You couldn't want a better example of the Blair effect on health than MTAS. Ill-advised (because doctors were barely consulted), rushed, expensive, and entirely dependent on computers, Patricia Hewitt's declaring it dead was probably one of her final acts as Secretary of State for Health. To paraphrase the poet: ‘How did it fail us? Let us count the ways.’ Blogs, bulletin boards, and e-letters to journals have documented a disaster far worse than the petty inefficiencies of the NHS about which doctors are daily criticised by politicians who see us as the problem.
Anyone who knows anything about computer databases knows what fields are. An address book is a simple database. There is a field for title, surname, forename, lines of address, birthday, names of children, and so on. There must be enough address fields to cope with friends whose addresses have five lines or just two; lines can always be left blank. In fact, they have to be left blank. The database will fail if those blank address lines are filled with the birthday and names of children. At some stage in the MTAS process, two databases were merged. The two databases had different numbers of fields. Order in; disorder out. The merged database was unusable.
Then, somewhere else along the line, important information was sent electronically to the assessors. They were sent compressed as ZIP files. ZIPped files cannot be virus-scanned, so most organisations bounce them. As a result of this, two of my consultant colleagues spent 6 hours one Friday photocopying application forms, before one of them spent the weekend driving around the region delivering them.
There can be no excuse for this level of incompetence. It is below the level of GCSE computing studies. And then, unbelievably, while Mrs Hewitt had been telling the House of Commons that apart from a start-up hiccup or two MTAS was really working quite well, a spreadsheet became publicly accessible. It didn't contain anything very much: just applicants' names, addresses, sexual preferences and police records. This is not just incompetence but verges on negligence.
Someone someday, I suspect quite soon, will write the definitive history of why and how it all went wrong, and how most of the fiasco could have been predicted: apparently, the algorithm set up to fit applicants to jobs was never shown to work.
It is not enough that heads roll over this; there are wider lessons to learn about the rampant idea-ophilia that infected the NHS in the Blair years.
- © British Journal of General Practice, 2007.
