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.
A Replacement for Warfarin?
On BBC Breakfast this morning, they were talking about a replacement for Warfarin, that would be just one pill a day.
For a lot of people, this will obviously be better and it is likely that the cost to the NHS will be less in terms of blood testing. But this new drug will not be cheap.
In a way, I think that the alternative of providing an up-to-date National Anticoagulant Service might be much better.
As an example, I’m moving to London in a few weeks, so I’ll have to get that sorted fairly quickly. But as I usually have to be tested every two weeks or so, I can envisage a few small problems, especially as I’ll be needed to be tested over Christmas.
Stem Cells and Stroke Patients
A lot of people mat well object to the fact that foetal stem cells have been used to help a stroke patient in Glasgow.
I’ve probably been fairly lucky with my stroke and it is doubtful whether I would have needed this treatment.
But, would I have said yes or no, if I had been offered the treatment. I don’t know, but I would have always wanted to get better.
It is interesting to postulate what families and the NHS will say. After all, if someone is completely disabled, it doesn’t help anybody, least of all the patient.
I must admit too, that if this treatment is a success, then the three parties involved, the patient, his family and the health service will all probably be in favour.
It will be interesting to see how the moral arguments develop.
One In and One Out!
I had a bone density scan some weeks ago and as I’ve not heard anything, I asked the nurse to see if there was anything on their computer, when she did my Warfarin blood test and gave me a shot of B12 today.
There wasn’t any news and judging by how I feel, my bones may not be tip-top, but they certainly aren’t in falling apart mode, as I would have hoped that I would have been called in for the bad news.
It strikes me that there could be a big increase in efficiency here, with possible cost savings!
If you have a test that can be quantified accurately and you are well on the right side of the problem level, surely, you can be told the results either by a more or less standard e-mail and/or letter.
With my bone scan, it might say that I’m reasonably fine, but I should come back for another scan in say six months. A copy could also go to my GP, so she would know as well. I have a feeling, that a lot of communications from hospitals to GPs are actually letters not e-mails and are scanned in the surgery. If I’m wrong, which I hope I am, about these letters please correct me!
There must be hundreds of instances in the NHS, where a sensible bit of automation could save money and redeploy staff to more important duties, than writing lots of similar letters.
We are seeing instances of automation, like appointments systems that text you reminders, but we need to see more. I personally would like to see a better system for anti-coagulant testing.
Using NHS Direct
Because of my pain, I felt like a pain killer might be an idea. So I searched the NHS Direct web site and I couldn’t find anything that might help.
Eventually I gave up searching and phoned them directly.
I was on the phone for perhaps ten minutes before I got through to a nurse, after answering a load of questions. The nurse reapeated some of these questions and then quizzed me extensively to check I wasn’t aving another stroke. She did say that if I thought I was having another I should phone 999 immediately.
When we got to talking pain killers, she said I wasn’t to take an aspirin as I was on Warfarin. But paracetamol was OK. So as I had some, possibly of a dubious age though as it had Victoria Regina stamped on the tin, I took one.
The system did work, but it was rather bureaucratic and over protective. Let’s hope the 111 system is better. A chat to a competent nurse or pharmacist is what I wanted and that is what I got. Will I still get that under 111?
NHS Direct
When I had my first stroke in March, I called NHS Direct, as I woke up and couldn’t speak very well. After answering lots of questions and phoning me back a coiuple of hours later, they felt I needed a visit from an out-of-hours doctor. They called him and he arrived an hour later. He advised me to go to hospital, as he felt I had had a small stroke. I was then driven to Addenbrookes and they confirmed the diagnosis and said that I should go to A & E if it happened again.
NHS Direct actually delayed me doing, what I felt I should have done in the first place by their bureaucratic procedures and delays. Let’s hope that the proposed 111 service would either upgrade my call to 999, send a doctor immediately or tell me to go straight to A & E.
It would appear that the Royal College of Nursing is against replacing NHS Direct. Are they just protecting jobs or thinking what is best for the patients?
But whether we have NHS Direct bor 111, does it affect the real problem in the Emergency Service of those that turn up in A & E, with things that need a visit to their GP or a pharmacist in the morning.
Some Muslims Risking Their Lives During Ramadan
I couldn’t believe the headline of this article on the BBC’s web site.
Apparently, Barts and the Royal London Hospital has found that some patients are missing appointments and delaying treatments during the month of Ramadan at great risk to their health.
I’m not sure that any religion would put religious observance above health, but I’m certain if I had any religion, I would defy such a statute.
In fact the article does go on to say that local imans are urging patients to continue with their treatment, so progress is being made. Knowing the hospitals well, I’m saure they are trying as hard as is humanely possible to improve the situation.
Also in these times of austerity, surely we have a moral duty to our fellow citizens not to load extra costs on the NHS. And I would think we also have a moral duty to our friends and relatives to do the best for our health, as they are the ones, who could really suffer in the long term if we stop treatment.
It should be said that “No-shows” are a big cost to the NHS and that is why my hospital, Addenbrookes, has installed an SMS-based system to ensure attendance. Perhaps, those who are persistent non-attenders should go to the back of the queue.
Homeopathy on the NHS
The most sensitive thing that you mustn’t criticise in this country is homeopathy.
But this government is actually allowing the use of this witchcraft (the BMA’s word not mine!) to increase in times of budget cuts according to the Daily Mail.
If fools want to be parted from their money, then it should be up to them to find their own quack, at their expense and not mine as a taxpaper.
The Power of Twitter
It would appear that Twitter has been having a hard time, as a war of words goes on about the NHS between Britain and the United States. Or at least between some people with axes to grind.
I am quite a regular user of NHS services in that I am a coeliac and have a B12 injection every three months, free prescriptions for bread mixes, ongoing issues with cholesterol, my left foot, which got injured on a beach by a shell and my left humerus, which got broken by a bully at school. Nothing is that serious and I suspect, I’m quite a way below average in my consumption of services. I never have a problem and I can always get an appointment when I want with my GP.
If I look at the last few weeks of my late wife’s life, I can’t fault the services she got from both the hospital and from the GP. She eventually died at home in her own bed, which is surely the way we’d all like to go. If we have to go at all!
But I’m not saying the NHS is perfect, but on the whole in mine and my many of my friends’ experience it works pretty well. I think we’re also lucky here in West Suffolk, in that we have two hospitals within reach; Addenbrookes and Bury St. Edmunds. For specialist problems, Papworth and London are not too far away. So if I have a problem, I’d make sure I get the right consultant from a choice of several.
I have never used the US healthcare system so I can’t comment directly, but whereas none of my friends in the UK would put healthcare to the top of their list of worries, many of my American friends do. I worry about living alone and perhaps having a heart attack by myself, but I don’t worry about the care I would get.
Recently, I’ve had experience off two other health systems in Europe; Italy and Holland. So in the latter it’s only indirectly, but the episode in Naples was only the second time, I’d had a ride in an ambulance. The ambulance was rudimentary, the hospital was very tired, but the care was good and there were lots of doctors and nurses. Compared to the UK, the buildings are a lot worse, the staff seem to work a lot harder, but the result is probably about the same.
Holland is interesting in that everyone has to take out insurance, even if you’re unemployed. If you don’t then you don’t get treated. So take your European Health Insurance Card with you! One guy in Holland got charged 740 Euros to remove a tick!
So we can find holes in every health system and these are going to get publicised all of the time. But they actually stop real debate about the way we’re going to have to manage health care in the future.
When I had my last B12 injection, the nurse told me that increasingly her time is taken up by the problems of the obese. It would appear that what the US and the UK do, that they can’t get to grips with this problem. I suspect it may be solved in the US, by the health insurance companies charging a lot more and people will either have to diet or take the consequences. So perhaps, their system has this control and that because the NHS is free at the point of delivery for all, the system will overload here in a big way in the next few years.
And then there is smoking! And excessive drinking, that leads to all sorts of problems. And don’t forget illegal drugs.
So to me the key to getting health costs under control, is to take action against obesity, smoking, excessive drinking and drug abuse. Do this and I suspect that the money will be there in the NHS for all the exotic drugs coming on stream.
According to this article in the Telegraph, in 2007, the NHS spent £750 million on drugs to combat unhealthy lifestyles. That is about 9% of the total drug spend of £8.37 billion.
But I do wonder about some of these drugs. And also the effects of the drug companies.
I am a coeliac and although it has been shown to affect about one-in-a-hundred of the population, there is very little research into the subject. Why? Because, everyone knows that the cure is to keep to that gluten-free diet and that if a drug came, that allowed you to eat gluten, most coeliacs wouldn’t trust it and would leave it in the pharmacy. You could argue too, that if we tested everybody for coeliac disease, this would save quite a bit of the drug bill, as many undiagnosed coeliacs suffer all sorts of problems like arthritis.
I wasn’t on any drugs before diagnosis, but I nearly had a couple of serious operations on my knees. Luckily I didn’t!
So better and earlier diagnosis would probably cut the drug bill.
I should also say, that many patients think that for every disease they need a magic pill. We are prescribing Tamiflu to all and sundry, when many commentators, think that bed, whisky and paracetamol might well be better for the run-of-the-mill cases.
I’m not taking it for a start, unless I get a serious dose of flu.
My late wife had a horrific cancer and they tried to use a drug to prolong her life. It failed and made her life worse. So on another point, I would never take a drug unless I had all of the facts. We must not judge success by an extra day of life, but by the quality of that life as well. The number of people in favour of assisted suicide shows that the general public rate the quality of life pretty high.
But we must also remember that over half the costs of the NHS are staff costs, whereas the total cost of drugs is a lot less than that. I can’t find accurate up-to-date figures, but the drug cost is probably between ten and fifteen percent.
So to get a better health service, we need to cut out those bad lifestyles and provide the tools for the NHS, so that we get more greater value for the large amount we pay staff.
I’ll give one personal example here.
To be diagnosed for coeliac disease, you need to have a full endoscopy. I’ve had two and they’re not that bad, but they cost the NHS a lot of money. On the other hand, before I had the first endoscopy, I was diagnosed as a very likely coeliac by just a simple blood test. I went on a gluten-free diet, my chronic dandruff disappeared immediately and I felt a lot better. In other words why bother with the endoscopy?
NHS rules say you can’t get gluten-free goods on prescription unless you are diagnosed by endoscopy.
There are several things wrong with this policy.
- Some coeliacs have a negative diagnosis by endoscopy, despite losing all symptoms on a gluten-free diet.
- My wife said that it could be construed as child-abuse to use a gluten challenge and endoscopy on a child.
- A lot of coeliacs get little on prescription, as much better offerings are available in the supermarket. I only get a bread mix.
How many other areas could better and more scientific procedures make the NHS more efficient?
Whoever wins the next General Election in the UK has a lot of scope for efficiency improvements in the NHS, but the entrenched views of those who work there will make it difficult.
What am I going to do?
Keep slim and fit! And not stand on any more razor shells on Holkham Beach.
And also use Twitter to publicise all the waste. It has a lot more power than anything else.
The Anonymous Widower 