Cowper’s Cut:Tesco, Disneyfication and avoiding the real problems

If you don’t have the right diagnosis, you’re not going to get the right treatment.

After the black swan event of Appless Matt ’Ancock being right about a thing which I noted last week, normal service has been resumed.

National Saying Stupid Things About The NHS Week

Indeed, system leaders have left this feeling like it’s National Saying Stupid Things About The NHS Week. Again. 

Speaking at the launch of the Topl Review this week at the RSM in London, Mr ’Ancock doled out more of his tech-Utopianism.  

And to point out that the NHS does indeed have inadequate technology and IT in many areas (which also have excellence in patches), whom did Appless Matt choose as his comparator organisation?

Tesco. Yes. A supermarket chain.

Mmmmmm.

“Right now, Tesco has a more sophisticated and more efficient technological system than the NHS. They know who you are from the loyalty card to where you shop, from store IDs to what you buy, and the items scanned at the checkout.

“That wealth of information means… they can shape the offer with a personalised service in order to deliver for you the customer.

“And they’re delivering groceries. The NHS doesn’t have anything like that yet.”

On non-linked primary and secondary care patient records, he added, “We don’t even record what devices are put into people. If Tesco can do this with groceries, by God we need to do it with life-saving operations for the NHS.”

Mr Hancock reportedly compared the review’s findings to “the forward thinking of Charles Darwin, Edward Jenner and Alexander Fleming”, displaying a sense of context and perspective that is second to most.

The Dunnhumbly loyalty scheme used by that supermarket chain’s customer loyalty scheme was technically impressive for its time. And as I have said before, we need to improve NHS IT.

The biggest real problems

But we also need to look at what the biggest real problem facing the NHS is in 2019. And it’s matching rising demand with available workforce, on which more below; closely followed by culture.

The Secretary Of State For The Time Being’s repeated emphasis on video GP consultations (which as I’ve previously stated, are already possible using one of the best-known primary care IT providers), and other IT initiatives, will at best make a marginal difference.

Yet, it is constantly being sold to the unwary as an NHS game-changer by The Appman.

Meanwhile, Mr ’Ancock’s efforts to onshore NHS Commissioning Board chief clinical information officer Dr Simon Eccles’ digital teams into the Department For Health But Social Care’s comically-named NHSX in another rapid restructure continue apace.

Lord Prior has previous

If things are ever getting a bit too subdued in the NHS national conversation, it’s probably time to wheel out the NHS Commissioning Board’s chair Lord Prior to pour oil on troubled waters and then ignite it. Prior has previous on contentions comments.

This week, the good Lord told a Reform event that NHS targets have had their day. (Yes, that is former Care Quality Commissiong chair Lord Prior.)

Lord Prior said, “We have had 15 years of this top-down target-driven culture that has driven the NHS. The degree of pressure to hit targets is something I have never encountered in the private sector, the un-nuanced level of these targets”.

Well. The former chair of the national quality regulator and the current chair of NHS Engroovement/Improveland, which is merging with a national performance and finance target regulator, has quite the hot take.

One almost wonders if the Sun King of Skipton House Simon Stevens sent the good Lord out on these manoeuvres so that when the accident and emergency target is re-categorised following the forthcoming review, it will “definitely” not be an abolition or weakening of the target.

Lord Prior also reiterated his view that competition in the NHS has proven “deeply damaging” and “failed almost totally”. This may come as news to those familiar with the peer-reviewed academic work of Carol Propper, Zack Cooper and John Van Reenen. (The meaningful debate here is probably whether the effectiveness of competition is also cost-effective in both financial and opportunity cost terms.)

Disneyfication

The risk here is that in terms of outlining the problems facing the NHS, which are big and real, figures such as Appless ’Ancock and the good Lord are Disneyfying the picture – and missing the point.

The real problem is the imbalance between service demand and availability of both resources and workforce, as Health Foundation analysis shared with The Guardian again shows.

If you don’t have the right diagnosis, you’re not going to get the right treatment. And in that case, not even a chief anthropologist will be able to help you navigate things better.