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OK computer

In the land of evidence-based healthcare the data-rich person is supreme

Sid Dajani gets geeky over technology and frustrated over politics

For most of us, the realms of IT stretch to sitting down with a cuppa, cranking up the computer, deleting every third email on the basis that if it was important they’d send it again,

and checking the news on an app. I am no different, although I did chair the Pan- Pharmacy Information Management and Technology Group for six years after arguing how valuable such a committee would be for the Royal Pharmaceutical Society. It’s now called the Pharmacy Digital Forum and is no less important.

When we started out we were talking about IT being a luxury to help our workload. Now it’s an obligatory tool we can’t do without. Back then we were about doing more with our glorified labelling machines. Now our computers
are invaluable professional tools which print leaflets, place our orders to multiple suppliers, hold our own patient notes and even access summarised patient notes held at the GP surgery. Back then, we mainly talked about hardware and servers, now it’s about the iCloud, data management and data security.

For a geek like me, this is the sexy stuff. We are the only healthcare professionals who have operated in an information vacuum, sometimes second guessing what patients ignore or forget to tell us. I’ve always said we cannot unlock our true potential without access to other patient data, proper IT training, digital investment and using IT in our normal workstreams. To me, to suggest anything else is short- sighted and crazy, especially considering we have confidentiality agreements and generate patient data.

Data deluge

Over the past two years we have been generating data like never before. We can access summarised patient records, clinical screening results for tests we’ve carried
out, and soon we’ll be matching patient medication to individual packs of medicines. But data also has its dark side, and the blackmailers, extortionists and commercially hungry pharmaceutical industry would find such information useful.

In the land of evidence-based healthcare the data-rich person is supreme and pharmacy systems need to be secured like never before. We are now talking about how best to do this and spotting where the risks are. It’s called future-proofing preparation and you can imagine what a hit I can be at social gatherings when I start talking about the three domains of information and data, infrastructure, and business and digital systems.

I’m now convinced there are also three key NHS domains. First, the NHS that the Department of Health press office inhabits. That’s the world of more money, extra this, people, political perfectness, and general Walter Mitty. Best to ignore their entire output!

Second is the world of think-tanks and analysts. Their penetrating analysis and forensic examination of policy and its implications are totally, utterly, and completely irrelevant to people working at the sharp end of care. They are the policy bubble, floating around Westminster.

Finally, there’s the real NHS. For any secretary of state to have no certainty of being able to deliver a simple manifesto promise is undemocratic, frustrating for everyone, and consumes energy and resources in fruitless argy-bargy.

Dangerous silos

Serious political direction and strategic management has been pushed beyond our reach. In their place we have dangerous silos – self-contained organisations that have to expend enormous energy and effort to work around, work out, and work up, ways of working together.

Politicians would do well to remember that they, and all of us, are custodians of this great public service and we do it no justice to render it – through wilfulness, thoughtlessness or carelessness – unworkable. That includes funding. How much money the NHS gets is a political decision. There is no real formula and usually a row. The NHS is carrying out more treatments and providing more care than it is funded for, and the government seems to think that pharmacy has a shed-load of extra money it can pillage. It hasn’t.

The NHS isn’t overspending on pharmacy and that’s been proven in all the independently commissioned research studies. For example, the 2009 Cost of Service Inquiry even recommended an increase in funding following years of underinvestment, and a formula was developed that took into account several variables as an aid to start annual negotiations. And in September, PriceWaterhouseCoopers showed pharmacy actually adds £3bn to the economy through free services, helping people back to work, preventing unnecessary NHS misuse, and providing care.

To everyone but the political mugwumps, the potential role community pharmacy can play in improving and maintaining the nation’s health is undervalued, and they’re making it worse.

I’m not an economist. Nor am I any kind of ‘-ist’, although perhaps I’m a realist because I rely on common sense, experience, and a pile of other stuff that helps me come to rational and reflective decisions. So never in a month of Sundays would it make sense that the government wants us to do more and be the first port of call for more patients, while wanting to close 3,000 pharmacies by cutting funding. As resources get diverted, it will eat into staffing levels, employment, training, and IT processes, putting lives at risk in the community and in hospital.

Healthcare professionals inspire you to lead healthier lifestyles. I honestly don’t think we have politicians right now that could inspire me to sit in a puddle if my trousers were on fire!

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