this must be controlled and in the npfit model it is, sometimes too tightly to allow the best care to be delivered. one concern is that gps and hospital doctors have given the project a lukewarm reception, citing a lack of consultation and complexity. key "front-end" parts of the programme include choose and book, intended to assist patient choice of location for treatment, which has missed numerous deadlines for going "live", substantially overrun its original budget, and is still (may 2006) available in only a few locations. the programme to computerise all nhs patient records is also experiencing great difficulties. furthermore, there are unresolved financial and managerial issues on training nhs staff to introduce and maintain these systems once they are operative. between 2004/5 and 2013/4 nhs output increased considerably. hospital admissions increased by 32%, outpatient attendances by 17%, primary care consultations by 25% and community care activity by 14%. hospital death rates reduced, especially in stroke. at the same time there was an increase in wages of 24% and an increase of 10% in the number of staff and increases in the use of equipment and supplies. as a whole nhs output increased by 47% and inputs by 31%, an increase in productivity of 12.86% during the period, or 1.37% per year. coalition and cameron government reforms royal college of midwives picketing the west middlesex hospital, isleworth. thousands of other nhs staff across england also staged a four-hour strike over pay on 13 october 2014. the return of a conservative-led government in 2010 coincided with another deterioration in industrial relations. the introduction of further private sector involvement in the health and social care act 2012 provoked mass demonstrations led by health workers, and some nhs workers also participated in a national strike over pay restraint in 2014. 2016 also saw major industrial action by junior doctors, protesting at the imposition of a new contract aiming to extend weekend working. the health and social care act 2012 did not extend patient choice as envisaged (as this policy subsequently took a backseat) but did lead to an increasing amount of the nhs budget being diverted to private providers. in 2019, doctors and mps warned that the ongoing privatisation of certain nhs england cancer screening services would lead to patient harm. in july 2019, it was announced that the nhs would be partnering with the virtual assistant amazon alexa to offer health advice directly from the nhs website.