Weekends stop people dying of overwork

We could move to a more complicated system of alternating work and rest – which includes family life, bringing up children and assorted things that make the world and the people in it work without directly making lizard richer.

But it needs a better quality of thought than any the current UK Government has ever displayed to make it work.

Consider: 2 people in 7 of you – that’s you sir, you madam, and the chap 9th in place down that line and so on – Your week no longer starts on Monday, it starts on Wednesday for half of you, and Thursday for the others.

Of the other 5 in 7 of you, 1 of you now has their Monday on Saturday, and another 1 has it on Sunday.

That leaves 3 of you to do the work that used to need 5 people working together on each day. Including Sat and Sun.

You only need to do 5/7 as much work each day, so that’s OK if you all did the same thing – moving stuff or whatever.

But if you did a job that needed 7 different people (but particular people, not randoms: Adam, Brian, Clarisse, Diana, Eudoxus, Frank and Georg/ina let us say) standing or sitting next to each other or in the same building at the same time or even able to exchange emails quickly to sort out stock levels, customer service, the assembly of an engine or how to analyse complex multi-dimensional data in real-time then you are suddenly stuffed.

No, you can’t just carry on the way generations of your forebears have done, because we have a conservative and unionist government which is not going to conserve any old ways of working just because they have been arrived at over generations and people like them, any more than it is going to keep up union of England with the rest of Europe (and that means you, you Scots. My mother left me a Mackintosh, I may start wearing that tartan).

So … you work in a nice small firm/hospital of a convenient size and place … shut it. Combine with another 2 of the same to make something that can skew its teams over the 7 days.

it won’t fit on any of the existing sites? Well no. Nor will that hospital be in the right place for the 3 times as big catchment area.

So knock them down and build them again, bigger, mostly elsewhere.

Yes sir, that is indeed In Your Back Yard. And the traffic will be coming down your road as well.

Are you getting a hint that some of us have been thinking about this for 30 years… and that none of those people are Jeremy Hunt MP? Nor his Treasure of a friend or Prime Minister?

Check the arithmetic. Feel free to disagree over quantum.


The Times and the NHS again

The Times used to be a newspaper, one of the world’s greatest, and checked its facts and by and large didn’t say things that are not true.

Its leader is reported to me as saying :-

‘GPs bear some responsibility… It is hardly surprising that A&E departments are overrun in areas where they are the only part of the health service open after 5pm or at weekends… Yet the introduction of roundtheclock GP service is being fiercely resisted by claims of insufficient funds… Given their current terms of employment… GPs must earn their generous wages… By doing more to ease the burden on hospitals.’

There are no areas of the country where A&E Departments are the only parts of the NHS open after 5pm or 6 pm or 7pm overnight or at weekends. None. (BTW, the people working in them like to call them Emergency Medicine Departments this century) .

General Practice provides a service around the clock, including at weekends. It is provided by GPs, the same GPs in general who provide a day time routine service.

The service is not identical, expecting to have a routine blood pressure check and advice on treatment from your GP who knows you is sensible, but expecting to have it at 0300 as well as at 1000 hours is not sensible, there is only one of me, I’m a diurnal mammal and I sleep some of the time. If I’m your GP I suggest you see me, not someone random unless you are suddenly ill.

However, if we were to run 24 hour surgeries for all routine work, to which you would presumably arrive on the 24 hour bus or Tube service, by the taxis which run as well at night in all parts of the country as they do in the day, or by walking along the roads which perhaps have their lights turned out to save power at night, there would need to be more of us, or we would need to be less available in daytime.

Also open all the time is the 111 service.

111 sends a lot of people urgently to Casualty (A&E, ED) departments often by ambulance. This isn’t helping.

111 is a franchise, let by the government to various corporations and others, and is only regarded as a great success by those running it, or in positions which would be imperilled by an admission that it is not the greatest thing since sliced processed cheese.

What is the agenda of the Times and its leader writer? And what investigative journalism did they do, and fact-checking? Does the Times still employ a fact-checker?

Dr Ebdy’s letter to the Daily Telegraph

You report today (p6) that the coalition has achieved an improvement in cancer survival rates.
How is it that when statistics are poor it is my fault, but when they are good it is down to the Government?

Dr Mike Ebdy
General Practitioner
Health Centre,
Mark Square,
West Lancashire

Oddly, not published but to the point.

(As another colleague points out, the cancer survival figures are for cases starting at least 5 years ago, and therefore actions leading to improvement are not very likely to have been initiated in this government.)

Oops! The hospital records have been sold


“Hospital records of all NHS patients sold to insurers
Hospital records of all NHS patients sold for insurance purposes days after controversial plans to extract patient data from GP files put on hold “

Portable training for voice recognition systems

I’ve experimented with ViaVoice and Dragon Dictate a little, and come to the conclusion that Sphinx is probably the way to go, however how to use it is a bit of a riddle.

What is clear is that systems which rely on training to a single individual should also be built portable, so a doctor in a particular post can take their voice model files on to the next occupation, or so that when a random doctor with an NHS Smart Card arrives and logs in, their voice model files become available to that computer, or to the server, and to whatever is runing on it. Indeed, the voice model would probably arrive from their student or school days.

Doing recognition as a slow batch process, throwing unconstrained cycles at it, seems more sensible workflow than doing it in real time and blocking the speaker. Therefore recording the voice file digitally, then sending it to a directory or server where it is processed on the server before the text and the sound are presented to somone for finishing the document seems the way to go.

Much science on it, and Sphinx, at

We know how to run cascades of information

And it isn’t the way the Department of Health does it in the NHS.

I suspect this is an indication of the ingrained habit of DoH and NHS administration, that people have to be used to do repetitive things, and it was out of date last century.

In each area:-
Set up a list of doctors and one of each other set of people of interet.
(You can do this by advertising the existence of the list and letting people sign up to it, but this may lead to you realising many people don’t pay any attention, and some may fail at it, so by all means make that list. Then tell off one admin. person to keep it up to date.

At each subsequent layer – there may not need to be more than one, but whatever – hold a list of lists.

Now, each alert goes out to a listserver – one address. That list goes notionally to other listservers, and is echoed to the lists in the lists of lists.

The time from the desk of the PA to the Chiefe Medical Officer to my inbox should be around 11 minutes with this, and nobody gets in the way.

(Watch the movie “Wargames” – “We’ve got to get the humans out of the loop!”)

At present people are used at each level to badly perform the tasks easily done well by computers.

And that as well as daft and ineffective is one of the things to do that seems to me evil.

(Watch the movie “The Matrix” to get a feel for why).

Windows and Shingles?

winauth.nhs.uk is not responding to HTTP or ping requests. It seems to be some sort of arguably pointless authorisation server for pages on NHS Choices – the front page of the NHS. The announcement that the Shingles vaccine will be introduced from 1 Sept. is a good bit of front page news, but clicking the link as invited gets a long wait and then a failure notice. I know it is hot, but come on.

Prefatory to Francis: good hospitals are run by doctors.

“In 2011 Dr Amanda Goodall from the Cass Business School published, in the journal Social Science & Medicine, her findings of a strong positive association between the ranked quality of a hospital and whether the CEO was a physician. This paper at long last nails the myth that doctors do not make good managers. Medical and other health professionals should urgently be restored to the highest levels in hospital management if the problems to be revealed by Robert Francis, QC, are to be dealt with in a radical manner.
Sir Miles Irving ”
http://www.thetimes.co.uk/tto/opinion/letters/article3677766.ece via a colleague on DNUK

The TImes, behind its paywall, also has an article by Tallis