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Our management consultancy columnist, Mick James, this week takes another look at the NHS IT programme and the criticism it continues to receive.
Systems and cars always crash
"Well, it hardly counts as a breakdown, does it?" This was my brother's response when I informed him that the "car trouble" that was making me late for an important appointment was actually a case of me locking the keys in the boot. I fought back the urge to respond -- "Well, in that case I'm not late then, am I?" Fortunately the RAC took the same view as me: My car won't go; that's a breakdown. It doesn't matter why.
But sometimes it does matter why. I've been trawling through the recent reports on the implementation of the NHS national IT programme. "Crash!" scream the papers. "Teething troubles," murmur the officials.
The negative impression will remain and for the general public, who must by now be merely skim-reading these things, it's probably just a case of "computer problems at the NHS. Yada yada yada. Can't these people get anything right?" They won't have noticed, for example, a recent piece in The Evening Standard, under the headline London's health bosses were accused today of endangering thousands of patients by relying on faulty computers, that made a completely spurious link between a hardware failure at the London Ambulance Centre and problems at the Royal Free Hampstead NHS Trust caused by the introduction of the new patient care records system. The paper described these as "two major computer crashes" which, to go back to the car analogy, is a bit like expecting the same amount of sympathy for reversing into a lamppost as for having your brakes fail while doing 70 on the motorway. Cars, eh? Always "crashing".
It's clear that in the second case we're not talking about "crashes" so much as people getting to grips with a system which they are not familiar with, and possibly don't like very much. The list of problems experienced by one Trust starts with a technical-sounding bang -- "bed availability not displaying correctly ... reports not printing" -- but ends with a whimper -- "passwords being forgotten". In other words, a lot of the problems are with what IT bods used to charmingly call the "wetware". But let's not be too hard on NHS staff. As I understand it, while the care records system itself is basically free -- and therefore attractive, albeit in a purely cynical way -- a lot of the costs associated with implementation will actually fall on Trusts. And as we all know, no budget is more vulnerable than the training budget. A telling phrase from the British Computer Society's response to the Department of Health Informatics Review from July 2008 cited a "lack of commitment from NHS management at all levels" in the implementation of IT systems for patient care. It's not surprising then that the staff, who have to use these systems, aren't exactly throwing themselves into it.
There's a point in any system's lifecycle when it starts experiencing real problems and that's when people start using it. And it's in the nature of the media, and the NHS, that ugly messes will make better copy than millions of successes. It only takes one acorn to persuade a chicken that the sky is falling, and in an implementation of this size there are going to be plenty of acorns. In the fullness of time I suspect the system will sort itself out, but who will be interested by then? I suspect the NHS won't have the dosh to follow BAA's lead, which is currently running ads on the Tube stating "Terminal 5 is now working".
There's another little-documented point in the IT lifecycle, that one where the system becomes to blame for everything. Despite an entertaining claim from one mathematically challenged NHS blogger that having to do everything twice has "trebled" his workload, I notice that an awful lot of the problems experienced seem to result in less work being done: appointments cancelled, patients not visited. We all know how hard-pressed the NHS is. If "the system" unexpectedly hands you a few precious free hours to catch up on paperwork or finish a clinic on time for once, are you really going to spend your lunch hour working round it to solve the problem? I doubt it. I've recently had a couple of experiences with systems (run by financial services and phone companies) where my "impossible" problem suddenly became soluble through the simple expedient of ringing in again and getting a different customer representative. Whether that person was better trained, brighter or just more willing to help it's hard to say. But where there's a will there's a way. I fear though that the NHS is running out of will.
Staff commitment is -- or was -- the NHS' most valuable asset, one which it has squandered as recklessly as a dotcom entrepreneur who also happens to be a sailor on shore leave. With a gambling problem. All the money in the world (and the NHS can give master classes in getting through that, as well) isn't going to correct that problem. At the moment the service is painfully learning, in a piecemeal manner, lessons about change management and staff buy-in, which the consultancy industry knows by rote. But the role of consultants in this exercise has been so severely delimited that they have been deprived of opportunities to do what they do best: to question, to challenge, to rethink and to really implement. You may have doubts about the wisdom of such enormous, overarching projects as the NHS IT programme, but as it rolls out it offers the chance to reveal some very deep truths about what the NHS really is. Will people be prepared to take this on, or will they just continue to blame "the system"?
Which brings me back to the RAC, which I cannot praise enough, particularly as the chap didn't have the little customer service feedback machine working. Not only did he get me into the car in a jiffy without damaging it, he was also kind enough to throw in some consolatory remarks about the deficiencies of Ford's central locking system. But he also told me an anecdote about having to get the same driver back into his car on two successive days. On the first day he blamed his wife. On the second visit he blamed the kids. "See you tomorrow," said the RAC man. "Why?" said the customer. "Well, it's got to be your turn next."
All views expressed in this article are those of Mick James and do not necessarily reflect the views of Top-Consultant.com and Consultant-News.com.
Contact Mick with your views or suggestions at: mick.james@top-consultant.com.
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