Anyone with a blog, like me, can essentially make a choice. I could delete a load of old stuff. It wouldn’t make it completely unavailable online, as content from this site is cached all over the place; I guess it might make it slightly more difficult to find. But I’ve chosen not to do that. I’ve chosen to keep the complete sjhoward.co.uk blog intact. And I’m sure many people wonder why.

Firstly, let me say that it’s not because I think everything on here is great. It’s not. There’s some terrible stuff. There’s stuff that’s just plain dross. I’ve written things that I’m a ashamed of, like using “gay” almost as a punchline, or referring to the entire French population as “crazy frogs”. There’s positions I’ve asserted that, at best, are altogether blunter than I’d ever express now, like saying “I’m very anti-smoking”. And that’s before we even open the can of worms labelled “unnecessarily base humour”.

So why, you might ask, do I keep this stuff online, with my name written at the top of the page in a massive font size?

This is something I’ve thought a lot about. In the end, my reasoning was fairly simple. What I wrote in 2003 might have been unprofessional, but I wasn’t a professional then. It might have been immature, but so was I. The date is clearly and prominently shown on all the posts I’ve written. Of course I don’t hold all the same opinions I did when I was 18 – does anybody? We grow, we develop, our viewpoints and opinions change.

One of the more remarkable things about this little site is that you can how it happened. You can see the softening of my opinion on Tony Blair, from barely concealed hatred, to grudging admiration, to actual respect. My changing interests are reflected, from the 2005 election, during which I published daily “swing updates” based on a complex formula weighting different polls, to the 2012 local elections which were only mentioned in passing beneath a pretty picture of a bus stop.

All of this history, and all of these changing opinions, set out the path to where my politics and opinions lie today. And, of course, both will continue to shift over time.

In the end, I guess I came to the conclusion that if someone chooses to judge me on a personal opinion I held a decade ago, then so be it. Though I’d suggest that a far more interesting and intelligent approach is to ask questions: “You once said you thought x: do you still believe that?” or “Your position used to be y, now it’s z. What changed your mind?”

I don’t know exactly when the meaning of the term “flip-flopping” in political discourse changed from being about presenting different views to suit different audiences to being about actually changing your mind on a given issue, but I don’t think it’s a helpful change. I’m vaguely suspicious of people who claim to have “always believed” something – it has a slight whiff of valuing dogma above thoughtful and reiterative consideration of the issues. I can only speculate that the increasingly tribal nature of politics has led to increasing institutional derision of free thought: we must all toe the party line.

If you ask me, the sooner we lose the vogue notion that a change of opinion or reconsideration of position represents a weakness, the better off we all will be.

I own a house in North Kensington and my house in the constituency in Oxfordshire and that is, as far as I know, all I have. Do not make me sound like a prat for not knowing how many houses I’ve got.

David Cameron, talking to Ginny Dougary for The Times, in 2009. I missed this first time round, but have just found it via David Eaton in the New Statesman.

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.

Julian Glover (formerly of The Guardian) writes the following for Mr Lansley:

As I grew up, the NHS wasn’t some remote organisation. It was what we knew, what we cared about and what we wanted to make work. And that is every bit as true today. As a son, as a father, and as a patient, I know what it is to have the NHS at your side.

It is returned from Lansley’s office as:

Outcomes depend on integration across services. Opportunity of NHS/public health/and local authorities together. Like they do in Sheffield … Not structural integration but integration around families and children. Marmot (universal proportionalism) – early intervention.

Go and read the full thing, it’s fantastic.

The first argument against the Bill is that we don’t need legislation. Those who articulate this argument all of a sudden should be asked why, then, do they oppose it?

Because it isn’t needed, perhaps? This utterly bizarre defence of the Health and Social Care Bill by Baroness Warsi is car-crash online commentary. It’s poorly informed and logically flawed.

With friends like these, does the Health and Social Care Bill even need enemies?

The House of Commons authorities would be surprised if the clock tower fell into the Thames any time soon. It may well be raised with the Speaker on Monday. Given that Big Ben is situated over the Speaker’s apartments, he may have a view on it.

Thomas Docherty, a Labour MP on the Commons administration committee, according to this Sunday Times article.

video of Gordon Brown picking his nose has now been viewed over half a million times – 581,610 times to be precise – on YouTube alone. That’s on top of it’s appearance on Newsnight, and pretty much everywhere in 2007. It’s had 2,584 comments – more than the rest of the site put together.

It’s quite clearly the most successful thing ever to come from this site: A video of someone picking their nose. Crazy!

The inefficient status quo - surely there's a better way?

There’s been a lot of heat about the NHS National Programme for IT recently, with both Labour and the Conservatives suggesting that it will be, at best, scaled back. Often referred to as “the £12bn NHS Computer”, the idea of having a national IT system for the NHS is often ridiculed as one of Whitehall’s biggest white elephants.

But, contrary to what almost everyone else thinks, I firmly believe that a national NHS computer system is a good idea. I think it has the potential to revolutionise healthcare, and vastly improve the health of the British population in a much more meaningful way than anything else the NHS has ever done.

As a doctor, I’ve worked with a variety of NHS IT systems, some of which are brilliant, and some of which are terrible. On the one hand, I’ve worked with an electronic patient record system in a hospital Trust that is an absolute disaster of a system. It does not fit in to the way anybody works, it is obstructive, and it actually provides less data in a less useful manner than the paper system it replaced. It is terrible, and should never have been introduced. Projects like this give NHS IT a bad name.

On the other hand, I’ve worked with SystmOne in Primary Care, which is a Department of Health endorsed Über success of a computer system. The data is stored in a secure cloud, the program auto-updates, and it is constantly being improved. It’s a massively powerful system. When recent research showed that a high proportion of patients with diabetes and a history of heart attacks would have undiagnosed heart failure, it was the work of moments for a practice near me to generate a list of such patients and invite them for screening. The upshot was that the detection rate for heart failure soared by a factor of ten, and those patients are on the right treatment for their condition.

Without the IT system, this could not have been efficiently acheieved. It would have involved looking through thousands of sets of paper notes, which is just not practically possible. The implications for the availability of this sort of intervention are manifest. And that’s on top of the often sold benefits of all doctors, wherever you go, having access to the same set of complete medical records.

The disease-coding in SystmOne is done in an intelligent and unobtrusive way. If I type someone’s blood pressure in as part of a consultation, this is coded instantly and automatically by the computer, which merely highlights the data to show that it has been entered into an encoded database. Similarly for when I enter a diagnosis – coding is quick, automatic, and accurate. If, for example, I note that someone has diabetes, this is automatically captured and the patient is automatically sent letters for diabetic annual reviews. That is astoundingly clever, and stops individuals falling through nets.

Incidentally, the crap IT system does none of this. It is badly designed by people not familiar with the day-to-day workings of individuals in the hospital, and is actually obstructive when it comes to getting things done.

In most hospitals which remain paper-based, data intelligence just does not exist. The data on millions of pages of paper notes cannot be effectively mined. In order to receive payment for the services an NHS hospital provides, all the paper notes are shipped to a department named ‘coding’, where they are combed through by a team of non-medically trained secretaries, who decide from the often illegible medical notes how many patients with a given condition have been treated, and what interventions have taken place. It is slow, innaccurate, labour intensive, and doesn’t result in a patient identifiable database for mining. It is an extraordinary waste of time and money.

If a system like SystmOne could be extended to cover all NHS care, all over the country, the database it would produce would be immense, and the opportunities for mining of that data would be far more advanced than anything else undertaken by any country on earth. We would know at a glance if an outbreak of a disease was happening in a paticular area of the country. Research could be acted upon in a flash with intelligent, national, targeted screening programmes. And that is just the start.

A well implemented national NHS IT computer system would revolutionise care in the NHS – and frankly, for that, £12bn is an absolute steal.

no-one will complain to the local paper about a longer wait to get their genital warts seen to.

Frankly, I don’t think they need to worry so much. Whilst, perversely, sexual health services aren’t sexy, there are much less celebrated parts of the NHS. Like those that deal with children with serious mental health problems.

Back in 2006, I wrote a polemic on here about the underfunding of Child and Adolescent Mental Health Services (CAMHS), and I guess it’s become something of a recurring theme on here. Back in 2006, services were underfunded to such an extent that 25% of the country didn’t have CAMHS crisis teams.  If, like Newt in Hollyoaks, a schizophrenic teenager wants to kill themselves, there was no-one to call to get immediate specialist help. For adults, there are dedicated teams.

We’re now in 2010, at the dawn of a brave new decade, and over the intervening years not much has really changed. Just last year, The Guardian reported how many young people were waiting almost three and a half months for specialist assessment of their mental health problems – with 75% of them having no support whatsoever in the meantime.

Compare that level of service to the sexual health drop-in clinics or the guaranteed two-week cancer wait, and you begin to see the level of neglect of CAMHS in the UK.

Child and adolescent mental health problems are the very definition of unsexy. All of us regularly see tin-rattlers and chuggers asking us to support a whole range of childhood cancer charities, or raising money for hospitals like Great Ormond Street or the soon-to-be-opened Great North Children’s Hospital – All worthy causes in their own right.

But collecting-tins for children with mental health problems are very seldom seen, not because the diseases are less common, but just because of the level of public misunderstanding of the field, and a general perception that mental health problems are unpalatable.

1 in 3 of us will have cancer at some point in our lives. Similarly, 1 in 3 of us will have a mental health problem at some point in our lives. And, thanks to the chronicity of mental health problems, 1 in every 6 people are suffering with a mental health problem right now. And 1 in 10 children have a diagnosed mental health problem.

Which of those statistics have you seen on a TV ad or bus-stop poster recently? I’m guessing only the first.

Thanks to tabloid newspaper obsession and the underactive imaginations of TV and film scriptwriters, popular conception links mental illness and criminality. Criminals and the mentally ill are one and the same to many people. Of course links exist – I’d be a fool to deny that mental health problems are rife in our prisons for example (there’s a post for another day) – but when such vast numbers of people are affected, it is hardly the case than one equals the other.

Problems of perception likely affect CAMHS even more than adult services, as I’m sure many Daily Mail readers fail to believe that mental health problems can affect children: They’re probably seen as a Guardianista cover-up for naughty kids who should be caned rather than mollycoddled. Against that background, I’d wager that many people would rather write to their local newspaper about their genital warts than about their personality disordered child.

Luckily, there are some people out there who care enough to try to change the status quo. There’s a great charity called Young Minds who recently launched a manifesto on child and adolescent mental health issues, in an attempt to influence the political classes in a General Election year with a view to tackling these issues for the long-term. To his credit, Nick Clegg of the Lib Dems seems to be broadly in support of what they’re trying to do.

But the fact remains that CAMHS are chronically underfunded, and definitely underappreciated. As things stand, CAMHS win no political votes, and so when looking for things to cut, they will likely be first in the firing line.

In this context, I hardly think the Family Planning Association needs to worry. As long as preventing teenage pregnancy remains a vote-winner, their services will be well-funded.

Perhaps one day, CAMHS will be able to enjoy that level of confidence and certainty too. For the sake of our children, I hope so.

If you remember the last general election, in which Tony Blair secured an historic third term of government for the Labour Party, you may remember that I blogged about the campaign fairly intensely. And, looking back to my post about the Budget of that year, I came across this embarrassing paragraph:

The main message that I took away from today’s events was how much better Mr Brown would be as Labour’s leader: Tony Blair’s fake emotion and anger versus Mr Brown’s real commandeering and forceful delivery, appearing to actually believe what he says? I know who I’d choose.

Jeepers, how wrong can you be?

So apologies for that. I’ll try not to write anything so crap this time around. But it may be difficult to judge the crappiness until four years hence.

Still: I guess it’s a bit reassuring to know that it’s not only ‘new media’ writers like me that mess these things up – the dead-tree press are at it too. My favourite U-turn of this year has to be Michael White’s:

A hung parliament is not going to happen – And a good thing too
- Michael White, The Guardian, 23rd November 2009

Make ready the smokeless rooms: a hung parliament is on the cards
- Michael White, The Guardian, 24th November 2009

Fabulous.