Be brave, acknowledge our failings #WILTW

This is the 181st #WILTW

If you are frequent blogger it’s easy to experience deja-vu.

I got that sense having been invited to an “innovation leadership” event. It was better than it sounds [a note to organisers that sadly cynicism has made the juxtaposition of these words an oxymoron in many peoples’ minds] but I started the event badly as I couldn’t let a  bug bear of mine go unchecked.

“I’ve rallied against this topic before” I thought. And I have, back in December 2013 before I was even regularly using #WILTW.

The below is the blog “We must never forget what we have failed to do“. I am re-sharing as although there has been some progress (our trust has moved forward to newer digital solutions and my bespoke work-a-round is no longer needed) so much still stands. Have we really learnt the lessons of the past of what went wrong or are we just developing different ways of not being able to provide solutions?

Last week I attended the latest King’s Fund Medical Leadership Network/Development event. These bring together a number of clinicians and managers of varying degrees of experience. There is a focus on outcome, rather than just being talking shops, and there is a clear aim to increase the number of those attending who are early in their careers.

One of the talks was from Prof. Rory Shaw, the Medical Director of Health Care UK. This organisation aims to bring NHS healthcare expertise to the world and establish partnerships that will be beneficial for the UK economy. Prof Shaw was quite open about the questions this raises and some of the challenges to be faced. My interest peaked however in respect of NHS expertise in digital healthcare. It is an interesting paradox that many worldwide healthcare services don’t have access to, or any clear plan to develop, some of the initiatives and expertise which exist here. The concept of a universal number, for example,  is something that is taken for granted in the UK but is not present at all in many other healthcare systems. However from my point of view, a young (but potentially naive and impatient) junior doctor, there is nothing particularly brilliant about our digital systems. Very recently I was involved in a case where the failure to have access to the healthcare information of a patient presenting to a paediatric emergency department may well have resulted in harm to the patient. This was not an individuals fault, it was the fault of the absence of an electronic system that can share information about patients throughout the country.

I was pretty vitriolic about this at the conference, and despite furtive glances and frowns from some members of the audience, will remain so about this. It is not an excuse to say we tried that and it didn’t work. The simple fact remains that most members of the public remain extremely surprised that we are unable to access electronic records in one vicinity but not another. Even worse it remains a cause for concern patients can frequent numerous different health care providers  without any of them knowing anything about these visits. This isn’t about being a ‘big brother’; it’s about managing risk for vulnerable patients and ensuring patient safety in a system which harm if often to easy to come by.

What then are we to make of the failure of the National Programme for IT in the NHS? One argument is that we have moved on, a new initiative for developing local solutions and then joining up, being more pragmatic and ultimately more achievable. There are still large costs involved though as the government’s recent announcement of a £1 Billion fund for Emergency Departments emphasises.

Appreciating it’s sometimes easier to judge rather than action, I have been working hard locally towards an electronic integrated illness identification system for children (POPS)  which is now used in other centres and could ultimately be used to compare acuity rates between emergency centres. This solution had to bypass NHS IT and is not the safeguarding safety net that is desperately needed.

It is vital that we remember where we have been in the past and what we haven’t achieved. There are many people and organisations passionate about improving the digital infrastructure of the NHS, and Tim Kelsey is clearly keen on making progress. It is likely solutions will eventually be found but we must honest about our past failures. It would be equally disastrous, probably more so, should further Berwick and Francis reports be needed, but unfortunately history demonstrates we often fail to learn.

Extolling our strengths is fine, acknowledging our failings much the braver thing to do.

So to those at #innovationleadership I apologise for stating that we don’t really care about patients, because I know we do. But we must persist in being honest. The right things to do are often the most difficult and we definitely haven’t got everything right yet.

What have you learnt this week? #WILTW

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