This all started last night when a link flashed before my eyes. It had the magical word ‘NHS’ in there and that word works on me like a red cloth on a bull. I believe that there is a lot wrong there and even more needs fixing, it needs to be done. There is no disagreement from anyone. The way to do it that is where the shoes start feeling tight. There are so many sides to fix, the side to start with is not always a given. There will be agreement and disagreement, yet overall most paths when leading to improvement should be fine. There is however one almighty agreement. You see the data analyses side of health care is not that high on the list. Most would agree that knowing certain stuff is nice, but when you have a primary shortage (nurses and doctors) the analyst does not rank that high on the equation. Although I am an analyst myself, I agree to that assessment of the NHS, my need is a lot lower than getting an extra nurse (at present). So when I see ‘Another NHS crisis looms – an inability to analyse data‘ (at https://www.theguardian.com/science/political-science/2017/feb/08/another-nhs-crisis-looms-an-inability-to-analyse-data), I start wondering what actually is going on. The first issue that rises is the author. Beth Simone Noveck is as the Guardian states “the former United States Deputy Chief Technology Officer and Director, White House Open Government Initiative. A professor at New York University“, you see, it is a given that Yanks always have an agenda. Is this about her book ‘Smart Citizens, Smarter State: The Technologies of Expertise and the Future of Governing‘? Just asking, because the by-line there is: “New tools—what Beth Simone Noveck calls technologies of expertise—are making it possible to match citizen expertise to the demand for it in government. She offers a vision of participatory democracy rooted not in voting or crowdsourcing but in people’s knowledge and know-how“, which seems to match the article. So, is this her sales pitch? You see, she must have missed the memo where the previous labour government wasted £11.2 billion on something that never worked and now as the NHS has plenty of crises moments, spending it on something that limits the growth towards nurses and doctors is a really bad idea.
Then she sets the focus on the HQIP with: “The Healthcare Quality Improvement Partnership (HQIP) conducts forty annual audits comparing hospital and physician outcomes, and the implementation of National Institute of Clinical Excellence standards across England and Wales. But, as HQIP Director Dr Danny Keenan admits, although they have the expertise to do the analysis, “we are woefully inadequate at translating such analysis into improvements. What’s the takeaway for the hospital or community provider Board or the medical director? They cannot understand what they have to do.”“, from that I get that the existence of the HQIP is under discussion because they cannot communicate. This we see in: ‘They cannot understand what they have to do‘, which means that the hospital or community provider Boards or the medical directors are either incompetent or there is a communication issue. I am willing to ‘auto-set’ to: ‘the inability to communicate’. I admit that I would have to read those reports to get a better view, but it is clear that the HQIP has a few cogs missing, which is on them and not on the NHS as such. So if the NHS needs to cut further, that’s where the cutting can start.
Am I against the HQIP? No, of course not, but the NHS has actual problems and putting more resources in communication gaps when a place is running low on gauss and staff the priority seems to be pretty clear. I also accept that if this path is taken that restoration of the NHS will take longer, I get that, but I hope you can agree with me that once the ability to properly aid patients is restored, we can look at the next stage of fixing the NHS, because aiding patients’ needs to be the primary concern for all sides of the NHS.
A second element in the given sales pitch comes from Dr Geraldine Strathdee, where we see “National Mental Health Intelligence Network, together with partners, launched the Fingertips Mental Health data dashboard of common mental health conditions in every locality. Strathdee points out there is a tremendous need for such benchmarking data: to design services based on local need, build community assets, and improve NHS services“, I have stated at a few conferences (mid 90’s) that there is an inherent need to document and create clear paths of internal knowledge retention, which included healthcare, education and government departments. I literally stated “as you grow the knowhow with your own staff members, you will increase their value, they will be better motivated and you create a moment when you become less and less reliant on outside sources, which usually cost a fair amount“, I have been proven correct in more than one way and the lack from some people who saw the gravy train benefit by being aligned with consultants is now at an end and those people tend to not have any allegiance, other than the need to grow their bank account. Creating internal knowledge points has always been a primary need and as this opportunity was wasted, we now see the plea ‘a tremendous need for such benchmarking data‘. They should have listened to some of their IT people a long time ago. The second opposition is seen in “Without it, NHS resourcing is just based on historical allocations, guesswork or the “loudest voice”“. This implies that there has been no proper data collection and reporting for well over 5 years, whilst 10 year gap would sound a little more correct (an assumption from my side). When you look at the Netherlands, there is a long list of reports that psychiatrists and psycho analysts need to adhere to and deliver towards those paying for the services. That has been the case for the longest time. What happens afterwards? Are they not properly collated and reported? In the Netherlands it was and I think it still is (a fact, not verified at present). Yet what happens in the UK? The yank might not know, but I reckon that if the MP’s ask these questions from Dr Geraldine Strathdee that we will get proper responses on what is done now, how it is recorded, reported on and considered for continued improvement. If all of that is absent, who should we talk to? Who needs to give an accountable response?
At that point the doctor becomes a little confusing to me; perhaps that is just me, because when I read “The data dictates investment in early intervention psychosis teams, which dramatically improves outcomes. Fifty per cent of patients get back to education, training or employment. However, there is a shortage of people able to draw these insights“, I just wonder what is set in reports. It is confusing because psychosis is only one of many mental health issues that are in play. When someone gets diagnosed as such a treatment plan comes into focus and as such data had no impact. The patient is either correctly treated or the patient is not. Data had no influence there, it is the carer’s report that is submitted and for that this person will either get the resources needed, or not. Data will not influence this. A report on how many are treated with psychosis is required, but as the reports are handed upwards, those numbers would be known and as such the required needs in medications, staff, treatment plans and of course the required funds to pay for all this would be known. If not, the question becomes: is Professor Noveck there to aid in obscuring events, or should we consider that the National Mental Health Intelligence Network has become redundant and is draining funds needlessly? If you think that this is an exaggerated notion, consider that when we look for the ‘National Mental Health Intelligence Network‘, we get the website (at http://mentalhealthpartnerships.com/network/mental-health-intelligence-network/), the latest thing on their website is a meeting from September 2013, in addition there is something from Professor Chris Cutts on STORM Skills Training and that is May 2014. So I think that the National Mental Health Intelligence Network did get itself involved in a sales pitch and a very poorly constructed one I might add. You see, when we go to Public Health England, we see that there are health Intelligence Networks, but the one they have is called ‘National Mental Health, Dementia and Neurology Intelligence Networks (NMHDNINs)‘, perhaps an oversight from the two sales people? You see the Mental Health Dementia and Neurology path gives us all kinds of information (shallow information I admit), but I wonder if that is wrong or just not the proper place to find it. In addition I see when I look at ‘Severe Mental Illness‘, some 2017 mentions (so it is up to date) with the Psychosis Care Pathway, where I see “The Psychosis Care Pathway provides a high level summary using 16 key indicators to help users assess and benchmark how they manage this important condition. This pathway is consistent with and linked to the Commissioning for Value Psychosis packs to be published by NHS England“, this is an interesting part isn’t it? Does this mean that this is happening, not happening, or more important, what on earth does Dr Geraldine Strathdee think she is doing? Perhaps it is an ill-conceived hostile takeover using an outsider who was published and has a name, whilst the minimum needs to be taken seriously are not even there (an up to date website perhaps). This whilst the mention ‘based at Public Health England‘ is an issue as the Public Health England (at https://www.gov.uk/government/organisations/public-health-england), has no mention at all of the ‘National Mental Health Intelligence Network‘, is that not odd? So what ill-conceived sales pitch are we reading in The Guardian?
Perhaps the quote ‘The NHS needs data analytical talent, which comes from a variety of disciplines‘ gives us that. And as the NHS has no immediate need to hire analysts, see there, the ‘National Mental Health Intelligence Network’ would come to the rescue and save the moment. Perhaps the first thing they would consider is hire a web designer and make sure that the latest INTEL is not 2+ years old (cautious advice from my side). In addition, as it seems that the NHS is likely to be pushed into a ‘we need analytics data‘ conversation (one they can go without at present), not taking the word from a professor and a doctor who dropped the ball might be a first notion to consider. Making a proper inventory of what data the NHS has and seeing if a conversation (a non-invoiced conversation) with someone from Q Research Software is likely to be a hell of a lot more productive than talking to the previous two ‘sales’ people that the Guardian article touches on. I will be honest I had a few issues with that program in the past (for specific reasons) but Q Software has never stopped improving and it has grown to the extent that it is now chiseling to the marginal groups IBM Statistics had and they are now losing those customers to Q Research, which is quite the accomplishment. In that I think it is Dr Danny Keenan who is likely to get the most out of such a meeting. From what the Guardian tells us, we get the implied understanding that he needs the solution to tell a better story. You see, translating statistical results into actions is done through stories. Not fabrications mind you, but a story that helps the receiver understand what direction would be the best to take. The listener will get a few options and each will have a plus and a minus side and usually the one with the best track movement tends to win. If that path includes successfully suppressing the negative elements even more, so much the better.
My main reason for opening this door is because there is enough low level talent in the NHS in several places that might have the ability to do this on the side, a simple path that allows additional reporting whilst not needing to drain essential resources. I call them ‘low level’ not because of anything negative. When working with proper analytics you need to have someone on your back and call with a degree in applied mathematics. Anyone claiming that this is not needed is usually lying to you. In the case of Q, a lot of the calculations have been auto completed and the numbers that are reflecting in the tables still need some level of statistics, but many with a tertiary business degree would have had exposure to a lot more stats than is needed here so as such this person would be low-level only in that regard. It is for all intent and purposes a reporting tool that goes a lot further than mere tabulation and significance levels. It could be the tool of choice for the NHS. Even when they start getting forward momentum, this tool would still be massively useful to them and any change might be limited to getting a dedicated person for this goal. Which with the current shortages all over the NHS is not that far a stretch anyway.
So as we realise what one program can do, we see the questionable approach that the sales person named Beth Noveck is making. The mention “the NHS should expand efforts already underway to construct an NHS Data Lab“, “Improving public institutions with data also requires strong communications, design and visualisation skills. Digital designers are needed who know how to turn raw data into dashboards and other feedback mechanisms, to support managers’ decisions” and “So the NHS needs to be able to tap into a wide range of data analytic know-how, from computer scientists, statisticians, economists, ethicists and social scientists. It is impractical and expensive to meet all of these needs through more hiring. But there are other ways that the NHS can match its demand for data expertise to the supply of knowledgeable talent both within and outside the organization”
Three distinct statements which are not false, yet the first one is currently not feasible with the shortages that the NHS has the second one was debunked by me in merely 5 minutes as I introduced Q Research Software to you the reader. Anyone stating that this is not the best solution has a case, but in the shortage world the NHS lives in, with the cost of Q-Software against 93% of all other software solutions, it is the best value for money the NHS could ever lay there fingers on and the third one is even more worrying, because that expensive track of consultants is one of the ways that partially accounts for the £11.2 billion loss that the NHS already suffered. Should the esteemed professor come up with ‘additional considerations’ the NHS should become really scared, because there is a growing concern that some people want to get their fingers on the NHS data, the one treasure the bulk of ALL American healthcare insurers and provides want, because that is one data warehouse they have never been able to properly build.
She ends the article with “Whether the NHS wants to know how to spot the most high-risk patients or where to allocate beds during a particularly cold winter, it can use online networks to find the talent hiding in plain sight, inside and outside the health and social care system“, so how does that work? Where to allocate a bed in cold winter? Are they moved by truck to another location (impeding nurses and doctors as more aid needs to be given at that location), will it require the patient to move, which is actually simply done by finding out where a bed is available. The article is a worrying one, in that light that the article was published and I wonder if it was properly vetted, because there is a difference of many miles between a political science piece and an opinionated sales pitch. So my next step is to take a very critical look at “Smarter Health: Boosting Analytical Capacity at NHS England“, because my spidey sense is tingling and I might find more worrying ammunition in that piece.
Lawrence van Rijn - Law Lord to be 