One of the projects we are undertaking at work is evaluating how well public services are delivered. The project is captured at the group weblog Ideal Government. In a fiendishly clever ploy to get my boss to link to my weblog, I am posting this modest contribution to the debate here.
I am one of countless thousands who benefit from atorvastatin, a drug used to treat my (formerly) elevated cholesterol count. I have been using the medicine for 8 years, and it and modest dietary changes have left me with a healthy level of cholesterol in my system.
Here in the UK, as I am on NHS, I pay little out of pocket when I pick up my medicine. Of course, I pay quite a bit more when I look at what has been deducted from my pay packet.
Getting the medicine is an interesting exercise in wasting the time and efforts of a number of people, including myself. Bear in mind while reading this that I will probably be using this medicine for the rest of my life.
The first absurdity is the prescription, which is only valid for 3 months. I have been in the UK for two years, and nobody has measured my blood or tracked the progress of my cholesterol levels. But the receptionist merely says that's the longest they can write the scrip for. Why not a year? Why not five? Now, lower strength packages of statins are on sale at the chemist—it's not as if they are monitoring Lipitor's safety. And it's not as if they are monitoring my progress.
So I pay a quarterly visit to the GP. So what? Well, it involves almost a half day off work, essentially. Well, actually more. I cannot pick up my prescription during my official visit. I have to come back the next day, another half day off. Then, finally, I get to go to the chemist. So I pay 8 visits a year to the surgery to process one piece of information.
I admit, it's not much more than a minor annoyance for me, and probably the receptionist at the GP feels the same. But it does waste my time and the time of the NHS. I can safely assume that the government does not care a fig about wasting my time. But how much of its own time and money does it waste on this?
The Prescription Pricing Authority, part of the Department of Health, has this to say about costs and prescription volumes:
"Prescription volume has increased by 5.9% per annum, to over 667 million items in the year to September 2004. The main increases in volume have been for drugs used in cardiovascular (11.6% growth, 195 million items) and endocrine diseases (7.3% growth, 53 million items). Net ingredient cost increased by 8.1% per annum (£7,786 million) in the year to September 2004. The therapeutic areas contributing most to the increase in prescribing cost in the year to September 2004 were cardiovascular (9.1% growth, £2,131 million)." You can do the math, figuring between five and eight pounds per transaction now, and using about 27 pence per transaction if it were done electronically. When you do the math, remember that not all prescriptions could or should be automated.
The essential issue here is that the NHS sets up its arrangements without thinking of me, or of the surgery I visit. I would imagine that they set a quarterly limit for duration of prescriptions sixty years ago for reasons that are not applicable today. Now, it would appear to me that savings would be significant if this process were automated. Regular information exchanges are exactly the type of transaction that IT is designed to cope with, and using alerts and emails would probably wring about 99% of the costs out of the NHS investment in this particular procedure. Honestly, they could bring about dramatic improvement without IT investment—they could just change my prescription frequency from quarterly to annual. But the true problem with the NHS is that they are blindly following a guideline, slavishly propitiating the forms of bureaucracy without remembering why they are in business. The NPfIT may or may not cause them to wake up and examine why they do what they do. I suspect that if it doesn't awaken them, the project will fail. I also suspect that had they awakened 10 years ago, the NpfIT would scarcely have been necessary.
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