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.
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 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.
Under the Care Act, 2014 Local Authorities have additional responsibilities this link provides a detailed list of their duties. In many London Boroughs they are not living up to these challenges:
- Promoting individual well-being. It’s not good enough to just hand out leaflets, it requires a proper campaign to address the well-being in all demographics. Cherry picking vulnerable and disabled people for example would discriminate against those that are trying to keep themselves fit and well. It’s as important to engage the self funding middle class as pensioners receiving pension credits. And it’s important to see their children as an constituency of interested people.
- Preventing needs for care and support. Prevention has to be done at scale, there is no point in having two people as the single point of contact in a Council. This approach will fail for even the most vulnerable groups. Typically there are 15-20,000 chronically lonely people in a London Borough. To address a problem of this scale, the solution has to the facilitation of self and community help. Councils cannot set themselves up as the one place to go for everything. They need to develop the social capital within their communities to tackle this problem within each Ward. In Ealing the Councils approach touches less then 1,000 of the 17,000 chronically lonely people in the Borough.
- Promoting integration of care and support with health services etc. The NHS cannot have it both ways, complaining about a shortage of funding and failing to engage with the social capital development in their communities. The NHS has over the last few years conducted a scorched earth policy around their services. Placing impossible contract requirements on Social Enterprises, often letting contracts to itself and failing to integrate its care services in a meaningful way with local community organisations. As as a result, there is little innovation in local health and care services.
- Providing information and advice. If you have looked at any council health and care information services, this link is for older people in Ealing, (you can make your own mind up how useful it is), most information is partial, out of date, broadly inaccurate and not designed with the user in mind. Information is not even curated for particular demographic groups. More often than not they are just a list of organisations and locations that mean nothing to local people. Contact number is really answered and access and disability services poorly described. So why do authorities see this as a useful way to spend resources, at best it’s likely to be a box ticking exercise to address the bare minimum of requirements.
- Promoting diversity and quality in the provision of services. The first step here is to allow online feedback on the services, few councils do this, and it’s very hard to understand the quality of a service. In Ealing you can complain but we have no idea what people have been complaining about, no one can judge the quality of the a service. Pretty much all industries have worked out the benefits of listening to their customers.
- Co-operating generally. Looking beyond local services and embracing the people that create and run them is a better way of thinking about how cooperation might work. Most Councils have no idea of who runs such 3rd services and does not provide any support services for them. The relationship is often transactional and based on erratic funding. Most of the effort of these hugely generous people is unacknowledged and certainly never engaged with. More often then not the Council is quick to criticise even the slightest failing in such people, and yet it ignores the rising complaint about its lack of local relevant services, blaming anyone but criticise itself for the issues.
Addresses these issues would not cost a great deal, probably no more than is being spent currently. Sadly not doing it means that peoples self-reliance is under-minded and they struggle to stay away from the local health and care services. We should all demand higher standards of the information provision and local coordination within communities this would go a long way to reducing costs and improving outcomes.
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 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.
- 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.