Pseudonymisation

This post concerns the English NHS but, as many readers live in England, it’s important they know what’s happening to their medical data.

What is happening is that it’s being sold to organisations such as university research departments, insurers and drug companies which will be able to apply to the new Health and Social Care Information Centre (HSCIC) to gain access to the database, called care.data.

If an application is approved then firms will have to pay to extract this information, which will be scrubbed of some personal identifiers (seriously?), but but enough to make the information completely anonymous - a process known as pseudonymisation.

Starting in March, medical data covering the entire population of England, will be uploaded to the repository controlled by the new arms-length NHS information centre.

A leaflet is being sent to every household explaining the new database, with the patient being given an ‘opt out’ choice, but how many people will not realise the importance of this further intrusion into their personal lives?  Of course, if an ‘opt in’ rather than an ‘opt out’ option had been offered, then the population may have scrutinised the leaflet more thoroughly and decided against it.  

This is all part of the agenda of government and big business and the on-going privatisation of the English NHS.

Recently the FT reported that the EU/USA trade deal has been ratified. (Apologies no link but it’s behind a paywall). It appears David Cameron has been pushing hard for this as it opens up all public services to tendering from USA private health giants.

Did anyone watch the Dave: Loan Ranger programme on Channel 4 last week?  Dave Fishwick was investigating pay day loan businesses and how his bank, Burnley Savings and Loans, could help reduce the scandalous interest rates charged.  He trudged round some of the big lenders in an attempt to pay off the loans of some unfortunate people.  What he found was that every address given on websites was solely a forwarding agency.  Then he researched further and found the companies involved were all linked to global financial organisations; thus profits were going out of the UK.  The series continues this week.

The link between the new English NHS database and Dave’s pay day loan series may seem tenuous to some, but once this database is up and running it will be obvious that the English NHS will become another huge earner for foreign investors.

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The English Health Service And Privatisation

'The Department of Health has appointed Lazard, an investment bank, to explore a privatisation of Plasma Resources UK (PRUK) in a move that could raise tens of millions of pounds for the taxpayer' states Sky News.

For the taxpayer?  Will the taxpayers have any say in whether they want blood plasma products privatised?  Of course not.

Will privatisation make the service more efficient?  If G4S is an example then no.

Often I consider myself fortunate to live in a rural area where change happens very slowly.  This morning I consider myself fortunate to live in a country where politicians appear to understand privatisation is not always the answer to our woes.

Does this mean blood donors will be paid for their donations?  Surely the DoH doesn't expect the public to donate their blood free to a private company.  If that is the case PSUK may be in for a surprise because I doubt if many will be happy to give their blood so as a large organisation and its shareholders can  benefit financially.

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The Shame Of PFI

The Royal Infirmary of Edinburgh (pictured) is a major teaching hospital which provides a full range of acute medical services for patients from across Lothian and specialist services for people from across the south east of Scotland. It also provides services from many from as far a field as Perthshire. Quite a few people of my acquaintance owe their lives to the skill of the cardiac unit in RIE and speak highly of the medical and nursing teams.

It is one of Scotland's largest hospitals, cost £190m and was opened in 2003. It was funded, along by schools and other public buildings at that time, by Labour's pet finance system the Private Finance Initiative (PFI).

All governments have to borrow to pay for infrastructure projects, but the shame of Labour's PFI system is that instead of paying up front with borrowed money, it agreed to pay private companies an annual fee to take on the entire construction and management of hospitals and schools.

The contract with Consort, who won the £60m annual PFI contract to build and operate the RIE, is due to run until 2028 but the lease of the land is for 130 years. Consort has been criticised for poor performance since the opening of the hospital and the latest incidents have sparked NHS Lothian into consulting their lawyers.

I've never totally understood Labour's PFI contracts. I see PRI as like purchasing a car on credit, with the condition that only the credit company employees can drive it and maintain it at excessive cost to the purchaser. That's the shame of PFI contracts.

Murdo Fraser, the tory MSP for Mid Scotland and Fife, thinks 'it would be wrong to use this one incident to try to damn all PFI projects and that many have an excellent record of delivery. Publicly-funded institutions are not without problems as we have seen in the all too recent past such as at the Vale of Leven hospital'.

I agree publicly funded projects may have problems, but the difference is the people feel they 'own' these buildings. With PFI there is no sense of public ownership.

According to the Scottish Government website there are currently 31 projects funded by PPP/PFI and NPD finance systems at a cost to the public purse of £1.332 billion, totaling 21% of capital value. No detail is given on contract lengths or values.

Fortunately the current Scottish Government have decided to use a Non-Profit Distributing (NPD) finance system for future projects because they quickly saw the exorbitant overall costs of the PFI system, but that is little comfort to the taxpayer who will be paying for projects like the ERI most of their working lives.

Let's hope Lothian NHS's lawyers can find some loophole in Consort's contract to allow them to either cancel it or renegotiate it to ensure that patient safety is paramount and value for money is also considered.

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The Fragmenting Of England's NHS

"Wakey wakey Mr Beasly. Two o'clock in the morning

and we think you're well enough to go home now."

UK plc's chief salesman is touring overseas accompanied by his back up team of weapons salesmen. Every media clip shows him looking more and more uncomfortable in formal situations and his speeches are lack lustred and robotically delivered.

Shouldn't he be back in England sorting out their NHS rather than selling arms abroad?

English NHS Trusts have reportedly sent home 239,233 patients between 11pm and 6am last year. The Mail is up in arms about the numbers, although it does mention that senior doctors say the numbers will be far smaller, as the statistics include patients who want to go home as test results come back with the 'all clear', as well as women who have just given birth. Also included are drunks sent home after being admitted earlier to A & E to sober up and some Trusts also count patients as being'discharged' if they have died.

The most worrying excuse given by senior Trust officials is:

'...  nursing staff may only get round to recording patients as being ‘discharged’ on computer systems late at night even though they left earlier on that evening.'

If nursing staff can't accurately record a patient's discharge time what trust can a patient have in other medical records?

I'm all for escaping from a hospital ward at any time of the day or night and if I was told at 3am that I was fit enough to leave I would do so - as long as was able to make the necessary arrangements for a safe journey home. To send anyone home at any time of day or night without verifying the patient's safety is irresponsible.

What would be interesting is to know how many of those discharged were admitted drunk. Many times I've said the NHS should not be used as a depot for drunks and they should be put in police cells until they are able to stand on their own two feet.  If that happened the number of drunks on the streets may well diminish rapidly.  There's nothing glamourous about staggering out of a police station into the street early in the morning, clutching possessions in a plastic bag and being aware that the previous night's attire doesn't look so alluring in the cold light of day.

I remember some years ago being desperate to leave hospital after a minor operation. The medical staff refused to allow it until a relative or friend presented themselves to the ward sister and gave her their assurance that 'her' patient would be in safe hands.  This patient safety net has since been removed from hospital discharge procedure.

Of course, if a patient wants to go home, they are free to discharge themselves. But if hospitals are discharging patients in the middle of the night without ensuring adequate arrangements are in place for their return home, they are breaking one of the basic rules of medical care.

The Patients Association receives several calls a week from distressed relatives whose loved ones have been sent home in the middle of the night. How many friends or relatives don't contact the PA?

When I read this earlier in the week I shook my head in disbelief at how the English health service is fragmenting. Irresponsible night discharges are possibly all part of 'the plan'.

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Pill-Popping Isn't The Answer

Portrait of a Pregnant Woman

Raphael c1506

Obese women are likely to have larger babies and rates of caesarians are much higher as are births with forceps and other very serious complications.  Some years ago I worked with a young woman who was obese yet her desire for children transformed her, over a year, into a bonny woman half her original size, with a more contented outlook and a confidence which hadn't been visible previously.

Unfortunately her efforts to conceive were non-productive and her husband and herself saved hard to pay for IVF treatment (it wasn't available on the NHS then).  During her second IVF attempt they emigrated to Canada and we lost touch but I've often wondered if they had a family.

However, society has changed and now obese pregnant women are to be given drugs to stop their babies becoming overweight.

More than 500 pregnant women go to the Liverpool Women's Hospital every year with a body mass index (BMI) of more than 40, meaning they are severely obese and now 100 of them are to be given the drug Metformin, which is usually given to diabetics to reduce blood sugar levels.

The medic involved in running the trial said, "The difficulty comes when you have been living in a particularly way for years that is not healthy.  To suddenly change to a different lifestyle is not easy to do.  Lifestyle change takes time and we would always encourage this as well but the use of Metformin gives us another option when the other is not realistic."

Metformin is a strong drug which may ensure a smaller baby and therefore less risk during delivery, but what effect will it have on the newborn is not known.  I expect this is the reason for the trial but isn't it sad that, in these well-informed times, there are so many grossly overweight women happy to become pregnant in the full knowledge of the risks to their unborn child's health.

Is pill-popping the answer?  I don't think so.

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NHS Privatisation

The video relates to the English NHS but it's important here in Scotland we keep ourselves informed of what is happening in other parts of the UK.

A similar plan could apply to Scottish Water and the Forestry Commission if certain political parties get their way.

Thanks to Dr Grumble.

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Our Elderly Generate Losses Not Profits

A damning report issued this week by the Health Service Ombudsman, criticised the care of the elderly in English hospitals. It is no surprise to a retired nursing friend who lives in England.  She has been concerned for some time about reaching 65 (which is this year) because she knows her health trust treats the over 65s quite differently from younger generations. More than once she's said when we reach the magic 65 we will become second-class citizens in the eyes of the NHS.

I have told her I've seen no evidence of this here but that it's very obviously today's nurses are a different breed from the nurses of yesteryear.  No longer is the overall wellbeing of patients paramount - their sole interest is the medical care of the patient.  Nutrition, personal hygiene and emotional needs are not important.  Part of this is because nurses now need to have university degrees which cannot assess their natural caring skills, but that's not the only reason.

Money is the main reason our elderly's wellbeing is way down the list.  There's no money generated from nursing the elderly.  Dr Grumble and a GP explain their findings.

I'm more than grateful I live in an area where the elderly are treated with as much respect as others.  Also I'm more than grateful that the Scottish government refuse to go down the privatisation road, but maybe they will be forced to do so before long. Why should I feel so grateful when, looked at objectively, I have paid my health insurance all my adult life.  It's a scary time to be reaching the magic age of 65 - particularly for those who live in England.

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NHS and Lobbying

This shows why the three main UK parties think similarly on NHS policy.  Change is well advanced in England.  Do we want Scotland to go down this road?

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The Return of the White Plague

Tuberculosis is a common and often deadly infectious disease.  In the past 100 years Britain has taken great steps to erradicate this crippling disease.  By the early 1980s TB was considered to be conquered in the UK and NHS tuberculosis services were scaled down considerably, after having controlled the disease by the introduction of antituberculosis drugs and BCG vaccination plus improved health services.

Travel and migration has allowed it to resurface as a public health problem in all European countries and there were over 14.6 cases reported per 100,000 population in 2009.  The UK is the only European country in which incidence rates continue to rise.

In London TB has returned 'in force' with 3450 cases diagnosed in 2009 (almost 40% of all UK cases) compared to 2309 in 1999.  This is likely to be an underestimation as sputum microscopy and culture only detects up to 70% of active cases.  Drug-resistant TB is also becoming a problem in the capital, with 172 isoniazid-resistant cases and a further 58 multi-drug resistant cases reported in 2009.

There is an interesting podcast here in which Dr Marc Lipman (UCL Medicine) discusses the challenges of tackling the disease in London, its development over time and why TB is still prevalent today.

Video courtesy of RFB

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Are English Patients Disadvantaged?

I would prefer to contribute something towards any prescriptions I may need but the Scottish Government has decided prescriptions will be free from April next year.  Since coming to power the SNP government has reduced the cost of prescriptions from £8.85 to £3.  Removing the charge altogether is expected to cost around £40 million.

Ms Sturgeon said: "The prescription charge is a tax on ill health that Scotland's poorest families can ill afford. Some have argued that in this financial climate, we should not go ahead with our plan to abolish prescription charges. Well, times are tight and we believe that the last people who should be paying the price of the current economic mess are the sick."

Yet the Taxpayers' Alliance campaign manager Fiona McEvoy complains that this is the latest in a series of moves which disadvantaged English taxpayers compared to their Scottish counterparts.

Does Ms McEvoy not realise Scotland is, very fortunately, not attached to the English health service?  We presently have a government which wishes to use our allocation of the UK budget in the way the people want it spent.  The SNP government show they listen to the people and it's up to the English themselves to lobby their politicians for a similar policy.  It's shameful that English patients with long-term conditions are not given free prescriptions yet millions is spent funding fake charities and some dubious overseas projects.

My suggestion to Ms McEvoy is to use the example of the Scottish Government as leverage with your political contacts in England.  Oh, while you're talking with them, suggest a freeze on council tax.  We've had a freeze here for 3 years now and hopefully it will continue for another 2 years.  It's not how much money you have, it's how well it's used.

In this case the Scottish government are creating policy which the majority support then finding the finance to support it.  That's the way it should be, instead of the present 'what can we do for the money' attitude at Westminster.  Wednesday's announcement concerning our security requirements will be a fine example of that no doubt.

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The NHS and Hygiene

Figures released last Thursday showed rates of MRSA and C.diff are declining in Scottish hospitals. Not before time, because the source of these infections is down to one thing and that is hygiene. Hand washing has become an after-thought rather than a necessity in the lives of many. Publicity about these hospital-acquired infections, which have killed or played a part in the deaths of almost 3000 people in the past five years, may have helped jog the consciences of some, but not all.

Experts claim the bugs are often spread by doctors, nurses and other hospital staff who fail to wash their hands before contact with individual patients. Last year Nicola Sturgeon said that those staff who did not comply with hand hygiene guidance would face action, but only one worker has been taken to task for flouting the rules.

An investigation revealed several health boards, including Ayrshire, Arran, Fife and Tayside don't treat breaches of hygiene rules as a disciplinary issue. Two others, Grampian and Greater Glasgow and Clyde, claim they've no idea how many people they have disciplined because they do not routinely collect information. Unbelievable!

Margaret Kennedy, the hand hygiene co-ordinator at NHS Tayside, said any breaches of hygiene picked up during a hospital audit are used as a training opportunity.

A training opportunity?

Last month Scotland first hospital inspector said she was disappointed by the poor standard of cleaning on wards. We have yet to hear what action is being taken.

But wait, maybe it's because managers are not being well enough paid. Nicola Sturgeon has the answer: 'Managers in the NHS should be paid more.' They should start on higher salaries and progress up the pay scale more swiftly, according to an official report.

They should also receive some form of performance-related bonus - even though the current scheme, which cost more than £1.2 million over 4 years, is found to have done little to motivate staff.

Earlier this month Nicola Sturgeon said she had scrapped bonuses for senior NHS managers in their latest pay settlement because of the financial climate. However, the next day the Scottish Government sent health board chairs the review of executive and senior management pay arrangements, which says they should earn more.

In a covering note, Dr Kevin Woods, chief executive of NHS Scotland, said he had told the chairman of the review group that it had done its job "well". Indeed they have. NHS managers must be feeling much the same a GPs did when they were told their their salaries would rise dramatically for less working time.

Claire Pullar, Scottish officer for Managers in Partnership which represents NHS executives, said she was aware some health boards had found it difficult to recruit and retrain managers.

She added: "The salary is not exactly ideal. but it is also about how you treat people in the NHS, where they can see their career going and if they think they are being treated fairly and equally. We need to look at pay, but also our attitude to how we value managers".

Any person interested in the politics of the NHS knows there is a surplus of managers with the organisation, yet we have the Scottish government agreeing they should be paid higher salaries.

Have I missed something here? If managers aren't performing even after receiving performance-related bonuses in the past, the answer is sack them and replace them with someone who can do the job efficiently. Another idea would be to delay replacing them as it could well be found the post wasn't necessary.

Getting rid of just one manager in each hospital in Scotland could pay for a years supply of bleach to clean the wards thoroughly. There's a thought!

A Sunday Telegraph article discusses hygiene in English hospitals - 'Muslim staff escape NHS hygiene rule'. I make no apology for saying I would refuse to be touched by any staff member who did not comply with the basic hygiene rule of 'bare below the elbow', whether they be Muslim or agnostic. We must have one standard for all. If that doesn't suit certain people for various reasons, then a job in the health service isn't for them.

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Another Scalp for the Righteous

One thing I've discovered in very recent years is that the Righteous don't have a sense of humour. Their lives are spend finding fault with those of us who support the 'live and let live' adage.

A fine example of the Righteous at work is this:

A charge nurse, 33, who had four years' unblemished service, said "It's months since I have been in this position," as she straddled a patient while helping her colleagues control him. She was dismissed for gross misconduct from her £25,000-a-year post at London's Central Middlesex Hospital.

Laura Bowater was on her way home from a shift in July 2006 when she stopped to help staff restrain the 'extremely strong' 31 year old patient whose trousers had been removed so doctors could inject his buttock. She sat on his ankles to control his flailing legs, but the patient span onto his back, exposing himself and kicking her forward. It was then she made the 'humorous' comment which senior staff investigated six weeks later.

An employment tribunal initially agreed she had been unfairly dismissed but the decision was overturned on appeal because, although the comment was heard only by other medics, it was made in a public A & E department.

The NHS has lost an efficient member of staff. The Righteous have gained another scalp.

I really don't want to live in a country which is fast becoming a place where common sense no longer prevails do you?

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Stafford Hospital Management

Much is said in the MSM and blogs today about one of the worst hospital scandals, in which up to 1,200 patients died in Stafford Hospital.  An independent inquiry found that managers at Mid Staffordshire NHS Foundation Trust stopped providing safe care because they were preoccupied with government targets and cutting costs.

What hasn't been highlighted much is the fact that two Chief Executives of West Midlands Strategic Health Authority, responsible for Stafford hospital during 2005 until 2009, have been promoted.

David Nicolson, who was Chair and Chief Executive of West Midlands SHA until 2006, is now Chief Executive of the English NHS.

Cynthia Bower, who replaced him in 2006, was promoted, in 2009, to head of the health super-regulator the Care Quality Commission.

No one on the board of West Mids. SHA has faced censure and all of them were either paid off, walked into another job or allowed to remain in post.

This is a where the problem lies with the NHS.  Not only are politicians setting unachievable targets but NHS management is in no way concerned with patients only budgets.  Not one has taken responsibility for their incompetence, in fact they have benefitted from it.

Surely every person in England must be very concerned that the two top positions within the England health care system are currently managed by these two people who were responsible for Stafford Hospital during the years of complete patient neglect.

Stafford is not the only hospital that has put lives at risk in recent years.  Basildon and Colchester hospitals were also discovered to have jeopardised patient safety in 2009.  The failure in Stafford is not just the story of one badly run hospital, but the failure of a regulatory system that did little to sound the alarm.  It was the Healthcare Commission (now the Care Quality Commission) which did, in the end, sound the alarm after being alerted to the higher than usual death rates.  Ms Bower, who was in charge of Stafford hospital from 2006-2009, is now of course in charge of the CQC.

If I lived in England I would have emailed my MP and MEP by now to inform them of my disquiet about English health care and the people running it.  It's time the public said "enough".

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The Privatisation of Primary Care

Produced and directed by Dr Grumble

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England's NHS Capital Spending to be Cut by 22%

Channel 4 News has learned that England's Department of Health plans to cut expenditure on new hospitals and crucial equipment - known as capital spending - by 22% in the next financial year.

According to the report the Tories, should they be elected, will not overturn the policy.

Wouldn't they be better cutting some of their excessive management?

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Dan Hannan and the NHS

There has been much angst spoken and written in the past couple of days about Dan Hannan's criticism of the NHS on US television (courtesy of Amper's Rants). Above is the video of what he actually said and I have to agree with him. The NHS is an expensive, bureaucratic organisation which badly needs a good overhaul. It doesn't work well.

There are those who say 'it's an entity admired the world over', what nonsense. Which other country has adopted the British system of healthcare? None. If it was so admired surely there would be at least one or two. The problem with the likes of Jamie Sport is that he involves emotion instead of realism into his fondness of the NHS and that is a bad starting point on which to evaluate our healthcare system. In its infancy the NHS was greatly welcomed as healthcare would be available to all. Let's get one fact straight; it is not free, but free at the point of delivery. It is paid for by NHI contributions from those who work and further subsidised by the treasury (taxpayers).

Over the years it has not evolved but rather revolved, stuck in the circle of 'our NHS' rather than a developing 'our healthcare system'. An example is the money that has been poured in to give GPs big salaries, which resulted in GPs working far less hours and a significant number of vacancies for GPs occurred. Many posts, particularly in large cities, are still unfilled even though we are providing a par exellence education in the training of doctors. In recent years doctors, once qualified, did not see any future for themselves within the NHS and have moved abroad where they have many more opportunities and far less interference from government. What are other countries offering our doctors that we don't? The cost of training a doctor is around £500,000 so as well as losing the benefits of their skills, we are paying for the privilege. We have an NHS which has more managers than staff at the customer end of the service.

I doubt if many who 'love the NHS' have ever had the (mis)fortune to use the healthcare system of any other European country because if they had, they would realise the NHS is failing in many ways and it is by no means perfect. We have some of the worst results for the treatment of cancer and heart disease in Europe and we (parts of Scotland in particular), have the worst results for longevity. Other countries have similar social problems yet they provide better healthcare.

In Germany for example, blood test results are usually available within 24 hours. My GP here tells me to telephone in a week. There is no extensive waiting time for specialist appointments in Germany where 90% of the population contribute towards around 1,000 semi-private, fiscally independent, sickness funds (only 10% use private commercial insurance). The premiums are calculated on an 'ability to pay' basis and joining a fund is compulsory.

Recently I calculated that I have paid more here in the UK for my healthcare throughout my lifetime that I would have done if I had lived in Germany. The UK has a two-tier system and the lovers of the NHS do not want to acknowledge that, but it is very evident. On several occasions I have opted for private consultations with specialists for various reasons but the main one is the length of time it takes to have basic scans etc here. In my local hospital the scanning machine is only used 9 - 5 Monday to Friday and if the radiologist is on holiday it is only used for total emergencies, if a radiologist can be found. What a waste when there is a long list of patients requiring the service.

The NHS is Britain is now nearly 10% of GDP, a similar figure to Germany. So often we hear that the present problems within the NHS are caused by the increasing elderly in our population: 15.5% of Germany's population are over 65 with the UK's just slightly higher.

I have used the example of Germany because I have experience of their healthcare system and its quality. It still surpasses the best Britain can offer by way of results and it is not as expensive as the figures bandied around by politicians. It is not my intention to suggest we adopt the same system as Germany or any other European country, but we need a debate about healthcare. It is now time we, as individuals, took responsibility for our own health instead of leaving politicians to make the decisions for us. We've had the smoking tsar, the drinking tsar, the drugs tsar and now the dancing tsar - all people, paid by us, to tell us how to live our lives.

Billions of pounds have been poured into a healthcare system in past years and we see little improvement by way of results. Of course we have some shiny new hospitals but it is the treatment which matters. If we want the treatments that produce the best results, we have to look and listen to those who work in our system, medics and nursing staff - they know what is needed, not politicians. It is the job of politicians to decide the best way to fund a system without interfering in the running of it.

Just published, a post which may be of interest, from the Adam Smith Institute.

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Caring Homes or Uncaring Homes?

A 90 year old war veteran has been banned from visiting his brain damaged 88 year old wife who is in the Canford Chase Nursing Home in Poole, Dorset.

A member of staff telephoned the police last Sunday alleging an assault on a female member of staff by a male visitor.

Dennis Woodward (pictured), an arthritis sufferer, said he lost his footing, because his knee gave way, when he got up out of a chair. "I stumbled forward and held my arms out for somebody to help me, but a carer brushed me aside. I fell and landed on a chair - I must have knocked into her as I was going down. The next thing I knew I was being ordered to leave. I signed out in the visitors book and they showed me out the front door."

Mr Woodard became his wife's sole carer five years ago when she suffered brain damage after keyhole gall bladder surgery. She was moved into the £1,000 a week nursing home in December, since when her husband has spent hours every day sitting by her bedside to keep her company.

A spokesman for NHS Bournemouth and Poole, which funds Mrs Woodward's care, added, "We are aware of the allegations and, with the home, are working to resolve complex and difficult issues."

There certainly seem plenty complex and difficult issue to resolve in this particular home. Somehow I think Mr Woodward's continual presence may be a nuisance to staff and one of the issues. How sad he is stopped from seeing his wife by some 'jobsworth'. Surely, until the problems are resolved, the home and council could organise a social worker to be present while he visits.

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NHS Food and Baby Care

An NHS Tayside roadshow highlighting the importance of food, drink and nutrition to clinical care was launched at Ninewells Hospital, Dundee this week. It is estimated that between 15% and 40% of patients who are admitted to UK hospitals are at risk of malnutrition. Ninewells is playing a significant role.

Dietetic consultant Joyce Thompson said "We're invested a lot of time in training staff to carry out assessments with patients. To begin with we have a discussion with the patient, then we weigh them and work out their body mass index to find out if they're already suffering from malnutrition, or if they're at risk. Patients are involved at every stage from menu to recipe development. There's been a lot of enthusiasm and positive vibes from the wards and the kitchen. At the end of the day, food and drink matters and it's something the patients talk about - they care."

To be honest, if you're in hospital food becomes the highlight of the day for most, or at least mealtime does. To think that between 15% and 40% of patients are at risk is a vast amount. A more interesting analysis would be to see how these percentages relate to age groups, although it is admitted the elderly are more vulnerable.

Now NHS Tayside is offering individual menus to patients, perhaps they can get around to ensuring every patient is able to feed themselves. Just the other week a friend mentioned when visiting her mother, she complained of hunger. It appears she couldn't reach her lunch tray and nobody offered help. Did my friend complain? No, she thought it would be a waste of time with endless letters going back and forth.

I wonder if this has extended to Scottish maternity units? In recent years Bounty, best known for providing "goodie bags" to mothers, have started to take photographs if newborn babies in increasing numbers of hospitals in England, signing separate contracts with trusts in which it agrees to pay out about £1.50 per picture taken.

It's staff - who are allowed to park free on hospital sites while patients and relatives are forced to pay - tour maternity wards with laptops and cameras and after a new mother arrives from the delivery suite they ask to take photos of the new child. If the mother signs up she is charged for the prints.

Surely this is an invasion of privacy - perhaps not legally but certainly morally. Childbirth is stressful enough without worrying about a complete stranger thrusting a camera into your baby's face then charging you for the privilege.

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The Reason the English NHS is Not Fit for Purpose

This video is about the English NHS which has had 12 Health ministers since 1987 making two a year on average and not a single one has ever worked at the sharp-end of healthcare.  Not one. Here in Scotland we've had 3 in 10 years as far as I remember - Sam Galbraith, Andy Kerr and Nicola Sturgeon. Not a much better rate than England really is it, but in Nicola Sturgeon we have a Health Secretary who is highly regarded by the profession and also respected for the grasp she has of her brief.  May she stay long enough to continue to improve our NHS for all in Scotland.

Do watch the video because it is interesting even although the comparison is with Tesco.  

My thanks to Burning Our Money

Update 8 June:  Sam Galbraith was not Health Secretary once Scotland gained devolution, it was Susan Deacon.  Thanks to my reader for correcting me.

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