Thursday, 19 February 2015

NHS Waiting times.

Its not often I get to blog from actual experience and while I cannot claim to work for the NHS department responsible for dishing out statistics, its fair to say - from my desk situated at the throbbing heart of Scotland's National Health Service - I can offer something of an insight into How Things Really Work.

This post might be a bit dull, so I'm including The Seven Wonders of the World to keep you interested. The Great Pyramid of Giza is first. Impress friends at dinner parties by referring to it by its lesser known names; The Pyramid of Khufu or Cheops.
First of all, I and the people who sit around me are the NHS staff most folk want to see the back of. It's in this building (among one or two others) where all the managers and bureaucrats so reviled by the taxpaying public work. However, people who work here do things like make sure lead gonad shields and aprons in x-ray departments aren't riddled with holes, negotiate contracts to make savings worth millions, plan new hospitals & health centres so they are fit for purpose - like checking doors are wide enough to allow ordinary or bariatric hospital beds (that we buy) to pass through or that new over-bed tables will actually go over the beds or (somewhat more critically) making sure women's bits aren't overly irradiated during mammography scans plus a heck of a lot more besides.

The bit that I work in concerns itself with hospital equipping; its where the people who know about things like electro-medical or lab equipment sit. You can't just go out and buy a blood analyzer, pharmacy robot or a PACS imaging system for medical imaging (be that x-ray, CT or CAT scanning.) These things are often part of the fabric of the building so require a fair bit of forward planning.

The Hanging Gardens of Babylon. Babylonian Priest Berossus attributed their existence to Neo-Babylonian king Nebuchadnezer II - he was so cool; in The Matrix, Morpheus named his ship after him.
The next time you're in a hospital or health centre, look out for bins - why? because bins are a pain in the arse. Every room must have at least one and it needs to be the right kind. If its a treatment area it'll need to have a domestic bin and a clinical waste bin - they'll also need to be the right size. I haven't even mentioned user preference - I mean to say - you'd think a bin was a fucking bin, but its not. You get solid walled bins, bins without walls, plastic bins, metal bins, bins of different colours (white for domestic waste yellow for clinical waste and red for body parts (joking) the entire bin can be coloured or just the lid.) You get soft closing bins (the standard these days) and waste paper bins also of different colours and capacities. Where I work, we make sure every room that needs a bin gets a damn bin. Take a project like Aberdeen's Emergency Care Centre; across seven floors we distributed 693 sack holders, 329 small pedal bins and 429 sanitary disposal bins. And its not just that, its everything from plug sockets to bog roll holders and paper towel dispensers, laboratory equipment to gamma cameras and CT scanners.

Zeus at Olympia; made famous by Laurence Olivier in the original (and much better) film Clash of the Titans.
Over and above all of this, for clinical areas we also have HAI compliance - which stands for Healthcare Associated Infection - this is the reason nurses get all frowny when you sit on hospital beds or patient chairs, its why there are bottles of hand wash every five metres and its why buying hospital equipment isn't straight forward. For example, in examination areas you won't see any fabric covered furniture, it'll be vinyl; there will be blinds instead of curtains and there shouldn't be any untreated wood visible - even floors in new builds curve as they join walls so germs can't congregate in hard-to-clean corners.

But I digress.

This is also where the people who punt out all those statistics on waiting times, cancellations and attendances sit - its called Information Services Division. I say that, the name might have changed, we've just been through a reorganisation and if I'm being honest, I'm no longer sure what division I work in, never mind ISD.

Temple of Artemis at Ephesus. Sometimes (although less accurately) known as the Temple of Diana - what ever you do, don't let The Daily Express know. 
In the 'news,' you'll never guess; we have Jenny Marra from Scottish Labour claiming credit for an SNP government U turn which didn't happen on a policy which up until that point Labour MSP's didn't give a shit about.

Its been a while since 'Scottish' Labour had the reins of government in their grubby little mitts, but when they did - they didn't report NHS statistics with any regularity - which leads us to my point.

As you would imagine, its a lot more complicated than you might think - to go from quarterly to weekly reporting is no mean feat, in fact, I imagine it'll present significant challenges. There are fourteen NHS boards in Scotland who collect & own the data required. Sitting to one side is National Services Scotland which is essentially thought of as another board but is mostly not patient facing - its where all those pesky managers and bureaucrats are - all that data coming from the boards needs to be shared with ISD (which is a division of NSS) then crunched.

The Mausoleum at Halicarnassus. Well this is awkward, A.K.A The Tomb of Mausolus, who was interred there with his wife Artemisia II of Caria... Who was also his sister... (As you do...)
Except the word 'crunched' doesn't do it justice - its massive undertaking in terms of computing time. Also some of the data is patient identifiable - a huge no-no - so needs to be anonymised. After that it needs to be checked and checked again.

Take Orkney, home to the smallest NHS board serving just under 20,000 people. In Dec 2014, 419 A&E attendances were recorded. Hospital in-patient activity to September 2014 saw 1457 (Quarterly figure) patients treated across all specialties. At the other end of the spectrum you have Greater Glasgow & Clyde who's A&E departments saw 36,118 patients in December 2014 and saw 423,926 in-patients treated to the end of September 2014.

The Colossus of Rhodes. Accounts differ, I like to think he stood astride the entrance to Mandraki harbour as drawn above. It was a statue of Helios; the Greek Titan-God of the sun. Some say Colossus referred to its height (some 30m.) There are scholars who believe it is what seafarers thought when they looked up and saw his 'package' as they entered the harbour. (I made that up.)
I know I'm being a bore, even finding the information in the previous paragraph took monumental patience and while I didn't contemplate suicide as such, I never ruled out self harm.

Suffice to say, those figures represent the two boards at either end of the range in terms of population and represent a fraction of the patient facing activity all boards take part in. We haven't even mentioned the number of GP appointments or home visits, or talked about referral waiting times across all the various services the NHS in Scotland provide - not limited to cancer care, child health, drugs & alcohol misuse, dental care, health & social community care, heart disease, maternity & child birth, mental health (adult and child), sexual health, strokes and a good bit more besides.

The Lighthouse at Alexandria.Finished in 247 BC, it was finally abandoned in 1323 AD after earthquake damage. During that time, it was the tallest structure (120 to 137m tall) in the ancient world - which is impressive, but not as impressive as Helios' balls as you entered Mandraki harbour.
To get stats in all, or even some of those areas published on a weekly basis is going to be tough. I'm told the relevant departments are enthusiastically recruiting statisticians and analysts - bearing in mind, a large number saw their jobs evaporate during a previously severe workforce contraction - to get the figures out on a monthly basis. 

No doubt the clueless (and slopey shouldered) Jenny Marra will be on hand to bemoan the number of so-called backroom staff employed by the NHS in Scotland.

Tuesday, 17 February 2015

The Workhouse Comparison.

Many will have seen on Twitter or in newspapers the claim that Westminster parties would dearly love to bash those in receipt of welfare even more by bringing back the workhouse. Its said half in jest, but how accurate a claim is it?

The image above is the first paragraph from the main entry on Wikipedia about workhouses, the gist of which is, a place where people could go for accommodation and work - since you couldn't go there and not work, the former was very much a condition of the latter.

You might think David Cameron's ideas around young folk doing community work isn't so bad. Certainly, conditions won't be anything like as bad as those you'd find in workhouse of ye olden days right?

There are those who scoff when you make the comparison - but, leaving the terrible conditions in the past - is there so much of a difference and if there is, is it a bad idea?

First off; what David Cameron suggests is comparable to workhouses. If you don't do the 'community work' you don't get paid and if you don't get  paid you don't eat or maintain the roof over your head - that seems to be indisputable.

Even East Lothian had a poorhouse (Scotland's versions of the workhouse.) Situated in East Linton but long since knocked down to make way for a community centre. (Photo H/T to © Peter Higginbotham.)

Secondly; what kind of community work are we talking about? Is it work in local business' that might otherwise be done by someone who was paid - as in 'a job'? The example given in the article above said "...such as making meals for older people." Its a bit vague, we can't say if that could be a paid job or not, (we might also be suspicious of the quality of said meals if those preparing them were less than chuffed about having to do so.) Is it going to be painting swings or railings in local parks? Because that falls within the remit of community service - which is a thing people get when they've been bad - not being able to get a job between the ages of 18 & 21 isn't a crime, its a symptom of shitty governance.

Or could it mean placement in already existing voluntary organisations? Having worked in that sector (paid and not) from experience I can say, that won't work. For a start, as soon as you compel people to do a thing, its not voluntary and the very nature of voluntary work is that its, ummm, voluntary.

Is this not just Workfare for the young, or will it be valuable experience in the work place? Given some of the experiences with Workfare where people in work were laid off then offered the same job back via the scheme - it could be problematic. Workfare did specifically include private enterprise in placements, will that be the case for this latest Tory wheeze?

The ambiguity will be deliberate because this will appeal to huge swathes of the population who feel young folk are getting a free ride, it would be easy to agree with them, if you're prepared to exclude all the complicated contributing factors that surround the problem. Or do we think Westminster parties would altruistically give young people who predominately don't vote, who are also in receipt of benefits meaningful, valuable employment experience over a quick gain from a soundbite policy, a cheap source of labour for big business or being seen to do something about the 'youth of today?'

Or could it be that there are very few jobs in the market for these young folk to apply for and those jobs that do exists, do not represent employment of a kind that would be recognised by the very people who'd support this kind of policy?

It seems to me, the age group this is aimed at - having been that age myself in the dim and distant past - when dinosaurs roamed the plains and we used to get lumps of coal to play with - is a formative time. We should be doing our best by these young folk, not treating them like criminals or second class citizens.

We'll rue the day when this kind of treatment becomes the norm. While vassals of the British State run around sticking fingers in the fractured dyke that is Britain, they refuse to step back and see that plugging holes or slopping vapid policy filler around the ever-widening cracks just won't work any more.

Make no mistake, this policy - so attractive to pinch-faced Tories and their Labour imitators - is just so much watery grout thrown at the crumbling battlements of a doomed system of government, far from being answer to what ails the UK, its just another part of the problem.

Friday, 6 February 2015

Warm toilet seats.

I won't go over old ground by talking about the Ashcroft poll that came out earlier this week, except to say; while the prognosis for Labour and the Lib Dems in Scotland looks bad - we shouldn't sit back. I'm not talking about activists from all those incredibly worthy organisations like Women for Independence, Business For Scotland or National Collective (to name but a very few) because they'll be doing their thing regardless - they don't need to be told.

Don't panic, everything is fine - 'Scottish' Labour have deployed Hypnosquirrel
Its us I'm talking about. We need to be out there boring the pants of friends, family and neighbours - well hopefully not boring them but certainly bringing up the subject of the General Election and who they might be awarding their vote to.

With most of the Scottish media doing its best impression of a party political broadcast for 'Scottish' Labour, we need to do our best to remind our peers, pals and co-workers just how astonishingly crap they are.

Look in to those eyes, you can't resist...

Is it safe to discount the Tories in Scotland? I'll stick my neck out and say yes - they're still marginalised in Scotland. The Lib Dem's on the other hand may elicit in those who previously voted for them a pity-vote. We've all got a soft spot for Charles Kennedy - the Liberal Democrat's answer to Party Boy - but we must stand firm against wishy washy emotive voting. If you feel yourself wavering in the polling booth, remember that Danny Alexander is a Lib Dem and uses your money to cart his wife and kids around the country - he's also simpering, Tory-enabling git.

Not around the eyes...

In Scotland, the problem has always been with trust - for years the SNP have been portrayed as chancers, usurpers and lightweights. Westminster pulls around its narrow, sloppy shoulders a thick cloak of effrontery - that a party might challenge the British State's hegemony - its treated as risible and the UK Press - grasping cheerleaders of the establishment - stands by ready to parrot the Union mantra of the day.

You are feeling sleeeeeepy...
Its not all about the SNP of course, if it makes any one feel better, they are a conduit (one that happens to be not bad - but not perfect either - in government) to something better. Imagine a Labour party that actually works for Scotland instead of enabling the London Head Office to gain votes in constituencies in the south of England? Imagine a Tory party ready to do its best for business' based in Scotland instead of the City of London? And imagine Liberal Democrats working hard for - ummm... Doing its best to - erm... Fighting hard for - something?

Could these poll results mean enough people in Scotland have finally realised the problem isn't left, right or middle; or capitalism, socialism or libertarianism - it's the union? Not to put too fine a point on it: its fucked.

Your eyelids are getting heavy...

As the latest EVEL turd shat out by the Tories via William Hague lands on the floor of various Westminster meeting rooms with a wet plap - any attempts to limit Scottish MP's voting in the house of commons is going to be fraught with problems - the Smith Commission's output was only ever going to be useful as scrap paper for primary school kids to doodle on, and even then - only if they did one-sided print runs.

Vote Labour and buy me some nuts...

Or does Scotland still suffer hopelessly and terminally from Warm Toilet Seat Syndrome? I know what you're thinking - what exactly is WTSS - well I'll tell you. You know when you're faced with the incontrovertible actuality that you need to go for a 'sit down', but you are far away from facilities offering optimum comfort and peace of mind? Which is a particularly verbose way of saying, you need to go to the toilet and the only available option is to use a public convenience - forgive my delicate Victorian sensibilities... You find a moderately clean looking cubicle suitably equipped with a door that locks, an adequate supply of toilet paper and no holes drilled in the walls in suspicious places.

You remove/decouple/unlatch (delete applicable) clothing as required and hover gently over the toilet seat - only to find on contact that it is disconcertingly warm. This is traditional Westminster voting in microcosm. As you cast an exasperated vote for the usual party - you are simultaneously repulsed and comforted. Equally; as you sit there - waiting for your bowels to evacuate - its nice that the toilet seat is warm, but the thought that it was made so by the arse of a perfect stranger whose personal habits you know nothing about, doesn't bear thinking about.

Soooo veeeery Sleeeeepy...

I'm not for a minute suggesting that if Scotland was an independent country, we'd all be able to defecate comfortably using brand new toilet seats or that if a toilet seat had been pre-warmed, some sort of notice - a Post It note for example - would be affixed to the wall describing the essence of the backside that took the chill off it.

I think what I'm trying to say is, perhaps we've reached a tipping point in Scotland. None of the London based parties are trusted any more - voters are no longer content to cast their vote based on the old two-and-a-half party system. They realise old voting habits offer little else but cold comfort because once the vote is in, their hopes and aspirations are flushed down the bog the next time their newly (re)appointed MP sits down on their pre-warmed (by an unpaid intern) luxury toilet seat (purchased with parliamentary expenses) for a dump.


For what it's worth, I'm still not sure the voting intentions as shown in Ashcroft's poll would necessarily equate to a Yes Vote if one took place tomorrow - my suspicion is, that while people are fed up with Westminster politics, enough of them still prefer a warm toilet seat - which is why ordinary folk like you and me need to re-initiate the kind of momentum that existed during the independence referendum.

Although I wouldn't use that warm toilet seat analogy - its terrible.