nhs

Choose and Wait

A warning to Americans enamoured with Socialised Medicine.

You can ration by price, or you can ration by time. But you can’t have something for nothing.

 

  • Nearest Hospital: 400 yards
  • Approximate Wait Time: 71 – 91 days

Time to get my allergy to sunlight sorted out.

Don’t Panic! You don’t have Swine Flu…

…and in the unlikely event that you do it probably won’t cause you any lasting harm. Unless you’re already ill, very old or very young, in which case it still probably won’t kill you.

Furthermore seeing as it is July, you probably don’t have seasonal influenza, and in the unlikely event that you do it probably won’t cause you any lasting harm. Unless you’re already ill, very old or very young, in which case it still probably won’t kill you.

Via the Mail on Sunday:

Twenty million people will be vaccinated against swine flu by Christmas, with everyone receiving the jab by the middle of next year.

Experts are drawing up a priority list of patients to be given immunity before the bug becomes more virulent.

Those first in the queue are expected to be the elderly, infants under the age of five, people with asthma and diabetes, and those with compromised immune systems. NHS and social care workers would also get them first.

It would appear the vaccine they are proposing to jab everyone with is the experimental vaccine currently on the fast track to regulatory approval. The words “fast-track” and “vaccine” in the same sentence don’t fill me with confidence; I think I might wait for someone else to get their shot first.

Here are four reasons to worry less.

Reason #1 – You are more likely to die of something else:

Via the Health Protection Agency (NHS):

HPA receives weekly death registrations from the Office for National Statistics. In week 26/09, an estimated 8433 all-cause deaths were registered, which is a slight decrease compared to 8728 in week 25/09. It should be noted that these deaths are due to all causes and cannot be attributed to influenza. The weekly number is in the expected range for this time of year and no excess deaths have been observed.

Reason #2 – There isn’t that much Swine Flu about

Looking at previous years, here’s a graph derived from Routine influenza data from HPA and NHS laboratories, reported to CDSC on a weekly basis. England and Wales 1992-2007:

Influenza specimens detected in England & Wales from 1992-07 (all strains)

These are years where the World Health Organisation wasn’t declaring a pandemic. (Average 1,949 influenza cases detected per year).

Given the whole pandemic announcement, the press coverage and the people ringing up the Doctors (and NHS Direct) for every cough and sniffle, more samples are being tested so it isn’t too surprising to see a big jump this year. Total UK confirmed (swine) influenza cases are currently 9,718. But:

The overall daily GP ILI consultation rate […] was 9.8 per 100,000 which is equivalent to estimated weekly rates expected when ‘normal seasonal influenza’ is circulating during the winter months.

The total number of influenza detections (community and hospital) characterised by RVU by week 08-09

An interesting comment from medical call centre NHS Direct:

NHS Direct has an existing algorithm for ‘cold/flu’ calls, [and] in response to the current situation, a new algorithm to handle ‘swine flu’ calls was introduced. When both indices are added together, they show that the ‘estimated total’ proportion of cold/flu calls to NHS Direct peaked and decreased very quickly soon after the outbreak was declared in late April. The estimated total proportion of cold/flu calls has increased rapidly again since June.

Unsurprisingly lots of newspaper stories produces lots of calls to NHS Direct and visits to the GP. From a Welsh report:

During week 27, the percentage of total calls to NHS Direct Wales which were influenza related increased to 20.6% from 18.9% in week 26. […] Flu related calls are the sum of calls recorded as 'cold/flu', 'cough', 'headache', 'fever' and 'sore throat'.

Remember that if you hear people talking about huge numbers of calls to NHS Direct. Anything involving a cough, headache, fever or sore throat gets marked down as a flu-related call.

Reason #3 – Swine Flu seems to respond to existing anti-viral drugs:

Again, from the HPA:

Seventeen of the Influenza A (H1N1v) isolates have been fully tested for susceptibility at Respiratory Virus Unit, Centre for Infections, Colindale (RVU); all 17 were found to be sensitive to oseltamivir and zanamivir and resistant to amantadine. One hundred and ninety-nine positive specimens have been analysed for the marker commonly associated with resistance to oseltamivir in seasonal influenza (H274Y), all were found not to carry this marker

(Although if you’re not very old, very young or otherwise ill then taking an anti-viral drug seems a bit excessive)

You probably know oseltamivir under its non-generic brand name Tamiflu.

Reason #4 – Politicians always talk up a crisis that isn’t their fault

Via Reuters:

Britain's Health Minister Andy Burnham said last week the government was projecting more than 100,000 new cases a day of the flu by the end of August.

There would need to be a massive rise in infection rates to get to that sort of figure. According to the World Health Organisation, there aren’t even 100.000 cases worldwide yet. (as of 6th July: 94,512 cases, 429 deaths)

Here’s a graph from the HPA’s Weekly pandemic flu update (9 July 2009):

Satellite

The UK has had about 10,000 cases in the last three months. Getting up to 100,000 new cases every day in the next six weeks seems improbable, even if people do pick it up on their summer holidays.

Certainly, rates will go up. Here’s a week-by-week count of Influenza specimen detection in UK laboratories in 2003-2007.

Influenza specimens detected in England & Wales from 2003-07 (by week)

Notice the peak around the New Year, every year. The non-swine flu variants are called “seasonal flu” for a reason.

Related Links:

NHS National Programme for IT - Gateway Reviews

Via Computer Weekly (Tony Collins).

The National Health Service  Programme for IT has released some of its Gateway reviews in response to a Freedom of Information request.

The Office of Government Commerce (OGC) Gateway process is a mechanism by which – in theory – major IT/Change programmes in the UK public sector are governed; providing the owner (senior responsible officer) of the project with the proof that the programme’s management team are following a standard procedure and justifying the release of money to fund the next phase of programme activities.

31 Gateway Reviews are available, with quite a bit of redaction in places.

With some of the reports, it is possible to compare the views of the project team to public statements from customers and users. For example, here’s an excerpt from the 3rd August 2005 “Gateway Review 4” for the Choose and Book system:

There is widespread support for the Choose and Book concept. In addition to improving the patients’ experience and care it is seen as a key enabler of a wider system reform process across the NHS. Many GPs however have still to be convinced that it will work in practice. [..]

The December 2006 target of 90% deployment of a fully integrated Choose and Book system is still achievable providing current deployment issues are quickly resolved.

Here’s an article from BBC Health dated 30 May 2006:

Half of the GPs said the "choose and book" online booking system was poor or fairly poor. The poll was completed by 447 hospital doctors and 340 GPs. […]

Four out of five GPs [surveyed] had access to the computer system, but half said they rarely or never use it.

And finally here’s a Silicon News article from January 2009:

According to research by the British Medical Association (BMA), GPs reported the Choose and Book still has issues with reliability and slowness. [..]

One practice said it took up to 30 minutes to reboot their systems when Choose and Book crashed, while another said the system crashed for 50 per cent of referrals.

Consultants using Choose and Book to review appointments also said they were struggling with its slowness.

Ultimately the buck stops with the SRO (name redacted) but responsibility for a major public sector programmes is inevitably a poisoned chalice. Even the review team remarked:

During our visits and interviews we encountered no one who did not support the underlying concepts, although it is clear there is little pull for the new system from GPs themselves at present.

When you customer is not the user, and the specifications are changing regularly, then the result is pretty much guaranteed to be a failure of budgetary control or failure to reach the final scope. Consider the following  paragraph from the review:

Choice was brought into the project after contracts had been signed and has had a significant knock on effect on delivery plans for CAB [Choose and Book]. As implementation of the fully integrated IT system has been delayed the need to deliver Choice by end 2005 has resulted in the requirement for the Indirect Booking Service (IBS). Choice continues to provide the imperative despite somewhat ambiguous messages about the urgency – for example, the lack of clarity over the Choose and Book December 2005 milestone and the PSA [Public Service Agreement] target.

Scary. Originally Choose and Book was intended to be an online booking system to formalise the process by which a GP would refer a patient to a Hospital-based specialist. But half way through, the word came down from Whitehall that the system should also be a means to allow patients to choose their specialist. Quite a change of scope, even assuming GPs actually wanted the original service.

Syndicate content