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Flu, Cow's milk allergy, Robotic pharmacy

Dr Mark Porter investigates how much protection the latest flu vaccine gives us from Aussie flu.

What goes into our flu vaccine always has an element of guesswork. Usually the experts get it right but sometimes nature has other ideas and a new strain emerges. Dr John McCauley, Director of the Worldwide Influenza Centre at the Francis Crick Institute in London tells Dr Mark Porter about Aussie flu and how different flu strains pose risks to different groups of people.

Cow's milk allergy is the most common food allergy among infants and it affects at least one in 50 babies, toddlers and pre-school children in the UK. It's an allergic reaction to the protein in cow's milk. There are two different types though and one type, called delayed cow's milk allergy, is often missed by health care professionals because it's easily confused with other common conditions. Lucy Wronka tells Inside Health her baby son George was ill for months with reflux, eczema and an upset stomach. It was only a chance meeting with a friend who recognised the symptoms that led to a diagnosis of delayed cow's milk allergy. Twenty four hours after diagnosis and treatment, Lucy says George was a different baby. Dr Adam Fox, paediatric allergist at the Evelina London Children's Hospital explains the difference between the two different types of cow's milk allergy and discusses new guidance for GPs and health visitors which are designed to improve diagnosis.

One of Europe's largest robotic pharmacies is housed in Glasgow and this super high-tech hub has replaced fourteen separate pharmacy stores. It handles almost a hundred thousand packs of medicines a week and Inside Health's Dr Margaret McCartney, herself a GP in the city, reports on how this automation has transformed pharmacy services in Greater Glasgow and Clyde.

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28 minutes

Programme Transcript - Inside Health

Downloaded from www.bbc.co.uk/radio4

 

THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT.  BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

 

 

INSIDE HEALTH – Programme 2.

 

TX:  09.01.18  2100–2130

 

PRESENTER:  MARK PORTER

 

PRODUCER:  FIONA HILL

 

 

Porter

Coming up today:  A robotic pharmacy – Margaret McCartney travels to a secret location to meet the robots dispensing drugs in her home city Glasgow.

 

Clip

The robot is whirring up and down, it turns around 180 degrees, the arm extends into the shelf to grab something and then seamlessly it just moves on to the next task.

 

It does and it’s also rather sophisticated in the sense that if there is a bit of downtime throughout the day it will turn into a house tidy type mode and what it’ll do is it’ll start tidying up its shelves.

 

Can I get one of these at home?

 

Porter

And cow’s milk allergy in children, it affects around one in 50 children under four in the UK.

 

Clip

His skin was getting worse, he was starting to refuse the bottle and I will remember this for the rest of my life, the GP said – well it’s extremely fashionable for babies to have reflux these days and you’re a first-time mum, this is what babies are like.  And so, I sort of walked away without a prescription and without really knowing where to go from there.

 

Porter

New guidance to help GPs like me spot tell-tale signs earlier coming up later.

 

But first, an all too common problem at this time of year – influenza.  There have been headlines about an outbreak of Aussie flu, the H3N2 strain that caused problems down in Australia last year.  And although it is too early to tell if we face a major epidemic, the number of flu related hospital admissions is rising and the next two weeks will be key.  And there are concerns about the effectiveness of this year’s flu vaccines. 

 

Dr John McCauley is Director of the Worldwide Influenza Centre at the Francis Crick Institute in London.  John, is there anything special about Aussie flu that makes it a particular problem for us this season?

 

McCauley

Different strains pose different threats to different age groups in the community, all of those with different susceptibilities.  So, the H3N2 virus, that’s…

 

Porter

This is what’s been labelled the Aussie flu?

 

McCauley

That’s the Aussie flu – appear to be a particular problem in the elderly, whereas the H1N1 virus, that’s those viruses that came in with the pandemic in 2009 and are still in circulation, doesn’t actually hit that group badly at all but hits the younger age groups.

 

Porter

Now this strain is included in the vaccine, so does that mean that the most vulnerable people are protected?  I mean if you’ve had the vaccine are you protected against so-called Aussie flu?

 

McCauley

Within the UK we’re using two different vaccines.  For the children they receive a live attenuated vaccine, that’s a weakened virus that gives you an immune response but doesn’t cause any disease.  Whereas for the other members of the community – the elderly, other people at risk, the adults at risk – they would receive an inactivated vaccine and they’re different.

 

Porter

A jab.

 

McCauley

Well it’s a jab, it is given by injection whereas as you’re aware that the live attenuated virus is delivered by nasal drops or nasal spray rather.  The vaccine given to the children actually has been performing well but it was somewhat disappointing to see the performance of the inactivated vaccine, particularly in the very elderly, where it was not good.

 

Porter

You say not good…

 

McCauley

The performance was not good.

 

Porter

… I mean looking at the official figures, I mean it basically didn’t offer any significant protection at all.

 

McCauley

There’s a lot of margins of error in those estimates.  But the point estimate is hardly…

 

Porter

Fairly marginal.

 

McCauley

…it’s marginal.  But a marginal benefit is better than no benefit whatsoever.

 

Porter

So, looking at this year, I mean we’re using similar vaccine technology, using similar strains, and we’ve got a similar circulating strain out there, so I mean what you’re saying is we’re not expecting great protection in older people?  I mean they are the most vulnerable, that’s why it’s important, and there are millions of them.

 

McCauley

Indeed.  This is a problem that we have.  The elderly population is increasing in size and this vaccine, the inactivated vaccine, seems to be performing poorly, the one that we’re giving.  Now what we have options for in the future, I think, are improving this vaccine for that age group, for example, including an adjuvant to stimulate the immunity to the viruses or even larger doses.

 

Porter

So, put simply this is something that you’d add to the vaccine to make it more immunogenic, it provokes a bigger response…

 

McCauley

Yeah, I think immunogenic, the word you use there is right.  I mean immunogenic meaning simulating a greater immunity, a broader immunity.  And this is something that one needs to consider for the future because if we are seeing poor vaccine effectiveness that is effectiveness in the field, when it’s used, then we need to make sure that we’re using the best vaccine that we possibly can.

 

Porter

What about other strains?  Aussie flu has grabbed all the headlines but it’s not the only strain that’s circulating…

 

McCauley

No indeed.  So, this year it’s somewhat unusual that we’ve also got Influenza B viruses in circulation so early on in the season.  So as far as I can tell from the recent numbers from Public Health England, in England and Wales at least, there are similar numbers of H3N2 viruses and Influenza B viruses of the Yamagata lineage.  I should have explained there’s the Influenza A viruses, which come in sub-types, H1N1 and H3N2.  And Influenza B viruses that are somewhat similar, as coming in to two lineages, but they’re not as different as Influenza A sub-types.  And one is called the Influenza B Victoria lineage and one is called the B Yamagata lineage.  The component of the vaccine for the Influenza B trivalent vaccine…

 

Porter

That’s the jab given to most adults?

 

McCauley

That’s the jab, the trivalent jab, although the quadrivalent jab is available.  The Influenza B component of that is the B Victoria lineage and not the B Yamagata lineage and it is the B Yamagata lineage that is causing the problems that we’ve seen for Influenza B in England and Wales or the United Kingdom this year.

 

Porter

So, to summarise, we’ve got this Aussie flu strain which is proving quite difficult to provide an effective vaccine against and then we’ve got this other strain – Yamagata – which actually isn’t contained in the most widely used jab.  Is there a difference clinically between A and B type influenza, is one worse than the other?

 

McCauley

It’s generally reckoned that Influenza A viruses are worse than Influenza B viruses.  And it’s recognised that Influenza B viruses, of the population, the most susceptible age group in the population is the children for Influenza B viruses.  That said the vaccine that children are given, the live attenuated vaccine, has got both the Influenza B Victoria lineage virus and the Influenza B Yamagata lineage virus in it.

 

Porter

So once again, this year, we would hope that actually children are probably better protected than older adults in our society?

 

McCauley

Indeed, and it may well be that by protecting the children you indirectly protect the adults by not introducing the infection into the household in the first instance.

 

Porter

And for people listening to this in the UK, who’ve not been vaccinated but are eligible, it’s not too late?

 

McCauley

Not that’s right, I mean it’s well worth asking for the vaccine.

 

Porter

So, it might not be the most effective jab we’ve had, particularly for older but it’s the only protection we have?

 

McCauley

It’s the only thing that we’ve got other than complete isolation.

 

Porter

And what about if you get a choice, and most people won’t have a choice about what flu vaccine they’re offered, it’s whatever their suppliers got, but if you had a choice between quadrivalent, that’s the four strain, or the three strain, trivalent, presumably you’d go for the quadrivalent one because it covers more possibilities?

 

McCauley

I would go for the quadrivalent yes but generally I’m not given the choice, it’s I get given what’s there on the shelf.

 

Porter

Dr John McCauley Director of the Worldwide Influenza Centre.  And there are links to more information on this year’s flu vaccine, and who should have it, on the Inside Health page of the Radio 4 website.

 

Clip

I’m allergic to it – milk – I get an upset tummy.

 

I was also [indistinct words] on my face.

 

And your tummy swelled up didn’t it?  And what else happened George?

 

Itchy.

 

Itchy didn’t you?

 

Yeah.

 

Porter

Lucy Wronka from South East London and her four-year-old son, George.

 

Cow’s milk allergy like George’s is common affecting at least one in 50 babies, toddlers and pre-school children in the UK, which currently has the highest prevalence in Europe.

 

The diagnosis is often missed, not least because it is easily confused with other common problems.  George’s symptoms began after he was switched to formula milk when his mother Lucy became unwell and couldn’t breastfeed.

 

Wronka

Looking back he obviously had hives and rash and eczema as a result of the formula but he was a new-born baby and I just thought oh he’s got a bit of baby acne.  But he always had a bit of tummy troubles, so he was always slightly constipated, then we’d have a nappy explosion.  But first-time mum, your head’s all over the place anyway, so you’re sort of just muddling your way through those early stages.  And then I noticed after about a month old, month and a half, two months his skin was getting worse.  He was starting to refuse the bottle and there’d be days where he wouldn’t take any bottles at all and would fight me trying to feed him.  And I’d been back and forward to the doctor, initially thinking well perhaps he’s got a touch of reflux and that’s why he’s not sleeping and he’s so unsettled.  I couldn’t put him down, he just wanted to be held the entire time and he was being quite sick a lot of the time.  And I will remember this for the rest of my life, the GP said – Well it’s extremely fashionable for babies to have reflux these days and you’re a first-time mum, this is what babies are like.  And so, I sort of walked away without a prescription and without really knowing where to go from there.

 

Porter

Lucy’s experience, is, unfortunately not unusual. There are two types of cow’s milk allergy – one not so obvious and often missed.

 

Dr Adam Fox is Consultant Children’s Allergist at Evelina London Children’s Hospital.

 

Fox

There’s what we refer to as immediate milk allergy, the technical name is IGE mediated milk allergy which involves allergic antibodies and this is the sort of allergy that people recognise very easily.  Typically, an infant will have their first bottle of formula milk and almost straightaway they’ll come out in hives and swelling, they’ll be itchy and it’s pretty obvious that it was the milk that would have caused it because the reaction happened so quickly afterwards.  It is possible to have really severe allergic reactions, very rarely fortunately it can even be fatal.  There’s another type of milk allergy and it’s a milk allergy that is often not recognised easily at all.  We refer to it as delayed milk allergy, the technical name is non-IGE mediated milk allergy which really just reflects the fact that it doesn’t involve allergic antibodies in the classic sense that we understand them.

 

Porter

And listening to that story there, presumably that’s the type that George had?

 

Fox

It certainly sounds like it because the typical symptoms will be an infant who has milk regularly in their diet, they’re on formula, starts getting chronic symptoms and they’re persistent.  Typically, they involve the gut, so it can be reflux, cholic, diarrhoea, faltering growth – there’s a whole range of symptoms.  And also, symptoms in the skin, so classically it will be difficult eczema that won’t respond to the normal treatments that eczema would get better with.

 

Porter

And what is it in the milk that the child is reacting to?

 

Fox

It’s the protein and in fact it’s because it’s the protein that makes this an allergy. There’s often a lot of confusion between delayed milk allergy and lactose intolerance.  Lactose intolerance is an issue with digesting the sugar that’s in milk and it’s completely distinct from delayed cow’s milk allergy. 

 

Porter

And this protein in the cow’s milk is then triggering an abnormal immune reaction and that’s what’s responsible for the symptoms of the allergy?

 

Fox

That’s right.  What’s happening is inappropriately the immune system is seeing the cow’s milk protein and it’s triggering an allergic response.  Now if it’s an immediate allergy that triggers the release of histamine and all the symptoms that you get of itch and swelling from that.  But with delayed allergies it’s the slow acting part of your immune system that recognises the cow’s milk and releases a whole range of different chemicals that lead to inflammation and that inflammation can be in the gut, it can be in the skin, and it’s that that leads a little more slowly but to those chronic symptoms of either reflux, cholic, diarrhoea or eczema.

 

Porter

And of the children that you see in clinic with this sort of problem is George’s story of back and forth to health visitor and GP etc. is that quite common?

 

Fox

Sadly, it’s absolutely typical.  There is an issue of recognition in primary care and in fairness that’s understandable because this isn’t an obvious condition.  These are children who come in with symptoms that are extremely common in other babies who don’t have a milk allergy.  And it’s very difficult to tease out from the large number of infants coming in with symptoms like eczema and cholic and reflux which are the ones who have the underlying milk allergy and which are the ones who just have eczema and reflux and cholic that needs treating in a more straightforward way.

 

Porter

If the diagnosis is consistently missed in the delayed type how serious can this get for the child?

 

Fox

Well the symptoms will be very persistent and they can really unpleasant and these kids, when the diagnosis is delayed, have a pretty miserable existence with the symptoms getting often progressively more severe.  That said these aren’t dangerous allergies, there’s no risk of anaphylaxis or anything life-threatening with delayed allergy but it can be deeply unpleasant.  And lots of studies have now showed what a profound impact it can have on the quality of life, not just of the infant but of the whole family.

 

Porter

And that’s exactly what was happening with Lucy and George.

 

Wronka

He was about three months old and I’d been back to the GP because his skin was worsening and by this point his eczema on his face and torso and especially in his neck was red raw and weeping and I’d been given prescriptions and I’d been given lots of different types of emollients to try for the bath, creams, mild steroid creams, you name it I’d been given it.  And it just so happened that then we went to see some friends, who were having a barbecue, one afternoon and she’s a very good friend of mine and she happens to be a paediatric dietician who’s a specialist in allergies.  And it was the first time she’d met George and he was three months old by this point and she took one look at him and said has he got a milk allergy.

 

Porter

A lucky break that meant George was then referred to the Evelina Children’s Hospital in London.  His delayed milk allergy was confirmed and he was given a hypoallergenic alternative to the usual cow’s milk based formula, and within days George was a different child.

 

Wronka

His skin cleared up, it started to heal almost straightaway.  His reflux went away overnight.  He was contented, he’d have a feed and then go to sleep.  And at that point then we actually just started to enjoy our lives together and I feel quite guilty saying this but I started to enjoy my baby.

 

Porter

Adam, is that speed of response typical?

 

Fox

It is.  And actually, making a diagnosis like a delayed milk allergy and switching the formula or asking mum if she’s still breastfeeding to cut milk out of her diet can be really fulfilling from a doctor’s perspective because you see sometimes a really rapid and complete response.  And the classic line is – I’ve got a different baby.

 

Porter

What about in older children, milk from other animals – from goats or from sheep?

 

Fox

Yeah well very commonly we’ll have patients who will be moved on to a goat’s formula.  As it happens the proteins in goat’s milk are pretty much the same as in those in cow’s milk and likewise for sheep’s milk.  So, although the research suggests that donkey milk and camel milk might be okay, they’re not so easy to get hold of.  So other mammalian milks are a bit of a no, no here and in fact sometimes because of bad advice kids with a milk allergy are advised to take those formulas and end up having some quite nasty reactions.

 

Porter

What happens in the longer term as the child’s growing up?

 

Fox

So, the norm for a delayed cow’s milk allergy is they’ll outgrow it, the prognosis is good.  The majority of kids have outgrown it by about one to two years of age.  There are some stragglers who won’t outgrow it to a little bit older and occasionally, and unfortunately, it’s the minority, you’ll get more complex cases where it’s not just milk, it’s often a number of other foods and they tend to have allergies that can persist a little bit longer into childhood.

 

Porter

Because Lucy had already had one child with cow’s milk allergy when she gave birth again two years later, to George’s baby sister Iris, it was decided to check her at the outset.  So, Iris was given a tiny test feed while they were both still in hospital.

 

Wronka

She was a day old and she had a drink of formula and immediately was head to toe in hives, swollen face, bright red and extremely upset stomach and that was just after an initial taste.  And so there and then I knew that there was a problem.  And so, we were able to get a formula prescription for her before we’d even left the hospital.  So, for the first four months George’s sister, Iris, had none of those symptoms at all.  We were able just to go out and start enjoying our lives together.

 

Fox

For a long time, it’s been enormously frustrating that there’s so much delay commonly in infants having their delayed milk allergy picked up.  Lots of visits to the GP, a lot of very frustrated mums before diagnosis is made.  So, to try and develop things a little bit and allow GPs to have a framework really for knowing what questions to ask, what tests to do, how to take forward this possibility that the infant in front of them with eczema, reflux, cholic, diarrhoea who might have a milk allergy, we developed something called the Milk Allergy in Primary Care, so the MAP guidance in 2013, and it was really intended for local GPs.  And then 70,000 downloads from the journal it was published in later we realised there was maybe a bit more demand than we expected for this.  So, we actually got together with collaborators from across the world and produced a new version – the International Milk Allergy in Primary Care Guidance – that really allows any healthcare professional to think in a structured way about the possibility that an infant that they’re seeing might have a milk allergy and to make the right management decisions to ensure that that child gets better as quickly as possible.

 

Porter

In a nutshell, Adam, from that guidance what sort of management can be done by the health visitor and the GP in the primary care setting because unfortunately access to specialists like you in clinics like yours is tricky?

 

Fox

Access to specialists is a big issue, particularly in the UK and in fact one of the main drivers for this guidance is to take the diagnosis and management away from specialist care and back into the community where really it belongs.  The best placed people to make these early diagnoses are the GPs and the health visitors.  What we’ve seen a lot of is the mums having to sort of wave guidelines at their healthcare professionals to say have you thought that maybe the reason my baby’s eczema isn’t getting better with the steroid creams you’ve given us is because of an underlying milk allergy?  We want that to be the other way around, we want the GPs to be raising it with the parents.

 

Porter

Paediatric allergist Dr Adam Fox.  And there is a link to those new guidelines on our website, where you can also listen to that interview again.

 

Now to Glasgow, home to one of the biggest and most advanced robotic pharmacies in Europe, and where Inside Health’s Dr Margaret McCartney practises as a GP. So, it seems only right to get the two together.

 

McCartney

It’s a beautiful day in Glasgow and I’m here in the middle of an industrial estate in front of a non-descript warehouse and I have been asked to keep the location secret and the reason for that is that this is the warehouse that supplies all the drugs and medicines to all the hospitals across Glasgow, so I can understand why they don’t want that publicised.

 

It’s a massive place, this used to do the job of 14 different hospital pharmacies and it’s run by robots and I’m very keen to see what it looks like and I’ve arranged to go in and take a look today.

 

Robertson

My name is Gale Robertson and I’m the lead technician within Greater Glasgow and Clyde for [Name]. 

 

McCartney

We’re just standing beside the window at the outside edge of this enormous warehouse and in the middle I can see a big white cube.  What’s that Gale?

 

Robertson

So, that big white cube is actually our robot installation.  There are eight robots all interconnected with a conveyor system.  Inside those robots there’s a number of picking arms that will actually go to a shelf to retrieve the product and output on to the conveyor system.

 

McCartney

So, by robots what do you mean, is it just robot arms, are these kind of cyborgs, what do they look like?

 

Robertson

It’s not metal mickey.  It’s certainly just an arm that reaches out on to a glass shelf and draws the stock back, so almost like a fork type finger that selects a product, brings it out and puts it on to the conveyor system.

 

McCartney

So how do the robots know what it is that you want?

 

Robertson

Every product has a unique barcode which then interfaces with our drug catalogue and that’s how it identifies which packet it needs to pick.

 

McCartney

Where do the orders come from, who are you supplying?

 

Robertson

The orders are coming from across the Greater Glasgow and Clyde Health Board, which is vast in size.  We’ve also got customers in NHS Highlands and the lower area of Argyll and Bute and we also supply to places like Oban, Islay, Mull.

 

McCartney

So, the deliveries come in, they’re then unpackaged and checked, then they’re put in to the robot machine and then they are distributed and organised from there, is that correct?

 

Robertson

Yeah, so we load them into the robot, they pick up the barcode that’s on that product and they recognise what that product is and they will put that away on a relevant shelf within inside the robot, so using that barcode technology the robot knows exactly what product it’s brought in and that’s all done automatically without intervention. 

 

McCartney

And there’s just a big amount of drugs spilling down from the top of the conveyor belt just now.

 

Robertson

Yeah, so that’s obviously the deliveries just down now starting to come out this morning and we will output for probably about eight to 10 hours a day, orders will just be getting picked and packed through that mechanism and shipped out to our hospital sites across the organisation.

 

McCartney

So, there’s several chutes emerging from the top of the white cube and they’re coming down on to a conveyor belt and from there they’re going along and it’s a bit like the generation game, they’re on the conveyor belt, and then they’re dropping off at different points into these green tubs that are underneath.

 

Using automation like this is part of a deliberate policy to free up pharmacists to work directly with the patients and use robots to do the jobs that humans don’t need to.  Janice Watt is the lead pharmacist for the hospital services in NHS Greater Glasgow and Clyde.

 

Watt

This has been part of an overall pharmacy strategy in Glasgow and Clyde where the traditional model of pharmacy, good pharmacy, was very much about medicine supply has changed over the years and we now have pharmacists who are very much working with doctors and wards and pharmacy technicians who are professionals in their own right who are again working on wards checking discharge prescriptions, speaking to patients and in order to free up that resource in order to give that direct patient care we needed to look at the things that were routine and easily managed in a different way.  And so therefore picking stock from shelves and putting it in boxes seemed like an obvious thing to do differently and to use automation to free up our staff time, to use their technical and professional skills in a different way that’s more beneficial to patients.

 

Robertson

So I can just take you round to one of the robots just now and if you just look through the glass you’ll be able to see straight ahead there’s the picking heads and you can see…

 

McCartney

So, we’re looking into a kind of glass window aren’t we and it’s just extraordinary, there’s floor to ceiling glass shelves with lots and lots and lots of packets of drugs on them.

 

Robertson

Yes.

 

McCartney

And there’s a flying arm that’s whizzing up and down them…

 

Robertson

The picking head basically just finds a shelf where that product pack size will fit and it just slots it straight in.

 

McCartney

It’s quite mesmerising to watch, the robot is whirring up and down, it turns around 180 degrees, the arm extends into the shelf to grab something and then seamlessly it just moves on to the next task.

 

Robertson

It does and it’s also rather sophisticated in the sense that if there is a bit of downtime throughout the day, if we’re not outputting orders, it will turn into a house tidy type mode and what it’ll do is it’ll start tidying up its shelves.

 

McCartney

Can I get one of these at home? [Laughter]

 

Watt

The other thing that seems slightly counterintuitive is that we can’t have the shelves too clean or dust free because if they’re too shiny and slidey then it can’t pick the products easily, so we can’t be going in with our duster and tidying up because it needs an element of Glasgow dust on the shelves.

 

McCartney

This is just sounding better and better.

 

Robertson

Now what’s just happened here is we’ve now got a live error on one of our robots and one of our superusers will come now and deal with this error.  There’s been a problem with the picking head…

 

McCartney

So, one of your superusers has been into one of the robot areas, presumably to try and sort out this fault that’s been beeping…

 

Robertson

Yes, been beeping in the background, so it looks like there’s just been a pack possibly has been caught on the picking arm and Natalie’s just removed that, just now.

 

McCartney

So, Natalie, you would be in there because there was an error message come up and there was a lot of quite angry beeping from the computer?

 

Natalie

Yeah, yeah it beeps until you fix the problem.  It just hadn’t acknowledged that there was a packet right at the back of the shelf, it could be just the picking heads just not got the shelf – the correct location.

 

McCartney

It seems quite happy now, it’s zooming back up and down…

 

Natalie

Oh no definitely, once you fix it it’s completely fine.

 

McCartney

I think everyone’s a bit anxious that someday robots are going to come and take over our jobs.  Was that a fear?  Has that been something?

 

Watt

I think there was a lot of anxiety in the beginning because the pharmacy staff are very proud of the service they deliver and we’re very anxious about a machine doing the work they previously did and thought will it be done as well and that was a journey for us but I think no one would want to go back now to what we had previously.  It’s definitely a positive development.

 

McCartney

And there are plans to take this automation even further as lead pharmacist, Janice Watt, told me traditional medicine cabinets in hospital wards could be transformed too.

 

Watt

The next stage is to consider whether there are some areas where we could look at including automated medicine cabinets, so they really are a computerised system that holds the medicines at ward level and would give us that IT intelligence about exactly what stock we have across the organisation and that’s something that I think we’re actively considering.

 

Porter

Janice Watt talking to Margaret McCartney.  And Margaret’s on the line from Glasgow now.

 

Margaret, people often forget about what goes on behind the scenes, these are the backroom workers aren’t they?

 

McCartney

And the hospitals and the NHS more broadly could not function without these many, many unsung heroes that are just getting on and doing an extraordinarily complicated job of making sure that the right drug gets to the right patient.  It might sound simple but it’s actually highly, highly complex and the logistics of it I think are probably invisible to the vast majority of people that work in the NHS.

 

Porter

Well you’re going to be doing a few more reports from Glasgow.  Can you tell us what’s going to be coming up in the series?

 

McCartney

Yeah, I’m delighted to say we do have a few more reports coming from my home town.  One of the things we’re going to be looking at is mesothelioma, which is a type of lung cancer that’s sadly very common in Glasgow, in fact it’s got the highest incidence of mesothelioma in the world in the west of Scotland, mainly because it’s caused by asbestos, a type of insulator that’s now banned but is responsible for causing asbestosis and the lung cancer associated with it – mesothelioma.

 

Porter

And of course that was associated with the ship building industry presumably in Glasgow was it?

 

McCartney

That’s absolutely right and all the heavy industry as well and the problem with asbestos is of the lag period between exposure and later harm that’s done.  So, Glasgow has sadly but has built up a real expertise in dealing with this type of lung cancer and we’re going to be discussing that with Dr Kenneth Blythe and with some patients as well.

 

Porter

And continuing the high-tech theme of pharmacy robots you’re going to be looking at blood sugar monitors too.

 

McCartney

Yeah, so, for people with Type I diabetes knowing what your blood sugar is is a really important thing in order to make sure that you’re staying within the right kind of measures, you don’t want to be too high and you certainly don’t want to be too low.  And the technology has moved on apace and there are now devices which attach to your skin and can tell you what your blood sugar reading is.  The problem is that this is not funded for in many areas and the technology is really moving well beyond what the NHS has organised to supply and to fund, so we’re going to be talking to some parents of children who have Type I diabetes and their doctor to find out what the latest technology means for both them and for the NHS more broadly.

 

Porter

Thank you, Margaret, we look forward to that.  Well that’s what is coming up over the next few months, but what about next week?

 

Well we take a closer look at the recent announcement that younger women in UK can look forward to fewer smears thanks to the introduction of the HPV/cervical cancer vaccine. But what about the millions who missed out on the jabs because they were too old? And how does the national screening programme know who has been vaccinated and who hasn’t?

 

Join us next week to find out.

 

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