NATO Crypto (actually NHS)

[Ross Anderson]

>  > The name of the game in the NHS is demand suppression, not
>  > efficiency. That's one reason most NHS computing projects founder:
>  > they would cause at least one critical participant to do more work,
>  > so they get sabotaged. It's also perhaps the most powerful
>  > institutional dynamic that still protects privacy.
> 
> That last sentence is interesting but I suspect I don't understand it.
> Please can you enlarge on the relation between demand suppression
> (demand for what?) and privacy?

Let me give you an example. Someone I know well got appointed to a
lectureship in surgery at the same time I got hired as a lecturer in
computer science. Being keen and idealistic, he rolled up his sleeves
and cleared his waiting list. His budget was promptly cut. This taught
him to play the system a bit better.

Many NHS administrative procedures are there to massage the appearance
of demand. I came across a case of a hospital deliberately having
fewer diagnostic machines of a certain type than optimal, so waiting
for that specific test inserted another link in their demand
management chain. This came to light when they refused an offered
donation of this equipment. One hears of even more extreme cases - of
waiting lists to get on waiting lists.

The people who propose many central computer systems don't understand
this: they tend to come from a general consultancy background in which
one optimises clients' business processes by finding one bottleneck
after another and removing it. However, in the NHS, many bottlenecks
are not there because someone was stupid when designing the production
line, but because someone was smart. Their function is to choke off
the firehose of potential referrals into a manageable stream while at
the same time creating an impressively large waiting list.

So the typical IT proposal is threatening, and gets sabotaged. 

Recall the initiative a few years ago to build a system that would
enable GPs to make hospital appointments while the patient was sitting
in front of them?  There is already a technology that can do that -
the phone. But that's taken care of by the internal market. If GP
appointments are 6 minutes, then getting through to a consultant will
take 7. OTOH, having a computer system set consultant appointments
independently of the consultant would have broken the system. I've no
idea how it got sabotaged - but it looks like it was.

And a non-existent or non-working system can't threaten patient
privacy, can it now?

Ross