Lord Darzi's review - a good effort, but why aren't we doing this already?

I just wanted to say, I haven't totally given up on this blog, I've just been a bit distracted - by really interesting things. These come after my thoughts on the Darzi review, and include a slightly (er, very?) cynical rant about NHS Connecting for Health. For those of you who have come here because you're are interested in the Darzi review (and not my life story which I'm assuming you couldn't give two hoots about) I've left the personal bits till the end, so you don't have to read them if you don't want to (I'm nice like that :-) But the fact that Patient Opinion is up for 2 awards is reason enough to read the entire post...

As the Darzi review on High Quality Care for All has just been published, I felt I should put my two penneth in.

It's all very well saying we're going to empower the staff and patients to develop a high quality NHS, but to actually do that requires a long, hard look at what is preventing the NHS from doing that already - namely huge bureaucracy, historical and systemic scapegoatism (is that a word? it is now), conflicting targets, political maneouvering and an awful lot of conjecture and rhetoric and (contentious I know) an attitude that the medical profession knows all, despite the fact that some patients are actually experts on their own conditions (god forbid we actually have patients who are intelligent enough to understand medical theory!!!).

I read Darzi's review (very quickly, obviously) and I was, well, suprised! Seemingly ridden with conjecture, in that in every section the introduction makes sweeping references to something each and every politician with anything to do with health would love - the right words are there, but there is actually some weight behind them. The review contains some practical examples and realistic suggestions (in my considered opinion, obviously).

Of course, the majority of the NHS will say every one of those suggestions is unworkable, but that's what happens when people with great ideas are squashed under a ton of processes, policies and long, long conversations about what colour it should be. It just needs some brave, fearless and quite positive people to try and make what appear to be sensible actions a reality.

I thought it was a good effort :-) Make your own mind up, read it here.

Other stuff stopping me having time to blog is that I've
1) begun blogging for and supporting the "webinisation" of the inclusive and innovative website Patient Opinion (they're up for both the New Media and Catalyst awards btw...and yes, they paid me to say that - I'd say it for free, just don't tell them that :-)
2) been taking even more photos and learning to paint on silk (if only there was money in being an artist)
3) been trying to decide what to do for the (immediate) rest of my life.

Generally though, I've had enough of being resolutely hated by everyone in the media, the NHS, and eHealth Insider, due to having the audacity to work NHS Connecting for Health and have decided to discover what really useful stuff I could be doing without the booing when I mention where I work (yes, that really happened....) - I've got until the 1st October. If someone wants to offer me a job, preferably before that date, that would be lovely :-)

Oh, and did I mention, I'm looking for work? :-)

Comment on the social networking masterclass

I read with interest a comment from RayJones on the Health Informatics Social Networking masterclass I referred to previously, on the Informaticopia blog. He writes that we "should be concerned about the decline of the scientific approach and the use of evidence in healthcare" and references two particular points I made in my own session - that Web 2.0 encouraged examples of ‘the wisdom of the masses’ and that it recognised that more brains = more information.

Ray's argument is that

"Quite often the masses do not have wisdom but follow prejudice, hearsay, and urban mythology. How often do we see public opinion radically influenced by the tabloid press, for the story to change a few weeks later? The tabloid press and tabloid TV use the case of Uncle Norman or sister Mary to tell one person’s story. That story may be true but if we are to take a rational approach, for example, to our understanding of the cost effectiveness of a particular treatment we need to consider evidence gathered on representative populations."

I'm not sure if this is a comment about the press, or about the lack of intelligence of "the masses". My talk was emphasising the fact that if we treat people as if they are stupid, they will act stupidly, particular in reference to what appears to be an overly paternalistic approach to healthcare which assumes the GP is the font of all knowledge and the patient can't possibly be informed about their own condition. To assume "the masses" are a prejudiced bunch with no ability to make their own choices, is for me, a very negative view of humanity. I'm not saying people always make the right choices, but having the opportunity to consider their options might be a good start.

His second point,

"Similarly, the phrase ‘more brains more information’ may apply in a limited range but if we were to ask 1000 or even a million people to work together would they have come up with Einstein’s theories? More information may just mean more noise rather than more intelligence."

I think has some validity - although I'm not sure Einstein worked in a vacumn - and when he did, he didn't get anywhere (thinking of his later efforts to align theories of quantum mechanics and general relativity). What I was suggesting, was that one person may be an expert in say, Sport, another in the works of Shakespeare, another in astrology etc. Get them all together, and they know more about everything than they do individually. Again, the attitude that people cannot be intelligent on mass, is one which prevents effective collaboration reducing the opinion of others to "noise".

Always interesting to understand alternative viewpoints don't you think...read the full post and make up your own mind.

Scam Warning - Whos Who of Professionals

I've had quite a few responses recently to this post on the WHO'S WHO of Professionals recently, so obviously our friends are at it again...just wanted to to draw your attention to some of the comments I've received - tells it all really:

Comment 1

Good work, Nicole (ok, so they got my name wrong, hey ho). I wish I could say that I hadn't fallen for it in 2004, but I did. At that time they claimed more than fifty thousand members world-wide, but the invitation letter was about the same. I joined and became active. IN FACT I ended up running a club free of charge and of benefit to these people while paying a huge sum of money to them for the honours.Of course, at the time, the supposed book in which entries would appear was constantly "fastly approaching the editorial deadline",... year after year. I never received it and after showing patience began to speak legalese, after which part of my money was promptly refunded. The book still had not come out when I checked in 2006.After visiting the website:http://www.internationalwhoswho.de/and getting a strong "deja vu" feeling, I looked these people up in the Better Business Bureau databases and lo and behold I found a wealth of info on Gibralter Publishing (at the time, the core persona) and the about fifteen other names these people use.Not long after quiting IWWHS, I was approached by a new "networking" society (apparently they had shared my details) and when I asked who their executives in charge were I found several of the same North Carolina-based names from IWWHS!Unfortunately, those vane enough to list this "merit" not only advertise a questionable enterprise, but many times will have their OWN integrity questioned by those in the know! Beware!

Comment 2

Hi all,I (in France) received this e-mail a couple of weeks. And last tuesday, a woman who claimed to be in Washington proposed to me an interview with her "director" for "the final step of selection".The day after, "the director" called me and our "interview" was interesting ... he sounds actualy like a professional interviewer, but he ended the call when I choose a $800 registration option but never give him may credit card details.I hope it's for free!!!Thank you all for your information.

Comment 3

WARNING: “WHO IS WHO”/ internationalwhoswho IS quite probably SCAM !!!I have exactly the same experience: "deadline was "fastly approaching" - this time in March 2008, and one day, when I was busy ,I gave them my information and my credit card number (we ARE busy, and this is what they take advantage of). They immediately withdrew $800 for a book and some pins & stuff I had orally been coaxed into saying "yes" to. I understood the same afternoon that this might be scam and cancelled the 'order'. Got a letter back from them, which said "We will be more than happy to assist you with your membership cancellation as soon as the proper information is pulled. An Account Manager will get back to you as soon as possible and thank you in advance for your patience." Signed Sabrina Fuentes. Many days later the letter from the "account manager", Sandy Garcia, came. According to Sandy Garcia, who would from now on be my contact, the "cancellation policy" of "whoswho" was to retain 358$. I protested immediately in an e-mail to Sandy Garcia, only to receive a bounce-back e-mail that I was "not authorized to contact" Ms (Mr?) Garcia. This is no doubt SCAM, and probably
plain fraud. The method is: 1. Appeal to /boost people's vanity, or other things which may make them feel good (for some time). Promise people something good and cheap (here: for free).2. Give the poor fool an opportunity to buy something expensive, but valuable, in addition to the free stuff.3. Be sure you have a huge "cancellation fee" - more or less hidden underneath the offer.4. Ask for the credit card numberof the stupid fool you are fooling5. Withdraw the money immediately6. When the stupid/ victim realizes that he is about to be fooled, promise your "account manager" will contact you "soon": However, that will take so many days, that the fool/ victim will give up, or the deadline of complaint is running out.

We must warn the world against these crooks ... I was one of the fools. I have learnt, and will do what I can to warn others. I will also try to sue them (very unpleasant, but - if necessary -I will grin and bear it).ViVa

Comment 4

hello, just had an interesting interview with these people too - you can learn a lot from their interviewing style and the gaps in their so called research - the fact that my business is not yet registered or trading, and that the relevant website is not yet active, did not seem to deter them. They also suggested that I would be able to make use of the informal social networking down the road at a local pub (450 miles away in London) and never once gave any indication of understanding what sector I might actually be in. VERY smooth interview style, very much about stroking the old ego. I swear I heard the file being deleted when I said I'd be in touch as soon as I thought such a membership
would be appropriate (ie, no thanks) - in fact I thought I was very pleasant given that someone had just asked me for $950 for what we all do through Facebook anyway.cheers (see you down the pub!), Sarah, Edinburgh

So, learning from these experience, don't even bother to speak to these people (unless you want your ego massaged for free, then tell them you're not interested :-)

Social networking and knowledge sharing the NHS way

So, I've had a few months off, due to losing my spark and being distracted by a photo a day project on Flickr, Project 365. But now I'm back...

Today I took part in a fantastic event, organised by the NHS Health Informatics Faculty, on the Power and Perils of Social Networking which was downright inspiring, as much for the people who attended as for the realisation that there are others out there who think like me...which is always nice - I feel validated :-)

Four of us presented:
Rowan Purdy - ex-Knowledge manager for the CSIP (Care Services Improvement Partnership), now of Surepoint, a new knowledge consultancy
Rod Ward - freedom of information campaigner and blogger (see Rodspace and Informaticopia)
Paul Hodgkin of Patient Opinion (see this post on Headshift for a rather good write up of his work and thinking and here for their blog to which I contribute also)
And me....

Interestingly, and despite my concerns about the degree of crossover in terms of our talks, we all complemented and support one anothers perspectives. It was thoroughly enjoyable to not be the only maverick in the room...

There are several key points I touched on, which were reflected in the others presentations to some degree:

1) The way we communicate is changing, has changed in fact, and Web 2.0 means the internet is now, as well as being a paradise of shopping and porn, a very large, very complex conversation. Studies are beginning to show that we trust the opinions of our peers more than those of institutions, in retail, and in health. The consumer, and the patient, now has a voice, and it's getting louder. If we (the NHS) don't join the conversation, it will happen without us.

2) The NHS is hugely paternalistic. In fact, the UK is hugely paternalistic. We're told what we can and can't do to such a degree that we are being treated like errant children. Unsuprisingly, sometimes we behave that way. If the drive is towards a wellness rather than an illness model of care, then surely we should be able to make our own decisions, to be empowered to make our own choices, do our own research, live our own lives. Unfortunately, there's a conflict between what the government et al want us to do (self manage more) and the existing culture of health, which is often one of superiority and knowledge conservation, which hampers our efforts at self management. Informed and intelligent conversations are happening outside the NHS about patient care but these are not integrated into daily practice. Some clinicians still feel threatened when a patient turns up having researched their own condition...(I'd love to qualify that statement, but I've forgotten where I read it - so consider it an observation...).

3) The NHS is a brand - it doesn't actually exist. There is no one controlling body. The DOH does this to some extent, but it isn't "The NHS". That is actually an enormous number of diffuse organisations. That said, how do you leverage social networks across the NHS? There are a multiplicity of sites and networks, all with different focuses (or should that be foci?) so inevitably, you get different business models which drive different types of networks, silos of sharing based on role, geography, culture, specialty, profession etc. It's incredibly complex but that shouldn't be a reason to ignore the fact that multidisciplinary working is so very important for the success of the NHS. So, I bit the bullet, and suggested that we try to join some of these diffuse sites together - possibly along the lines of Open ID, maybe Dataportability is the way to go, but someone somewhere needs to think about this on a national level. That's not to say that we should create yet another bureaucratic, hierarchical monstrosity, but that some leadership is needed, or some collaboration, but something...

Interestingly, this week, NHS Networks posted on their site a closure notice which states:

We regret to announce that, due to lack of funding, NHS
Networks will cease operations on 31 October 2008. More information

I spoke with the National Institute for Innovation and Improvement, who currently fund NHS Networks, and was told it isn't their core business, so they are no longer providing funding. Which begs the question, who would say the support and encouragement of networks in the NHS is their core business - I would suggest, it's the core business of every organisation in the NHS! But with so many targets and directives and changes and plans and strategies and measurements each and every one of these organisations has to adhere to, the basic requirement for people to learn from what they do is way way way down the list of priorities....

What can you do?

To see what was talked about at the event, you can read about it on Rod Ward's blog Informatacopia which he wrote (amazingly quickly) during the event.

A long one, but I feel better for a bit of a rant :-)

Apple know their onions: shameless promotion for Podcast Producer

I recently had the pleasure of attending a presentation by a couple of guys from Apple on their Podcast Producer. It's a very nifty tool which takes full advantage of all the great products that come with a Mac (and I love Macs) like GarageBand and enables you to produce and publish a podcast in minutes.

It's easy enough to create a low-tech podcast, but publishing is a bit more difficult, and Podcast Producer has a simple interface for getting around all the fiddly bits. The only down side is that you need a Mac OS X Leopard server to use it.

Apple are really hot on the educational possibilities of podcasting, and work closely with US Universities including MIT and Stanford, to examine the learning possibilities of podcasts. They've developed the iTunes U, accessible from the iTunes store, where you can access 30,000 video and audio files. Easy access learning from top institutions? Go Apple!! (whoops, lapsed into American there :-)

For me, podcasts have been a godsend, and I've now developed quite a vocabularly in Spanish, having been listening to the fantastic Coffee Break Spanish podcast on my commute.

The guy who produces it, Mark Pendleton, was described as a podcast guru by the Apple guys. He started small, but has a phenomenal number of downloads from around the world. It just shows what a powerful medium for learning podcasts can be.

I'm also learning more about photography techniques with the Tips from the Top Floor podcasts - a combination of audio and video casting, which has improved my pictures no end.

From a personal perspective, I think podcasts are the learning tools of the future - another fantastic addition to the e-learning possibilties already available, making anytime anywhere learning a reality and catering from those of us who have an auditory learning style.

All we need now is to persuade those pesky purse string holders to fork out for a Mac and a Leopard server and we're off...

Dilbert on Knowledge Management II

The knowledge hoarder - that individual we all know and love...

Dilbert on Knowledge Management I

Funny...