Home held physiotherapy notes

The body responsible for information technology in the NHS, Connecting for Health, has announced that they will be running a trial study of giving patients access to computerised versions of their hospital records from home. This seems further evidence of the loss of direction with the NHS information technology programme. It sound a really nice idea to be able to look up records from home but it seems a bit of a waste of time.It's going to make little or no difference to patient care and carries with it a huge security threat. It will be only a matter of time before a determined person will compromise the security of the system and confidential records will be available to unauthorised people. There's also an issue with the rules being changed (all in the interests of national security of course) whereby the police and other government agencies will be allowed to access the computer to find people or get personal details. If this is linked with some sort of pin number or swipe card which will have to be used every time a patient sees their doctor or goes to hospital then we will always be under survailence. It will be interesting to see how this move could affect physiotherapy records and record keeping in general. It will "dumb down" records because in effect they will be on display to patients and it will force further changes in attitude to documentation. The one ray of hope is that at present it will be possible to "opt out" of the system. No one has clearly explained how the computerisation of records will be an advantage. The idea of any member of a healthcare team being able to access the record is good but that has to be offset against the inevitable paralysis of the health system on those days the computer system fails combined with the massive costs in setting up and running plus the security risk. It looks like the people who initiated this have been so seduced by the technolgy that they have lost sight of its purpose.

Health promotion

Understanding long term health problems is crucially important in the future of health services in the UK. Important long term conditions include heart disease, cancer and diabetes. In the last 2 years there has been a lot of attention given to childhood obesity as a long term health issue but it has come to light that the current short term priorities in health planning are threatening a long term study into activity and diet in children with diabetes. a study being undertaken in Plymouth will be forced to stop at less than its half way point because the Government funding body does not want to commit to long term projects yet there has been no shortage in projects on which public money has been wasted. There is serious shortsightedness in healthcare planning when something which could make such a difference to the understanding of children's health problems such as this study faces being closed down whilst so many meaningless projects are funded. This is yet one more example of how healthcare funding priorities in the UK are driven by short term political objectives rather than a real desire to change health. At the best the desire for improving health is confused and short sighted. At its worst it deliberately manipulates public fears and aspirations for narrow political gain.

media health scares

It seems that the media are always on the lookout for a health scare to fill out the contents of the evening news or the front page and the latest of these in the last few days is additives in children's medicines. A few years ago it was media scare mongering about the MMR vaccine. The main problem is that often popular reporting of health issues is distorted, sometimes deliberately to produce a good story. The last thing a journalist wants is for viewers or readers to ignore the item and go to do something else. With the latest thing about additives it's not clear if this is just a case of the reporting lacking balance or it there has been deliberate distortion to create an emotive news item. As with the MMR hype the problem with this health scare is that it ignores the problem that the treatment aims to solve. In the case of additives the idea is to make children more likely to take the medicine. If anyone has experienced the bitter taste of adult paracetamol tablets it is easy to undestand why there might be the need to improve the taste of children's medication. Which is more important, for a child to take the medicine or the child to avoid tiny amounts of additive taken on an occasional basis? It seems possible that if there is a push to make medicines additive free then things will resort to Victorian methods of having to use a teaspoon of sugar to help the medicine go down, or else brute force. Being logical about this the whole issue is somewhat contradictory; there is a fuss about children taking tiny amounts of additive on an irregular basis but no one questions the effects of the chemicals that the additive is meant to disguise.

Time to call time on the NHS?

Amongst all the pressure on the NHS and the privatisation by stealth there has just been a radically new idea suggested for regenerating a Surrey Hospital. Apparently Epsom District Hospital could be bought up by a millionaire and turned into a charitable trust. This is probably only one step away from NHS foundation trusts. It would be interesting to see if running a hospital as a charity would be any more effective than via government funding. The problem with the current funding system is that it is complex beyond belief, subject to the whims of politicians and fails to reward good practice. One idea which at the moment has not been aired but is a "fourth way" in NHS structure is having a totally independent NHS, free from Dept of Health control, a bit like the BBC where it would receive an allocation of money but it would be up to the organisation to plan it's own services without significant Government involvement. It's hard to say if this 4th way would work any better because at the heart of the problem is trying to meet infinite demand without always increasing the resources. This is something that politicians are not willing to admit.

Job losses and over regulation

The NHS crisis continues to deepen. News out today reports concern by senior NHS managers about duplicated regulation within the NHS. Also annonunced today is the loss of 100 NHS jobs in Warrington. There are myths being put about to support the over regulation and cutbacks in the NHS. Regulation is meant to bring about safer, better healthcare but it can be called another name;bureaucracy. The current levels of regulation are ineffective because they are essentially a bureaucratic process. The mistake made a long time ago by politicians is to think that healthcare is like any other service industry when in fact it is unique because of its complexity and its lack of standardisation.With the latter features millions of decisions are made daily on the basis of judgement not a predetermined set of criteria. The lapse of regulation into bureaucracy comes about because regulation is applied as if healthcare is something standardised and easily measurable. The tragedy of job losses in the NHS is underpinned by the myth that this is part of restructuring into better, more community based hospitals with patients needing shorter stays and much more being treated as day cases. That's the explanation that's give when jobs are being cut. What is totally unclear is why have these hospitals trusts and other NHS organisations gone on knowing all along that they could provide their services in a much more efficient way and it needed a crisis in the funding to make them be more efficient? Why have they only just decided that what they were doing was so inefficient that they can cut large numbers of jobs AND make their services better?

Skin cancer

Recent reports highlight the growing munbers of people getting skin cancer especially in younger age groups. Perhaps the time has come for the physiotherapy profession in the UK to embrace a wider health education role and instead of restricting its education to mainly postural and exercise education it promotes health in the widest sense. UV skin damage through sunbathing is a long recognised risk but what many members of the profession do not realise is that physiotherapists at one time undertook ultraviolet treatment, themselves not doubt contributing to patients' UV damage to their skins although in a worthy cause (usually trying to treat psoriasis or acne ) Physiotherapists being a fun loving bunch, are also are at risk of skin cancer from summer holidays spent on the beach. maybe we will be facing a situation in the future where smoking declines and with it lung cancer to be replaced by skin cancer as a higher risk. The problem is that it is possible to tax or ban smoking but you cannot do that with the sun.

NHS protests

Up to now the physiotherapy profession in the UK has been rather ineffective in its protests about the adverse effects of NHS changes. These impact on the profession in a number of ways including job losses, reorganisation and graduate unemployment. However in the last few weeks ther has been a growing amount of protest by many other workers in the NHS and it will be interesting to see how physiotherapists respond. Reading some of the things written within the profession one could almost believe that the profession is in its high summer rather than facing the biggest crisis since the foundation of the NHS. There are many outstanding individuals within the profession who are achieving massive amounts but as a group within the public sector there is a growing threat posed by managers wishing to save money and for whom physiotherapy means little because they originally were nurses or accountants. The growing voice of dissatisfaction amongst NHS staff needs to include the concerns of physiotherapists.