A document hit my inbox recently that has emerged from the informatics transition programme and has the rather wordy title of the Accountabilities and Relationships Model. Essentially, it’s an attempt to codify the relationships between different elements of the healthcare system (Department of Health, NHS Commissioning Board, Clinical Commissioning Groups, public health etc) and their responsibilities and accountabilities for informatics activity.
I dread to think how long it took to create this, how many hours of meetings and conversations, how many hours of head scratching, writing, revising and reviewing that went into the creation of the final document, because in essence it’s bollocks.
I’m not saying that it’s completely without value, because it does contain some useful information about what some of the organisations are expected to be responsible for and how they should related to each other. The problem is that any value is drowned in a vast tide of detail and complexity. It’s not just unhelpful in that it obscures some of the higher level information that people need to understand, but because there is no way at this stage in the development of the organisations that the detail is likely to be accurate.
Unfortunately, this kind of problem is quite common in government where very intelligent people (sometimes but not always management consultants) are given a task to try to clarify and explain something that is quite complex and obscure. The frequent response is for those leading the work to try to model the detail very accurately, attempting to capture everything that is known about the problem and build it into some kind of coherent whole.
This can be disastrous for those needing to understand what’s going on and for those trying to communicate this, because what emerges is something frighteningly complicated and difficult to understand. In this case, my will to live started to evaporate before I’d got through the definition of terms and the initial paragraphs claiming that this was a ‘plain English language’ explanation of the relationships and accountabilities.
Paa and phoey. It’s nothing of the sort. In many cases these pieces of work are carried out by very intelligent people, so people for whom complexity is no barrier to comprehension. Indeed, it might even be something that is appreciated, because these are people that enjoy getting their head around complex problems and ideas. They are also likely to be the sort of people that have succeeded both academically and in work by demonstrating just how much complexity they can handle.
So we’re left with something that purports to illuminate us to the relationships and accountabilities that underpin the informatics functions in the new NHS but which has all of the simplicity and elegance of the average PhD thesis. So the problem is, who is actually going to read it? Who is it going to help and why did anybody spend a whole lot of time and energy in putting together something so patently useless?
Answers on a postcard please.
