2 posts tagged with "nhs"

The letter arrived on a Tuesday. Oncology outpatient appointment, 9:15am, Thursday fortnight. It was in English. The patient spoke Somali.

She didn't attend. The clinic marked her DNA — Did Not Attend — and returned the slot to the general pool. Three weeks later, a re-booking letter arrived, also in English. By the time a care navigator reached her by phone, her chemotherapy cycle had shifted. The treatment window had narrowed.

This happens eight million times a year across the NHS. The aggregate cost is approximately £1.2 billion annually, but in oncology the cost isn't primarily financial — it's clinical. Missed chemotherapy cycles and delayed radiotherapy planning disrupt treatment pathways engineered around strict timing for efficacy. The slot that goes unfilled at 9:15am on Thursday is time that cannot be recovered by anyone on the waiting list behind her.

I built Appointment Guardian this week to close a specific gap: not sending the reminder, but handling what comes after it. The system imports appointments from FHIR, generates personalised reminders in the patient's language using a local LLM, manages patient replies, classifies barriers, routes tasks to the right care team, and escalates non-response automatically — without any human initiating each step.

It went live on a home-lab MicroK8s cluster on 2026-07-18. This post documents what I built, the four architectural decisions that shaped it, and five things that went wrong.

A 999 call comes in: a 3-storey building is on fire, casualties are reported, and High Holborn is gridlocked. The Incident Commander has roughly 90 seconds to answer four questions. Which hospital can take burns patients — and is it under pressure? How many pumping appliances does the NFCC minimum require for a multi-storey structural fire? Which traffic corridor can the ambulances actually reach? And does this cross the threshold for a formal Major Incident declaration?

Which agentic pattern you use to support that decision changes everything — not just how fast the answer arrives, but whether the answer is auditable, protocol-compliant, and safe to act on without a human double-checking it.

This is Part 2 of the JigsawFlux series on open-source agentic frameworks. Part 1 compared LangGraph, CrewAI, and AutoGen at the framework level. Part 2 puts eight specific reasoning patterns — ReAct, ReWOO, Plan-and-Execute, Reflexion, Hierarchical, DAG, Network/P2P, and Consensus — through the same incident and measures what each one actually does. The full source is at github.com/JigsawFlux/agentic-patterns.