On the 25th March – approximately a lifetime ago in internet terms – the GMC published guidelines for doctors’ use of social media. The guidelines come into effect later this month.

Publication of the guidelines caused something of a social media uproar, particularly around the anonymity clause. The brilliant Anne Marie Cunningham, who has written and spoken a lot about social media in medicine, has hosted a particularly fascinating conversation about this on her blog, with well made points on both sides.

With all the high-quality discussion and carefully thought-through points flying back and forth, I’ve taken a back seat on this one. I’m not sure that I have all that much that’s new to add, and I don’t blog all that much about medical matters any more. But a nagging feeling in the back of my head says that this is exactly the sort of debate I would once have jumped into with both feet, and the focus hasn’t been on the part of the guidelines to which I most object. So here goes.

In all guidelines, I’ve always been lead to believe that definitions are crucial. For a guideline to be effective, let alone for it to be enforced, it must be clear what it covers. And yet, the GMC’s definition of social media is absurdly wide:

Social media describes web-based applications that allow people to create and exchange content.

Later in the guidelines, it is clarified that this definition includes non-public, professional social networks too. As I’ve discussed this issue with tech friends and colleagues over the last couple of weeks, this definition has caused several to – literally – laugh out loud.

It, of course, includes all manner of things that are not social media, and essentially describes any form of cloud-based application. If we interpret this guidance as written, then from 22nd April patient-identifiable information can no longer be uploaded to web-based GP note systems, or to HPZone used by Public Health England to track outbreaks, or indeed transferred via NHSMail, the restricted-level security email system designed exactly for that purpose. Use of Choose and Book will be against the GMC’s rules. All of these are online applications which allow people to create and share content. All are clearly not supposed to be covered by this guidance.

It can be argued that even if the definition as written is unclear, it is perfectly clear to most people what it is supposed to refer to. I don’t buy that, for two reasons. Firstly, what’s the point in publishing the guidance at all if we aren’t to interpret it as written? Some might say that the definition has to be broad in a fast-moving environment, and that the guidance would quickly be outdated if it were too pinned down.

Which brings me to my second problem: you may understand it, but I don’t. I actually don’t know whether this guidance applies in edge cases. Office 365 and Google Drive are both web-based applications which allow the creation and exchange of content. Applications like these are almost certain to replace locally hosted applications like the Word and Excel of today within this decade. Indeed, some organisations have already made the switch.

Is use of these outlawed by the guidance? I can see arguments why it, perhaps, should be. There are inherent risks about patient confidentiality in these systems. But to ban their use for patient identifiable information is a big statement, and I suspect that they didn’t actually mean it. But I’m far from certain.

To me, the nub of the problem here is that this is guidance on using a particular medium – and one that is ill-defined, at that. Publication might feel relevant now, and everyone from the BMA to the RCGP is helping people to understand how to use this medium safely. But I don’t think this is the place of a regulator. I’m acutely aware that others will strongly disagree with this position.

By and large, I think the GMC should stick to outlining principles. I no more expect to see supplementary guidelines on social media use than I would on letter writing or telephone conversations. Although, if – like many hospitals – you’re using a VOIP system, it could be argued that these guidelines apply. Just like the GMC does with those two media, I think case studies would have been a better way to illustrate the application of principles, rather than a list of inflexible “rules”. I don’t think it’s sensible or advisable to try and give over-arching “explanatory guidance” about an area of life which is changing so rapidly.

After all, these are only supposed to be explanatory. They are not intended to introduce new regulation. Though, to my reading, their poor formulation does lead to new regulatory burdens being placed on doctors.

When the last Good Medical Practice was published, Twitter had barely been conceived, and Facebook had yet to open to the general public. These guidelines aren’t clear now, so goodness knows what we’ll think of them in seven years’ time. I think they should be withdrawn.

A little over twelve months ago, I was asked on a discussion forum to make predictions about the retail sector in 2012. I’d forgotten all about this until today, when somebody pointed out my prescience!

On 30th December 2011, I posted the following (forgive the reformatting!):

M&S is going to have a bad year: They seem to be doing everything humanly possible to disassemble the formula that brought them back from the brink a few years ago. On the other hand, WHSmith’s profits are up, even if their sales are down – I reckon they can ride out the storm for a while. My predictions for chains that will collapse are JJB (frankly surprised they’re still around); Past Times (feels like it’s had its day, so to speak); and Mothercare / ELC (already pulling out of town centres, doesn’t bode well).

And, indeed, M&S had a bad year, WHSmith did reasonably well, Past Times closed, JJB closed, and Mothercare is on the brink.

You might think I’d feel proud of my amazing predictive abilities, but in fact, I feel mainly freaked out – especially since my history with predictions isn’t great. It’s also weird to think that I correctly predicted thousands of job losses – it gives me a creepy sort of guilt, as though I’m somehow responsible.

So given the discomfort I’ve inadvertently caused myself, the only prediction I’ll make for this year is that the economy will fully recover with no more companies folding, and unemployment will hit record low levels. Though if that turns out to be true as well, I might displace Mr Soult as the media’s favourite north east retail analyst!

You might have read that today M&S reported a £297m drop in profits for the first half of this financial year, with non-food sales particularly suffering (though admittedly improving somewhat towards the end of the period).

Mark Bolland is working on supply logistics, merchandise design and technology (including thousands of iPads) as the solution to these problems. There’s also, of course, the oft-cited problem of the M&S bust of the 1990s – over-diversification, especially of brands – which Mark Bolland is ploughing an awful lot of time and effort into repeating for reasons that frankly baffle me.

But I think there’s a slightly under-discussed problem: the state of the estate. Despite Sir Stuart Rose investing some £2bn in the estate only a handful of years ago, the estate is a mess. Here’s some pictures I took last weekend in the Newcastle flagship store:

The store has broken signs, patched up floors and fitments, the whole works. Note that these are not front-line problems – these are problems caused by poor quality, poorly designed store fittings. This despite going through Mark Bolland’s slightly half-hearted £600m store re-invigoration programme.

At heart, M&S is a premium retailer charging premium prices, which needs a premium retail environment – not shoddy broken fitments and badly scratched floors.

Clearly, the estate isn’t M&S’s biggest problem, but I think it needs further consideration. But then, when you’ve spent £2.6bn on refurbishing the estate in just eight years – the better part of £1m per day – how can anyone possibly convince shareholders that further investment is warranted? Does it start to look like serious mishandling of the original investment?

I don’t have the answers – and, frankly, I’m not convinced Mark Bolland does either. I’m obviously not party to the details, but I don’t think integrated multichannel retailing should be a massive priority – multichannel sales are increasing, but almost half of online orders are collected in store. In fact, if I were Mark Bolland, I would be trying desperately to retain in-store sales where service – M&S’s primary point of difference – is maximised. I’d be worried that one in five sales of men’s suits is online, not celebrating, as it puts customers a click away from, say, Brook Tavener, who compete strongly on price and quality, but without a bricks-and-mortar presence can’t hope to compete on service.

Why isn’t M&S pushing it’s service? If it wants to embrace multichannel, why not do it in a novel way that makes the most of bricks, mortar and service? ASOS famously advertises it’s free returns service, inviting customers to order clothes in a number of sizes and return the ones that don’t fit. Why doesn’t M&S push a similar order-a-range-of-sizes-to-store service, which could be a strong competitor, losing the complexity for the customer of organising parcel drop-offs and pick-ups? It’s a service which is pretty much already available under the current system, but isn’t pushed at all online.

Anyway, this is getting remarkably ranty for photo-a-day. I do hope you’ll forgive me! I’ll be back to normal service tomorrow, I’m sure!

I am not an MP for any reason other than because God wants me to be. I constantly try to do what Jesus would do.

So said Nadine Dorries in 2007. Obviously, Jesus has now recommended that Dorries abandons her constituents and takes a month off her regular job (while retaining a full £65,738 salary) to earn about £40,000 appearing on a tacky reality television show. God certainly works in mysterious ways!

Rail fares are going up again. Every time this happens, talking heads on the news suggest that a re-nationalised railway would be cheaper. Is this true?

That is, of course, an impossible question to answer. It is undeniable that private companies now take profits that would otherwise have been returned to the Treasury under a nationalised system. But there is some data to crunch – There’s some data I’ve located with the help of @jrothwell (he blogs here) and @welsh_lisa2 in the House of Commons library.

This sets out rail fare increases in real terms since the late 80s, using the contribution of rail fares to RPI. I don’t think it’s too erroneous to assume that this is an okay proxy for an inflation-corrected comparison of the average change in rail fares. Because it’s based on a comparison of contribution to RPI with a 1987 baseline, the data isn’t in intelligible units – it’s all comparative.

This data shows a 42% increase in the real cost of rail fares from 1987 to 2011: this seems like a bad thing. This graph shows how rail fares increased over time. It shows the percentage increase on the 1987 fare for each year (including the 42% increase over 1987 fares in 2011).

That looks fairly damning! But is it down to privatisation? Privatisation got underway in 1994. The average year-on-year increase in fares between 1987 and 1994 was 2.34%. If we assume that this level of increase would have continued had privatisation not happened, we can plot the new course of history (red) versus the old one (blue):

As the new red line shows, had fare increases continued at the pre-nationalisation level, they would’ve ended up higher: they would be 73% higher than the 1987 equivalent.

However, some people claim that between 1992, when the Conservatives were re-elected with a mandate to privatise the railways, and 1994, when this actually happened, fares were artificially inflated to make the franchises seem more desirable. So, perhaps it’s unfair to include 1993 and 1994 in our calculation of the pre-nationalisation average increase. If we exclude them, the average year-on-year increase drops to 1.73%. The graph then looks like this:

That is, fares still end up higher in real terms than they actually did: in this scenario, the 2011 fare is 53% higher than the 1987 equivalent.

It would be great to have some pre-1987 data to see if that suspicious looking flick up in 1991 is really unusual, or just part of the pattern of the background picture: certainly if the 1987-1990 trend had continued, fares would hardly have increased. Combined with the above data, this answer in Hansard from Norman Baker suggests that the change from 1980 to 1986 was of the order of 6%. If we assume a 1% year-on-year increase, as that figure suggests, then the predicated and actual fare increase from 1987 to 2011 are pretty much equal.

Bearing in mind all of the above, I’m not sure it’s fair to say that privatisation has driven up passenger fares, even if some of the revenue is now siphoned off to private profit rather than being invested in public services.

Add this decrease in the rate of increase of fares to the indisputable data showing that passenger numbers have risen, passengers satisfaction ratings with both trains and stations have risen, and delays have decreased considerably, and suddenly privatisation seems like it might not have been the disaster we’re often lead to believe it was.

Of course, this is an extremely simplified view of things. I’m ignoring the complexities of the timing of various changes, I’m ignoring the government subsidies that have happened even under the privatised system, I’m ignoring the added jeopardy of train operating companies handing back franchises and leaving the government to pick up the pieces, and I’m ignoring the potentially dubious morality of selling off national infrastructure.

I’m not left with an overwhelming sense that privatisation is the best thing since sliced bread – or even that it was the right move – but I think that perhaps the waters are a little muddier than some would have us believe. And I’m going to stop being geeky now, and resume normal service…!

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Every now and again, I find myself moaning to Sky News about some report or other they’re running, usually on a medical topic. This might put me in the same box as the green-ink angry brigade of old, but I kind of hope it doesn’t.

Sky News is normally the outlet on the receiving end of my moans because Wendy likes to watch Sunrise in the mornings, so they tend to be the ones to irk me when I’m sleepy-eyed and vulnerable. Usually, they’ve misunderstood the findings of some piece of research, or are giving advice that needs a little more nuance. Generally, I fire off an email to them, and they correct either their script or package pretty quickly, or else get back to me to explain why they won’t. I actually think I have a pretty good relationship with them.

A few years ago when the whole MTAS debacle was kicking off in the medical world, I helped Channel 4 News with some of their reporting, and also found them really helpful, willing to listen to my explanations, and good at accurate reportage.

Until a couple of weeks ago, I don’t think I’ve ever complained about a BBC News report. But then, the BBC News website published this article about the Queen’s faith role. This couldn’t be further from the stuff I’d usually moan about, but the report was based on a COMRES poll, and originally opened with the claim that 80% of the population supported the Queen’s faith role. I didn’t believe this, and so checked out the original data on the COMRES website, which revealed that 80% responded positively to a question about whether the Queen has a faith role. This is, of course, different from giving support – it’s a question of fact, and, as the Queen is the head of the Church of England, it seems pretty undeniable that she has a faith role, whether or not it’s supported.

So I fired off an email. And, within hours, the article was changed to the current version, which reports the actual survey findings more accurately. What I hadn’t anticipated, and hadn’t had from any other outlet, was that the Religion Editor gave me a call. We had a great chat in which he explained how the article had come about, how the mistake had been made, and also a general talk about the complex rules that the BBC has around commissioning surveys. This was fantastic.

So what’s my point? Essentially, any time I personally have moaned to a media outlet about a factual reporting error, I’ve received a positive response. Granted, it would be better that the mistakes weren’t there in the first place, and it’s probably true that not all sections of the media are as responsible as those I’ve been involved with.

But journalists are humans too. They make mistakes, and many of them seem happy to have these corrected. Leveson might give the impression that all journalists are unethical idiots, and Blair might think they’re feral beasts, but some journalists are just doing a bloody hard job as well as they can, with the utmost professionalism.

I know it’s not a popular view at the moment, but maybe we can consider giving journalists a break sometimes? Just a thought.

BBC One should reflect the whole of the UK in its output.

That’s a key part of BBC One’s remit. I get that the ratings are better on the CBBC channel, and I sympathise with that position; but I simply don’t see how BBC One can meet it’s remit without kid’s programmes. BBC Two hasn’t got over the existential crisis it had because of BBC Three and Four, yet they’re inviting the question: “What’s BBC One for?”

It also invites criticism, means that they have to find (and pay for) something to plug the gaps in the schedule, and reduces awareness of kid’s TV amongst the people who actually pay for it. As strategies go, it seems like madness.

On Saturday, a rally was held in London against the Health and Social Care Bill. Tweets have suggested that this peaceful rally was somewhat over-policed, with armed riot police in attendance and protesters being kettled. There’s some coverage on Indymedia, but little coverage by the mainstream media.

There’s a Twitter meme stating that the reason for the lack of mainstream media coverage is because a “D-Notice” has been issued by the Government to prevent reporting. This meme appears to stem from Dr No’s blog.

I should state clearly at this point that I have no inside information about what the defence services have or haven’t done, and no inside information about the media. I’m neither a professional journalist nor a signatory to the Official Secrets Act. However, the idea that a D-Notice was issued to cover up a protest by a couple of hundred people about a Government bill seems utter crap.

D-Notices, which have been called DA-Notices since 1993, are controlled by the Defence, Press and Broadcasting Advisory Committee (DPBAC): they are not under the direct control of government. There are five government representatives on this committee, and 16 members of the media, nominated by bodies like the Press Association, Google, the BBC, and ITV. So for us to believe that a DA-Notice was used to cover up a protest, we must also believe that 16 members of the media – or, I guess, at least six members of the media to carry a majority on the committee – felt that this was appropriate action. Also, since DA-Notices are merely advisory, it must also be the case that not one journalist chose to break rank and shout to all and sundry about the most audacious UK government cover-up of a peaceful protest in history.

DA-Notices are very seldom used. Often, the existence of the DA-Notice itself is reported – these aren’t super injunctions. Back in 2009, the existence of a DA-Notice was extensively reported after Bob Quick accidentally flashed sensitive information to photographers when arriving at Downing Street. The photos were printed in many newspapers and shown extensively on news programmes, with the offending information blurred out and the DA-Notice cited as the reason. There was also discussion around DA-Notices and Wikileaks. So we must also believe that not only have media representatives voted for a DA-Notice to be implemented, but that journalists have also spontaneously agreed not to discuss the very existence of a surely controversial notice.

DA-Notices are so seldom used that in possibly the biggest temporary media blackout of recent years – when Prince Harry served in Afghanistan – a DA-Notice wasn’t issued, but merely a gentleman’s agreement by the press attempted (unsuccessfully) to ensure that the news wasn’t leaked in advance.

There are five standing types of DA-Notice, which relate to: the military; nuclear facilities; secure communications; sensitive installations; and security and intelligence services. I wonder which type of DA-Notice Dr No believes this protest falls under?

A quick Google search reveals that, in addition to Saturday’s relatively small NHS protest, a rally against climate change, an anti-workfare protest, a protest against the Assad regime in Syria, a protest against stop-and-search, and an anti-fur demo all took place in London on Saturday. I’m sure all feel that their protests were under-reported in the mainstream media.

Perhaps the media agreed to the issue of DA-Notices against all of these protests this weekend. Or perhaps it was felt that none of these protests was particularly newsworthy. Perhaps the protests were felt to be a little predictable – a restatement of a known position, rather than anything new. And I’d imagine that there were many complaints about perceived poor policing over the weekend, given the level of complaint against the police on any given day. Each incident in itself is unlikely to be newsworthy.

Perhaps I’m wrong. Perhaps there has been a cover-up and a media blackout about this protest. But that’s an extraordinary claim and, like Carl Sagan, it’ll take extraordinary evidence to convince me. Until that’s available, perhaps protestors should stick to the facts.

The happiest moment of my year is about three hours before the first race at Cheltenham.

So wrote Charlie Brooks in a Telegraph article on Sunday. This morning, he and his wife Rebecca Brooks were arrested on suspicion of conspiracy to pervert the course of justice… just hours before the first race at Cheltenham.

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