The Spine

A lot of people are getting quite worried about the NHS Spine, a project to digitize everyone’s medical record to make it easier for doctors, nurses, etc. to provide better, faster care across different locations. Lots of people are worried about whether the government can be trusted to hold all this information securely given their poor record with data protection. So should you be worried? (Well if you live in Scotland, Wales, Northern Ireland or anywhere in the UK that isn’t England the answer is no, because the Spine won’t include you!)

First off, I’d like to say I think digital medical records are a good thing. Certainly, I don’t like the idea that my records could be hacked or stolen (although since the most interesting medical condition I’ve ever had is Salmonella when I was 1 year old, they won’t find much to interest them!). But I think people are blinded to the potential benefits electronic records could bring by their fear that it will be poorly implemented.

I don’t think we will ever be fully ready to digitize our records. It’s too big a project. There’s nothing to be gained from ‘waiting for a bit’ before we do it. It’s time to bite the bullet. Mistakes will probably be made, but so long as the government is honest and careful and responds to these mistakes well, things will not turn out as bad as all the fear mongers would have you believe (hmm, a government that’s honest about the mistakes it’s made, perhaps not…).

So in the end, which is the better solution: centralized database or disseminated, local nodes? The advantage of a central system, I suppose, is that you have highly trained monkeys IT professionals looking after the thing as a whole. They are there all the time and will know the system intimately. If the Tories are suggesting putting a server in every GP surgery, each accessible and editable by the people who’s records it holds, and employing all the necessary security protocols that entails, it’s laughable. I mean, even splinting by individual PCTs would be a nightmare. The suggestion that “IT firms such as Google or Microsoft could host the information” is an interesting juxtaposition to the statement “You want to have your data held locally”. So instead of having a central database run by civil servants, all of whom are at least working for the British Government or contracted by same, we are handing over control of our data to Google, who have one of the worst data privacy records of any major IT company, or Microsoft who… well, the less said about them the better.

Local node represent a logistical problem as well. I don’t think the local IT guy at the rural surgery in Timbuktu would be best placed to maintain a node in a national database. I also have nightmares about some slightly dotty receptionist (or GP, or practice nurse for that matter) accidentally nosing around in the server system and de-encrypting all the data held there. Remember MTAS, and the guy who was fiddling around with URLs and discovered he could access the correspondence of thousands of junior doctors by changing a few characters; and he wasn’t even trying to hack the system.

‘Ah,’ I hear you cry, ‘but surely the same could be said of a national database?’ Well, this is true, but the chances of something going wrong if the system is duplicated in hundreds of poorly monitored locations is far higher.

So really, I think the Conservatives’ plan is a bit of a façade. They recognised that people are not happy handing over their personal data to ‘the man’ and tried to make you feel more comfortable by bringing things closer to home. You’d much rather have your nice, kindly, local GP look after your data, wouldn’t you? Well actually no, I wouldn’t, because if this data is accessible from the internet at large so that “every patient … could update their records” then it doesn’t matter where the data centre physically is; I mean, that’s the point of the internet isn’t it, global access?

So what is the solution? I don’t know. I think in the end, we’re going to end up with something like the Spine. What we need to do now is keep shouting, shout louder and more clearly to the government. We want transparency, we want openness, we want slower and more secure implementation, not quick and dirty, and finally, we want (at least a limited) opt-out system, whereby we could keep all but essential data in paper form for as long as possible. I know it’s a lot to ask, but it’s our data (and we will sue your ass off if you muck it up ).

Bug Bites and Pharmacists

I have a whole bunch of bug bites on my legs. I don’t know when or how they appeared, but they’ve been there for what seems like longer than normal. They reminded me of when I was in Bratislava, capital city of Slovakia. We were staying in a slightly dodgy hostel. Not the worse on we stayed in that trip, but not the Ritz by any means.

And there were bed bugs.

And they loved me.

They had a feast on both my arms. I’m sure there are pictures somewhere, but I can’t find then. My forearms looked like they had been carpeted in red lumps. The bites were so densely packed that we weren’t even sure if they were bites or some kind or rash.

Being in Slovakia, we didn’t really know where to go to find out. So I did something that I’ve never had to do before or since that day; I asked a pharmacist!

Now I know they are highly trained professionals with a great deal of knowledge, but still, would you really want to go and see them about your minor health complaint? In this country? Because there are plans in place to do just that. Maybe you would rather be able to walk into a chemist and see a pharmacist straight away than wait for a doctor’s appointment, but me? I think I’d rather wait.

Back to the story in hand; we found a pharmacy. Actually we found several, but they were all closed except one. We had just had an early dinner out to celebrate the end of our trip as only the five of us, since two more would be joining us in Berlin. So it wasn’t really surprising that most places were closed.

After standing in line for a goodly long time, I managed to speak to a member of staff… who presently directed me towards her English speaking colleague, so I had to wait for her to finish with the previous customer.

The long and short of it is she didn’t actually know whether I had a rash or simply a helluva lot of bug bites, but she offered me anti-histamine tablets anyway. They whould help regardless of the cause.

Trouble was, I didn’t have any money for them. It seems a little strange now, since we still had 5 days left in a different city before we flew home, but I remember that we had spent the last of our Slovak koruna (we just called them “SK” to make life easier, that’s what is stamped on the coins) on our meal out, trying to get rid of them really since we didn’t have enough left to exchange and they weren’t going to be much good to us in Berlin. We had fun counting the bill out at that restaurant I can tell you, but that’s a story for another time.

If it had been serious we could have taken more money out and claimed it back on the travel insurance (maybe!). It was really just because it was so damn itchy. But it made me realise something.

“This is what it’s like to get sick in America.” And many other countries too, but the fact remains it is perfectly possible to die from a 100% treatable disease, like Diabetes Mellitus, in the world’s largest super power.

Sure we moan and complain about the NHS, for all kinds of different reasons. (I get uncharacteristically worked up when I hear people complaining about having to wait 6 hours in A&E, well if you go in with a stubbed toe what do you expect. Go and see your GP.) But I can say for certain that if we didn’t have a National Health Service, we would have a great deal more to complain about.

Petition

Proper post coming soon, I promise.

There are currently around 6,000 signatures for the petition below.

This is from the Royal College of Nursing website:

Dear Colleagues,

Last week, many of you will have seen extensive media coverage around RCN member Margaret Haywood who was removed from the nursing register for breaking patient confidentiality. Margaret took part in undercover filming as part of a BBC Panorama documentary in 2005 which exposed poor care at the Trust she worked at.

Margaret has been supported by the RCN since charges were brought in relation to her participation in the Panorama programme. Whilst the RCN cannot condone breaking patient confidentiality, we feel that the decision taken by the NMC to remove Margaret from the nursing register was unduly harsh.

The RCN would always encourage members to raise any concerns they may have about patient care with their employer in the first instance. However, if members do not feel able to do this for any reason then they should contact the RCN as a matter of urgency and we will take action on their behalf.

In consultation with Margaret, I am currently working with the RCN’s Director of Legal Services, Chris Cox, and Margaret’s barrister to look at the legal options around the NMC’s decision. Although we are not able to make public the detail of these discussions at this stage, we are investigating what grounds there may be for an appeal. If an appeal does go ahead it will have to be lodged within 28 days of the NMC’s decision to remove Margaret from the register.

In order to gauge the feeling around Margaret’s removal from the register, the RCN has set up an online petition. This is open to anyone that would like to show their support for Margaret. Due to the fact that the petition is aimed at gathering views from the general public and the nursing profession, I don’t feel that it would be appropriate for RCN staff members, myself included, to sign the petition. However, please be reassured that the RCN is vigorously defending Margaret and supporting her at this time.

The petition can be found at: www.gopetition.com/online/27030.html.

Yours sincerely

Peter Carter
Chief Executive & General Secretary

Why should you sign? Well if you’re in healthcare you should sign it to defend your right to whistleblow from within the NHS. Currently, if you bring poor standards of care to the attention of the general public you are either force to flee the country, disciplined on a technicality or told you are just plain crazy.

And if you aren’t in healthcare? Well wouldn’t you rather the doctors and nurses at your local hospital felt that they could do something if patients weren’t being treated right; more than just fill out an incident report form that is no doubt ignored.

So please, defend the right to free speech; all it takes is your name, your email address and a couple of clicks. (You will not be spammed from this website.)

[Edit 23/04/2009. In the space of two days we doubled the number of signitors to more than 12,000. A big thank you to everyone.]

Polyclincs Coffee

I realise this image means nothing to most of you, even most of my medic friends. But it means something to me because I believe in a future for the NHS that actually cares about caring for the patient.

The Doctor is in the house

NHS Blog Doctor is back.

Head over there for some candid insights in to “GP land” the the lunacy of Today’s NHS.

Just some of my thoughts below, Dr. Crippen at NHS BlogDoc will explain them far better than I. (If you don’t really care, which is fair enough, it’s only going to be you and everyone else who ever needs to see a doctor in this country who suffers, read this article for an example of what exactly it is we’re all going on about.)

The trouble is the Labour Government…. what? Too much? Ok, the trouble is the Government, regardless of party.

The NHS was for a long time run by the people in it. Doctors were professionals i.e. they regulated themselves. There were the Royal Colleges and the Academy of Medicine and the GMC. All run by doctors, and those doctors were chosen by other doctors. The same was true of the nursing profession also. These two groups came together to run the NHS. Matrons ran hospitals, assisted by admin staff. Almost everyone was scared of Matron, everyone respected her because she had more experience than anyone else.

Now, was this system perfect? Of course not. Maybe somewhere in all that self regulation I was talking about there was some mutual back scratching. I have no doubt that mistakes were made and covered up because ‘that’s just how you do it’.

The conservative government came along and crippled the NHS by introducing the ‘internal market’. Basically, each Primary Care Trust was given a set amount of ‘funds’ to spend on sending patients to primary and acute secondary and tertiary services (that’s “GPs”, “hospitals” and “fancy hospitals” to the rest of us). This was supposed to stimulate competition within the NHS as hospitals competed to provide services at lower prices. The trouble is half the time these same hospitals are trying to work together, on research projects, on patient transfers and on specialty services. It is a bit difficult to stimulate a competitive market one minute then expect seamless cooperation the next, but that’s what the Thatcher government did.

When Blair came to power in 1997 it was with the promise that he would abolish the internal market. However, in his second term he changed his mind and instead decided to strengthen the market.

That is really only a taste of today’s modern NHS, there are thousands of other things going on. Nobody has the answer, and no system is going to be perfect. But I can tell you one thing for certain: The NHS is have more money poured in to it than ever. It is providing care now to a standard far below that seen since its conception in 1948.

What will happen in the years to come, nobody knows.