I tweeted about this Times article yesterday – it’s really brilliant, like the plot of an off-beat West Wing episode.

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.

I’ve just noticed that my (infamous) YouTube 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.

This post is based on my contribution to Episode 17 of The Pod Delusion, originally broadcast on 15th January 2010. Other topics that week included “The Big Freeze”, Google, and ITV’s regional decline. How could you not want to listen to the whole thing at poddelusion.co.uk?

Back in September, the Family Planning Association was publicly worrying about the fact we were in a recession. With something rivalling the foresight of Derren Brown, they came to the conclusion that a recession would mean NHS budget cuts, and they were frightened for the future of their service. They thought that a lack of willingness to talk about sexual health issues would lead to their services being the first to be cut. Or, as they more memorably put it, their services will be the first to be cut because

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.

This post is based on my contribution to Episode Two of The Pod Delusion, originally broadcast on 25th September 2009. Other topics that week included the BNP on Question Time, an undercover homeopathy sting, and the future of intellectual property rights. How could you not want to listen to the whole thing at poddelusion.co.uk?

I’ve been nostalgically browsing the site’s archives today, and flicking through the digital version of Instant Opinion.

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.

You know those bags of Rowntree’s Randoms, constantly advertised on TV? Seemingly reasonable people suddenly start spouting inappropriate words for their situation because they’ve indulged in a jelly sweet which has an unusual shape?

I’m beginning to wonder whether Gordon Brown has accidentally ingested a whole packet of the Prime Ministerial equivalent. How else can you explain the way he claims to be “pleased” and “proud” to apologise for the appalling treatment of Alan Turing, surely one of the greatest British heroes of the twentieth century? The words are simply inappropriate, as can be clearly seen by applying them to similar situations:

Mr Smith, I’m pleased to have the opportunity to apologise for your wife’s unfortunate death!

Mrs Jones, I’m proud to say that I can apologise for running over your cat!

Mr Thomas, I’m pleased and proud to apologise for your son’s death in Afghanistan!

Except, Gordon Brown wasn’t pleased and proud in the latter case. He was reportedly “devastated” about recent deaths in the country. Not angry, not apologetic, not regretful, not mourningful, not sorry, just “devastated”. Of course, not “devastated” enough to go to a military funeral, or even visit any injured soldier in hospital. Just “devastated” enough to repeatedly use the word and move on.

There are some who suspect there’s something altogether more worrying underlying Gordon Brown’s unusual responses. They claim, based on reports that he must avoid eating cheese and drinking chianti, that he is taking MAOIs, and old-fashioned kind of antidepressant.

The assertion that Gordon Brown uses MAOIs was recently made plain by Matthew Norman in the Independent, after months of hinting from Simon Heffer in the Telegraph and Matthew Parris in the Times.

The substantial problem with this theory is that virtually no-one takes MAOIs, as they’re extremely outdated and have some pretty nasty side-effects. On top of this, there are manifest reasons for avoiding cheese and chianti: A tendency for migraines, a plethora of food allergies, or a sensitivity to appearing too middle-class.

Yet whether or not he’s taking MAOIs, there are substantial rumours suggesting that Gordon Brown might be depressed. Whether or not this may impair his ability to fulfil the role of Prime Minister is debateable.

Iain Dale, for example, believes that it shouldn’t matter if Mr Brown is depressed – he deserves our compassion more than our criticism. He cites the example of Churchill, who was undoubtedly depressed but still a great Prime Minister.

I see entirely where Iain is coming from, and, for what it’s worth, I largely agree. I see no reason why depression should preclude decent Premiership.

But we live in a media-driven world that Churchill never experienced. Churchill was an alcoholic, and this may never have affected his leadership. That didn’t stop the Lib Dems overthrowing Charles Kennedy – their most charismatic leader to date – because he was a recovering alcoholic. The image wasn’t right. And if the image of a recovering alcoholic isn’t right for leader of a liberal party, how can a person with mental health problems ever be the right image for a Prime Minister?

To me, it actually doesn’t matter whether Gordon Brown is depressed or whether he fits the model image of a Prime Minister. What matters is that he’s terrible at his job. Performance must surely be judged above all else, especially for one of the country’s top jobs. And Mr Brown fails that test, and fails it miserably: From the economy, to student debt, to any one of manifest crises between which Mr Brown has lurched, it’s clear that he simply doesn’t have “The Right Stuff”.

But in today’s politics, who does? David Cameron? I suspect we might be on the verge of finding out.

Last Friday, The Pod Delusion launched. The pilot episode included a contribution from me on this subject, on which this post is based. Now go and listen to the rest!

Andy Burnham has written a piece for today’s Guardian announcing that

For Labour, it all comes down to defending the N in NHS … By contrast, the Tories are ambivalent about the role of the centre, preferring localism in health as in other areas.

It’s probably churlish of me to point out that Mr Burnham has previously espoused about the paramount important of locally, rather than natioanlly, influenced healthcare (“The hospital and Primary Care Trust must listen to patients and local people and involve them in shaping the future of the hospital” – hardly a nationalistic approach).

To point him in the direction of the Conservatives’ 45-page Green Paper on the NHS in response to his claim that “on health, Cameron doesn’t do detail” would probably be missing the point.

And let’s just ignore Mr Burnham’s complete lack of insight into the effect of his target-driven culture – Patients being moved like pawns around a hospital-sized game-board to avoid staying in one place for too long – regardless of their clinical need.

Let’s just park all of those thoughts in the vastly overpriced hospital multi-storey, and concentrate on his main point. The ‘N’.

I’m an ardant supporter of the broad principles of the NHS. I think healthcare free at the point of need is a wonderful thing. But I don’t subscribe to Andy Burnham’s ideology of a national health service with national targets to tackle national problems.

The residents of Byker have different healthcare needs to the residents of Mayfair, and the needs of the residents of Tunbridge Wells or Toxteth differ equally again. Whilst it’s true that residents in none of the above places would relish waiting more than four hours in A&E, such meaningless targets do little to disprove the inverse care law which appears to be Burnham’s prime argument for focusing on the ‘N’.

In fact, quite obviously, the most imporant bit is the ‘HS’. The country needs a Health Service that is adaptable to the needs of all. Different locales will, necessarily, have different priorities. Giving Respiratory Medicine the same priority in the North East (where lung disease is relatively common) and in Southern England (where it is rarer) would appear to me to be a failing of a nationalised system, not a benefit.

Targetting outcomes seems eminently more sensible – The respiratory services in the North-East and the South don’t need to be equitable, provided the outcome – measured in cure rate, death rate, or howsoever seems most sensible to the respiratory physicians who are far more intelligent than me – is equitable.

That’s the kind of Health Service I would like. One with an ability to respond to the local health needs of local people – not by “national standards, national pay and national accountability” – all three of which have everything to do with bureauocracy, and nothing to do with healthcare.

I’ve been intending to post for ages on the subject of patronising, irritating, and most certainly excessive Government advertising. I have found recently that it’s impossible to watch a single commercial TV programme without seeing at least one Government funded advert, whether it be for direct.gov, the road safety Think! campaign, the NHS Stop Smoking campaign, car tax renewals, Fire Kills, the Know Your Limits alcohol campaign, the ubiquitous Change4Life, the Act FAST stroke campaign, Act on CO2, the Food Imports campaign, the irritatingly clever Get On ads, or any one of the miriad campaigns the Government is funding at any one time. Listening to the radio is worse. And even Spotify has been invaded.

Government posters are everywhere – the recent slightly threatening Policing Pledge ones are spreading like a rash, but my personal favourite is the Food Standards Agency one shown here. Apparently, choosing something with fewer saturated fats helps me reduce my saturated fat intake. Well, duh.

These adverts are even invading cash machines. I’d never really noticed cash manchine adverts before – are they new? – until one had an NHS advert on it, with someone sneezing in my face.

But all of this came to a head yesterday. Whilst wandering round Eldon Square, I found no fewer than three government supported advertising stands. One was for Change4Life, there was one advertising the local NHS Walk-in Centre, and one talking about reducing CO2. All in the same shopping centre, at the same time.

This is nannyism taken to another level.

What on Earth is the cost of all of this manifest advertising? It surely must be huge.  Now no-one in their right mind would argue with some of the campaigns – fire safety is important, the Act FAST campaign is a major attempt to get people to re-think stroke, and road safety is in everyone’s interest. But there’s a difference between informing the public and forcibly ramming things down their throat.

The Conservatives have posited Government advertising as one of the big areas in which they can reduce waste. Frankly, the sooner they get the chance, the better.