Joe’s view: All I want for Christmas

It was Christmas Eve. The snow flakes fell like goose feathers in the still air and added silently to the white carpet on the High Street, made briefly beautiful in a little under an hour.

I was happy man. Every year there was some “must-have” present that would be talked up by Roland Rat and the new breakfast television lot, so that by Christmas Eve the shops would be full of panic stricken parents desperately seeking the long sold out Texta the robot dog, or fighting over the last Tamagotchi in the North East.

Of course, we had taken all the proper precautions to avoid the dreaded trip into town with the other lost souls who wander the malls on Christmas Eve as the shops close around them and the realization dawns that they have left it too late to make a loved one’s dream come true.

The kids letters to Santa were written and posted three weeks ago so that Santa had plenty of time to get things right and it was carefully explained that if it wasn’t in the letter it couldn’t go in the sack. We didn’t want a repetition of the great Barbie House Fiasco of ‘97.

All was going to plan until that morning a visit by Nana prompted this conversation with the middle one, Fin:

Nana: “What’s Santa going to bring you?”

Fin: “I only want one thing.”

We held our breath, one thing?

Fin: “Yes, just one thing. Tracey Island.”

Fiona and I exchanged glances, it wasn’t in the letter she explained, Fin’s big blue eyes filled and he fought tears, so did I as I picked up my wallet and keys and set off to join the lost souls as the first of the forecast snow fell.

But my heart sang on the way home up the High Street, after I had paid twice the face value for the last cardboard box of injection moulded plastic crap in Newcastle that was Tracey Island. I was International Rescue; I was SuperDad; I was invincible.

A very British misunderstanding

As I approached the end of our street in the weird, sodium light and flat sound that snow briefly brings to the city, my thoughts strayed to the hero’s welcome that awaited me.

These thoughts were shattered by a scream. A scream. A young woman screaming hysterically. Then I saw her, terror etched on her face as she ran toward and then past me – pursued at top speed by a much older man, thick set but fit, and gaining on the girl who was struggling to keep her feet in Christmas-party-red shoes.

My arm shot out instinctively and Tracey Island hit him full in the face. He fell back and landed heavily in the snow, obviously winded.

At this point I thought I’d best try to keep control of the situation with a show of aggression and some colourful language. There are some advantages to a comprehensive education in the West End of Newcastle and the ability to do a passing impression of “fierce” is among them.

“What the **** do you think you’re doing?” I screamed into his face, holding him down with one hand, the other balled into a fist and poised, drawn, ready to, ahem, strike.

A young woman’s voice behind me said. “He’s my Dad. We’re having a snowball fight.”

“Beam me up, Scotty,” I said into my fist. There followed a very English conversation, in which everyone apologised and my victim thanked me for my unprovoked assault on him and hoped he would do the same thing, were our situations reversed.

I went home chastened but impressed that the season of goodwill to all men was alive and kicking.

The moral of this story…

So, things are not always as clear as they seem to be and a rush to judgment can rebound on the judge. In this season of goodwill, spare a thought for those in Colchester who face a criminal investigation for possibly, allegedly, fiddling figures in cancer waiting times.

Personally, I’m unconvinced by the value of criminal proceedings in improving the safety culture of the NHS. Furthermore, I’m sure Colchester will not be the only case; but I’m damned sure criminal proceedings will drive other cases underground.

At a time when the budget means NHS staff are trying to squeeze a quart out of a pint pot, the pressures to deliver targets mitigate against a transparent and open culture.

For those of us who are committed to trying to improve services and patient safety using information technology, it has been an interesting year; with Robert Francis QC asking trust boards to pay more attention to outcomes and not to focus on reassuring data in his second report on the Mid Staffs scandal.

The Keogh reviews that followed the report have sent teams of experts crawling over the data of trusts perceived to be in difficulty, and a new means of assessing trusts involving an initial assessment of the data that already exists about trusts is being rolled out by the Care Quality Commission.

I have been banging on about the need for an open culture for some time now  and encouraging a culture of more reporting of untoward incidents and unexpected deaths in my own trust.

I am proud of the work I have done in my own trust and would like to claim some small credit for the fact that we are reporting many more incidents than previously.

However, high levels of reporting – the essential first step in building a safety culture – will put a trust at risk of criticism if crude numbers are compared with no account taken of the size of a trust or the complexity of its patients.

This was beautifully illustrated last month by the Daily Mail’s front page describing my trust as “second worst for deaths”. No account was taken of the size of the trust.

Journalistic ignorance, laziness or malice? Your view will probably vary with your politics, but we have to have a more sensible debate about quality comparisons between healthcare providers led by clinicians who understand the complexities of, say, how to define an unexpected death.

Chief clinical information officers need to be given time to engage with NHS England and the CQC to make sure the new regulatory framework is better than that which failed so spectacularly in Mid Staffs.

Clinically led data is a must

The CCIO Leaders Network that EHI has supported following its successful EHI CCIO Campaign will will shortly launch a CCIO manifesto urging the appointment of a CCIO for every healthcare organisation.

One of the roles of the CCIO should be to act as first port of call for those being pressured to fiddle figures. A CCIO should also be the first port of call for the CQC when it wants to know what data means locally.

I remain optimistic that computers will enable us to eventually compare, contrast and improve health services. But poorly collated data, ill understood in board rooms and twisted into true lies by axe grinding journalists, needs to be countered by a knowledgeable cadre of trustworthy clinicians.

Clinical oversight of an organistion’s data is not something that can be left to chance and the appointment of a CCIO should no longer be an optional extra. A CCIO is not just for Christmas. A CCIO is for life.

Joe McDonald

Joe McDonald is a practising NHS consultant psychiatrist. Over the past five years he has been an NHS trust medical director and national clinical lead for IT at NHS Connecting for Health – a stint that included 18 months as medical director of the Lorenzo delivery team!

His experiences in the National Programme for IT in the NHS have left him with a passion for usability and "end user knowledge networks.” He is the founding chairman of the National Mental Health Informatics Network. Motto: we don’t get fooled again. Follow him on twitter @CompareSoftware