Nov 192011

I used to work for a bank.  The messages I received were often mixed.  From HR, for whatever reason, the messages were generally supportive and humane.  From my most immediate managers, however, the need to hit targets was imperative.

You can imagine how confused I sometimes got.

Nevertheless, health and wellbeing were seen almost without exception by everyone as key concepts for all.  One wonders if this was out of a sense of humanity – or out of an understandable fear of legal recourse were anything to happen in a health and safety sense to any of the tens of thousands of employees.  Even as I suspect the latter weighed more heavily than it should, there was still an element of the former – without a doubt.

So whether by hook or by crook (that is to say, whether by law or by morality), generally unscrupulous behaviours were indeed kept at bay.

It seems, however, that this will soon all go by the wayside.  I say so, for two very good reasons.  One, for quite a while now (and as I have been reporting on these pages), the Legal Aid bill going through Parliament at the moment is looking to take out of scope a vast swathe of current legal cases.  Over at ilegal we have further evidence, if evidence was needed, of how incoherently (or perhaps not) this is being done:

The government considers social welfare law including employment to be “general advice” and therefore legal aid should be removed from all non-discrimination employment cases. We have already seen how Djanogly is removing legal aid from every level of employment law, so that vulnerable people will not have legal advice at the Employment Tribunal level, or advice or representation in employment in the Employment Appeal Tribunal (purely for points of law), the Court of Appeal in employment cases and the Supreme Court in employment cases.

If consummated, this will presumably lead to situations whereby people will find themselves at the mercy of their own ignorance, without a safe and secure path to obtaining the legal support they might require.  This will allow unscrupulous employers (and in times of severe economic crisis, who mightn’t be tempted to become so?) to take even greater advantage of vulnerable workers than they would have otherwise cared to do so.

Meanwhile, these Tories of naked ambition are messing about in a similarly incoherent way (or perhaps not) with respect to a matter I would argue to be of a pretty similar nature.  As Paul reports:

So the same GPs who are to be entrusted with the £80bn NHS budget from April 2013 may be stripped of their role in telling people whether they are too sick to work or not:
A new body could decide whether people are fit to work, according to drafts of the Government’s Independent Review into Sickness Absence.

Employers would be able to ask the assessment panel, rather than GPs, to make independent decisions.

It is likely to say that family doctors can be too quick to sign people off on sick leave because there is no incentive for them to help people stay in work.

It hardly needs a physicist to put two and two together and come up with neutrinos which can go faster than light to realise that the attack on Legal Aid and employment law on the one hand coupled with the attack on the confidential nature of the GP-and-patient relationship with respect to matters of employee health on the other are part and parcel of a coordinated break-up – a pincer movement if you like – on employee health and wellbeing.

As well as containing within itself a potentially mighty step forward for corporate profits everywhere.

Which is why I would argue we should not be worried about the unscrupulous employers.  They, to be honest, are the least of our worries.  Rather, we should fear how many of the supposedly good ones will become sufficiently tempted by such changes for them to choose to retire entirely their erstwhile crumbs of decency.

The recent stories of internships for shelf-stacking jobs only go to show what companies may try and do – when given the opportunity – in order to maximise their earnings at the expense of their workforces.

So it’s not the so-called bad ones we should be frightened of here.  They are, at the moment, quite in the minority.

It’s everyone else who’ll be going along for the ride

Horses for courses you might say?  Be careful what you wish for.  Before you know it, we’ll all be getting ready for that grand knacker’s yard in the sky.

Oct 032011

Now I don’t know if the following really happened.  But let’s say it did.

In a far-off country not unlike the United Kingdom, where public IT projects were collapsing here and there – in particular one relating to its national health service (though not the British NHS itself (more here), you understand) – someone suggested, in the following way, that perhaps the dynamics of traditional IT development weren’t all they could necessarily be:

Can no one get IT right? RT @PrivateEyeNews: The pisspoor Post Office IT system that’s landing innocent staff in dock

To which someone else responded vigorously:

@eiohel @PrivateEyeNews Short answer to that is no. A wise open sourcer once said to me: “fucking open source public sector IT programmes”

The conversation then continued with these very fair points, which basically explained why this far-off country was precisely as it was – that is to say, when your manual processes are broken, the very worst thing you can do is blindly automate them.

An interesting tangent in the discussion in question circled around how to get engaged experts participating with a desire to reach common goals.  One exchange went as follows:

@citizenandreas 100s of engaged experts with interest in solving shared problems would [solve problem of public sector IT projects]. Good OS is just that. @CarlRaincoat @PrivateEyeNews

With the sad but understandable reply being thus:

@eiohel not sure we could count on finding said experts, domain knowledge would be hard to find @carlraincoat @privateeyenews

Which is exactly when I was reminded of the stories which are actually at the heart of this post.

Two cases.  The first involved a psychiatric patient who was talking to his psychiatrist.  Luckily for the patient, this psychiatrist was an open, friendly and empathetic sort – luckily, I say, because this wasn’t his wider experience.  Anyhow, they were talking about this and that, as was generally the case, and the psychiatrist mentioned, by the by, how long it was taking for tests and other information to move electronically from one hospital department to another.  This psychiatrist, in fact, pointed out that it would’ve been quicker for her to have physically walked the documentation in question from one end of the institution to the other – rather than wait the weeks which the zippy IT system employed.

Meanwhile, the second case involved an A&E GP who, seeing an awfully strange condition on the skin of a young patient of his, asked for informal permission to take a photo of the aforesaid condition via his mobile phone’s camera – and thus whizz it across to a specialist paediatrician in order to expedite the diagnosis more efficiently.  This GP was then careful to ensure that the photo in question was both removed from his phone and the phone at the other end.  And thus it was all done with very little cost to the health institution itself: both an efficient sharing of crucial information and a rapidly confirmed diagnosis as part of the package.

In both these cases, the fear of loss of confidential data meant that neither professional felt absolutely free to carry out what was the most efficient course of action – although, in the latter case, the urgency of the matter and the safety of the patient in question in the end drove the doctor to do what was right for his charge, even where it was potentially wrong for the institution.

If, instead of finding himself in a leafy suburb in some far-off but nevertheless well-off country, he had been ministering to a dying patient in an African village, I am sure he would have had no compunctions about sharing important medical information via the most efficient and cheapest means available to hand: his own mobile phone.  It would only be in far-off well-off countries like the one under discussion where personal privacy became such an issue that it would be more important for a physician to preserve such privacy than to do his job appropriately – and save lives.

A picture tells a thousand words and privacy is a millstone.  The level of privacy a society requires is an indicator of its level of opacity.

And the sooner we are able to be honest and open with each other, the sooner public sector IT projects will be able to succeed.


So very difficult to find those experts in the domain of knowledge that we require?  How about allowing patients and physicians both in on the development and engineering?  If a doctor with their mobile phone can resolve a problem of diagnosis in minutes at the cost of a personal multimedia message where a hospital with all its bespoke technologies is unable to move electronic documentation within a reasonable timeframe to facilitate patient care, then let the doctor him- or herself suggest the processes and the means – and let the patient choose whether to provide the necessary permissions.

Properly devolve power to informed users and caring professionals and the change you might see could be miraculous.

Mar 302011

I remember very clearly that soon-after-moment – when I was ten or eleven and had just been diagnosed as epileptic.  I asked my GP if I could have more information about my condition, and he responded by telling me that when people had the flu they didn’t ask for more information, so why should I expect any in my situation?  Naturally, I thought that this was different from flu – but his white coat and my parents’ trust in the medical profession gave him the power to deny my young reality, a denial which, later on in life, I discovered was far more profound than I had ever imagined at the time.  For my GP considered for a while, in the face of an initially insoluble case, that I was faking it so as to escape having to go school.

Illness served to define one in those days – although, even today, I’ve noticed how a disabled person is inscribed by their condition (especially if this is physical) a long way before their character and personality is allowed by the rest of society to shine through.  I have often argued on these pages that it would be far more acceptable, accurate and inclusive to describe “disabled people” as “people with support needs” (and before you complain about cumbersomeness, there is only one extra syllable in the phrase I prefer).

So why then do I suggest this?  Perhaps mainly because, during the relatively short time allotted to us on the planet and in this universe, the vast majority of us will acquire support needs of some kind or another.  Such a use of language might therefore help to make the unkinder and more selfish elements amongst us think twice about cutting back on support services of this nature, before it is their turn to turn to the rest of us for help.

Anyhow, back to the original reason for writing this post.  I’ve just seen this tweet from Time to Change:

Really touching to hear Rachel Bruno saying how proud she is of her dad! Mental illness can be so tough but talking about it can really help

And so I was reminded of my disbelieving GP, that man who with all his knowledge and intelligence refused to allow me to discuss what for me was a terrifying experience – absolutely undermining for a ten-year-old like myself who was just making his way in the world, just understanding his options and opportunities, just on the point of comprehending how wonderful life could be.

All of a sudden, then, it was for me to discover that my young body of a decade could fail me at the most inappropriate moments – falling over and becoming unconscious and making me weak without warning or prior notice.

And I’m sure he did it out of good faith.  “Better to ignore awful reality than deepen it” was, perhaps, his unthinking – or unthought – strategy.

Later in life, my epilepsy and my experience of realities denied was to be magnified by my losing my job; by my losing money I foolishly entrusted to a boss I had considered a real friend; by my wife losing her mother painfully to brain cancer just as we were considering setting up a business; by my own vicarious experience of the obfuscations of the Iraq War … and by far more things than, today, I can usefully set out on these pages.

Suffice it to say that I have experienced serious mental ill health as a result of realities denied all round – and can honestly say if one survives such a process, one knows the world and its awful underbelly far better than a banal and tirelessly consumerist relationship with the planet can ever offer.

So then … with brave people like Rachel and Frank Bruno – and others like Alastair Campbell and Stephen Fry – we begin to talk importantly about illness.  And this is good I think.  This is positive.  This, if it had happened to me when I was a child, not just ten but when I was a very young child too, would have provided me with a behavioural template I could have used to shield myself against later experiences.  As it was, I fell prey to them for a terrible while, as I journeyed through an upended truth that only coincided with reality on sufficient occasions to make me believe I was still in touch.

A final piece of advice to today’s parents: don’t ever tell your children they don’t need to talk about something, nor allow anyone else to do the same.  The consequences may not be immediately obvious – but, some day, in some way, they will emerge and bite back when you least expect them to.  And, as parents, you may never understand the real reason for the pain – even as you have served to serve it up on a silver platter.

Feb 012011

Salespeople are the lifeblood of business.  Their job is generally to convince potential customers that amongst a fairly limited range of standardised products they can find something which perfectly matches their needs.  It never will match their needs exactly, of course – that is the challenge of massive implementation.  Far easier to sell competently three or four basic products and tweak our perceptions that they are actually ten or twenty than try and manage the design, production, distribution and delivery of ten or twenty products which truly fulfil the requirements of the aforementioned customers.

A simple example is that of McDonald’s: a menu apparently as long as your arm – but essentially just two products: round sandwiches on the one hand and ice-cream with bits in on the other.  This is the key to the massive implementation I referred to above: if you simplify the product, you simplify the processes – and you have a far better chance of making those crucial sales.

For there’s nothing which depresses a salesperson more than having to try and follow a complicated spiel.

Which brings me back to the original subject of this post: that is to say, our blessed salespeople.  Now it’s possibly true that with the kind of substantial investment the NHS has undergone over the past decade – much of it, it has to be said, a question of playing an essential catch-up after the sad under-resourcing of the sorry years of Thatcherism – we’ve complicated matters unnecessarily.  Surely you can both love the NHS and still be prepared to accept that the continuous improvement of any organisation – whatever role it plays in the nation’s subconscious – is not only something we can contemplate but also, finally, something we should see as desirable.  And simplification, as we have seen, can be a virtue.

When, of course, it doesn’t lead to the kind of uniformity which arguably squeezes the customer into the standardised box our salespeople too often get assigned as their product or service of the month.

That box which leads to misleading claims of appropriateness and suitability at the very moment a deal needs to be closed – and which too many customer care departments know the implications of only too well.

So.  We may see salespeople as a necessary evil or we may prefer to perceive them as consummate exponents of the art of communication.  But however we understand their skills and however we feel about their profession, whenever – as happens perhaps more frequently than it should – they step over the line which divides the gift of the gab from an entirely inappropriate over-promising of product or service (driven as they inevitably are by that terrible need to hit overarching and omnipresent targets), we end up with a situation where, sooner or later, customers will feel short-changed by such short-termism; will feel short-changed by such a poor management of expectations in the interests of making that sale.

Let’s assume in the best of circumstances, then, that salespeople are both the above: that is to say, necessary evils and consummate communicators – the oil, in fact, which allows the wheels of industry to continue turning.  How does this understanding of their role in business and commerce inform our understanding of the British government’s decision to put the responsibility for commissioning NHS products and services in the hands of our friendly neighbourhood GPs?  Might not the fact that drug companies spend twice as much on marketing as they do on research impact – at least to a certain degree – on how we view such a proposal from here on in? 

And is it not conceivable – whether the intentionality exists behind the proposals or not – that the result of moving all this technical responsibility for contracting service providers and treatments from broader organisations such as primary care trusts to busy and potentially harassed individuals such as GPs is to serve the NHS up on a silver platter to these professionals of the art of communication – those trained squeezers of customers into highly profitable standardised boxes – who we all know and love from all areas of our lives as those blessedly unremitting and tireless shakers and makers of deals?

I suppose, then, my question really is as follows: do we seriously want our NHS to be run, resourced and managed on the basis of the kind of information a GP will almost certainly end up getting (will almost certainly end up, some way down the line, learning to positively welcome and appreciate) from the silver tongue and snappy patter of his or her friendly neighbourhood medical-sector salesperson?

Especially when we remind ourselves of the fact that these individuals work for organisations and companies that spend twice as much on branded pens, notepaper, assorted freebies and corporate logos as they do on the lifesaving products and services which supposedly add that essentially precious value to our still precious society …

Update to this post: further background reading to the all too apparent disaster-in-waiting the Coalition’s proposed NHS reforms are rapidly becoming can be found in the Lancet here.  Their conclusion runs as follows:

Health professionals cannot say that no change is needed—it most certainly is. But there is sufficient uncertainty and concern about the changes outlined in the Health and Social Care Bill to pause, to learn from the past, and to consider what the changes mean for patients’ outcomes. As it stands, the UK Government’s new Bill spells the end of the NHS.

Aug 292010

There’s an interesting story here which has come my way via Facebook.  From back in June this year, we have the BBC reporting that, at their annual conference, GPs were already looking to scrap NHS Direct:

Consideration should be given to scrapping NHS Direct as part of a scaling back of health spending, GPs say at their annual conference.

The British Medical Association questioned the effectiveness of the telephone service, claiming it delayed patients getting healthcare.

The report goes on to say:

Dr Laurence Buckman, chairman of the BMA’s GPs committee, highlighted the telephone service – rather than the website – provided by NHS Direct.

He described it as an “interposition” between the patient and clinical care.

“It is an interposition between the patient and healthcare. It stops them getting through to nurses and has ended up an expensive telephone service.”

NHS Direct claims to have other evidence however:

NHS Direct chief executive Nick Chapman said: “The comments made about the propensity of NHS Direct to refer patients on, are not backed up by the data on what we actually do.

“Over half of patients who contact NHS Direct are given self-care advice for their problem, which means they can care for themselves at home without needing to seek face to face appointments.”

Which is why I do wonder, in the light of the above, whether what we have here is less a considered assessment of patient needs and more a possibly subconscious but nevertheless self-interested defence of professional territory and arc of operation.  In much the same way that other professions before them have had to accept that certain aspects of their black arts can be carried out just as effectively by less qualified suppliers or even by automated processes (teaching is one example of this whilst the lawyerly profession will – I am sure – shortly become another; if, that is, it has not already done so), so it is possible that the medical profession perceives – without caring to make its perception patent either to itself or to a wider audience – that its absolute hold over medical care is in the process of being chipped away at the edges.

And chipped away quite usefully.

NHS Direct is one clear example of how a patient-friendly intervention could easily be spun by those in white coats as an “interposition” and even a bureaucratic “extra tier”.

We should be sensibly and responsibly wary of people like Cameron and Clegg, where they choose to put into the hands of vested interests like our general practitioners grand responsibilities for spending NHS budgets that directly affect these professionals’ own wellbeing and working conditions.

But, more importantly, we should be wary of the aforesaid vested interests also having the right to define how quickly and how far their stranglehold on delivery is broken up – or not, as the case may be.  Especially where history is now indicating to us that the tendency towards breaking up the hallowed ground of such practitioners is overwhelmingly in favour of intelligent dispersal.