Jambalaya

The Commission for Health Improvement (CHI) has released this year's 'star ratings' for NHS hospital Trusts. The star ratings are part of New Labour's misplaced campaign to 'improve patient choice' through the imposition of somewhat meaningless targets. ("If targets work, so would have the USSR" attrib. John Kay, Economist Apr 26, 2001)

Our local Trust (the Oxford Radcliffe Hospitals) has managed to hold onto its single star (or, if you prefer your glass half full, it only narrowly missed gaining a second). And all despite a financial crisis and the precipitous departure of its chief executive and chairman.

The Health Services Journal (HSJ) has spotted that there is a strong North-South divide in the distribution of stars, with the North coming out 'better'. I have written about this before, in relation to CHI's clinical governance reports:

...CHI is somewhat deficient in its attempts to explain or even understand why there is such variability. Funding distribution comes to mind as one possible factor...

The reality is that the star rating system detracts from good clinical care, distorts priorities, and produces dysfunctional behaviour at all levels, as highlighted by a recent BBC Panorama programme.

What all this means for patient choice is perhaps for patients to decide. Choice based on star rating seems somewhat limited for those in the South East region, unless one is prepared to be treated far away from home. This, of course, is not a realistic prospect for many and certainly not for those needing emergency care.

I suspect I am not alone in having adopted Portable Document Format (pdf) as an easy and convenient way of publishing documents on the web, especially those that have been initially created in a word processor such as MS Word. The ease with which such documents can be translated to pdf and the resulting file uploded to (and downloaded from) a website are hard to beat. There is also the added advantage that the downloaded document can be almost guaranteed to print identically to the original.

Well, if distributing documents for printing is the aim, then pdf is ideal. But if making the content available to people to read on the Web, then it sucks.

Why? Several reasons come to mind:

1. PDF documents intended for printing will usually be in portrait orientation, whilst most computer screens are landscape
2. Printing font sizes are generally smaller than those commonly deployed on the web, so legibility may be a problem
3. it is unlikely that the 'look and feel' of the pdf document will match that of the website
4. PDF documents of more than a handful of pages will be very large & will take up bandwidth and load slowly
5. The server your site is located on may not be able to search pdf documents

Adobe was cleverly able to position Acrobat (pdf) as a nifty way of presenting documents on the web at a time when there were browser wars and before the Web Standards Project and CSS got underway. Now the challenge is to get word processor vendors to use XML creatively to describe document structure in an exportable fashion, allowing the serving site's style sheets to determine how that structure should be presented. Given that MSWord file structure is XML-based, this should not be technically difficult. Political will is another matter.

(Since writing this my attention has been drawn, via Lockergnome Bytes to an article by Jakob Nielsen entitled PDF: Unfit for human consumption which makes many of the same points.)

David Davies seems as bemused as I am at the recent spat of vituperative and at times childish discussion on the future of RSS. Thanks to his recent post, I now have a much clearer idea of the issues, and I have to say that I cannot get worked up about them. Through Brent Simmons's sterling efforts we have NetNewsWire, which has effortlessly handled all the feeds I have thrown at it, without my having to look under the bonnet to determine their provenance. Time to move on, I think.

Today I redesigned this site, mainly as an exercise in learning Web Standards, but also to cheer it up from its Movable Type blues.

The site actually validates as proper XHTML. I shouldn't take much credit for that as the original Movable Type template and style sheet ensured validation before I changed anything, which is more than be said for Radio or Manila. But at least I didn't mess it up.

I expect there will be a few more tweaks over the next few days.