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June 22, 2012

Alan Turing Enigma

Picture of the user console of ACEIn the photographs, dressed in jacket and dark tie, he looks like the prefect at my grammar school who cowered against the corridor walls when other pupils approached him. The mathematician and visionary Alan Turing is the subject of a compact exhibition at the Science Museum in London.

During the Second World War Turing famously helped to crack the German Enigma code using one of the earliest electronic computers, the 'bombe'. The cracking of the cipher, which the Germans believed impossible, probably shortened the war by years, saving countless lives.

Dozens of wheels rotated in each bombe making a noise like 'a thousand knitting needles'. And a legion of bombes supported decryption on an industrial scale. So effective was it that on one occasion a message was decoded in less than 15 minutes.

When the war ended, Turing worked on the government Advanced Computing Engine (ACE) project. Before such machines were invented, large scale arithmetical calculations were carried out by teams of specially trained women.

Computers were then quickly applied to complex problems in chemistry and life sciences. At Manchester University, Turing researched the relationship between mathematics and cell growth, beginning a new field he named Morphogenesis. At Oxford, in 1957, Dorothy Hodgkin used Pilot ACE and X-ray crystallography (a technique also fundamental to the discovery of the structure of DNA) to help her to crack the structure of vitamin B12 and was awarded a Nobel Prize.

Turing was condemned for homosexuality in an era when it was illegal. Under constant surveillance as a security risk, he apparently took a bite from a cyanide-laced apple. His death was officially declared suicide, though the exact circumstances remain a mystery.

As a leader in computation--particularly in programming--he deserved better. However, in recent decades he has been recognised as one of the greatest thinkers of the 20th Century.

June 17, 2012

Information Governance Industry

Has the NHS gone compliance crazy? In a few years information governance has expanded from a toolkit into an industry. NHS trusts are spending more and more on ensuring compliance—a trend accelerated by the large fines being handed out.

I worry the NHS is developing a compliance culture in the way of Children’s Services or to some extent the Police. This is a particularly concerning when staff are challenged to improve the efficiency of services, because structured compliance soaks up the time needed for innovation. It is easier to tick a box than seek solutions outside the box.

Information governance is following a similar path to data quality. I still come across NHS staff whose job is to correct the data entry mistakes of frontline staff. It is also impossible to eliminate risk. One of the commonest things I find when managing programmes, or digging out those in a hole, is the gulf between risk identification and risk management. Risks are often identified and then forgotten.

Of course, you have to question NHS culture when photographs of patients are posted on Facebook, confidential data on hard drives are not erased before disposal, and the correct identification of a patient needs policing.

If I know that someone else will correct my mistakes, there is less incentive for me to get it right first time. Therein lies the problem and the solution. The emphasis should not be on creating an IG industry but on empowering, and training frontline staff. Then the solution lies not in compliance but in good mangement.

June 10, 2012

Twenty First Century Healthcare with IT

There was a good turnout of clinicians at the planning session with an NHS client the other evening. Main strategic work streams were quickly agreed, and we got onto enablers. I expected the usual suspects: more consultants, more nurses and more money. I was wrong. Almost all of the groups chose IT as a major enabler of change for the better.

The NHS must save £20bn in the next 4 years or so. It has well worn approaches to economising—top slice budgets, freeze recruitment, cut some services. Mergers and takeovers and consolidations are also looming. That lot may keep us on target for a couple of years…and then what?

Now the traditional fixer for the NHS is money. Yet, despite unprecedented increases in funding in recent years, the National Audit Office says efficiency has fallen steadily. Most of the increased funding has gone on increased salaries and increased staff, but that hasn’t led to comparable increases in procedures and appointments. That means even if more funds were available, the NHS would still not meet increased demand.

I hope this will lead it to the conclusion that options around status quo are exhausted. In its present form, the NHS has gone as far as it can. The only way to create an affordable, efficient service that meets customer expectations—in other words a 21st century service—is complete redesign based on the effective use of IT.

I hope the participants at that planning session realise that. After all, adding 21st century digital parts to a 20th century mechanism will not do it. What is needed is a complete rethink. Part of me thinks the time is right for just that, and part of me thinks the powerful interests in and around the NHS will make it impossible.