A controversial database which holds the details of every child in England has now become available for childcare professionals to access.

ContactPoint was a response to Lord Laming's report following the death of Victoria Climbie, who was abused by her great aunt and the aunt's boyfriend.

But the system, costing £224m, was delayed twice amid data security fears.

The government says it will enable more co-ordinated services for children and ensure none slips through the net.

But in 2007, a report into the project by auditors Deloitte and Touche said it could never be totally secure.

Last summer ministers delayed the database, admitting there were some "issues" identified in testing.

It says 390,000 people will have access to the database, but will have gone through stringent security training.

And it is a certainty that not one of those 390,000 people will be able to be blackmailed or bribed in order to give up a child's details.

Ahem.

I would suggest that giving over a third of a million people 'stringent' security training will be rather harder to do than the government thinks it will be.

Much like getting children used to handing over their fingerprints to borrow library books it seems that we are educating tomorrows generation to be content that the government has all their details.

Some quick comments to two pieces of ambulance news.

A chief constable has said he fears an injured person will die in the back of a police car heading for hospital due to poor ambulance response times.

Mick Giannasi of Gwent Police, was commenting after it emerged 92 people had to be taken to hospital by his officers over six months.

In December 2008 alone, police cars were used as a last resort 41 times because ambulances were not available.

I'd like to see the LAS figures on the number of calls that come to us from the police, normally assaults, that have 'no units to send'. The police are just as busy and stretched as us, and often our jobs overlap - it's just a matter of numbers that we sometimes end up doing each other's work. To be honest, given the exceedingly minor injuries that a lot of 'assaults' cause, it would seem a waste to have an ambulance pick up someone with a few scratches, of course using a police car in such a case, while quicker, is still not an ideal use of resources.

But picture the uproar from the headline 'Assault victim told to make own way to hospital'. Even if such an assault is a scratch the bad PR isn't worth it - which is one reason why we take everyone to hospital.

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A Derbyshire man is angry his 98-year-old mother had to wait several hours for an ambulance, on two occasions, after injuring herself in falls.

Brian Beardsley said his mother Agnes had lengthy waits for an ambulance called by a doctor at her Ilkeston care home on 4 March and 27 April.

Mr Beardsley says the waits were not acceptable for a 98-year-old.

East Midlands Ambulance Service officials apologised for the delay but said they had to prioritise 999 calls.

Mrs Beardsley, who has a history of falling, suffered head injuries during three falls in one day at the Victoria Care Home on 27 April.

Paramedics were on hand in minutes for two but for the third she had a lengthy wait.

Sadly the number of ambulances available are not infinite, and so all calls have to be prioritised - in this case the patient had been seen by a doctor who said that a four hour wait was acceptable, and she had to wait twenty minutes longer than that. I'm trying my hardest to see how this is 'news'. Note that when a doctor hadn't been out to see her first that 'Paramedics were on hand in minutes'. The flip side of the story is of course 'My husband died of a heart attack while ambulance crews dealt with a minor injury already seen by a doctor'.

It's lovely to be hated so much.

A Sunday Mirror investigation has revealed how Lewis Day Medical Services billed for phantom trips supposed to have been made by a non-existent driver.

An average of 20 journeys were faked EVERY DAY, and the scam lasted for more than 18 months. The minimum charge for each journey was £8.60. But some cost cashstrapped hospitals £109 a time.

In one instance Villas's fake ID was used to charge £73.20 to take a patient with lung disease just two miles home. In fact, the trip had been cancelled hours before because the patient was too ill to travel.

Our investigators were passed a secret file listing all the fraudulent journeys relating to Villas. We handed the evidence to the NHS, who called in their own detectives. Lewis Day subsequently agreed to pay back £281,894 to Imperial College NHS Trust.

Despite the fraud being discovered, Lewis Day will carry on working for Imperial College NHS Trust because it is tied into a contract. And there is no prospect of anyone being prosecuted.

Wow.

More and more the NHS is relying on private ambulance companies, initially for this sort of patient transport and increasingly for A&E work. (More on which later). Sadly I suspect that this isn't going to be the exception and I foresee other companies being caught out in a similar fashion.

The very interesting thing is that

Despite the fraud being discovered, Lewis Day will carry on working for Imperial College NHS Trust because it is tied into a contract. And there is no prospect of anyone being prosecuted.

I can say, with some certainty that if I were to be found guilty of fraud I'd, quite rightly, be out on my ear. So why isn't this happening to this company?

My suspicion is that it would cost the trust more money to run the contract bidding system again, that or someone in Lewis Day has a friend or two in high places. I can't see any other reason how such a serious fraud would occur without the police being informed. I mean, the LAS has issued guidance on the sort of kit that we can keep in our cars - it's a small list with such items as 'Latex gloves - three pair only', they would be a bit upset if I were to steal over a quarter of a million pounds.

And then, when I get caught, go 'oops - here, have it back - no hard feelings eh?', and head out to pick up my next patient with hardly a word spoken.

Here is hoping that the other ambulance companies take a long hard look at the way they run things and the people that they employ in order to prevent similar situations happening in the future.

There has been talk for years now about how blogging will kill off 'mainstream' media (MSM) like newspapers - I'm yet to see it happen. After all the benefits of a newspaper and the organisation behind it are obvious, they have people who go out looking for news while a large amount of 'news' blogging is repeating and commenting on stories put out by commercial media websites.

The strength of this commenting culture is that 'experts' on the story being discussed can weigh in where the journalist originally writing the story may only have limited knowledge of the subject involved. An example of this would be where I discuss an ambulance story that is currently in the news.

Mainstream media should do what it does best, research around stories, find experts to corroborate what they believe is happening and provide well thought out copy. Unlike many bloggers they should have the resources and, most importantly, time, to fully round out a story.

Of course it doesn't always work like that.

Paramedics told: 'Let accident victims die if they want to' in new row over patient rights

Health Service paramedics have been told not to resuscitate terminally-ill patients who register on a controversial new database to say they want to die.

It has been set up by the ambulance service in London for hundreds of people who have only a few months to live so that they may register their 'death wishes' in advance.

...and so it goes - while I have linked to the Daily Mail, this story appeared all across the media, for example 'This is London' is especially crazy. I have no idea where this story originated, I suspect a pro-life organisation issued a press release and the various journalists jumped on it as an 'interesting' story.

Of course, the truth didn't enter into it.

So it was up to the LAS to respond, and so they issued this release,

Reports in the media today (17 April) about the resuscitation of patients involved in serious accidents are misleading.

We have a system whereby patients with longer-term or complicated medical conditions can ask for a specific treatment to be carried out if we are called to them, or for them to be taken to a preferred place of care.

These are a very small number of patients who we will normally attend at home and with whom a written agreement is in place. It is inaccurate to suggest that this approach would be taken with patients involved in serious accidents.

These agreements are often used to give guidance to our staff on how to proceed with treatment in very complicated clinical cases.

They document what the patient’s requirements and wishes are and may refer, for example, to places of care, preferred treatment options, do not resuscitate advice, and home care requirements.

These details are kept in a secure database which can be accessed by our control room staff. This information can then be passed on to staff attending patients at the addresses on our system.

The ambulance crew will then be able to provide the most appropriate care to the patient taking into account the details kept on our records about their wishes and clinical needs.

There are currently 1,624 patients with their details registered on our system.

But, of course, the retractions weren't exactly forthright. The damage had been done and with no real right to reply, I suspect that a few of our patient's have been looking at ambulance staff in a different light.

That isn't the point, the point is that the journalists writing this story could have easily found out the truth, that we aren't going to go to a car crash and refuse to resuscitate someone, that we aren't bringing in 'death wristbands' and that, in fact, of the 1,624 people on the treatment database the only a few are 'do not resuscitate orders.

I'd guess that the majority of the people on this database are only on it because they suffer from sickle cell crisis and the database has their preferred hospital on it.

In the case of 'do not resuscitate' orders, it is not the ambulance service that initiates these things, it is the patient's GP and the team at the hospital - we just get informed of these decisions due to their need for ambulance transport to hospital.

Where patients have complex conditions the details often state what treatments are, and are not, recommended for the patient. We have a few on my patch, mostly children with severe medical conditions.

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While I might expect such lurid headlines and misrepresentation of the facts from a blogger (because we don't always have the time to research something we are writing on account of our 'day jobs'), I would have hoped for better from people who are paid to write these things.

The newspapers should stick to what they can do best, fully researched stories and information gathered with the money and time that these organisations have. They should stop printing press releases as if they were facts in an effort to fill column inches of come up with the most lurid story that they can.

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Oh, and swine 'flu? I'm not panicking over it, and I try to have forty days worth of tinned food in my house at all times in case of an actual serious pandemic.

The LAS has issued utterly sensible advice to it's staff that I suspect we will ignore.

The advice is to leave the patient at home if the symptoms aren't too serious and contact the patient's GP. However most ambulance crews are aware that if the patient then drops dead (of something completely unrelated) it will be the roadstaff's fault and we'd end up risking our job not taking them to hospital. After all, we aren't doctors, so how do we know who we can leave at home? How can we predict who will have a cytokine storm?

Nope - if this does go pandemic I predict A&E waiting rooms full of people with 'flu who make their own way there if the ambulance refuses to take them, all crying out for anti-virals. Then medical staff will get sick and some folks will die because of that rather than from the 'flu itself.

But that won't make the headlines - what will make the headlines will be the death from 'flu, someone who would have died from any 'flu.

And of course, once the storm has settled NHS management will start disciplining those who had the temerity to catch the 'flu themselves and go sick...

(erm... the title of this post has nothing to do with this section about 'flu, just in case you thought I was wishing for some sort of 'humanity die-off' from the 'flu).

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From Fox News.

AUSTIN, Texas —

Just nine people accounted for nearly 2,700 of the emergency room visits in the Austin area during the past six years at a cost of $3 million to taxpayers and others, according to a report.

The patients went to hospital emergency rooms 2,678 times from 2003 through 2008, said the report from the nonprofit Integrated Care Collaboration, a group of health care providers who care for low-income and uninsured patients.

The average emergency room visit costs $1,000. Hospitals and taxpayers paid the bill through government programs such as Medicare and Medicaid, Kitchen said.

Eight of the nine patients have drug abuse problems, seven were diagnosed with mental health issues and three were homeless. Five are women whose average age is 40, and four are men whose average age is 50, the report said, the Austin American-Statesman reported Wednesday.

I would say that pretty much the same thing happens in the UK - so, what is the solution?

Here's the crazy idea, if it costs $3 million for these people to keep attending the emergency room, and that isn't counting the cost to other people of ambulances and A&E staff being tied up with these patients - how much would it cost to provide 24 hour care for those people? Because if it costs less, wouldn't that be a more effective use of money?

Per year each person cost $55,555 which, while clearer, isn't as 'sexy' a number as $3 million - it's pretty obvious why the larger number is the headline. That isn't, I think, enough to provide 24 hour care, it's the cost of one and a half hip operations. If you moved all nine people into one house you could cut some costs there and then I think it *would* be cheaper to look after them. And with that sort of concentrated care you could maybe move towards 'curing' them of the things that they keep attending A&E for.

Of course, there would be opposition from those that would argue that it is not 'fair' on those people who work every day, pay their own rent and struggle to make ends meet. But even with that argument, isn't that annoyance worth having more free space in ambulances and A&E departments? And if you save money, well, that's just more hip operations for the people who 'deserve' it.

I don't know - am I being daft, because it seems pretty obvious to me?

There are currently around 6,000 signatures for the petition below.

This is from the RCN website - and I'm happy to reproduce it here.

Dear Colleagues,

Last week, many of you will have seen extensive media coverage around RCN member Margaret Haywood who was removed from the nursing register for breaking patient confidentiality. Margaret took part in undercover filming as part of a BBC Panorama documentary in 2005 which exposed poor care at the Trust she worked at.

Margaret has been supported by the RCN since charges were brought in relation to her participation in the Panorama programme. Whilst the RCN cannot condone breaking patient confidentiality, we feel that the decision taken by the NMC to remove Margaret from the nursing register was unduly harsh.

The RCN would always encourage members to raise any concerns they may have about patient care with their employer in the first instance. However, if members do not feel able to do this for any reason then they should contact the RCN as a matter of urgency and we will take action on their behalf.

In consultation with Margaret, I am currently working with the RCN's Director of Legal Services, Chris Cox, and Margaret's barrister to look at the legal options around the NMC's decision. Although we are not able to make public the detail of these discussions at this stage, we are investigating what grounds there may be for an appeal. If an appeal does go ahead it will have to be lodged within 28 days of the NMC's decision to remove Margaret from the register.

In order to gauge the feeling around Margaret's removal from the register, the RCN has set up an online petition. This is open to anyone that would like to show their support for Margaret. Due to the fact that the petition is aimed at gathering views from the general public and the nursing profession, I don't feel that it would be appropriate for RCN staff members, myself included, to sign the petition. However, please be reassured that the RCN is vigorously defending Margaret and supporting her at this time.

The petition can be found at: www.gopetition.com/online/27030.html.

Yours sincerely

Peter Carter

Chief Executive & General Secretary

As some of you may know, as well as being ambulance staff, I'm also a registered nurse. For that privilege I pay the NMC a sum of money every year to be on the professional register. If I am not on that register then I cannot practice as a nurse.

Should I ever have to leave the ambulance service nursing would allow me to pay the rent.

The NMC have the power to strike me off the register, meaning that I would no longer be able to work as a nurse.

Which is why this blog should come to an end.

No longer can I be safe to tell you all about the terrible conditions in some of the nursing homes that I go to. I can't tell you about the problems that occur in A&E and I can't shout about the atrocious state of home/social care.

It's just not safe because to whistleblow like this can result in you being struck off the register.

What this decision means is that all bloggers that have a professional registration are now skating on thin ice. Nurse bloggers, Doctor bloggers, Paramedic bloggers - all these are on a professional register and all end up writing about situations that trusts would rather were kept under the carpet.

Might I also suggest that in the cases of hospital trusts wanting to get rid of a 'troublesome' staff member they may well turn to organisations like the NMC, HPC or GMC to do their work for them. I know I could point you to HPC rulings that appear to do that, not evidential to be sure, but it does look very much like that.

One further suggestion that I'd like to make is that you don't see many managers being taken to the professional registers for malpractice. Are any trust managers from Stafford hospital being struck off any professional register that they might be on?

What I can say with certainty is that, as a nurse, no matter how many Incident Reporting Forms you fill in, nothing seems to change. You end up not filling them in at all, because you know that they will be ignored.

So you want to shout about the situation as loudly as you can. Which can lead to you losing your job or being struck off the register - which results in your career ending.

Which is why most people just try to o the best they can, and avoid 'rocking the boat'.

And this is why I should stop blogging.

But I won't. I, and many others who are braver than me, will continue to try and get the truth of the situation in the NHS out there, out in the public eye because that is the only way that change occurs.

It's the right thing to do.