Let's Get Physical

en·tro·py

• For a closed thermodynamic system, a quantitative measure of the amount of thermal energy not available to do work.


• A measure of the disorder or randomness in a closed system.


• A measure of the loss of information in a transmitted message.


• The tendency for all matter and energy in the universe to evolve toward a state of inert uniformity.


• Inevitable and steady deterioration of a system or society.

Dr Rant is a child of a different time. A time, if you can imagine it before GCSE media studies and A-level psychology, when studying physics was not regarded as a breach of a child's human rights. Physics seeks to explain the world around us, and illustrate the ways in which humans are able to manipulate the physical world. Physics describes the principles by which 'systems' work and predicts how they behave. The NHS could be described as a system, even a 'closed system', so what can physics tell us about the NHS?

You are probably thinking that given the list of bullet points above that I'm about to make some smart-arse comments about the way in which the NHS is administered - and you'd be right.

Entropy as a concept is central to the second law of thermodynamics. It describes the way in which energy is distributed within a system, and its tendency to spread itself evenly throughout that system. It can be summarised as;

When a system's energy is defined as the sum of its "useful" energy, and its "useless energy", i.e. that energy which cannot be used for external work, then entropy may be (most concretely) visualized as the "scrap" or "useless" energy whose energetic prevalence over the total energy of a system is directly proportional to the absolute temperature of the considered system.

So it would appear that high ENTROPY is bad because it reduces useful energy. It also implies that if a closed system is left alone the energy will become distributed evenly throughout the system, and a lower proportion of that energy will be 'useful energy'. For example, water behind a dam has useful energy, but it wants to flow down hill to the lake below. This useful energy can be removed from the system by turning a turbine to create electricity as the water flows down hill. If the system is left alone, all the water will form a single body of water (with high entropy) and no electricity can be created - therefore the dam is a good idea.

Applied to the closed system of the NHS, it would imply that unless the system is actively managed to separate the 'useful energy' and reduce entropy, then the system will become increasingly inefficient over time. Therefore what is needed is dams everywhere, controlling the flow of water and creating useful energy. Right? Therefore, what the NHS needs is more managers to construct the dams that keep the useful and bad energy separate. Yeah?

If you agree, then you could be a management consultant. You are exactly the type of person needed by McKinsey and Accenture to 'dynamise' their NHS egg-sucking facilitation and assesment programme for grannies. In a few years time you could even be a New Labour Health Minister, providing you don't let common sense, awareness of the limits of your own competence or reality get in your way of course (this seems to be the natural 'career' progression).

Let's face it; those holding the reins of the NHS are either on drugs, or they subscribe to the type of psuedo-scientific bullshit that I've just concocted about entropy. Let me let you in on a little secret.......

I'm talking out of my arse!

I don't know the first bloody thing about the application of the laws of thermodynamics to systems like the NHS. I just have to deal with day to day bollocks and fuckwittery of the never ending reconfiguration of the latest reorganisation of the last reform that the government swallowed hook line and sinker off some day nursery for workshy pseudo-academic adolescents that calls itself a think tank.

Bollocks to entropy! Here's what I really think; every time those of us on the front line manage to make a small silk purse out of the last pile of sow's ears we were given, it's back to square one with the next round of management job justifying shake ups and a even bigger pile of porcine pinnas to work on.

Why not treat the NHS as a biological system. As Jeff Goldblum declares in Jurassic Park;

"Life will find a way."

The NHS isn't a 'closed system', it's a living breathing organism with a beating heart and a pretty good central nervous system in the form of the healthcare professions.

And here's another fucking analogy for you - That living organism called the NHS has been fattened up, and is currently being lead to market by it's substantially less intelligent master. But it's OK, the private sector has got lots of magic beans to swap for it......