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Patsy talks more bollocks December 7, 2006

Posted by MadRad in NHS & Politics.

The A&E Unit of the Future

Ms Hewitt said that casualty services in future would divide into three kinds, with “super- A&Es” for people with the most serious conditions, local A&Es for most treatment and the A&E that “will come to you” for less serious injuries.

(From The Times, Wed 6th December weblink here)

I’m sorry, I’m not going to beat around the bush about this one. What the fuck is she talking about?

So, if I get this right

Major injuries will go to trauma centres. No problems there.

Local A&Es for most treatments – er, like we’ve got already. But just a few more of them, but not to save money of course.

It’s the third category that’s the clincher however. Lets say it again for its full effect

“The A&E that “will come to you” for less serious injuries”.

No matter how much I look at it, it still sounds ridiculous.

We are closing local A&E to save money to redistibute the funding to massive trauma centres of excellence but, meanwhile we will have staff going to the most minor of injuries?The malingerers, who can’t get off their arses to come into casualty until the footy has finished, will now get a door to door service, a bit like pizza delivery, so they can be seen at their convenience, and not miss too much of the game.

And how will we run this service? Who will ‘come to us’ Patricia?

Will it be paramedics? Oh no, they will be on the road to the new super A&E as “Long ambulance journeys do not lead to more deaths.” ( Sir George Alberti) [1]

Will it be GPs? Will you try to bully them into it? I see Lord Warner may have started the campaign already. They want out of hours cover back.

Will it be some of the staff you are in the process of sacking because of your monumental fuck ups?

Will it become another pressure placed on current staff?

Are we going to see A&E on-the-road caravans?

So please Patricia. Don’t leave me in suspense. Tell me what you mean. Show me your vision of the A&E of the future. Tell me how I’ll take their x-rays when I go to them.

 +++++     +++++     +++++     +++++


[1] So why bother with air ambulances then?



Say that again? December 4, 2006

Posted by MadRad in IT.
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Metal Mickey

There has been some discussion recently on Dr Crippin’s blog regarding voice recognition and the particulartly the accuracy of radiology systems.
I thought I’d take this opportunity to let you see some real world examples.
The following items are all live reports from our RIS along with the corrected version.

“There is a calcifcation and three in the right breast.
Report: No dlatation view was confirmed presence of calcification was do not have adequate diameter with a year time shown. The right. The follow-up times six -1 years time or consider the centimetre seen. The end of the right.”

“Indication: Mocrocalcification R3 in the right breast.
Report: Magnification views confirm the presence of the calcifications but do not add a great deal to the evaluation. We could either follow-up in six months or one years time or consider stereotactic biopsy now.”

“There is cells: The patient was of a questionable area in the right breast.
Report: left shoulder was shown to indicate the presence of a focal mass or gross tissue distortion or any other features. I think the four the appearances probably due to composite shadowing. The calcification to the”

“Indication: Compression views of a questionable area in the right breast.
Report: The compression views are reassuring and do not indicate the presence of a focal mass or localised tissue distortion or any other worrying features. I think therefore the appearances are probably due to composite shadowing (Reclassification R2)”

“Clinical indication: Line with the fall. Pain in right hip.
Report there is a left T8 chang ascites. No bony injury seen.”

“Indication: Unwitnessed fall. Pain in right hip.
Report: There is a left THR in situ. No bony injury seen.”

“Report: No bony injury seen to skin fold. The radial metastasis or sclerotic although there is a fracture has been identified in this region. Follow-up film in seconds 10 days would be useful if the patient has ongoing symptoms.”

“Report: No bony injury seen to the scaphoid. The radial metaphysis is a little sclerotic although no definite fracture has been identified in this region. Follow-up films in 7-10 days would be useful if the patient has ongoing symptoms.”

“For details for the injury to the persistent sweeling and cellulitis and right knee is a moderate effusion. The venous cruciate ligament collateral ligaments are normal. No abnormality of the articular surfaces are sub-articular dense any abnormalities of the soft tissues to indicate inflammatory changes around the body and there is no evidence of thickening. Cause of the joint effusion is clear scan no other shown.”

“Indication: Blackthorn injury to knee. Persistent swelling and cellulitis.
Report: MRI Right Knee: There is a moderate effusion in the joint. The mensci and cruciate ligament are normal. Patella ligament is normal. Collateral ligaments are normal. There is no obnormality of the articular surfaces or subarticular bone. I don’t see any abnormalities of the soft tissues to indicate inflammatory changes around foreign body and there is no evidence of synovial thickening or synovitis. The cause of the joint effusion is therefore unclear from the scan as no abnormality has been show.”

“For details of rectal tumour MRI pelvis there is a radial head from the right hip replacement but this does not the perirectal tissues. Scans show approximately 12cm above the dentate line in the neoplasm extends at least extent is most wall of the. On the axial images there is a presacral lymph node in the 1 o’clock position of the rectum. There is no measure 13ml in diameter and has a transverse internal texture. The is in contact with the 7-French or section margin. Thee is further smaller perirectal at the 7 o’clock position and 10 o’clock position also having intravenous internal texture and probably represents a focal lung metasteses. The para-sagittal images of O group of along the inferior recent Eric vessels between the aortic bifurcation. The largest tear measures 16ml and again slightly projects texture around the likely to represent metastases. The primary tumour itself extends through the muscularis into the surrounding area rectal fat indicating invasion is seen on scan is nine 779 the invasion is in the lateral position there is no patient to the peritoneum at this level. Assess for his AST 3 and one tumour.”

“Intication: Rectal tumour
Report: MRI Pelvis: There is a great deal of artefact from a right hip replacement but this does not seriously affect the perirectal tissues. Sagittal scans show an upper rectal neoplasm approximately 12cm above the dentate line and the neoplasm extends at least 6cm and is almost all above the peritoneal infection. On the axial images there is a presacral lymph node in the 1 o’clock position relative to the rectum. This node measures 13mm in diameter and has a hetrogeneous internal texture. It is in contact with the circumferential resection margin. There are further smaller perirectal nodes at the 7 o’clock position and 10 o’clock position also having heterogeneous internal texture and probably represent local lymph node metastases. The sagittal images also show a group of nodes along the inferior mesenteric vessels between the aortic bifurcation. The largest node here measures 16mm and again has a slightly heterogeneous texture and a rounded outline likely to represent a metastasis. The primary tumour itself extends through the muscularis into the surrounding perirectal fat indicating vascular invasion here and this is seen on scans 7 to 99 but the invasion is in the lateral position so there is no invasion into the the peritoneum at this level. This therefore is a T3, N1 tumour.”

Corecting some of these took longer than it would have taken to type it it the first place. Unfortunately the corrections are part of the learning process so highlighting the lost and typing it from scratch isn’t an option.
The system is getting better but sometimes ‘Metal Mickey’ has off days or funny five minutes – five perfectly readable reports are followed by one of total garbage.
The worrying thing is that in at least two of the above the meaning implied in the machine transcribed report is the exact opposite. “left shoulder was shown to indicate the presence of a focal mass or gross tissue distortion” became “The compression views are reassuring and do not indicate the presence of a focal mass or localised tissue distortion”. “Cause of the joint effusion is clear” became “The cause of the joint effusion is therefore unclear”.
Thats before we get to confusion between hypo- and hyper- and the odd ‘no’ getting missed (as in “no evidence of…”).

Something to think about.

More depressing reading December 2, 2006

Posted by MadRad in NHS & Politics.
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I’ve spent a little while perusing the latest “Public Expenditure on Health and Personal Social Services 2006 Memorandum received from the Department of Health containing Replies to a Written Questionnaire from the Committee“.
Some of it makes very interesting reading.

Some little nuggests contained within its 294 pages include the fact that   NHS infrastructure support has increased staff from 170,623 to 220,387 between 1997 & 2005. However of this total there has been an increase in managers and senior managers from 22,173 to 39,391 – a 77.65% increase. Compares this to the mid 20’s percentage increase for nursing staff and radiographers (All figures are for headcount not FTEs)

There are now more managers than GPs (39,391 vs 35,302,2005 figures)

The Government admitted to underestimating the cost of Agenda for Change. In the first 12 months this amounted to £220 million made up of £120 million in case terms with another £100 million for the indirect costs of replacing additional hours and annual leave arising from AfC.

From 05-06 to 08-09 the yearly costs of implementing Agenda for Change are £950M, £1,390M, £1,780M & £2,200 M respectively.

It confirms they blew another £90 million undersetimating the cost of the new GP contracts.

PFI expenditure, both the cost of running existing PFIs and the cost of abandonning plans is even too depressing to comtemplate.

They spent £133 million on Patsy’s friends the management consultants in 05-06 alone. To put this into context the projected  net deficite which has us all shitting our pants is only £94 million

Turn-around teams in underperforming Trusts have, so far, cost £21.1 million. However we don’t need to worry about that (yet)

Before we can say whether this has been money well spent, we need to know what has been released in terms of savings. If it has delivered more than £22.1m it will have been money well spent; if it has only delivered £5m it may have been a waste.

(Dr Gill Morgan, NHS Confederation chief executive).

Lets face it. They’ve fucked up. Big time.
We know it. They know it.

Busy times November 30, 2006

Posted by MadRad in General.
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Hmm…Its all gone quiet in Madland (if anyone out there has even noticed!).

Two reasons for this. Firstly rather embarassingly I fell over last week, my fall being broken by my mobile phone, which now has a dirty great crack on the screen. So my favoured input device (here) is with the phone doctor at the moment and is hence unavailable for use at the moment.
The time without fully functioning phone was further exacerbated by mobile phone insurance company insisting the phone was 3G enabled and therefore the excess was twice as much. In the end I had to resort to

  • emailing the company who sold me the phone (and the insurance) to let me know how to access 3G
  • emailing Nokia to confirm the phone was not 3G
  • emailing 3 to enquire whether I could connect to the 3 network with the phone [1]
  • Googling reviews and tech spec on the phone which stated the phone was 2.5G and lack of 3G was it’s week point then forwarding it to the insurers.

The situation was finally resolved but it added an extra week onto the process.
To be honest it was getting more difficult anyway as the dark nights draw in. Is was only a matter of time before I walked into an old lady or slipped on dog turd.
The other reason is more of a worry. Out department IT manager has given in his notice. They do not anticipate appointing someone into the same role. A decission has been made to move his hardware/back-up functions to the hospital IT department and, for the short term (where have I heard that before), create a team from others who have knowledge of the various discrete IT systems within the department to look after it while long term plans are decided. (The whole department is undergoing a ‘help we’re overspent’ workforce review [2]).
So this team will look after things in the meantime. But they need someone nominally in charge. Guess who’s the only band seven in the team.
So I have been tasked with obtaining all the info I can in five weeks from someone known for being forthcoming. Someone who’s been doing the job for five years.
…And I’ve got to keep on at my day job.
…And the boss would like me to update our intranet site and produce marketing leaflets for the GP.

[1] Interestingly 1 week later and I have still heard nothing from 3. Good job it wasn’t a real problem! 

[2] ie can we downgrade/sack/put out to pasture/not replace anyone.

Saving it all up November 23, 2006

Posted by MadRad in General, IT, NHS & Politics.
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So many snippets of information over the last few days; so little time to do something with it.

First up
We’ve got the bastards worried [1].

What is the big breakthrough, in terms of politics, on the web in the last few years? It’s basically blogs which are, generally speaking, hostile and, generally speaking, basically see their job as every day exposing how venal, stupid, mendacious politicians are.

(Matthew Taylor, Tony Blair’s outgoing chief strategy adviser).

..and the problem with that is?

This leads nicely to another episode of NHS doubletalk.

The No Delays Team is supporting NHS staff to provide a healthcare system in which no patient waits unnecessarily for any service. Delays will only occur where patients choose to wait for their treatment or where a medical reason for waiting would produce the best outcome.

(NHS Institute for Innovation & Improvement)

Full article here

Meanwhile to save money our PCT has told us to delay the treatment of their patients and aim for 5 months turnaround.

If nothing else this seems pretty mendacious and stupid (and as for venal we only have to go to the Alan Milburn posting).

Now moving swiftly on to the announcement [2] that

The Department of Health is expected to publish a code of practice allowing hospitals to market their services under the era of choice.

(HSJ, 20/11/06)

The other day I made this statement .

I’d like to add to this by saying “I think every penny spent by an NHS institution an advertising solely for the purpose of luring patients away from another NHS institution is morally wrong.”

If competition was intended to improve the NHS this is a strange way to go about things.
We are being advised how to spend tax-payers money advertising our services to avoid these service being taken over by the private sector. We are spending tax-payers money to attract patients from one tax-pyaer funded hospital to another tax-payer funded hospital.

NHS hospitals will have no option but to invest in marketing tactics, such as advertising, if they are to survive against private firms who will already have large marketing budgets and considerable expertise in selling themselves.

It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care and compulsory redundancies in order to save money.

(Dr Jonathan Fielden, chair BMA’s consultants’ committee)

Voters are overwhelmingly againt this. According to a survey conducted by YouGov for the NHS Together alliance of health unions in a poll of more than 2,000. Thirty nine per cent strongly disagreed and thirty four per cent disagreed with the proposition that ‘I want to see competition in the NHS with doctors and hospitals competing for my custom, such as spending and advertising’. (HSJ, 20/11/06)

+++++ +++++ +++++ +++++ +++++

Radio 4 was entertaining this morning with Patsy wriggling like a fish dodging answering questions on single sex wards and spouting the usual diatribe about how well they’re doing. My daughter couldn’t understand my growing irritation with the woman. I don’t suppose me shouting “Just answer the bloody question” at the radio is the sort of behaviour I should be subjecting her to at that time in the morning.

The Huwitt woman, like a wild animal in a cage, tore off in any direction except an answer to the question. John Humphry’s patience was only equalled by her determination to equivocate.

(akaProfessor from Today Program message board)

+++++ +++++ +++++ +++++ +++++

And finally after my previous posts regarding ‘Lorenzo’ I find an article in the HSJ form 02/11/06 telling me that “CSC used iSoft’s existing iPM software in it’s implementations and will upgrade to Lorenzo later”.
Great. So we experienced all these problems with an existing system. Heaven knows what new bugs will come to the surface when Lorenzo does arrive.

+++++ +++++ +++++ +++++ +++++

[1] Well big fish like Dr Crippin, Wat Tyler, Guido & the Devil – not little fish like me.

[2] I know this is a couple of days old now, but I just had to say something and this is the first chance I got.

Time to go November 22, 2006

Posted by MadRad in NHS & Politics.
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Health secretary Patricia Hewitt has hinted that she may resign if the NHS does not break even by the end of this financial year.

(HSJ, 22/11/06)

Maybe we could all help her on the way.

Anyone know how I can charge a new Aircraft Carrier to the department budget?

Secret London base shock November 18, 2006

Posted by MadRad in General.
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Secret Base

Secret base under construction

We’re spending a long weekend with the kids revisiting the bright lights on London (tied in with an appointment for them at one of the specialist hospitals so it’s not truancy OK?).
We found a reasonable deal on the ‘net for North London Days Hotel [1]. Arrived last night, checked in as normal. Noticed nothing out of the ordinary.
Went out to the car this morning to get the old A to Z and noticed the hotel car park is absolutely heaving with British Gas vans.
I’m sure there is some innocent explanation but, as we are in the middle of Daniel Craig/new James Bond fever at the moment, I can’t help imagining the Days Inn is just a front and there is a massive secret [2] base underneath it preparing the way for the British Gas-British Government military industrial complex to make a move on democracy. Just hope we’ve checked out before the grand finale when the whole thing blows up while JB makes a break for it with the tenuously named girl.

[1] Formerly London Gateway Days Inn at London Gateway service, which I still know as Scratchwood services.

[2] Well OK not that secret with all the vans outside.

Scanners November 15, 2006

Posted by MadRad in NHS & Politics, Waiting Times.
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Am I just being naïve in saying that every penny given to shareholders is a penny less spent on healthcare?

A while ago I made this comment in reply to a posting on Dr Crippin’s blog I don’t think I made myself clear at the time and I’d like to take this opportunity to do so. Firstly I was referring to NHS money going to shareholders not payments from insurance companies or self-paying patients. I have nothing against private patients, in many cases I can see why they do it. I do object however to private patients expecting to jump queues in NHS hospitals [1], but that is a different story.
A few years ago the Government supplied quite a number of DGHs with MRI scanners. Many scanners don’t run to capacity. Those that do mainly do so during normal working hours – nine to five, Monday to Friday. This is predominantly due to staffing levels, either radiographers to run the scanners or radiologists to supervise and report the scans. MRI is only one example. Other modalities such as nuclear medicine and CT scanning are in a similar position. These are not insignificant pieces of kit. Any one of these cost between quarter and half a million quid to buy and install, maybe even more if it’s particularly flash. Furthermore they have an accepted life cycle of seven to ten years (Royal College of Radiologists’ figures). After this the technology is superceded, spares are difficult to obtain; they become obsolete.
With all this cyclic capital investment it makes sense to invest in staff numbers to maximise the use of this equipment. It would not be unreasonable to run a scanner 8am to 10pm Monday to Saturday and at least some time on Sundays. Wasn’t it Ian McGreggor who said he paid interest on the loan used to buy the equipment 7 days a week 24 hours a day and should use it by the same principle?
Do we do that?
No! We agree to give 20% of our scans to the independent sector. We pay the likes of Alliance medical [2] more than we would pay an NHS hospital to perform scans for us. We allow them to cherry-pick the easy case leaving the NHS the difficult & costly to perform scans (this means a 25% reduction in the number of patients waiting realistically means only 10% in the time patients can wait). We have a financial crisis. We panic. We freeze posts. We lay off qualified staff further reducing our capacity to perform scans or to react to an increase in demand (if a post is subsequently ‘unfrozen’ you are looking at six months before it is filled[3])

It is this money I begrudge going into the pockets of shareholders.

One hospital with problems… is treating patients with a mobile scanner while its own machine is often switched off. It should run for 10 sessions a week but the trust can only afford six.



[1] I have lost count of the times I have been asked “Can I have it done quicker if I go private?”. The answer is ‘No’. It will always be ‘No’. I do not have the luxury of keeping empty slots for a PP just in case one comes along. I book cases by clinical urgency. Most scans have a 2 week wait anyway.
[2] You will note I refer to Alliance as an example. There are, of course, other companies such as Lodestone, fulfilling similar roles or aiming to do so in future contracts. I am however particularly worried about Alliance. That’s another story. Please refer to the posting entitled ‘Unholy alliance‘ for further details.
[3] Including advertising. shortlisting and interviews. CRB checks are currently taking two months or so and no one in their right mind would give notice until all checks are through. AfC requires 2 months notice.

Unholy alliance November 15, 2006

Posted by MadRad in NHS & Politics.

 The following is nothing new but it sheds some light on comments I make elsewhere on this site. It’s a story about Alan Milburn (remember him?) and Alliance Medical.
Back in 2004 Mr Milburn resigned as  Secretary of State for Health “to spend more time with his family”. During this time he took on a £30,000 a year consultancy with the venture capital firm Bridgepoint Capital Ltd, part owners of Alliance Medical Ltd.

When he took up the job with Bridgepoint in March 2004 he was told by the advisory committee on business appointments  he could begin the job “forthwith but for one year after leaving office he could not be personally involved in lobbying any government ministers or officials”. As he left the DoH in June 2003 he was free to lobby from June 2004. On 29 June, Health Minister John Hutton announced that Alliance Medical had been awarded a £95 million five-year contract to provide and operate 12 mobile MRI scanners for the NHS carrying out 120,000 scans.
At the time the Allliance Medical contract was announced, Professor Adrian Dixon from the Royal College of Radiologists cautioned: “There are a lot of MRI systems in hospitals which have just been put in by the government which are not running to full capacity. We hope [the deal] will not interfere with proper funding of these machines.”

This deal broke a promise made by Labour in 1997.

“After the 1997 election Labour said its privatisation programme would only embrace ‘non-clinical’ parts of the NHS. The DTC scheme ends this promise…. I recall sitting in a fringe meeting at the 2000 Labour Conference, at which an angry radiographer asked Alan Milburn why scanning services, although clearly ‘clinical’, were being privatised. The former health secretary did not answer.”

(Solomon Hughes, Red Pepper magazine)

The contract itself was controversial. John Hutton told the House of Commons “Standard Government procurement processes were followed in which advertisements were placed and companies were invited to send in expressions of interest. Following a robust negotiation process, Alliance Medical was selected as the company that offered value for money and capacity to deliver services.”
However, using the Freedom of Information Act it was later found that “the original idea for the MRI scan contract had come not from the government but Alliance itself. The only difference between the deal that Alliance finally secured and what it had at first proposed is that the company had also wanted to provide endoscopies, and ultrasound and PET/CT scans.” (Solomon Hughes, Red Pepper magazine).

Unicorn (http://www.againstcorruption.org/BriefingsItem.asp?id=12433)
Source Watch (http://www.sourcewatch.org/index.php?title=Alan_Milburn)

Pariah on wheels November 11, 2006

Posted by MadRad in General.
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I have a confession. We have a Land Rover Discovery. It has seven seats, two of which fold away in the back. Ideal for when the grandparents visit.Ideal for delivering my children’s friends home after a visit. We live in the middle of nowhere. Their friends live in the middle of nowhere.Widely dispersed.
In my wife’s last job she had to travel around the county down dirt tracks to Nowheresville. A Nissan Micra wasn’t an option.To cap it all, just after we moved to the area, we were hit by horrendous flooding that cut off the North half of the county from the Southern bit.
Now everything has changed. My wife’s job is more office based, we have not experienced any more monsoons, road tax has gone up and we’re pissing through diesel like its water. And then there’s the green issue.
What to do?
I get annoyed when I hear witterings about taxing ‘gas guzzling’ cars for two reasons. Firstly because we are not American and therefore do not use ‘gas’. If we have to resort to clichés can we at least use one of our own (and, being an abbreviation for gasoline, gas is not appropriate for oil burners anyway). Mainly however my annoyance is based on the fact that I am already paying tax on gas guzzling by guzzling gas.
So I get rid of the car. What do I do?
Do I sell it and buy something more economical and eco friendly? But isn’t whoever buys it going to drive it and therefore create the same environmental damage I would have?
Maybe I should scrap it? Even if I could afford to lose more than ten grand how many years of driving is it going to take to produce the same amount of CO2 that will be used to dispose of it and to produce the new I would replace it with? (I think I’ve established the fact that public transport is rubbish where I live).
Surely if the Government wants us to stop using such vehicles (and we’ll forget issues like personal freedom and consumer choice for a moment) the only way to do it is to prevent further vehicles entering the system. Penalise new sales. Create incentives not to buy them more. Anything else would be nothing more than passing our guilt onto the next person.

More taxes aren’t going to stop this cycle. The revenue raised doesn’t allieviate the situation. It pays for expensive mistakes like Iraq. I know it. You know it. They’re not fooling anyone.
 Maybe the Goverment could encourage us by starting a car exchange program. We give them our 4X4s, SUVs and executive saloons; they give us approved vehicles in return.
…Oh and they could give up their Jags and BMWs too. There’s only one of them and their driver. What’s wrong with using a Smart?
[1] Or the one further up the chain of cars that rolled off the production line to supply my replacement?