Attentive readers will recall my Near Death Experience in an NHS hospital back in 2011, and the thoughts it prompted on how a large UK hospital works:

In one banal way of looking at it, the NHS is a huge quasi-shop. It has ‘customers’ who need ‘products’, so the key issue must be getting those products to the right customers with as few transaction costs as possible, right? Mainly an information management and delivery-process problem, albeit a damn big one?

The analogy promptly breaks down. In the NHS’s case, the customers do not know what products they want, or the quantities they need. So as well as the formidable problem of having to hand all sorts of different products, the NHS mega-shop needs to run all sorts of checks to find out precisely what each customer needs and be incredibly careful in delivering just the right dose to the right customer at the right time.

It doesn’t matter if you get a few grams more or less rice or cornflakes in your shopping bag – it may matter a lot if your drug dose is out by even a small proportion, or if they give Mr Jones’s drugs to the wrong Mr Jones. So the need for precision and checking adds exponentially to transaction costs in a medical context.

I asked how they managed my records. It turns out that when I am admitted into hospital a paper file is opened on my case which then follows me around the hospital, growing at each stage of the treatment as this and that is recorded by those responsible. But as well as that there is an electronic file on computers, containing results of blood and other tests as monitored by the machines concerned.

This sounds and probably is old-fashioned and ‘inefficient’. It is clear how ‘information decay’ caused eg by our deadly enemy the EU Working Time Directive can set in…

Things have not changed much. Having recurring pains that reminded me of my pulmonary embolism back then, I attempted to get into the NHS system quickly and managed to do so, reaching the Emergency Assessment Unit of the nearby general hospital within a couple of hours. I staggered out some seven hours later. Most of the time was spent waiting glumly for something to happen.

Result? Nothing serious spotted. Take some paracetamol!

The information management problems for hospitals are formidable. At each stage more and more information about each patient is collected, noted down, and then has to be put somewhere useful. Different people need some of this information but not all of it. Crawf Minor tells me that his University medic friends are aghast at the way that hospital doctors are now trapped by their iPads. Ward rounds are taking longer and longer as more and more information on patients is sent ‘efficiently’ by wifi to the doctors concerned, who then need to read it all. Except when the wifi signal is not powerful enough to reach the doctor in the ward, when things get stupid.

All this information of course comes in myriad forms and sizes. Some of it is noted down by nurses and doctors taking simple tests and asking questions. Some will be printouts of scan or test results (numbers, text and images). There is no easy way to standardise all this to make it easy to use (including by meaningful prioritising), not least because the medical technology keeps changing and new ways of presenting information keep being invented.

While all this is going on, actual processing of doctors’ and nurses’ shifts happens, so the information decay problem appears: the more people dealing with a patient, the more each person has to spend time reading up on where matters now stand.

The upshot is that I generated a plump cardboard file of paperwork that somehow followed me round the hospital. I ended up being given a couple of minor painkillers and sent on my way, but only after the cheery nurse whom I’d met several times previously over the long day had asked me to confirm my name and address AGAIN. No doubt this was driven by fear of litigation if something goes wrong – was the medicine/treatment somehow given to the wrong Charles Crawford?

Conclusion?

None. It all staggers on, at a just about tolerable but low level of effectiveness and motivation. (A word to Polish NHS staff: if you hide in a corner to waste time gossiping in Polish, someone who is not Polish may well be listening to you and getting annoyed.)

My special sympathy to the NHS folk at all levels who have to deal with the hapless ‘underclass’ tendency: people of marginal intelligence who are (probably) trapped in the state benefit industrial complex and apart from any illness they may have (or think they have) are now too poor and inarticulate to solve their own medical problems or to avoid getting new ones. Dealing with them day in and day out must be really difficult.