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The presentation may be awful, but sharing of information can be very useful for clinical decision making



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Whenever I hear of somebody refer to ‘Big Data’ and the NHS, it’s an immediate ‘facepalm’.

When I saw a blogpost shared by a Twitter pal shared yesterday, a blogpost written by Sir Jeremy Heywood, my first instinct was completely to ignore it.

I am, though, mindful of the Civil Service’s prolonged campaign to measure wellbeing; this first came across my RADAR from Lord O’Donnell.

I have a disclaimer to make: I am not a corporate shill.

Having done certain training, I am aware of the hard sell of ‘Big Data’ as the next big thing by the multi-national corporates. “Big data” seem to have been given a somewhat pedestal status, like 3-D printers.

We are often told how intelligent technology rather than being a costly burden to the NHS could bring great benefits and outcomes for the NHS.

Undoubtedly, a lot of democratic deficit damage was done by the Health and Social Care Act (2012). At close to 500 pages, it was very easy to say it was too incomprehensible to be analysed. I always felt the Act, for anyone trained in commercial and corporate law, was in fact relatively straightforward.

The Health and Social Care Act (2012), often called “the Lansley Act”, has three essential prongs of attack: one to introduce a competitive market through legislation for a heavy penalty for non-one-commissioning not going out to tender, a beefed up regulator for the market (Monitor), and some detail about insolvency regimens (but not all).

In this, it was completely consistent with work by Carol Propper; and other noises from ‘independent think tanks’, such as the King’s Fund.

However, the acceleration of this Act through parliament by two parties which are extremely sympathetic to the free movement of multinational capital has done long-lasting damage.

I think there are problems with having data so transparent. When I did my Masters of Law practice-focused dissertation in cloud computing law, I unearthed a huge literature on data security and data confidentiality/sharing.

When I later did my pre-solicitor training, I discovered the regulatory requirements on the balance between confidentiality and disclosure to be complicated.

When I later came to revise ‘Duties of a Doctor’ (2013), the General Medical Council’s code of conduct, I found there to be equally onerous considerations.

I am aware of the problems in my own field of work; about concerns that NHS patients will be scared from going to see their GP for fear of being diagnosed, incorrectly, with ‘incipient dementia’ because of a GP’s practice wanting to meet a financial target.

Or a junior Doctor not wishing to share his alcoholism with his own Doctor, for fear that this information will end up with the clinical regulator, with a super-un-sympathetic sanction. This is a subject close to my heart, as you will well know.

Indeed, if you’ve been following me on Twitter, you’ll know that a year after erasure by the GMC (in 2006 to be endorsed by the High Court in 2007), I spent a year sitting in a pub with no family or job. I later was then admitted to the Royal Free Hospital having had a cardiac arrest and epileptic seizure, then to spend six weeks in a coma.

I am now knowledgeable about what both the legal and medical regulators expect me to do, as I am regulated by them.

The next Government will be wishing to implement ‘whole person care’. While I think some of Jeremy Heywood’s claims are a tad hyperbolic (for example saying unleashing data will lead to wellbeing improvements), and while I don’t feel he currently ‘owns’ the data (the data are confidential property of the people who provide the data), there are clinically-driven merits to information sharing.

From now on, I will avoid the word ‘data’ and use the word ‘information’. But ‘information’ does not necessarily mean ‘knowledge'; and it certainly doesn’t necessarily mean ‘wisdom’.

One scenario is somebody prescribed Viagra for erectile dysfunction in the morning. He then has sex with his partner in early evening, and has Angina. He has longstanding ischaemic heart disease, and then takes his GTN spray. His blood pressure then goes through the floor, and he collapses. He then is blue lighted into his local emergency room.

Do not take this anecdote as ‘medical advice’ or any such like where I could get into regulatory trouble please.

Viagra is a class of drug which can interact with the GTN spray to send blood pressure through the floor. If this information were known to an admitting Doctor in the emergency room, this would be useful.

I can come up with countless examples.

A lady from a care home turns up in hospital at 4am. An admitting Doctor wishes to prescribe a heavy-duty blood pressure lowering drug, but notes she has had a series of falls. This is found out by looking at her electronic medical record. She indeed has a history of osteoporosis; weak bones could mean that she might fracture a bone if she had another fall.

But I could come up with countless examples. And I won’t.

I am not a corporate shill. I understand completely the concerns about the loopholes in current legislation meaning that ‘big data’ could go walkies to drug companies, though this is vehemently denied.

I am also aware of ‘cloud failures’ – the Playstation one for some reason springs to my mind.

That’s another reason to keep an eye on ‘My NHS’.

But we do need, I feel, to take a deep breath and to discuss this calmly.

Aspiration is still pivotal for Labour, but so are the insecurities of citizens



 

Aspiration is incredibly important. My late father came to this country £10 in debt, and then did nearly 30 years successfully as a Doctor in the NHS. He is a totally self-made man. If there were ever a better ‘advert’ for ‘education, opportunity, aspiration’, it is he. All three are critical ingredients that help take people out of poverty and help create new products that make a contribution to humanity. But we definitely need to add to that genuine aspiration the concession that people are frightened by real threats in their everyday life, like never before, and therefore a change in emphasis in policy may be needed; relying on aspiration alone is poverty of aspiration in itself, if it does not acknowledge citizens’ concerns such as employment rights, housing, or immigration. By not appearing to adjust to the changing political landscape, Labour dangerously either gives the impression of being stuck in a time-warp, or perseverating on ‘transmit mode’. However, all is not lost. There are some people who use the social media brilliantly in Labour. They are individuals, including councillors, MPs, supporters and members, who ask questions, listen to answers, engage in the debate, or produce solutions, even if they are operating within the narrow bandwidth of one-hundred-and-forty-characters of Twitter.

 

Before I go onto explain what I would like the discussion to embrace as well as aspiration, I should like to submit humbly that being stuck on transmit mode is dangerous. It means that you can send out a message, and concentrate so much on whether it is being communicated well, that you do not listen to the answers. “The Big Society”, from Lord Wei, Steve Hilton and David Cameron is a good example of that. The idea itself was not clearly explained, including to the Third Sector, of why it was not yet another reincarnation of volunteering. Whilst massive efforts were made into interacting with potential stakeholders, explaining “The BIg Society” reached an impasse on numerous occasions. Many of us used to poke fun at the ‘focus groups’ idea of Lord Mandelson and Philip Gould, or the idea that the Conservatives use polling data to form policy (it is alleged), it is definitely worth ‘listening to the voter’, in the same way that Laennec advised ‘listening to the patient’. True innovators are not only keen to observe which ideas are successfully adopted, where, why and how, but they are exquisitively sensitive to the environment around them. Aspiration is a good example of where Labour policy makers have gone wrong.

 

Ed Miliband is said to like the aspirational approach of Baroness Thatcher, and indeed this infectious ‘setting free’ of the hopes of citizens in the UK was massively successful. This possibly may even be akin to David Cameron wishing to protect the ‘strivers’. But hold on guys. Aspiration was the “low-hanging fruit” for when the economy was doing well, and indeed growing. Too easily this debate can become framed as Blairites versus the rest of the world, but that is a cop-out. Ed Miliband, who is not a card-carrying Blairite, has embraced ‘aspiration’, but without thinking through the consequences. There is of course nothing wrong with unemployed citizens, or citizens in work with low income, being aspirational; indeed this is to be encouraged. In marketing, it is impossible to treat the market as a single mass, that’s why professional marketing professionals talk about ‘market segmentation’. If you take a similar approach to doing market research in a political capacity, you soon arrive at the (obvious) conclusion that aspiration for a CEO earning £100,000s in a multi-national company in the City is different from aspiration from a public-sector lowly-paid nurse in Wigan. Whilst it may be appropriate to target aspiration at the former, through not imposing a 50p tax rate or cutting the rate of corporation tax, different mechanisms are needed for the latter; and, in fairness, through a Liberal Democratic success in lobbying, the threshold for paying income tax has been increased yet again.

 

Aspiration, whilst clearly very important,  remains as a key issue for a country, but there are now other factors at play (and they may have always been there to some extent during the “boom” years): for example, it is thought to be about to enter a ‘triple-dip recession’ or lose its coveted credit-rating. Whilst many voters apparently seek to establish that the economic performance of the Conservative Party has been poor, the same individuals apparently feel that Labour were reckless with the economy. It has proved impossible to explain how ‘saving the banks’ had involved spending money, worsening the deficit, and the Conservatives are willing to advance the notion of how Labour ‘won’t say sorry’. Security, in my opinion, is the critical issue. This encapsulates a plethora of different issues. One has to be about the NHS, seeing some NHS Foundation Trusts going into administration, or become privatised. In a privatised NHS, it is unclear how a comprehensive health service can be provided, when the legal imperative is to maximise shareholder dividend, and it is further unclear who is accountable or to blame when anything goes wrong. For those who are lucky enough to be in employment, this Coalition has started an ideological onslaught on providing basic employment rights, even having the audacity to launch a ‘shares for rights’ scheme which has been universally panned by virtually all major business and financial stakeholders in the UK. Furthermore, it is very hard for the Conservatives to be on the side of the ‘aspirational’, when their cabinet is comprised nearly exclusively of millionaires. It is therefore advisable in my view for Labour to change ‘mode’ from a narrative about aspiration to a dialogue about security. It will be perceived as ‘out of touch’ if it bangs on about aspiration when people are increasingly feel that they can take nothing for granted. The reason that there are increasing numbers in employment is because there are more people in flexible, part-time jobs with absolutely no job security – this is certainly not anything for the UK government to boast about.

 

Why is security or insecurity relevant? Thousands of disabled citizens are finding themselves removed from disability living allowance due to a re-calibration of the welfare benefits system, so their concern will be less about aspiration and more about security. This disability living allowance is not an employment allowance, it is a living and mobility allowance, so removing it from disabled citizens who remain disabled is an ugly disgrace. If you’re a pensioner, you will have been totally cobbled by the low interest rates, so to talk about aspiration to them is utterly inappropriate. David Cameron’s government is not one of ‘aspiration’, it is one of ‘expectation management’. The Conservatives are already talking about how they might be losing their triple A rating, when having talked about they had managed to retain the AAA rating as a result of their ‘successful’ policies. Their ‘successful’ policies included murdering all infrastructure investment (including ‘Building Schools for the Future’), and killing off consumer demand (through increasing the rate of VAT). It is indecent for Cameron to talk about aspiration, and equally indecent for Ed Miliband to wish to emulate it, when their basic incompetence in running the economy has seen the aspirations of many individuals in the UK utterly annihilated.

 

If Labour takes itself off ‘transmit mode’, there is a chance it might be able to listen to workers who feel insecure in their jobs, or disabled citizens who are worried about their life in general. Whilst Tony Blair and Gordon Brown were possibly appropriate leaders for their time, Ed Miliband needs to take a lead, but acknowledging that he is in a materially different world to the one they were in. The alternative is that ordinary voters will continue to be disinterested and disenfranchised in UK politics, and this would be the ultimate tragedy. Labour has risen confidently to challenges in the past, and I am confident it will do so again.

The Golden Age Of The Cloud



This article looks at a new technology which is taking the business and IT worlds by storm: “cloud computing”. As this new industry has a lot of clients with a lot of money, it is not particularly surprising that commercial lawyers have become acutely sensitive to the cloud clients’ needs, concerns and expectations.

Why get involved in the cloud?

Small and medium sized enterprises (SMEs) have been fast to appreciate that the internet offers a golden opportunity for them, and equally lawyers have been quick to realize that they can offer specialist advice to the benefit of SMEs. Businesses remain fascinated by ‘cloud computing’.

But what is cloud computing? In the simplest of terms, it is IT-as-a-Service. Your company has access to its data and software over the internet (which in most IT diagrams is shown as a cloud). This, like many new technologies, it has its own set of benefits and challenges.

Benefits

Cloud computing fans claim five key benefits, and these contribute to the overall competitive advantage of the business.

  • Cheap: your IT provider will host services for multiple companies; sharing complex infrastructure is argued to be cost-efficient, and you pay only for what you actually use. This is very attractive to SMEs.
  • Quick: The most basic cloud services work ‘out of the box’ – it’s perfect for start-ups, especially in the current harsh economic client.
  • Up-to-date: Most providers constantly update their software offering, adding new features as and when they become available.
  • Scaleable: If your business is growing fast or has seasonal spikes, you can go large quickly because cloud systems are built to cope with sharp increases in workload.
  • Mobile: Cloud services are designed to be used from a distance, so if you have a mobile workforce, your staff will have access to most of your systems on the go.

Market uptake

A report by the Centre for Economics and Business Research (CEBR), was published shortly before Christmas last year. Widespread adoption of cloud computing could give the top five EU economies a 763bn-euro (£645bn; $1tn) boost over five years; the CEBR also said it could also create 2.4m jobs. The US analysts Gartner estimates that, over the course of the next five years, businesses will spend $112 billion cumulatively on Cloud Computing.

Potential issues which businesses and lawyers can address

Cloud computing is not without potential problems.

  • Usability is an important issue. Some people, firmly wedded to “their” software, whether it’s Lotus Notes or Microsoft Outlook, are reluctant to switch to plainer online applications.
  • Perhaps the greatest concerns that customers face when using a cloud computing solution are those relating to security and privacy. In a traditional commercial relationship, providers will typically split up the servers for a specific customer, and a customer may even be able to impose certain physical and logical security requirements. This may not be possible once data are transferred to the cloud.
  • To the extent that personal information is stored in the cloud, customers must also consider compliance with applicable laws governing the privacy and security of personally identifiable information.

Who are the providers?

Cloud computing is at an early stage, with a small group of large providers delivering a slew of cloud-based services, from full-blown applications to storage services to spam filtering. Currently, Amazon, Google and Microsoft are key suppliers of cloud services.

Further reading

An interested reader is strongly recommended to go to the ‘cloud computing’ page of Taylor Wessing LLP. Taylor Wessing LLP is one of several firms with a specialist interest in the international commercial law of cloud computing:

http://www.taylorwessing.com/download/cloudcomputing.html


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