Hyslop:

> If only because no-one will do it, here's an attempt to piss into
> the prevailing wind on GP-UK.

Always a 'risky' thing to do!

> --- Starting point: improving communication will be a good thing for
> healthcare.  Assumption: developments in technology can be exploited
> to improve communication.

No problems with that.

> Tricky bit: the NHS family operates a myriad of internal computer
> systems. Making them all use the same system is not an option.

Hence my love affair with the Web.  It is available to all platforms.

> Thing to avoid: anarchy of incompatible communication.  Reason: B
> cannot receive anything from A, greater costs to the NHS as a whole,
> inability of local clinicians to judge whether local standards are
> safe.

-  Granted,  but,  easily avoided:

-  I communicate with lots of people and organisations without any
anarchy at all except that of thoughts!

-  There are millions of people using effective and *free* protocols to
communicate everyday (IP/SMTP/POP3)

> Solution: specify the bits in between these computers, i.e. the
> standards which must be used if A is to be able to receive something
> sent by B.

See above,  unless the NHS wants to indulge in re-inventing the
square wheel all over again!

> Helpful extra: make available communications services which
> incorporate the said standards and which can be bought by A or B.

Sure,  no problem.

> Another helpful extra: use the communication infrastructure to also
> offer web stuff.

Obviously!

> Insurance: set up more than one communication service to ensure
> competition, but make sure that they inter-operate.

Not sure what you mean by "more than one comms service"?

> All done by: pan-NHS and profession organisations. IMG and Royal
> Colleages.  Who else?

There is a growing feeling that a great many are disfranchised and
powerless.  Solution??

> So far, so good.  Or can this logic be challenged?  No?  Well then
> the unhappiness must be to do with making it happen.  Several
> categories of unhappiness exist:
>
> 1.  The standards are daft.  Anyone got better standards which meet
> basic criteria such as proven robustness and availability/ cheapness
> of software products which support them?

You said it.  Better standards?  IP/SMTP/POP3.  Cheap,  often free,
certainly available and very robust.

(snip)

> 3.  The wrong suppliers are offering the communications services.
> Are their contenders to BT and Mercury operating nationally,
> especially when they submitted the best tenders?

What do you mean by "best tenders"?  Who decided what?

Of course there are lots and lots of better suppliers.  Only
yesterday I posted about U-NET providing services to JANET.  Are we,
at the coal face of NHS as it were,  not good enough?

> 4.  The prices are staggering (at last, says Ahmad!).  The prices
> quoted by Ahmad certainly are staggering - if compared to Demon,
> Compuserve, etc.

The prices that i quoted are the official BT prices.  It is not a
case of "at least says Ahmad".  And they *are* staggering!

>  But the key thing is that these prices are for a lot more than
> Internet, which essentially is offered as a freebie.

What?  I mean:  what is a lot more?  And,  what is the freebie here?

For 8 quid a month I get unlimited access to the Internet,  free
e-mail service,  full FTP access,  free web space,  full newsnet and
tons of free software,  and,  all it takes is a simple phone call to
set it up.  Now,  what is it exactly that NHSnet is offering more??

We haven't even begun to talk about charging for email!  And storage,
 and and and...

> So the comparison is spurious.

No,  it ain't.

> And anyway, considered NHS-wide, such prices are maybe of the order
> of 0.00001% percent of the total budget and save many times that
> amount while improving healthcare

But not of *my* budget.  Is the assumption here that *I* subsidise
the improvement in healthcare?  I do that all the time already and am
not prepared to do more

>. 5.  The NHSweb, being an intrAnet ring-fenceded by firewalls, is
> the wrong approach.

About bloody time too :-)

> How else to safely get helpful web page stuff to the clinical coalface?

Let's think about it.  Let's have a real debate about it in a
healthy partnership between IM&T professionals and the users.

> 6.  Not enough's being done to ensure everyone in the family gets
> hooked up. (if it's such a good idea, then why not come up with the
> dosh to kit everyone out and pay their running costs?)  Head office
> doing this means no local control.  Plenty examples of previous
> disasters of that ilk.

Why should this mean loss of local control?  I get paid by Head
Office evry month and I am still pretty much in control of *my* local
set up.

> PS  I don't work for IMG and can't therefore speak for them.
> Scotland has it's own strategy.  In many respects the words above
> apply.

I  believe that this List and IMG would  benefit greatly from knowing
what is going on in Scotland.  Most of the stuff up there is probably
on the right track :-)  :-)

Ahmad
______________________________
Dr Ahmad Risk MBBCh
home:     01273-688121
work:     01737-240022
fax:      01737-244660
web:      http://www.cybermedic.org/


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