Turning from a critique of GP clinical systems let us consider the 
administrative systems used by Health Authorities, and their 
faithful sub-committees, the Primary Care Group Boards.

Technology introduced some 500 years ago has been demonstrated to be 
inadequate, the Gutenberg era is over.

Apportioning blame for the current state of affairs between 
malevolence, Machiavellian manouverings, incompetence in the 
technical and administrative fields on the first hands, and the 
inbuilt limitations of the technology of physically carried paper on 
the final limb of the octopus is difficult and would be tedious.  
Such a fine splitting of blame should be reserved in case 
identifiable HAs or officers within them can be seen to oppose the 
introduction of the now mature technology of the int{ra|er}net.

Secrecy more rarely begets tyranny and oppression than it is used to 
cover up incompetence, muddle, failure and the imposition of 
impossible tasks.  The cover-up when successful prevents early and 
easy correction of such faults and is truly in nobody's interest.

The technical obstacles to the free flow of information are trivial, 
the political and administrative ones considerable, but the time is 
ripe to overcome them.

The paradigm of secrecy and openness must be reversed.  Instead of 
all of a HA's information being secret, unless a senior official 
declares it may be published, in which case a long a tortuous 
process results in a piece of paper, the rule must become that all 
of the HA's information is public, unless a senior official declares 
it to be secret.  
Rather than publishing on demand the information must be placed 
where those with a need or a wish to see it may do so.  There is no 
effective alternative to the Web-based Extranet approach, nor does 
there need to be.

Health Authorities should be provided with the means to make this a 
reality, and given a short timetable to reach it.

As is usual for hidebound bureacratic institutions of modest 
competence populated by people who in general are individually 
well-disposed to helping humanity the first benefits of the change 
will be to the HAs themselves, in their mission.  For the first time 
they will be able to find the documents which are now in the wrong 
place, having been distributed to a subset of those eventually 
needing them and a superset of those interested in them at the time. 
Typical payback times in organisations more concerned with physical 
realities and less with abstract information flows have been as 
short as half a year.  I would expect[1] an HA to deliver savings on 
its Extranet in no longer than that.

Next - several simple systems seem sensible to achieve this end.

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[1] and in other words the performance criterion for the Chief 
Executive and Finance Director to be judged upon.

--- OffRoad 1.9r registered to Adrian Midgley


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