NHS Mobile (2003)
From Nhs It Info
This week's announcement of the NHS on line patient booking system reminded me of a unique preview I received a few months ago, courtesy of Virgin Trains West Coast Line. I had requested and received an Oxenholme-Euston ticket for the first-class quiet coach, hoping to work on the way. But Virgin forgot to include the coach and instead, I was treated to an episode in the life of government.uk from the man across the table, sorry desk, from me.
Small, balding and in his 40s, Richard G.* appeared to be an IT manager attached to the Department of Health probably, I thought, one of that twilight army of government special advisors. Non-stop high-volume input into his mobile and dictaphone demonstrated ad nauseam he was not one to use plain English when a managerial cliché was to hand. 'Emerging thinking'; 'in the frame'; 'operations domain'; 'hot desking'; 'gateway review' tripped readily off his tongue. The purest David Brent moment occurred when he speculated whether a female colleague, who had been out-sourced to Essex and begged not to be called an Essex Girl, might not have some 'gender issues'.
But Richard turned out to be much better connected than the Slough paper merchant manager ever was. Lord Hunt (Parliamentary Under Secretary of State, Department of Health), Sir John Pattison (Director of Research, Analysis and Information, ditto), Nigel at the Treasury - or was it the Cabinet Office? - all needed 'to be appraised of' his travel plans which were, since you ask, a three-day first- class trip to San Diego to attend a health IT conference, at a cost (to us?) of over £5,000.
Fortunately, thanks to modern technology, Richard could sift through the fore-log before leaving his desk. Having checked with his garage if he could post-date the MOT on his Range Rover, he dictated a thank-you letter to the BA travel shop in Leeds which was closing down, asked for the number of Interflora in Whitehaven, declared three glasses of wine under conflict of interest rules and claimed £10 for networking drinks, he got down to the serious business of NHS management.
You may be relieved to know that 'accelerated procedures' are being used to 'tune up core submissions' so that 'as small a forward column as possible is used in planning that area of the river-bed'. I am sorry I cannot tell you which part of the mighty NHS river we were swimming in here but I do know that NAO (National Audit Office) was hot on its trail. I can also reveal that the '25% uplift on framework procurement' was one of IA's (NHS Information Authority) stupid rules and could safely be ignored.
Entangled in the bureaucratic gobbledegook, a deeper administrative malaise was discernible, despite Richard's efforts to keep his colleagues in and systems on line. Most of his energy was spent reminding people to do what they had said they would do before Christmas. Richard did not want 'to go with the flow and reward dysfunctional behaviour' but his threat of 'professional competence assessments' as a prelude to dismantling whole operations rang hollow. He could barely cope with his own work load. Having calculated that he spent forty hours a week just clearing his in-tray, he confided to Sally (his - long- suffering - PA?) that he was not going to deal with it any more.
The previous Monday the entire EMIS (Egton Medical Information Systems, lead providers of Primary Healthcare 'medical informatics') for Lambeth and Lewisham, covering 23 general practices, failed. As Richard told an IA colleague, 'we should be seen to be doing something about it', it being run from a server shed in Leeds. He proposed first to congratulate the hapless victims on stripping out the old RT (possibly shorthand for SNOMED RT, Systematized Nomenclature of Medicine Reference Terminology) and looking to the future. But they were, he intimated, deeply unflattering about the entire IA contract. Rather than putting 'spider monitors' on the equipment - which might not be where the problem lay - he suggested calling a meeting to try and sort out the whole mess.
Not all was doom and gloom. Richard proposed a 'ground floor opportunity' to one supplier. The latest 'sexy' thinking from a consultant at the Maudsley was tele- psychiatry. With the help of a VC link, a patient in a dedicated room at a general practice in Tulse Hill (which had to be spelt out letter by letter like a remote flight destination) could now be put in touch with a consultant, thereby increasing productivity, decreasing patient disruption and cutting costs. This seemed to Richard a fertile area to 'explore as an exempla'.
Richard's mobile battery gave out at Milton Keynes, so he was reduced to feeding more items into his dictaphone and shuffling through his briefcase. But I must say I feel privileged to have been party, if only for three hours, to such a frank and fearless demonstration of open government in action. Would another Whitehall department care to volunteer a candidate to entertain me on my next journey north?
[*Richard Grainger, a partner with Deloitte Consulting, was appointed in September 2002 Director General of NHS IT on a salary of c.£250,000 a year. The journey this note refers to took place on February 4th 2003]
Celina Fox
