Sunday, 4 May 2014

Bluebells and Dog Bites, and Simon Says Back to the Future

Yesterday was so different from last Saturday. Last Saturday I was traveling back from the Czech Republic a journey that took over 12 hours from leaving the hotel to putting the key in my front door. Yesterday I spent the day on the beach playing in rock pools (I did have a grandchild with me!), tending my new garden, and best of all, walking through the woods with Cello. The woods were ablaze with colour, the ground carpeted with bluebells, the gorse and broom out in bright yellows and the crab apple trees full of blossom.

The sun shone and Cello and I enjoyed a couple of hours wandering free and far. Dogs and people don’t always have it so good however. The Health and Social Care Information Centre (HSCIC) last week published their figures for bites and strikes by dogs. In the 12 months to January 2014 there were 9,710 people admitted to hospital because of bites by dogs (and other mammals, such as horses, foxes and cats). This was a 7% increase on the year before. 6,740 of these admissions were dog bites.

Cello and I were blissfully unaware of the facts as we walked and ran through the woods. It appears that admissions to hospital for dog bites are highest in the summer, children up to 9 years of age have the highest admissions and more males than females get bitten. The most common reason for admission is an open cut to the hand although young children tend to have more injuries to the head than other age groups. People in Merseyside are more likely to be bitten than other parts of England.

It could be worse mind you. Dogs are the source of the vast majority of deaths in people from rabies. Rabies occurs in more than 150 countries, and more than 55000 people die of rabies every year in Asia and Africa. Death is not inevitable if post bite treatment is available and given very quickly. More than 15 million people received post-exposure vaccination to prevent the disease last year. What Cello and I didn't know either was that David McRae died after he was bitten by a bat in Scotland. He was the first person to die of rabies in the UK for over 100 years. That was in 2002, but a bat with the same strain of rabies was caught in Perthshire in 2009.

There was lots of wild garlic out in the woods, which is supposed to protect one from vampires, but not, I think, rabies. So in part it was good to read that the new NHS Chief Executive Simon Stevens, having some back to the future thoughts. Last week not only did he posit that further centralisation might not be the way to go (at long last someone gets it), but he expressed a desire to involve Care Commissioning Groups more in decision making over primary care services. CCGs are made up mainly of GPs, who currently already spend over 60% of the NHS budget on our behalf, but not on primary care services. Other organisations are responsible for commissioning the services GPs provide (and of course get paid for).

Now my PhD was on relationships, Specifically those that GP Fundholders used in commissioning secondary care service in supporting the primary care services they were providing for their local communities. That was in 1999. Yesterday I drove past the soon to be opened new Primary Care Centre in the town nearest to the House in Scotland. I wondered if they would carry any rabies vaccination, and who was going to be commissioning primary care in Scotland. So please Paul (Paul Gray, Chief Executive NHS Scotland) can you have a conversation with Simon. GPs commissioning their own services didn't work in 1999, and I am not sure it will now.