Monday, 28 September 2009

Strange things a happening in the Ether perchance?

Following our last post we thought we would drop it into conversation with a friend who being on the net in disbelief looked up the website and found a “new” map!

Strange things are a foot as if you go there , but don't look in to his eyes for too long, Newcastle, Hull and Norwich are now on dry land which they were not previously. Leeds Manchester and Carlisle have also mysteriously changed their positions.

That was yesterday afternoon and evening but this morning the map has changed back to the one we reported on in our last post?! (We think we are not seeing things but who knows what they put in the water up North).

Click on the image “to morph your photo” it still does not work ‘though so our faith in Party IT is still not completely shaken.

Dr Grumble seems to be having his own problems with the ether that is Cyperspace as have we and we think at least one other blogger in the recent past may have had the same problems as well. A conspiracy or just chance events? Stop whispering.

The local IT idiots are now after 5 years starting to believe what we are telling them that our snail like system is slow. Why are people starting to believe us they told us there was nothing wrong and it was all in our heads?

Praise be to the Party but they are busy at present.

If we were paranoid (who said that?), and we don’t (or do we?) think we are, would not a DOS (denial of service) attack at the same time as a major medical announcement at a political Party conference be a good idea?

Must take more of the chlorpromazine but at least Newcastle, Hull and Norwich are now dry (or are they?). We think they were or was it our therapist who told us? Is he or was she a member of the KGB . . .

Friday, 25 September 2009

The Big Care Debate, morphing and geography.

We think we ought to get out more here at ND Central but because 10 minute appointments often mean between 8 to 2 minutes down time per patient we find ourselves using the super slow dial up connection called N3 to while away the hours.

We stumbled across this website by accident after following links to it and thought we ought to draw it to our readers’ attention for two reasons.

The first is that there is a serious issue here namely the funding of care in old age in our increasingly elderly and therefore more dependant population.

The second is the quality of the website.

We start with number 2 first. What led us to the website was the offer of morphing software to see how we would look in old age.

Always a good laugh because try to predict how your friends from school would look now if you meet up with them after say 25 years. Who would be bald, grey, fatter, thinner than you last time you met them? Could you accurately predict how they would look now? So we thought we would try some of our younger looking photographs for a laugh.

Click on the photograph and see what happens. We tried it several times and absolutely nothing happened. Note the little logo in the top right “Care Support Independence” – CSI, wonder where they got that from?

Going back to our original link we found that if you click on the Face of Care link in the first paragraph something does happen but can you get to the morphing part of the site? Try it and see how quickly you lose interest.

Next have a look at the map of the UK and try and locate your nearest Big Care Debate (BCD) centre. We are old enough to have done geography but when was Newcastle ever located several miles off the east coast in the North Sea? Or Carlisle located closer to the east coast than the west coast? Similarly with Leeds which has moved from its roughly central location closer to Hull which is also now in the North Sea and Manchester seems to have jumped the Pennies to be roughly where Sheffield should be.

May be we have missed something? May be global warming has altered the map of Britain as the sea levels rise? Certainly Wales looks like it has had a high speed impact with the Irish Sea on the map unless this is Nu Labour geography?*

The blog section has been bigger than our own little missive with 149 posts since possibly April the last one being the 1st September. Not bad from a concerned population of 60 million. Still we expect there to be a bit more interest in the general election blog whenever that will be.

Website design is a nice little earner so no doubt this little piece of useless non functioning Party propaganda would have cost a fair bit in order to advance the “debate” no further.

The serious issue is that of funding old age care. We suspect the decision has already been taken as with so many Party debates they listen hard to those who repeat their own mantra.

The options seem to be, and we admit to paraphrasing a summary we found here (our original link), costs shared by the person receiving the care and the Government (the current model with most being from the person), an insurance based approach for some care (is that similar to the National Insurance cradle to the grave model?), or a comprehensive state insurance scheme (perhaps called National Insurance?).

You can’t have something for nothing as we all age costs will inevitably rise. More dependence and less young creators of wealth do not boded well for when we retire. We can hear us now: “we don’t want to be in an old folks home surrounded by old people" when in fact most people then will be old so even care in the community will be similar.

Still at least the Party is having a debate with a useless website as its portal to that debate.

Praise be to the Party and all its well spent money on healthcare related IT (failures?).

*we jest.

Wednesday, 23 September 2009

Déjà vu?

When some of us starting working in the third world of medicine that is the NHS we recall being stationed in an area of the world that did not have a CT scanner. This caused some embarrassment to those of us used to first world medicine as we had had available to us not only CT scanners but MRI as well in grunt training.

We remember being on a ward round when asked how we would investigate a particular medical problem and we said “CT scanning with contrast, sir” only to be laughed at. There were no CT scanners, heaven forbid MRI scanners, up in this southern part of Northernshire at the time. The first CT scanner in that area was paid for by public subscription sometime after that embarrassing ward round.

A former squad member, who has contributed to this blog before, and who still works down South has drawn to our attention as to how history is repeating itself.

You can read the article here.

The question we have at ND Central is, despite there being huge increases in NHS expenditure (internal markets, commissioning, Connecting for Health, Choose and Book, etc. sorry did we mean frontline healthcare?) why is a children’s hospital in a city of 500,000 serving a population of 1.8 million having to replace a basic CT scanner by public charitable donations?

Gordon has allegedly saved the world through his Prudence so what has gone wrong? Surely the year on year expenditure increases should have allowed for basic “world-class”, sorry basic first world, equipment replacement after 7 years?

Thanks HP, once again, for the heads up. We here up North too have scanners but not doctors that can use them. We were both first world medical graduates (once) and know what can be done (with ability and purpose). Both are lacking here in Northernshire but we leave you the reader to decide whether you think the same.

None of us trained as economists but perhaps, if all the Chief Executives of the various PCTs that represent the hospital’s catchment area gave their annual salary to the hospital, then the scanner could be bought today. After all why had they not planned for the need at some point for a replacement?

Normally incompetence of this order in business is rewarded with the sack but we forgot this is the NHS “market” where failure means promotion (and more money going directly out of frontline healthcare).

Praise be to the Party for suffer the children let them come onto Gordon the saviour of the world? Almost a generation separates the first charitable purchase of a scanner for use by taxpayers and what seems to be happening today? Despite all the reforms to make things “better”, how can this be happening again? What has gone so badly wrong?

Bet you no-one is responsible for this state of affairs.

No wonder the Americans are worried. Pay your taxes and then buy the scanner yourself for the kids?

Monday, 21 September 2009

Electronic is best? Not Necessarily.

Here in Northernshire our local laboratory services (haematology, biochemistry and microbiology) have been happily sending us their results by a Party forbidden means of communication called paper.

A recent edict has decreed, from sources as yet unknown, that all the above lab results will now no longer be sent via paper.

One can see the angst in the hours of committee time in the various departments involved discussing the vexed question of how do we save money, not improve services, that must have occurred at Northernshire PCT plc.

Can we pay lab staff the same rate for working out of hours?

Any junior grunt in the UK will know that lab staff earn most of their money by working anti social hours for more than junior doctors did (then) and still got upset if their sleep was disturbed. No, it will cost us most of our income.

Can we change the letterhead?

We could but no one from the logo section commissariat, sub commissariat lab letter heads, sub commissariat letter head design (new) section was present.

Or why not stop sending our results out on paper? Yes that will save us a few pence on our large pounds millions budget. We will do that as it is no skin off our nose.

Result an anonymous email saying that from date X no paper lab results will be sent.

A classic result of the law of unintended, or more likely unthought through, consequences. Electronic results does not necessarily mean better.

Most GP computing systems in the UK handle lab results in a completely crap way. You can read them slower than your pet snail can deposit a mucous trail across the width of your computer screen. And when you read them, and post them, the whole computer freezes until the result is posted from your inbox to a patient’s records several very long seconds each time.

The current paper systems allows GPs to see at a glance at least 5 separate lab results on a single page of A4 for example a FBC (Full Blood Count), ESR (Erythrocyte Sedimentation Rate, a non specific indicator of inflammation), U&Es (Urea and Electrolytes measures kidney function and basic blood chemistry), LFTs (Liver Function Tests tells us how your liver is), Calcium, TFTs (Thyroid Function Tests) on a single page. This can be scanned, analysed and acted on in a matter of seconds and provides in no more than 2 A4 pages max a complete lab screen for an attending physician.

Compare that with the slug that is electronically provided lab results.

Each individual result, for example a FBC, has to be selected read and then posted. Then you have to do the next result for example a U&E and so on. Instead of a complete scan of all of the results you can spend an hour just reading and posting a days lab results one slow test at a time doing what may have taken 10 minutes to do if the results were sent on paper.

So now, because electronic reading and posting of results is so very slow, to enable us to read the next set of results and see the odd patient during the working day as well we have to print off each individual result.

Not as the labs did printing off the results 5 sets at a time on one page of A4, oh no, nothing is ever that easy with NHS change for the better. We now have to print off 5 sets of results 5 pages of A4 at a time. A ream of paper (500 sheets of paper) a day versus may be 100 sheets from the labs.

So instead of a doctor in a matter of seconds being able to scan one patient’s complete results on one page of paper we now have at least 5 separate pieces of paper.

So what was a very simple and efficient process at the General Practice end is now an incredibly inefficient paper wasting, staff time wasting, doctor time wasting exercise.

No doubt there will be some cretin at the hospital putting on their CV how they helped saved the rain forests of the Amazon by stopping the labs printing results off on paper little realizing how much more paper is now being used and how much more electricity is being used to do things electronically than the old system.

Better still he, or she, will be writing in their CV, with their best crayon and using a fist grip, how they saved the lab budget money by abolishing paper results and marched progress forward using electronic delivery of lab results. Most readers of this blog probably last used their best crayon writing in their infant school but this is advanced NHS management we are talking about here. Crayon is the new supersonic electronic way of communication especially if it is red.

Paper has other advantages for example if you see some results ordered by a colleague that might be of interest to them you can take the paper and leave it on their desk for them to see.

I look forward to disconnecting my computer and leaving that on someone’s desk. Alternatively I will have to leave them a piece of paper telling them to boot up their computer, log in and look at the abnormal results one at a time. This will take about 3-4 minutes (just to boot up your average NHS PC speed machine before you start looking at the results) compared with the seconds to scan a piece of paper.

Isn’t technology wonderful dear reader? All the time it saves us.
Illustrates the ND law of NHS computing which states any new idea that claims to save time or improve service does not. Just think Choose and Book (or perhaps not even go there if you work in GP land in England?) you get the point we are sure.

Praise be to the Party for when it says things will only get better we know we get closer to the Stone Age with each new innovation it and its managers come up with especially in matters computing. Why go forwards through technology (vorsprung durch technic) when you can go backwards (Rücksprung durch technik )?

Thursday, 17 September 2009

The Doctor will see you now?

Sorry not posted for a while but those nice idiots at BT who screwed an extra half billion out of the Government to fund the N3 super fast dial up connection seem to have done the same to our local internet service lately. After many phone calls to India we are now sometimes getting 4kbs connection which I am sure given that dial up was 44kbs is good value for money.

However moan over and hoping that this will hit the blogosphere sometime before the next century starts. While attempting to very slowly crawl the web we saw this article in the GP magazine Pulse.

Now to those of us at the coalface this is not exactly news but what is concerning is the numbers involved. What is interesting is the use of non medical “consultants”.

Other bloggers have commented on “consultants” for example “consultant” physiotherapists and “consultant” nurses. This is another example of the current Party’s progress though ignorance initiative. If it is dumb give it a degree out of a cornflake packet or make them a “consultant”. Then allow them to “treat” patients instead of nasty expensive doctors.

In the good old days the word “consultant” was spelt “senior” so a Senior Physiotherapist meant exactly what you got. A senior complimentary therapist not a doctor. Similarly with nurses but a senior nurse was still a nurse not a consultant which implied a doctor with a lot of years of experience in training and several exams passed in order to earn the title of a real consultant.

According to the article 36% of trusts contacted said they did not allow GPs to request that a patient saw a medical specialist (doctor) rather than a specialist nurse or allied health professional. More Party “Choice”? Allow a Party dummkopf manager to decide what medical care is best for you comrade patient all in the name of Prudence? We think it is call "World-Class" Commissioning.

Locally this system is up and running (very badly). We get lots of letters from these “consultants” who if we had done what they do now when we were junior doctors we would have been killed by the real consultants. But still they are “consultant” “practitioners” (failed doctors like the “pratitioner” word a lot).

What is more frightening is that some of these idiots don’t just get to “treat” you they actually read the referral letters and decide what "treatment" you get in the first place. This is particularly a problem with orthopaedics locally and one of the team has quite a lot of experience of how badly patients are mistreated by the local “consultants”.

They have accumulated a lot of cases where something as barn door obvious in a referral letter such as:

“had sudden onset of leg pain followed by weakness in the leg which has persisted and worsened day on day with associated muscle wasting on that side. I think he needs an urgent MRI scan in case there is something surgical that can be offered . . . .”.

Any guesses what the GP is asking for? The letter was sent to an orthopaedic surgeon urgently but no surgeon saw these patients.

The letters were intercepted via Choose and Book and then read by a “consultant” complimentary therapist. What in any First World country would have resulted in an urgent MRI scan in Mr Brown’s dumbed down “consultant” led NHS resulted in several months of painful complimentary therapy as the muscle wasting and pain got worse after each “treatment”.

After several months, the patients finally got their MRI scans (as per the protocol) which showed (guess what?) a prolapsed disc pushing on a nerve causing the pain and muscle wasting. And guess what the “consultants” did then?

They stopped “treating” their patients “it is too dangerous” and referred them several months late to see a consultant orthopaedic surgeon. The real consultant knew straight away what was needed for they, like the patients’ GP, were qualified doctors, not a complimentary therapist, sorry “consultant” complimentary therapist, and did the surgery.

Amazingly the patients then got better. Remember who we referred the patient to first? Remember who sorted the problem out? Remember who got in the way?

Remember too dear reader that a GP can refer direct to a complimentary therapist if they choose to do although the local Politburo prevents direct referral to an orthopaedic surgeon via its organs of “Choose and Book” and the “Referral Management Centre” both organs of a four letter description.

We here at ND Central think it is an excellent idea to let people who are unable to operate, and indeed have never operated, see patients and decide who needs surgery or not. If you are trained as a complimentary therapist the only thing you are good at is complimentary therapy - not surgery. Unfortunately local Commissars don’t see things like that.

The figures in the article are quite frightening with some trusts allowing 50% of GP referrals to be seen by “hospital specialists” and the average 28%. We seem to recall that patients were meant to see consultants in outpatients a while back not “consultants” or junior doctors?

Praise be to the Party for over training doctors but replacing them with “consultants”. Will the next stage NHS review be planning a return to year zero to improve UK healthcare? We know that worked well some where else in the world and with all the cuts being forecast . . . who really needs doctors when the local shaman is so much cheaper?

Tuesday, 1 September 2009

If you have a problem, if no one else can help, don’t call the A-team - set up a call centre instead.

While sneaking into our main surgery after a sortie out to a branch surgery we were scanning the horizon looking for hostiles, all right then receptionists lurking with messages or prescriptions to sign, when something green in a corner caught our eye.

A possible hostile contact? With Ninja like fleetness of foot we leapt across the chair, OK then leaned across it, to the surface on which it lay, all alone in the world.

In a Victor Meldrum, “I don’t believe it” moment the piece of lonely green paper was read. It is displayed in all its green glory for all to see above.

Bet that didn’t take too many NHS man(agement) hours of meeting and planning? Rather than lend money to businesses to survive the recession let the Government borrow more money to set up more call centres?

No doubt after 3 hours training all their operatives will have a MBA in recession management and no doubt a flow chart to follow which probably ends with:

“You sound depressed, caller, (lots and lots of meaningless empathy before the next call). After all you have no money. no job and a mortgage you cannot pay and are about to be reprocessed and evicted. It isn’t our fault, honest Gov, go and see your GP”.

Full details are given here and this is when it started. Cynics might say about the time that the Swine Flu call centres were being disbanded. Hope we haven’t missed this one earlier and apologies if any other blogger got the heads up first. It seems to have slipped below the radar somewhat in contrast to other great call centre initiatives like the Swine Flu line.

We believe the first call went something like this:

“Hi, my name is Gordon, I do nay want to give ye my surname. I seem to be in a wee bit of bother. I am running a small country, sorry business, which I have done for several years and I seem to be spending more than I earn something which is nay ma fault, it is the recession. I may be losing me job in the next year can ye help me please? I feel a wee distressed by this all . . .”

Hope “Gordon” has a good GP to help him as we doubt the 3 hours training of former Swine Flu Pandemic line operatives will help anyone but it is nonetheless cheap and cheerful.

Praise be to the Party which if it hadn’t invented the call centre how could we ever help all those unfortunate enough to be hit by the recession? Or “Swine Flu”? Or even genuine illness?

British Engineering and a Bank Holiday in Northernshire.

Here in Northernshire we are celebrating this weekend the last Bank Holiday, or public holiday, in the UK until Christmas. The roads here are quiet and so are the shops but that is because it is a traditional British Bank Holiday cold, over cast and so no one wants to do anything. Bit like the NHS on a weekday.

Neither did one of us at ND Central whose residence has been in the process of being redecorated for the first time since the seventies. What should have started as a few weeks job has become a nightmare: dust, dust everywhere, wood shavings and nails under foot on bare floor boards. Files, books in corners, can’t find anything, sleeping in a tent you get the picture your average Vietnam dug out.

So following the failure of a lawn mower, and the ideal growing conditions of the British summer for grass in the UK damp, wet and warm, one of us was sent to the local home improvement store after the most catastrophic equipment failure known to a wife of NO WORKING LAWN MOWER. The grass needs cutting NOW.

After extensive research and a chat over the garden razor wire fence and minefield to our neighbours we opted to purchase a BRITISH lawnmower. There wasn't really any other Choice at the local DIY megastore.

Big mistake. The instructions followed to the letter led to an immediate destruction of a vital component. Super glue and Sellotape used against the background of screams of “take it back NOW”. The instructions said that you must route a cable into a guide but the cable would not reach the guide in anyway or form hence instant destruction of a vital component in trying to do so.

The instructions refer to a plate that you had to remove and then reinstall but after a lot of lateral thinking this was totally unnecessary. We still cannot work out where the “plate” is and cannot work out why the “plate” needed to be removed at all.

The instructions referred to a “primer button” but we could not find the “primer button” anywhere. We can only conclude that this lawnmower company employs brain damaged halfwits whose first language is not English and then use Babel fish to translate their rantings into English. Furthermore their graphic artists must have had used some serious weed to draw pictures that did not relate to the product before us. They even show the non existant "plate".

It took half an hour to get the lawnmower 2 hours to figure out how to operate it. The instructions were the biggest load of sh*t* since the last Party manifesto we read and the pictures bore no relation to any product we had purchased that day.

Of course if you did not work for the NHS where crap is the common denominator, especially at weekends and Bank Holidays, you would have read the incomprehensible literature which said don’t take this crap product back to the store ring an equally crap helpline and oh yes it is an 0870 number on a bank holiday weekend.

Curious that? Print incomprehensible instructions with meaningless drawings and provide a helpline number costing up to 8p a minute to ring. If we had not the experience of working in the NHS where such crap is commonplace we would probably have succumbed to the help line scam. We did not and eventually we worked out by logic how to work the equipment. And cut the plains of elephant grass on our large rolling estate in Northshire that the wife was not happy with.

We have also had the misfortune to have our broadband service (again) drop to less than the “world class” N3 connection speed which is known anywhere else in the civilised world as dial up speed. This happened a week ago.

We had a conversation with Vijay in India in a call centre who assured us that this would be fixed and service has got worse day on day. Case automatically closed after 5 days with no consultation with the customer who was at work when call back occurred so therefore Vijay has no problems. Just like a NHS manager he can tick a box, say a problem sorted and do nothing but all the boxes are ticked so Vijay will get a promotion for doing nothing.

On the phone again to Vijay #2 who goes through the whole process again with the case notes on his screen telling him that the problem was fixed. Eventually after trying every trick to avoid running a line test, which is what we wanted, he succumbed and did it. And guess what? It confirmed to him that what the customer was telling him was right the problem was worse than before.

An engineer was put on the case and as we write the line speed is up to what it was last week when we reported the original fault. Many messages left on answer machine overnight from India too. Funny how we were asleep with the answer machine in night mode. We think Vijay #2 is on track to a promotion fast as the problem will be "fixed" automatically after 5 days.

Once again Britain shows what it does best. Produce over inflated costly goods that don’t work. After a period of reflection and consumption of some organic naturally produced liquid chemicals we at ND Central realised that none of our high cost products be they cars, TVs, fridges, washing machines, etc we own are British.

None of them.
We asked why? The answer we think is selfevident.

What has happened to British manufacturing and servicing industries? Compare British Leyland with Toyota. One had the crap bombed out of them and came back better. Another had, dare we say, state intervention for many years.

The parallels of our bank holiday experiences mimic the health service which seems to be using the private sector as a means to drive things forward. Unfortunately it is not using the same models from the countries that produce our reliable cars, TVs and fridges it is using the same model that makes our lawnmowers and telecommunications and their back up services.

Praise be to the Party for using the private sector to model our healthcare and all its successes thus far: NHS Choices (none), NHS (re)Direct, NHS Flu PANdemIC line and British Leyland (long since deceased).

British Engineering at is best. The Party probably does lawnmowers as well as it does healthcare. It is using the same models to do so. You have been warned . . .

And back to work tomorrow whoopee!! An extra Brown shift to start the week too. Uncontained joy after a relaxing Bank Holiday.