Tag Archives: should

Nations that cannot fight tobacco industry should raise taxes, says WHO

African nations whose attempts to regulate cigarettes are increasingly bogged down in the courts by wealthy tobacco companies should impose high taxes to deter people from developing a smoking habit, the World Health Organization says.

Vinayak Prasad of WHO’s Tobacco Free Initiative said many African governments were at a disadvantage in the fight against the industry over regulatory controls, like graphic health warnings on packs, which are the norm in the west. They have neither the funds nor enough expertise to deal with the big tobacco companies’ threats, intimidatory letters and law suits.

His comments follow the exposure by the Guardian of the attempts by multinational tobacco companies to delay and dilute regulatory controls in Africa through litigation and threats. At least eight African governments have been pressured by the industry.

“Just focus on getting the tax raised,” urged Prasad. WHO, the World Bank and others were trying to encourage and assist countries in changing their tobacco taxation, which countries from the Philippines to India had demonstrated could raise millions of dollars for healthcare or other essential government spending.

Developing nations do not have enough money or staff devoted to public health, he said. Often those in government who lead on tobacco control are also the key players for other areas, such as mental health.

“The tobacco epidemic has already reached the African continent. Countries have started to prioritise it but inherently the systems are weak. They need to build human resource capacity and technical capacity to respond to industry threats,” he told the Guardian. “We are working extremely hard [to help them] but we need to do more.”

Reacting to the Guardian’s reports, the former public health minister Caroline Flint said: “It is sad to see firms like BAT fighting African governments for years over health warnings on cigarette packages and modest taxes. In any western nation they would have conceded these issues years ago. It speaks volumes about their approach to Africa that the tobacco giants appear willing to fight on all fronts to protect their sales.”

Lord Rennard, the vice chair of the all-party parliamentary group on smoking and health, said a tax on the profits of firms “could provide funds for legal support to governments in poorer countries seeking to resist tobacco damaging the health of their local populations”.

The tobacco industry also vigorously opposes hikes in the taxation of cigarettes, which is proven to reduce the numbers who smoke. The companies and tax advisers who intervene on their behalf with governments claim that tax hikes lead to smuggling from countries where the prices are lower. Prasad says that is not so if taxation is simplified, so that the same sum is levied on every carton regardless of brand.

Deborah Arnott, chief executive of campaigning group ASH, said the revelations showed that the industry had not turned over a new leaf, focusing on vaping and aiming for a smoke-free future, as it claims. “The Guardian has thrown a spotlight on the dirty truth, the leopard hasn’t changed its spots, it’s still promoting the same old lethal products the same way it always did, in countries where it can get away with it,” she said.

“Last century 100 million people died from smoking, if Big Tobacco isn’t stopped then this century a billion will be killed by their lethal products and most of them will be from low and middle income countries. The tactics being used in Africa of denial, deception and delay were used very successfully in the UK in the last century, but they’re no longer being allowed to get away with it here and smoking rates have plummeted as a result. Africa needs to learn from our experience, if you regulate the industry strictly the smoking epidemic can be halted and reversed.”

Dr Tom Frieden, former director of the Centers for Disease Control and Prevention in the US, said in a tweet that the revelations showed the “outrageous and shameful activities of tobacco industry in Africa”. US senator Richard Blumenthal, who spent his career promoting anti-smoking legislation, and was one of 46 state attorneys general to secure hundreds of billions of dollars in damages from tobacco companies in a 1990s settlement, said that in developing markets “tobacco companies have actively resisted” health regulation. “They have actively intervened with governments, and particularly so in Africa.”

José Luis Castro, president and chief executive officer of Vital Strategies, an organisation which promotes public health in developing countries, said: “The danger of tobacco is not an old story; it is the present. The industry is using every tool at its disposal to hook new smokers, especially kids, in Africa and other parts of the world.” There is a huge gap between what the industry says and what it does, he said. “It’s time this sham was called out in every country and in every public forum. When the tobacco industry gets near government, it poisons efforts to protect health.”

The multinational companies say they do not oppose tobacco regulation that is sound and evidence-based. “However, where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it,” British American Tobacco told the Guardian. Imperial Tobacco also said it supported regulation, but it would “continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals”.

Philip Morris International said it has contact with public authorities on a range of issues, “such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best”.

This content is funded, in part, by Vital Strategies.

Should your supermarket receipt count calories?

Fancy your supermarket receipt assessing the healthiness of your trolley? Well, a new proposal says the “traffic lights” system – widely adopted on food and drink packaging since 2013 – should be migrated from individual items to entire receipts. Forget the problem of making it through checkout without impulse-buying three bags of bonbons and a copy of Heat! magazine; now it is about the half-price pizza catapulting your basket into “red” territory.

“Instinctively, it seems like a good idea,” says Ed Morrow, campaigns manager at the Royal Society for Public Health. “If health information is just on the product, it’s easy to ignore, but if you get another reminder at the till you might start to compare receipts, see what you’ve scored each time, then try to do better. Doing things that gamify the experience of shopping can be a good motivator in terms of changing behaviour.” That is if you want your midweek trip to Tesco to be gamified: is this just 21st-century code for the nanny state? “It’s not telling people what to do,” Morrow says. “All it does is provide people with extra information.”

According to Matthew Cole, the health expert who came up with the idea alongside designer Hayden Peek, receipts are a reliable indicator of a person’s dietary habits over time and, like labelling in supermarkets and on menus, could help us make healthier choices. But does such labelling really work? Research shows that consumers spend only six seconds looking at a product before buying it and can find labels confusing due to information overload. Meanwhile, obesity levels continue to rise: according to Public Health England, nearly two-thirds of adults were overweight or obese in 2015.

“Labelling is not the solution to the obesity crisis,” says Anna Taylor, executive director at the Food Foundation. “But what’s important about the traffic lights system is it encourages businesses to reformulate because they don’t want to have a product with lots of reds.” As Morrow puts it, whether or not it makes people eat more healthily, “it’s still important to have the information in terms of consumer rights. The traffic light system is a massive improvement because it’s accessible to everyone, not just those who are nutritionally literate.”

“What would be really interesting is if the retailers link it to algorithms set up for loyalty cards for those who want it,” says Taylor. “So, if a till receipt shows lots of reds, you might get vouchers to buy more veg. That’s when it could start to get really powerful. But let’s be clear: the whole food system has to work harder to make the easiest choices the healthy choices. That’s what needs to change.”

Six jobs the new World Health Organisation leader should prioritise

The first ever African director general of the World Health Organisation assumes office on Saturday. The election of Dr Tedros Adhanom Ghebreyesus, or as he is popularly known, Tedros, by an overwhelming majority of this year’s World Health Assembly is rightly hailed as historic. This was the first time that each of WHO’s 194 member states got a direct say in selecting the world’s top health leader. The public got involved too through many open debates and social media also influenced the final outcome.

Tedros has impressive credentials. As Ethiopia’s health minister, he presided over a massive expansion of healthcare with impressive health gains by his poor nation. And as his country’s foreign minister, his political and diplomatic abilities influenced extra financing for the UN’s sustainable development goals. He played critical mediation roles in Somalia and South Sudan: useful experience for reconciling states’ diverse positions on health issues. Forging partnerships is his particular strength: he chaired boards at the Global Fund and UNAids, and pushed numerous international health initiatives, from malaria and TB to maternal and child health.

His election signals a changed global mood. An Ebola-panicked world got fed up with the same old technocratic prescriptions that have failed only too often. Faced with many more borderless health threats including climate change and, with increasing discontent fuelled by widening global health inequalities, they voted for change.

But will Tedros be the change the troubled global health body needs? He has declared health to be a basic human right and said: “All roads lead to universal health coverage. Because UHC means leaving no one behind”. If he wants to have a real impact though, the following should be on his to do list:

Promote home-grown national solutions

WHO’s principal priority should be to help countries build their own sustainable human and infrastructural capacities to deliver UHC in their own contexts. This means valuing home-grown national solutions – just as Tedros did in Ethiopia – and not being driven by the one-size-fit-all models or vertical disease programmes pushed by donors. This is also the best insurance for preventing or controlling the next pandemic. Meanwhile, Tedros should resist being set up to fail as the world’s health policeman by paranoid rich countries. In the aftermath of Ebola and Zika, they may be tempted to push WHO to pressurise poor countries to enforce the International Health Regulations without also fully investing in their capacities to do so.

Remember WHO does not have a monopoly on health wisdom

Delivering change will require a revisioning of WHO’s long-presumed position as the centre of the global health ecosystem. Today we have many well-resourced international bodies and national institutions with highly-qualified experts. Thus, WHO does not have a monopoly on health wisdom and its norm-setting and convening authority is questioned. It’s high time that the humbleness that has endeared Tedros to many people rubs off on the organisation.

Hire diverse talent

Tedros needs a radically different business model for WHO, and for international health cooperation. He can start by enabling WHO to regain the trust and ownership of all its member states. The global public good that is the World Health Organisation cannot remain in hock to half a dozen rich countries who pay most of its bills and occupy most of its senior positions. So, an early test for him is if he can construct a senior team of diverse talents from all around the world.

But don’t get bogged down in internal reform

Tedros can’t afford to waste his five-year tenure on simply rearranging institutional furniture. All his recent predecessors as director general have huffed and puffed but ultimately failed to reform WHO. An effective and efficient organisation is just a means towards an end. So, Tedros only has to do enough to make WHO fit for the purpose of delivering his vision.

Look beyond traditional thought leaders

At the same time, he needs fresh ways to tackle intractable issues. He should reach out beyond the self-validating orthodoxy of the elite thinktanks and medical journals, most of whom are in the global north. Tedros is much appreciated for his accessibility and he will find it mind-broadening to encourage new voices in all continents to question existing paradigms.

Accept WHO has to live with its means

Another early test for Tedros is financial. WHO is broke with budget gaps in priority areas and excessive reliance on ad hoc voluntary funding. But he should resist setting out with a begging bowl and instead reform the budgetary architecture and agree a new compact for consistent and predictable funding. As he starts in Geneva and discovers what it is like to live in the fourth most expensive city in the world, he must ask whether everything that is done at headquarters needs to come from there. He will also, no doubt, approach member states for a hike in core contributions. He should only do this when he has delivered something first. Even if he succeeds, WHO must learn to live within its means. Sacrifices must be made to stop the organisation drowning under the weight of numerous competing technical agendas, especially when other agencies do them better.

Encouragingly, he has already recognised that a greater responsibility than saving WHO is championing adequate resources for a wider partnership of global health actors, and to inject more resources into countries themselves.

Already dubbed the “People’s DG”, Tedros’ pledge of togetherness for a healthier world has generated much goodwill and excitement. He has fired-up the hopes and imaginations of people worldwide. He must not let them down. Acting boldly and quickly according to his own moral values will be the best guarantee of that.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

Six jobs the new World Health Organisation leader should prioritise

The first ever African director general of the World Health Organisation assumes office on Saturday. The election of Dr Tedros Adhanom Ghebreyesus, or as he is popularly known, Tedros, by an overwhelming majority of this year’s World Health Assembly is rightly hailed as historic. This was the first time that each of WHO’s 194 member states got a direct say in selecting the world’s top health leader. The public got involved too through many open debates and social media also influenced the final outcome.

Tedros has impressive credentials. As Ethiopia’s health minister, he presided over a massive expansion of healthcare with impressive health gains by his poor nation. And as his country’s foreign minister, his political and diplomatic abilities influenced extra financing for the UN’s sustainable development goals. He played critical mediation roles in Somalia and South Sudan: useful experience for reconciling states’ diverse positions on health issues. Forging partnerships is his particular strength: he chaired boards at the Global Fund and UNAids, and pushed numerous international health initiatives, from malaria and TB to maternal and child health.

His election signals a changed global mood. An Ebola-panicked world got fed up with the same old technocratic prescriptions that have failed only too often. Faced with many more borderless health threats including climate change and, with increasing discontent fuelled by widening global health inequalities, they voted for change.

But will Tedros be the change the troubled global health body needs? He has declared health to be a basic human right and said: “All roads lead to universal health coverage. Because UHC means leaving no one behind”. If he wants to have a real impact though, the following should be on his to do list:

Promote home-grown national solutions

WHO’s principal priority should be to help countries build their own sustainable human and infrastructural capacities to deliver UHC in their own contexts. This means valuing home-grown national solutions – just as Tedros did in Ethiopia – and not being driven by the one-size-fit-all models or vertical disease programmes pushed by donors. This is also the best insurance for preventing or controlling the next pandemic. Meanwhile, Tedros should resist being set up to fail as the world’s health policeman by paranoid rich countries. In the aftermath of Ebola and Zika, they may be tempted to push WHO to pressurise poor countries to enforce the International Health Regulations without also fully investing in their capacities to do so.

Remember WHO does not have a monopoly on health wisdom

Delivering change will require a revisioning of WHO’s long-presumed position as the centre of the global health ecosystem. Today we have many well-resourced international bodies and national institutions with highly-qualified experts. Thus, WHO does not have a monopoly on health wisdom and its norm-setting and convening authority is questioned. It’s high time that the humbleness that has endeared Tedros to many people rubs off on the organisation.

Hire diverse talent

Tedros needs a radically different business model for WHO, and for international health cooperation. He can start by enabling WHO to regain the trust and ownership of all its member states. The global public good that is the World Health Organisation cannot remain in hock to half a dozen rich countries who pay most of its bills and occupy most of its senior positions. So, an early test for him is if he can construct a senior team of diverse talents from all around the world.

But don’t get bogged down in internal reform

Tedros can’t afford to waste his five-year tenure on simply rearranging institutional furniture. All his recent predecessors as director general have huffed and puffed but ultimately failed to reform WHO. An effective and efficient organisation is just a means towards an end. So, Tedros only has to do enough to make WHO fit for the purpose of delivering his vision.

Look beyond traditional thought leaders

At the same time, he needs fresh ways to tackle intractable issues. He should reach out beyond the self-validating orthodoxy of the elite thinktanks and medical journals, most of whom are in the global north. Tedros is much appreciated for his accessibility and he will find it mind-broadening to encourage new voices in all continents to question existing paradigms.

Accept WHO has to live with its means

Another early test for Tedros is financial. WHO is broke with budget gaps in priority areas and excessive reliance on ad hoc voluntary funding. But he should resist setting out with a begging bowl and instead reform the budgetary architecture and agree a new compact for consistent and predictable funding. As he starts in Geneva and discovers what it is like to live in the fourth most expensive city in the world, he must ask whether everything that is done at headquarters needs to come from there. He will also, no doubt, approach member states for a hike in core contributions. He should only do this when he has delivered something first. Even if he succeeds, WHO must learn to live within its means. Sacrifices must be made to stop the organisation drowning under the weight of numerous competing technical agendas, especially when other agencies do them better.

Encouragingly, he has already recognised that a greater responsibility than saving WHO is championing adequate resources for a wider partnership of global health actors, and to inject more resources into countries themselves.

Already dubbed the “People’s DG”, Tedros’ pledge of togetherness for a healthier world has generated much goodwill and excitement. He has fired-up the hopes and imaginations of people worldwide. He must not let them down. Acting boldly and quickly according to his own moral values will be the best guarantee of that.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

Hospitals should stop asking for cash and focus on getting better

Just as sustainability and transformation plans (STPs) and new care models show signs of faltering, a clinician-focused approach to driving costs down and quality up could make a difference.

Delegates at the BMA’s annual meeting have just voted for STPs to be abandoned. While some of the language around the vote was the usual conspiracy theory about it all being a plot to privatise the NHS, it was harder to argue with pleas for STP decisions to be based on robust, publicly-available evidence.

STPs, or some evolution of them, are here to stay. Working as collaborative systems rather than isolated, competing organisations is the rational way forward. But there is a growing sense that STPs and the development of new care models are losing momentum, and risk being overwhelmed by financial pressures.

Almost three years on, the principles in the Five Year Forward View have proved robust. Local development of new models of community-based, patient-centred care within a national framework is the right blueprint.

There has been progress, such as substantial improvements in mental health services for children and young people. But despite many successes, there is a growing realisation that the development of new care models by the vanguards is proving far harder and taking far longer than almost anyone anticipated. More worryingly, there is little evidence that their ideas are being adopted in other parts of the country – which was the point of the programme.

The uncertain future of the minority government means STPs are having to work in a fraught political environment where service reconfigurations and closures risk becoming bogged down in party battles.

Even if they can secure political support, STPs are having to trim their plans because they cannot find the staff. Every part of the country is struggling to attract recruits.

STP leaders are finding it tough to convince managers and consultants to put patients and the cost and effectiveness of the system above their desire to protect their own empires.

The acute sector continues to take and spend other people’s money. NHS Improvement is struggling to find the right approach to the 14 “capped expenditure” areas with the most egregious overspends, having now clarified that savings plans should not include circumscribing patients’ rights to care.

NHS Providers’ latest demand for more cash is £350m to ease winter pressures. Humorously, it suggests the money could come as a loan, as if it would ever be paid back.

But alongside this maelstrom of plans, models, vanguards and caps, there are signs of a renewed focus on the fundamental but rarely discussed issue of clinical performance.

In punchy comments for a King’s Fund report on the Getting It Right First Time initiative – the push by NHS Improvement to help individual hospitals tackle unwarranted variation in clinical performance and costs – NHS Improvement national director of clinical quality and efficiency Professor Tim Briggs condemns the variation revealed by trusts’ own data as unbelievable and unacceptable. Briggs takes the attitude that the NHS should not be pushing for more money until variation is tackled.

There is nothing marginal or debatable about the big messages emerging from the data. To take just one example, the orthopaedic analysis reveals a 25-fold variation in surgical site infection rates. Treating each infected joint typically costs between £75,000 and £100,000, while the impact of an unnecessary hospital admission ripples through the rest of the system. Other data exposes the human and financial cost of surgeons dabbling in procedures for which others have far more expertise.

So far at least, the data is not being used as a stick with which to beat clinicians, but as a way of helping them understand what they are doing, so they can focus on what they do best and improve or abandon areas where they underperform. These are peer-to-peer conversations, not management edicts.

Too many NHS hospitals equate more spending with higher quality, while world leading hospitals understand that lean, efficient systems deliver better care. Trusts owe it to patients and taxpayers to address unacceptable variations in quality and cost before coming back for more cash. And it just might create the headroom for new ways of working to flourish.

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Theresa May should spend any political capital she has left on mental health

“I’ve contemplated killing myself a few times.” Sensing the pause in my throat the 19-year-old young man quickly followed: “But obviously I didn’t, I self-harmed instead. It was the only way they’d take me seriously.”

This young man went on to explain to me how, from an early age, his parents had suspected he was autistic but hadn’t taken him to be tested. At school, his emotional and mental health began to rapidly deteriorate. Bullying led to severe panic attacks, which meant rarely leaving the house. Throughout all this he had bounced from one counsellor or support service to another. Finally the panic attacks became so bad he was admitted to hospital. At first he felt “relieved” at the attention, but when he found out the waiting time for a specialist appointment would be three months his condition regressed. He felt he had no option left but to self-harm to get the right help.

This story was shared with me as part of a focus group conducted for the recently released report A Healthy State of Mind from Localis, the thinktank for which I am director. The four participants sketched out a wretchedly consistent picture of a young people’s mental health service letting down too many, too often. We are at risk as a nation of failing an entire generation of vulnerable young people who need specialist support.

The system, bedevilled by months-long waiting lists because it fails to differentiate between those in crisis and those close to it, makes vulnerable young people feel like nobody cares and nothing can be done. The solution is urgent reform, but where to start?

The most obvious place to provide support is in schools. Localis analysis shows 75% of local mental health plans mention school-based approaches – 40% of those plans refer specifically to school-based counselling. And yet, when you get into the detail, a meagre 3% actually plan to commission school-based services. Of course, an effective mental health system for young people is about more than school-based services, but it’s hard to imagine one without them.

Norman Lamb, former minister for mental health, criticised the “inertia of implementation” at our report’s launch, arguing the coalition government set the right direction with the report Future in Mind but local failures to deliver and commission services are responsible. According to Lamb: “The £1.4bn (we) leveraged has been funneled into other parts of the NHS to prop up budgets. The money hasn’t been spent on young people’s mental health services.”

Performance locally varies considerably. Take the strength and difficulties questionnaire which every child in the looked after system must be assessed against. The questionnaire is a screening tool that helps professionals understand the level risk of a young person faces with regards to their mental health.

Despite completion of the questionnaire being a statutory duty for councils, the national average completion rate is only 75%. There are 62 councils that fall below the national average and there are even a handful which record 0% completion rates. This means for the most vulnerable young people, those in care, it’s too often a case of pot luck whether your council assesses you or not.

More troubling is the low likelihood of services being able to hit the government and NHS England’s target of 35% of young people with a clinically diagnosable mental health condition receiving specialist community based support by 2020-21. Localis analysis suggests 58% of local areas are on course to miss their target. In some areas this will mean thousands of young people missing out on the specialist support they need. Even if government hits its modest target of 35%, Localis estimates that by 2020-21 approximately 555,000 young people in need of specialist mental health support will still not be receiving it.

The government should commit to a programme of mental health services reform, not just the repeal of outdated legislation. It should accelerate the investment in the promised 3,000 GP-based mental health therapists and implement the Carter review’s recommendation that teacher training include a mandatory module on mental health. It should also be bold and take a percentage of the pupil premium and mandate that it is used for the provision of mental health support in schools.

What political capital the prime minister has left should be spent addressing our mental health crisis, particularly for young people. Mental health was one of the “burning injustices” Theresa May called out on the steps of Downing Street last July. She should not forget this commitment. Significant reform would be a worthwhile legacy.

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Should doctors use WhatsApp to bypass archaic NHS tech?

It’s Thursday night, and as I gear myself up for yet another round of night shifts a message flashes across my phone screen – it’s a group of colleagues on WhatsApp. They’re discussing an anonymised foetal cardiac tracing, recorded during the course of a birth, and sharing thoughts on the interpretation and appropriate management. I’m amazed and grateful for these kinds of learning opportunities and they’re a testament to just how far technology has developed over the last 10 years. The ability to share and discuss a patient’s clinical case helps doctors to seek advice at crucial moments. The opportunities for learning are endless.

But so is the potential for pitfalls, as the recent virtual shutdown of many parts of the NHS in May following the widespread cyber-attack has shown.

WhatsApp was also in the news following its alleged role in the Westminster terror attack, but my worries are quite the opposite of home secretary Amber Rudd’s. While she’s concerned about cracking WhatsApp wide open, I’m worried about how we can keep our conversations and, more pertinently, patient information closed and confidential.

The use of WhatsApp is now ubiquitous in NHS hospitals. A recent study of 2,107 doctors across five hospital sites found that 98.9% own a smartphone, and just over a third use web-based messaging apps to send clinical information. This is hardly surprising given that the other options available to us are hospital pagers and fax machines: laborious technologies that are neither quick nor convenient. In fact, pagers are now so archaic that one of two companies running them, Vodafone, recently announced it was pulling their obsolete plug.

Instant messaging is a more efficient way for us to communicate, but we need a system that doesn’t put patient confidentiality on the line.

Last year I decided to investigate this further and conducted a study with a colleague into the use of WhatsApp by doctors, later written up in the BMJ. We found that use of these apps breaks down traditional hierarchies and allows doctors to communicate more freely with their immediate clinical team. From the most junior doctor to the most senior (though in practice often excluding the consultant), these groups allow all of us to work together more effectively, and enable shyer or less-experienced team members to seek help when they need it. They inspire camaraderie.

The use of WhatsApp in emergency situations is growing too. Although I wasn’t personally involved, WhatsApp was almost literally a lifesaver during the emergency response to the Croydon tram crash in November 2016, as it allowed doctors at the scene to communicate with colleagues at the nearby hospital about what patient injuries to expect.

However, despite these benefits, official advice from NHS England is very clear: “Whatever the other merits of WhatsApp it should never be used for the sending of information in the professional healthcare environment.” Most doctors are careful not to include more than one patient identifier in messages, using just initials, for example, or a bed number. But in practice this is not always the case, and I’ve heard several reports of messages containing full names, along with personal medical information.

If a member of staff forgets to anonymise the information they send, they are putting themselves and their patients’ data at risk. From simple requests to confirm an inpatient’s treatment status at a hospital to more complex situations involving do not resuscitate orders, information can, and does, slip. Doctors are human, under more pressure than ever, and in the heat of the moment when expedient, appropriate treatment is at the forefront of their minds they may easily forget that they are not using compliant communication methods.

Forgetting to anonymise patient images such as scans can land a doctor in deeper water still. Sending patient imaging on a service like WhatsApp without the patient’s express, written consent could not only put sensitive patient information at risk, but could result in disciplinary measures with the General Medical Council.

At the core of all of this is information governance and how apps like WhatsApp fail to comply with NHS regulations. The concern is not high-tech hackers. In fact, the app’s end-to-end encryption has been causing a stir because of its impenetrability. But as a doctor using WhatsApp, all you have to do is leave your phone unlocked in the pub, press the wrong button, or forget it in the canteen and you could compromise your patients’ security.

WhatsApp doesn’t require a separate password, so an unlocked phone, left unattended is an easy target for a motivated intruder. The proximity of social and work-related conversations within the app can also be problematic and it’s not uncommon for messages to accidentally reach an unintended recipient.

Doctors will continue to use whatever method of communication is most efficient and useful in practice. Doctors need a system that replicates the functionality of WhatsApp while complying with NHS information governance regulations – adaptable smartphone technology that can support the evolving requirements of clinical practice in the years to come.

Dr Georgina Gould is a junior doctor and is on the development and advisory board for medCrowd.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Should doctors use WhatsApp to bypass archaic NHS tech?

It’s Thursday night, and as I gear myself up for yet another round of night shifts a message flashes across my phone screen – it’s a group of colleagues on WhatsApp. They’re discussing an anonymised foetal cardiac tracing, recorded during the course of a birth, and sharing thoughts on the interpretation and appropriate management. I’m amazed and grateful for these kinds of learning opportunities and they’re a testament to just how far technology has developed over the last 10 years. The ability to share and discuss a patient’s clinical case helps doctors to seek advice at crucial moments. The opportunities for learning are endless.

But so is the potential for pitfalls, as the recent virtual shutdown of many parts of the NHS in May following the widespread cyber-attack has shown.

WhatsApp was also in the news following its alleged role in the Westminster terror attack, but my worries are quite the opposite of home secretary Amber Rudd’s. While she’s concerned about cracking WhatsApp wide open, I’m worried about how we can keep our conversations and, more pertinently, patient information closed and confidential.

The use of WhatsApp is now ubiquitous in NHS hospitals. A recent study of 2,107 doctors across five hospital sites found that 98.9% own a smartphone, and just over a third use web-based messaging apps to send clinical information. This is hardly surprising given that the other options available to us are hospital pagers and fax machines: laborious technologies that are neither quick nor convenient. In fact, pagers are now so archaic that one of two companies running them, Vodafone, recently announced it was pulling their obsolete plug.

Instant messaging is a more efficient way for us to communicate, but we need a system that doesn’t put patient confidentiality on the line.

Last year I decided to investigate this further and conducted a study with a colleague into the use of WhatsApp by doctors, later written up in the BMJ. We found that use of these apps breaks down traditional hierarchies and allows doctors to communicate more freely with their immediate clinical team. From the most junior doctor to the most senior (though in practice often excluding the consultant), these groups allow all of us to work together more effectively, and enable shyer or less-experienced team members to seek help when they need it. They inspire camaraderie.

The use of WhatsApp in emergency situations is growing too. Although I wasn’t personally involved, WhatsApp was almost literally a lifesaver during the emergency response to the Croydon tram crash in November 2016, as it allowed doctors at the scene to communicate with colleagues at the nearby hospital about what patient injuries to expect.

However, despite these benefits, official advice from NHS England is very clear: “Whatever the other merits of WhatsApp it should never be used for the sending of information in the professional healthcare environment.” Most doctors are careful not to include more than one patient identifier in messages, using just initials, for example, or a bed number. But in practice this is not always the case, and I’ve heard several reports of messages containing full names, along with personal medical information.

If a member of staff forgets to anonymise the information they send, they are putting themselves and their patients’ data at risk. From simple requests to confirm an inpatient’s treatment status at a hospital to more complex situations involving do not resuscitate orders, information can, and does, slip. Doctors are human, under more pressure than ever, and in the heat of the moment when expedient, appropriate treatment is at the forefront of their minds they may easily forget that they are not using compliant communication methods.

Forgetting to anonymise patient images such as scans can land a doctor in deeper water still. Sending patient imaging on a service like WhatsApp without the patient’s express, written consent could not only put sensitive patient information at risk, but could result in disciplinary measures with the General Medical Council.

At the core of all of this is information governance and how apps like WhatsApp fail to comply with NHS regulations. The concern is not high-tech hackers. In fact, the app’s end-to-end encryption has been causing a stir because of its impenetrability. But as a doctor using WhatsApp, all you have to do is leave your phone unlocked in the pub, press the wrong button, or forget it in the canteen and you could compromise your patients’ security.

WhatsApp doesn’t require a separate password, so an unlocked phone, left unattended is an easy target for a motivated intruder. The proximity of social and work-related conversations within the app can also be problematic and it’s not uncommon for messages to accidentally reach an unintended recipient.

Doctors will continue to use whatever method of communication is most efficient and useful in practice. Doctors need a system that replicates the functionality of WhatsApp while complying with NHS information governance regulations – adaptable smartphone technology that can support the evolving requirements of clinical practice in the years to come.

Dr Georgina Gould is a junior doctor and is on the development and advisory board for medCrowd.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Should doctors use WhatsApp to bypass archaic NHS tech?

It’s Thursday night, and as I gear myself up for yet another round of night shifts a message flashes across my phone screen – it’s a group of colleagues on WhatsApp. They’re discussing an anonymised foetal cardiac tracing, recorded during the course of a birth, and sharing thoughts on the interpretation and appropriate management. I’m amazed and grateful for these kinds of learning opportunities and they’re a testament to just how far technology has developed over the last 10 years. The ability to share and discuss a patient’s clinical case helps doctors to seek advice at crucial moments. The opportunities for learning are endless.

But so is the potential for pitfalls, as the recent virtual shutdown of many parts of the NHS in May following the widespread cyber-attack has shown.

WhatsApp was also in the news following its alleged role in the Westminster terror attack, but my worries are quite the opposite of home secretary Amber Rudd’s. While she’s concerned about cracking WhatsApp wide open, I’m worried about how we can keep our conversations and, more pertinently, patient information closed and confidential.

The use of WhatsApp is now ubiquitous in NHS hospitals. A recent study of 2,107 doctors across five hospital sites found that 98.9% own a smartphone, and just over a third use web-based messaging apps to send clinical information. This is hardly surprising given that the other options available to us are hospital pagers and fax machines: laborious technologies that are neither quick nor convenient. In fact, pagers are now so archaic that one of two companies running them, Vodafone, recently announced it was pulling their obsolete plug.

Instant messaging is a more efficient way for us to communicate, but we need a system that doesn’t put patient confidentiality on the line.

Last year I decided to investigate this further and conducted a study with a colleague into the use of WhatsApp by doctors, later written up in the BMJ. We found that use of these apps breaks down traditional hierarchies and allows doctors to communicate more freely with their immediate clinical team. From the most junior doctor to the most senior (though in practice often excluding the consultant), these groups allow all of us to work together more effectively, and enable shyer or less-experienced team members to seek help when they need it. They inspire camaraderie.

The use of WhatsApp in emergency situations is growing too. Although I wasn’t personally involved, WhatsApp was almost literally a lifesaver during the emergency response to the Croydon tram crash in November 2016, as it allowed doctors at the scene to communicate with colleagues at the nearby hospital about what patient injuries to expect.

However, despite these benefits, official advice from NHS England is very clear: “Whatever the other merits of WhatsApp it should never be used for the sending of information in the professional healthcare environment.” Most doctors are careful not to include more than one patient identifier in messages, using just initials, for example, or a bed number. But in practice this is not always the case, and I’ve heard several reports of messages containing full names, along with personal medical information.

If a member of staff forgets to anonymise the information they send, they are putting themselves and their patients’ data at risk. From simple requests to confirm an inpatient’s treatment status at a hospital to more complex situations involving do not resuscitate orders, information can, and does, slip. Doctors are human, under more pressure than ever, and in the heat of the moment when expedient, appropriate treatment is at the forefront of their minds they may easily forget that they are not using compliant communication methods.

Forgetting to anonymise patient images such as scans can land a doctor in deeper water still. Sending patient imaging on a service like WhatsApp without the patient’s express, written consent could not only put sensitive patient information at risk, but could result in disciplinary measures with the General Medical Council.

At the core of all of this is information governance and how apps like WhatsApp fail to comply with NHS regulations. The concern is not high-tech hackers. In fact, the app’s end-to-end encryption has been causing a stir because of its impenetrability. But as a doctor using WhatsApp, all you have to do is leave your phone unlocked in the pub, press the wrong button, or forget it in the canteen and you could compromise your patients’ security.

WhatsApp doesn’t require a separate password, so an unlocked phone, left unattended is an easy target for a motivated intruder. The proximity of social and work-related conversations within the app can also be problematic and it’s not uncommon for messages to accidentally reach an unintended recipient.

Doctors will continue to use whatever method of communication is most efficient and useful in practice. Doctors need a system that replicates the functionality of WhatsApp while complying with NHS information governance regulations – adaptable smartphone technology that can support the evolving requirements of clinical practice in the years to come.

Dr Georgina Gould is a junior doctor and is on the development and advisory board for medCrowd.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Should doctors use WhatsApp to bypass archaic NHS tech?

It’s Thursday night, and as I gear myself up for yet another round of night shifts a message flashes across my phone screen – it’s a group of colleagues on WhatsApp. They’re discussing an anonymised foetal cardiac tracing, recorded during the course of a birth, and sharing thoughts on the interpretation and appropriate management. I’m amazed and grateful for these kinds of learning opportunities and they’re a testament to just how far technology has developed over the last 10 years. The ability to share and discuss a patient’s clinical case helps doctors to seek advice at crucial moments. The opportunities for learning are endless.

But so is the potential for pitfalls, as the recent virtual shutdown of many parts of the NHS in May following the widespread cyber-attack has shown.

WhatsApp was also in the news following its alleged role in the Westminster terror attack, but my worries are quite the opposite of home secretary Amber Rudd’s. While she’s concerned about cracking WhatsApp wide open, I’m worried about how we can keep our conversations and, more pertinently, patient information closed and confidential.

The use of WhatsApp is now ubiquitous in NHS hospitals. A recent study of 2,107 doctors across five hospital sites found that 98.9% own a smartphone, and just over a third use web-based messaging apps to send clinical information. This is hardly surprising given that the other options available to us are hospital pagers and fax machines: laborious technologies that are neither quick nor convenient. In fact, pagers are now so archaic that one of two companies running them, Vodafone, recently announced it was pulling their obsolete plug.

Instant messaging is a more efficient way for us to communicate, but we need a system that doesn’t put patient confidentiality on the line.

Last year I decided to investigate this further and conducted a study with a colleague into the use of WhatsApp by doctors, later written up in the BMJ. We found that use of these apps breaks down traditional hierarchies and allows doctors to communicate more freely with their immediate clinical team. From the most junior doctor to the most senior (though in practice often excluding the consultant), these groups allow all of us to work together more effectively, and enable shyer or less-experienced team members to seek help when they need it. They inspire camaraderie.

The use of WhatsApp in emergency situations is growing too. Although I wasn’t personally involved, WhatsApp was almost literally a lifesaver during the emergency response to the Croydon tram crash in November 2016, as it allowed doctors at the scene to communicate with colleagues at the nearby hospital about what patient injuries to expect.

However, despite these benefits, official advice from NHS England is very clear: “Whatever the other merits of WhatsApp it should never be used for the sending of information in the professional healthcare environment.” Most doctors are careful not to include more than one patient identifier in messages, using just initials, for example, or a bed number. But in practice this is not always the case, and I’ve heard several reports of messages containing full names, along with personal medical information.

If a member of staff forgets to anonymise the information they send, they are putting themselves and their patients’ data at risk. From simple requests to confirm an inpatient’s treatment status at a hospital to more complex situations involving do not resuscitate orders, information can, and does, slip. Doctors are human, under more pressure than ever, and in the heat of the moment when expedient, appropriate treatment is at the forefront of their minds they may easily forget that they are not using compliant communication methods.

Forgetting to anonymise patient images such as scans can land a doctor in deeper water still. Sending patient imaging on a service like WhatsApp without the patient’s express, written consent could not only put sensitive patient information at risk, but could result in disciplinary measures with the General Medical Council.

At the core of all of this is information governance and how apps like WhatsApp fail to comply with NHS regulations. The concern is not high-tech hackers. In fact, the app’s end-to-end encryption has been causing a stir because of its impenetrability. But as a doctor using WhatsApp, all you have to do is leave your phone unlocked in the pub, press the wrong button, or forget it in the canteen and you could compromise your patients’ security.

WhatsApp doesn’t require a separate password, so an unlocked phone, left unattended is an easy target for a motivated intruder. The proximity of social and work-related conversations within the app can also be problematic and it’s not uncommon for messages to accidentally reach an unintended recipient.

Doctors will continue to use whatever method of communication is most efficient and useful in practice. Doctors need a system that replicates the functionality of WhatsApp while complying with NHS information governance regulations – adaptable smartphone technology that can support the evolving requirements of clinical practice in the years to come.

Dr Georgina Gould is a junior doctor and is on the development and advisory board for medCrowd.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.