Sepsis – NHS England’s Plan A failed!

Did you notice the rise in cases in Sepsis reported by the NHS? You may know that NHS England has an action plan

Bottom line;  the NHS England plan has not worked.   So I guess we need Plan B.

Here are three things that NHS England could do now:

  • Create a Sepsis Registry – we would then know the extent of the problem. NHS England currently doesn’t have a succinct policy for Registries (perhaps they could get round to that).
  • Adopt the international standards of Sepsis treatment. Making sure the poor primary care practices are called out and addressed. (although you need a Registry to do that).
  • Refer every Sepsis death to a Coroner to investigate.

That should cut the number of entirely avoidable deaths.

 

Who pays for local journalism – we do?

You may have felt a little schadenfreude when you read the $Billion reduction in the value of Facebook. Not unlike the 2008 crash, this money has gone to money heaven, and will probably never reappear.

However, something else is also dying as the Facebook and Google scorched earth policy rips the heart out of the paid-for newspaper advertising revenue. It’s journalism, as the business model of newspapers comes under threat, the newsroom can no longer afford a full roster of journalists.

The effect is both National and Local, but the local impact is much more significant as there is no one else to scrutinise local political and public services.

In New Jersey, the state’s lawmakers will begin to  fund community journalism, and this will include for-profit as well as non-profit groups.

I sadly can’t see this coming to our communities anytime soon; who would be prepared to pay for such a subsidy? It’s a real dilemma, failure to scrutinise local political decision making will lead to poorer decisions. In turn, this will lead to a more significant waste of public money. Undoubtedly more than the cost of the subsidy in the first place.

I think there may be three practical steps we can all take:

  • Find our local news site; it may be a newspaper or a community group, sign up and join the discussion.
  • Attend local Council and Public service meetings and remember to ask a question, how they handle the response may tell you a great about how they feel about scrutiny.
  • Support national and regional newspapers through their subscription services, pay a little to benefit a great deal.

Full-time work – it’s over rated

Full-time work is overrated!  It’s also a recent thing.   It arrived with the industrial revolution, and it will leave hand in hand with one of the many trends weathering the way we work today.

Dan Rasmus looks at these trends in his book Listening to the Future published in 2007, he identified the trends as:

  • One World of business
  • Always on always connected
  • Transparent Organisations
  • Workforce Evolution

By looking back at a book written ten years ago, we can get a sense of its insight.   If you’re in the UK, it predicts and explains, the rise of Amazon, Brexit, the advertising domination of social media, WikiLeaks and millennials in the workforce.

But most of all it predicts the way work has changed from full-time jobs for life into a spectrum of work from the precarious to the fully employed.  The balance of that spectrum for many is heading towards low paid, zero time contracts that define poor job quality.   For a few, it’s the sunlit uplands of work anywhere when they want, and for significant reward.

The leadership challenge of the next ten years to manage the quality of that spectrum of work and make sure that work has an innate quality and provides a respectful and decent living for all.   And the one way to begin redressing the balance is to pay the National Living Wage.

 

 

Mobile Banking and the lack of online security.

I left Barclays Bank PLC after their appalling “Online security” screwed me over. I got my money back, others have been less lucky. I see Dr Ben Goldacre seems to be thrashing NatWest on Twitter for perhaps similar reasons.   My advice is to stay away from all Online Financial Services, they are just too insecure at present.

If you must could I suggest the following top 10 tips:

1. Have a separate Mobile and Number for all your Online Banking apps.
2. Only communicate with your bank using PGP encryption. (they hate it but will put up with it. (Proton Mail is good). Never send anything personal information in the clear to anyone.
3. Use a Monzo card or like for all debit card transactions. Top it up with your Current Account. It makes fraud easy to spot.
4. Use a credit agency (although mine Experian dumped my Creds into the dark web).
5. Use haveibeenpwnd.com
6. Don’t use your Mother’s maiden name as the answer to that question. Change your date of birth and don’t answer any of those “your first” questions with anything that is true.
7. Use complex passwords, all different and secure with a password manager like Dashlane or LastPass. (Don’t be mean pay for a good one ).
8. Turn off all the Google spyware on your mobile and computer, or better still use FireFox Quantum. And if you use Safari then you’re beyond help (not really but Really).
9. Use Kill Disk to rewrite your hard drives or better still never throw one away and if you must throw them away Kill them, then destroy the disc and then chuck it.
10. Do not rely on “Phone Reset” to remove information from your phone when you get a new one.

If you do most of this, I think you have a good chance of not being hacked, scammed, tricked or worked over. And if you think I’m paranoid you need to stay in more and have a look at what the internet knows about your promiscuous online behaviour.

Social Prescribing – what are the practical issues for NHS England

Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.  the KingsFund have a helpful article here
I am the Founder and CEO of BriteLives.  BriteLives is about providing activities and connections that help people avoid the NHS and its expensive statutory services. For us, it’s all about staying fit and well.  If someone does become unwell then, of course, they should go and see someone at their primary care practice.  But there are other options that the NHS could offer and signpost.
A comparison between current models of prescribing and treatment in primary care and how social prescribing might work shows some stark practical challenges.
Let’s take the example of someone feeling depressed, it’s common mental health issue that people feel increasingly able to acknowledge.   A doctor could prescribe antidepressants, (64.7 million were prescribed in 2016, 31million in 2006, that’s106% growth)  in fact, the Pharmaceutical companies profits are predicated on this behaviour.
It’s easy for the GP to do so, the workflow is found in the GP System, the Electronic Prescribing System,  the paperwork of the NHS and its Green Prescriptions forms, the Pharmacy systems and NHS payment systems.  All pretty much automatic and easy for the GP and patient to follow.
But, if the Doctor wanted to refer the patient to a BriteLives service; like a wellbeing course such as  http://www.britelives.com/listings/growing-wellbeing-6-week-course/ (this is a practical course that helps people address their depression without the recourse to drugs).   How might the Doctor go about that?
  • There is no listing of local services in the GP system.
  • No method of auto referral, it’s “not at the touch of a button”.
  • No reporting system telling the service provider someone is on the way
  • Not even a referral letter that can be printed or emailed
  • No Payment method for the service provider.
  • No system to make sure the final payment is only taken on the delivery of the service.
  • No Copayment system should the patient want to do more or add services
  • No way of innovating new ideas such as:
    • A reward split, GP pays £20 for service,
      • £1 goes to GP to encourage use of non-pharma
      • £15 goes to the provider for the service
      • £4 goes to the patient for completing the course (it can be seen as covering transport costs or the like if you don’t like the “bribe” aspect of this)
I believe that NHS England needs to become serious about centring social prescribing care around the individual and the local community. Developing an effective social prescribing policy and strategy would be a good start.  At present, there isn’t one and progress will be slow.