December 2009
Christmas magic
The Christmas Carol – Dickens’ immortal rendering of the Christmas story in narrative form– has much to tell us about the way information is being treated in New Zealand.
If you recall, in the Christmas Carol Scrooge doesn’t celebrate or understand what all the seasonal fuss is about. He is visited by the ghosts of Christmas past, Christmas present and Christmas future in an attempt to help turn his life around. For many – certainly for Scrooge (and me if I am honest) it is the ghost of Christmases to come which is his final undoing. The ghost of Christmases to come shows Scrooge how there will be a selling off of the family silver, how no-one will mourn his passing and the way he will so soon be forgotten. It all makes for a humbling and pathetic rebirth, in which Scrooge sees the error of his ways and, contrite and chastened, in which he hopes for a kind of redemption from his past miserliness and lack of insight.
Scrooge is like those entire nay Sayers who know the cost of everything but the value of nothing. Alive to the world of information only in as much as it helps them (as it did Scrooge) amass piles of cash but dead to its essential nature. As we look toward Christmas it is worth perhaps reflecting on the ghosts of mental health information who float over our services. For together the three ghosts tell a potent and profound story, not perhaps of redemption as for Scrooge, but a story of indifference and neglect.
Imagine then if you can the many Scrooges, the nay Sayers of information value, on Christmas Eve. As usual they have spent the day counting their money and deciding how much everything costs but not understanding the value of anything. Having blown out the candle and repaired to bed the first ghost – the ghost of Christmases past makes an appearance. The ghost picks up our many Scrooges and takes them back in time to an age before computers.
Our Scrooges see a man diligently counting pennies and placing them in a counting tray. The man is tired and rather self absorbed. Indeed he is so self absorbed that he fails to notice the crying of a woman down the hall who is depressed and lonely. For the women, as the ghost shows, is dying and the man who counts the pennies – one of Scrooge's own fathers – has no time for anything but his money. When asked who the woman was, the Scrooge father figure replies ‘I don’t know, we don’t keep information on people here!!’ While shocked at the apparitions of Christmases past, Scrooge has seen it all before. So when the ghost of Christmases past leaves he still settles down for a good nights sleep.
The ghost of Christmases present is made of different metal. He sweeps our Scrooges off and shows them the many people who are unwell and all the people who are trying to help them and not knowing who has improved and all the people who cry out ‘outcomes!! Who cares about outcomes!! ?’ Then he shows Scrooge a few people who are trying to show the value of all the money spent on mental health services. He shows Scrooge the faces of all the people who are seeing the first crop of outcome measurement reports in New Zealand. Scrooge is slightly perplexed and baffled, since he had never expected to see any value accruing from outcome measurement.
Finally the last ghost- the ghost of Christmases to come- hove’s into view. He shows our Scrooges many mental health services and clinicians who have gone to the wall because of their indifference to outcomes and quality. He shows our Scrooges that no-one mourns their passing and that they are soon forgotten, with no tears. He shows Scrooge a truly amazing sight. A view of mental health services where money is allocated based on performance and where performance can be measured and determined.
It is a chastened Scrooge who awakes in the morning to the miracle of Christmas day, full of the Christmas spirit. Full of the spirit of giving he emails all his own DHB outcome reports to every other DHB in New Zealand and gives away all his information as a very model of openness and transparency.
Page last updated: 9 December 2009