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Johnson’s crazy screening plan

Alan JohnsonIn an effort to outdo his predecessors and aim a policy so firmly at middle England that it almost hurts, Alan Johnson is planning to introduce vascular health screening for all 40 to 74 year olds. Frankly, the only conceivable policy which would satisfy the Daily Mail more would be a knighthood for Paul Dacre.

Mr Johnson wants to write to every person in the country between the given ages and invite them to attend their GP surgery for screening. The screening method will be very simple, involving only measurements of BMI, gender, family history, blood pressure, and cholesterol. Essentially, it will let overweight Mr Goggins know that he’s at risk of having a heart attack, just like his father and his father before him. It doesn’t add an awful lot of anything over and above the existing QoF targets, but Mr Johnson maintains that these simple measures this will save 2,000 lives per year. And that’s not a bad soundbite.

He’s a very clever man, Mr Johnson: He must be, because he hasn’t yet decided who will do this screening nor where it will be done, yet he already knows its exact cost – £250m per year. I’m not entirely sure where it is he’s found this figure. Perhaps it came to him in a dream.

Perhaps, in his dream world, the inverse care law does not exist. He admits that only 75% of people will come to his screening appointments (indeed, that’s the percentage on which his mystery funding figure is apparently based), but perhaps in his world this won’t be made up of the worried well. In contrast to any other health intervention ever introduced in the UK, the people who will attend his screening appointments are the ones who really need to attend.

The clinically obese will beat a path to their GP’s door for the experience of being told they’re fat. Those living on the minimum wage will take a day off work and pay for the bus ride to their local pharmacy between 9am and 5pm to be told their cholesterol is high. And those at greatest risk of vascular events – men – will suddenly have an overwhelming desire to engage with health services. Or not.

Instead, this will turn out to be another ill-conceived plan pitched to the worried well of the middle classes, helpfully providing the promise of a new ‘life-saving service’ to the age and class demographic most likely to vote in the upcoming local elections. Not only will it add little of clinical value, but it will divert a vast amount of money from parts of the NHS which desperately need it – particularly those parts which have a less ‘sexy’, populist image.

This is one case where I’m very happy to be proved to be a cynical political blogger rather than a realist. I’d like nothing more than for this plan to turn out to be a vascular panacea. Unfortunately, I can’t see that happening – and the one thing worse than an ineffective NHS is one which squanders money pandering to the worried well, for such an NHS cannot survive for very long.

» Image Credit: Original photo by Catch 21 Productions, modified under licence.

This post was filed under: Health, News and Comment, Politics.

Automatic organ ‘donation’

This decision over one’s own body is for the conscience – the conscience of individual citizens in this country. It is not for this Parliament, by free vote or other vote, to impose upon them a requisition of their bodies after death for the state.

So said John Reid, a little over three years ago. It would appear that Gordon Brown now disagrees. And, for once, I agree with Reid.

I have no moral, religious, or ideological issues with organ donation, and have been a registered organ donor for several years. I do, however, have a strong objection to the proposed suspension of the idea of informed consent – a guiding principle of modern medical practice.

There are so many deep practical problems with the idea of presumed ‘consent’ – not least of all that presumed consent in such a context is realistically no consent at all, and that once a mistake has been made, it cannot be undone.

But, most of all, we’re skipping steps. We’re going from a situation of maintaining a relatively little-known and little-promoted organ donor register to presumed consent, without trying anything in between.

For appropriate candidates, it should be made a legal requirement that relatives are asked about organ donation as part of the death certification. This would immediately increase the number of donations, as doctors are poor at asking such questions for fear of embarrassment, insensitivity, and upset. As a standard legal question it would be unavoidable.

This would be a simple, non-controversial measure that could be put in place very quickly and would increase the number of viable organs available for transplant.

Why don’t we give it a go?

This post was filed under: Health, Miscellaneous, News and Comment, Politics.

The world’s most honest advert?

I note that Vicks are currently running a TV ad with the strapline:

We start with solutions, not problems

Is this a pharmaceutical company admitting that they invent dubious syndromes to fit their drugs? They say that honesty is the best policy, but claiming that their products may form the solution to a non-existent problem might prove to be a little too honest.

This post was filed under: Health, Media.

Minister thinks Government is unethical

Dawn Primarolo MPYou may have noticed that Dawn Primarolo, Health Minister, has asked for a report into the ‘unacceptable’ and ‘unethical’ situation whereby recovering drug addicts are given extra doses of methadone or shopping vouchers in return for clean drugs tests.

Perhaps she should start by investigating the advice endorsed by her own Government, and published by the Government-established NICE three months ago. If she does, she’ll come across this:

Principles of Contingency Management

  • Offer incentives contingent on each drug-negative test, usually either:
    • vouchers that can be exchanged for goods or services of the service user’s choice, or
    • privileges, such as take-home methadone doses.
  • The value of vouchers should start in the region of £2 and increase with each additional, continuous period of abstinence.

You see, that’s one of the many problems with evidence-based medicine – it doesn’t necessarily fit in with the Daily Mail‘s ‘druggies are scum’ agenda. Sometimes, the most effective thing to do isn’t the most popular.

But presumably, since NICE advice is now officially unethical, the government will now be performing a spectacular U-turn on all NICE guidance, and issuing drugs regardless of ‘cost-effectiveness’ – and the dementia patients who so vigorously campaign for drugs (in a way that fits in with the tabloid agenda) will now be granted all they want, as the government will no longer be able to hide behind NICE Guidelines.

This post was filed under: Health, Politics.

MTAS designer rehired after £1.9m failure

Alan Johnson

MTAS was the utter failure of a computer system which was designed to match doctors to jobs but instead merely spewed out personal data onto unprotected parts of the internet leading to criminal proceedings and an unprecedented crisis in the training of junior doctors. It was hardly the government’s finest hour, and we’re still on course for crisis on 1st August as a huge number of doctors will be unemployed.

Earlier this week, it was stealthily revealed by the Department of Health that this now defunct system cost £1.9 million. That’s the same as over 70,000 GP consultations, which I think many people may consider a better use of the money. That cost is merely for the system itself – the upset it has caused through it’s failure and the contemptible lack of contingency planning is estimated by some to run into billions of pounds.

Taxpayers’ money well spent.

The private company whose designed the MTAS computer system, using some of that £1.9m, is Methods Consulting. Just to remind you, MTAS spewed personal data onto unprotected websites, and failed to perform its basic function of matching doctors to jobs.

Guess who’s now helping to design the computer service for the National Care Records Service, a program for storing highly sensitive medical records on a national network? Methods Consulting.

Yes, the company behind the biggest data security failure ever in the NHS is now being trusted with your medical records. And, of course, with a huge amount of taxpayers’ money.

Is there any private company on Earth that would give the job of helping design a highly sensitive computer system to a company that failed to secure a previous system with so much as a basic password? It just seems an utterly moronic decision.

This company has committed one of the biggest failings of NHS data security in its history. There is no question in my mind that they should be removed from the National Care Records Service programme immediately. And why are we paying a company so much money for a system that simply didn’t work?

These are things which Alan Johnson needs to tackle now if he’s to have any chance of regaining the trust and restoring the morale of doctors in this country. I have little faith, but I sincerely hope he can restore it.

This post was filed under: Health, News and Comment.

MTAS: Ditched. Hewitt: Still on £255,000 a year.

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MTAS has been ditched. It will no longer be used to match junior doctors to specialist training posts. Ministers have realised that it is simply not fit for purpose.

Let me remind you what Patricia Hewitt said on Question Time on BBC One on 8th May 2007 (or remind yourself using the video mini-video on the right, or see the full-size version here):

If a minister is responsible for a major policy blunder or acts unethically then of course they should go.

Patricia Hewitt oversaw the introduction of a massively expensive computer system for matching junior doctors to specialist training posts. It has failed. It has spewed out intimate personal details of applicants onto publicly accessible parts of the web. And now it’s been ditched.

How is that not a ‘major policy blunder’?

This post was filed under: Health, News and Comment.

MTAS: Entering the twilight zone

Patricia Hewitt

After finding that the MTAS system was a complete balls-up and had not only failed in its designed intention to match doctors to jobs but had also spewed applicant’s intimate personal details onto the internet such that they were publicly accessible (see here), it would seem reasonable for Patricia Hewitt to take some action.

Perhaps you might expect that she’d sack the people who design the system. Perhaps she’d resign, and admit that the system she’s introduced was an absolute unmitigated failure. Mad Pat did neither of these.

Instead, she reported Channel 4 News to Ofcom. She hasn’t done anything in terms of getting rid of the company who designed this lamentable system, but has reported the programme which exposed the problem to the broadcast regulator, on the basis that Channel 4 should have reported the problem to the Department of Health more quickly.

Clearly, she thinks that it was absolutely unacceptable that a news programme should take 120 minutes to verify a story before notifying the interested parties, yet spewing junior doctors’ and medical students’ personal data all over the web for anyone to see is merely a minor error.

She said she was sorry ‘to junior doctors or foundation programme applicants who have been caused anxiety or, in some cases, inconvenience as a result’, which is all very nice. But remember, she has broken the law. This is an enormous breach of the Data Protection Act. Saying ‘sorry for causing anxiety’ doesn’t really cut it. If I were to post her intimate details on a website for all to see, would ‘sorry’ be enough?

She also claimed that

There is no evidence that members of the public or other commercial interests, apart from staff at ITN and “Channel 4 News”, accessed the site.

That is an out-and-out lie. There is evidence, and the MTAS project manager has that evidence. And, what’s more, it’s clear from her own speech that it is a lie. She said:

The overwhelming majority of individual accesses before the security breach was closed came from an internet address belonging to ITN, the providers of “Channel 4 News”.

The ‘overwhelming majority’. That means, quite simply, that some of the accesses were not from these internet addresses, but from elsewhere. Therefore, there is evidence that other people accessed the site. She is quite clearly and openly lying to Parliament. If you want to read more of her misguided spiel, check Hansard.

The system has criminally failed, and now she’s lying to cover her own back and kicking off against the people who exposed the flaws.

The Ministerial Code is quite clear about this. Section 1.5.c:

Ministers who knowingly mislead Parliament will be expected to offer their resignation to the Prime Minister

She surely knows what she has to do.

This post was filed under: Health, News and Comment, Politics.

MTAS: Doctors want Hewitt to go

Patricia HewittThere’s a danger of this turning into the MTAS blog at the moment, but I can’t hide my incredulity at the complete and utter failure MTAS has been.

Now it emerges that Patricia Hewitt was told about the problems with MTAS security (covered here and here) by the British Orthopaedics Trainees Association a month ago, yet chose to do absolutely nothing about it. She knew that intimate details about doctors’ personal lives could be viewed by others, and even modified by them, and yet chose to take no action. If that doesn’t make her personally liable for prosecution under the Data Protection Act, I’m not sure what would.

Lord Hunt has confirmed today that the MTAS system is down, and he’s no idea when it will be back up. Until then, doctors will be missing interviews, because there is no mechanism in place to communicate the times and dates of these interviews to them. And he refuses to guarantee that the process of matching doctors to jobs will be completed by the August deadline. What he plans to do if it’s not is a mystery: Leave doctors without jobs and hospitals without doctors?

Patricia Hewitt has agreed to appear on Channel 4 News next week. Other than resigning live on air, I’m not sure what she can say or do to make up for this absolute shambles. Junior doctors have today voted for her to go, and I don’t know if she can survive the pressure long enough to go when Blair goes, as she inevitably will. It’s just a shame that won’t fix the problem.

This post was filed under: Health, News and Comment, Politics.

MTAS: Unbelievably, it gets worse

Patricia HewittI thought we’d hit rock bottom yesterday. Once you’ve openly and illegally posted intimate details about applicants on the internet, I didn’t think there was anywhere else to go. I was wrong.

The failed system has been shut down. But now, thanks to an utterly contemptible lack of contingency planning, doctors don’t know if they’ve got interviews next week, or even where and when the interviews will be held.

MTAS was supposed to make NHS job applications more like the private sector. Do companies really try and attract people to work for them for the next thirty-five years by ignoring their past work-related experience, posting their intimate personal details all over the internet, and then not telling them when and where their interviews are? Is that how Mad Pat was appointed?

We no longer have anywhere near enough NHS dentists thanks to this government’s policies so people use other dentists from services online like Asecra. Soon, we won’t have any doctors either.

Latest Update 16:20: It’s now emerged that after a failure of the security of MTAS’s predecessor MDAP, the BMA was promised that the new system would be super-secure. Now we know that not even a password was needed to access thousands of people’s personal details. And I guess we also know the value of a government ‘promise’.

This post was filed under: Health, News and Comment, Politics.

MTAS: Breaks spirits, breaks doctors, breaks the law

Patricia HewittI’ve lost count of the number of times I’ve said Mad Pat should resign. I’m starting to get a reputation. But she really is not fit for purpose. After presiding over a catalogue of failures, she’s still in post.

She thinks services for rare diseases should be scrapped, doctors and nurses who don’t wash their hands should go to prison, hospitals should treat animals alongside humans, that NHS debt doubling is a good thing, that the NHS has too many doctors and nurses, and that dirty sheets are the way forward. She’s presided over an absolutely catastrophic failure in reform of medical training, and yet still thinks the NHS has just enjoyed its best year ever. She’s even cut the most vital of services because it’s not a political priority.

And now, it’s revealed that not only was MTAS a failure in selecting the right people for the right jobs, it was also a total security shambles.

Thousands of medical students’ and junior doctors’ personal details – including mobile phone numbers, addresses, and even criminal records – were posted, unprotected, on the internet, for anyone to access. They’re even available on Google.

As if that wasn’t enough, highly sensitive personal data which was supposed to be stored anonymously and separately from personal data – things like sexuality and religion – have been posted on the internet alongside the applicants’ names.

When this was first reported to the NHS’s IT commission, they say ‘Ah, there’s not much we can do about that’. That’s when the doctors went to the media. Then Lord Hunt comes along and claims that these were posted by some malicious individual. That was not true. Then it was claimed that the details had only been visible on the web for a few hours. That was also not true. The system was so badly designed that this data was simply being stored online, without even simple password protection, and had been available to anyone with an internet connection and a titter of wit for at least three days, and almost certainly much, much longer.

But just in case that’s not terrible enough, it has emerged today that not only could such information be downloaded and seen by anyone with an internet connection, but it could also be edited. By anyone. Yep, anyone could get into any applicants online application and edit it to their heart’s content without so much as a password.

This is not only incredibly shoddy security, it’s also illegal. It’s quite clearly against the Data Protection Act, and legal experts are predicting that if any junior doctor decides to sue the government over this, then they’ve got a pretty decent chance of winning the case.

But heck, that’s not enough for this failure of a government.

The system which is currently being tested to hold patient records has managed to spew out the personal details of many consultants, including their home addresses and phone numbers. This is the super-secure system that is virtually impossible to hack, spewing out personal details onto the internet in a completely unprotected fashion.

Patricia Hewitt has presided over the introduction of a system which has destroyed confidence, made lives hell for junior doctors, and now broken the law. She’s been an unmitigated failure of a Health Secretary, and has done damage to the NHS that will take years to put right.

I don’t think I can ask her to resign again. The fact that she’s been through all this and not even considered tendering her resignation tells us everything we need to know about her, and everything we need to know about New Labour, and everything we need to know about political integrity. There’s none left.

This post was filed under: Health, News and Comment, Politics.




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