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Archive for the ‘Health’ Category

It is two months since the General Election and already the past feels like another country. Two parties who didn’t seem to agree on anything are now in government together – and between them they have somehow agreed that the National Health Service should be consigned to the dustbin of history. I don’t recall either party campaigning on this and I’m certain the British people didn’t vote for it. But make no mistake, that is what they are now proposing.

Ok, they have dressed it up a bit. They have talked about the essential principle of healthcare being free at the point of delivery, about curtailing “NHS bureaucracy” and handing power to GPs and patients. But the logical end of their plans is the break-up of the NHS we know and mostly love.  Handing commissioning powers to GPs may not sound that significant, especially if it is being taken away from the villainous NHS ‘managers’, but actually these reforms are the most significant since the NHS was created. Ironic too, given that the first thing Andrew Lansley promised was an end to “top down reorganisations”.

What is proposed is that £80 billion of public funding is handed to GPs, who will be asked to spend it commissioning local services.  They will replace Primary Care Trusts – statutory local bodies who currently carry out this commissioning work and are held accountable to a Professional Executive Committee of GPs, dentists and other clinicians. The vast majority of GPs – who may be great doctors  in most  cases, have no experience of buying services.  If you have tried to get an appointment with one recently, you will know they don’t have a great deal of time to spare. They are now expected to be able to plan, cost and commission NHS services in consortia with their fellow GPs – and act as “patients’ expert guides” through the NHS.  How on earth they will have the time to do this – never mind the skills or the inclination – is anybody’s guess.

Alongside this breathtaking proposal sits another – that hospitals should opt out of the NHS and become ‘social enterprises’, able to make a profit, set their own wage structures and develop partnerships with the private sector. It could be said the previous government opened the door to this by creating foundation trusts, but it is an astonishing development nonetheless. It means that we will have private contractors (GPs) commissioning services from ‘social enterprises’ – in effect private concerns – and presumably looking to private providers such as Humana, Virgin Healthcare and BUPA to provide the administrative, technical and accountancy support they will need. “The NHS” will in effect become a sort of central board, a regulator which oversees these business to business dealings. It will also mean that national standards become a thing of the past – already, vital patient rights are being removed, such as 18 week hospital waits, GP appointments within 48 hours and A&E services within four hours – and seemingly the right to see a specialist within two weeks of a cancer diagnosis. As ‘social enterprises’ team up with private providers to pick off the most profitable treatments, expect a postcode lottery the like of which we have never seen before.

If this was about tackling the much-vaunted economic deficit, it would be bad enough, but in fact it has emerged that the proposals will cost much more than they save over the next five years. These changes are driven purely by ideology – a belief in the ‘small state’ and opposition to the welfare state’s finest achievement. Nor is this just a Tory position – LibDems including Nick Clegg and David Laws have previously called for more private health provider involvement in the NHS.

A service on the scale of the NHS requires substantial management – in fact, a comparable private sector enterprise would probably have more people managing than the NHS does. Healthcare commissioning and healthcare pathways are complex business, and if you are to have a single national service with one set of standards, you need people to run it. The suggestion that GPs are these people is incredibly muddled – sure,  clinicians should have more say than they have perhaps traditionally had, but their skills don’t lie in planning, accountancy, monitoring or booking appointments. As one respondee said, if you go to a restaurant, you hope the waiter is good, but you don’t want him designing the menus.

But the government – cheered on by a slavering right wing press with its hatred of public sector workers – doesn’t see it that way. In fact, they don’t see it the way most British people do – the NHS retains a remarkable 90% satisfaction rate from patients. This is an administration which doesn’t believe in the NHS – it conflicts with everything they believe about the role of the state, which they think should be tiny. So not only do they want to scrap the NHS, they also want to wage war on welfare benefits, cut back on policing and allow parents to set up their own schools outside the state system. This government is going further in its opposition to the NHS and the public sector than even Margaret Thatcher dared. It is, in effect, abolishing it. If you believe in the NHS – and poll after poll says that a huge majority of Brits do – it’s time to stand up and fight for it.

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Because the Department of Health thinks you should! Here is a photo of a poster from an unnamed source at the Department of Health.
DH poster

I don’t know where to start with what is wrong with this. Patronising, sexist, a waste of money. Searching and tagging is better than folders anyway. And what category are the shoes in the open locker?!

Perhaps this sort of thing should be cut… anyone feel like a FoI request to see how much it cost?

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Latest rumours circulating suggest that as a result of ‘efficiency savings’ and cut-backs, local hospitals will have to shed 1000 members of staff, close 200 beds and see less patients in clinic. Naturally, the local populace will obliging be less ill. This of course is a nonsense. It is well known that during times of economic hardship, demand for health services grow, especially in areas such as mental health. Additionally, the recession has led to a boom in births, maybe as people take stock of what is important (or indulge in leisure pursuits that are free of charge). It is worrying then that historically whenever cuts are made in the health budgets, it is Children’s and Women’s services, along with Mental Health Services, that are the first in line for the axe.

Some time ago, the local hospital received financial support to expand and enhance services. Circumstances led to the funding being scaled back and improvements to the Children’s Hospital were the first thing to be axed. The same hospital is now looking to merge Women’s and Children’s Services as a first-line measure in cost savings, an agreement that will surely fail to benefit either party aside from the accountants.

Mental Health Services are strapped for cash at the best of times, and are well-known to be Cinderalla services in times of need. Mental Illness is not perceived as ‘sexy’ or at the forefront of medicine. Neither is there going to be a big public outcry, either due to stigma behind mental illness, or a misguided but prevailing view that mental illness is neither life threatening and those suffering are somehow responsible for their plight. Sadly, the mentally unwell are less likely to make their voices heard at the ballot box.

The shortages in midwives and poor standards of care in some maternity units has been well documented over recent years. It is with some trepidation that I consider what the effect of further cuts will be upon healthcare for women of childbearing-age, particularly in view of the current baby boom.

However, the fact that children’s medical services are often in the firing-line surprises me. Any parent knows the pit of worry you experience when your child is unwell, anxiously checking for rashes that don’t disappear and fretting that the tummy-ache could be incipient appendicitis. Aren’t we a nation of child lovers? Don’t we want to invest in the health of the future? Surely children are a fluffy, vote-winning, feel-good priority? It seems not. Why? Is it cynical to suggest this is because children are not voters? Whilst the parents may be on the electoral register there seems to be little resistance to cutbacks that affect their offspring. Does the general public place a higher degree of importance on shorter waiting lists for cardiac surgery, outpatient appointments, or not hanging around for half a day waiting to be seen in the Accident and Emergency Departments? Politicians certainly do as these things are easily measurable and bandied about at an indicator of a ‘Good Practice’. The problem is that many Children’s Services cannot be as easily compartmentalised nor are inadequacies in these areas reflected as much in hospital league tables as adult services.

In times of peril women and children are put first. It would seem that this adage is still be applied; this time in cutting health services for women and children first. There are difficult economic decisions ahead and I envy not those charged with commissioning healthcare services in the current financial climate. I just hope that the vulnerable groups or those without a voice at the ballot box are not left by the wayside.

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Here we go again: Children of working mums are less healthy than those who work part time. To the BBCs credit, they do at least briefly ask ‘what about Fathers’ – but this is yet another judgemental article, castigating full time work, and making assumptions about the type of parenting that goes on. I found the abstract for the paper (and why doesn’t the BBC link to this??), and it is clear that the associations found are very small – and short lasting! By the time the children in the study are school age, no association exists! However, surely what these studies highlight is the need for good quality childcare – rather than yet again putting working mums on the naughty step.

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Confessions of a Has-Been

We hear that Ray Gosling, veteran broadcaster and gay rights campaigner has been arrested on suspicion of murder following a rather bizarre and puzzling ‘confession’ on a BBC local news programme, broadcast on Monday night.

I am sure I am not alone in feeling wholly uncomfortable about this whole story- the rather phony grief that Mr Gosling seems to be exhibiting within his subsequent interviews, his attempts at equating smothering a young man with a pillow to the recent high-profile Dignitas assisted suicides, the arrogance of presuming himself above the law and the unforgivable lack of consideration for this man’s family. Not to mention the sheer disrespect for the victim himself, describing him as his ‘bit on the side’.

However, the nastiest taste in my mouth is left by Mr Gosling’s attempts at disguising himself as a foolish elderly man who has unwittingly wondered into a media whirlwind. Having worked as a journalist for the majority of his life, one could be in no doubt that Mr Gosling would have fully expected to provoke a significant reaction from the media when he revealed his ‘long-kept secret’. Maybe I am a cynic, but the whole farce smacks of attention seeking by an aging has-been and I’d be surprised if there was even a fragment of truth in his ‘confession’.

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Purely anecdotal, of course, but my experience is not this. Instead I find that in the process of trying to tempt my granddaughter with tasty morsels most of them end up in my mouth.

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There is nothing that fascinates the mother of a young baby as much as their little darling’s development. We watch carefully for signs of progress, be it rolling, sitting up, crawling and the holy grail of baby development, walking! And we assume that other people are as equally fascinated and (particularly in the case of first borns) can be guilty of being an utter bore about it. Get a group of mothers in the same room and it becomes a competitive sport. You may well hear a lot of crowing about how old little Johnny was when he crawled, isn’t he advanced since he walked at 9 months, oh how clever he is because he picked up a piece of plastic tomato with his thumb and forefinger at 28 weeks. Those of us with less exceptional children still squirming around on their tummies grit our teeth and tell ourselves that it doesn’t mean little Johnny is a genius and that ours will excel at school instead of on the carpet.

Except that now, we can’t. A new study indicates that there is a correlation between early development of gross and fine motor skills before age one and cognitive ability at age 5. In the study of 15,000 children:

Children who failed at nine months to reach four key milestones in gross motor development, relating to sitting unaided, crawling, standing and taking their first walking steps, were found to be five points behind on average in cognitive ability tests taken at age five, compared to those who passed the milestones.

Yikes. So babies who are ‘slow’ physically are likely to be thicker? Is that what they are saying? I guess so, but of course like all cohort studies, it means diddly squat for individual children. I am sure many of us with more than one child can point to instances where this doesn’t hold up. But the number of children in the study is impressively large, so I don’t think we can dismiss the findings out of hand. If we take them at face value though, what do they actually mean? Apparently the report says:

‘This finding highlights the importance of early screening for developmental delay at ages under one year, as a tool to promote positive child development.’

So now failing to walk before a year is a ‘delay’?!? [Incidentally, why does the Guardian have to use the headline ‘Children can fall behind as early as nine months’?? Why use the phrase ‘fall behind’? Behind what? Why does it all have to be so competitive?!? Pffffffffffffffffffffft.] I hope that this doesn’t (but am afraid that it will) mean that parents would be subjected to (even more) scrutiny about the development of their child. And to what end? Just because there is a correlation between early crawling and cognitive ability doesn’t mean that if you make your baby crawl earlier (how?!) they will be smarter. Maybe it’s just how babies are? I find the report fascinating, and since it sheds light on how our children develop it’s all good. But I worry that it will be yet another stick used to beat parents with, and we are already obsessed enough about these things as it is. I am having a flashback to my eldest daughter’s 8 month check where the Health Visitor tut tutted about her not being able to pick up a piece of fluff from the carpet in a pincer grip. Maybe that is why she is struggling with maths.

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