To be remembered...

As this week's blog has been dedicated to eating disorders, it seemed only fitting to remember that eating disorders often affect young people. This link offers a somewhat chilling insight into those who unfortunately lost their battle against the illness.

Do Role Models Matter?

The short answer is 'yes'. Modelling is the copying of certain behaviours of others which have proved successful, another way of putting this, is to create a short-cut to the end goal.

Nature vurses nurture
The human brain develops long after nature’s unique genetic code has been allocated and subsequent embryonic growth. The brain continues with the capacity and the necessity to develop and learn via nurture. Children learn their behaviour and coping strategies, in part, by copying and mimicking. Learning from people around them; parents, siblings, friends and society in general. Therefore your brain develop as a conglomeration of an infinite source of memories; a bank of situations that you and those around you have found themselves in and how those situations were dealt with.

Imitation and reinforcement
According to social learning theory, behaviours are part learned by imitation of others and via reinforcement, progressively built upon. In fact, throughout life each social situation is uploaded into the brain and the brain has the potential to lay down, modify or reinforce its own hard wiring. Hence, the information the brain gets given is important and perhaps especially so whilst children, as the child’s brain is very rapidly developing social hard wiring.

Brain hygeine
Whatever the precise answer to these issues, there is little doubt that the continual inputs the brain receives from the outside world are important factors in shaping decisions and actions. On a more political level, there is the issue as to whether the media itself should actually regulate some of the messages it sends out given the power which role models can have on people’s lives. This has recently come to the fore in the debate about underweight models being used by modelling agencies, and whether role models actually change society's view as to what is normal or not and what effect this can have on the vulnerable. It's definately food for thought in this blog week I have dedicated to eating disorders.

A Mental health Icon

Kate Elizabeth Winslet (1975 – present)
She is a modern icon and a BAFTA-winning and multiple Oscar-nominated English actress. She is noted for playing a wide range of diverse characters over her career, but is probably best-known for her role in the highest-grossing film of all time, Titanic (1997).

The media, particularly in England, have enthusiastically documented her weight fluctuations over the years. Winslet has been unusually outspoken about her refusal to lose weight in order to conform to the Hollywood ideal. In February 2003, the British edition of GQ magazine published photographs of Winslet which had been digitally enhanced to make her look dramatically thinner than she really was; Winslet issued a statement saying that the alterations were made without her consent.

Kate Winslet considers images of "size zero" models and actresses "unbelievably disturbing." She is known to keep magazines with pictures of unhealthy body images out of her house, in case they are seen by her 6-year-old daughter, Mia.

Quotations from Kate Winslet:

"It's so disturbing, because young girls are impressionable from 11 up to 19 or 20, even. Women are very impressionable at those ages…They're trying to figure out who they are, and they want to be loved, and what I resent is that there is an image of perfection that is getting thinner and thinner, and it's truly upsetting to me."

"I hope that in some small way I'm able to say 'I'm a normal person, I'm doing all right, I've got a lovely husband and children and I didn't lose weight to find those things, and those things are what should be important."

Perhaps London Fashion Week could consider her as a role model.

Thought of the Week

After receiving an unprecedented large number e mails following concerns about eating disorders - ‘thought of the week’ is dedicated to the impending ‘London Fashion Week’ which starts on 11th February.

Eating disorders including anorexia nervosa, bulimia nervosa and binge-eating disorder, affect a staggering 12% of the UK population. The sad fact for anorexia nervosa sufferers is that as many as 20% may die as a result of their illness. This puts anorexia nervosa as one of leading causes of death amongst young girls.

In September 2006, Spain introduced rules banning models with a Body Mass Index (BMI) under 18, from appearing on the catwalk in Madrid. This followed growing concerns after the death of the model Luisel Ramos, who died of heart failure after eating nothing for days.

Unfortunately, this week London Fashion Week announced they would not be following the Spanish lead. Instead, under weight models will be allowed to appear on the catwalk. Susan Ringwood, chief executive of the Eating Disorders Association said "It's a mixed message [the public] get, when they are being told they are damaging their bodies and yet see other people being celebrated for it."

Oscar-nominated actress Kate Winslet has said she refuses to have any magazines in her house that show skinny celebrities because of the damaging effect it could have on her six-year-old daughter, Mia. She described the trend as "unbelievably disturbing". Perhaps we should all consider following Kate’s lead and avoid buying magazines during London fashion week which are celebrating underweight models, and use our consumer power to make a health statement.

News Flash - new book - Why Lawyers Should Surf

A new book entitled Why Lawyers Should Surf is now available to pre-order. It has been written by myself and Tim Kevan.

In an attempt to prempt the question "why lawyers?", the following offers insight as to why we chose the legal profession to write a book regarding work-life balance.

In an early 1990s a John Hopkins University study compared the rates of depression among 104 occupations and found that lawyers were 3.6 times above the average rate of depression. This then begs the question ‘why do lawyers have such a high level of depression’? There are several hypotheses for this, well beyond the explanation that law is a stressful and busy job.

Professor Martin Seligman argues that the key thing about lawyers is that they tend to have pessimistic personality types. When lawyers are asked the famous question: ‘Is the cup half empty or half full?’ most respond by saying half empty. This somewhat pessimistic response may be seen as an actual advantage in the legal profession, because seeing troubles as pervasive and continuing, is at the heart of being a prudent lawyer. The inherent and honed ‘scepticism skill’, enables the lawyer to see every conceivable snare and catastrophe that might occur in legal transactions. Therefore, the ability to anticipate any pending or possible snag or disaster gives a positive legal outcome, as the lawyer can then help clients defend against those negative eventualities. Hence, ‘pervasive pessimism’ and possibly ‘catastrophizing’ can be seen as powerful tools in law, helping to anticipate disaster, and encouraging lawyers to think the worst before it has happened. However, on the flip side of that same coin, is that if you take the same pessimistic mindset home with you from the office, it may form part of the answer as to why lawyers are more likely to suffer with low moods.

Another hypothesis is that lawyers tend to express ‘high-dominance’ as a key feature of their personality; again something which aids successful legal careers. Key features of a ‘high-dominance’ personality include people who: interrupt others, talk longer, take charge of conversations, decide when to change topic, state strong preferences and opinions, have an unyielding manner and tend to enjoy giving instructions and advice. ‘High dominance’ personalities also tend to believe in statements, such as, ‘winning is more important than playing the game’. This may be an integral part of being a successful lawyer who never looses a battle, however, when this mindset is extended outside the workplace it fits less well with life’s challenges. When things have not gone the way high dominance personalities have planned it can be a time when they struggle to manage.

The risk of the inherent pessimism in many lawyers means that they have to be particularly careful not to bring that perspective into every area of their lives. How circumstances are translated in any particular person can have enormous effects on the way they react and ultimately on the effect those circumstances have on their lives. This book will hopefully assist in finding a perspective where even the most difficult times can be seen in some sort of context which can also provide something useful, something to learn or grow from. As Shakespeare said, “There is nothing either good or bad, but thinking makes it so”.

The above photograph was taken by and is copyright of Dr Heidi Tempest.

More Inspiring Medical Stories

William Harvey (1578-1657) and the foundations of physiology.

Back in the seventeenth century science began to looked towards measurement rather than magic. William Harvey having studied at both Cambridge and Italian Universities, took a post in London full of new ideas. One example he gave was that veins contained a series of ‘little doors’ – valves, in fact, which only opened one way. He went onto to start his own department of anatomy and was importantly given the position of Lumleian Lecturer to the College of Physicians.

As part of his duties he was to give public lectures. It must have been a very strange scene on the day he first made public his discovery in a public lecture. On the table lay the corpse of a criminal who had been executed the day before. Harvey, a little dark man proceeded to say things which staggered his listeners claiming that veins carry blood to the heart. He declared; blood is returned by veins to the right side of the heart, is then flooded into the lungs, cleansed by the air in the lungs and passed over to the left side of the heart, and then pumped into the arteries and around the body again. The same blood over and over again. In just one half-hour, he pointed out heart physiology. However, the audience stirred restlessly as Harvey was overthrowing the knowledge that arteries contained pure spirit which had been held by all mankind for two thousand years!

Angry at his reception about his theories which he had worked on for 14 years, Harvey ran out of the theatre. Back in his own laboratory, he continued with his research and another thirteen years after that lecture room day, he published his book with a long Latin title – Exercitation Anatomica de Motu Cordis et Sanguinis in Animalibus. Its publication brought to a head the controversy between the old school of traditional thinkers and the new men of science. His book challenged the old ideas; as result William found his private practice dwindle as his patients shied away from his new talk about bodies.

There were things whispered against him, but despite this, he remained focused on his work. A few years after his death, men of science began to use a microscope and everything which Harvey had said was proved beyond all shadow of doubt.

“It were disgraceful, therefore, with this most spacious and admirable realm of nature before us, and where the reward ever exceeds the promise, did we take the reports of others on trust… Nature herself is to be addressed; the paths she shows us are to be boldly trodden; for thus and whilst we consult our proper senses shall we penetrate at length into the heart of her mystery.”
William Harvey

Obesity - Be SMART

Once again the daily newspapers are filled of stories about obesity, with MP's describing current policy as "confused" or "dithering".

Surrounding all this negative talk about obesity, there seems to be little printed about any constructive weight reduction advice.

This blog offers a helpful weight loss motivational acronym SMART:
S - specific
M - measurable
A - agreed
R - realistic
T – time bound

Using the framework ‘Be SMART to be kind’, offers helpful motivational tips for weight loss:
Specific.
When setting a goal, be as specific as possible, don’t be vague. If you want to loose weight you must consider the details of your weight loss programme.
Measurable.
To be motivated to loose weight you need to know how much you weigh now, how much weight you want to loose and over what time period. Only by collating this information will there be a quantifiable scale to measure. This will help understand how to adjust performance in order to attain the set targets. Interestingly, tracking is unpopular as a motivational strategy, because it often involves receiving unpleasant feedback about how badly you are doing. However, unless you track then you have no idea how you are progressing, meaning you can not modify your behaviour to become successful.
Agreed
It is helpful to have an agreed and structured weight loss programme. Agree it by telling everyone about your plan to loose weight, as this makes it much less likely you will back out and also gives others the chance to offer support and encouragement. Involve others in your routine, this may include going to weekly gym classes with your friend. Link up with others with similar aims of weight loss and all learn form each other.
Realistic
Any plan must consider resources necessary to attain the goals, this is often overlooked as an important part of the strategy. For loosing weight this may include a budget for buying scales, healthy food, trainers and tracksuits etc. Also be prepared, there will inevitably be setbacks during the weight loss programme, but the key is not to let failure put you off persisting. Learn from failure. See setbacks as a resource and a learning opportunity, a necessary part of any journey. Be aware of your own weaknesses, as if you are aware of them you can think of strategies to overcome them. So, if for example, you know you have a weakness for chocolate midnight feasts, then you may decide upon a strategy of not keeping any chocolate in the house
Time bound
Goals need to have fixed timetables and timescale for success, and include sub goals within your timetable. Timescales add pressure to help you continue with your vision. Tracking progress is an essential step in goal attainment but it’s vital that you can be flexible, as any completely rigid timetable is unlikely to work especially if goals are totally unrealistic. Plans may need to be revaluated, but don’t get put off, keep up with the programme.

Finally, be kind to yourself, give yourself a break. Always remember to congratulate yourself on each success, this should be done throughout the programme, with lavish praise each time your sub-goal target has been achieved. This will help you continue with your next target. After all if motivation is analogous to a seed; you need to provide the right conditions and environment for the seed to develop and grow into a flourishing plant. So, don’t forget to provide yourself with the correct environment by praising yourself so this can lead onto a breeding ground for successful sensible weight reduction results.

More of these helpful tips will be available in a book published later this year entitled 'Why Lawyers Should Surf'. (publishing details)

Medico-Legal Expert Witnesses – The Start of a Reform

The Chief Medical Officer (CMO, Sir Liam Donaldson pictured left) is proposing a radical overhaul of the current medico-legal expert system to improve the quality of the service and to ensure a sustainable supply of expert witnesses. The report Bearing Good Witness: Proposals for reforming the delivery of medical expert evidence in family law cases has been launched for a period of public consultation ending on 28th February 2007. The report was originally commissioned in response to some very high profile court cases. One such case, involved the memorable flawed statistical evidence given by Professor Sir Roy Meadow that initially helped convict Sally Clark of killing her two sons.

The CMO’s key proposal is that the NHS should establish teams of specialist doctors and other professionals within local NHS organisations. These teams would be offered mentoring, supervision, peer review and teaching of skills required for court appearances. Currently, the proposals are focused on developing the guidelines for the family courts, however, it is easy to see how these proposals could be rolled out as generic guidelines for all medico-legal expert witnesses.

These proposals come in the wake of legal wranglings as to the professional position of experts in legal proceedings. In 2005, a High Court ruling offered immunity to medico-legal experts from disciplinary proceedings for evidence given in court. However, this has recently been overturned in the Court of Appeal. This was welcomed by the General Medical Council whose Chief Executive Finlay Scott said that they did not believe in any immunity solution “that placed doctors and other professionals beyond the reach of their regulator.”

Overall, it seems that combining accountability with support for medico-legal experts is a welcome combination.

This article will be published in the Medico-Legal Brief Update newsletter. If anyone wishes to receive this free e-publication please sign up at: MedicoLegal Brief Update

Memetag - A blog game

Having been sent a memetag, the result is to step up to the challenge and list five things on this blog that others might not know about me. So here it goes (all in the name of the memetag game!):

1) I have previously worked for a recording studio.
2) I manage the drum section in the band Stained Glass Heroes.
3) Whilst a student I was presented with the dilemma between continuing with my medical studies, or becoming a BBC weather presenter… your screen is safer that way.
4) I used to work as a ‘housekeeper’ in an NHS hospital. The uniform was old fashioned back then, yet even today the uniform remains unchanged.
5) I have been employed as a security guard.

Now it's my turn to pass on the memetag.

What is Liaison Psychiatry?

Recently, I was asked by a reader "what is liaison psychiatry?" Liaison psychiatry is a unique specialty providing psychiatric treatment to patients attending general hospitals, dealing directly at the interface between mental and physical health. Specific liaison psychiatry services were set up in the 1970's and in 1997 liaison psychiatry was recognised as a distinct Royal College of Psychiatry Facualty.

The requirement for liaison psychiatry is evident from the high prevalence of psychiatric disorders within the general hospital setting. In fact, the prevalence of psychiatric disorders amongst general hospitals patients is much higher than the general population[1]. Epidemiological studies have revealed that the prevalence of mental disorders in general hospital inpatients range from 41.3% to 46.5%[2]. It has been reported that unless a specific liaison psychiatry service exists within the general hospital, a significant proportion of psychiatric co-morbidity remain undetected and untreated[3]. To add to this, advancements in medical technology such as, intensive care treatment, organ transplantation and cardiac surgery[2] have had an important knock on effect, increasing the workload for liaison psychiatry.

[1] Department of Health 1994
[3] Mental Disorders in General Hospital Patients Rothenhausler HB. Psychiatr Danub. 2006 Dec;18(3-4):183-92.
[3] Business Case For Consultation-Liaison Psychiatry Service Southampton (Peveler, Kenwood, Martin; August 1995)

Knowledge Brokers - A Welcome Role?

It is well known that advancements in medicine bring challenges to ethical and legal boundaries as to how to apply the new medical knowledge. This week the High Court ruled that a woman in persistent vegetative state (pvs) could be given an experimental treatment, contrary to her family’s wishes. The 53 year old woman had been diagnosed with pvs after she suffered a brain haemorrhage during a holiday in August 2003. The experimental treatment involved the drug zolpidem - a frequently prescribed medication for insomnia. There are a small number of case reports with the unexpected finding that this medication has brought people round from pvs for a few hours, just 20 minutes after administration. One theory is that if pvs victims awake, even temporarily, they can be asked what further care they would wish.

The High Court decided to give the go-ahead for a zolpidem trial, believing that it may offer a glimmer of hope for recovery. This was despite her family being concerned that if she awoke she may be very upset upon learning about her condition. Her family’s preferred option was for her not to undergo any experimental treatment. Unfortunately, in her case, zolpidem did not increase her responsiveness, in fact, it seemed that it had its normal intended effect causing her to become even more sleepy. Following this report the Dignity in Dying chief executive Deborah Annetts said the decision was deeply troubling as "the human rights of the woman at the centre of this case are being ignored, and she is effectively being treated as a guinea pig."

Coincidentally, this week the British Medical Journal (Jonathan Lomas BMJ 20/01/07) discussed the need for the latest research to be made more accessible and more understandable. “In the case of research, accumulating sequential processes reveal…often haphazard cycles of discovery and validation.” To aid communication the idea of ‘knowledge brokers’ was mooted.

With research becoming ever more diverse, it is perhaps increasingly important to be aware of new advancements and consequences before applying new techniques to new situations. In the modern age of an increasingly democratic media, the often mysterious world of research arguably needs to respond with greater transparency. The proposal for knowledge brokers is therefore a welcome one, and if implemented thoroughly it could have wide-ranging effects. Not only would it help to bring together the various strands of learning and research into a more cohesive, interdependent body, it could also be used to good practical effect on a day-to-day basis.

Cases such as the one discussed above, highlight the need for a comprehensive review of all the literature and research available. 'Knowledge brokers' may have been extremely well-placed not only to review the research material but also to explain it to the health providers, family and the court.

Thought of the Week

The death of a child is always sad. Last week mother Rosalind Ponomarenko-Jones buried her 19 year old daughter who died from anorexia. She said "burying a child is probably the hardest thing any parent has to contemplate."

This news comes in a week when some fashion shows are not following the advice that models should have a body mass index (BMI) over 18. Rosalind pointed out "When I was a child, smoking was seen as glamorous, but now we all know that it kills. It is hardly seen in films and never promoted in other media. I think the same should be true of emaciated women. Thinness should carry a health warning just like obesity."

A Life Dedicated to the Safety of Others

Samuel Plimsoll (born 1824)

Upon the side of ships you will find the ‘Plimsoll mark’: a circle with a horizontal line across it to guarantee that no ship is loaded so heavily that the line is submerged under water. His symbol spelled the difference between life and death for untold thousands of sea merchants.

It seems incredulous that ships were actually sent out to sea overloaded and not seaworthy, but heavily insured. The men who sailed in these ‘coffin ships’ were doomed, no trade unions were there to defend them; no laws gave them any protection. However, Samuel Plimsoll devoted his life to championing their cause and fought for change via the House of Commons.

He wrote a book called ‘Our Seamen’, which was an attack on ship owners, for the existence of the extreme evil of coffin boats and for the absence of humane conditions of life at sea. After much political debate, his book rallied the moral force of public opinion and the Merchant Shipping Act was passed. This ensured sea vessels could to be examined and detained if deemed unsafe.

Quotation from Samuel Plimsoll
“I cannot trust myself to say what I think or feel in plain English. I shall therefore put my feeling into my work. And, oh! How I will work!”

In response to Why The NHS Needs People Power, Will Hutton

Will Hutton wrote an interesting article (British Medical Journal13/1/07) suggesting the need for more local involvement in the NHS. However, the institutionalising mechanisms he suggested such as, surveys, citizen juries and focus groups for introducing democracy, may not be sufficient. Once these become more than merely small guides to the direction of public opinion and start to take on the significance of affecting policy, they would have to satisfy certain basic democratic requirements such as fairness, transparency and above all, being open to all. If they were to satisfy all of these, they would stop being focus groups or surveys and instead would be, in effect, the same as local elections. If we are to have local elections, it may be sensible to consider using existing structures.

For example, if the whole structure of the NHS is simplified down to as few layers as possible, perhaps making health authority boundaries coincide with those of local authorities, then many elements of the decision-making process could be handed over to local politicians. For example, with the democratic safeguard, national government could hand over powers to set targets and potentially even budgets. Primary Care Trusts (PCTs) could hand over the power of commissioning to make local authorities in effect into ‘local commissioning bodies’. The local authorities would then be responsible for implementing the will of the people through the mechanism of local politicians. This would not only invigorate local democracy but it would make the NHS far more responsive to local needs.

This has been added as a response to the BMJ article on eBMJ.

Can Gerry Robinson Fix the NHS? – Let’s hope the answer is ‘Yes’.

Management guru Gerry Robinson was the star of a BBC 2 series last night when he was set his ‘biggest challenge’ - to reduce hospital waiting lists. For those of us who work within NHS hospitals, the stories seemed all too familiar. Delays getting patients in and out of theatre (or in reality anywhere), different specialties not working in harmony, committees and sub-committee’s having endless meetings with no conclusions or outcomes…..

He admitted, that after spending just 2 days a week in a hospital environment he returned home feeling “depressed”, “frustrated” and even doubting his own self-belief to make simple changes. Another familiar tale.

So what was his main challenge? He understood that hospital workers were all highly dedicated to their patients, skilled, and often worked long hours under stressful conditions. But what he came to realize, without actually the coining the term, was that his challenge was how to overcome ‘learned helplessness’.

Learned helplessness is a psychological condition, when a human or animal has ‘learned to believe that it is helpless’. It thinks that it has no control over its situation and that whatever it does is futile. As a result it will stay passive when the situation is unpleasant or harmful and damaging.

In an interview with Gerry Robinson he said “It’s actually quite hard to explain, the psyche…you had any number of people saying well we’ve been talking about this for two years, or I’ve brought this up with this committee for the last 10 years.” Historically it has been difficult to take control of a system undergoing rapid regular changes and cutbacks. Often basic questions just never got answered. In simple economic terms it would seem almost impossible to comprehend any business which could not calculate basic supply and demand data. Yet in the case of hospitals, working in the dark and not having access to vaguely accurate patient numbers was common.

So how can we break this cycle? Let’s hope that having people like Gerry Robinson going into hospitals will allow the workers to realize that they are free to be entrepreneurs. He may just be that paternalistic figure who entered Rotherham NHS hospital, and rather than saying "no", said the unmentionable word - "yes"….. this may well be the catalyst to start breaking the 'cycle of learned helplessness'.

More Inspirational Human Stories

Dr. Muhammad Yunus, (DOB June 28, 1940), was the third born of 14 children in Bangladesh. As a banker and economist, he developed of the concept of microcredit, the extension of small loans to entrepreneurs, too poor to qualify for traditional bank loans.

He first got involved fighting poverty during the Bangladesh 1974 famine. He discovered that very small loans could make a disproportionate difference to a poor person. His first loan consisted of $27 US from his own pocket, to a women who made bamboo furniture. Traditional banks had not been interested in offering her such a tiny loan. However, he found that by loaning her money, with a very reasonable interest rate, she was able to finance her entire family. His revolutionary discovery was that by loaning money, rather than just giving money, he discovered the cycle of poverty could be broken.

In 1976, Yunus founded the Grameen Bank (Grameen means "of rural area", "of village") to offer loans to poor Bangladeshis. To ensure repayment, the bank uses a system of "solidarity groups", where small informal groups apply together for loans, and its members act as co-guarantors. As it has grown, the Grameen Bank has also developed other systems of alternate credit that serve the poor. In addition to microcredit, it offers education loans, housing loans, financing for fisheries and irrigation projects, venture capital, textiles, and other activities, along with the other banking services, such as savings. In 2006, he and the bank were jointly awarded the Nobel Peace Prize, "for their efforts to create economic and social development." The Grameen model of micro financing has been so inspiring that it has been emulated in 23 countries.

Quotes from Dr Muhammad Yunus
"I was teaching…and feeling helpless. I teach beautiful theories of economics, and people are going hungry," he said. "Forget about those theories. I'm a human being, I can go and touch another person's life.'"
He advocates that by fixing poverty, you are also attacking a root cause of terrorism:

“We must address the root causes of terrorism to end it for all time, I believe putting resources into improving the lives of poor people is a better strategy than spending it on guns.”

Innovative Ideas - Inspiring people

Dr Sam Everington OBE first trained as a Barrister and then as a doctor. He first made his name back in the 1980s when he found novel ways of highlighting the absurdly long hours which doctors worked. He slept outside the Royal London Hospital, creating a media storm. These days Dr Sam Everington is a GP, who attracts nationwide interest for the idiosyncratic ways in which he uses talented people in his practice area, a deprived part of London's east end. Through his innovation the government now uses his “Healthy Living Centre” as a model. His holistic approach to medicine means that education, employment, housing and creativity are all crucial in helping patients get back on their feet.

His centre is no small undertaking it includes over one hundred projects – a church, complimentary therapies, art studios, a nursery, community care projects, garden projects, a community café and a community cinema. It is a unique partnership between the private, public and voluntary sector.

Apparently the first thing former secretary of state for health John Reid said when he came to visit was, "Where's the NHS sign?" But Sam reminded him who the centre belongs to – the patients. When Sam talks about setting up such massive centres, he does not give false hope, but believes in being a "can do" person with a strong belief in the end goal. He strongly encourages other doctors and believes they too have the potential to be great entrepreneurs. What an inspiration.

Why doesn't the NHS profit from its' own data?

To continue with the theme of starting a new year with developing new ideas, this proposal includes:

The NHS should profit from data it has already collected.

Within the NHS, it is well known that there is a divide in the service between medical staff working with patients, and managerial staff working with finances; a sort of ‘them and us’ mentality. It is sometimes difficult for medical staff to see the good results produced by managers, all too often focusing on frequent messages about cuts and targets. Yet indisputably, management is imperative to allow the medical profession to continue the caring role. Is there a way to encourage NHS management to directly aid the NHS budget?

Currently, NHS management collect data - a high value commodity. Increasingly, there is awareness in partnerships between public and private health care providers. Prior to private companies offering a service, they research supply, cost and demand figures. This data is often collected by telephone surveys, with vast quantities of time spent talking to ward staff, taking them away from their primary role of patient care to discuss bed availability. Yet, every good manager already collects this supply and demand data, very accurately, within their hospital. For example, the data may include bed numbers for each specialty and sub-specialty, giving supply data, and then the occupancy of these beds, showing demand data. Another example would be how much it costs to run these beds. My proposal would be to ask mangers to publish this valuable data on a monthly basis, offering the following advantages:

1) Publication of the data already collected by managers would allow interested parties (often private health companies) to buy this data, and in turn provide the NHS with a revenue source.

2) Publication would aid the integration between managers and health care workers, as the importance of the data collated by managers would become evident.

3) Managers and health care workers would be encouraged to work together, in turn, improving the accuracy of the data collected.

4) Publication of data would increase the accountability of managers and increase motivation to illustrate good value for money.

5) Publication would provide valuable NHS data for strategic planning.

The NHS should not be encouraged to be secretive about information, however, why not allow the NHS to collect revenue from the vast quantity of data it has already collected.? Indeed, the Freedom of Information Act 2000 (Section (19) and other provisions) deals with the possibility of charging fees for information intended for publication.

In conclusion, NHS data knowledge could provide a further useful funding source.

New Year Resolutions - New Ideas

As the New Year starts many people have decided to make the 2007 resolution to get fit. This seems an honourable endeavour - yet is there a way of doing this whilst also helping society or the environment?

One idea may be to actually generate energy whilst burning off calories. This could be done using 'alternative fitness centres' with gym equipment that generated electricity whilst people exercised. The quantity of energy produced could be displayed individually or combined in groups to encourage teams representing communities, firms or schools. Currently, most existing gyms have a system whereby to expend calories you are using a machine using electrical energy during operation. Hence using electrical energy to expend human energy, but why not use the human energy and transfer to storable energy?

Simple modification of these gym equipment designs could incorporate small generators that feed into the building energy system. For example, a fitness cycle could be fitted with an alternator via the flywheel instead of using air or magnetic resistance. The gym building could also be designed in a highly energy efficient manner to include power generators such as wind turbines and solar panels incorporated in the construction.

So next time you go to the gym, have a think whilst on the running machine, if there is a way you could burn your calories and help the environment.