Wednesday, 28 January 2015

Health Service

Well, having criticised the NHS in my last post, I must now praise it.

I spent the weekend with sore tonsils and  earache, so dialled our local surgery on Monday morning expecting to have to sit on the phone for half an hour in a queue, as is usually the case. But I got through straight away, was told to take an emergency appointment, saw the doctor quickly and was back home with antibiotics and advice before coffee time.

So it is true, then, that using our national health service can be straightforward, customer-oriented and efficient. And virtually free (prescription charges are now £8.05, for the record, about the same as the co-payment we used to have to make in America for a medical appointment even though the costs were insured).

Isn't it marvellous?

Monday, 26 January 2015

Consumer Health

How much longer will the crisis in the NHS endure?

Almost daily we hear of intolerable A&E waits, hospitals refusing admissions, and non-emergency operations being delayed.
Clearly the lack of adequate GP care is having an impact on the rest of the system. I am not alone in finding my local surgery operating 'emergency-only' appointments for those unable to wait over two weeks for a scheduled consultation.

Our local hospital in Winchester has called non-medical staff to help out on wards to try to cope with overwhelming demand, and has had its share of ambulances queuing to drop off patients for whom no care but the mobile version is available.

And yet the day to day running of the system continues to operate without so much as a nod towards technology, which in every other area of our lives is easing the simple burdens.

I have just finished reading "Do No Harm", a brain surgeon's account of some of his more interesting cases during his continuing professional career in a British NHS hospital. It is fascinating on many levels, but Henry Marsh's peripheral comments on the state of medical records are depressing.

The surgeon tells how his patients' notes are still held in physical files which follow them around the hospital. Naturally, patients with serious brain conditions produce mountains of paperwork, but Marsh notes that there is no sifting of important information, so the files he must read through still contain long-irrelevant details of his patient's meals and stools on a previous admission.

The retention of unnecessary records not only slows medical staff in finding what they need, but produces a physically-bloated file, with all the extra manpower and transport that involves. Were this a private business such excess would have been culled long ago.
Sadly the waste does not stop there. The surgeon mentions too the repetition that goes on within hospitals, each separate practitioner asking once more for your details. When last in hospital I found it immensely frustrating to recount every step of my problem, from when it had first arisen, what it was like, what I did, what I had been prescribed and so on, to many different staff.

Of course I understand that sometimes medics need to check a story, or hear it from the horse's mouth, but if the details were properly recorded and could be checked by anyone involved surely this would save a lot of bedside time?

Government attempts to computerise health records in England have hit the headlines repeatedly over delays, system failures and huge cost overruns. Last year it was announced that bills for the latest abandoned system would exceed £10 billion.

Yet in studying for my Marketing course I have come across so many computer systems for tracking individual customer behaviour that I find it hard to believe this is a nut the NHS cannot crack. In commerce, knowing your customer has become the most powerful means of persuading them to buy, and you can be sure that these systems know a great deal more about your personal traits than you would ever guess.

Granted, an NHS-wide system would need to be huge and highly secure. But vast, cheap storage is now available in 'clouds', whilst technological innovation is speeding ahead. Even schools now offer I pads not just to teachers but to pupils, aware of the time and effort that can be saved through technology to increase the capacity for real learning.

Tablets seem an obvious prescription for hospital ills. Real-time access to medical files could literally save lives, especially where a patient needs urgent treatment but cannot explain what medication he is already on.

NHS England announced in November another plan to digitise patient  records: "real time data will be available to paramedics, doctors and nurses, ensuring patients receive safe and effective at the point of care.  All NHS funded care services are expected to have digital and interoperable systems that remove the limitations of paper records and slow bureaucratic systems by 2020".

Perhaps this time it will work.

Commercial entities are way ahead in these areas. Having figured out the need for vast and reliable databases some years ago, they are now creating Customer Relationship Marketing systems that give real-time, accurate and individual insight into their consumers.
 

The rise in connected hardware, from fridges to vehicles, and the evolving wearable technology, means that the digital world is sending ever more refined messages on our location, activity and needs to whomsoever cares to collect it. If a Fitbit can monitor your heart rate and send data wirelessly, how long before that information could potentially rescue a heart attack?

In this whole new world the NHS needs first to take that essential step of digitising patient records. Only then can it start to benefit from the technological progress driving the consumer world.

Treating patients as consumers seems morally wrong (they have not chosen to need medical care, and should be treated equally, whatever their social standing, just for starters). But in terms of assessing how best to serve their needs the government could take an instructive leaf from the big business book.
Marketers address the "quantifiable self": data identifying the individual consumer's statistical details (including sex, age and socio-economic status) as well as their aspirations and preferences. It is this data-rich world which a national health service must explore if it is to fathom the demand for healthcare, not just in time but by geographical location, and plan appropriately.

We'll know they have succeeded when our doctors know more about us than our supermarkets. When they realise that health provision must exist around the clock, within geographical reach of the community it serves, and when waiting rooms no longer harbour an "unexpected item in  bagging area".

Saturday, 17 January 2015

Fixing Things

It's been a grotty sort of week really.

The septic tank saga rolled on, our printer stopped working (amazing how much you desperately need to print once you cannot), Max had a fight with a tree in the car (minor but needed urgent fixing due to smashed lights), I got a speeding ticket (and I know everyone probably says this but I AM usually very good) and to cap it all some friends in France have fallen out with us over what we think is a misunderstanding of an email, as it is wholly incomprehensible otherwise. Plus I burned my thumb making soup.

So poor Martin had a week away and came back, jet lagged and tired, to a somewhat grumpy pair.

Today, however, things are looking up. Halfords helped with the car (though they claimed they couldn't), and Martin has fixed the printer. And we have just this minute decided that a dry January, having survived meals out with friends and an entire business trip, can just go hang for one evening. Actually I could argue it was necessary on therapeutic grounds, since holding a chilled glass of wine is soothing my burning thumb considerably.

Something very nice did in fact happen this week. My choir friend Mandy kindly paid for me to have a trial singing lesson with her lovely teacher, Evelyn. I was all a-feared but Mandy took me over there and introduced us and... well, it was a wonderful experience!

It is so very hard to separate your voice from your self. I think it is this that makes us cringe when we hear a recording of our voice: does anyone ever think they sound good? So not just talking but singing in close proximity to an expert sounds like the most embarrassing possible experience. Certainly I found it so on the single occasion I plucked up courage to audition for a choir solo (I vowed never to put myself in that position again).

But thanks to Mandy's generous offer, and an intrinsic feeling that if ever I am going to find out whether I can actually sing or not, now is the time, I stood before a lovely, ordinary and sympathetic lady in the depths of Hampshire and sang.

But not before she had asked what I was. Resisting the urge to be humorous I replied "alto" and she told me I didn't look like one! Then I sang two little series of notes and she confirmed that I was definitely not an alto but a soprano.

So there you go. Now I can be diva-ish, spoiled by holding the tunes rather than the accompaniment, soar over the rest and turn blonde.

It turns out that whether you are a sop or alto depends not on whether you can sing the notes, rather where your voice sounds at its best. And strange to say, I have been an alto since primary school, on the basis that I could differentiate and sing the note that was needed (and less easy to hear than the sop) rather than what I could sing best.

Now it is true that I am not good at high notes, soprano home turf.. But apparently this is easy to cure with a little style and education, which I am more than happy to learn.

Singing and  breathing properly also appears to depend on good abdominal muscle control (well, she told me it was pelvic floor but I think this is what she meant) so I now have a great excuse to do some sit-ups and planks, which it has to be said I could do with for other reasons.

So there we are. I am going to sign up to some singing lessons (my kind in-laws' Christmas present) and learn how to breathe and hit notes and have some fun. And I might just borrow a blonde wig and diva-air for the next choir rehearsal.

Thursday, 15 January 2015

Airports

Martin drove off to Heathrow for his trip to the US on Sunday within minutes of me driving off to Gatwick for the second day of training for my marketing course.

Sadly for him, the new company insists on Martin using their scheduled return flight, so he was unable to extend the trip and enjoy meeting up with old friends in the Bay area. But at least it means he will be home earlier!

As for me, the two-day training was interesting, though I was the oldest student by probably a decade! But it was good to start learning again and I at least now have the push I needed to get on with studying for the exam (in the form of a portfolio) in April.

Max's shoulder is slowly improving after his rugby injury, so he is now past the frozen peas and hot water bottle stage and starting some light exercising. It has been a real pain for him, after a lively Christmas, to see his friends go back to university, to be once again on the hunt for a job, and then to be excluded from any rugby. Here's hoping that a few more weeks of rest will work their magic.

Rosie is near the end of her job too, having decided to look for something more suitable. She has been managing to get interviews, which is great but also distressing when they reject you. At least she has re-started her improvisation classes so has some time for fun, and with any luck she will be able to spare a few days to pop home around the time Vicki returns from Buenos Aires.

Meanwhile we have been sorting out a septic tank blockage in France, which has already necessitated a big bill and further work is required. So much for trying to make the house pay its way! Fortunately Ron and Grace have been a great help, stepping in to do what they can, talk to workmen and get on top of wood-chopping and mouse-catching to boot.

A new local builder has helped us seal the leaking chimney, built a support for the barn wall that appears to be bulging outwards, and fixed a lintel and guttering that were not done properly in the first place. We are keeping fingers crossed that this time the work will have been done properly and we are not throwing good money after bad.
 Rather beautifully done.

Now we just need to find some holidaymakers who want to rent a lovely family home for their holidays. Anyone out there?

Thursday, 8 January 2015

Ben the Pro

An excuse to post this lovely photo of Ben performing with White Noise Radio.
His new band now has a number of gigs under its communal belt, with a couple more coming up in Bristol this month. Plus he is busy advertising for more pupils for his lessons. Go Ben!

Tuesday, 6 January 2015

High n' Dry

Our baby has been lifted out of the water to dry out for a while. Martin went down to keep an eye as she was hoisted and settled, and to bring back her contents to dry out at home.
Unfortunately despite Martin's ministrations, the heater has failed to re-start so it looks as though we shall have to invest in a new one. His work on the engine, however, seems to have located the fault. Some more investment is clearly required before the new sailing season. Still, she's not looking too bad down below:

Saturday, 3 January 2015

De-Ranged

My Belling dual fuel range cooker has survived about 8 years of heavy family use.

But over Christmas the grill finally died, leaving me with a cooker whose other ailments include knobs that tell me nothing (the figures having worn off over the years so that we now guess cooking temperatures), cracked and wobbly burner supports, a broken timer/programmer and a variety of blemishes including peeled and melted coatings.

In truth I expected this appliance to last better than it has. But New Year optimism led me to treat the latest failure as an excuse finally to replace it: after all, 8 years on, showrooms are now heaving with range cookers, hard to find when we bought ours.

How wrong I was.

All I need is a straight replacement: a 110cm wide, dual fuel range with four working cavities (2 ovens, grill and slow-cook). No fancy fripperies, nothing exotic, though I rather hoped to see some improvements.

Instead, my online searches and then showroom visits yesterday made me despair. Who are range cooker manufacturers building these things for? These are not 'designer' items (well, one can buy designer versions for many thousands more than we can spare) but family workhorses. If you are buying a cooker with a large hob and at least two ovens, you surely intend to cook for several people most of the time?

Well, modern ranges have irrationally evolved to cater for smaller numbers. Take, for example, the grill cavity (which according to Rangemaster "gives you an exciting and effective way to crisp and brown your food").

On a four-cavity oven, this is usually above the main oven. Which means the space is not only useful as a grill, but also as a plate-warmer. Yet on most new ranges this cavity is so small as to make it virtually useless for warming.

Many new ranges also boast a 'glide-out' grill. Sounds swanky: in reality it is a load of extra hardware allowing you to leave the grill-pan supported whilst turning your bacon, but thereby hogging much of the cavity space. Moreover, the gliding mechanism restricts the height at which you can grill, rendering the grill even more useless.
Even more annoyingly, some of the grill-pans I looked at had such large, flat borders that the actual grilling area was minuscule.

Then there are the ovens. Lots of lovely cooking space...except that many of the main ovens are now equipped with a 'handyrack', a small roasting rack fitted to the main door, supposedly to make it easy to check on your roast. Oh so wrong. For a start, even cooking for six I rarely made a roast more than once a week. And when I do, not only would it not fit in this tiny pan, but the immoveable racking would mean I could not use most of the rest of the oven at the same time. Again, the manufacturers seem to be solving a problem that doesn't exist, and in doing so limiting utility.
The fourth cavity in my range (a slow-cook oven perfect for casseroles and as a warming oven) is now instead a 'convenient storage drawer'. Part of the oven, yet wasted for any kind of cooking or heating. I have a storage problem in my kitchen, but I most certainly do not want to sacrifice useful oven space for that purpose (and in any case, I can always store cookware in any part of the oven should I choose to do so).

My biggest problem by far, however, is the knobbage. What would it cost to pop some proper, robust metal knobs on the fascia of a £1k+ cooker? Knobs that would not fall out or wobble, with markings that would not rub off? Every single range cooker I have looked at has awful, tacky-looking knobs in mock-metal which you just know are going to rub through or fall off with minimal use. Every person who cooks will use the knobs every single time, probably many times a day: they should be the single most sturdy item on the cooker. On top of which, since they grace the front of the cooker, they can make or break a good impression.

And I haven't even mentioned the fact that each of my current ovens has 15 possible heights for the oven shelves, whereas modern versions have a maximum of five.

So my search for a replacement range cooker has been in vain.

And all I want is four useful cooking cavities...with knobs on.