Sunday, 24 March 2013

Numbers and Texts that might Save Lives


My favourite read of last week was Nick Jones and Anita Charlesworth’sThe Anatomy of Health Spending 2011/12. This research report is based on work with 117 NHS Trusts. Not only did the title appeal, but it is 56 fact filled pages that examines the state of NHS finances. Anita Charlesworth, who is the Chief Economist at the Nuffield Trust was for many years the Director of Public Spending at the Treasury, where she led the team working with Sir Derek Wanless on his reform for NHS funding in 2002. When she speaks we need to listen. Last week she presented the outcome implications of her report and it made for uncomfortable reading. 

Government spending on health across the UK in 2011/12 was £121.4b. Since the NHS was formed in 1948, the overall spend on health care has increased by an average of 3.8%. During this time, there have only been 8 years where there has been a real decrease in funding, and 2 of these years were 2010/11 and 2011/12. The latter was the first year of the current governments tightening of the finances for the NHS. 

Anita Charlesworth noted that the underlying economic situation and the current period of austerity will last until at least until 2017/18, and the NHS will continue to experience reduced funding. Only larger cuts in other public sector services and/or welfare provision or relatively large tax increases would allow NHS funding to grow at historic levels. Tax increases are likely to be politically unpalatable - 1p extra on income tax raises £4b a year (the NHS cost £300m a day to run). She noted that whilst the NHS is making headline savings it is not making progress on service productivity, and without unprecedented productivity gains, the gap between demand for care and the ability to provide service, this will grow exponentially.

Increasing workforce productivity was clearly in the minds of our North West Local Education and Training Board (LETB). This LETB is one of the 13 across the UK who will be responsible for spending over £5b each year educating and training the future health care workforce. Last week they published their priorities for the next 5 years. There were the usual suspects – develop an agreed approach to medical workforce planning – good luck with that one – but amongst the long list of priorities was one that caught my eye – this was one concerned with taking forward the North West Tele-health and M-health Strategy.

It appears m-health (using mobile technology, phones, and tablets and so on) has much to offer in terms of increasing productivity. For example, in the US, 75b texts are sent each month. Last week a report presented at the American Academy of Neurology conference by Dr Omran Kaskar described how the inability to write a text message may be a vital new ‘tool’ in diagnosing an ischemic stroke, in which clots cut off blood supply to particular areas of the brain. If untreated or not treated in a timely way, it is a condition that can be fatal or result in physical impairments.

The report focused upon a 40 year-old man who despite showing only slight facial asymmetry and having no other apparent symptoms, doctors at the hospital diagnosed the man as having suffered an acute ischemic stroke. Although he had no problems speaking normally he showed signs of ‘dystextia’ - the inability to write a coherent text message. The patient, could only produce garbled messages when asked to write a simple text message, but also saw nothing wrong with such a text. When asked to type “the doctor needs a new blackberry” at the hospital, the resultant message was “Tjhe Doctor nddds a new bb,” but he did not recognise any errors. Goodness only know what they would have thought if they ever received any of my text messages!