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NHS: The end of an era

Roy Lilly, healthcare author and broadcaster, talks about recent changes in the NHS and the departure of IT head, Richard Granger

TzarThrone.psdIf you were there when your wife gave birth to your first child, you will know what I am referring to. The first funeral you attended will leave its mark on your memory, and escaping a motorway pile-up will put a finger print on your soul.

Watching England win the Ashes was a shambolic climax that deserved more spectacle, but to the cricket cognoscenti, it was a moment to savour. Wilkinsonís last minute drop goal in Australia needs no date stamp; we all know when it was.

The Falklands - that's all you need to say. Until 25 years ago, when the politicians of the day decided to do the impossible, most of us had no idea where the Falklands were. Brave men and women delivered an indelible memory to us then.

The World Cup, Bobby Moore, Lance Armstrong, Tammy Grey-Thompson, Redgrave and Pinsent: sport is rich with these moments. Tracy Emmin, Darcy Bustle, Warhol: contemporary art has them too.

The first Band Aid concert, Queen, Status Quo, the death of Diana, the disintegration of the space shuttle, 9/11, 7/7.

These moments, interludes and events mark us, stick in the mind, shape our thinking and form our attitudes. They are the sentinel moments in life.

The NHS has just gone through one such moment. To be there was to witness a moment in the history of public services that will never be repeated.

I joined the NHS in 1973, the year of the Watergate break-ins. Since then I have been able to stop queuing at a bank to cash a cheque and am no longer charged to get my hands on my own money. I now use a hole-in-the-wall. The machine in the hole-in-the-wall, knows who I am, how much money I have and whether I can have some, or not. It does this for free. It knows all this, in any country in the world, in any language, in any time zone.

Since 1973, when the Sydney Opera House opened for business, I have moved from buying my insurances from a toffee-nosed insurance broker to a stranger on the phone in Mumbai. The stranger fixes me up, for half the price, over the internet.

Since 1973, when the US and North Vietnam signed the Paris Peace Treaty, I have grown accustomed to buying my annual holiday over the internet, looking at U-Tube videos of where I'm going and reading the blogs of people who have been there. I no longer rely on the testimony of a high street travel agent who couldn't even point to the place on a map.

Since 1973, when Britain joined the European Economic Community, I have become used to switching my electricity and gas supplier at the touch of a button, if their prices rise and their standards fall.

However, since 1973, I have still had to register with a GP in whose area I reside. This is convenient for the GP. It assures him and his practice of an income. No matter that I leave home in the morning before he is open for business. No matter that he is closed for business by the time I return in the evening. No matter that he is not available on Saturday and is closed on Sunday. No matter that this is inconvenient for me and that I would like to see a doctor where I am, when I want to - like shopping at Tesco's.

Since 1973, my medical notes have been written in illegible handwriting, lost, overlooked, misunderstood and disappeared at an outpatient's clinic. Since 1973, I have been sent to where the doctors want to send me, to have things done to me that I don't really understand and may not want - in places that are inconvenient, dirty and dangerous, by people who may have no track record of success.

Since 1973, when the first TV teletext system was introduced, I have waited for the NHS to do the things that came naturally to business, or the things that were taken for granted and de-rigueur in the real world. We are nearly there.

A Tangible loss
This month the NHS's IT Tsar, Richard Granger, announced he is standing down. I'm not surprised. Granger has been ritually flogged, humiliated, door-stepped, lied about and traduced. The fact that he has stayed in his post for as long as he has is a miracle. To have been in the NHS while he was at work was to witness history in the making.

The management of information, by the use of technology, tells organisations what they are doing, who's doing it, if it is working and if it should be done next time. For the NHS - populated by doctors who are largely unaccountable and management that is more used to creative accounting than number crunching - the management of clinical data, budgets, outcomes, transparency and real-time is a culture shock, a menace and an intimidation.

Granger made enemies. He made enemies of suppliers who thought they could get away with dealing with the NHS like it was still stuck in the Sixties. He made enemies of doctors who could see that everyone would soon see, measure and calibrate what they did.

However, he made friends with a silent majority in the NHS who realised they had more IT power in their kid's bedrooms than they had on their desks at work. He made friends with everyone in the NHS who realised they could get access to their cash from a hole-in-the-wall in outer Mongolia, but couldn't find their patients' notes at an out-patient clinic down the road. He made friends with the knowing mainstream who regularly saw that the NHS could invert business logic and buy more of anything, for more than anyone else. Granger taught us you can buy more for less, better, quicker and consistently.

He is going. The end of an era. His inheritance will be priceless. My fear is that the NHS will squander it.

The Author
Roy Lilley is a healthcare author and broadcaster

6th August 2007

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