WRITTEN ON December 18th, 2006 BY William Heath AND STORED IN Design: Co-creation, Foundation of Trust, What do we want?

After a conversation with my mate LP last week I’ve been reflecting on transactional analysis, and keeping an eye on whether we treat each other as adults, or as controlling parents and adaptive children. It echoes Engelbart’s Augment vision which has so challenged the “automate” presumption of the militaristic coffee-drinkers.

Applying TA is fun in the office, and at home, and it’s instructive as we look at public services such as the NHS.

After a debate on R4 this morning (quite good – Johannes Humphrissimus Maximus Interrumptor allowed Prof Anderson and “Lord” Warner to finish some of their sentences) I went to the Connecting for Health site and searched for “opt out”. Given the present interest, you might hope to find an adult to adult dialogue about the pros and cons.

Instead it answers the question “Can a patient opt out of [something called] the PDS. There are half a dozen lines about smart cards, PINs and role-based access is (which we don’t understand but which will obviously work perfectly, especially when staffed by Bulgarians or outsourced to Bangladesh). Then it says bluntly

Patients cannot request that their data is not stored on the Personal Demographic Service (PDS) as it is necessary for some information to be held about everyone who is a patient of the NHS.

Controlling parent indeed, to which one cannot respond as an adult eg

I’d prefer to do it differently if that’s OK with you

or

Very well, if your system’s like that I shall take my business elsewhere

but ony as an adaptive child

When I grow up I’m going to pee all over your server farm so it explodes, and then you’ll be sorry

or I’ll protest, vote you out of office, sabotage your evil controllling scheme in some other way. Hell, I’m getting cross even as I write this.

We can’t have sensible discourse on this basis.

Anyway, the adaptive children leaped for joy like Australian cricketers this morning, as a measured and effective Ross Anderson laid “Lord” Warner to waste. It was game over when an insider rang in to describe NHS systems as “the leakiest sieve”. I’m tempted to shower “Lord” Warner with extra insults (eg did he cough up for his peerage or brown-nose his way into the Upper House) because As I’ve said before my direct experience of him is of a curt and dismissive man who doesn’t “get it”. I have no experience of courtesy or truthfulness on his part so feel inclined to hold garlic near the radio while he speaks. He’d have to do a lot better than waffle about PINs, smart cards, reassurance, approval and disciplinary action to win my trust, and I resent the thought of having to pay his pension.

Stop trying to to automate us, “Lord”. We’re busy augmenting ourselves. Clear off and let us co-create local health records with people who treat us with respect, like our GPs.