Mediffairs

I share my pearls of wisdom on two matters.

The first concerns a drug which, for present purposes, may be called poppyparazodamiene, 30 portions of which were issued to me for use as required during my recent visit to hospital. As it turned out, I was fairly needy and was getting through my supply fairly quickly. So I started to worry about what would happen if I ran out? I had no idea how long the need would persist for but the prospect of being very needy was not pleasant. Now it is not the sort of thing that you are going to be able to get over the counter at Boots. Or at Lloyds for that matter. So I apply to my GP who kindly arranges for me to be given a further 100 portions and there is now nothing to worry about.

But being of a worrying disposition I manage to come up with something. My need is showing signs of abating and it is possible that I will not need any of the additional supply. But my understanding is that, in this event, I cannot usefully return the stuff to the pharmacist. His instructions are to send all returned medicines to the incinerator and I can see that in the great scheme of things it might not be worth his time to try and sort out the stuff which can safely be reused from that which cannot. So my worry is, supposing this stuff is expensive? Maybe even very expensive - I don't happen to think that it is, but it is always possible.

And my question is, given that we need to manage the potion bill for the nation at large, where should the price of the stuff bite? Is it enough that the GP, who is or is about to become the budget holder, worries about this, and if he decides that the potion costs a lot relative to the transaction cost of a prescription, he can always prescribe in smaller volumes? Is it right that I should be worrying about the costs of potions when I should be worrying about getting better?

My answer, is that it would not hurt for prescriptions to carry a price ticket. Those who do not care what they spend in this way will not be hurt and those who do care will be able to do so. This is, of course, quite different from asking people to pay at the point of delivery. Hopefully we have, in large part, got away from that and will not return, bullingdons permitting.

My second concerns the possibility of getting lost in the system and I spent my quality waking up time this morning thinking about I how would reduce this possibility.

Step 1, get the IT department to buy some decent work flow software. It seems quite likely that there is something available on the shelf, perhaps a spin off from all the billions poured into healthy IT by the Blair Brown team. The outfit called Filenet (mentioned in the other place on 20th October) used to sell the sort of thing that is needed.

Step 2, divide the hospital up into teams, with team leader roughly equating to consultant.

Step 3, make a rule that when anyone is admitted to the hospital for more than a passing visit, they are assigned to a team. That person is then the responsibility of that team and it us up to the team leader to make sure that the work, that is to say the patients, flow (systems of this sort not called work flow for nothing) through the system in an orderly way.

Software of this sort is very good at keeping teams up to scratch. At making sure, for example, that observations are made and recorded (in which connection, see 25th September). At raising exception reports. At escalating problems to senior management. Generally making sure that the flows are orderly.

Step 4, make rules for transferring someone from one team to another. Maybe another team at another location - this last apt to be slightly tricky as it is too much to hope for that the other location will be operating the same work flow software. Some sort of protocol which requires a positive acceptance from the receiving team before the donor team can sign off.

Step 5, make rules about who is allowed to do what to which records. So a member of team A is not, for example, allowed to tamper with key details of a patient assigned to team B.

Step 6, add some bits and pieces to do team maintenance. For team members and team leaders to come and go. Sometimes one can deal with this by talking of roles rather than people.

Over a liquid lunch, a work flow salesman might get quite enthusiastic. Use the system for controlling the management of patients in quite a detailed way. So for example, a request by doctor A to nurse B do procedure C on patient D might be expressed as a work flow. An item, rather like an email, which arrives in the nurse's in box. Authority, documentation, everything he or she needs to get on and do the job. And make the record afterwards.

In other process or transaction orientated industries all this is bog standard stuff. Been around for years. But has it percolated to the health world yet? All this being prompted by reports in the DT which suggest that it has not percolated as far as North Devon.