I referred in a previous post to the National Audit Office's reports on the National Programme for IT in the NHS i.e. NHS Connecting for Health. In their first report, dated June 2006. the NAO had the following to say about the NHS contract with Microsoft:
"In November 2004 NHS Connecting for Health negotiated renewal of the Department's NHS-wide licence for Microsoft desktop products, which NHS Connecting for Health estimates will save £330 million over nine years with a firm commitment only for the first three years.
Microsoft agreed that the price paid by the NHS would continuously match the lowest charged anywhere in the world. The agreed price for their committed volume was substantially lower than that previously negotiated by the Office of Government Commerce (on a non-commitment basis) on behalf of UK government users. Microsoft also committed to spend £40 million on developing an NHS user interface to help standardise healthcare applications for clinicians, increasing efficiency and reducing the risk of clinical error.
NHS Connecting for Health also considered open source solutions for NHS IT but decided against doing so for two reasons;
The NHS already had an installed base of 500,000 Microsoft environments and users were familiar with Microsoft, and;
Open source solutions are not necessarily cheaper: they may be cheaper to acquire but the total cost of ownership is material when ongoing support, maintenance and training for users are taken into account."
The Office of Government Commerce (OGC) is a department of HM Treasury responsibly for providing advice to all government departments, both national and local, on contracting etc.
In 2002 it produced a report "Open Source Software - Guidance on implementing UK Government Policy". It followed this up with a report "Open Source Software Trials in Government".
It is widely recognised in the IT industry that Unix or "Unix-derivative" operating systems (e.g. Linux) are far more appropriate for servers, particularly webservers. Hence the DoH/NHS will be storing its electronic patient records on Unix (Solaris) servers using Oracle (rather than Microsoft's SQL Server or even the open source MySQL) as its database software.
The desktop environment is more controversial, it being cited that Linux desktops are "insufficiently mature".
The OGC seeked to examine this along with the cost benefits of using open source software (henceforth OSS).
I have some limited experience of deploying Linux desktops to regular users - my employer donated some legacy machines to respectively the national radio station, the national television station, a local primary school and the local municipal council's library.
The machines originally ran Windows NT 4.0. As a government organisation and as Microsoft no longer supports NT 4.0 we had to wipe the hard disks and, after some evaluation, I installed Xubuntu Linux (a light version of Ubuntu Linux suited to machines with small hard disks and little RAM).
The first deployment at the national radio station was a disaster - as soon as I turned my back they had a local technician come in and install a pirated copy of Windows XP.
At the television they took to it immediately - two machines for video editing with firewire ports so they could hook up their DVCAMs and download video clips using the open source KinoDV and edit them using the open source Cinelerra suite. Machines were also provided to the director's secretary and the admin. department - pleased as punch, OpenOffice and Mozilla Firefox no problem at all.
The machine offered to the director of the local primary school couldn't even handle the memory requirements of OpenOffice so I made Abiword the default wordprocessor. Both OpenOffice and Abiword will save documents in a variety of formats including MSWord doc and plain text txt (useful for blogging as Google's Blogger does not like doc embedded headers).
One of the case studies in the OGC report is particularly relevant to this post - that of the Beaumont Hospital in Dublin, Ireland.
Prior to its adoption of OSS it operated a mixed environment of MS Windows and Unix. The hospital had 3000 directly employed staff, and used 22 Linux servers, 14 Windows servers, a Hewlett-Packard HP3000 mainframe for primary clincal applications and a HP Unix system for financial applications. In 2002 there were 1000 workstations.
The hospital was experiencing severe financial problems and started to look at where it could make cost-savings - including in IT.
The IT department came up with the following results and subsequent implementation, between using OSS and proprietary Closed Source Software:
Email, online forms, laboratory procedures and results, patient care records etc - and even X-ray imaging - could all be dealt with by OSS.
There was some resistance to the Linux desktop GUI - Beaumont purchased an e-learning course to deal with this.
GUIs (there are various) have come a long way in the six years since Beaumont made the change. As I related above, our relatively unsophisticated IT users here in Sao Tome have taken to the Ubuntu-family GUIs as ducks to water.
The OGC strongly recommends that government entities should not tie themselves into closed proprietry systems - the NHS have chosen to do just that!
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