Sunday, 8 March 2015

Liverpool Care Pathway - Fracking The Data

This isn't just mining the information, Number Six; it’s owning it! And everything is in place for the most tremendous abuse of power.

Knowledge is power; it is also control. There is an Asimov story about humans who build the most powerful computing machine in the universe to ask The Last Question. But this is not Deep Thought; it is Multivac.

Here is this same obsessive pursuit and it will lead to us becoming the tools of the creation we sought to make a tool to serve our purpose.

GPs have been told to complete a workforce survey by May of this year and to audit all ‘unnecessary’ appointments.

This is Pulse –
Exclusive GPs have been told to hold off on completing a mandatory survey of practice staff, described as ‘intrusive’ and ‘time consuming’ by GP leaders, until the GPC has concluded urgent meetings with the Department of Health.

Pulse revealed in January that GPs had been told by NHS England that they should complete a census of 75 different categories by May, including a report of staff absences, ethnicity and the reasons for staff members leaving, for the NHS workforce Minimum Data Set (wMDS).

The BMA legal department reviewed whether practices can opt-out of the census over data protection concerns, but advised that data sharing powers introduced in the Health and Social Care Act overruled their objections.

The BMA legal department had found that NHS England and the Health and Social Care Information Centre can demand the information under powers granted by section 259 of the Health and Social Care Act – the same section which blocks GPs from preventing the extraction of their patients’ records under, NHS England’s GP record-sharing scheme.

GPC deputy chair, Dr Richard Vautrey told Pulse that the GPC had concerns over the ‘huge workload’ for practices, and that practices should continue to hold off completing the forms. 
He said: ‘Practices have been raising real concerns about this for a number of reasons; the huge workload involved for individual practices, at a time when they’re already struggling; and concerns about what data is being requested, particularly concerns around requests for national insurance numbers for individuals, which many people have been anxious about.

Sectioned! This is not a Section 2, however, and you may not have the facility of an AMHP (Authorised Mental Health Professional) to decide. This is a Section 259!

What’s going on?

Data collection shall be relevant and not excessive [Data Protection Act].

Is it that they just need to know?

They need to know because they have to know. Why? Because they want to know.

Beware empire builders...

Care minister Norman Lamb has told HSJ that he wants to create a single government department for health and social care by joining budgets at a national level.
In a wide ranging pre-election interview, the Liberal Democrat minister said the government should lead by example by integrating budgets at a national level.

He said that after the May general election a new financial settlement needed to be agreed for health and social care nationally, and that this should be done within “a new department for health and care”, established immediately after the election.

Makes sense? HSCIC is sponsored by the DoH to collate information on health and social care. Joining up health and social care will facilitate the programme to limit life, Mr. Hunt's £5.3 bn Better Care Fund to keep people out of hospitals, the Health and Wellbeing Boards and the greater responsibilities in this area which local authorities are expected to shoulder.

Pertinent reading –
Liverpool Care Pathway - Back To A Way Forward
Liverpool Care Pathway - Crying Wolf
Liverpool Care Pathway - The Many Pathways To The Perdition That Awaits Us
Or is it simply grasping at straws, going full circle and hankering back to a future DHSS SS DHSS...?

But it’s all on hold until after the elections. We don’t want to rock the boat, do we? is all about transparency. It is there for your own good, citizen. And for pretty much anyone else willing to pay for information, information, information. And ‘anonymisation’, like the Emperor’s new clothes, will pretty much expose you, transparent, to the scrutiny of all.

Last year, the management consultancy company PA Consulting obtained 27 digital discs of HS ‘anonymised’ data from the HSCIC (Health and Social Care Information Centre) and uploaded the information to Google Cloud. Employing Google Big Query to extract the detail of the data from the information, the ‘anonymised’ data was reverse-engineered and interactive maps formulated.
The Independent
The security of NHS data was thrown into further doubt yesterday after it emerged anonymous patient information has been used by a marketing consultancy to advise clients on targeting their social media campaigns.

It comes amid growing concerns over plans to trawl patient records from every GP surgery in England, which were postponed last month after NHS chiefs admitted they had not done enough to inform and reassure the public about the scheme, known as MPs sought reassurances last week that the GP data, which could be accessed by researchers and approved private companies, would not be vulnerable to breaches of patient confidentiality.

In another blow to public confidence in the scheme, it was also reported yesterday that the entire hospital episodes statistics (HES) dataset has been uploaded to Google servers. A management consultancy firm called PA Consulting used Google tools to create interactive maps out of HES data, it emerged. The HSCIC said it had received assurances that no Google staff would be able to access the data, and the firm said that the data was “held securely”.

However, Phil Booth, from Medconfidential, said that their use of the data raised serious concerns that NHS records were being used for commercial purposes.
“47 million people don’t have a clue that their hospital history has been used to target ads on Twitter and Facebook,” he said.
No information is ‘secure’. No matter how well ‘anonymised’ or encrypted, it can be ‘cracked’ with persistence and determination.

In the States, Stanford Hospital & Clinics faces a lawsuit over encrypted data breaches on 20,000 patients. Is it this way comes across the pond?

The DoH has appointed Dame Fiona Caldicott as the National Data Guardian for Health and Care. She will oversee "extra legislative safeguards" for record sharing and the Care dot Data trawl of GP patient data.

They have roped her in to use the Caldicott name to provide assurances and to make the whole endeavour seem, well, pretty innocuous and ‘mostly harmless’ really.

Loyalty cards may seem pretty innocuous and ‘mostly harmless’ but personal habits and trends and preferences may be secured thereby and sold on to target you and tailor you for marketing purposes - commercial, political and who knows what else.

This is Government Computing –

National Data Guardian Dame Fiona Caldicott has said no deadline is currently in place to complete a review of measures required to address concerns around NHS England's controversial scheme - leaving a launch date to begin trialling the programme uncertain.

After being appointed by the Department of Health (DH) as the first ever data guardian last year as part of efforts to ensure "extra legislative safeguards" are in place for patient information strategies, Dame Caldicott back in December called for clarification on some 27 questions relating to privacy and the wider scope of

Implementing the programme has continued to prove controversial, with pressure groups raising concerns over the confidentiality implications of sharing highly personal data concerning medical and mental health histories - leading to the project's launch being delayed from last year.
Under a new implementation plan, NHS England is looking to trial at selected surgeries in the CCG areas of Leeds, Somerset, West Hampshire and Blackburn with Darwen - though information extraction is only to commence with Dame Caldicott's backing. 

An 'Accredited Safe Havens' (ASH) plan was promoted in order to create an environment where the rules about the security of extracted data are defined and designated. The information is confined and the movement of information is bound by stringent regulations.

The ASH strategy was first published in a Guidance Paper released last June. Plans for whether there will be a lone ASH or a forest of them round the country wasn't made clear. Whether a bastion would be more or less secure than an outpost is debatable.
Speaking to Government Computing today, Caldicott said that no formal timetable had been set by either herself or senior health figures like Tim Kelsey, NHS England's National Director for Patients and Information, for when the clarifications required about the programme will be addressed.
Caldicott noted that the programme's trial launch was therefore dependent on the Independent Information Governance Oversight Panel (IIGOP), which she chairs, receiving sufficient responses from health authorities to ensure the required levels of protection measures and information governance is in place.

"My crystal ball is not really clear. With an election coming, who knows," she said in response to when the information may be received.

Caldicott was speaking in London today at a keynote seminar on data protection and the use of electronic health records in the NHS to discuss the challenges around balancing confidentiality with service innovation. 
The designated ‘safe havens’ resorted to in the wars which dismembered Yugoslavia didn't stand up to much as 'safe havens' as I remember.

Dame Caldicott noted two issues proving hard to resolve...
"The two I would probably pick out are that we are working with local GP practices to ensure they understand what data is leaving their practice for purposes other than direct care so they can communicate that to their patients," she said, noting this would be important to ensure the public were better informed before deciding to 'opt-out' of the project.
"So the practice does need to know what data is going out of the surgery and where it is going." 
The NIB (National Information Board) has published Personalised Health and Care 2020 -

This provides a framework for how patient data is used. ‘Real time’ data will be available to paramedics, doctors and nurses so they will know who is safe for use of DNACPR orders and the withholding and withdrawing of life sustaining treatment and provide access to advance decisions.

The DoH says that ‘digital and interoperable systems’ will be in operation and remove the limitations of paper records and slow bureaucratic systems by 2020.
Established by the Department of Health, the NIB is a new body which brings together national health and care organisations from the NHS, public health, clinical science, social care and local government, together with appointed lay representatives. It is charged with developing the strategic priorities for data and technology in health and care to deliver the maximum benefit for all of us, as citizens and patients and to make appropriate recommendations for investment and action.

The NIB helps take forward the ambitions of the Care Act 2014,1 the Government Digital Strategy (2013),2 the Department of Health’s Digital Strategy: Leading the Culture Change in Health and Care (2012)3 and the proposals in the Department of Health’s Power of Information (2012).
Down this maze of dark Whitehall corridors doth stride the makers and the breakers and may information stray.

The NIB, a central DATA Agency, appears a beneficent Big Brother figure, innocuous, and yet frighteningly familiar for have we not met him before?

The NIB is a board of bodies which themselves have  been found wanting, involved in scandals and cover-ups and political bias -

It is no more reassuring to see this accumulation of self-impressing logos than it was to see another fine collection lending their support and backing to the LCP.

This board includes NICE and the NHS LA.

The former determines treatment provision on light years life years (the 'quality adjusted life year or QALY) and the 'quality adjusted life year' (the CQG) which is a ratio of the treatment cost divided by the estimated years to be gained by the treatment. Obama adviser, Cass Sunstein, has devised a similar "senior death discount", as if 'quality of life' may be so determined by a mathematical calculation or defined at all!

The latter works to cover up and defend clinical and non-clinical liability and provide legal services to these same board members and others. It is a £400m legal advice panel paid for out of our pockets to protect and defend their interests against ours. It is all about damage limitation and obfuscation.

NIB seeks to 'exploit the digital information revolution', but who owns and collates this information may control and may direct. Those who have conceived the NIB have also rolled out the LCP and sought to bury - literally and metaphorically - its consequences; they have sought to conceal the dark truths of Gosport, Mid Staffs and Morcambe Bay. Can they be trusted; may we entrust them?

Putting health and social care under the same umbrella may yet lead to a purpose. There has been a mission in health and social care for nearly fifty years to bridge the gulf between provision and demand that separates the two. Ever since Mr. Patrick Gordon Walker’s landmark speech in 1967 and the creation of the DHSS in 1968...
Liverpool Care Pathway - When The Caring Had To Stop
The State is putting itself on a war footing. They need to act and they need to act now.

What do they want, Number Six?


This is akin to the WarAg (Wartime Agricultural Orders).

But this is not Warfare but WarCare and Welfare.

And that is why, good doctors, they need to know.

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