There’s a big brouhaha going on in NW London at the moment over the proposals to reorganise the way our hospitals work.

Needless to say all the local agitators and pressure groups are out in force, mostly peddling totally inaccurate messages like “Save our hospitals”, “You won’t have A&E services”, “Major cuts to your health service”.

Needless to say most of this is totally fictional and they have not understood the actual proposals, which are contained in an 80 page consultation document. I even wonder if any of them have read it.

I have been to several public meetings recently. I am appalled at the inability of people to understand the proposals, the way in which everything is parochial, angry and internalised, and their inability to step aside from “it might be inconvenient for me” and see the bigger picture. People are being angry and frightened, because they dislike change and they cannot (or will not) make the effort to understand.

Nevertheless, and although my GP is one of the team responsible for the proposals, in fairness I have to say they have not been well presented, in clear and straightforward messages and in a way which Joe Public can understand. Joe Public does not listen to detailed arguments (he never did!) but needs sound bites and simple statements. The NWL NHS team may be excellent clinicians, but they have not got good PR/marketing/presentation skills — and it shows. I’m no expert but a lifetime in business (including training) has put me ahead of the pack.

As a working thinker I have therefore made it my business to get involved. Having read the consultation document a number of times I have now distilled it down into a 10 slide, simple presentation for my doctor’s surgery patients’ group. And I have tried to help the NHS team to hone their messages.

Here is a copy of my presentation slides, which are on Slideshare. If you are in NW London then please read the presentation.

[slideshare id=14342271&style=border:1px solid #CCC;border-width:1px 1px 0;margin-bottom:5px&sc=no]

The bottom line is that this is roughly a 10% change in what the patient will see. In other words for every 10 people who go to hospital, one may go to a different hospital. All these hospitals are within something like an 8 mile radius — it’s not like we have to travel 30, or even 60 miles to hospital as is the case in many other areas of the country.

Now I’m not pretending the proposals are flawless; of course they aren’t. There are currently some big gaps like the lack of appropriate public transport services — something he NHS team are well aware of and are already discussing with Transport for London. However ultimately we have to stand aside from our parochial feelings and do what we know is right. In my mind, and regardless of the business case, these proposals are clinically, logically and logistically the right ones and should have been done years ago.

If you can, please also read the Shaping a Healthier Future consultation document.

When you’ve done that please have your say on the proposals; there is an online questionnaire.

The consultation runs until 8 October.

There’s an interesting short article in the October 2012 issue of Scientific American, which I was reading last night.

Under the banner Target the Super-Spreaders, Kathleen A Ryan proposes that the best way to tackle flu is not by vaccinating the elderly, the immuno-compromised and the pregnant. It is actually by vaccinating all schoolchildren between the ages of about 5 and 18.

The article doesn’t seem to be online, so here are a few key extracts:

[T]he most effective way to protect the elderly, and everyone else, is to target kids … Schools are virus exchange systems, and children are “super-spreaders” — they “shed” more of the virus for longer periods than adults.

Computer-modelling studies suggest that immunizing 20 percent of children in a community is more effective at protecting those older than 65 than immunizing 90 percent of the elderly. Another study suggests that immunizing 70 percent of schoolchildren may protect an entire community (including the elderly) from flu.

Perhaps the best example of the effectiveness of childhood vaccination comes from Japan. The 1957 flu pandemic prompted the Japanese to start a school-located childhood vaccination program. For at least 10 years vaccination against influenza was mandatory for all children. Excess deaths from influenza and pneumonia … fell by half … The study showed that for every 420 schoolchildren immunized, one life was saved, predominantly among the elderly. Once the program ended, immunization rates fell, and death rates rose dramatically over the next few years.

In Alachua County, Florida … a school-located influenza vaccination program has been in full operation since 2009. Implemented as a coalition of schools, health departments and community advocates … the program administers FluMist nasal spray, a live attenuated vaccine, free of charge to students, from pre-K to 12th grade, in public and private schools regardless of insurance status. Immunization rates of elementary students have reached 65 percent — enough to reduce the incidence of influenza in Alachua County during the past two flu seasons to nearly zero.

School-wide vaccinations would require a big conceptual change in immunization strategies, involving schools, communities, paediatricians and health departments. Who will fund and lead such an effort?

Well who’d have guessed it? Kids spread germs. Sounds a sensible strategy to me. But it needs a paradigm healthcare thinking. Just a little something else for the NHS to get its teeth into!