When Luggage Becomes Furniture

When we last encountered Bryan Dodds, systems continuity analyst, he had already made a series of entirely sensible decisions that led to an extremely improbable outcome. He had become an accidental time traveller.

He had also managed something most NHS programmes aspire to and very few convincingly achieve.

He had successfully gone live.

Unfortunately, he had gone live in the 1960s.

This had followed a brief but decisive encounter with a button labelled “Synchronise Historical Patient Streams", which Bryan had pressed in the reasonable belief that it was either metaphorical or badly named. It turned out to be neither. The button had instead relocated him into a functioning healthcare system in which records travelled with patients, clinicians wrote in the same place without formal negotiation, and nobody had yet discovered the therapeutic properties of an interoperability workshop.

Bryan had since begun to suspect that the past was not actually simpler. It was merely less inclined to explain itself. This struck him as an approach of considerable merit, particularly in environments where explanation had become a full-time occupation.

For the moment, he remained surrounded by a healthcare system that had not yet discovered how inventive it could become when trying to prevent information from moving. Everything existed on paper, which is to say it existed in a universe where things could be misplaced, misfiled, or occasionally mistaken for something to steady a cup of tea, but never encrypted, duplicated into twelve subtly incompatible formats, or declared accessible while remaining functionally out of reach.

There was a calm to it all. Not the reassuring calm of complete understanding, but the quieter, more ambiguous calm that arises when nobody has yet stood up and announced that transformation is imminent. Paper did not aspire to transformation. It had no strategic intent. It did not seek alignment or compliance. It simply allowed itself to be written on, folded, carried, and occasionally leaned on by someone thinking about something else. And, rather awkwardly for several decades of future planning, this arrangement mostly worked.

Back in Bryan’s own time, matters had progressed enormously and, in doing so, had also become rather peculiar. Information now inhabited multiple carefully maintained environments: hospitals held test results and admissions, GP practices kept longitudinal histories and prescriptions, community services tracked ongoing care, and mental health trusts maintained detailed but often separately held narratives, each with its own logic, rules, and preferred interpretation of reality.

The information itself was never truly missing. A medication change recorded in hospital existed. A GP’s diagnosis existed. A community nurse’s notes, a mental health risk assessment, and a social care support plan all existed, somewhere. The difficulty was that each lived quite happily in its own system, and reaching across to retrieve them required knowing not just what you were looking for, but also where it had last decided to reside.

Each part of this system was technologically sophisticated, and each part was also remarkably capable of behaving as though all the others were largely hypothetical.

Modern healthcare, Bryan reflected, had become exceptionally good at producing information and even better at ensuring it remained precisely where it had been produced. The difficulty arose when someone needed it somewhere else. At that exact moment, the system would begin a ritual involving dashboards, escalation pathways, and a general atmosphere of polite uncertainty, as though the information itself were considering whether it wished to participate.

Bryan had spent much of his career watching these fragments attempt to find one another. The machinery assembled to enable this was impressive in both scale and vocabulary: integration engines, interoperability frameworks, messaging standards, and transformation programmes. From a distance, it suggested a grand, coordinated effort. From closer inspection, it began to resemble something much more familiar, a highly organised attempt to get computers to pass notes to one another without drawing attention.

Meanwhile, the patient had been quietly reassigned an additional role within the system. Without consultation, training, or remuneration, they had become a form of biological courier service, carrying medication histories between organisations, repeating diagnoses to different clinicians, and reconstructing their own clinical narrative as though navigating a library where every book was slightly miscatalogued and none entirely agreed with the others.

Bryan found this both ingenious and mildly alarming. Human memory, after all, is not a database. It is better described as an enthusiastic archivist who occasionally decides that Tuesday was optional and files Wednesday under “pending clarification". For people with complex or long-term conditions, particularly in mental health, this resulted in something approaching a conceptual puzzle. The most complete version of their record existed nowhere in particular. It emerged temporarily, assembled from fragments of systems, recollections, and assumptions whenever someone asked enough questions in approximately the right sequence.

In the surgery before him, things worked differently. Not necessarily better, and certainly not without flaws, but in a way that felt internally consistent. Clinicians were not especially interested in “information” as a distinct entity. They were interested in care. Information followed this activity as best it could, occasionally lagging behind, occasionally catching up, but always moving in the same general direction.

Admittedly this system had drawbacks. Paper records could be lost, destroyed, misfiled, or accidentally used to stabilise uneven furniture. Handwriting frequently evolved into abstract art. Entire sections of a patient history could disappear into administrative voids from which only myth and photocopies returned. One limitation of these paper systems was that they showed a rather touching loyalty to the individual rather than the population. Everything revolved around whichever carefully folded bundle of paper happened to be attached to a person at the time. If you wanted to understand what was happening to a community, you first had to accept the mildly inconvenient truth that the “system” had no idea what a community was. It only knew people, one at a time, each with their own travelling archive.

Bryan realised, of course, that this was also a period before computers had arrived to explain what everyone had been doing wrong all along. Large-scale population analysis belonged more to the category of “interesting thought experiment” than “thing you could actually do without several decades of clerical devotion and an unreasonable number of pencils”. In that sense, nobody was really missing anything except perhaps the future. They were already quite busy making sure the right envelope ended up with the right person, which, given the circumstances, felt ambitious enough. And yet embedded within the use of maternity notes was an idea so unfashionable it had become quietly radical.

Information moved because care moved.

A maternity record Bryan had seen earlier did not belong to a system, a building, or an organisation. It belonged to a person. Consequently, it travelled with them, accumulated over time, and arrived where it was needed because that was where they were. No integration strategy was required. No coordination meeting was convened. Movement was not a feature. It was simply what happened.

In Bryan’s own time, by contrast, the architecture was vastly more impressive and slightly more confused about its purpose. Information could be stored with extraordinary precision, secured with admirable diligence, and analysed with increasing sophistication. Entire constellations of dashboards could confirm that something existed in great detail. What they could not always confirm was whether it might actually turn up when required without first navigating a maze of systems that had all independently concluded they were the correct place to look. This is rather like saying your missing sock is definitely still in your possession, but currently in a different building that you also own, provided you can remember which entrance to use and how to get back in.

The result was a form of careful fragmentation. Hospitals knew things. GP practices knew things. Community teams knew things. Social care knew things in a way suggesting they were being carefully transported across difficult terrain inside encrypted containers. Everyone knew something, and a considerable amount of effort was spent attempting to persuade other parts of the system that this knowledge was both real and relevant.

Watching another folder change hands, Bryan experienced the uncomfortable sensation that the simplest explanation might also be the least compatible with modern thinking. Nothing here was integrated. It was simply moving, because movement was the only way it remained useful.

He had expected the past to feel primitive. Instead, it felt oddly coherent in a way that did not require diagrams. Not better. Not worse. Just operating under the assumption that information had somewhere to be, and that somewhere was usually wherever the patient happened to be standing.

Back in the present, he knew, we had become extraordinarily skilled at making information stay very still indeed. We could catalogue it, audit it, model it, and arrange it on dashboards so reassuringly tidy that it gave the distinct impression that nothing had ever been lost, misplaced, or even mildly inconvenienced.

Unfortunately, this impression tended to persist right up to the exact moment someone needed something.

At that point, the information would reveal that while it was unquestionably present, meticulously organised, and held with complete confidence somewhere within the system, it had also embarked on what could best be described as a small but determined administrative journey of its own, involving several systems, at least two logins, and the quiet conviction that it might prefer not to be found just yet.

The thought lingered with him, slightly inconveniently, like a notification that refused to be dismissed no matter how often one attempted to ignore it.

Information, he realised, was not furniture. It was not designed to be arranged neatly and admired for its organisation.

It behaved much more like luggage.

And luggage, as any reasonably experienced traveller will tell you, is at its most useful when it has already managed to arrive in the same place as you.

And if anyone from the present had asked Bryan for a summary of what he was seeing, he might have said this:

“We already knew what worked. Maternity notes travelled with the patient, got updated on the way, and showed up exactly where they were needed without anyone organising a programme board to discuss their travel arrangements.

Then we made the information live in one place instead. Which is fine, except it now spends most of its time being somewhere else.

So we didn’t lose the information. We just stopped it turning up where and when it was actually useful, then built an entire industry around acting slightly surprised about it."