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Seeing Red

Friday 2 August 2019

Democracy rocks! The people, or at least 0.2% of them, have spoken and we’ve now got a new Prime Minister, the third of my gavelship to date, and possibly not the last. I fear we might also have the government we deserve. Boris has taken over the wheel of the bus, turned sharply towards the cliff edge and stamped on the accelerator, but maybe last night’s by-election result might have partially deflated a front tyre?

He’s packed his cabinet with colleagues who are prepared for a no-deal Brexit, and that must therefore include Matt Hancock who stays in post as the Health Secretary. The appointment of Dominic Cummings as chief Brexit strategist and senior adviser to the PM is interesting, not least because of the reporting in the media this week of his comments to a conference in 2017, when he said, “Tory MPs largely do not care about these poorer people. They don’t care about the NHS. And the public has kind of cottoned on to that”. Whoops.

Let’s hope Jacob Rees-Mogg never gets the Health brief, given his recently published dictat listing the words his team can and can’t use, and that all measures have to be referred to in Imperial form. Before we knew it, he’d have us back using the apothecaries’ system, dealing in drams, scruples (not you, Boris) and grains. The starting dose of ramipril would be 0.0385809 grains daily. (I didn’t know until I looked it up that 1 grain is 1/7000 of a pound- intriguing).

Alexa, how has it come to this? Much has been written in the last few weeks about the NHS partnering with Amazon to offer health advice by way of the Alexa voice assistant. Alarms have been sounded and concerns raised, but are they valid? I heard an article on Radio 4’s ‘You and yours’ (stop it- I’m nearly retired), which noted that the advice it gives could vary wildly, depending on the way the question is asked. I tried asking our Alexa for help with a headache using very similar language, but different phraseology and was directed to a variety of possible solutions, including paracetamol, dialing 999, or a spot of therapeutic gardening. Hmm.

Last week saw the latest quarterly gathering of the LMCs from around the region at Taunton Racecourse. This was the first meeting under new arrangements whereby the chairing and administration, previously the remit of Somerset, rotates on an annual basis. Devon are first into the breech, and it was relaxing for me to sit on the sidelines without the burdens of Chairmanship, not the least of which is juggling the agenda items to coincide with the arrival of the lunchtime chips.

There is increasing value in the LMCs working as a region, and it was agreed that we would ask for central funding to help support a regional event for the Primary Care Network Clinical Directors in Taunton, probably in November. We have influential medicopolitical beasts on the committee, and have managed to secure Dominic Hardy, the Director of Primary Care and System Transformation at NHS England and NHS Improvement (effectively Simon Stevens no. 2), to attend what should be a useful event.

We heard of a 20% cut in the IT capital budget in Devon, and a similar approach in Cornwall- in line with the national edict from NHSE to reduce CCG costs across the board by 20%. We don’t appear to have been affected the same way in Somerset, and IT is one area that is critical if systems to become more integrated, and needs to be prioritised, or at least protected. We all agreed that this needs a strong collective regional voice when discussed at our next Saltash meeting with the CCGs and NHS England.

I was at a meeting recently to comment on the clinical models being developed by the Alliance between Taunton and Somerset/Somerset Partnership to support the business case for their merger. One which struck a chord was labelled ‘Joan’s story’, but could have been named after any number of unfortunate patients affected with leg ulcers, which due to a dysfunctional pathway often become larger and more complex before they get expert assessment and treatment. The stated intention is to get all patients seen by the leg ulcer service within two weeks of referral. It will need up-front funding, but everybody, up to and including the Chief Executive, recognises that the benefits down the line will prove a significant return on investment, and dramatically reduce morbidity and improve quality of life for our patients. I suspect many of us still underestimate the misery and discomfort associated with chronic, painful and often smelly ulcers, and the social limitations that constant visits for dressings entails.

The idea is hardly revolutionary. I first heard it suggested by Jonathan Lewis, then CEO of Bromley Healthcare, at a Westminster Health Forum event in March 2016 who realised that by reducing the rate-limiting step in the pathway- the wait between the first presentation of the ulcer to a clinician and doppler scan/treatment- would save many millions if implemented across the NHS.

Regular readers will have gleaned that the LMC places great value in headwear. Committee members often wear multiple metaphorical hats and if challenged need to be prepared and able to describe their millinery status, in case it’s not already obvious from the position they’re taking. We also go in for real hats, and at successive LMC Christmas parties I’ve acquired a golden Stetson, a green conical number with bells, and a pair of rather fetching antlers. All are wearable and carry appropriate authority and gravitas throughout the year. Last week I had a cryptic message from Bazza, currently enjoying his annual graze through the crustacean stocks of the Channel Islands, asking whether I liked my new cap? Nothing had arrived, but then it does take a few days for stuff to wing its way from the Peoples’ Republic of China. It eventually arrived on Monday, and I’m not really sure what to do with it.

Barry had stuck a moistened finger into the political breeze, and mindful of our new masters’ willingness to suck up to the US (mal)administration, can see that the NHS, along with other national silverware, might soon be pawned off and in American hands. We could all be employees of the Trump organisation with all the ‘glory’ that confers, and Bazza wanted me to be ready. Yes, my cap was red, made in China, and proudly proclaimed my desire to ‘Make America Great Again’. It evoked the same sort of visceral reaction as a punter pointing me in the direction of anything written in the Daily Wail. Nevertheless, I had to try it on, but having no mirror in my room walked about five yards down the corridor to the loo, and in the process managed to scare the bejeebers out of a young mum-to-be en route to her midwife appointment. It occurred to me that if every front door into the NHS was staffed by ‘red hats’- it might help reduce demand.

You might have seen a big splash in the media yesterday about a new App being used at the Royal Free to speed the identification of acute kidney injury (AKI) in hospital patients. It wasn’t that radical- all it seems to do is interrupt the F1’s Facebook or Instagram session with an alert, using the same algorithms as most hospitals already use, but with a 21st century methods of getting the results to the clinician. There’s undoubtedly scope to reduce the incidence and more quickly identify patients with AKI, and renal disease would appear to be the flavour of the moment on both sides of the Atlantic. As the Donald put it recently in a speech announcing a greater focus on preventing and treating kidney disease in the States: ‘You've worked so hard on the kidney. Very special -- the kidney has a very special place in the heart. It's an incredible thing.’

Eloquent, inspirational and wise words as ever, Mr. President.

Thanks, Barry. I shall wear the hat with pride.

Nick

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