Thursday, 22 June 2017

Re-learning that ‘worn out tools’ are still the most reliable

From an NHS in ‘meltdown’ to domestic politics in turmoil and recent tragic news events, ‘crisis’ seems to be the word on everyone’s lips and certainly the media’s! Last month as I sat at Heathrow watching the BA screens turn black, just a week after being in the midst of a cyber-attack on the NHS, Rudyard Kipling’s famous lines came to mind; ‘If you can keep your head when all about you are losing theirs and blaming it on you’, I realised that I had already learnt that there is always another way of doing things.

The newly elected WHO Director General, Dr Tedros Adhanom Ghebreyesus, reminded us that the status of global health is in a far direr place; ‘still, half of our population doesn’t have access to healthcare.’

But why is this still the case and what can we do when our own NHS is struggling? Having proudly worked for the NHS for over 30 years and seen daily the dedication staff continue to apply, I feel a duty to stand up and say that things can change and I know at least one way to go about it. For a start we need to start listening and learning from each other and not just through echo-chambers between NHS departments, but exploring the way healthcare is done around the world.

In the last month, I have acquired first-hand experience of working in an NHS hospital during a cyber-attack, and of trying to board a BA flight on the day of a global IT problem.  These unrelated but equally disruptive events made me wonder what the NHS and the aviation industry could learn from our dependence on the idea that we know best. I came to the conclusion that the NHS, at least, could and should learn from hospital colleagues in lower income countries.

My hospital was not directly affected by the cyber-attack, and compared to some, the disruption was minimal. Others had big problems.  Hospital pharmacies and most other NHS departments are increasingly reliant on computers for pretty much everything.  In many hospitals in Africa, however, medicine bottles and boxes are labelled by hand and ward stock is accounted for by writing in ledgers using a pen. Many health facilities do of course have computers but power outages, surges, and internet issues mean they can’t always be relied on.

My recent experience volunteering in Mozambique with the DFID funded Health Partnership Scheme (HPS) has given me an alternative perspective, and as such I approached the challenges posed by the cyber-attack from a different angle to many of my colleagues. The Scheme’s emphasis on mutual learning, on teaching new  skills to our overseas counterparts whilst improving and furthering our own knowledge left me feeling that I gained more than I gave and as the attack continued, I began to realise just how crucial the experience had been. For a start, the lack of computers and inability to send and receive emails left me unfazed. We still had working telephones, after all. WhatsApp groups were also being used for general advice.

Although no IT expert (ask my colleagues!) I do see the need and great benefits of technology in the health sector, however given the increasing frequency of IT system failures, we must ensure our backup procedures are resilient.  Patients were both treated in hospitals and passengers flew on commercial airlines long before computers – it must be possible.

The HPS has given me the opportunity to think and learn differently, and develop and problem solve in ways I never thought possible. It has also given me new perspectives not only on my NHS role, but also on life in general.  In the grand scheme of things, complaining about a cancelled holiday (and missing by all accounts an excellent party), seemed a rather trivial first world problem.

In the last two weeks, the UK has been left not knowing which way to turn, and the NHS cyber-attack revealed our need to not forget the ‘worn out tools’. The NHS is considered the greatest learning institution in the world and a global leader on patient safety. We can learn a great deal from colleagues overseas and write in a few simple lines to our procedures reflecting how to best maintain a service, without the luxury of highly complex integrated IT systems.

“In the midst of chaos, partnership has been exemplified and is something I hope will continue to be championed. Certainly as I attended an event in Woodbridge on Sunday as part of ‘The Great Get Together Weekend’ in celebration of Jo Cox’s memory[1], it was clear in my mind, that these events, articles in the media and other joint contributions will continue to demonstrate the need for working and learning together and from each other wherever we come from and whatever our beliefs or established systems.


Sarah Cavanagh

Acting Director of the East Anglia Medicines Information Service, Ipswich Hospital 
@SarahM_Cavanagh