Don't Confuse Me with the Facts

In our neck of the woods, "polysystems" are the flavour of the moment. They are the result of Lord Darzis's major review that in far too many words and way, way too much money, concluded that:

1. London has too many hospitals;
2. Lots more care should be delivered "locally" (which is healthspeak for "not in hospitals");
3. GPs should work in polyclinics (but we'll call them something else because polyclinics don't work).

I attended a meeting last month at which I said (yet again) that the wholesale disruption of existing referral processes can only work if the communications infrastructure is in place.

The director chairing the meeting agreed.

I then said that this would be especially true if the Darzi model is implemented (it is happening right now).

The director chairing the meeting agreed.

Then says I, but the current infrastructure is not in place; it's years behind schedule and billions over budget.

The director chairing the meeting agreed.

So, I went on, if you agree that it will only work if the comms are in place and you agree that the comms are not in place, the only logical conclusion is that it won't work???

The director said it was too early to say that!

Mmmm... now there is a good idea. let's wait until the system isn't working and patients are transferred from here to there, and then somewhere else, whilst their notes move from anywhere to nowhere.

Makes perfect sense to me.

If Only Patients Were Apples

On telly the other evening was an article about how farmers are able to deliver "fresh" apples to us all year round. The answer is that they store apples in reduced-oxygen cooled storage units. Similar things are done with the humble potato. The way in which Tesco et al monitor the growing, storage and packing of everyday food items is astonishing. Consider the following the next time you are holding a bag of spuds in the supermarket.

Mr Sainsbury or Mr Morrison can tell you everything there is to know the batch of potatoes in that bag:

• What day it was originally planted and the weather conditions (wind, temp, etc)
• What chemicals have been applied to it (batch number, date, weather conditions, etc)
• What day it was picked (weather, blah, blah ..)
  
• Where it was stored and all the records of temperature, location, etc.
• When it was removed from store and packed
• Which lorry delivered to where and then the same for final delivery.

It is an amazing system and it hasn't cost twenty billion quid!

Into the valley of death

Many, many years ago, I was a military chap. I look back on my ten years defending Queen and country with fond memories and an ever-increasing amount of nostalgia for an organisation that was just that - organised! Quite often I resort to military metaphors to try and get across what I see are some of the things our senior NHS dafties get up to.

Time to bring on Connecting for Health.

CfH is a big plan. No, bigger than that. It's bloody enormous! Conceived as a "let's do away with these little systems and get big companies installing massive systems across whole regions". Multi-million pound contracts that now have a couple of extra noughts on the price tag. A completion date that is moving away so fast you'd have the warp drive from the USS Enterprise to keep up with it. The functionality is poor. The user interfaces are "clunky" and the speed of the system often reminds me of telex. Apart from that, it's a winner?

It feels like a battle where the plan was to capture the enemies' gun emplacements on the hilltop so the infantry could advance in safety across the valley and engage the main enemy force. Good plan. However ...

The attack on hilltop fails. When told, the general realises that the main body of troops has already started advancing. "Well, they've started now so I guess we'll just have to let them carry on. It would be just too embarrassing to admit defeat before the main event!"

Delays to right of them, cost overruns to the left of them,
Into the Valley of Financial Death rode the 600 ... um ..milllion
nope make that 2,4 billion
ooops, I meant to say 12,6 billion
or should that have been 16,billion

for an electronic care record to be delivered in 2005,
2007,
2009,
2011,
2014 .....

How is the National Shared Care Record Project Going?

Today's FT prints a concise summary of the rise and predicted fall of the National Care Record project. You can read it here.