the "Who has swine flu?" thread

[Mr Larrington]

There was a piece on the Wireless With Pictures this morning, apropos the BRITISH yoofs quarantined by The Mgt in Beijing on suspicion of having pig plague.  It amused my tiny mind no end to note that the item was fronted by Chris Hogg.

[andygates]

Hot tea and Jaffa cakes, Liz!  And a thermometer.  Not at the same time as the tea.

[Regulator]

Snigger time...


They've got a 'Swine Flu' special on You and Yours at the moment.  One chap's just rung in to ask why people with 'qualifications'* are more prone to die.

Never mind him getting the 'flu - I think he needs to get his ears syringed or have a hearing aid fitted... 





*He did, of course, mean 'complications'.

[clarion]

Did you hear the woman who complained they hadn't got antivirals ready?

I think she meant we should have had a stockpile of vaccine ready for whatever strain should occur, before it does

[Regulator]

Did you hear the woman who complained they hadn't got antivirals ready?

I think she meant we should have had a stockpile of vaccine ready for whatever strain should occur, before it does

I did think that Liam Donaldson waffled rather unconvincingly on the question about keeping Tamiflu stocks locally.

A woman had explained that she had had to travel some distance to get Tamiflu from a 'bunker' and she asked why it couldn't be kept locally in normal pharmacies.  After all, it still has to be prescribed by a doctor whether you get it from a bunker or Boots.

Liam Donaldson then said stocks would run out quicker if kept locally?!?!?  WTF?  Do they have bunkers that contain Star Trek style replicators which ensure that the stock level is always maintained.  Are they magic and never depleting?

No matter where the stocks are stored, they will be depleted at the same rate.  It's not as if stocks can't be transferred easily - they do it with all the other drugs that pharmacies stock.

He sounded like a real prat on that question.... 

[clarion]

Not quite.  The more dispersed the stock, the quicker you will run out in some places, while having stocks elsewhere.

And there is a scenario (albeit in a more vicious viral situation) where antivirals have a cash value, so there might be security issues.

[andygates]

Plus GPs are slightly loose cannons (chain's a bit slack) so they can't be relied upon not to just dish the stuff out like candy...

[Zoidburg]

To be honest I think it is rife and the vast amount of people are just not that badly affected by it.

Like they say, it's out of control, there is no containing it and the very very small minority of people are going to react badly to it.

[Regulator]

Plus GPs are slightly loose cannons (chain's a bit slack) so they can't be relied upon not to just dish the stuff out like candy...

Errr.... who do you think is doing the prescribing at the moment, to allow you to collect if from THE BUNKER? 

[andygates]

At the moment, but that will change very shortly to getting a seekrit code so you can send your minions to fetch drugs.  Pandemic flu service ftw.

Cheerfully bunker-feeling here, waiting for the "when" not the "if"...

[Regulator]

At the moment, but that will change very shortly to getting a seekrit code so you can send your minions to fetch drugs.  Pandemic flu service ftw.

Cheerfully bunker-feeling here, waiting for the "when" not the "if"...

It will still be GPs providing the seekrit code.  The regionalisation of supplies is a daft idea.

Look at what other countries (such as Australia and NZ) are doing.  They're getting the drugs, etc. as widely dispersed and accessible as possible.

[clarion]

The problem if NHS Direct (for it is they in a cunning disguise with an unconvincing false moustache) take over, they will apply their notoriously risk-averse algorithms, sending increased numbers to see their GPs and to A&E.  GP phone triage is better at risk management.

So in fact you are more likely to see Tamiflu being handed out like sweeties next week.

[Regulator]

The problem if NHS Direct (for it is they in a cunning disguise with an unconvincing false moustache) take over, they will apply their notoriously risk-averse algorithms, sending increased numbers to see their GPs and to A&E.  GP phone triage is better at risk management.

So in fact you are more likely to see Tamiflu being handed out like sweeties next week.

Indeed.  GPs are far better placed to make a clinical decision, particularly as they have access to the patients notes, than some poorly trained call centre operative.

[andygates]

But they can't handle the workload.  There are expected to be a comedy number of calls.

[Regulator]

But they can't handle the workload.  There are expected to be a comedy number of calls.

GPs and their staff deal with a comedy number of calls every day anyway.  They are very skilled and competent at doing so.

This has more to do with cost cutting than the welfare of the public.  Using call centre staff, albeit working their way clumsily through an algorithm, is cheaper than properly resourcing GPs to deal with the problem.  I'm sure the additional deaths that will arise from such an approach have been deemed 'necessary collateral damage'.  After all, this government's very practised at accepting collateral damage...

[clarion]

I'm not going to share the figures, but it is into comedy class of phone calls and presentations.

The workload is difficult.  And will probably get harder.  But the targetting of antivirals has been better up to now than it will be. 

And, as I've indicated, there are a lot of exceptions who will be referred to us for f2f so our workload could well increase as a result of the new service, even if, by some miracle, people stopped calling their own GP and rang 'Priscilla' in Mumbai*


* Speculation.  There may be commissioned capacity in versatile call centres in this country.  But we're not talking trained clinical staff.  Not by any means,

[border-rider]

But they can't handle the workload.  There are expected to be a comedy number of calls.

GPs and their staff deal with a comedy number of calls every day anyway.  They are very skilled and competent at doing so.

This has more to do with cost cutting than the welfare of the public.  Using call centre staff, albeit working their way clumsily through an algorithm, is cheaper than properly resourcing GPs to deal with the problem.  I'm sure the additional deaths that will arise from such an approach have been deemed 'necessary collateral damage'.  After all, this government's very practised at accepting collateral damage...

Realistically, they are not going to be able to provide sufficient temporary resource at GP level to deal with the expected numbers of enquiries at peak.  Yes the call centre service will be worse than going to see your doctor, but that's not going to be a realistic option when the queue to get in stretches twice round Waitrose's carpark and there are 10 phones ringing 24/7, with half the receptionists off ill.

Mrs MV's lot are part of the system, and they're gently trying to point out that their own emergency plans are predicated on them having 1/3-1/2 of staff unavailable at any time, so they're unlikely to be able to lend much in the way of resource to move bodies and run emergency centres.  This is emergency planning.

[Regulator]

Quite frankly, if I think I'm coming down with hogpox then I'll call my GP.  He has access to my medical records and knows what my medical history is.  He is in the best position to advise whether any of my chronic conditions are likely to impose a greater risk.

Priscilla in Mumbai will not have access to this information and is unlikely to have the clinical background to make an appropriate assessment.

... This is emergency planning.

This is emergency planning done on the cheap.

[clarion]

If you have a chronic condition, then the National Service won't touch you with a bargepole, and will ask you to contact your GP.

[border-rider]

This is emergency planning done on the cheap.

I think it's emergency planning done to maximise the effectiveness of available resources - which is what it's about.  Emergency response always involves draughty village halls and school gyms, and the police/army/fire service/local authority doing the best they can for people.  It's not a five star service.

On this specific issue,  it's going to be physically impossible to throw sufficient temporary resource at GPs to allow them to cope with the vast numbers expected.  If you try to do that, they're no longer GP's surgeries - they're emergency response centres full of the walking sick and the people doing the responding are no longer your GP and their receptionists anyway, and the triage is going to be done from a script.

[andygates]

If you call your GP, expect to get an answerphone message that says "we're horribly busy, leave a message, and if you've just got flu without complications, bog off".

Cheap?  Manpower is a finite resouce.  We can't invent two thousand doctors and strap them into a call centre in Mumbai or anywhere else, set up secure medical records systems and do that all on reduced staff and expect it to be anything less than broken!

[Regulator]

If you call your GP, expect to get an answerphone message that says "we're horribly busy, leave a message, and if you've just got flu without complications, bog off".

Cheap?  Manpower is a finite resouce.  We can't invent two thousand doctors and strap them into a call centre in Mumbai or anywhere else, set up secure medical records systems and do that all on reduced staff and expect it to be anything less than broken!

Funnily enough, in NZ they have a Healthline.  It is staffed by specially trained staff, including specialist infection control nurses.  It is not a call centre with untrained staff, which is effectively what the UK system will be - all that staff in the call centres here will get is training on an algorithm.

The New Zealand Influenza Pandemic Action Plan 2006 (note this plan was prepared well before the hogpox outbreak - and is the last in a line of plans that stretches back to 1919) also envisages creating community based assessment centres, where staffing would be drawn from local primary care practices, public health units or DHB providers arms.  As these assessment centres will be concentrating only on swine flu, although they will take staff from other areas, they will be more streamlined and be able to handle much greater throughput, so the excess demand will be dealt with.

Australia and most on the Pacific Rim countries are following the example provided by NZ, including making sure that antivirals are made available on a local rather than regional level.

[border-rider]

NZ population density is 15 people per square km.  UK is 246.

List of countries and dependencies by population density - Wikipedia, the free encyclopedia

[Regulator]

NZ population density is 15 people per square km.  UK is 246.

List of countries and dependencies by population density - Wikipedia, the free encyclopedia

Actually, the majority of NZ's population is concentrated in metropolitan areas (e.g. c. 32% of NZ's population lives in the Auckland region), the same as any European country.

In the UK there are plenty of place where the population density is 15 people or fewer per km².

[border-rider]

Indeed.  You can cut it any way.  Make the comparisons in terms of total population, or size of cities, and you get big differences between NZ and UK.