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Why the care record sends NHS managers a bit bonkers

What is it about IT that brings out the maverick in the otherwise grey-suited world of NHS management?

By Richard Hoey

What is it about IT that brings out the maverick in the otherwise grey-suited world of NHS management?



Royal Cornwall Hospitals NHS Trust was probably a perfectly sensible organisation until it first heard about Choose and Book.

Five minutes later and staff were busy playing the alchemist by turning paper referrals into electronic ones, in a rather desperate attempt to hit a Government target for online booking.

But it's the Summary Care Record that really turns managers nutty, although in fairness, PCTs are caught in a bit of a bind.

Trusts know they will be clobbered from above if they fail to get huge numbers of patients signed up to the scheme.

Unfortunately, they also know the only way to get the numbers is to place ever more ridiculous barriers in the path of those pesky independent-minded types who might want to opt out.

And then they get clobbered by Pulse.

First we revealed NHS Lincolnshire was demanding GPs handed over details of patients who wanted to opt out, so the trust, with the sinister under-statement of the East German Stasi, could ‘discuss it further'.

Two weeks later and that plan was scrapped, only for another equally daft one to emerge elsewhere.

We reported that managers in Birmingham and Stoke had decided it might be a good wheeze to insist that any patient wanting to opt out would have to do so in person.

NHS South Birmingham knew it had been rumbled, calling our story ‘accurate, but limited'. And sure enough, within two weeks Connecting for Health had issued new guidance making clear that patients must be allowed to opt out by letter.

But why are PCTs getting themselves in such a mess?

It seems to be a product of the rapid and confusing transition between the old world of targets and central diktat, and the fluffy new world of local decision-making.

Just as with vascular screening, PCTs are being placed under strong central pressure to deliver on the care record, but given no firm national guidelines about how to do so without messing up.

And if a PCT is presented with an opportunity to mess up, it will be sorely tempted to take it.

Many of the Government's national targets have been deeply unhelpful and driven precisely the kind of gaming we have just seen in Cornwall.

But where targets do exist, the Government cannot wash its hands of responsibility for their delivery.

The present uncomfortable half-way house is not working for the care record or for vascular screening.

It's only succeeding in making the PCTs look like fools.

By Richard Hoey, Pulse deputy editor

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