems to me to be something that everyone could easily understand… is all

  3. Or the surgery could just go to the Market and buy one of the many 10s of already existing off the shelf systems that have widgets and add ons and interoperability and government could leave well alone? Maybe as a patient you could tell the practice manager they didn’t make a great choice. If enough people do they may replace it?

    • I know that is very true, but I just am not convinced that there is enough knowledge of what is available off the shelf, or what is exactly required. And yes I could complain but I suspect it cost a fair few quid and I am not keen on them scrapping it right now! I was just thinking of how to help those who have common requirements but simply do not know what they need. But you are right… this guidance could include a list of what to look for ‘on the box’ and to suggest that there are products already built. But let’s not go down the whole issue of having approved supplier lists again ;)

      • Emma, as corrupter of the nation’s youth, why don’t you just issue a call to YRS and find which ones have parents who are doctors. There’s bound to be a few.

  4. And inevitably, someone at the practice will have decided that it is an absolute that portal must be able to do xyz, which isnt in the DoH spec and they’ll spend a fortune trying to find something that satisfies this requirement.

    The problem with centrally produced specs is that someone centrally can’t help themselves by trying to offer a ‘complete solution’. No, I like Emma’s idea. Spec it centrally, but also provide implementation and tendering guidelines. And absolutely forbid the public sector from creating potential solutions.

    Unfortunately this is what has happened with our schools, and now many schools do not want to implement a low-cost, off-the-shelf, easy-to-manage, Joomla/Wordpress solution. no, they want to pay £10K+ to a specialised school website service company who want to charge £1K for an RSS feed.

    And it all comes back to education, education, education – of the purchasers and specifiers. We need to develop their knowledge and abilities in the techie fields

    • Really? For schools websites? Oh my…. yes I agree, you are right about the education in the techie fields – also the early warning systems. Someone shoudl build something that lists all manner of webby additions, with a thing that says ‘”xxx” <- techie thing should not cost more than £xxx – for example, if you could do this for the RSS feed, and a non-techie could just check it, they would realise that they are being ripped off… hmmm

  5. And despite all these comments, the UK government wants to make England GPs into ” Commissoners ” of everything…..

    From the comments, it sounds as if you don’t trust most medics to boil an egg on the web, let alone commission a practice web site.

    KPMG, PwC, Serco and all the others must be slavering over the potential business.

    • Actually, Alex, I am assuming that practice managers are in charge of the online booking systems and websites, that GPs are GP-ing. I could be wrong… but there is no assertion here that medics can’t boil an egg. INteresting take on it though

    • Don’t forget:

      BDO, E&Y, PwC, Capita, Sodexo, Northgate, Carillion, Arc, HFS, GE, Lawton, Livingstone, Synergy, Pacon, Kinapse, Arvato and more…

      All ready and waiting to help GP’s cook their lunch.

  6. I went to visit my Mum last week and discovered how her GP handles appointment bookings.

    The phone lines are open from 8:30 am to 1:30 pm. You phone, get the engaged tone, hang up and redial. Eventually, you get through to a receptionist, who tells you all the appointments have been taken, and suggests you try again tomorrow.

    As far as the practice is concerned, this system works, because the surgery is full to capacity. Ideas like queueing and prioritising don’t seem to have occured to them.

    • NHS Direct was a step in the right direction…Speak with a Nurse or Doctor and book an out of hours service by phone.

      Most Surgeries employ front of desk reception staff…The argument is one of costs and trained staff shortages…A service building on the successes of NHS Direct would be better perhaps?

      I have been doom and gloom about things in my other comments. So want to say this:

      “If there is a lesson we must learn from this experience, it is that we must stop thinking about the NHS as some kind of unmanageable monster and get back to realising it’s an extremely precious thing that just needs managing in a day-to-day way.” Sir Gerry Robinson (Can Gerry Robinson Fix the NHS). ;0)

      Perhaps through Social Enterprise we could start to fix our NHS Monster and locally solve booking issues?

      NHS are set-up locally with Trust Status and local GP’s are capable of judging how well their booking services work very simply:

      “Hello Mr Laity, come in and take a seat. Before we talk about you today can I ask if it was easy to get to see me today?”

      No Duck tape required.

  7. My surgery, like many other throughout the UK has a simple website with a link to an appointment booking service. It give me three options: On the day (a limited number released in the early hours); Any doctor for a single issue (a list of all the 10 minute unbooked slots); Named doctor (a list of that doctors next slot). All these options are available by phone. In addition I can request test result phone calls, repeat prescriptions, book a nurse, travel clinic, foot clinic and baby clinic appointment.

    It don’t look great but it works fine and was bought off the shelf, tweaked for the surgery, is delivered with various back end integration options and whilst they wouldn’t tell me what is cost the Practice Manager was very proud of the fact that she had pulled together a consortia of other practices to reduce cost. Same way she has with phone services, courier, office, facilities management, etc. She also took me through their thinking about purchasing primary health care.

    I worked in primary care on and off for many years and this is far from unusual. The NHS is not one big amalgam, it simply wouldn’t work like that. I really struggle to see how a central list of requirements would help these many businesses that know their business and customers/patients well and have long histories of buying, developing and using IT systems to deliver patient services

    • Because not every surgery has the skills you describe. Indeed my example and the surgery I speak of is as far removed from yours as could be possible. Of course a central list of requirements would *hopefully* replicate the work of the practice manager you describe. And whilst I completely applaud their enthusiasm in procuring this and drawing together a consortia, I can’t help but think that their time would be freed up for the acceptably and demonstrably massive pile of work involved in running a surgery. So there is no downside. For those who are more digitally competent, they can just scrap the extremely time consuming act of procuring a new website.

      Also, whilst the NHS is not one huge amorphous mass, surgeries do do the same thing, to greater or lesser degrees according to location/population etc. So their can be no cry of ‘but our requirements are completely unique’ really, can there?

      This feels all a bit like website rationalisation arguments to me!!! So familiar and yet so completely not where I was going when I suggested a central list of requirements :)

  8. The issue now-a-days is that “consumerised” IT (iPhone, iPad, Android) and “Apps” set user experience expectations way in advance of most organisations ICT capabilities.

    My iPhone or Droid can tell me where I am in the world, find me a local place to eat, tell me how to get there, book my bus ticket and even allow me to pay via a screen 3d barcode…

    Which is why Emma’s NHS booking system seems so… Well lets face it, 1980′s at best.

    It isn’t just public services, commercial organisations are struggling with this, even the most technical ones!

    How can you present yourself as a technology leader if your IT systems look dated alongside a free APP downloaded from the AndroidMarket?

    Apple, Citrix, Talk Talk and Colt Telecommunications are all currently restructuring their Networks and IT infrastructures to embrace consumer technologies. They are using BYOD (Bring Your Own Device to work) schemes and other models for “Consumerisation” that allow consumer devices and applications to be deployed at a corporate level.

    This is where ‘the Cloud meets reality’!

    If I am moving too fast, here is Siemens video on BYOD: http://ubuntuone.com/p/jFJ/

    The really interesting thing, is that Consumerisation schemes have a real “Big Society” feel about them:

    >Government raises tax revenues where it previously did not. (Employees are buying devices to bring to work which are liable for taxation / VAT)
    >Manufacturers sell higher specification equipment. (Success = Jobs & Taxable profits)
    >Work-place technology becomes more standardised, lowering skills thresholds
    > Technologies and services become simpler and thus more inclusive.

    So why are we all not being promoted BYOD?

    BYOD implementations are cutting edge. They are making the most of the very latest thinking on “dirty” wifi networks and handshake security…All of which is exercising the brightest minds at Sophos, Veloxum, Intel, VMWare and others.

    One thing is for sure, this could be a “grail” moment in IT procurement.

    Companies implementing Consumerisation are saving on the TCO (Total Cost of Outsourcing), improving user experiences and delivering standardised Applications that take advantage of the Cloud and APP revolution.

    For example:
    If the NHS moved to a consumerised infrastructure, you would not need to have a booking tool. You could write a $2000 APP on the back of GMail or Windows 365. It could then be offered as a free download on the Apps Store.
    = Book your doctors consult on your iPhone.

    Consumerisation http://www.slideshare.net/slideshow/embed_code/7893573 View more presentations from eyeskyward expeditions

    The big issue for Consumerisation is that it is a “Technology Thing”. Worse still, it impacts upon PAYE accounting…Two subjects that put Ministers to sleep and Civil Service Officials on edge.

    This is a real shame…Citrix has already saved over 15%*on it’s TCO by implementing a Global BYOD scheme for employees.

    (* I am told by Citrix UK that this figure is old hat now. It is a lot more…I am still awaiting confirmation of the real figure, which I am led to believe is more like 22%)

    [youtube http://www.youtube.com/watch?v=FKl8i7mSiDM&w=560&h=349%5D

    If the UK could save such amounts on it’s TCO across Departments, how different would the departmental spending review look? Bet that deficit reduction plan would look different too…

    That should exercise Mike’s thinking ;0)

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