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NHS e-Referral Service: What is it and why does it matter?

Charlotte Jee | Aug. 17, 2015
The NHS e-Referral Service has been beset by glitches since it launched in June. A seemingly minor setback perhaps - but here's why we should be worried.

That is why the problems with the service are so worrying: their knock-on effect on wider plans to digitise the NHS, which evidence suggests will cut costs, help to improve care and save lives.

A history of glitches

Choose and Book - now the e-Referral Service - has a chequered past. Although the NHS likes to quote the statistic that it has been used by 40 million patients, implementation from 2005 was repeatedly delayed and there were technical glitches throughout.

The problems were partly within the system itself, built by Atos, and partly as it depended on other components of the National Programme for IT.

The national programme aimed to move the NHS onto a single, central electronic care record but was cancelled in 2010 after costing £12 billion but delivering little functionality, according to the Public Accounts Committee.

It was the biggest government IT failure in UK history and did huge damage to the reputation of technology in the NHS. Senior NHS IT staff say the shadow it cast has made it harder to recruit IT staff even to this day.

Although Choose and Book did eventually launch and was used for about a decade until e-Referrals launched year, it has only ever been used by half of the potential population, according to the PAC.

Senior NHS IT bods promised they would take Choose and Book's failures into account when building the new system, but in April 2014 the PAC said it was sceptical e-Referrals would be used any more fully.

It called for NHS England to develop clear plans for how it will build confidence in the new system and improve its use.

Unheeded warnings

Unfortunately it seems some of the concerns about the service went unheeded before it launched this year.

The vision for the e-Referral Service was sound: build it using open source software, thus allowing it to integrate with other clinical services more easily than its proprietary forerunner, and use Agile development techniques to make it more user-focused, with the understanding that would encourage adoption.

However some have questioned have far this happen in practice.

"E-Referrals has all the hallmarks of a system that has gone live too soon before known glitches have been resolved and proper beta testing," said Tola Sargeant, director at analyst house TechMarketView.

"Given the history of Choose & Book and the issues with uptake (which had more to do with politics and process change than the system) it will be a huge shame if users' early experiences of e-RS are negative," she added.

Speaking to ComputerworldUK shortly after launch, NHS Patients and Information Director Tim Kelsey dismissed the problems with e-Referrals as "relatively minor and being resolved".


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