“Of $4 billion NHS spent in 2009 on health service projects and innovation, only $224 million had impact on patient care, chasm must be closed”
The above was my response to Bob Hudson, whose article “Annulling competition rules is the most important NHS battleground” appeared in the guardian on April 2nd.
It has been suffice to say, an interesting exchange with Bob because I am not disputing the importance of placing patient care as the main priority of any procurement policy. You simply have to read my coverage of the Veterans Health Administration’s ongoing procurement “difficulties” and the impact it has had on patient care viz-a-vie the Bay Pines fiasco, to understand my position.
My problem with the debate that is raging across the pond has nothing to do with intent of focus but instead with the approach to a balanced resolution.
While many are bristling at the thought of tighter controls being implemented at the expense of patient care, the veiled “threat” of privatization looms in the background. As a result instead of moving the discussion towards a resolution, it now seems to be descending into a personalization of rights and responsibilities. In such scenarios inertia almost always proves itself to be the winner as opposing factions dig in.
This impasse is reminiscent of the old saying that you cannot see the forest for the trees.
To start, and referencing my twitter exchange with Bob Hudson, when only $224 million of $4 billion spent on health service projects and innovations have an impact on patient care there is something seriously wrong. Especially when you consider the fact that prior to the recently proposed changes the “level of patient care in the UK had fallen behind those of comparable countries.” This clearly demonstrates that the present system is seriously broken. Or to put it another way, the reasons for the proposed changes are at least in part, the result of steadily declining levels of care for patients.
Something has to be done! But what?
In Part 2 of this post, I will present the concept associate with a Relational Governance Framework that I believe represents an approach to the problem that has not yet been considered.
Procurement Insights 
Nexus789
April 21, 2013
The real issue is that the ‘IT’ solution is not being driven from the patient perspective. They think they can put in an ‘ERP’ type solution and it will work. It will not and no amount of money will solve the problem – a bottomless pit comes to mind. My observation from reading a range of reports is the underlying health technologies that are being ‘imposed’ are destroying clinical excellence. In many ways they are going backwards.
Many systems that were built over time with clinical input are being swept aside and being replaced with systems that are not up to the job and add no value to the clinician (they have an administrator and transaction focus). An excellent report by Sydney University pointed to the uselessness of the systems they were being forced to use (one comment suggested that going back to pen and paper would be more efficient). There is also a 600+ page report from the UK by medical professionals that basically says that IT could really help health performance but there is no evidence of that to date (this is after £20biiion plus has been spent). The whole debacle reminds me of CFO’s choosing ERP’s in other environments and the people at the coal face having to then try and use a system that is ill suited, or not suited for the task.
Another issue is that we need to change the way we build information systems and focus on developing a business model that puts the patient at the centre of activities. Building a system that would truly support health and patient care needs to support a highly collaborative project and informationally dynamic environment. One that changes the premise and perspective from transactions and data to collaboration and knowledge management (management of complex ontology’s, taxonomies, secure, audit trails, etc).
piblogger
April 21, 2013
Very well said Iain.
Nexus789
April 21, 2013
It is not an IT ‘problem’. It is a business design problem. They keep coming from the wrong perspective. Only ill informed politicians a silly enough to believe that throwing money at the ‘problem’ will get a result. As Einstein quipped doing the same thing over and over and expecting a different outcome is a sure sign of madness.