Tag: NHS

Compulsory suicide?

Do your duty, prepare for your lethal injection.

Tl;dr: Our medical/care system is screwed, governments are all efficiency- and cost-obsessed. They’re fixated on ageing and on the explosion of the ‘economically inactive’ population. These ghouls like the idea of more people taking the voluntary way out.

Is this just paranoia? Am I being a conspiracy nut? My concerns about the assisted suicide bill, currently in the UK Parliament, are not with the risk of coercion by family members or doctors or scumbags of one kind or another (total red herring).

I’m not worried about ‘the slippery slope’ or about the risk that old people might want to avoid becoming a ‘burden’ (they’re already worried about that). My concern is much simpler. It’s about this system, a system of governance that is less and less humane; more and more obsessed with measurement and control, with efficiency and throughput and the management of shrinking resources.

In this system – this diminished and dehumanised system – the pressure to move the sick and elderly, the incurable and the intractable (the awkward, the unemployable, the unproductive) along the expensive health and care timeline and onto the fast track, onto the slip-road out of here, is already enormous.

Do not be under any illusion: there are managers and administrators and government ministers (and global consultancies and insurers and private equity firms) who would very much like to speed things up a bit, to increase the throughput, to just slightly improve the ratios.

They’d like to reduce the pointless expenditure on keeping the sick and the inactive alive and to create in the citizenry – the customer-base, you and me – a new habit – the habit of volunteering to step off this mortal coil a bit early.

Not too much. Just a few months or a year. Barely noticeable. But every little helps. Move along now. Off you go. Thank you for your contribution. It’s been lovely knowing you… See ya!

  • I’m ready to make a small bet that within a few years we’ll see the first ‘Dignity Unit™’ or ‘Goodbye Suite™’ in the grounds of a hospital or a care home. It’ll be all pastel colours and there’ll be a wild-flower garden maintained by volunteers. A minor Royal will cut the ribbon…
  • This, incidentally, explains why politicians are not freaking out about the fact that life expectancies are now falling in parts of the developed world – including Britain. That looks like a self-adjusting system to these people.

Googlification vs picklification

Before I get my teeth into the BBC Trust’s service review (I feel obliged to sooner or later) I enjoyed the collision of cultures (or contrast of cultures I guess) evident in two announcements made last week. In the first one Google announced that the company’s personal health platform thingie Google Health now works with medical records systems at various US hospitals (they started in Cleveland).

Obviously this is just another step in the advancing Googlification of Everything but it’s also interesting because of the way it contrasts with the second announcement, which was from mega-government IT contractor Fujitsu (which used to be ICL) that they’ve got into a terrible pickle and have finally had enough of the vast and (by the sound of it) out-of-control government IT disaster-in-the-making that is the NHS medical records system.

The former (Google and the hospitals) says: use light-weight, consumer-grade tools, put control in the hands of users and not administrators and concentrate on incremental methods, standards and interoperability. The latter (the £12 Billion NHS system) says: build grim, centralised and monolothic systems on a military-industrial scale, exclude open, incremental or agile methods because of your 1950s risk model and hope for the best.

So the big question is: how many of these epic, national-scale contracting disasters do we need to see before we change our approach and try building important national systems by assembling existing code and services in a smart, non-dogmatic way? My guess: at least another ten years. Contractors (BT In particular) are queuing up to replace Fujitsu in the NHS job because the money is just vast. A real web 2.0 type approach to the project would cost 10% of the bid price for the whole thing and would get dozens of executives fired.

In the meantime, I think everyone involved (at the NHS and Fujitsu at least) should read this fascinating presentation about the re-engineering of the BBC’s online identity system from Brendan Quinn and Ben Smith (thanks to Jem Stone for the link). To quote:

1. Each project must have a clear customer and a real benefit
2. Don’t repeat yourself
3. Be as simple as possible
4. Be as open as possible
5. Start simple, then iterate
6. Don’t optimise prematurely…
7. …but build to scale
8. Test often
9. Evolve
10. Let it die

If the BBC, which is a pretty big institution—although I’ll acknowledge it’s an order of magnitude smaller than the NHS—can build like this then the NHS could too. I wonder if there is any radical thinking of this sort going on there or is it life in the bunker for all concerned?