Tuesday, 12 May 2015


"The best test of a civilised society is the way in which it treats its most vulnerable and weakest members."
Mahatma Gandhi

With David Cameron saying he is going to revitalise the concept of the One Nation Tory (I really hope he succeeds), he's going to need some tools for the job. One good place to start is to focus on the most vulnerable. This is all very well but by their nature the vulnerable are often so because they can be hard to spot. Those exploiting or creating vulnerability are hardly going to advertise the fact and the vulnerable themselves generally struggle to stand out or even recognise their condition.

A civilised society is one therefore that takes a more pro-active role. Given that primary care seems to be held up as the solution to most of society's ills we're not going to be able to escape this responsibility. So what to do?

Much has been made of the need for the NHS to keep up with new technology. However the focus too often is on the gadgets and remote monitoring of tele-health where the benefits so far have not proven that exciting; largely, it seems to me, because when you are ill the last thing you want to do is faff around with more gadgets. I'm sure this will change but in the meantime the NHS has to hand something pretty special in Western medicine - an abundant source of rich, comprehensive, well-structured data. Our USP, which, in any more NHS re-organisations, must be preserved, lies mainly in the fact that the data describes geographically oriented, list-based primary care. Theoretically, we know a lot about local populations, unlike health systems without this local focus. It is this we need to exploit to prove how civilised we are.

Working in a practice serving a deprived population at Saffron Group we are only too aware that the context of someone's illness is key to recovery and vulnerability. We like to think of ourselves as family doctors but too often we aren't fully aware of this context, even in patients we think we know well. The irony is that often this data is available in other household members' records; we usually don't have time to hunt for it so its presence just passes us by. This is a lost opportunity for our patients.

But what if we moved our unit of analysis away from the individual patient? What if we moved our unit of analysis to the household?

We decided to use our IT skills to bring primary care data together at the household level. The tool we have developed consolidates a huge range of data from our clinical system and presents it by household. The tool contains a search engine to analyse it and a viewer of the output. This means you can search for a huge range of possible combinations of diagnosis and vulnerability. You can view the whole household in one go with vulnerabilities such as domestic violence, dementia, being a carer etc highlighted, which we are hoping will bring new insights to our practise, with vulnerable people as the beneficiaries. This is our first attempt and we are making it available for others to use free of charge at www.ukaguzi.com/VH.htm. Read more here.

The Household search tool and Household explorer

With the increased collaboration between health and social care this could become a powerful force for good. We have only just begun to explore its possibilities such as using it to view the whole household in our child safeguarding meetings. We hope this can develop into a wider open NHS collaboration. Please acknowledge us if you do any work based on this and if someone else decides to make money out of the idea or the system suppliers adopt it, remember where you saw it first. Sadly, as it is entirely voluntary we cannot provide support for the use of the tool. We hope you find it useful.

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