Joe’s View: Santa, this is unsustainable

Santa was buckling under the strain – until Mrs Claus came up with a plan. Joe McDonald’s Christmas column this year looks at whether this festive tale could hold a lesson for the NHS.

A long time ago, on a cold winter’s night at the North Pole, Santa slammed the door on the blizzard outside, kicked off his snowy boots and flopped down into a huge armchair by the log fire. He sighed and quickly fell asleep, snoring loudly with one arm still in his red fur-trimmed coat.

Mrs Claus knew what to do; she rolled up his trouser legs and fetched the tube of Deep Heat from the bathroom cabinet. She lovingly rubbed it into his knees. His poor knees. He’d been out all of November visiting every toy department in every major department store in every city in the world. And every child in the world had sat on his knee. With the global population rising so quickly Santa’s arthritis was worse every year.

When he woke, Mrs Claus poured him a large Glemorangie, and handing it to him said “Santa, this is simply unsustainable. We have to find another way”. Santa looked glum. “But how will I know what the children want for Christmas?” he said. “I haven’t even had time to update the naughty list today and it’s nearly midnight.”

“Look,” said Mrs Claus “I’ve been thinking. What if you didn’t have to do everything yourself? What if we modernised and automated a few of the simpler tasks so that the children could let us know what they need through some sort of asynchronous chat system, perhaps by the sending of letters up chimneys or via the post.

“We could delegate the answering of letters with top quality standard responses personalised by the elves. They could do more than simply make toys if you let them, you know. They could even manage the naughty and nice lists. The elves could do all the simple ones and escalate all the tricky ones. Santa should only be doing the things only Santa can do.”

Automate to save Christmas

Santa was unconvinced. “Are you nuts?” he bellowed. “Open another channel of communication with the general public? I’m already overwhelmed. With all the extra work that would bring, it might well be the end of Christmas altogether.”

“Well, we can’t go on as we are, can we?’ said Mrs Claus. “If we don’t automate, delegate and get them to serve themselves then Christmas has no future.”

Santa’s buttocks clenched at the thought of all the messages, but he knew something would have to give; they would have to change.

Last month, I sensed similar fear of change among the clinicians in the audience at London’s Science Museum at the glitzy launch event of Nervecentre, the British, dark horse in the electronic patient record race. Paul Volkaerts, CEO, was presenting some new features including a facility built into the EPR, not a portal, to allow the patient to input directly into their own record and communicate directly with clinicians. Sensing the mass clenching of buttocks, Volkaerts added, “of course, you don’t have to turn it on for everyone all at once”. Audible sighs of relief in the packed auditorium.

Open up to patients

During the lunch break I stood under the Vickers Vimy aircraft, suspended from the museum ceiling, in which Alcock and Brown had first flown the Atlantic and marvelled at the motorised box-kite nature of it, stuffed with drums of fuel, open to the elements. Courageous innovators who lived to tell the tale when all around them told them they were mad. Is Volkaerts mad? Open up to patients?

Shadow health secretary Wes Streeting’s recent visit to Singapore has evidently led him to the same conclusion as Mrs Claus. The NHS is unsustainable without major reform, and he sees tech as the way forward.

Seemingly impressed by Singapore’s approach Streeting said “What a contrast to back home, where I think patients in hospital don’t really know what’s going on. I definitely think there is an institutional and structural problem in the way the NHS works. It claims to be patient-centred, but it really isn’t.” Fighting talk. I can hear NHS buttocks clenching at the thought. But what if he’s right?
NHS productivity has not been improved by the installation of EPRs, if anything we’ve made it worse. Clerical tasks have shifted on to clinicians. We’ve conflated performance management recording and the patient record.

Recent user experience surveys indicate the NHS has some of the worst health IT user experiences in the world, but like Santa the idea of opening up to more communication with patients is terrifying to many clinicians.

However frightening the idea, opening up to patients can be done. Tasks that would usually fall on the clinician can then be done by the patient, therapies can be automated, work delegated, time and money saved. How do I know? Because we’ve been doing it at Sleepstation for over 10 years now.

We have democratised cognitive behaviour therapy for insomnia (CBTi) and allowed people to help themselves to therapy supported by asynchronous chat with coaches; and all for a fraction of the cost of conventional CBTi.

Top of Santa’s list

Is this the kind of genuine transformation of care that Streeting is talking about? I think so. Done right, opening up to patients is the way to genuinely transform the NHS and maybe secure its future. It will require a genuinely patient-centric approach and EPRs that are equally patient-centric. Maybe Volkaerts isn’t mad.

Meanwhile, back at the North Pole, Santa’s new asynchronous messaging system and delegation of the curation of the naughty and nice databases to the care of his most trusted elves has saved Christmas for future generations and freed him to do the things only Santa can do – tricky edge cases for the naughty or nice list.

Top of his list this year? Wes Streeting. Is he naughty or nice? Santa sipped his Glenmorangie and furrowed his brow. “Oh, go on,” said Mrs Claus. “Give him the benefit of the doubt this year and review it next Christmas…”.