…could be a cloud with a silver lining. The recent and well-publicised breach of the IT systems of various NHS Trusts across the UK, by an as yet unknown force, could be just the wake-up call the NHS and the people it serves needs. If the result of this crisis is that the NHS starts to both understand the importance of IT and then and more importantly provide the resources to develop a competence in its deployment and use, then the ne’er-do-wells of cyberspace will have done us all a favour. When I joined the NHS in January 2012 in a newly established role as a Stakeholder Engagement Manager, something we from the private sector would call Account Management and Relationship Building, one of the first things I did was to ask for access to the business intelligence that the NHS Trust I was working for possessed in relation to the use and uptake of its services and the sources of referral for these. In short, I was asking what the nature of demand was, what were the types and quantities of what we were doing and where and for whom were we doing them. A minor sarcastic outburst follows; we marketers call this data and interpreting it and then using the results are the cornerstone of many successful businesses. Even more so in an increasingly digital (excluding the NHS) age. You would think from the looks I got in response to this seemingly simple question that I’d been both speaking Swahili and asking for unlimited access to company funds at the same time.
In the five years I worked in the NHS my request for what I saw, and still see, as basic performance information was never fulfilled. At first, I had thought the information was being withheld because it was commercially sensitive, not the concern of junior managers like me. And perhaps it was potentially useful for other providers who might wish to bid to deliver services on our patch, so could not be shared outside of directors circles. But as time went on and I continued to ask for it, sometimes speaking of it in hushed tones in corridors, kitchens and by the water cooler with other managers, it became clear the answer was far simpler and much more worrying. The Trust just didn’t have access to the information or the means by which it could be gathered. Some clinicians and managers were making noble attempts to gather data and there were oodles of spreadsheets and differing versions of spreadsheets that were available if you knew where to look or had built the trusting relationships that facilitate access to such things, but there was no-one and nowhere who had a fix on what you and I would call basic business intelligence. In an age where we can log onto WiFi on the train and video-call loved ones on the other side of the world, could anyone sincerely suggest that such a lack of basic IT capability would be allowed to happen anywhere other than in the Public Sector? “Sorry boss, I don’t know what or how many widgets we sold this month or who we sold them to” … good IT produces meaningful data, accurate and up-to-date. Working in 2017 without harnessing the power of IT is like working with one eye shut, a low battery in your hearing aid, a hand tied behind your back and balancing on one foot.
For me, this position was and still is utterly incredible, for at least two reasons. Firstly, that you and I can reliably log onto our Amazon accounts and track our purchase histories for the last fifteen years, yet we cannot easily access, and more alarmingly nor can those treating us, our own medical records and information, much of which is still stored on paper, is gobsmacking. How did it happen that a bloke, albeit a very clever and driven bloke called Jeff Bezos, who started his business selling us books online, has the kind of IT capability that makes our NHS, a Public Service with an annual budget of 120 Billion Pounds, look like a technological anachronism? And secondly, that we seem to have a significant strata of senior management in the NHS who do not appear to see or understand the importance of getting to grips with what many would call a basic business function; namely that of having the means to easily and quickly understand the nature of demand on the services you are responsible for providing, is a significant cause for concern. I wonder if the executives running the large businesses listed on the FTSE are allowed to be IT and data illiterate? If not, and I imagine they are not, then should we be so accommodating in our Public Services?
When I worked for Carlsberg (here he goes again, feel free to sigh) in the late 90s and early noughties, we, including the lowliest of minions in the business, knew how much beer and how many bottles and cans of fizzy pop we had sold and were selling at any point in time; the type the quantity and the location. That was nearly twenty years ago. The driver for Carlsberg was nothing more or less than the future sustainability of the organisation in the pursuit of profit. And as much as I value the vital role of enterprise and wealth generation in our society as well as the pleasure of a cold beer, surely the delivery of health is a greater cause than the refreshing of the masses; we could all live without beer, just, but health and modern medicine, probably not. And for those who say, well that would be much simpler, selling beer is not as complex as healthcare, I should point out that Carlsberg implemented and ran systems to gather data from 140 countries and sold many thousands of product lines. When I joined the NHS just over five years ago, we were still building new warehouses to store more paper records, and in fact, visitors to our local Acute hospitals will often see one of the half dozen people employed there specifically to manage file and push trolleys of paper patient records around the hospital to wherever they are required.
The recently established and publically accessible Digital Maturity Indexes for NHS Trusts reveal how the NHS in many parts of the UK has a tremendous opportunity to improve. They say you should never waste a crisis and the NHS should not waste this one. Change and progress come when you either see the light or you feel the heat, and if NHS Trusts and NHS England can respond adequately to the flames around them right now then ultimately we could all benefit from the warm rosy glow of being part of the world’s most technologically enabled healthcare system. I’m pushing 50 so I’m all for that…