Please hold, caller…

Posted on September 30, 2015 by gaynah

NHS 111 is in the news again for all the wrong reasons.

Under-staffed, under-skilled, under-experienced, under-performing…all the old recognisable issues.

The report in the Daily Mail says that Ministers are demanding assurances there are enough staff for the service after reports that only one nurse was left to cover an area of 2.3 million people. The Royal College of Nursing warned that a “tragedy” could occur. According to the Sunday papers, tragedies are already occurring.

It is understandable that NHS managers want to protect the performance of the ambulance emergency services. We are all familiar with the business case for providing an alternative service for “urgent” cases, as opposed to the 999 service for “emergency” cases:

-reduce the emergency services time spent on non-emergency calls;

-reduce the response times for emergency calls; and

-make this critical emergency service more affordable.

But is it the concept of how the alternative is provided that is fundamentally flawed?

Would anyone chose a disembodied voice on the end of a telephone to advise at a critical moment in their existence, when at that moment the caller may well be stressed and fearful?

Perceived wisdom may say there is no truth in it, but there is a body of work* that indicates that any communication is made up of:
Body language 55%
Voice 38%
Words 7%

Based on this premise, the NHS 111 service can only ever communicate 45% of the whole, to callers whose anxiety levels are likely to affect their ability to make well-thought out decisions.

Add to this the “remoteness” of the operator (who are they?), which may well contribute to trust issues (are they unaccountable?) and the delays experienced (do they really care?) and you have a complete turmoil of emotions that is not helped by the telephone as a communications medium.

I don’t have any bright ideas for how else the service could be provided, but I’d be pleased to hear any suggestion you might have…

*Mehrabian, Albert, and Ferris, Susan R. “Inference of Attitudes from
 Nonverbal Communication in Two Channels,” Journal of Consulting Psychology,
 Vol. 31, No. 3, June 1967, pp. 248-258
 Mehrabian, A. (1971). Silent messages, Wadsworth, California: Belmont
 Mehrabian, A. (1972). Nonverbal communication. Aldine-Atherton, Illinois: Chicago

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Pharming the Health Sector

Posted on July 28, 2015 by gaynah

I’m always wary when I see the words “NHS” “drug companies” and “partnership” in the same sentence. Call me an old cynic, but conflict of interest springs to mind. We are purposeful beings and there is a purpose to everything we do no matter how remote or obscure it might seem to others. Just as there are always two sides to every argument, one man’s meat is another man’s poison, etc.…there are always two sides to the coin:

Safety education for medical staff v converting more sales;
Promoting correct drug usage v converting more sales;
Encouraging economic medicine management v converting more sales.

© Alexey Lisovoy | Dreamstime Stock Photos

The recent article by Margaret McCartney in the BMJ makes reference to medicine management programmes paid for by the drug industry, and of course such a well-researched piece caught my imagination.

Apparently, a 1995 parliamentary enquiry called for “greater restraint in medicines promotion, particularly soon after launch.”…which I must admit I read as “soon after lunch”…but then as I said I’m just cynical.

So, how have we arrived at the current position? I think it has to be because NHS staff value the services they are receiving from Pharma and Pharma are prepared to provide the services for the return on investment they are making. The basic business of supply and demand, then.

And what are the services that NHS staff value? It seems to me that medical staff are being provided with information based on data, often gathered from their own patient cohorts, which happens to indicate the need for increased/changed drug usage. The key here is that the data evidences the need and it is difficult to disconnect the statistics from the clinical decision-making process which is more subjective based as it is on skill and experience. It is hard for anyone to ignore information about a possible risk without worrying that that risk might occur and they would be “to blame”.

NHS Informatics groups already know what is prescribed, why, when, how long for and to whom. What is missing is the bit before and the bit after…the inputs and the outcomes, such as what did the patient present as their symptoms and when the course of treatment was over did they recover or is it on-going? There is much talk of the “Patient Journey” but in terms of information in the NHS we are a long way off joining the dots.

So, if the NHS was able to provide end-to-end informatics on drug usage e-prescribing solution could be developed and medics wouldn’t need to accept the drugs companies conclusions. Bearing in mind the complexity of all the factors that need to be considered these days when prescribing, it’s only a matter of time before this type of system becomes essential to protect the prescribers.

Perhaps Big Pharma could make an altruistic move and use the existing funding that they have already set aside for the creation of an independent NHS “drug squad” to review prescribing and ultimately to implement an e-prescribing system that works.

Care.data could have been the NHS’s ultimate repository of patient data, making a useful contribution to the institution that provides care free at the point of use. Could we re-task them?

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Change the Record

Posted on June 6, 2012 by gaynah

Earlier this week Health Secretary Andrew Lansley published the Department of Health’s long awaited Information Strategy whitepaper “The Power of Information”. It details plans to take all patient records online by 2015…but haven’t we heard all this before?

Back in 2002/3 the National Programme for IT (NPfIT) was born. It promised to do much the same thing, as part of the overall revolutionary plan for NHS interoperability. We all know what happened next – at the last count the Programme had spiralled to £12.4 billion and was officially ‘axed’ in September 2011 with us being years older and no wiser. I accept that we are a little closer than before to the goal of a standardised, electronic system for patient records across the NHS…but what needs to change to make Mr Lansley’s vision a reality this time around? Here are some pointers:

Break down barriers to change – the NHS Spine has been in existence for many years…it’s not the technology that’s holding us back but the attitudes. However, things are moving and nearly 15m Summary Care Records have been created. It is interesting to note that a patient’s ability to “opt out” was a huge sticking point…to date only 1.29% have chosen to do so.
Identify patients by one unique number – incredible as it may sound, a patient’s NHS Number is not always the primary identifier for an individual across all sections of the NHS. This needs to change so we move to a one patient, one record system. This is a key message from the Information Strategy.
Clean up ‘dirty’ data –in the last couple of months we’ve had news that 20,000 pregnant men and 95,000 ‘ghost patients’ remain on the NHS books. This needs sorting and much of this process can be automated. As an example, Quicksilva’s orQestra® system is helping our customers to verify NHS Numbers…in one case resulting in a 1.1% improvement in verified records in the first month…when you’re talking about 1.3m records, that’s getting us there.
Pharmacies need to be encouraged to provide electronic transmission of prescriptions using barcodes – the Electronic Prescriptions Service (EPS) shows promise, but is far from the universal standard. Greater take-up will improve the quality of the data online and remove the need for routine appointments, a significant overhead for GPs.

No one can pretend that any of this will be happening quickly. One of my main concerns is that there is no optional central guidance as to what solutions can be used to deliver on the Strategy. Mr Lansley has instead called on GP surgeries and hospitals to use “imaginative solutions”. It’s true that the top down approach of NPfIT did not work but I think more guidance is needed for those healthcare providers who cut their IT budgets leaving them with no-one to help them make important decisions which will affect their future in competition with the private sector.

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