Computer Says No - Telemedicine

NHS 24. National Programme for IT. Gpass. Now telemedicine. Is technology the answer to all our problems in the NHS and are those of us campaigning to retain A&Es just old stick-in-the-muds? Three words I would reply with; resources,resources,resources.

My dad and I were having a conversation one day about robots (as you do.) There had been a programme on the telly about the latest AI and how you would maybe get robots to visit people living on their own.
'That's a good idea,' I said. 'Each elderly person could have a robot of their own; they could cook and clean, and help them if they fall.'
'That's not what you would get if it was a council robot,' said my dad.' They would buy the cheapest robots on the market, and there would be one very slow robot to five houses. You would only get it if it was means tested, and if you asked it to do anything useful it would say, 'Computer says no.'

I'm afraid that's how I feel about telemedicine. It is very good in its own context; for use in the Highlands and Islands or on oil rigs. It's very good in road traffic accidents where you can send on pictures of injuries to the hospital you are going to. It's good for people with long term stable conditions such as diabetes if they want to send in a blood test or if you want to do an ECG. But if we shut Monklands A&E for example, do I believe that NHS Lanarkshire would immediately set up a state of the art telemetry system to everyone in Lanarkshire who had diabetes, COPD and cardiac problems? Do I believe that they would provide the necessary trained staff to interpet angiograms and scans coming in? Do I believe that they would do anything, apart from use it as an excuse to fling people into the black hole of 'Care in the Community' whose biscuit tin budget would barely cover the price of a community alarm in every elderly person's house, let alone broadband? Terribly sorry to be cynical, but the answer is no.

We have had IT systems before, promising to be cheaper,faster and sexier than old boring doctors. One of these was the National System for IT down in England and Wales for medical records. The initial cost was estimated at £3.2 billion. The final official cost was £20 billion. The unofficial estimate is £50 billion. You see, it isn't just the computer you need. You need the staff. You need staff training and you need an engineer to fix it when it breaks down. This all costs money.

NHS 24 is going much along the same lines. It was going to be cheaper than doctors out of hours service, it was going act as a triage system and reduce the number of time wasters and A&E admissions, and reduce pressure on GPs. Well, so far it has cost £126 million. Each phone call to NHS 24 costs £36. The number of A&E admissions has gone up over the past two years and according to Audit Scotland, last years admissions reached a ten year peak, with an extra 50 0000 admissions. How many of those went up to A&E, because they couldn't see a doctor to reassure them? Oh, and half the calls were referred to local GPs.Under the old system, when someone phoned their local health centre, the chances were that the person on the other end knew them.They would have their medical records to hand, and they would know whether the person was a simply a pest, or if they had a condition that merited an out of hours visit. Now that middle filter has been taken out and we have been left with what is little more than a helpline for the worried well.

Can I make an old fashioned boring suggestion? Instead of introducing more IT into the NHS, how about introducing - human staff? Some extra consultants? Reintroduce out of hours run by GPs with proper funding this time? You might find A&E admissions going down, and GPs don't break down as much as computers do. If the vast amounts spent on IT were spent on doctors and nurses, you would have a first class service. And that's not computer science.

I Am A GP - Not a Public Convenience

Do have a look at this post on Barry Monks blog. Be warned; it's strong meat, but heartfelt..

Divide and Rule- Dilution of the Health Service

It's Jan 5th, just five days into New Year and I'm feeling depressed already. No, it's not the lousy weather that's doing it, and it's not the excesses of Christmas, although I have been feeling a little tender and tight around the waist. It's the mud slinging fight that has erupted over at NHS Blog Doctor between doctors and nurses, that's making me feel down. And it's happening because the government is playing an old and very effective game with the NHS - divide and rule through dilution.

Perhaps the best comparison of what is happening in the NHS, is what happened to teaching. Before WWII, a teacher in a secondary had to be a university graduate. If they wanted to teach Higher classes, they had to be an honours graduate. After 1945, this changed. Graduates with a BA were allowed to teach further up the school. This was good for them, as it gave them more job opportunities and possibilities for promotion. But it caused division, because it meant that there was no incentive for a graduate to study for honours; those who had studied longer gained no advantage. At the same time, the teachers' pay was going down. If someone wasn't so well qualified, then why pay them a good wage? It took until 1964, for the teachers to pull together and stage their first strike, and by then the game was a bogey. Honours graduates had gone elsewhere into business, medicine and law, where the pay was higher, and teaching lost its place as the top profession to be in. 'Those who can, do; those who can't, teach,' was said of those who went into teaching. It was what you did when you couldn't get a job in another profession. Now the use of classroom assistants to take classes when a teacher is off, is another step down the rung and I'm sure we are going to hear more about it.

The same thing is happening in medicine. The introduction of the nurse practitioner and salaried GPs is causing division amongst the profession. Nurse practitioners were mooted as highly trained nurses who could take over some of the routine work in minor injuries in hospitals, or in GP surgeries. In reality, what is happening is that they are replacing GPs, especially in health centres. Instead of having an appointment with a GP, you have an appointment with a nurse practitioner. That's ok if you need something bandaged, or a blood test done. It's not ok if you are presenting vague symptoms and you need a diagnosis of illness.

Again, salaried GPs are causing division. A salaried GP is a GP recruited by a private healthcare company, running a health centre. They get paid much less, and have to abide by the rules of the company. They also do not come under the jurisdiction of the General Medical Council. They are leaving other GPs out of work, who are too principled to work under these conditions. Yet at the same time it's hard to resist. If you are a young doctor, and your local NHS has allowed a private company to do recruitment of staff, what else can you do?

It's one of the oldest governmental tricks. Pay some more, pay some less and let them fight. Divide and rule.

Guys, you need to stick together. You need to get involved in politics, get your people into local government where you can oppose much of this and drive some stakes into the ground now. You cannot indulge in mud-slinging just now and hope it all comes right later. It's not going to.

Nurses, doctors, nurse practitioners,salaried GPs unite! You have nothing to lose and everything to fight for; the professionalism of medicine,the ethos of patient first and the NHS as a public service. No pressure.

Time for Beds (said The Economist)

A health warning to all blogging geeks reading this. Do not, I repeat DO NOT buy the Economists 'Pocket World in Figures.' You will not be able to put it down, you will have sudden urges to fill awkward gaps in the conversation with statements like, 'Do you know that India has the highest number of cinema attendances in the world' and your marriage will break up, like the other 2.9 per 1000 in the UK this year. On the other hand if you're looking for a man,girls, then the best place to go is the United Arab Emirates, where there is 210 men to every 100 women. And they're all hunky oil workers..

On a more serious note however, it has statistics on health. I took a look at the comparative list for hospital beds per population. Japan, North Korea and Belarus are the top three with 14.3, 13.2 and 11.1 per 1000 respectively. Germany, France, Belgium, Ireland, Poland and Switzerland make it into the top 40. But where's the UK? The UK has only 4.2 beds per 1000. That's less than Turkmenistan, which has 4.9 and is 40th in the list.
See waiting lists? See more beds? See joined up thinking?
Right I'm off to the UAE to see about those oil workers..

He's Alive!

Urban le Grandier dropped me a line to let me know that Dr Crippen is not dead; he has been the subject of a rather cruel hoax on NHS Blog Doctor. Someone calling themselves Dr P falsely said that he had died in a road accident,and then posted on another blog saying it was all a hoax.

I'm delighted that John is alive,furious at the idiot who did this to him,and feeling slightly sheepish,because I wrote him an obituary.

But hey, you shouldn't wait until someone's dead to let them know what you think of him, so I'm just leaving it up.Hope you enjoy it John. Please post soon. And as to what I think of the person who pulled this stunt, it's just as well I have my parental filter on...

RIP John Crippen

It is with great sadness that I pass on the news that John Crippen aka NHS Blog Doctor, has passed away.

John made his last post in mid October. He did not post for a while and we wondered what had happened. He had already taken a break from blogging and we thought that maybe he had simply burnt out. The dreadful news came yesterday in a post put on the blog by his fellow practitioner that he had died in a traffic accident. By this time there were 128 comments on his blog asking where he was; a mark of how revered he was amongst medical bloggers.

John's blog was funny,vitriolic,bilious and insightful by turns. Above all it was fearless and it made a difference. He was the first to report on the loopholes in the MMC scandal; he wrote touching posts about mental health and he raged against the destruction of his profession which he was passionate about. He wrote the kind of posts that got thundering denunciations and standing ovations at the same time. The blogging world will be very much poorer without him. The rest of us have a class act to follow.

John, I hope where you are there are no PFI hospitals, crap IT systems, joke turds undusted and no Patricia Hewitt. We will miss you dreadfully. Put in a word with the Big Man for those of us who are still carrying on the fight. And enjoy your rest - you've had your share of hell already. RIP.

Devil in the Detail

It's mid November and not a key struck in the old blog. So what's been up? Well, firstly I've been finishing off a response to the 'Better Health, Better Care' document, which is due in tomorrow. Secondly, I've had the cold. And last but not least,my broadband is b****d at the mo.

I thought at first this was a virus. It was actually a 'you've-been-on-overdraft-for-one-nanosecond-you-dumb-stupid-peasant-so-we'll-muck-up-your-direct-debit-charge-you-£20-for-a-5p-envelope-and-the-spittle-that-the-dumb-blonde-uses-to-seal-it-and-then-we'll-pay-your-next-invoice-but-not-the-last-one-to-really-muck-things-up' virus, courtesy of Halifax.
So I phoned up Demon to put it right. The chap on the other end apologised and said that he could not fix it, because- wait for it- their computer system was down.

Demon. Broadband. Computer Engineers. Broken Computer System. Someone join the dots please?