Guest Editorial > Stop Saving the NHS and Start Reinventing It: By Colin Jervis
Stop Saving the NHS and Start Reinventing It: By Colin Jervis | Valerie Isles
Valerie Isles reviews a new book which offers some interesting and entertaining perspectives on the way forward for the NHS, if not quite the whole answer
Colin Jervis has an eye for a good quotation and an enthusiasm for all kinds of information technology and he brings them together here to make his case for a future in which simplification and standardisation of health care is enabled by integrated IT systems.
It is always interesting to see the world presented through the eyes of others and an excellent use of this book would be to ask participants of clinical leadership programmes to read and critique it, because it raises many vitally important and ill understood aspects of life in health care organisations.
Before tackling this task I would introduce them to the sociology literature on status and status differences, to some complexity theory so they can distinguish between puzzles, problems and messes, and some human psychology; and the fact that I would do so will alert you to the fact that I believe Jervis does not take these sufficiently into account.
It is an engaging book; as the reader I felt included in his thinking, his observations, his generalisations, and his enthusiasm for ‘big’ IT. He has worked extensively in the NHS and, as Tony Blair would say, he has the bruises to prove it. Like Blair he has been influenced by the economists’ view that vested interests lie behind all resistance to the changes imposed by policy makers and organisational leaders, including, for example, clinical resistance to the electronic patient record. He is convinced too by their belief that it is greater competition that leads to innovation.
However he joined the NHS after an information initiative that would have proved him wrong: the Resource Management Initiative of the late ‘80s.
Here, clinicians and IT specialists worked together in pilot sites to design data sets and information systems that were driven by clinical need. Not only were clinicians enthusiastic, they ensured the quality of the data, and were happy for anonymised aggregates of it to be used to make managerial decisions at directorate and hospital levels. When the IT was actively supporting the clinical task and improving patient outcomes clinicians were happily innovative, welcomed it warmly and became its most active advocates.
In the 1990/91 hyperactivity associated with splitting purchasers from providers the RMI was killed off. What a tragedy. We could have saved 20+ years of re- and restructuring if we had rolled out RMI instead (See Nick Timmins interview with Andy McKeon in March this year for Nuffield Trust http://www.youtube.com/watch?v=0Bm2aFVayAM ).
What Jervis and the economists fail to recognise is that although there are many areas of health care that are indeed amenable to systematisation, simplification and standardisation, there are many where the wisdom, judgement and intuition of clinicians (based on practical experience over time) are needed. He suggests that all care can be codified into pathways administered by ‘lower skilled generalists’ and that the role of expensive specialist doctors will be reduced to that of assessment and codification of best practice. It’s rather unclear in this scenario where the expertise to assess and develop best practice will arise, although I think he might argue that this will emerge spontaneously from ‘big data’.
His enthusiasm for social media, and the world that the ‘screen babies’ of today will know tomorrow is enjoyable and his vision for it fortunately goes much further than the current use of occasional texts reminding of an appointment. Indeed I’d support his frustration that the NHS is using new media in old ways – largely still one way communication with little opportunity (with the honourable exception of sites like the excellent Patient Opinion) for completely authentic patient voice.
His prescription though is for major IT systems designed to support radical but planned changes in service delivery. This feels like yesterday’s solution. If we seriously believe in the potential of networks we won’t plan beyond ensuring common systems integration. We’ll trust that the change that is necessary will be prompted by the people who need that change finding and working with those who can make it happen.
The NHS Hack days show what happens bright IT savvy health care professionals identify solutions to problems they have experienced for themselves – no central IT planner will out-perform that.
From reading his book I surmise that I would like Colin Jervis, and that his energy, enthusiasm, IT expertise and recognition of the massive changes that must take place in health care mean that he can play a significant part in the way forward – but only a part; and that discussions between him and his colleagues, some of the NHS Hack day participants, screen babies, and interested patients and clinicians would give us a fuller picture.
Valerie Isles can be contacted at email@example.com