Sunday 22 August 2010

(NHS ) A communicative diversion

This blog has been quiet for a while. Things twinkle as they happen and I think 'I must blog about that, it's interesting' but it doesn't fit inside the remit of this blog, nor the other one, and so it never gets written. So consider this a pre-emptive shot in a volley which I suspect will take in health, politics, society, change, communications and social media. For me, those subjects are tied very closely together because I see health, politics and society through a social media filter, as most of my news and information comes from that source - but I don't think that negates the ability to comment on those subjects, simply that my view might be offset by 45 degrees. As the title might suggest, I'll try and give some indication on what the subject matter might be in an effort to aid peoples manipulation of the insta back button manoeuvre.

Despite never giving birth, the event in most womens lives which necessitates a reliance on the NHS, I've been unfortunate enough to require health assistance on a few occasions. Being the sort of person who'd rather avoid interaction with complicated services unless absolutely forced to, I'm the kind of idiot who ends up needing twice the help initially needed because I leave it too long before mentioning there might be a problem. Currently I'm playing collect the specialist. Which is irrelevant to this post, except that it's not, because this is why I have discovered a fatal flaw in the NHS communication system. Or at least, I think it's ridiculous. Others may know why this state of affairs persist, and I'd be appreciative of being disabused of my perceptions but frankly, it's a joke.

It just seems important in this assumption jumping age, that I make it absolutely, completely and utterly clear that the NHS has actually saved my life on one occasion, is responsible for my teeth not resembling a disorganised graveyard, ensured I could see when I was 12 and we couldn't afford glasses, have sorted out untold results of my tomboy leanings and have done all of these things with patience, grace and kindness in a framework which is clearly, and I do mean clearly, screaming and groaning under the pressure which us humans are putting on the system on a daily basis. They've done their very best in helping a rather complicated problem become unravelled, piece by piece, and yes, sometimes some people are not kind or gracious or patient, sometimes the odd one or two people in the system are rude, ignorant and insulting, but my experience, on the whole, comes out with a clear and flashing 9 out of 10. I would be absolutely lost without them right now.

So, disclaimers out of the way, please tell me this.

Why does specialist A who I see on a 6 months basis, communicate with specialist B, who I see on a 3 month basis, via letter?

They work in the same hospital.

They work 1 floor apart.

It can't be the audit trail. Email leaves trails. Emails are stored on servers which are backed up. Emails can be enterprise vaulted, compressed into tiny little kilobytes, and forgotten about until needed to be retrieved for enquiries or analysis. Emails, more to the point, are instant. You don't have to read them when they arrive, they can be parked. They can even be farmed off to your secretary who can filter them, decide which ones are important, and flag them for you in a nice colour of purple so you know they're not that urgent, or red if they are.

Letters are flammable. They are not backed up. They are one instance of something which when destroyed may as well have never existed. They take a while to be delivered, they cost money to be delivered, hell they cost money to be printed. They are inefficient, temporary, damp ridden effigies of a pre-internet age. (Disclaimers here are made for letters between non-professionals. I'm not for a second saying they don't have a place, I'm really not, we're talking about professional arenas here)

So why the hell are two intelligent human beings, smarter, way way smarter than I, still talking to each other like the year 2000 never happened? What am I missing here? Am I missing something, or do we have a health care system which may be so resolutely stuck in a pre-internet age that we're never going to get them out again? Who's responsible for getting them out? Do they understand IT and it's possibilities, capabilities and limitations? Or are they contractors, another example of the national rip off, geeks gone to the other side who see only pound signs and not the ability to earn a decent living but also change the world in the process?

Sadly, I suspect the latter. Sadly, because once upon a time, I didn't believe there were good geeks and bad geeks. The figures coming out of Whitehall in recent weeks regarding IT projects have finally smashed that belief into pieces. Now I know there really are good geeks and bad geeks and that we need to find a way for government and the public sector to differentiate and pretty damn quickly because otherwise we will be forever stuck in a world where the NHS is 10 years behind the rest of the world and operating inefficiently because of it.

And I don't want that, and neither, I suspect, does anyone else. Apart from those bloody contractors who I could merrily put in stocks.


  1. Excellent blog, glad you wrote it. Totally agree. Its a shame all these clever people don't harness the benefits of the technology available and do a bit of joined up thinking.

  2. You don't understand how NHS contracts are awarded. Your doctors can't just invent a new system between them. They also have better things to do, such as fix you, instead of designing a communication system.

    You have quite blinkered opinions on contractors too. Why are they bad? You are right that the NHS system is in a very big need of overhaul but you don't mention that a lot of very good and important projects are going ahead using very skilled contractors. Not all the projects are overbudget or out of scope.

  3. Hi Anonymous.
    Firstly, I wish you weren't. It makes me sad you felt you needed to be. If I'm wrong, it's entirely totally cool to tell me so. I'm just a girl, I don't know everything, I just know what I see. The point of blogs, surely, is to be crowd sourced in the right direction if you're view point is wrong? It is for me, anyway.
    Secondly, fair point. Absolutely fair point. An old university mate is one of the good guys and he does his very best to quote correctly, bid properly, and when he wins the contract, I know he conducts himself ethically and properly. I know this.
    It's just...surely you agree that the system isn't right as it is and that some kind of professionally recognised body needs to monitor and accredit ICT professionals? The British Computing Society exists - have you ever heard of it?
    The problem I am having with blogging is that I could go on _forever_ explaining my own views and opinions but that's boring and results in wall of text crits. What I want is people like you to come and tell me and the others reading this what's actually happening inside, because from the outside, communicating by letter is ridiculous?
    Lastly, I humbly propose that those outside the process are looking in and asking questions and that a constructive response would be to acknowledge there is an issue and look at ways of solving it, not ignoring there is an issue at all and carrying on regardless lauding the good guys?
    I stand by my comment. These days there are good geeks and bad geeks. We have to ensure there is a method of discering.

  4. An all too common tale, I'm afraid of people like your consultants just not getting IT or seeing it has any relevance to their lives, and thus missing how it could transform the way they work, and make life better for their patients.

    Consultants are very, very busy people, many of whom have grown up before IT became embedded in people's lives and now don't have the time, or inclination to learn about it. And they are a very powerful lobby in the health system which will often stand up against any attempt to change the way they work. And, attempts to persuade them otherwise are doubly difficult in the NHS with its history of spectacular failures of enormous national IT systems, which tars anything IT-related with a similar brush.

    Many people fall into the trap of thinking the NHS is an integrated national system. The truth is that it is made of thousands of autonomous, self-contained units who have little communication with each other, and where resistance to methods which could improve those communications is strong.

  5. John> Is the failing on the part of the consulatants who are resistant to a change, or is the failing on the part of those whose job it is to sit and explain, patiently and clearly, what the benefits, pitfalls, opportunities and threats are of new technology? I fear no one is communicating with them, and that no one is enthusing at them, and thus they cannot see the return on the amount of effort that they see is required to engage with technology.

  6. Sorry, it was anonymous just because I wasn't paying attention to the form fields, I wasn't trying to hide.

    I don't think contractors need accreditation anymore than permanent staff do; the person responsible for hiring them and overseeing their work is responsible for ensuring quality of work.

    There's a misapprehension that contractors are all money-grabbing and have no care about the quality their work. I've never seen that, but that misapprehension seems to always be brought about by permanent staff in the same role who feel underpaid by comparison (which is like comparing apples to ducks, given the things that permanent staff get that contractors don't (pensions, paid holidays etc)).

    Undoubtedly some contractors are crap and don't give a toss about the work they're doing beyond extending their own contract, but that's exactly the same with permanent staff. In the case of contractors, their ability to hold onto their contract is based entirely on the quality of their work. The success of future contracts are often based on their references or on word-of-mouth so if anything they're more likely to be more diligent than permanent staff.

    I know a couple of people currently working as contractors on the same team on an NHS project (ironically to do with communications). I'm employing a couple of really decent ones too.

    You're right about the NHS systems straining at the seams though, but that's not really the fault of the teams involved in working on it. It's just been an over-complicated, messy, problem for a long time, with too many governments having their own 'solution' that doesn't join up well with the last half-implemented 'solution'.

  7. Aha, hello :O)
    I know many geeks - well most of my friends are geeks, so as a result, I know many contractors and I know what formula they use to calculate their rates and I understand and agree with that formula. It's not the money I have an issue's the implementation of the projects that money creates. Or rather...I don't think the contractors are perhaps being pointed in the right direction. Maybe that's it, that the people giving the instructions don't have a clue and so the end result is never quite fit for purpose because the original spec was wrong, perhaps because it was written by someone who didn't fully understand the tech?

    I just have this sneaky feeling tech and the understanding of it is at the root of the problem. If more people had the ICT understanding of Tom Watson MP, for example, would we be in this mess?

    I also understand legacy systems are an issue. But something has to be done because it simply can't carry on like this.

  8. This might be a better place for my ramblings!

    I agree with Rik about the contractors, seeing as I'm sort of one, having had customers contract us out to write software for them.

    Is it our fault that the customer doesn't understand, even though we've gone out of our way to explain in layman's terms? There's also a line that we won't cross, i.e. we're only responsible for installing and commissioning what we supply. If the customer has no IT and has issues with their infrastructure, why would it then be our fault? We've also got to be very careful what we touch - if we start interfering with the operating system for example, then the customer thinks then that we take responsibility for it.

    I think you saw my postings recently where I did a wasted 400+ mile round trip where the customer had not bought, never mind installed, some other piece of software that we required and hadn't done, even though they'd been told several times in writing and by phone.
    But then their IT is contracted out, and was solely the responsibility of their contractor to do the job that we required.

    So yes, I do in some part agree that there are some bad apples out there, but don't tar the rest of us with them.

    As for the NHS IT, the fault with that I would say now would be lack of money as they've spent it all on IT projects where it would seem that no-one was looking after them.
    I have actually installed several pieces of software for the NHS in various hospitals over the years, and I don't even think they ever used them, as we heard nothing at all after the installation!


  9. Hi Ste,
    I think I should have made it clearer in my post that I feel there are good geeks as well as bad geeks!
    I think as this conversation has progressed, I've realised the fault isn't actually with the geeks either. The problem is, there's no transparency, so of course none of us actually know where the problem is stemming from, so none of us can fix it, should some of us actually want to.

    I can believe that perhaps the tech isn't being used after installation. Someone needs to be questioning why that is, however, and fixing it. Not your job as a contractor, more an internal job, perhaps. No use commissioning tech for no purpose other than ticking a box and making it look like you're stepping into the 21st century!

  10. Lou, the biggest problem here with IT is, sorry to say it, the public sector.
    Because each department gets a certain budget to spend within a financial year, if they find they're not spending enough to hit that budget, from our experience (with the projects I've done anyway), is that they'll spend money on equipment and services that isn't really necessary, so that they hit their budget. If they don't spend their budget, guess what, it gets cut the next year as it doesn't seem like they need it!
    And they wonder why the taxpayer in the street is up in arms about how much tax they pay versus services given!

  11. Oops sorry, forgot to sign last post:


    (and last keyword was "strop"! :)

  12. So there's two issues. Funding systems and then making an informed decision on the implementation of the system the money is spent on.

    I understand people are frustrated. I'm frustrated too. But I want to do something to change the way things happen so they get better somehow. Unfortunately, I'm damned if I know how to do that. Which is frustrating.

    And I was _not_ throwing a strop! :P