Pritpal S Tamber: The Red Hand Gang of healthcare?

I think I’ve joined a gang. I’m not sure only because it was first billed as a cabal. I’ve since looked up what cabal means and I suspect it’s too private for what this gang/cabal is wanting to do. Besides, I prefer gang, if only because it makes me think of the Red Hand Gang—inner city kids taking care of their own manor; it’s not a bad analogy.

Quite what the gang is, is best described by the invitation email: “It might be nice/informative/sinister for a group of UK health technology/social media/buzzword types [to get] together in a room to discuss some of the interesting developments that have been going over the past year or so. We’ve had open data from the government (yay), an information strategy (yay), a clear vision of  ‘every willing patient a research patient’ (yay), and a lot of rain.”

When I first got the email, I was worried it would be the usual suspects getting together, rubbing their chins, quoting stuff they’ve seen on Twitter (that they’ve not remotely understood), proffering opinions, all while having little to no real life experience of what it takes to make any of this happen in the NHS. The next sentence in the invitation email, however, suggested it would be different.

“However it feels like those of us at the sharp end are now getting on with the hard bit: implementing the revolution.”

It was different. Most of the people in the room were entrepreneurs in one way or another. I’m not talking about the glamorous world of Dragon’s Den. These are people working hard to make their ideas a sustainable, commercial reality, whether it’s for- or not-for-profit. It’s often a hand-to-mouth existence and failure is far more likely than success.

Quite what the gang is going to do is yet to be decided. However, one of the founders suggested it needed to be about helping each other to make their ideas the inter-connecting pieces of the jigsaw that are going to be needed if the information revolution is ever going to happen. There was also the suggestion that membership in the group needed to be restricted to those who really had skin in the game—those whose rents or mortgages depended on it. This is best described in the illustrative story sent in the follow-up email:

Pig and Chicken are walking down the road. The Chicken says, “Hey Pig, I was thinking we should open a restaurant!.” Pig replies, “Hmm, maybe, what would we call it?.” The Chicken responds, “How about ‘Ham-n-Eggs’?” The Pig thinks for a moment and says, “No thanks. I’d be committed, but you’d only be involved!”

I like the idea that group membership might be restricted—well, more proactively sought—to those people that have a lot to lose. It reduces the rhetoric and increases the focus on what to do, and what ideas to test in the real world.

I hope the group is able to add some reality to the recent good-but-impotent Information Strategy. Not talking about agreeing data definitions or experience design were massive failings, to my mind; the strategy’s bizarre focus on “portals” being a clear indication of trying to scrape some value out of the disparate systems now a legacy of the National Programme for IT, rather than any true blue-sky thinking (or perhaps they succumbed to lobbying from Intellect).

Normally I follow the Groucho Marx rule about clubs: “I refuse to join any club that would have me as a member,” he apparently said. I fear that clubs/gangs/cabals ultimately promote group think, no matter how disruptive or nobel their initial aims. For the moment, though, this gang has the potential to be something different. It has the potential to be about the real world of the NHS, about the true difficulties of getting traction with good ideas, and, hopefully, about being blunt with the NHS’ leaders (some of whom already seem to be trying to co-opt the gang even before its first meeting).

Bluntness is something I like. There is not enough of it in the NHS, or healthcare, in general. If there was it would not be ok to be performing as badly as we are (if you feel like defending the NHS at this point, take a brief moment to reacquaint yourself with the 2011 Atlas of Variation). It’s for that reason that I applaud the suggestions from within the gang to disallow the Chatham House rule—enough with the cloak and daggers, let’s call a spade a spade.

The Red Hand Gang is not a bad analogy because just like the resource-poor, inner city kids of the show, we’re trying to create positive change in our back yard with a similar level of resources. I hope, though, the analogy doesn’t prove too prophetic given that the show was cancelled half-way through its first series and two of the stars died by the age of 40. Then again, perhaps that’s what’s made it so memorable.

I’ll let you know what happens next.

Competing interests: I don’t believe I have any competing interests in relation to this post. 

Pritpal S Tamber is the director of Optimising Clinical Knowledge Ltd, a consultancy that helps organisations improve how they use established clinical knowledge. He was previously the medical director of Map of Medicine Ltd, a company that creates clinical pathways to help health communities design services. He was the editorial director for medicine for BioMed Central Ltd and he was also the managing director of Medicine Reports Ltd. He has twice been an editor at the BMJ, the first time as the student editor of the Student BMJ.