The prognosis is not good. Throughout the National Health Service MRSA (Ministerial Responsibility Shockingly Absent) is rife. The patient is confused, the doctors squabbling, the relatives increasingly angry.
Recent results on tests of the NHS IT central nervous system are bleak. Richard Granger, director general for IT in the health service, has publicly complained about the poor state of essential projects. In leaked emails, he goes further — diagnosing rapid changes in specifications which are arresting essential development. Cash is bleeding away, time is running out.
When civil servants break patient confidentiality like that while simultaneously straining professional mores — he named names — those of us clustered outside the intensive care ward can only assume things are bad indeed. We're glad he's talking, but there should be no need for such career-threatening strategies.
This is our health service, which is to say our health, at stake. The ministers don't know what's happening: they're only told that key projects are years behind when special committees investigate. The civil service is in open disarray. The contractors are not delivering — and as usual are probably well protected from the blame game.
We cannot expect the politicians to understand the technicalities of major IT projects, although we can expect them to make fine-sounding promises. Likewise, we can't expect contractors to turn down large contracts even though they suspect them to be badly conceived and unlikely to be deliverable. What we can expect is for the civil service to effectively mediate, telling the politicians what is and is not possible while keeping a firm grip on contract management.
This isn't happening, because the civil service has insufficient authority. In medical terms, it's as if clinicians have to obey diagnoses from part-time amateur professors while using untested drugs. No wonder the NHS is so poorly served.
To gain the authority required, the civil service must establish a centre of excellence for IT, a place of effectiveness and prestige capable of attracting the brightest and best. It must offer a proper career path, to keep those people in and the consultants out. It should aim for the impartiality and focus of the judiciary, and the technical savvy of the better academic institutions.
It will require cultural change, vision and expenditure — but nobody said good treatment has to be cheap. It just has to be effective and capable of long-term results, and on the current evidence nothing weaker can be prescribed.
Talkback
Something should be done. And not just with regards to health care. But locking away the best and brightest people away in an ivory tower isn't going to cut it. Likely it's going to make it worse.
Problem is that you need to have the real-life raw deal field experience to know what details actually matter and not only in one field of expertise but several. And then you need to combine that with great leadership, project and program management skills. Combined with great insights in financials, logistics, sales, politics, legal affairs, contract management, liability, business processes, maintenance, availability, security, organizational requirements and what not. While knowing how to handle back stabbers, small kingdoms, lobbying, hidden agenda's, power struggles and every other dirty trick in the book some people actually call career making. And this all isn't even half of what's needed.
So basicly what's needed is a team effort by people that are and stay experienced while keeping eachother honest and dedicated to the team goals because they want to, are asked to and are actually allowed to achieve that while being trusted and backed up all the way by the brass but questioned at every step of the way nonetheless (tell it, explain it, get backing for it, test it, show it, proof it, do it, maintain it). Many people could do that for a while since enough people have front line experience in at least some areas and are creative and clever enough to come up, certainly within an outstanding team, with lasting solutions that actually work.
I've seen it happen so it's possible. And basicly it was about making the right people (by the right people) fully responsible for the whole aftermath as well. No grey areas No assumptions. Full disclosure. Crystal clear definitions with unquestionable and repeatable mutual independant performance measurement at any given moment.
So my out-of-the-top-of-my-hat proposal would be to come up with some sort of 'community service' in which outstanding professionals (definition? how to find them? how to exclude the sponsored ones with hidden agenda's?) are called up to do their "tour of duty" of, say, two years. Ofcourse, details will need to be worked out but one thing is clear: brains need experience and vice versa. But once stored away in a comfort zone they'll peak but there after will slowly but surely loose the "cutting edge" they once had. So after a while they'll need to be send to the frontlines again to keep their skills sharp.
You have summarised the state of affairs accurately I think. It is not fair to blame the doctors on this sorry mess. General Practice in the UK has led the world in computerising the health record and implenting IT in the consultation. The government has run rough shod over the the GPs in tehis country and contracted the work with new players to the GP arena. Accenture is one of the lucky companies. However, this company was once Arthur Andersen Consulting who were invlved with Enron in the USA. It does not suprise me that large sums of public money seem to be wasted on the NPfIT programme while hospital beds close and patients clamour for expensive drugs that the government says it cannot afford. IT does not affect patient care; health professionals do.
I would rather see the UK move more slowly to an integrated electonic health record while spending more on direct patient care. Not sexy, but the voters (patients) would be better off.