Wednesday, 11 February 2009

NHS IT Strategy - Some Recommendations and Possible Solutions

Following my previous blogs in which I criticise NHS IT I guess it is only right that I should offer up some ideas and solutions to the problems. So here goes.

Organisational Reform Is Needed: Firstly assuming that NHS continues with its current structures and remit one has to make do with what’s in place and perhaps make some changes in the various established groups that are part of the UK Health sector. I refer to The British Medical Association, The Colleges of Dentistry, Nursing, Mid-Wives, Surgeons and other similar groups. These should be asked to take on the skills and quality management side of each of the professions, and if there are not similar organisations for para-medics, ambulance drivers, and hospital management, they should be sponsored and set up. These groups, which I would call Guilds, should not do anything that intrudes into the area of Trade Unions as the support and championing of the workers (cleaners to surgeons) should be via Unions whereas Guilds would champion quality and skills. Currently the BMA, for example, gets too involved in trade union type work while trying to ensure clinical excellence. This creates a conflict of interest which is never properly resolved and hence service, and the patients, suffer.

Understand That Our Health Is Part Of The State Of Our Being: It is not something managed for us by the government. Neither is it apart from how we live. It should be seen as part of the whole of life. Which means that our health systems must be integratable with our other life systems like; email, calendars, iPod, mobile phones, Facebooks and the like. Thus health systems have to be as user friendly and based on open standards and architectures which allow integration and assimilation. This would enable easier usage, and thus greater usage and uptake, leading hopefully to better health.

Empower The Health Sector Staff; by ensuring they are consulted and included in decisions and solutions design. Give them a part of the £18bln to spend within their team. In the previous blog I facetiously said it would be possible to give each person in the NHS £10,000 to spend on their personal IT and still have £3bln change left over for central solutions. If this £10,000 were pooled by team, or task force and all the members of the team voted on the best way to spend it, it is almost certain that this will give better solutions and value for money than the current Big-Brother-knows-best approach. After all – it has been shown that Big Brother most certainly does not know best as he has over spent by a factor of three and is late by 5 or 6 years in providing a solution. Can you imagine a team of ward sisters over spending their budget by such a factor, or waiting six years for their new IT to work for their wards?

Create More Openness and Support Empowerment; by publishing every statistic available on the components and participants in health. The Guilds could play a role of ensuring that stats are accurate and meaningful and auditable. But first publish everything that is to hand and deal with the inevitable entrenched power groups who prefer to keep information to themselves. Too often we hear that the public can’t be trusted to understand the information given to them. This is patently wrong. In every instance where the public are given the correct information they enhance their lives by making the right decisions appropriate for them and thier families. The statistics could be easily available via something like Swivel.Com which is now the universal repository for statistics and graphs. This would make it cheap and easy to do. The benefit would be that anyone from anywhere could look at the NHS performance, and query the results, offer suggestions for improvement and use the best ideas which deliver best performance. It would thus demystify NHS reporting and create support for it.

Address Only Specific High Priority and High Profile Items: rather than trying to be all things to all people and creating a universal messaging and record tracking system, beloved of apparatchiks and bureaucrats – which is where most the IT spend is currently focused, the NHS IT strategy should be enabling strategy which allows multiple solutions and applications to communicate across a common open back bone, ie the Internet. As many people die from infections picked up in hospitals why not focus an entire set of solutions on this problem, which seems to start from infected patients bring in the infections to staff and visitors spreading them? For instance simple monitors could be attached to disinfectant hand sprays located at entrance doors to see how they are used and to ensure they do not run out of disinfectant by flagging up empty bottles. For patients when first entering hospital there should be a monitoring system used to ensure they are checked and what the results are. Once outbreaks occur graphic map over lays of the hospitals could be used to show the extent and depth of infections. This information could be made available to all hospital staff to keep them informed and alert. Another area that consumes a lot of time and money is the movement of non-mobile, normally old, patients to and from hospitals. From personal experience I know of examples where; 80 year old people spend an entire afternoon in an ambulance moving around London in order to get home from a morning appointment, or where ambulances have turned up to pick up a patient with insufficient staff to help move them, or the right equipment or the driver does not have the right directions. Thus many patients miss or are late for appointments or are traumatised by the experience. In addition too many ambulances travel too far from base to pick people up. Instances of 200+ mile round journeys happen all too often. Most of the scheduling is done via telephone and recorded on pencilled log books, leading to many mistakes of recording, transcription, and interpretation. A fleet management system would pay huge dividends. The list of issues goes on. An empowered work force would be able to come up with the most important ones to act on, assuming someone listens to them. Start with the people – not their quasi unions.

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