NHS - New Initiatives

In the news reports we are told that in several hospitals nurses are given tabards to wear instructing patients and others that they are not to talk to them or interrupt them in their primary duty of shoving pills down throats.

Tabards are a very medieval form of dress. Increasingly the NHS is becoming more and more medieval in its approach to the general population, sorry, customer base.

The highly structured hierarchy of control, the extent of security services, the rigorous segregation of duties and functions, the number of plagues carrying off the unlucky, starvation, lack of clean water, general filth and primitive manners are taking us back to the past.

Add to this the whole service is now more a means of extracting money for predatory war lords of the financial and consultancy classes than it is of actually curing the sick or caring for the infirm.

It is only a matter of time before new management initiatives more related to the past medieval forms of contact will be introduced.

The one pictured above will surely be one of the first.

The NHS - Breaking Records

The ongoing shambles over the NHS computer schemes has many large sums attached to it. £12 billion seems to be the cheapest but it could be more. Nobody really knows, including the Department of Health and The Treasury. In the past decade figures of more than double have been suggested.

Also, any cancellation is alleged to cost potentially more than carrying on regardless. If it is cancelled then it will start all over again. In the meantime people who go to the doctors and the hospital spend much of their time explaining to the people what they are supposed to be doing and what has gone on in the past.

A near friend of mine is in the unlucky position of having to do this for critical reasons. He has told me, and many others, the gruesome tale. Time after time he turns up at the desk, waits while the assistant checks out the details and then asks if they are aware of his issue. He takes care to inform them of this well in advance and his records are supposed to be full of it.

Invariably, the staff at the desk do not know, so they tell him to tell the nurse. When he sees the nurse, then he has to go through again the business of who he is and what and it is clear they do not know there is a major problem. This needs sorting out and complicates matters. Eventually, the time for him to see the doctor arrives.

Also the doctor does not know and when told sometimes panics, sometimes just goes white. The last one he saw told him it would be better if he stayed away from any medical facilities because of the risks. My friend says the doctor was very right, despite the fact that he supplies at all times an updated and full record of his medical history.

He tells me that his experience is that the nurse has made notes for the doctor who makes notes and puts them on the file. He does not see the notes. Then he goes home and weeks later a letter may or may not come telling him what the hospital has told his family doctor. Sometimes things are not quite right.

His doctor cannot revise them, because it is the hospital. The nurse at the hospital cannot revise their records because it is a matter for the doctor. The doctor he will see next is always different from the last one and cannot correct the records they have because it was made by another doctor.

So we have a situation where he has accurate records but his family doctor, the hospital, the nurses and the system as a whole has no method of maintaining records that are readable, up to date or even correct.

Over the Atlantic a bunch of guys got together, hired a few people and looked at what was what. Because of the USA medical insurance system it is just as vital to have accurate up to date records that enable care and the relevant finance to pay for it. Yes it is money driven but given the USA legal system it is accuracy driven.

For a tiny fraction of the cost of our NHS efforts they have come up with a system, put together in four or so years, that meets many, if not all, of the requirements and allows a much more reliable way of dealing with patients. Critically, it involves the patient in the process and can be updated continually.

I made the mistake of telling my friend about this. He started banging his head against the wall and I was scared stiff he might need to see a doctor.

Life Is Full Of Surprises

It is a filthy wet morning and I have to walk to the doctors. The appointment is in the middle of the rush hour and there is no parking anywhere near the surgery. So I stagger down there muttering curses most of the way.

When I get there, he is running late again, this time very late, there has been a patient crisis that had to be sorted fast. OK this is what doctors do, the luck of the draw so there is a wait.

The seats in the waiting room seem to have been designed by persons who like to inflict pain before interrogation so the back tells me to stand but there is nowhere to stand except the middle of the room and that would look silly.

To keep us happy they are playing music through the Tannoy. It is a very old system and the sound quality is worse than that at any railway station. As for the music it is a mix of the most mind numbing mid 20th Century ballads sung by singers who shout out of tune.

Ten minutes in and the brain is telling me it does not like it and my head begins to ache. I begin to want aliens to land and take me somewhere else, anywhere else.

Then I begin to get the hit in the lungs. The room has no ventilation and is already full. The fug of various chemicals coming off the clothing and bodies is building up. I am not the only one to be getting a hit.

Around the room the coughing and wheezing increases in intensity. At least it is better than the music.

At last my name is called. The doctor asks me about a complaint that is strictly female. I explain kindly to him that I am male. He clicks his mouse a few times and realises that something is wrong with the listings on his computer so we sort that one out.

Then he tells me he has to take my blood pressure. I already have a long list of home readings. No go, the rules say that to meet the targets he has to take it. The figures are stratospheric. He tells me he has to prescribe something. The rules say so and the targets have to be met.

I remind him that the last time we went through this rigmarole the pills he gave me had me running up and down to the local dermatology clinic to sort out the severe skin problems that resulted. He looks for pills that might avoid this without success.

After some discussion we decide that the previous prescription still being on file we skip on a new one as he can still claim to be on target.

Now in the press I gather that the NHS has realised that there might be issues with blood pressure readings in surgeries and hospitals due to White Coat Syndrome. This is something that has been known about ever since I first encountered the NHS in 1950 when I was doing the paperwork for my doctor uncle.

I gather from the financial press that pharmaceutical companies are recommended as safe bets for the future and economies are needed in the NHS.

The NHS - Cutting The Cost

Looking for anything but politics during the week there were two stories that left me startled and with that sinking feeling again about what should be very obvious. After all the clatter above protecting “front line services” one wonders who exactly is being protected. Is it the patients, doctors, nurses, and medical support or could it be other interests?

One story was about children with behaviour issues who were difficult to control and were both over active and apparently over stimulated. According to the report the drug Ritalin is now being prescribed by doctors to around 750,000 children. Not long ago when a psychologist I knew quite well was asked he assured me that the drug was not given unless a number of criteria had been met.

If there were boxes to be ticked ordered by those on high then that was enough. In the past I have had too many rows with the “mind men” not to be worried about what appears to be the mass medication of large numbers of children with apparently little real control or analysis.

The other one was that last year 36,000,000, yes million, prescriptions were written on the NHS for PPI drugs, Proton Pump Inhibitors that are designed to reduce long lasting gastric acid production. Patients are rarely tested so that those who have levels of gastric acid that are too low have them lowered further. If the problems arise from something else they may never know.

Moreover these drugs may have a formidable array of side effects on the principle of garbage in garbage out. The NHS requires its family doctors to worry little about medication side effects; after all there are large numbers of other drugs to deal with those. Reporting the side effects is therefore sketchy to nonexistent in most cases.

But the report and other information say that PPIs increase the risk of pneumonia, osteoporosis, broken bones, kidney problems and infection with C.difficile, the superbug that afflicts thousands of older hospital patients every year. While PPIs were effective in several conditions, there was evidence they are excessively used to treat indigestion when other prescription medicines costing half as much would work just as well, without such severe side-effects

Doctors have previously warned the NHS is spending £100million unnecessarily each year over-treating indigestion patients with PPIs around one-quarter of the total expenditure on the drugs. A report in the British Medical Journal found overuse of the drugs flouted NHS guidelines, because doctors were reaching for the 'top weapon in the armoury' to treat even mild cases of indigestion.

Dr Mitchell Katz, of the San Francisco Department of Public Health, writing in the journal Archives of Internal Medicine, said overuse of PPIs was a major problem. He said: “That proton pump inhibitors relieve dyspepsia is without question but at what cost and I do not mean financial.”

That people have problems in the digestive and related systems is all too evident. When watching satellite and other TV you see many advertisements. Some are for chemical products of one kind or another and for junk food. A lot are for stomach problems. As advertising is expensive the companies must make enough from selling a great many products to a great many people to make it pay.

This is confirmed when I visit a chemists shop and look at the long aisle of such products and see them also in supermarkets. On the aisles also there are vast amounts of manufactured and pre-prepared foods. If you look at the contents there is a huge array of “fillers”, stabilisers, colourings, texture effects, salts, sweetening agents and in particular both flavourings as such, largely synthetic, and flavour enhancers notably MSG.

Again looking into the trolleys at the checkouts there are few people without products including some or almost all of these. Compared to the food I had when young, not only at home, but also in various catering establishments the increased chemical load is astonishing. Is it surprising that numbers of people will have gastric and other reactions?

The way the NHS works at family doctor level is to be able to put an easy label onto a problem, usually a catch all word or phrase for the identifiable symptoms and then shove an approved prescription drug at the patient. In a few cases something else quite serious may be spotted but often all too late and worsened by both the delays and the previous treatment.

What the NHS does not do is look for causes and address itself to getting rid of them. The Coeliac Society suggests that there are many more people with gluten problems than are identified. Getting a test done for gluten reactions too often involves a major campaign. My own NHS Primary Care Trust refused to test for Anaphylaxis (extreme toxic or allergic shock) contracted in an NHS Hospital as a result of NHS treatment.

There are a range of intolerances and allergies, testing for which is almost absent from many NHS areas. Doctor’s in the UK don’t do “causes” only pill popping for the most part. So vast amounts of taxpayers money is going on medications without any attempt to inform or advise people or to establish what the cause might be and how the relevant problems might be avoided or substantially diminished.

Children who are people in the process of highly complex development that involves the natural body chemistry are being stuffed with stimulant junk and then when they get jumpy are stuffed with medications whose side effects are unpredictable, maybe nasty and can cause permanent damage.

Major pharmaceutical companies are “private sector” but in effect bailed out by the NHS. They are the Northern Rock‘s and RBS of the public health sector. Whilst on the face of it having some useful functions they do a great deal of collateral damage. A huge amount is funded by government science spending on treatments and medications, these “add value”. Little is spend on causes and effective control and attempting to deal with issues at source do not “add value” so cannot have funding.

This has been governing policy of government, science, and the management of the health service for a long while now. If we cannot afford the present health service in the future then the use of it as a market place and guaranteed outlet for medications made by powerful pharmaceutical companies ought to he the first thing to look at.

But I suspect it may well be the last.