The Discontinuous NHS
I am a control engineer by training, although I haven’t really practised since the early 1970s. But any control engineer will tell you that the most difficult system to control is one with discontinuities. I always liken it to riding a bicycle, which you may be able to do happily on the flat, but then you need to go up or down a kerb and you have a problem.
Some of the biggest problems we get in life are concerned with discontinuities; such as birth, marriages and deaths. We also get a whole series of problems when we do something like move house.
Organisations such as the banks, insurance, utility and telephone companies, major retailers, supermarkets and some government agenices like the DVLC, TV Licensing and a few others, have used modern methods, such as web sites, e-mail, text messaging and dare I say it well-designed call centres to liase with their customers in whatever way those important customers find easiest and most convenient. If say a gas company doesn’t do what the customers want, then those same customers will desert it.
Moving wasn’t particularly difficult for me, with respect to gas, electricity, banks, gas, water, credit cards, broadband, TV and phones, even if I have a couple of minor issues to sort out.
One problem I have had was getting used to the refuse system. But Hackney council were very helpful over the phone and the binmen sorted out the small details. But in an ideal world all councils would use the same collection system. In a few years time, they probably will, as one method will probably be cheapest for all councils to operate for a variety of reasons. The method will probably have a high level of recycling too.
But the NHS seems almost to be designed to be discontinuous.
My previous and current surgeries are run on different lines, probably use different computer systems and have made my transfer a lot more difficult than it should be, as I can’t understand, why the same system is not used in both places. Would, BP, Shell or Esso, use different computer systems in all the garages they supply with fuel? I don’t know, but I suspect they don’t!
Today, I miscalculated when I would run out of tablets. I thought I had another weeks supply, which I do, except for the statins I take. So I needed to get some more.
At my previous surgery, I just e-mailed them and they would be ready within 24 hours. But my new surgery doesn’t have a pharmacist and after visiting them this morning, they informed me, I wouldn’t get the prescription forms until tomorrow afternoon. I had assumed as it was a repeat prescriptiuon, I could just pick one up and get it dispensed. I thought that I might be able to get some in emergency at a pharmacist, but this would need a visit to a doctor at an NHS walk-in centre. Would we accept such a system for buying groceries at Tesco’s.
We need two things.
- Every surgery should use similar systems and methods. They should also make it clear to new patients, how you get repeat prescriptions.
- All repeat prescriptions, should be on a central NHS database, so that you can walk into any pharmacy and get the drugs you need. But would that be giving too much power to the patient and pharmacists? What would happen say if I was on holiday in Cromer and I lost my backpack with all my drugs in it? I suspect, it would probably take a whole day to sort it out!
The NHS might save billions by doing what any sensible organisation would do and many government agencies already do. Service would improve to the more modern standards that people expect and receive from many companies they deal with on a day-to-day basis.
The Mother of Statistics
After last night’s program, The Joy of Stats, it was good to see one of Florence Nightingale‘s coxcomb charts in the business pages of The Times in an article headed, Bloodied but largely unbowed, things are looking up for Toyota. The chart has been missed off the web edition.
She was so much more than the Lady with the Lamp.
She also had a massive input into Brunel’s design for the prefabricated hospital at Renkioi in the Crimea. Here’s an extract from Wikipedia.
Brunel was working on the Great Eastern amongst other projects, but accepted the task in February 1855 of designing and building the War Office requirement of a temporary, pre-fabricated hospital that could be shipped to Crimea and erected there. In 5 months he designed, built, and shipped pre-fabricated wood and canvas buildings, providing them complete with advice on transportation and positioning of the facilities. They were subsequently erected near Scutari Hospital, where Nightingale was based, in the malaria-free area of Renkioi.
His designs incorporated the necessities of hygiene: access to sanitation, ventilation, drainage, and even rudimentary temperature controls. They were feted as a great success, with some sources stating that of the approximately 1,300 patients treated in the Renkioi temporary hospital, there were only 50 deaths. In the Scutari hospital it replaced, deaths were said to be as many as 10 times this number. Nightingale referred to them as “those magnificent huts”. The practice of building hospitals from pre-fabricated modules survives today, with hospitals such as the Bristol Royal Infirmary being created in this manner.
Sad to say, we don’t solve problems in that way anymore. Today’s civil servants would never let two people like Nightingale and Brunel even talk to each other, as they would come up with something that made the civil servants all look to be the dunderheads they inevitably are.
Remember that it takes twelve civil servants to change a light bulb. One to actually change the bulb and eleven to do the paperwork.
The New Evolution Diet
This was being promoted in The Sunday Times yesterday.
It basically says eat a variety of foods, like vegetables, meat, fish and eggs, nuts and fruit and avoid foods like grains, dairy, starchy foods, some fruit and soy beans. It also advises taking exercise, most of which appears to be walking and simple arm and back exercises. But then Dogtor J has been saying things like this for health in people and their pets for years.
Looking at it in more detaill, it is very close to what a coeliac might eat, except that I probably eat too many potatoes and bananas for the diet’s liking.
So have we coeliacs been right all along in avoiding grains like wheat and barley?
My late wife, C, wasn’t a coeliac, but she followed a virtually gluten-free diet, as she didn’t want to cook separately for me. She also did plenty of exercise.
In the end it didn’t do her any good, as she died of a very rare squamous cell carcinoma of the heart, but only a few months before she died, I took this picture on the beach in the Aeolian Islands.
The Power of Research
I’ve always been a great believer in research. This came home to me in spades, when as an engineer at ICI, I was investigating the dynamics of a particular chemical reaction. In the end, I found a lot of the information I required by going back to the 1900s, where a Chinese researcher working in Canada had obtained the rate constants I needed. So when you have a problem, there’s probably someone out there who has the information you need. But it may be extremely difficult to find, like my rate constants.
When C died, I needed help and as I was in touch with Liverpool University at the time, I asked if they had an expert on bereavement. They do in Kate Bennett and several times, I’ve talked things through with her and her research has shown me the way forward. So yesterday, as I had time to spare, I popped in on Kate for a coffee and a chat. All her publications are on her web site. There is a link there so that you can participate in her research as I have done, and that to me is better than any therapy, as by doing so, you’re not just helping yourself, but others too.
If you think about it, perhaps a million people lose their spouse or partner to death every year in the UK and how much does all this cost the taxpayer through the NHS and in ruined lives? But little research is done into the subject in reputable instutions to find ways to overcome problems in a constructive way.
I’ve asked Kate simple questions and got simple answers, which have been invaluable.
So thank you Kate for your help and support, these last three years.
Strange Affect of a Haircut
Last night a friend cut my hair. It had got a bit long in the last few weeks, but it has had the surprising affect of making my scalp feel better and less itchy.
How strange!
But I’m not complaining
England in the Pink
England finished the day on 488 for 7, which is a good score that could get even better with some quick runs and then a couple of quick wickets tomorrow.
The most amazing thing was that yesterday was Jane McGrath Day, in memory of the cricketer, Glenn McGrath’s wife, Jane, who died of breast cancer. Obviously, all the money raised will be wisely used. My late wife, C, had breast cancer a few years before she died and fully recovered, so I’m all for days like this and we should see more of them.
Provided of course, they raise either funds or awareness!
INR by Handheld Monitor
I had my first experience of this tonight and it worked well and took just a couple of minutes.
Some health professionals have said to me before that they don’t like the system, but as a patient it’s certainly less stressful than giving a blood sample. Or it certainly was for me.
My INR had hardly changed but the software used with the monitor, gave me a much more complicated schedule of Warfarin doses, than I used to get in Suffolk. Could it be that in Suffolk, the anti-coagulant team simplified the schedule, so that less patients got confused?
I won’t comment on all this from a medical point of view, but given a choice I would take the monitor route, as I got my result there and then and I suffered little or no discomfort.
But speaking as a trained control engineer and a competent software engineer, the software that works with the monitor, may be something that could be improved to make Warfarin regimes less complicated or prone to error.
Laptops in Hospital – 2
I put a post on this earlier and today as I travelled to try to see the eclipse, I got talking to a lady who happened to be a hospital physio working with stroke patients. I asked her whether they allowed patients to have laptops and she said they did to a certain extent. But they were always worried that they’d get stolen.
The latter may be true, but if hospitals have a crime problem, it should not be allowed to get in the way of patients’ care and well-being, Iit should also be properly solved.
I also think that most patients would also accept having the coputer in hospital at their own risk. I certainly would and would make sure it was a rather elderly but reliable machine.
Up Early Again
I’m watching the cricket at three in the morning, after perhaps six hours sleep. I think it would be better, if I could sleep a bit more, but then I have various niggles that can’t really be described as pain, but that give me a bit of discomfort. I think that a physio is somebody I need to do some work on my arm and now the bottom end of my spine, which seems to be hurting from sitting down a lot. But then, it’s always hurt a bit, as it sticks out and constantly used to bang it. Some cars I used to find very uncomfortable to sit in or drive.
Laptops in Hospital
In a previous post, some of the comments were about smart phones in hospitals.
I’m all for allowing patients to have laptops in hospital. I had my stroke in Hong Kong and I was allowed one there. It allowed me to do things like listen to Radio 5, talk on Skype, do the Sudokus in The Times and send e-mails, that I wouldn’t have been able to do otherwise.
I could also have done things like watch videos, which I never do anyway.
In Addenbrooke’s laptops were effectively banned and I don’t think it helped me.
The reason they are banned is that if they were allowed, it would mean they’d lose all that money they get from that crap Patientline system. The bandwidth wouldn’t be a problem, as they can now get enough Megabits easily.
The laptops could also be integrated into patient care and support. For instance, a physio in Hong Kong told me that typing would help my hands work properly again. She was right!
So let’s have some 21st century, healthcare thinking!
Remember too, that happy patients are less trouble for staff and might even leave earlier.
To me allowing laptops in hospital is a no-brainer. But then what do I know about healthcare? But I have seen good healthcare at work and know what works.
I am also in contact with universities, where they are developing computer games to help stroke patients. Let’s make those free and downloadable!
The Anonymous Widower 