Abandoned UK National Health Service IT System Has Cost $16bn... So Far

dryriver writes with news of yet another major software project gone awry. From the article: "An abandoned National Health Service (NHS) patient record system has so far cost the taxpayer nearly £10bn, with the final bill for what would have been the world's largest civilian computer system likely to be several hundreds of millions of pounds higher, according a highly critical report from parliament's public spending watchdog. MPs on the public accounts committee said final costs are expected to increase beyond the existing £9.8bn because new regional IT systems for the NHS, introduced to replace the National Programme for IT, are also being poorly managed and are riven with their own contractual wrangles. When the original plan was abandoned the total bill was expected to be £6.4bn."

Comments

great deal

[beefoot]

That makes the $1B Ontario (Canada) government spent in E-health for nothing a great deal to me.

Re:great deal

[FilmedInNoir]

The gun registry cost $2 billion. Not Health, but was an IT fiasco. *shrug*

Re:great deal

[sycodon]

I'd like to see the SOW for all these projects...if they exist.

Re:great deal

[Anonymous Coward]

But the gun registry was actually completed and working for years until Harper decided to throw it away (wtf?).

Now, it should never have cost $2bn though...

Re:great deal

[Mashiki]

That was of course after the liberals were telling everyone that the total cost was going to be dirt cheap. And more recently with the destruction of said data, the RCMP is lying through it's teeth. What burns my ass on the entire thing is that the registry did nothing. Except as a feel-good project for anti-gun nuts. Well that and allowing the RCMP to break into houses in High River, gets even more interesting when you find out that they targeted houses, and broke into where firearms were stored.

"Dayum!"

[wcrowe]

I cannot fathom any software system costing that much. I imagine even the people over at SAP are going, "Dayum!"

Re:"Dayum!"

[CastrTroy]

Yeah, It certainly is absurd. I can't even imagine it if you factor in the hardware to run it on. Assuming you spent half of it on hardware, you'd have $8 billion worth of hardware (which is just plain ridiculous). You now have $8 billion left over to pay people, assuming each person working on the project makes $100,000 a year, for $8b, you can get 80,000 person years. The project was launched in 2002, so even counting 12 years, that means they could have hired 6666.667 (nice how that works out) people to work on the project.

Re:"Dayum!"

[fustakrakich]

I cannot fathom any software system costing that much.

Padding... The money was/is being stolen, looting the treasury.

Re:"Dayum!"

[deusmetallum]

There's a lot to this kind of thing. I worked in a help desk once where a system was promised to be rolled out by X date. The contractor brought on all the staff based on that promised, kitted out the building with all the required hardware to provide the support and... nothing. The guys couldn't be fired, and there was no other contracts to move them on to, so they sat around waiting for the software to finally be rolled out.

In other words, it's not just the software that cost all the money, all the fuck-ups along the way compounded and inflated the price tag way beyond what it should have been.

Re:"Dayum!"

[Anonymous Coward]

That is kind of like one claiming to be able to afford $680.00/month auto loan when one has a total vehicle budget of $700/month.

Let's see some what you left out:

• non-development employees such as executives, managers, HR people, admin assistants, facilities management people, system administrators, etc.
• computers for the employees
• furniture for all the employees
• building rent for the employees
• any benefits paid to the employees
• electricity
• phone service
• water, sewer, and trash disposal
• Possibly data center costs

And that is just off the top of my head. Really, you should get a clue about business and ancillary costs before you go spouting off.

Re:"Dayum!"

[petes_PoV]

I cannot fathom any software system costing that much

It cost that much because that was the amount of money available to pay for it. If there had only been £5Bn in the budget, the project proposals would (magically!) have cost that much - and would STILL offered the same results. And exactly the same final outcome would have been proposed if the budget had been doubled. Success or failure was not a function of the budget, nor of the requirements. Even back in the 2000's when this was still a comparatively young project, I was asked to work on it. I spent a day with some of the project people and knew even than that it didn't stand a chance of ever going live. Mainly due to the intransigence of the NHS workers, especially the doctors and consultants (who all believe the only function of the NHS is to keep them employed - any resulting healthcare is merely a bonus).

The sorts of companies who bid for this work, just like defence contractors, are masters at configuring their projects to consume all available resources for a constant output. The problem is that they are much better at negotiating than government employees (who have no personal investment in the project) and more highly motivated, what with their contuned salaries, bonuses and commissions.

Re:"Dayum!"

[AmiMoJo]

That amount is not for the software and hardware alone. There has been a big reorganization of systems and computerization of records. Staff have been trained to use what has been delivered so far, and patients are being asked for permission to make their records available on the system. It's not a total write-off.

Re:"Dayum!"

[ShanghaiBill]

I cannot fathom any software system costing that much.

It is easy to fathom if you look at how the program was structured. All the incentives were inverted: nearly everyone involved actually benefited from cost overruns (the contractors got more money, the bureaucrats had the prestige of managing more resources, and the politicians had more patronage to dispense). There was no accountability (no one is being disciplined or fined). There is not even any political fallout because the blame is smeared out over multiple administrations (Conservatives can blame Labour for starting the project, while Labour can blame the Tories for mismanaging the implementation). It is like it was designed to fail. A decade from now you will be reading about some other project that failed in the exact same way, for the exact same reasons.

Re:"Dayum!"

[the grace of R'hllor]

You can pay all of those out of the OTHER 8 billion dollars he wasn't taking into account to calculate the number of developers you could hire.

Note that you can't put 6+k people on a project and have it go anywhere. A project like this would have at most a few hundred people working on the various components. Wages, including support personnel like managers, are therefore an absolutely insignificant part of this. Hardware, dito. Utilities, dito. If you're spending more than five-ten million per year on this, you're doing something ridiculous and/or illegal.

Not actually producing something after 12 years, that's just the icing on the cake.

IMO: Taking that much money from government should be considered a very literal hanging offense.

Re:"Dayum!"

[CastrTroy]

Even though I didn't make an itemized list, doesn't mean I didn't account for it.

non-development employees such as executives. I didn't disount these guys. We can lump them in with the 6000 employees working on the project. I didn't say that the 6000 people were all writing code. That would be even more absurd. This would probably include benefits as well. $100,000 is actually a somewhat high salary.

The rest can be lumped into the 8 billion I took off at the beginning for "hardware" Obviously, you can't spend 8 billion on hardware just to run the systems that support this. That includes all hardware needed to run the project, along with any service fees like electricity, phone service, and other incidentals.

Re:"Dayum!"

[Anonymous Coward]

Typically the customer gets charged between 2 and 10 times the developer time cost of developing the software depending on how management heavy the company is. In a lean company, a lot of that x2 covers office space, utilities and other less obvious costs. On the other end of the scale, you have the companies where each developer answers to 8 different bosses.

Re:"Dayum!"

[bobbied]

I cannot fathom any software system costing that much.

Haven't worked on any government programs I see.

Start with lots of money, fuzzy requirements and add general stupidity in the contracts office and you can get a LOT of money wasted. Who's got more money to waste than the government?

I've worked on government programs that I firmly believe where managed to get as much money out of the customer as possible (not to actually *deliver* something they wanted). One such program had taken more than 3x the initial cost estimate, taken 3 times as long and was nowhere near half done (by my estimate) before it got cancelled. Mission accomplished... (I made the mistake of actually voicing this theory in the midst of the program too.. I don't work there anymore...)

And here in the US we are rushing head long into government run health care... Yikes.. It's going to be way more expensive than you can imagine.

Re:"Dayum!"

[Anonymous Coward]

You forgot to factor in health insurance costs. From what I hear, they're quite high due to some boondoggle computerized records project.

Re:"Dayum!"

[Joce640k]

Yeah, It certainly is absurd. I can't even imagine it if you factor in the hardware to run it on. Assuming you spent half of it on hardware, you'd have $8 billion worth of hardware (which is just plain ridiculous).

You don't get it at all.

Before you even start buying hardware or writing code you have to build some modern new offices and fill them with nice desks, leather chairs, etc. to attract the right sort of people for the management positions. Then you need hot young secretaries around the place and plenty of thousand-pound lunches to discuss their six figure salaries, annual bonuses and exactly what model of luxury car they'd like to drive to work.

Only then can you start the actual "IT" part of the project.

Re:"Dayum!"

[sycodon]

Actually, if you put 6k+ people on a project, I'd fully expect it to go nowhere.

Re:"Dayum!"

[sycodon]

Isn't that what happened to New York City's time system?

Re:"Dayum!"

[fustakrakich]

It happens everywhere that's not being closely watched and corrected. SNAFU

Re:"Dayum!"

[clickclickdrone]

and patients are being asked for permission to make their records available on the system

Maybe they had more people (like me) say no than they expected making it non viable? Given the govt's record on protecting data, there's no way they were putting my medical records on it.

Re:"Dayum!"

[Kielistic]

IMO: Taking that much money from government should be considered a very literal hanging offense.

You are assuming that the government had nothing to do with this failure. Software development by committee never ends well.

It's not too uncommon for government projects to have every bureaucrat in the mix trying to get their grubby little paws on it and make it how "they want". I can't even imagine trying to write software and having, literally, thousands of "bosses" giving you contradictory or impossible requirements. Add in lowest-bidder and you start to understand why every government software service you've ever used sucks at least a little bit.

Re:"Dayum!"

[__aarzwb9394]

I can imagine the cost of your current for-insurance-co.-profit system.

Will it be more expensive than that?

Re:"Dayum!"

[Darinbob]

This is the one area where I think government should do the job but at the same time is incapable of doing it well. Government is no necessarily more corrupt that the private sector and no more greedy. However when government is greedy they tend to just spend more money, whereas when private sector is greedy they spend less money and pocket the savings.

The best outcome I think is a mix. Leave the implementation and management to the private sector but at the same time have a strong and robust regulatory system that is independent of the private sector. In practice this fails because the regulators are weak or understaffed allowing the private sector to break the rules with impunity, or because they've got side relationships with private sector allowing regulatory catpure. The conundrum is how to make the government side of the equation actually be effective, rather than being the complete screw ups like the US or UK systems.

Re:"Dayum!"

[gl4ss]

Let's see some what you left out:

yeah so you can ONLY afford what.. 4444 guys? and that is taking into account putting 8 billion in hardware.

you stupid? do you really think the cost is reasonable? it's an absurd money pump that only got to be so because the government kept paying the bills and they would have pumped it for far longer. government should have made such pumping illegal.

(not to mention that most of those mentioned are already in the xxx dollars per employee price, like a computer. you fail math and common sense ac).

Re:"Dayum!"

[bobbied]

Oh yea, it's going to be LOTS more expensive.. Insurance companies are in business to make money, government is about spending money.

The beauty of capitalism and the profit motive is that if somebody starts making loads of cash in some specific business line, others will see that and rush in to "make their share too". So competition reigns, supply increases and prices go down. The business of health insurance was no different. Government has no such "profit" motive to keep it efficient.

At one time, long ago, I worked for the Department of Defense. I can tell you that they are not primarily concerned about "profit" or being efficient. In fact, the goal was to get all your budget spent and not leave any money on the table. If you didn't or couldn't get all your money spent, it was given that next year your budget would be reduced. So where is the motive to buy option "B" that was cheaper but more risky when "A" was budgeted?

So.. Give me the evil capitalist insurance company over government run health care. A company will be more efficient than the government can ever be. And even if they mistreat me, at least I can sue the insurance company when they do something wrong...

Re:"Dayum!"

[Anonymous Coward]

Yeah, It certainly is absurd. I can't even imagine it if you factor in the hardware to run it on. Assuming you spent half of it on hardware, you'd have $8 billion worth of hardware (which is just plain ridiculous). You now have $8 billion left over to pay people, assuming each person working on the project makes $100,000 a year, for $8b, you can get 80,000 person years. The project was launched in 2002, so even counting 12 years, that means they could have hired 6666.667 (nice how that works out) people to work on the project.

That's silly, you can't spend $100,000 a year on someone who you hire for $100,000 a year unless they are a contractor (you forgot taxes and benefits, which can easily add up to $30,000 or more for a $100,000 salaried employee). If they _are_ a contractor, simply double your per head cost estimate.

Re:"Dayum!"

[Anonymous Coward]

Actually, this isn't true. At least, not in any real sense - the problem isn't corruption, it's widespread incompetence at the contract signing level, combined with the fact that the civil service in the UK is a dinosaur full of people who can't be fired, doctors who refuse point blank to do anything beyond their job description, and the fact that there's too little top down control over the individual trusts involved. That and the fact that lots of contractors have been used to avoid hitting government restrictions on hiring new staff during an economic crisis.

Re:"Dayum!"

[painandgreed]

Yeah, It certainly is absurd. I can't even imagine it if you factor in the hardware to run it on. Assuming you spent half of it on hardware, you'd have $8 billion worth of hardware (which is just plain ridiculous). You now have $8 billion left over to pay people, assuming each person working on the project makes $100,000 a year, for $8b, you can get 80,000 person years. The project was launched in 2002, so even counting 12 years, that means they could have hired 6666.667 (nice how that works out) people to work on the project.

I can imagine it. FIrst off, you are counting salaries, but not benefits, offices, personal computers, and other things it actually take to run a business. That'll cut your estimated number of employees in half right there. They're also not dealing with one location working on one program. They are developing a system that has to integrate and be deployed at every hospital in the nation. Each of those hospitals (and other health care locations) will have to treated individually with most running unique combinations of home grown and vendor software systems and keeping track of different data in different manners. Even with something like HL7 interfaces and ICD9 coding standards, each hospital will still essentially have unique databases that have to connect to this one system and make sense.

Still, they probably developed their own standards and expect the hospitals do make it fit on their side of things. From there they picked a few hospitals and then brought them into the picture one things were up and running enough to do so. For each hospital they add in, it's going to require and entire team to do so. Since these are not just businesses but also 24/7 businesses who view system downtime as risking lives, support also has to go 24/7, and for beta sites is going to mean for everybody from held desk, to coders, to all the way up. So now, all those people you theoretically have are spread all over the country taking care of their own separate issues which are unique to their location.

It's easy to sit back and think you could do better, but having seen the difficulties that come from just getting two hospitals working on the same system for one department, I can see if blowing up to that fairly quickly when talking about servicing and entire country. My department (not the hospital, just the department) can easily spend 5-10 million a year on such an upgrade and that doesn't even include salaries and is with a developed turn key system. Have a brand new system and multiply it times every hospital in the nations and costs can blow up quite quickly. I seriously just don't think people who sit back and say such prices are absurd have any experience in the enterprise field, let alone considering it across all sites of a country.

Re:"Dayum!"

[Anonymous Coward]

Also, the insurance companies are still in the mix taking a slice.

Re:"Dayum!"

[Anonymous Coward]

Neither system was designed after first creating a comprehensive data model. GIGO.

Re:"Dayum!"

[Capt.DrumkenBum]

The beauty of capitalism and the profit motive is that if somebody starts making loads of cash in some specific business line, others will see that and rush in to "make their share too". So competition reigns, supply increases and prices go down.

Except that this did not happen.
I live in Canada, pay a very reasonable amount for my health care. I have a sister who moved to California for a job. She has no health care.
My brother and sister both had separate accidents about 2 years ago. My sister fell off a horse, broke some ribs and punctured a lung. My brother had a motorcycle accident, broke his foot, and got a persistent infection that nearly cost him his foot.
My sister went to the hospital, and got out a few days later owing about $150,000.
My brother (In Canada) had a series of operations (6 I think) and treatments over a year. Amount owing $0 Plus a few hundred for prescriptions.
He never waited more than a couple of days for surgery.

Re:"Dayum!"

[malkavian]

No, they had lots of people that said the system was unusable.. There were priorities of error, and a priority 1 was a showstopper.
The places that consistently tested showed that the system for the first several years (already way past expected implementation date) for the Care Records part was seriously broken, and not fit for live use (bear in mind, this system isn't just supposed to be able to hold your office files, and it's fine if it's down for half an hour now and then, and perhaps lose a few things along the way with only a grumble; it holds your medical records.. The things that make the difference between life and death in some cases).

With things not working out on either side (again, for the Care Records parts; some parts, like PACS [Picture Archival and Communication System;the digitisation of your X-Rays instead of using film] work fine and are in almost universal use now, vastly changing the nature of care in the NHS.
The big problems with it were:

A) Tony Blair not having a clue what was wanted, but saying it should be done in a year.

B) Setting a guy in charge of it that failed his computing degree.. One Richard Granger. It was pretty much his ideas that doomed the Care Records part of it, and allowed out a spec that was more a back of a cigarette packet sketch than a real spec.

C) Failing to have a real spec. Now the companies all bid for a very nebulous thing that said "You give us a lovely system that does what we want, and we'll give you billions.". Of course, they produced what they thought the NHS wanted, but the NHS discovered that it wasn't what they wanted. You know, basic Spec documentation you cover on computing. Which Granger failed.

D) There was also fault with the companies who leaped at the cash without a real spec.. They should have known that the contract was WAY too wooly and actually tied it down to real deliverables.

At renegotiation time, some of the vendors (like Fujitsu) worked out the cost of really doing what the NHS asked for (which was all the project management of the first round, plus a semi accurate spec). Which was a truly staggering figure. More than the NHS could stomach. The two are still in a legal scrap.
Some vendors still kept the lights on in the data centres, and hosted what was there, but those installations are likely going to have to move out of those data centres by about 2015, as they're too expensive to maintain for the few installs.. And none of the vendors want to renew the system contract.

So, the price tag covers all the allocation (it was scaled to host EVERY NHS hospital in the UK, which is most of them), training, consultancy, migration of data (a high precision activity that needs zero data loss on a vast amount of very complex information, coming out of a vast quantity of different databases, and being shoehorned into one uniform schema. Doing this while still providing clinical care (you don't get to shut a hospital down for ripping out the heart of its data systems and replacing them with a new; it's all done while still treating patients and making sure nothing gets mis-recorded).. Training of a huge number of clinical staff (doctors, nurses, and anyone else who needs to use the system inside the NHS), the feeds.. Interfaces between that system and the various disparate ones that it needs to communicate with inside a hospital..

When you look at it, it's a breathtaking proposal, just nobody on high seemed to recognise that, and expected fast results because they said so and waved a fat wallet around. Unsurprisingly it went awry. The current UK government looked at the figures, the legal position and the chances of getting it sorted from a more businesslike side, and canned the bits that wouldn't work (the care records area).

As for the data protection side, that was one of the most heavily guarded I've seen anywhere.. It was pretty robust. The few 'leaks' that happened (people looking at records they shouldn't) were spotted by access audit, and people lost the jobs.. That simple, that strict.

Re:"Dayum!"

[Anonymous Coward]

it cost that much because that is how much they could get for it at the beginning,
and when half done and out of money ask for more money or the first portion of money is wasted because project isn't done yet

Re: "Dayum!"

[Anonymous Coward]

Do you work at or for the UK Ministry of Defence?

Re:"Dayum!"

[Macgrrl]

Obviously the 'missing' money is all in licensing costs.

Even I'm not sure if I'm being sarcastic there.

Re:"Dayum!"

[the grace of R'hllor]

<p>You are assuming that the government had nothing to do with this failure. Software development by committee never ends well.</p>
</quote>

Oh, I'm assuming that the contractor will throw his hands up and say that exact thing. But you know that going in. And I believe it to be exploited by the huge companies that get to make bids on contracts like this.

Let's face it, once you've got the contract, you're not going to get booted out quickly. As long as you have some sort of manager saying "But I want a pony!", you write that down, add it in the requirements with manager's name, and start work on a pony. If you're building a system that has nothing to do with ponies, it might take quite a while to shoehorn it in, and it will cost a lot. But you have some manager's approval, so you do it, because it means income.

What you or I or any smaller company that's focused on delivering quality systems would do is first limit the scope, get a product owner on the government side, and make that one person fully and totally responsible for scope. And if he tries to shoehorn in a pony, you'd say "Well, that means this core functionality you wanted has to go, or we'll go over budget".

Big companies don't care about budgets, as government will pay up. Interestingly, the increased income that's caused by being willfully incompetent allows them to compete in the next bid too.

Re:"Dayum!"

[Anonymous Coward]

http://upload.wikimedia.org/wikipedia/commons/a/a1/International_Comparison_-_Healthcare_spending_as_%25_GDP.png

I would suggest that the US already is way more expensive then you can imagine. By contrast, whilst this is a screw up of epic size by all involved, the nhs spends a great deal less (the UK is close to the global average)

Re:"Dayum!"

[Kielistic]

What you or I or any smaller company that's focused on delivering quality systems would do is first limit the scope, get a product owner on the government side, and make that one person fully and totally responsible for scope. And if he tries to shoehorn in a pony, you'd say "Well, that means this core functionality you wanted has to go, or we'll go over budget".

Great in theory and I agree with everything you've said. Limiting scope can be extremely difficult however. Especially when you are dealing with an organization as large and as used to always getting their way as the government. If you can manage to get a professional politician to be "fully and totally responsible" for anything, let alone something that could go very badly for them, then please get involved in lawmaking.

Re:"Dayum!"

[bobbied]

Have you heard of Anecdotal evidence? You are talking about specific peiple when we need to be discussing the overall picture.

Look, I'm not saying that it is a perfect system, only that it is the most efficient one. Government run health care will be less efficient and effective as the local driver's license office. My daughter just got her license and between her written test, driving test and getting her picture taken we spent the better part of a working day in the office (and we HAD an appointment). Do driver's licenses get issued? Yep. But remember, that's ALL this place does and you have to follow their process or you don't get anywhere. Healthcare is not as simple as issuing driver's licenses.

Where I feel bad for your sister, do note that she did GET health care without regard to her ability to pay. If it happened again next week, the same thing would happen, she would get treated. So we really don't have a problem with *access* to healthcare in emergencies. Of course it is not a good thing that your sister now faces $150,000 debt, but it was her choice to take the risk and not carry insurance. She *could* have had catastrophic insurance for pretty cheap and not have been left with the huge debt.

It would be cheaper for the government to provide tax credits or subsidies for catastrophic health care insurance than to provide universal health care. Your sister could have carried insurance with a high deductible (say $10k) and pay 90% after that for nearly nothing (about 150/month less government supplied subsidies). She would have been wheeled out of the hospital owing $20K or so. Plus, she had the option of carrying insurance before her accident, and decided not too.

And before you start complaining about how $20K is impossible to pay too, let me share with you my situation. I DO have employer supplied coverage, but it would cost me nearly $10K out of my pocket if I fell off a horse and ended up with a $150,000 hospital stay. This doesn't include my premium payments which run a few hundred a month (just my part) or what my employer pays for my coverage. Obamacare will actually REDUCE my coverage and up my out of pocket expenses from there.

Finally, if you sister plays a bit of hardball with the hospital and her providers, they will likely knock off a hefty percentage of the $150K. Folk who are working on a cash basis with providers can usually get a sizable discount over the initial billed amount. Think about it this way.. If your sister just declares bankruptcy, they will get NOTHING (unless there is some assets to get their hands on). They would rather have something than nothing. I've heard stories of providers knocking 50% off and taking the rest over time, interest free. But you have to ask or they will happily collect the whole bill.

Re:"Dayum!"

[Capt.DrumkenBum]

The US system is fucked! Enjoy your brainwashing.

Re:"Dayum!"

[bobbied]

Well it is *now*.. On that we agree. Enjoy yours too..

Re:"Dayum!"

[lissnup]

You had me at "Tony Blair.."

Re:"Dayum!"

[Anonymous Coward]

Mainly due to the intransigence of the NHS workers, especially the doctors and consultants (who all believe the only function of the NHS is to keep them employed - any resulting healthcare is merely a bonus).

Stop that, you'll scare all the US people that have been sold on the idea that overseas heath care is a Garden of Eden. They've been living for the last few years on a rosy fantasy view of the world in which you folks do everything better. Think of all the added stress you'll cause these True Believers by presenting data to the contrary. You might even be responsible for a few heart attacks. You horrible, cruel person.

Come to think of it, most of them are so good at only hearing what they want to hear that nothing will change no matter what you say.

Never mind. Carry on.

Re:"Dayum!"

[Xest]

"and patients are being asked for permission to make their records available on the system."

Did that bit even ever work? I got asked and said no, but hospitals/doctors since I moved house and changed doctors a couple of times (the first one I changed to was shit so I changed again) all seem to have instant access to my records.

I always assumed from then on that even though they asked that even if you said no they still didn't pay any attention to it and stuck your records on anyway.

Re:"Dayum!"

[Xest]

The other problem is ineptitude in public sector contract negotiation.

Public sector seems to not factor in penalties for companies failing to deliver on time and on spec, and in fact incentivise failure.

There was a good example in one of the Navy's new ship contracts, it might even be the new carriers, or the Type 45s, where the project overran in terms of costs beyond initial estimates and so the government just gave them more money.

Public sector is the only place I've ever heard of this happening, in private sector you produce a contract with a fixed price and if the vendor can't deliver to that price then it's tough fucking shit, they have to bear the cost of it and accept a loss on the project as a result.

If that means BAE or whoever footing a £2bn bill for their project overrun on the carriers then tough. It'll make them think twice about giving more realistic cost estimates in future.

But because none of that happens, companies are now systematic in exploiting it. They put forward a cost for the project, and then say they have an overrun by overinflating staffing costs, material costs and so forth and just up the price and government pays them it seemingly without any question.

You even see it in the G4S contract where government still paid them at least some of the money (still on the order of 10s of millions) even though they failed to provide the necessary staff they were supposed to and the Army had to be called in to do the job. Again, with sensible contract negotiation government should not have had to pay them a penny at this point, failure to deliver should've resulted in complete recouping of costs because of breach of contract on their behalf and possibly even damages for having to make alternative arrangements.

Until they sort of contract negotiation in public sector this will keep happening. Whilst there's no reason for companies not to fail, or not to budget overrun, then they will fail to deliver, and budget overrun where it's profitable for them to do so. The problem is that this doesn't happen and companies get favourable contracts because the people signing the contracts on the government side often went to school with (or whatever) the people at the top of the companies bidding for the contracts and are old friends so are more interested in helping a friend than serving the tax payer.

A high profile bankruptcy resulting from costs incurred from poor project planning in a major public sector contract would hurt the tax payer but it's exactly what needs to happen to stop the tax payer being hurt even more in the long run by dissuading companies from doing a shit job, or trying to scam the tax payer.

Lost cause

[Anonymous Coward]

My father was contracted a few years ago as a consultant to help update the NHS's infrastructure. After a year working there for a year he ended his contract. He said that it was impossible to get anything done because the higher ups didn't listen to the engineers and project managers on the teams. There was also a lot of unmotivated and lazy people working on the teams that slowed everything down. Politics also played a big part and people cared more about keeping their comfy job that never really had an end date than finishing the project.

Re:Lost cause

[Anonymous Coward]

After a year working there for a year he ended his contract.

I'm glad they didn't try to scam him on his timeline. I've had weeks were I worked two weeks but only got paid and recorded for one. I left that place, now I work at a different company that actually tries to maintain a congruous temporal reference frame between all offices.

Re:Lost cause

[TexNex]

Thats fairly common with IT install projects. Between mission creep and idle time (usually caused by mission creep and work outage disputes) its surprising anything gets done on these contracts. Install projects take a special kind of insanity to manage.

Re:Lost cause

[Anonymous Coward]

On the NHS projects I was working on, most things were working nicely on Sun systems. Then came this big idea that they should change everything and use Microsoft windows. Chaos ensued. I did what I could for about 2 years, but could just see the change going nowhere. In the meantime, the old systems just kept running.

Re:Lost cause

[Anonymous Coward]

So IOW the new and shiny MS offering, was chosen over something that worked?

Re:Lost cause

[Ash-Fox]

Can you tell me of a government organization that isn't like this?

Excellent!

[Anonymous Coward]

Government taking over healthcare! And pretty much everything else! What could possibly go wrong?! Keep spending other people's money!

Re:Excellent!

[lxs]

Terrible. Government taking over health care and a mere 50 years later they waste billions on an IT project.

Re:Excellent!

[Anonymous Coward]

And because the private sector always does everything better, they wasted billions contracting it out to the private sector.

Re:Excellent!

[plopez]

I bet the in-house developed and/or maintained legacy systems developed in the 70's, 80's, and 90's are still working fine. That was what happened when I was working for a University. The new system they bought from the was garbage but the systems built over the previous 20 years both in-house and through a vendor that specialized in University systems and university systems *only* worked fine. It problem was they did not have shiney new UIs. Oh, and the vendor scared the managers into purchasing their garbage using Y2K, which as it was later revealed their application was not Y2K compliant either. And of course said made extra money fixing the problem. Meanwhile the in-house staff and specialized vendor ensured their apps were Y2K compliant far before the Y2K arrived.

It was no surprise when was sued by a number of organizations.

Re:Excellent!

[Anonymous Coward]

The funny thing is: this horribly wasteful government system is still about twice as efficient as the perfectly organised private system in the US!

Re:Excellent!

[hedwards]

That's the thing, there's always going to be problems with the health care system, but when one system spends twice as much per capita as another, for worse results, only a die hard fascist would continue to support profits being made for inferior results.

Re:Excellent!

[Malc]

Is that why healthcare in the US is twice the price per person as in Canada, and most of the difference is in the admin cost per person?

George Bush was right during his re-election campaign when he wanted small businesses to be able to get together for healthcare: there are economies of scale that can benefit healthcare. The NHS is the largest bulk purchaser of drugs in the world, and it gets a correspondingly cheaper price on drugs. Meanwhile the pharmaceutical companies make 25% of their profits in the US.

Private healthcare pays. Not for the patient though.

Re:Excellent!

[Eythian]

If they're old systems that have been trucking along, that's because any issues with them were fixed long ago and have been forgotten about. Those that were unreparable probably got replaced quickly, and what you see now is the stable replacement.

This is what Ronald Regan protected us from

[TWiTfan]

Thank God that here in the U.S. we're protected from this kind of system. Sure, getting sick here without insurance can bankrupt you, drive you into lifelong debt, etc. But at least we don't have to put up with any red tape in our health care system!

America, America, God shed his grace on theeeeee!

Re:This is what Ronald Regan protected us from

[intermodal]

Unfortunately, what we're seeing is a preview of what I expect with Obamacare.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

What's all the rage about Obamacare?

If you listen to http://www.youtube.com/watch?v=R7LF5Vj2n64 @ 1:10 I wonder what exactly Americans do get for their money?

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

We get more tests than anyone else because the doctors are paid per test^W^W^Wafraid they might miss something and get sued.

Re:This is what Ronald Regan protected us from

[mi]

Sure, getting sick here without insurance can bankrupt you

Getting sick without insurance may bankrupt you everywhere, where insurance companies are the dominant payers for healthcare.

The problem outlined by this news is that, when the insurer has no competition, they can continue raising their premiums to no end and survive any sort of idiotic inefficiencies and waste. The joys of the "single-payer" system, that Obamacare is the harbinger for...

Re:This is what Ronald Regan protected us from

[sandytaru]

Naw, the primary burden of all those computer upgrades was stuffed upon insurers and hospitals/clinics instead, who quietly did the required systems upgrades with a minimal amount of fuss over the last couple of years. (Except the ones in denial who are now panicking.) They rolled it into their planned systems upgrades, and while the software was a large investment, it also replaced outdated systems with much smoother modern records systems.

About the only major issue with the electronic medical records that some of them are discovering is that clinics which specialize in areas frequented by the elderly consume more data storage since their existing records must be scanned and some of them are 100 pages long. (So a 1TB SAN quickly had to become a 4TB SAN at one clinic since they'd used up 500 GB in about six months.)

Re:This is what Ronald Regan protected us from

[SuricouRaven]

The silly thing is that 'obamacare' doesn't actually change anything. Same doctors, same hospitals, same procedures. No grandiose new projects. For most people, same insurance company. All it does is subsidize health insurance to make it affordable to those on low income - that's it.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Yep, there's no raising of premiums in the US, and no idiotic inefficiencies and waste in the US. If you work in a doctor's office, you know how streamlined all the insurance companies are, and how the patients complain that somehow they just keep getting more for less!

Besides, did you stop to think that somebody is profiting from this mess? It's not the bureaucracy of the single-payer system. It's the people empowered to sell to them.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Every american I know has moved here takes about 6 months before they realise private healthcare is basically evil.
I hope you never find out how 'insured' you really are.

Re:This is what Ronald Regan protected us from

[IanCal]

The problem outlined by this news is that, when the insurer has no competition, they can continue raising their premiums to no end and survive any sort of idiotic inefficiencies and waste.

Yep, which is why the US has such a low per capita cost for healthcare and the UK has such a high per capita cost.

Re:This is what Ronald Regan protected us from

[MickyTheIdiot]

The thing is that every post on every site you see about "Obamacare" is an accusation with no facts to back it up, just like the post you replied to.

Fox News did two identical polls recently, the only difference being the term for the program "Affordable Care Act" or "Obamacare" was used. When there was a significantly higher percentage of people that liked the act when it's called the ACA than when it is called Obamacare.

The debate against Obamacare has been the most fact free debate that the U.S. has seen in years. It's a screen for every projection of every annoyance we have about healthcare in the U.S. The people that are preaching against it the loudest have no idea what it really is and they show it daily.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

The silly thing is that 'obamacare' doesn't actually change anything. Same doctors, same hospitals, same procedures. No grandiose new projects. For most people, same insurance company. All it does is subsidize health insurance to make it affordable to those on low income - that's it.

Exactly! That's why it's so doubleplusungood! If we'd just let all those unsightly poor people go away instead of all this "helping the sick" and "humanitarian" falderol, it would make the country look so much cleaner, the average income would increase substantially, we'd have far less of that dreadful crying noise we keep hearing every time we cut one of their jobs (why on earth can't they understand that if we keep flushing money away by paying them, we can't afford to keep up our yachts and horse farms?), and everything would just be so much better!

Re:This is what Ronald Regan protected us from

[intermodal]

2009 just called. They want their blatant lies back.

Re:This is what Ronald Regan protected us from

[mi]

All of the problems you are mentioning would only get worse, when the insurers don't need to compete with other insurers.

The solution is not to reduce the competition, but to increase it.

Re:This is what Ronald Regan protected us from

[plopez]

As if insurance companies do not have red tape. Or death panels, they kill people all the time by denying care. Or computer systems that are running on bubble gum and bailing wire. God Bless the Insurance Companies!

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

It made my deductable quadruple. Is that a factor in the subsidies or am I going to get a double whammy while my tax dollars are funneled to yet another unproven and inefficient social program?

Re:This is what Ronald Regan protected us from

[mi]

Yep, which is why the US has such a low per capita cost for healthcare and the UK has such a high per capita cost.

US' higher expenditures are explained by the availability of much better treatments. Once the government officials begin deciding, what's "appropriate" (depending on the patient's age, health, station in life, political leanings), we will, likely have the costs reduced, yes...

Re:This is what Ronald Regan protected us from

[coolsnowmen]

I agree, but it has been mostly fact free because the law that was passed only dictates that the regulations need to be written, that is, we haven't really seen what the end result of the ACA passage will be.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Thank you! I was afraid that this is the case. Well, same old same old. At least you guys don't have to bother with the constant fear of the imminent "EURO CRYSIS"
(Heck yeah! That would be a great name for a game)

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

All it does is subsidize health insurance to make it affordable to those on low income - that's it.

*Ahem* Someone is going to have to pay for that.

And it won't be all those low income people.

And it won't be any of the people exempted from Obamacare; like most unions and Federal employees.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Do you think people don't get sick and die broke in the UK? Just because it's government subidised does not mean that you get the same care as the queen of england. If you want that sort of care you pay extra. If you want to get care with the unwashed masses then you get the bare minimum and still die anyway.

Re:This is what Ronald Regan protected us from

[Petron]

They are afraid they will get sued.

If you are a doctor, and you are sued for malpractice, even if you are proven innocent, your career is over. So doctors all try to cover their ass as much as they can and order every test that MIGHT help prevent a suit from going forth. So as more and more doctors are asking for more tests... Hmm high demand, limited supply... what happens?

Re:This is what Ronald Regan protected us from

[jareth-0205]

All it does is subsidize health insurance to make it affordable to those on low income - that's it.

*Ahem* Someone is going to have to pay for that.

And it won't be all those low income people.

And it won't be any of the people exempted from Obamacare; like most unions and Federal employees.

Yeah. Fuck 'em, right? Let 'em, die?

Re:This is what Ronald Regan protected us from

[hedwards]

That's because you're crazy. But, thankfully you'll be able to get affordable coverage starting in a few months.

Honestly, when you look at the cost of health care in America compared with even the most expensive systems in the developed world, the costs are higher here and the outcomes are inferior.

In other words, it may cost more in the near term as preventative care becomes more accessible. But, fewer people using the ER for primary care and fewer bankruptcies caused by medical bills should start to bring the costs down fairly quickly. Then in a few decades the savings from preventative care should be apparent.

It's mostly people who watch Fox Noise and have no idea what it is that they're paying for when they go to the doctor's office that are afraid. All that charity care isn't being paid for by the government, it's being tacked on to the cost of insurance.

Re:This is what Ronald Regan protected us from

[hedwards]

That's because most people that use the term "Obamacare" are doing it to disparage the President. I use the term because it's an accomplishment that the President should be proud of. It's just that until next month when people can start signing up, a lot of people view it as a failed initiative. Even though those plans don't start until the first of the year.

As soon as people start to actually get those plans, it's going to be impossible for the GOP to get them away from us. It's also harder to scare people about health related matters when they have access to affordable health care.

Re:This is what Ronald Regan protected us from

[hedwards]

We already know what the results will be, the care will improve, the costs will go down and if it doesn't work, the private insurers will be removed from the equation. That's basically what happened in the UK when they first tried to reform health care.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

I see you don't know any doctors. Many get sued for malpractice with no basis for the lawsuit all the time. They still keep practicing unless they've done something actually wrong and get their state medical board against them.

Re:This is what Ronald Regan protected us from

[hedwards]

Most of those treatments are available because it's more profitable to neglect preventative care and treat the chronic conditions that result from it. We do very well at treating strokes and heart disease at later stages because we allow for the conditions that are likely to lead to those disorders to crop up unchecked. And then spend a crapload of money treating something that could have been prevented.

Re:This is what Ronald Regan protected us from

[intermodal]

I don't particularly follow the news on this subject that closely, and I certainly don't align with either major party.

What I do follow are my finances, and the fact that when I went back to school in 2011, just after this was passed, I could afford insurance. Even though the coverage wasn't the best, my employer also kicked $100 a month into a health savings account to handle the high deductible. This was actually a very effective system, as it also allowed him to help out with routine dental and vision without providing specific coverage. Now, I've got my degree, a better paying job, and the costs have risen to where I cannot find affordable insurance. I'm better off paying out of pocket and paying the penalty.

Affordable Care Act my arse.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

That must be the reason, why the US has a far higher child mortality and lesser epectancy than any Western European country.

Re:This is what Ronald Regan protected us from

[IanCal]

The US has a higher per capita cost than any other country in the world, is that because you have the best healthcare in the world?

The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990.[2][3] Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country.[4] According to the World Health Organization (WHO), the United States spent more on health care per capita ($8,608), and more on health care as percentage of its GDP (17.9%), than any other nation in 2011. The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most. In a 2013 Bloomberg ranking of nations with the most efficient health care systems, the United States ranks 46th among the 48 countries included in the study.[5]

http://en.wikipedia.org/wiki/Health_care_in_the_United_States
And finally, you can get private healthcare in the UK too.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Yep. Tell you what--why don't you go ahead and pay my share too. I didn't vote for the clowns who passed this crap, so why should I have to pay for it?

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

All it does is subsidize health insurance to make it affordable to those on low income - that's it.

*Ahem* Someone is going to have to pay for that.

And it won't be all those low income people.

And it won't be any of the people exempted from Obamacare; like most unions and Federal employees.

Yeah. Fuck 'em, right? Let 'em, die?

Well, if you're willing to pay for a plan that's so wonderful that it was passed by a congress that exempted itself from it.

And signed into law by a president who's also exempted from it.

Aside from that, it sounds like a great idea.

Of course it still has to be paid for and as usual that's going to fall on the poor working stiffs.

And many businesses are already making plans to cut back on employee hours to escape the insurance increases. Which means less pay and higher costs passed those aforementioned working stiffs.

But hey, fuck 'em, right?

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

The current system does not, instead it waits until they get really sick then treats them for the emergency at much greater cost, then they go bankrupt and the hospital does not get paid and so everyone else foots a much larger bill than the cost of prevention in the first place.

This is what makes it so crazy, if the republicans want to get rid of it in order to save money for the "deserving" they should first put through the "Go die in a gutter" act to strip the protections off all those too poor or too old or unlucky with pre existing conditions, otherwise the costs will just keep on going up.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Costs of new treatments have been constantly going up. this has put cost pressure on every developed nation, but the current American system does not yet act in any way limit the expense, the affordable care act was an attempt to stem the rise not cut the costs. Companies took advantage of the panic to raise prices, but most of the important cost cutting measures are still yet to arrive, in order to get it passed the dates for activation where pushed back years.

Re:This is what Ronald Regan protected us from

[ColdWetDog]

Oh, BS. I've been sued before (unsuccessfully) and my career is hardly over. I have to review the applications of new docs coming into our system and quite a number of them have been sued successfully in the past. We need to perform due diligence, so I look at the reviews of the case, it's almost invariably bizarre. A doc sued for not preventing a heart attack when the last time he saw the patient was eight months before the event. A radiologist sued for missing a breast cancer that only one expert witness (out of five) saw on a mammogram. And on and on.

If we see someone who is sued repeatedly, then you have a big red flag. But it is rarity for an experienced practitioner not to have been sued at least once.

And yes, 'defensive medicine' is real - cost estimates range from 10-20% of the US health care dollar, so it's quite significant. But it's hard to pin down exactly what is meant by defensive medicine. It's not just fear of being sued - more of it comes from the understandable desire to get the diagnosis correct. Nobody, but nobody, knows just what the 'right' level of medical testing is appropriate. I suspect this will remain true for quite some time. Even in diagnoses that have been studied carefully, like a lot of heart diseases, we still don't know what the best treatment strategy is when patients deviate from study populations (like having two diseases simultaneously, the horror).

Re:This is what Ronald Regan protected us from

[ColdWetDog]

You mind sharing what you're smoking? Or is that sarcasm I'm smelling?

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

A lot of people pay for shit they don't use that you do on a regular basis. It's called living in a society, you fucking ignoramus. If you don't like it, Go Galt in Somalia.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

I don't have any children - and yet I'm still contributing to schools!

Re:This is what Ronald Regan protected us from

[CrimsonAvenger]

That's because most people that use the term "Obamacare" are doing it to disparage the President.

No, most people use it because "ACA" is just another acronym, and Obamacare actually has some meaning (good, bad, indifferent, but some meaning) to most people.

If I were to mention the ACA to my parents, they'd just look blankly at me. I say "Obamacare", they know what I'm talking about (and really don't care what I think about it, since they're not going to be affected by it in any way).

Re:This is what Ronald Regan protected us from

[SuricouRaven]

It also doesn't work very well. Maybe if it was an actual government health cover system of some form rather than just chucking giant heaps of money at private insurance it would work better.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Plenty of insurance companies won't pay for cancer testing but will pay for chemo. Save the pennies and less the dollars run free.

Re:This is what Ronald Regan protected us from

[sycodon]

Obamacare is the most fact free government program ever.

Mark my words, it will be common for people with identical conditions and similar physical attributes to be treated differently by Obamacare. Some will be denied treatment, others will get one kind of treatment and others will get a different treatment, all for the same malady. No one will know why and the people running Obamacare won't care until someone dies AND it gets on the evening news. Then, it will be "unfortunate" and require "re-examination".

Re:This is what Ronald Regan protected us from

[sycodon]

Just more expensive...as I just saw during open Enrollment. Why? Because although I am single and have a vasectomy, my new and improved, Obamacare approved plan is required to cover Obstetrics.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Why isn't there any insurance that sells "malpractice protection" for doctors? Anyway, according to: http://www.youtube.com/watch?v=qSjGouBmo0M @ 3:50 (According to this guy, the limit for malpractice "payouts" had very little influence on the "price" in Texas - So I guess something is fishy).

Re:This is what Ronald Regan protected us from

[sycodon]

When facing the same condition on a government plan, they just stick you in a room and stop feeding you.
How many old folks in Britain have been starved to death or had fluids withheld? Seems to be a regular news item.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Sounds like a problem with an easy solution: if you're a doctor, just refuse to help any patient who is a lawyer; the problem will take care of itself in a few years as lawyers start to die off from gangrene from paper cuts, squashed feet from dropping law books, etc. etc.

Re:This is what Ronald Regan protected us from

[intermodal]

That post has entirely too many baseless assumptions in it to justify Obamacare.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Did you warn them about Fukushima and Hurricane Sandy?

Re:This is what Ronald Regan protected us from

[intermodal]

No, they didn't ask.

Re:This is what Ronald Regan protected us from

[mi]

The United States life expectancy of [...]

Numerous factors other than quality of healthcare factor into life expectancy. You knew that, didn't you? But chose to make the fallacious argument anyway...

And finally, you can get private healthcare in the UK too.

Sure. And I can send my child to a private school here in the US as well. I just have to pay for it in addition to paying for the public one, that some other children will be attending...

In other words, these private options aren't really in competition to the public one — and thus pose no pressure on the public one to improve.

Re:This is what Ronald Regan protected us from

[I'm New Around Here]

You fucking idiot, my great-great-....-grandparents moved from Europe to avoid shit like this. They "Galt-ed" a couple centuries ago. Now pieces of lazy, greedy shit like you are telling us we have to do so again, because you want something you can't afford.

Fuck you, go back to Europe if you want the government taking care of you your whole life. My ancestors didn't want it, and neither do I.

Re:This is what Ronald Regan protected us from

[HornWumpus]

They can simply direct them to the nearest animal hospital. Lawyers families too.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

We get more tests than anyone else because the doctors are afraid they might miss something and get sued.

Doctors are also subject to patients who have already self-diagnosed based on an ad for Lyrica or Requip or a segment on Dr. Oz, and who will doc-shop until they find one "smart" enough to confirm the diagnosis. Advertising works, and it works best on people who don't know what they're talking about.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

And I bet that when you do have children, they will use schools. But not the inner-city schools. Not the failing schools. Not the ones with metal detectors at the front entrance and armed guards in the halls. Not the others with drug deals in the halls and rapes in the bathrooms.

Ironically, you'll be called the problem by leftists, for not putting your children into those schools.

Re:This is what Ronald Regan protected us from

[__aarzwb9394]

Spoken by someone who knows nothing whatsoever.

Do you think people don't get sick and die broke in the UK?

Do they go bankrupt because of unpayable medical expenses? So rare as to be unheard of.

If you want to get care with the unwashed masses then you get the bare minimum and still die anyway.

For every story about proton beam therapy being unavailable on the NHS I will give you another about a non investor-class person who saw a GP for free and thus found an illness earlier and was treated and cured at a lower overall cost.

(I mention cost, because to people like you $$ mean more than human life.)

Shall I give you a story?About being sent to a different hospital because the nearest one is "out of network"? How precisely does this maximise efficiency? The Holy Market (pbuh) brings 100% efficiency in all cases, does it not? Please help me understand.

It is difficult to tell with you people whether you actually believe that the insurance co.s exist to pay your bills. (To state it again for the willfully uninformed: They exist to maximise profit and deny your claim whenever possible.)

Or do you simply believe that poverty is its own punishment? The trouble is, that even the poor are uniformly undeserving, you will reduce social mobility by providing so few ways out of poverty for children with potential.

Re:This is what Ronald Regan protected us from

[I'm New Around Here]

As if insurance companies do not have red tape. Or death panels, they kill people all the time by denying care.

And that is the basis of why you guys can't figure out the real problem.

Insurance companies don't deny care.

They just don't agree to pay for some of it.

The doctors decide not to offer that specific care since you can't pay for it yourself.

And for that, you blame the insurance company.

Re:This is what Ronald Regan protected us from

[intermodal]

There's also the fact that the term "affordable" used in the ACA nomenclature is highly debatable.

Re:This is what Ronald Regan protected us from

[tburkhol]

Mark my words, it will be common for people with identical conditions and similar physical attributes to be treated differently by Obamacare.

Of course they will. "Obamacare" is not some kind of monolithic, one-size-fits all program that uniformly matches symptom A with pathology B and treatment C. It's a framework within which private companies are expected to compete, innovate, and distinguish themselves. There's no way a single payer system would ever get implemented, and this rich new market of people who have to buy insurance is a glorious opportunity for the invisible hand to optimize medical care, with some guidance to minimize the fraudulent offerings.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

My ancestors didn't want it, and neither do I.

Fine by me. Stop drinking clean water, breathing clean air, taking safe medications, eating safe food, driving on safe roads, living and working in building that adhere to proper safety regulations, and so on and so forth, you fucking hypocrite. Seriously, you leeches need to be rounded up and shipped the fuck out of here.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Compare cancer survivability rates in the US and Europe. The US outshines them. A big reason is that the US does a much better job at screening for cancer early, rather than when it's too late to make a difference. Yet that's not the only reason the US has a higher survivor rate.

So, not only is your argument not valid, as far as early vs late treatment, but you ignore the actual survivability rates even when the condition is progressed further before discovery.

Re:This is what Ronald Regan protected us from

[I'm New Around Here]

My ancestors didn't want it, and neither do I.

Fine by me. Stop drinking clean water, breathing clean air, taking safe medications, eating safe food, driving on safe roads, living and working in building that adhere to proper safety regulations, and so on and so forth, you fucking hypocrite. Seriously, you leeches need to be rounded up and shipped the fuck out of here.

Yes, because not wanting a company to pollute the air and water is exactly the same as wanting the government to force some third party to pay for my health care, regardless of my desire as to whether they should be forced to do so.

You fucking idiot.

Re:This is what Ronald Regan protected us from

[Eunuchswear]

US' higher expenditures are explained by the availability of much better treatments.

And we know they're better because outcomes are better in the US.

Except they're not.

Whoops.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

You know what? They called back, and I answered. I warned them about both those events. I made sure the top liberal in charge knew all the details of each. As we hung up, I heard them muttering something about "never let a crisis go to waste".

Re:This is what Ronald Regan protected us from

[I'm New Around Here]

That must be the reason, why the US has a far higher child mortality and lesser epectancy than any Western European country.

I have heard that the biggest reason is we actually count live births as "live births". Many countries don't include babies that die soon after birth.

Can someone confirm or deny that? My google-fu is borken right now.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

All of the problems you are mentioning would only get worse, when the insurers don't need to compete with other insurers.

Three years ago, we had competition among the insurance companies. We may not have lived in a glorious utopia of medical efficiency, but you're saying it was at least more efficient than single-payer, government mandated programs. Except that it cost twice as much per capita and delivered poorer outcomes in terms of lifespan, disability, and time-to-treatment than most of the socialist programs. And you say it will only get worse if we try to implement a national health care system.

I know America-bashing is popular around here, but it sounds like you're saying Americans are idiots, incapable of even apeing the successful programs in place elsewhere in the world. Or maybe that Americans are lazy, greedy fucks who insist, at every level, on three or four times the pay of equal performing Germans, Japanese, or Britons. Can you tell me why you think the more structurally sound free-market healthcare, when implemented in the US, was so much worse than the structurally defective NHS implemented in the UK?

Re:This is what Ronald Regan protected us from

[mi]

Three years ago, we had competition among the insurance companies.

Hardly. There were very few and all were (and remain) harshly and strictly regulated.

Except that it cost twice as much per capita and delivered poorer outcomes in terms of lifespan, disability, and time-to-treatment than most of the socialist programs

Somehow I doubt, you can get the government health-care to pay for your gender-change in Cuba (or even in the UK), but in the US insurers are obligated to cover the procedure for all. And that's just one example...

The government made all of us a giant disfavor decades ago by allowing employers to deduct employees' health-insurance from taxes. This tied "healthplans" to employment, crowded individuals out of the insurance market and made insurers cater not to actual individuals, but to their employers. Likewise doctors and hospitals began cater to the insurers more and more, rather than the patients.

It was bad, but it went to even worse with Obamacare...

Can you tell me why you think the more structurally sound free-market healthcare, when implemented in the US, was so much worse than the structurally defective NHS implemented in the UK?

I'm unaware of any objective comparison of health-care availability and quality between the two countries. Anecdotal evidence is certainly mixed to put it mildly...

Re:This is what Ronald Regan protected us from

[hedwards]

I'm sorry, but that's bullshit there. Again, it's profitable to screen people and the treatments themselves are very expensive. What's more, we have a tendency to keep treating people that are probably best just allowed to have their dignity. Most Americans don't want to be hooked up to a ton of machines when their time comes, but when it comes to what actually happens, they usually wind up hooked up to a ton of machines.

I'm not sure how your assertion disproves my assertion. Doctors in the US over test patients.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Did you actually have something of substance to add besides simply calling him a liar?

Re:This is what Ronald Regan protected us from

[hedwards]

I have anecdotes as well. The year after it kicked in, my insurer sent me a check for the premiums they collected, but didn't spend on health care. This year my premiums didn't rise at all. The year before Obamacare, my rates rose by nearly $15 a month, which for a health plan that was only charging a bit over $100 a month, that was a huge increase.

Bottom line is that insurance rates have been increasing by an average of 12% for a long time, blaming Obamacare when it hasn't even finished coming into effect is just plain ignorant.

Also, it's less than 2 weeks before the insurance exchanges open up and a ton of options come on the market. Right now, I can't change my insurance due to multiple misdiagnoses that the doctors won't remove, but in two weeks I'll have something like 20 plans to choose from.

Re:This is what Ronald Regan protected us from

[hedwards]

And you failed to provide any evidence in your post either. Just another misinformed moron spreading FUD about the health care overhaul without even bothering to understand what the reality is.

Re:This is what Ronald Regan protected us from

[intermodal]

So taking away the inexpensive plans by adding tonnes of new minimum requirements for all plans across the board, simultaneously poisoning the ability to save money by choosing plans that actually suit the purchaser's needs, is your idea of making things more affordable? I'm just not seeing it. Especially when I had coverage in 2011 that cost 25% of what the cheapest thing available to me today costs. But if you want to keep making ridiculous and flagrant false declarations, be my guest. It hurts your position more than it helps it, you can rest assured.

Re:This is what Ronald Regan protected us from

[intermodal]

I love how you call me misinformed when I'm one of the people who has been priced out of the market by this so-called "affordable" health care abomination.

Re:This is what Ronald Regan protected us from

[intermodal]

Well, I was thinking of adding an empty, rhetorical question, but you seem to have taken care of that for me. thanks!

Re:This is what Ronald Regan protected us from

[hedwards]

I love how you pretend like this hasn't been a problem over the last couple decades. Magically when they passed the ACA suddenly the health care rates became unaffordable. The reality is that the ACA was a conservative proposal that the Democrats barely got passed because it was the best they could do.

The fact that you're willfully ignorant of the trend in insurance costs is adequate justification for calling you misinformed.

Re:This is what Ronald Regan protected us from

[intermodal]

Have fun with that.

Re:This is what Ronald Regan protected us from

[intermodal]

Wait, are you trying to argue Democrat/Republican with an independent small-L libertarian? I think your talking points were written to bait a very different audience. Can we skip to the part where "hilarity ensues"? Trying to get me to defend either major party in this country is like trying to convince Israel that Hitler was a pretty OK guy.

I'd object to Obamacare coming from either major party, and so far the evidence is working against it, despite your optimism.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Yes, it turns out it boils down to the same thing.

Money.

Especially since what happens is usually you end up paying some money for clean air and water rather than for the company made not to pollute.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

You mean the same shit that already happens today?

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

Haven't you caught on the the naming system they use? It's the opposite of what they do. Remember the patriot act?

Re:This is what Ronald Regan protected us from

[Kalriath]

Oh, you mean malpractice insurance?

There is. Its very existence of course drives up your healthcare costs.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

there is not any evidence in play until
1 the regulated exchanges have been working for a while, they are supposed to drive the price down but it remains to see how well it works in practice.
2 The long term effect of the insurers being forced to pay for preventative care costs directly, rather than more expensive emergency care later through indirect means, starts to impact costs.
I would like to think that both will be positive but it will take at least a year for the former and several years perhaps even a decade for the latter to have it's greatest cost cutting effect, though the start should be visible again by the end of the year. Until that point for, or against, we are still operating blind.

Re:This is what Ronald Regan protected us from

[riverat1]

You're already paying for it in the form of expensive emergency room care when they can't pay and the hospital ups its rates to cover the uncompensated care.

Re:This is what Ronald Regan protected us from

[Anonymous Coward]

What exactly is the difference between health care and clean water?

Both require investment, both need paying for, both incur costs on their "providers" (in the case of water, all those companies who are restrained from pouring pollutants into it). The only big difference I can see is that water is something you need continuously, whereas health care is something you only need occasionally.

Re:This is what Ronald Regan protected us from

[will_die]

There were two studies earlier this year that found the reason.
1) The USA has alot of children having children and there is a better chance of the baby having problems and dieing. The USA counts birth from the first breath of the baby which is not used by other countries. This and the death rate from illegal people have babies really brings down the USA overall life exceptacy.
2) The USA leads the world in accidents and young people performing possible life threating activities. However the reports pointed out if have an life threating accident or something else you are more likely to live if you make it to a USA hospital.

Re:This is what Ronald Regan protected us from

[intermodal]

I've caught on to their system, but I refuse to play along because most of our countrymen seem not to have figured out the same.

Re:This is what Ronald Regan protected us from

[bugs2squash]

Inexpensive private healthcare is available in the UK. It takes up where the NHS leaves off, so you're only paying for the difference in coverage.

Re:This is what Ronald Regan protected us from

[mi]

That's awesome. However, if I am unhappy — for whatever reason — with how NHS covers what it does, I need to lobby my lawmakers to lean on NHS to change. I'd like to be able instead to just switch to an alternative the way I can switch to a different pizzeria or supermarket.

Re:This is what Ronald Regan protected us from

[volmtech]

The American population is 12% African, almost 20% Hispanic. Any statistic involving health or crime is greatly inflated by these groups. Comparing the US as a whole to Western Europe which is full of "Western Europeans" will of course reflect poorly on the US.

Insurance is not care, it's a payment system. To control cost we need to limit the incomes of doctors, hospitals, and drug companies. Why are there so many foreign born and trained doctors in the US? Money, money, money! When controlling cost means shipping your Mercedes to the shop by truck or air, nothing is "affordable". Most people only need to limp a Kia to the corner garage, but medical care is all Porsches and gleaming showrooms.

NHS software: open source it !!

[Anonymous Coward]

So, with all that money spent,
how can we, the taxpayer, get the
code open sourced ??

Re:NHS software: open source it !!

[grasshoppa]

That much money spent on a failed software product? I think releasing it in the public domain would violate a dozen geneva convention regulations. It could be legitimately argued that the code base would constitute a weapon of mass destruction.

No, the only way to effectively handle that steaming pile of...code...is to destroy all copies but one, which you then entomb in a sealed vault miles under the surface of the earth with warnings in every language imaginable.

Re:NHS software: open source it !!

[RoboJ1M]

I say we dust off and nuke it from space.
It's the only way to be sure.

But yeah, source code please or it never happened and we want a refund.

Re:NHS software: open source it !!

[Anonymous Coward]

... every language imaginable... including Welsh.

IT employees rejoice

[advid.net]

Usually when I hear about a doomed IT project, I share my optimism with other colleagues:
this means that we still have plenty of IT job offers guaranteed by these failing managements.

Re:IT employees rejoice

[kaur]

Indeed. The money did not disappear into a puff of smoke, but was distributed among Slashdot readers and the rest of UK IT industry. (Of course, various consultants and business process analysts got their share, too.) Better than spending resources on agriculture or education, any day!

Re:IT employees rejoice

[advid.net]

Of course you're right to ironically point out that tax payers money should have been better spent, especially for struggling sectors.

In that case I would rather have mixed feelings: too bad for the country, those wasted resources are a shame. Still good news for IT jobs.
And employees are not the ones to blame. We are not parasites fed in an ecosystem maintained by a deficient management. Or are we?

Re:Think of the shareholders!!

[Anonymous Coward]

I'm going to try not to feed you.

THE BRITISH WAY !!

[Anonymous Coward]

Get yourselves into a mess and hope the Americans will save your asses !! Again !! Obama don't play that game !!

Oblig.

[Anonymous Coward]

Have you tried turning it off and on again?

Re:Oblig.

[Eunuchswear]

Well, yes, they did.

Price went up by a billion or so each time.

(Haha, only serious).

To put things into perspective

[Anonymous Coward]

At an average salary, that's roughly the equivalent of 250 THOUSAND man-years. At that sort of price I expect nothing less than being diagnosed by the singularity itself.

I'll Save Them

[khr]

I'd be more than happy to save them a lot of money by abandoning a similar system for a mere tenth of that amount!

Re:I'll Save Them

[sycodon]

I think it could all be done with Excel.

Re:I'll Save Them

[Anonymous Coward]

That's nothing. I could abandon a system for a twentieth of the cost in half the time!

Wait, aren't these the guys that defined ITIL?

[sandytaru]

Isn't the British government supposed to have created the friggin' world standard for proper service management of IT projects? Do they not read their own material?!

Re:Wait, aren't these the guys that defined ITIL?

[Dann25]

Dont forget PRINCE (http://en.wikipedia.org/wiki/PRINCE2)

Re:Wait, aren't these the guys that defined ITIL?

[RoboJ1M]

Yep, sadly I think at some point everybody decided private companies would do it better and cheaper.
When all it really turns out is they did precisely *nothing* for 10 billion pounds.
If they are interested, I'll write the entire thing myself for just one billion.
I am literally one tenth the cost, it's a deal, it's a steal, it's the sale of the f*****g century.

Re:Wait, aren't these the guys that defined ITIL?

[sandytaru]

I'll be your PM and we split the money. You do the code, I'll write all your documents. Deal?

Re:Wait, aren't these the guys that defined ITIL?

[Xest]

"Isn't the British government supposed to have created the friggin' world standard for proper service management of IT projects?"

Yes. That's the problem.

Meanwhile everyone else that doesn't waste their time with ITIL because they instead just hired competent staff who don't need to be told the obvious or forced to follow some rigid process even where it makes no sense to do so for the sake of compliance gets on just fine.

Monolithic vs. standards

[gjh]

Surely for a few tens of thousands of pounds, it would have been better to publish and API for storing and modifying the info on (secured) web servers locally in a way that could be indexed and catalogued separately. Then, incentivize private firms to make and sell software to surgeries and hospitals that provide the API. Why do people always go for monolithic top down solutions for these things?

Re:Monolithic vs. standards

[Anonymous Coward]

Why do people always go for monolithic top down solutions for these things?

As you can figure out from the story, money. $16 billion going somewhere, and not actually having anything worthwhile to show for it, except money in important peoples pockets.

Re:Monolithic vs. standards

[durrr]

Because the moron with the cash listens to the psychopath that wants an early retirement.

The moron with the cash doesn't even have to spend his own cash, it's tax money after all, so he just signs whatever sounds good and goes home.

Re:Monolithic vs. standards

[LeadSongDog]

Yea verily, every large software system that works was made from small software systems that worked. Since they have to trash this one, why not have a look at http://freecode.com/projects/openemr

Re:Monolithic vs. standards

[Xest]

Because UK public sector contracts are usually written and decided by an old boys club whose knowledge is about as relevant to today's computing as Julius Ceasar's might have been.

Honestly, they choose monolithic because they only know monolithic and because all their procedure documents and project management standards only cater to monolithic.

There's very little young blood in UK public sector, and equally few older folks who know what they're on about. The problem is that it offers insanely good pensions so most people in management positions are just the people who have been there a while and wont leave because they're waiting it out until their gold plated retirement.

Every now and then you find a public sector IT department led by someone old and experienced who genuinely has a passion for IT and has as such kept uptodate and those are the few areas that have those rare IT successes, but I suspect they make up 5% of public sector in the UK at best.

Re:Think of the shareholders!!

[Eunuchswear]

Couldn't that $16 billion have been better spent devising sneaky new ways to deny medical care from the people paying into the healthcare system?

That would be alot better for the shareholders and executives, and would probably only kill a few thousand people.

What part of "UK NHS" do you not understand?

Anyway, everybody is thinking of the shareholders, the lucky shareholders of CSC who got 10 billion GBP for nothing.

Zowee!

Contractor Failure

[thoth]

Before all the anti-government bozos show up to point and laugh:

However, 10 years on CSC has still not delivered the software and "not a single trust has a fully functioning Lorenzo care records system". This failure, the report said, was "extraordinary", while CSC was accused of a "failure to deliver" and "poor performance".

Yeah, that's a private corporation failing to perform/deliver. They're too busy focusing on cashing their checks, locking in their revenue stream, and paying their executives to actually deliver the product they agreed to.

What the government is bad at is managing contracts:

"systemic failure" in the government's ability to draw up and manage large IT contracts.

"there is still a long way to go before government departments can honestly say that they have learned and properly applied the lessons from previous contracting failures."

CSC should be sued for breach of contract, sued for fraud, sued for damages.

Re:Contractor Failure

[RoboJ1M]

Too slow and expensive.
Seize all assets and nationalize them, fire every manager and conscript them into the army.
Good lesson for all the others, play the game and the rewards ($16bn) are tremendous but the risks come with catastrophic consequences.
>-)

Re:Contractor Failure

[Kjella]

What the government is bad at is managing contracts

Well, if you broaden contracting to the whole concept of being a professional customer with requirements, deliverables, change orders and decision making. It's not the lawyers to set up a proper contract that is missing, it's that the "the product they agreed to" is some vague concept that is all but impossible to spec, estimate or deliver. No contract can give you cost control when the essentials of the contract are so bad, it's just trying to polish a turd.

Re:Contractor Failure

[Anonymous Coward]

Poor acountability is bad wether it's the government or private sector. The government is particularly adept at wasting money without accountability or results. Mostly because the money isn't theirs, and all they have to do is raise taxes to get more. Vote em out? Sure, that's an option, but you're just going to get a new round of clowns that are equally inept and disinterested in the public at large. We're not anti-government because we're pro corporation. We're anti government because as bad as corporations can be, the government sucks much more. Corporations can at least be controlled by regulation, competition, shareholders (who watch their money a whole lot more carefully than the GAO), and the free market. The government just bends you over, skips the vasaline, and goes to town.

Re:Contractor Failure

[ColdWetDog]

Too slow and expensive.
Seize all assets and nationalize them, fire every manager and conscript them into the army.

3. Invade Great Britain.
4. Profit !

Re: Contractor Failure

[RoboJ1M]

Don't like 3, I live here way too much.
Besides, we've got at least 3... wait, no, 2 Warships left.
One, admittedly, is the Isle of Wight ferry, but we reckon we could at least keep the Belgians out...

How much would EPIC cost in those circumstances?

[Anonymous Coward]

Epic is pretty much the standard healthcare system in use in the larger places in America, and it costs millions a year to support. I'm wondering how much it would cost to use something like that, and have it in every department in every hospital in the UK, and whether it would cost more. Admittedly they'd have a working product at the end.

Clinical records are hard

[benjfowler]

Clinical records are the last big domain that resists computerisation.

Why? Because it's really hard to get right. You have a massive quagmire of competing interests, egos, a very complicated domain model and legal/regulatory environment that changes constantly and is different in every country. And to top this off, you have privacy whingers.

Common sense suggests that if it was an easy problem, they've have cracked it by now. As it is, I walk into my local GP for a checkup, and behind the reception, there's a massive wall of paper patient records. In 2013.

You have government of course (let's face it, governments have few very good people, and hire literally millions of bozos), but I'm not sure if it's any worse than the privatized, Balkanized carpetbagger-fest that passes as a health system in the US...

Absolutely not excusing the disgraceful and self-serving behaviour of the big integrators here (CSC and BT, amongst others), but they've blown billions for a reason.

Re:Clinical records are hard

[Anonymous Coward]

As it is, I walk into my local GP for a checkup, and behind the reception, there's a massive wall of paper patient records. In 2013.

There should be paper records. Paper records are much more difficult to falsify than computer records, so there is a strong chance that the paper record will still say what was originally written on it when you look at it later. With electronics, you can never be certain. This an important consideration in places where reliability of the information is very important, such as legal, military, and medical.

The point stands that they should also have a computer system that the paper records are a backup of.

Re:Clinical records are hard

[slimdave]

Speaking as a dyed-in-the-wool data modeller and corporate database guy, I wonder what the problem would be with throwing all of that data modeling and medical coding stuff away and just letting people write into the system what actually happened, exactly as they do with paper records. Some tagging for "this was a procedure" or "this was a test", but free text the rest of the way.

At least the information would then be accessible through a computer to far-flung locations (Norwich) in case it was needed there, it wouldn't be in some doctors squashed-spider scrawl, and it would be ultimately flexible. Of course it would not be as amenable to analysis and reporting, but it would be something.

Is this failure just the result of seeking a gold-plated solution?

Re:Clinical records are hard

[slimdave]

To the delight of many dubious business types, the shredding of paper is very easy though.

I was going to add that it should not be beyond moderately difficult to put in place a secure backup and audit trail, but these guys can't even get the basic system off the ground.

Re:Clinical records are hard

[xaxa]

The two GPs I've used (both in London) have had electronic records. The first, which was the GP attached to my university, had what looked like quite and old system -- full-screen CLI based interface.

The second has a Windows desktop application. I've only seen it twice. It told the doctor I was missing a vaccination, and she set a thing to automatically remind my in 1 year to get the second part of the vaccination (for better immunity).

However, I don't know what would happen if I was taken to hospital and they wanted my records, or if I felt ill and went to a GP somewhere else.

(I had travel vaccinations for a trip to China. The doctor offered my a "Little Red Book", which I thought was very appropriate. It had a teddy bear on the front -- children get them so their parents can track what vaccinations they've had while at school etc.)

Re:Clinical records are hard

[Anonymous Coward]

There are regions in Spain where clinical records are nearly fully computerized. Only papers you carry with you to the doctor are for you; doctors already have everything on their screens.

It has taken decades of centralization and standarization of both medical practice and software, with every hospital fighting with tooth and nail to protect every little trivial detail of their work nobody else in the world seemed to find neccessary at all, and a lot of records are still simple unstructured text or image blobs, but we are getting very slowly there.

If only we would not have to suffer the so-called standardization to that absurd pseudo-standard called HL7, which enforces nearly nothing useful, tons of boilerplate and empty or fuzzy as hell fields for something which would be much better done with plain old web services...

Re:Clinical records are hard

[johanwanderer]

Another use of the paper record is when they need to re-input all that into the new systems they upgrade to.

It sounds like a joke, but it's not. Happens all the time. These office systems are so obscure that the new vendors often time don't even bother to migrate the data, forcing manual data entry for all the relevant records. It's very sad.

It's the same when these "office" systems have thousands of connected offices. Each would still have to re-enter its records.

Re:Clinical records are hard

[Virtucon]

You can't really. Medicare for example has mandated that specific codes be used for billing and with that the rest of the industry has followed suit. These are called CPT codes and you'll see them on every medical bill you get here in the US. You now have multiple generations of doctors, nurses and medical coders who know what the codes mean and how to enter them for reimbursement but the doctors usually keep their own notes because the billing codes don't form a diagnosis or a treatment regimen, they just indicate how the doctor gets paid. It would seem that a logical step would be to embrace that and continue with it. You could keep original notes for reference and use Natural language translation to even come up with codes, i.e., "check BP 120/84 pulse 34 and administered 2 200mg tylenol at 1PM" That's two separate codes (93784 and J8499) in terms of billing but one line written in your chart. Given how the NSA and the FISA courts have recently trounced on our civil rights, I'm not sure how we can say that HIPPA still matters but if it does, maintaining tight control over who has access to medical records does come into this and how you create a secure system from a medical records perspective is a difficult task.

Re:Clinical records are hard

[ADRA]

Your companies should find better integrators. Data Migration is trivial and infinitely cheaper than manual re-entry (even if that was possible).

Re:Clinical records are hard

[Anonymous Coward]

Doesn't Taiwan handle it pretty well already?

Re:Clinical records are hard

[Anonymous Coward]

I'm 34, and my GP's have had computerised records going back most of my life (I can remember as a child of about 7 going to the new surgery and there being terminals on the desks). However, my new daughter recently had an emergency hospital visit. When we went to the doctors for routine jabs about 10 days later the computer system had all the details on, and I commented that the new joined up NHS computer system must finally starting to deliver. I was told that this wasn't the case, that the computer system was surgery specific and the details were there because the hospital sends a FAX to the surgery where someone re-keys the information. In 2013.

I can't say I was particularly impressed, but I suppose it is better than waiting for the soon to be extinct postal service, or carrier pigeons.

Why aren't these IT modernisation programs delivered incrementally?

Re:Clinical records are hard

[Anonymous Coward]

As we don't *need* specific codes I don't see why we couldn't just adopt that kind of system and use free form text where there's not an appropriate code.
  As I understand it (might have changed by now) the US/HIPPA uses X.12 format interchange files.

We sould just define a suitable interchage format (at a fraction of a fraction of the cost of what's gone on so far) and the market could develop multiple competing applications which all speak the interchange format (certified by a government agency) and be responsible for the cost of their own systems.

  Practices would download record from a central repository and essentially upload diffs. They would also receive diffs from the central repository after updates from hospital/a&e procedures. Any failures to merge patches to the central repository could be resolved manually.

Re:Clinical records are hard

[Kalriath]

Oh dear god, HL7. I know some people on the committee that works on that in my office, should I beat them with a cricket bat for you?

Re:Clinical records are hard

[slimdave]

I think that your response illustrates a very different approach and purpose -- in the US the computerised record is for billing, but in the UK the computerised record could simply be a description of symptoms and treatments.

There's no need for the UK to follow the medicine-as-a-profit-centre approach of the US.

£10 Bn? Not too bad

[petes_PoV]

After all, the olympic games cost that much - and they only lasted 2 weeks.

How to spend 16 billion

[Anonymous Coward]

I am trying to figure out how to spend 16 billion on a system that wasn't even turned on. Let's buy some servers. In fact let's buy one server every doctor in England for 10,000. Then let's spend 10,000 installing it. There we have blown 5 billion. Now let's hire some programmers: I wouldn't pay them less than 100,000 per year and I wouldn't feel comfortable hiring less than 4000 for the last 5 years. There is another 2 billion. Now let's buy a Boeing 777 .25 billion. Now let's headquarter in the 30 St Mary Axe (the big pickle shaped building in downtown London) we'll go way past asking and offer them a billion (Leaving us with a bit under 9 billion left) So now let's build a data center (Google can spend 1 billion on a data center so we'll spend 2). Now a good sized data center is around 100,000 square feet but often have plain ceilings so we will cover them in gold leaf ($25 per square foot/$125 applied) So 12,500,000. Now what data center isn't complete without a zoo? Another 30,000,000. Now let's convert the old records of everyone in England (60,000,000) for this we will just blow the rest of the money at 100 per record per person and spend around 3 billion (which is one of the few semi-legitimate expenses in this whole thing)

Now let's look at that last legitimate expense. Would you need all the old records converted? Does it matter that I broke my arm 30 years ago? I would even go so far as to say that the only data that should have been converted would be ongoing records. That is if I go in for an ongoing problem after the new system was deployed then that problem would be entered an backdated. So even the old record data could be a huge waste of money. Also any old record porting would be fraught with errors making the data fairly useless statistically.

My other guess was that this system was going to do some kind of stupid big bang approach. That is they were probably planning on shutting down every other system and then turning this one on. This would be stupid on many levels. The simplest being that they are then largely stuck with any design flaws. But if they had deployed a test system in a community of 5000 then they could roll out a few different systems until they felt good and then tried a small city of 50,000 then a few more small cities and then a region and so on. As everything fell into place and roadblocks were discovered and eliminated the deployment costs would just keep getting lower and probably be a tiny fraction of the first few tests when they did do the nationwide deployment.

I suspect that if you tried deploying on a nationwide scale in one go the system would have all kinds of WTF. What is the difference between an arm that is broken and a broken arm. Why can't people live in Liverpool? Why can't I mark a patient as dead? Why do you keep sending questionnaires to people who are in a vegetative state? How can a man be marked as pregnant? How can a fetus be marked as pregnant? Why do you insist on filling in the occupation of newborns?

But my real recommendation would be to do something radical and cool. You go completely opensource. You have a core architecture team who have the long goal in mind but you begin with all the low hanging fruit. Maybe the system for scheduling appointments with specialists doesn't work very well right now so that is the first and only feature and you deploy it. Then you move forward feature by feature. But in every case you tell people what is needed and any standards available. So you have some guy just send a patch with the entire share-an-x-ray system. Another guy does the share-an-mri system and so on.

You would also have a team of programmers that would be involved in high priority features that don't seem to get much love. And another team of programmers who just make unit tests for everything.

The beauty of such a set-up is that you can hire out various sections to as many companies as you want. Little 3 person companies or 100,000 person monsters. Plus with a continuous stream of volunteers. For this I would budget less than 1 billion.

Re:How to spend 16 billion

[Anonymous Coward]

My other guess was that this system was going to do some kind of stupid big bang approach. That is they were probably planning on shutting down every other system and then turning this one on.

FYI, October 1, 2014 is the date the United States will be shutting down every other system and then turning on their new one.

It was supposed to be October 1, 2013, but too many organizations were unable to be ready. Interestingly, the same percentage of organizations that said they couldn't meet the 2013 deadline also say they won't make the 2014 deadline either.

Re:Think of the shareholders!!

[smooth wombat]

the lucky shareholders of CSC who got 10 billion GBP for nothing.

Sort of like the health insurers in the U.S. who have gotten a multi-million dollar windfall by people being forced to buy something but won't use.

Straight into the pocket of Blair's pals

[Anonymous Coward]

This IT project did NOT fail. In the UK, this is the primary form of political corruption. Government ministers give massive projects to their cronies, receiving astonishing kick-backs and the 'employment' of their family members at the heart of these fake endeavours. The 'leaders' of these projects are people who are ALWAYS promoted to the House of Lords at some point. Meanwhile, the project activates endless levels of sub-contracting, so that the people at the bottom doing the real work are separated by as many sub-sub-sub-sub contracting shell companies, ensuring they neither care nor have the money or infrastructure to stand any chance of getting the job done.

After a few such failures, Blair's scum then justify massive sub-contracting to places like India, where some form of working system is spewed out, albeit of the lowest possible quality imaginable.

In China they shoot officials for engaging in corrupt practices a thousandfold less significant than what is commonplace with almost every Westminster politician. However, in the West, it is considered a perk of being in political office.

should we be helping?

[markhahn]

as a bit of a strawman, I'm suggesting that we IT people have a moral obligation to get involved in projects like this. sort of the way doctors are obliged to help any patient that presents, regardless of who they are or what they've done.

these sort of megaprojects seem to be self-justifying in some weird way: managers who don't know what they're doing adopt an incredibly conservative attitude toward risk management when any large project is proposed. once that phase-space is entered, it's an upward spiral to oblivion, since the project becomes more and more scary, and gains a kind of management momentum. the event horizon is when it exceeds the fear threshold of the strongest and/or highest-up manager.

a major part of the problem is that these projects happen in a domain where money is funny - a bit made up, subject to arbitrary stretching (or inflation). certainly governments, but certain kinds of businesses, and definitely public institutions. (the higher ed landscape is littered with smoking radioactive craters of failed ERP projects.)

typically these projects are considered internal - improving the business process, and so not really offered for public review. but maybe that shouldn't be the case, at least for branches of government.

Re:Think of the shareholders!!

[I'm New Around Here]

the lucky shareholders of CSC who got 10 billion GBP for nothing.

Sort of like the health insurers in the U.S. who have gotten a multi-million dollar windfall by people being forced to buy something but won't use.

And yet, it will still cause most of them to close within a decade due to huge medical payouts for a small fraction of those people.

That is assuming President Obama doesn't waive the individual mandate for everyone like he did the employee coverage mandate for businesses.

Re:Think of the shareholders!!

[__aarzwb9394]

At whose request did they spy on Miranda?

Re:Think of the shareholders!!

[Anonymous Coward]

At whose request did they spy on Miranda?

GCHQ, trying to avoid more of their dirty secrets being exposed in The Guardian.

Re:Think of the shareholders!!

[Anonymous Coward]

Smart move. Who the F cares about the UK anyway? The UK is worse than Zimbabwe these days. I'd recommend anyone to avoid that shitty place like the plague. Why? Because it is the effing plague. The UK is nothing but lost glory. It's not big brother, it's the whole big effing family spying on you. Ask David Miranda.

And to the Brits modding this down. You may mod me down, but deep inside you know it's true.

Why does the government use government contractors

[LostMyBeaver]

Throughout my life, I have never heard of a government contractor completing a project anywhere near on budget or on time. I assume it must happen sometimes, but what their incentive to do so?

The bidders come in, underbid each other to an unrealistic level, pump out a bunch of documents claiming they can accomplish a project without any proof of actually understanding the project.

The government pays a certain amount up front and some along the way and that money isn't used to develop the project but instead is invested in preparing for second round funding and lobbying for it.

The people who bid the initial deal are fired with gigantic golden parachutes for gross negligence.

Papers and stuff are assembled to make it look like they project is far enough along that the government can't possibly justify dumping the contractor and feeds the contractor the "Real financing" which they should have asked for when they initially bid.

The project is then overstaffed through an employment/consulting agency which charges 400% of what they're paying the employees which happens to be run by one of the guys fired for gross negligence.

Management is constantly promoted and the developers who actually can do the work are promoted to management several times ensuring that at no point in time does anyone actually have a good overview of the project.

A product goes into testing only to find out that instead of a medical billing system they wrote a medical pilling system for pharmaceutical management.

A new budget is approved to adapt the pill pusher records to hold medical data for patients.

Rinse and repeat.

This is not even something we need to be surprised about. These people are thieves and they play their hands the same way every time. Wouldn't it be better to feed all the bidders the startup money for the project. Then as milestones are met, the companies not managing to keep up lose their budgets until there's only one? It's a massive amount of wasted energy and work, but the project will probably come in at much less money then if they're managed in the classic sense.

Re:cheaper...

[larry bagina]

lol. Unfortunately, most religious conservative types get upset over that. Meanwhile, Barack Obama would go back in time and personally abort himself if he could.

I support abortion, for religious reasons. Think about it: Jesus of Nazareth died for your sins, right? So why can't Jesus of the Ghetto die for them, too? You know sacrificing virgins and what not, but who is more innocent and pure than a baby that hasn't even been born?

Also, consider this: The Aztecs and their god Quetzcoatl liked human sacrifice. Now, Quetzcoatl was white with blue eyes and blond hair -- just like Jesus (and Hernan Cortez). Coincidence? According to the Book of Mormon, Jesus was reborn in North America.

Just wait to Obamacare eRecords

[gelfling]

It will dwarf this and it will never be completed or work at all. And 98% of the world will be done in China and India. All Hail Dear Leader.

Re:How much would EPIC cost in those circumstances

[Kalriath]

In my experience, any product designed for the American market is essentially useless in national public healthcare systems. Too much of the systems are based around the batshit crazy private healthcare provider with multitudes of private insurance funders.

But then again, with CSC's acquisition of iSoft, they have all they need to deliver a UK-centric healthcare system without actually having to develop anything.

And if not, I'm sure Orion will step in and sell them something.

Re:Why does the government use government contract

[splutty]

Aha. It's good to see other people have worked with Accenture! Or IBM. Or Infosys. Or.......

Mediawiki

[NewYork]

is a good start for such complex systems.
"A complex system that works is invariably found to have evolved from a simple system that works." --John Gaule

project initial projected costs?

[astar]

If I read correctly,

When they decided to pull the plug,

The final cost, including the funeral, was to be about 6*1.6 billion dollars and the corpse is still rotting and the cost is 70% higher than that estimate. So what was the initial estimate for successful deployment?

how could this ever work?

[Anonymous Coward]

Does anyone know the original estimated budget.
Does a development project with a budget in n * 10^9 ever achieve success?