bev fitzsimons

User-centred research and service design, co-production and low cost coaching for values-driven people

recent posts

  • No cause for celebration

    I’m old enough to remember Neil Kinnock’s 1985 speech decrying the grotesque spectacle  of a labour administration sending around taxis to hand out redundancy notices to its own workers. This week’s news put me in mind of that, with a sense of jubilation in the press that the brief hiccup in West Streeting’s plan to cut back office functions in the NHS has been overcome, by robbing Peter to pay Paul it seems. A deal has been  done to allow the health service to overspend this year to cover the cost of all the redundancies it intends to make. And we’re supposed to think this is good news?

    This, at the same time that the BBC news covered a story about cancer waiting times: on a day that a highly complex set up complete with robots, surgeons and all the kit was left lying idle due to an admin cock up which meant that the patient didn’t show up for surgery because they had never received the appointment letter. 

    If you google “administrative error” and “patient care” you are spoilt for choice, and the think tanks and researchers have been talking about the impact of poor admin for years.  Not just on patients and families, though that is bad enough. Apart from the suffering of patients there is the wasted cost and soul sapping frustration of highly skilled practitioners not able to do what they do best.

    Minimising administrative and management systems as unimportant paper shuffling (which seems to be the subtext)  which can readily be replaced by Artificial Intelligence  ignores that these failures are cultural phenomena which clearly demonstrate what matters to the system (clue – not the experiences of patients or the staff).

    The fact is that most services are not designed, as such, but they are a succession of bits bolted on to what was there before: ending up a sort of Heath Robinson of healthcare.. I consider myself quite NHS-savvy, but have recently been bemused by an appointment on my NHS App which is firstly at 3 o’clock in the morning, and secondly (and I kid you not) is “not an appointment that the patient is required to attend.” Family members regularly describe being sent computer-generated appointments that neither they, nor the professionals they see, know the purpose of.

    At the moment it takes a human to make sense of the convoluted gobbledegook we have ended up with. So is it sensible to put our trust in AI and reduce human input into administrative systems at this point in time? How confident are we in the software that takes notes, provides transcripts, carries out calculations and the like? Has anyone else been amused by garbled note taking, hilarious captions, and the inability of the systems to cope with even the most benign regional accent? More seriously there are plenty of examples of chatbots giving false or illegal advice. I’m not saying the technology isn’t useful and won’t evolve to be even more so. But let’s face it, the NHS has hardly been at the cutting edge of the implementation of this sort of thing.

    What is more, if we do throw our taxpayer-funded hat in the ring with the big boys of AI, what does that do to responsibility and accountability for a quality of service and safety for patients, which after all can be a matter of life and death.

    I’m a strong believer in the adage that form should follow function – we should design the system to meet its intended purpose. The willy-nilly redundancy of thousands of NHS workers without a clear plan for the functions of their organisations is putting the cart before the horse, and  should hardly be a cause for celebration.

  • Computer says no

    My kids scoff when I remind them about the early days of the internet at home, about their older sibling only being allowed half an hour a day on a dodgy dial up connection. It wasn’t that long ago.

    I’m reasonably computer literate. I’m no stranger to the challenges of new software, a new CRM, or building a website. Though I must admit, sometimes my kids impatiently take my phone from my hands when ordering a takeaway just takes too long.

    However, my heart did sink with the latest pronouncements on the new NHS “digital first” strategy, with the ubiquitous “doctor in your pocket”. It is not that I don’t believe technology can’t shortcut no end of tedious routine tasks, but more that we are so blinded by the shiny new tech, that we fail to see when it is not designed with human beings in mind, even less tested by real life people with real life problems. Systems are designed to solve a problem by looking through the wrong end of the telescope – the system’s end. And at the other end – the patients, and the staff who have to jump through hoops to try and make these things work. Ultimately there are the refuseniks(both patient and staff) who ultimately insist on speaking to a human being when, inevitably, the system doesn’t work. The final step on this journey is an irate patient (or simply one that has given up), a frustrated practitioner who doesn’t understand how things work either, and finally the admission that “we’ll be getting a new system in a few months”. All repeated how many hundreds of times across an ostensibly “national” system. At what cost?

    Let me give you an example. Our usually excellent GP practice has recently established an automated triage system, to replace the human call handlers (“care navigators”) who generally picked up the phone. The new system (assuming you have a smart phone and an internet connection) is separate from the NHS App, and guides the patient through a series of prompts, depending on what is required. First, it excludes the big serious emergency stuff. Then there are  14 options to choose from – although why it can’t use words that people actually use, I am not sure. What do people think they are choosing when they tick the box to request “social prescribing” for example? Or if you receive a text instructing you to have a blood test (for what?) because your “primary eyecare provider” (who?) has mandated it. (Testing for what, why, requested by whom?). Shouldn’t the patient have some agency about what and whether he or she is the subject of these unsolicited tests? It wouldn’t take much to co-design such a system with some people who actually use services.

    Every option seems to lead to a menu which is aimed at gatekeeping services rather than offering them. Typically, “there are no appointments available”, or “the appointment we were going to offer has now been given to another patient”. The only remaining option is to ring the practice, the response to which is “you have to use the App”, and “you don’t know how to use the App” or “you are probably using it at the wrong time of day”.  Kafkaesque.

    Systems are set up to prevent dialogue.  They give an overall sense that the driving force is to fend off patients, rather than help and serve them. It is a great shame because once you get to speak to a human, they are usually great.  And here’s the kicker. Having gone through this rigmarole unsuccessfully, the only option is to start again. Previous responses can’t be saved.  The patient’s time is treated as valueless, their needs not met, and pressure on the NHS not relieved. Healthcare is a human endeavour to which human solutions are needed.