How does our healthcare system stand up to the festive test?

How do you define good service?

There can be no dispute that the basics for a good healthcare system, whether state or individually funded, should involve good service. Good service in healthcare terms means timely access to appropriate, quality treatment and advice. Any service-based industry will be put through it’s most stringent paces during a holiday period. Add to that some extreme weather conditions and you have an excellent benchmark to measure the basic services required for your health and wellbeing.

I am a self confessed insurance junkie. I have policies for electrical wiring, plumbing, heating and pest control (the joys of living in the country) along with the other essential household cover. Three days before Christmas, my central heating broke down. The charming lady at the call centre first checked my personal circumstances. Was there anyone elderly or infirm on the premises? Did I have other means of heating? Did I require urgent assistance?  Despite my reassurances that no, I was not elderly and infirm (although after trying to keep me upright on the icy pavement the next day my daughter, who likened me to Bambi, may have disagreed) I still received a visit by the heating engineer within 24 hours. My grocery delivery also arrived in time, even though he van driver had to park at the end of my long and impassable driveway and carry all the Christmas provisions some distance. My friend’s dishwasher repair man was similarly tenacious, parking two roads away from where she lives at the top of a steep hill closed due to icy conditions.

If only it were that simple to see a GP over the festive period. A close friend of mine was suffering from a nasty chest infection which started in Christmas Eve. By Boxing Day she was feeling a pain in her left lung. As a nurse, she was pretty sure that she didn’t need a trip to casualty but really should get some antibiotics to avoid pleurisy or even pneumonia. She called her GP practice and as expected, was advised by automated message to call the out of hours service. What she didn’t expect was that the GP practice was closed from 24^th to 29^th December.  Five days. The call centre operator was unhelpful and unsympathetic, advising that a doctor would call back within 3 hours but if my friend’s condition worsened, she should ‘go to casualty’

I suspect that a high percentage of the costly visits to casualty over the past few days could have been avoided through timely access to appropriate, quality primary care.

Interesting that the ‘betes noires’ of Andrew Lansley’s NHS, the hospitals, will of course have been providing round the clock care to patients. Even the PCT’s and NHS administrators, all facing the grim reaper’s scythe, will have ensured that each department has, at the very least, skeleton cover in the period between Christmas and New Year.

So… you can get your boiler and dishwasher fixed, you can get your groceries and go shopping to your heart’s content, and you can even have emergency surgery or a minor injury fixed, but see a GP? Not so easy with many practices closed for the best part of a week.

In the foreward of ‘Liberating the NHS – Legislative Framework and the next steps’ the Department of Health intends to ‘liberate professionals at every level to take decisions in the best interest of patients’. Is the best interest for patients to close local practices for such a long period of time?

Let’s hope that some of the £80 billion that the government is handing to primary care can be spent on the reintroduction of the basics - good old fashioned care, provided by local practitioners when and where it’s needed.

In the meantime, if you have a minor ailment or healthcare concern, just make sure that it doesn’t happen over a bank holiday and hope that your condition doesn’t worsen until the next working day.

10 treats for Andrew Lansley’s Christmas stocking.

If I was the Christmas fairy – these are the 10 wishes I would grant Andrew Lansley (UK Secretary of State for Health) – whether he wanted them or not!

1.   A super-set of ears that really listen. Listen to Hospital doctors, nurses, therapists, GPs, administrators, independent management consultants, patients, and the endless list of healthcare stakeholders.

2.   The gift of patience. I appreciate the desire to implement change and improvements, but being trigger happy means that bullets don’t always hit the right target.

3.   A crash course in Human Resource management. So he can teach the NHS managers how to initiate performance management processes and advise PCTs that sending out notices to staff advising them that their job is at risk just a week before Christmas is not the best way forward.

4.   A year’s subscription to Employee Benefits and Health Insurance magazines so he can see what the private sector is doing about health and wellbeing.

5.   A gag for Paul Burstow, Liberal Democrat Minister of State for Health. No special reason but he makes me nervous every time I hear him speak!

6.   A set of gift experience vouchers– to be magically transported into the life of a hospital consultant for a day, a GP for a day, an NHS administrator for a day and a patient for a day.

7.   A big box of realism – to counteract his Pollyanna tendencies on public health

8.   Some good luck – a magical reverse of the awful weather we are experiencing at the moment which will of course stretch resources as the freezing conditions take their toll on the elderly and vulnerable.

9.   A set of scales and a calculator – to help him achieve the right balance in budget allocation.

10.A good Christmas break with some rest and relaxation. There is a lot of

     work to be done next year and he will need all the energy he can muster.

Wishing you all a happy, and most importantly, a healthy Christmas.

Reasons to be cheerful – what’s your top ten for 2010?

Enough of the political rhetoric and insightful comment on health and wellbeing. It’s nearly Christmas and I’m sitting by a log fire in my 200 year old cottage, snowed in, in rural Buckinghamshire. I haven’t been able to get my car out of the driveway for nearly a week so I’ve given in – I’m here to stay for the next few days and hope that my family and Christmas guests (some flying in from New York) will be able to make it. I’m sure that my readers in Canada, Russia, Sweden, Norway and other countries used to harsh weather will be less than impressed with the UK response to the white stuff but I have all I need and I’m staying put.

Much has been made of happiness and wellbeing measurement this year and the UK government promises us a survey in the near future. But how do you measure wellbeing? I have listed here the top ten feel good factors for 2010. I would love to hear from you, my readers across 27 countries, to find out what has made you happy this year? Here is my starter for ten:

My family (of course): Always top of the list and always involve lots of joy.  My daughter and her boyfriend now live just a few miles away – it’s wonderful seeing her nearly every day.

Health and fitness: With the help of a great personal trainer I have upped my level of fitness and downed my weight!

Manchester United: I love football. I love talking about it, reading about it and watching it. I am a season ticket holder at Old Trafford and my moment of the year was the cheeky goal that Nani nicked from the Tottenham Hotspur goalie. Hilarious.

New friends and not so new friends: Especially those who I met during my trip to Los Angeles in September. My ‘new’ friends in New York and Miami have made that wondrous transition and are new no more, as they now feel like family.

Work: Finchers Consulting is now 18 months old and has given me the freedom to develop personally and professionally.

Music: Can’t imagine life without it. My favourites this year are The Script, Michael Buble and Paloma Faith

New York: Both trips this year were very successful and highly enjoyable – my favourite city in the world and I felt at home from my very first visit 17 years ago.

The Twilight Saga movies: There! I’ve admitted it in public! I love them. I love the romance and the way that the impossible becomes possible. The soundtracks are great too.

Memories – new and old: My mother passed away last month after many years in her lonely world of dementia. At her funeral we were able to enjoy the many happy memories of a life well lived, full of love and laughter.

And finally…..

My blog: I love the global reach if this medium and I hope to get to know many more readers throughout the coming year.

So that is my very personal snapshot of the high spots of this year. Give it a  couple more days of this weather and I may have a new high spot – seeing another human being!!

I would love you to email me some of your special moments for 2010. It would be great to share some personal recollections from readers all over the world. I shall, of course, keep your contribution anonymous if you prefer. Do either post a comment or email me on mreid@finchersconsulting.com

Stroke services in London – the NHS at its best

I was at a lovely party last week and at first glance you would say this was a standard office party. A jolly atmosphere – everyone relaxed and chatty – men dressed casually, women in their sparkly party outfits.

As we sat down to dinner – a man stood up to give a brief welcome speech. He firstly made reference to their colleagues who were ‘holding the fort’ while they partied. ‘The fort’ is a specialist stroke unit in North West London. The clinical lead for stroke continued by reminding everyone of their fantastic achievements this year. The massive input of time, money and effort into producing a wonderful stroke service for their local patients. As I glanced round the room, and forgive me if I sound a little romantic about this, every face was glowing with pride.

This team, like others in London have been implementing the ‘New London Stroke Model’ This lays out targets and performance measures for Hyperacute stroke units and Stroke units in London. The patient pathway is minutely mapped from onset of symptoms, through to arrival at an emergency department in the nearest hospital with specialist services. With the clock still ticking, the patient is then scanned if appropriate and then, again if appropriate and within the right ‘time window’, thrombolysed (given clot busting drugs). This clot busting process can be life saving and brain saving. Even if you nothing about stroke, this most catastrophic of events, we all know that time is of the essence in providing treatment to ‘save the brain’ and improve chances for a full recovery or  at least a reasonable quality of life post-stroke.

The new London Stroke Model is a perfect example of multidisciplinary working across the NHS. Performance measures for London Ambulance Services, A & E departments, stroke physicians, neurologists, specialist nurses and therapists have all being clearly outlined. These measures include staff levels, expertise within each unit, quality of care, treatment protocols and vital signs measurement (i.e. if the protocols and pathways are constantly achieved).

Each specialist unit is assessed and monitored on a regular basis and this performance is directly linked to the tariff the hospital earns for this specialist service. It is all perfectly logical – quality care is provided in specialist units, measured and monitored and the Hospital Trust rewarded accordingly. The unit must constantly achieve these performance targets to earn the tariff uplift.

I have been in the privileged position to be part of these assessment teams and I can assure you that this is a rigorous process. The results speak volumes. Since ‘go live’ in July, all acute stroke patients in London are taken to a specialist hyperacute stroke unit (HASU). The distribution of these units has enabled the average door to HASU time in an ambulance to be 14 minutes and the average ‘call to arrival at hospital’ time is 55 minutes. The number of patients receiving thrombolysis in London has now quadrupled and is reported as the highest rate for any large city throughout the world.

One of the patient pathways I checked last week went thus:

Onset of symptoms: 20.33

Arrival at Emergency Dept: 21.07

CT scan: 21.11

Thrombolysis: 21.12

Yes – the thrombolysis team literally wait with the patient as the scan takes place and are ready to start treatment immediately if the diagnosis shows that the patient would benefit from thrombolysis.

This patient was discharged three days later and with secondary prevention will hopefully continue to live an active life.

There are many more stories such as this, along with less dramatic but nonetheless as vital cases where patients who have suffered disabling damage from stroke receive wonderful acute treatment and commencement of rehabilitation in a stroke unit.

I can understand the desire of Andrew Lansley (UK Secretary of State for Health) to measure outcomes rather than targets. But aren’t they really the same thing? Targets produce outcomes. There will be more information regarding stroke outcomes published soon but I have no doubt that as the stroke model ‘targets’ (performance measures) have been met, outcomes for the stroke patients of London will continue to improve.

This really is the NHS at its best. As I mentioned in my previous blog, let's not throw the baby out with the bath water. There is some amazing work going on now and every day in the NHS, so please Mr Lansley – improve performance of individuals, make managers more accountable,  by all means measure outcomes too – but  don’t try to ‘fix what ain’t broke’!

And the party? Well – I’ve always been a fan of work hard, play hard….

NHS reforms – is Lansley throwing the baby out with the bath water?

Andrew Lansley the UK Secretary of State for Health announced today that he is giving even more powers to GPs by handing them responsibility for maternity services. So yet another item is to be added to the already unrealistic ‘to do’ list for GPs.

Lansley insists that the consultation process demonstrated that a ‘very large number of people were happy about the changes’ as he outlines his plans in an operating framework which surprisingly (not) appears to differ little from the original plans published. I wonder how large is ‘very large’ and, thinking back to David Cameron’s recent foray into happiness measurement of the nation, I wonder what ‘happy’ means in this context too.

Certainly there is a ‘very large’ number of people in the know, working in and alongside the NHS, who are ‘not happy’ with this operating framework.

Dr Laurence Buckman, chairman of the BMA GP committee stated ‘Andrew Lansley doesn’t appear to have heard our concerns and has not changed anything much’

Dr Claire Gerada, Chair of the Royal College of General Practitioners (RCGP) supports the reforms in principal but states ‘we still have a number of questions. These include the pace of change and how this sits alongside having to make unprecedented savings, how to balance patient choice with health inequalities….and how the policy of  any willing provider may impede the development of effective coordinated services as well as drive up the cost’.

These two organisations are not the only ones who have questions for Mr Lansley.

Why the indecent haste for these changes? The already wobbly ship of the NHS is becoming even harder to steer as the speed of reform increases. GPs, many of whom are still unsure about forming consortia are now faced with additional responsibility – for commissioning maternity services. Generalists are being given an increasing slice of a pretty unpalatable cake which would taste so much sweeter if each section was allocated to the appropriate area of expertise,

Ask any patient what they would like from their GP and I guarantee that a ‘very large’ number would state – ‘more time’. I wonder how Andrew Lansley supposes that these reforms can provide patients with increased, higher quality contact with their local GP?

So we have a government galloping headlong into change, without stopping to appreciate the excellent work already in process in hospitals and PCTs. Change for changes sake? I don’t think that anyone would disagree that the NHS warrants some reforms, but to heap all the responsibility and funding onto only one part of the patient pathway and to reject the opportunity to build of the expertise already gained really is an extreme example of throwing the baby out with the bath water.

As the beloved Harrier Jet took it’s last flight today, whoever would have thought that an RAF pilot and an NHS manager would have so much in common?

UK and USa Healthcare Reforms - spot the difference

As the UK and USA each attempt to solve the unsolvable – how to provide affordable healthcare - one must have sympathy for both nations. The leaders are on a hiding to nothing as our expectations for better and longer lives are fuelled by ever increasing technology and expertise.

As an observer on both sides of the Atlantic, I cannot help but notice the similarity of the challenge (at least in terms of complexity) and the difference in emphasis.

Scale: We are talking about a budget of £100 billion in the UK. In the US, the estimates vary between $1 and 2 TRILLION. In the UK, for instance, there are 2.8 million diabetics compared to 23.6 million in the USA.

Access: Not an issue for the UK as free healthcare is available within the NHS to all 61 million residents and many other visitors besides. Access is key for the US as over 32 million people have no health insurance or guaranteed access to medical care which is the main thrust of the Patient Protection and Affordable Care Act. (PPCA)

Health insurance: In the UK, there are currently 4 million policies probably covering around 5 million people. This insured population, of course, also has access to free healthcare with the NHS. A standard insurance policy does NOT cover for primary care, outpatient drugs, maternity or chronic conditions such as diabetes, asthma and epilepsy but does cover acute flare ups of the conditions. In the US, policies routinely cover primary care, drugs, pregnancy and chronic conditions and is therefore much more costly.

Cost: In the UK, the NHS is free, paid for by a ‘single payer’ (via national insurance contributions - i.e. taxed at source). Medical insurance is seen as a perk for the privileged few, guaranteeing fast track access to medical care, less rationing of expensive treatments and a more comfortable hospital environment with ‘hotel style’ facilities.  An individual insurance policy for a 50 year old with no medical restrictions is between £1,500 - £2,000 ($2250 – $3000) per year with no regional variation. In the US – there are 50 different definitions of Health Insurance (by State). The ‘equivalent’ policy in the US (which will, unlike the UK, cover for all the conditions listed above) – can vary greatly according to State and benefit package, will cost between $2,470 (Phoenix) –and $10,000 (NY)

Insurance cover for children: It is generally accepted that access for care to children through the NHS is pretty good in the UK and health insurance for ‘dependent’ children tends to be attached to adult schemes up to the age of 18 or 21 if in full time education. The new PPCA regulations in the US state that ‘adult children up to 26 years old’ should be covered.

Quality: Cost effective, high quality care is a priority for the NHS reforms. This will involve the measurement of outcomes instead of targets and mortality rates will become a key performance measure. The main emphasis for cost reduction is the many managers and administrators currently working in the NHS. Obama’s bill seems to concentrate more on access and availability and the assumption is that the medical providers will take care of quality. It would appear that the performance measures in place for this are down to the individual provider.

Promises: One common area for both reforms is that the governments both promise great improvements.

The PPCA claims to address access to care, cost containment, and quality of care.

The UK health reform initiatives aim to address quality, outcomes and cost effectiveness.

Obama claims that there will be no net increase in healthcare costs (medical inflation is currently running in both countries at around 10%) while Lansley (UK Secretary of state for health) aims to save £20 billion

Will the reforms actually take place? In the US, Republicans have drawn the ‘first blood’ as a federal judge has decreed that it is ‘unconstitutional’ to force people to buy health insurance. There are several other lawsuits pending in various US states, questioning the legality of the mandatory elements of this Act. If these other suits follow this ruling, the reforms may need to be enforced via the Supreme Court and Obama’s political victory of 8 months ago pails into insignificance as he struggles to bring the PPCA into being.

In the UK, the reforms will initially have their main impact within the NHS, as restructuring and rationalisation takes place, and I am not aware of any legal or political challenges currently threatening reforms. As the consultation process draws to a close, the government will be announcing the ‘roadmap’ for efficiency savings shortly. The inside word is that the aims of the White paper are unlikely to change, but whether there are enough GPs with the appetite to form new consortia remains to be seen.

Some tips for new bloggers – my first two months in the blogosphere

This blog is now two months old and I am proud to have readers in 23 countries, so my motto of ‘tomorrow the world’ is beginning to ring true!

Finchers Consulting blog has covered a variety of topics ranging from NHS restructure, USA healthcare reforms, drug therapies and preventative medicine. I have even allowed myself the indulgence of a rant about the world cup and a musing about the Royal engagement. As a passionate and committed blogger. I hope that any aspiring beginners out there will find my tips and observations of value. If you love writing, you will love blogging. It’s fun, addictive and challenging. It gives you a chance to express yourself across the globe. Blogging has broadened my horizons as I increase my awareness of current affairs in search of health related topics. Because this is linked to my professional life and can be accessed from my website, I must make sure that my statements are as accurate as possible and my opinions backed with reasonable argument.

So here are my personal top tips for beginners:

·      Consult the experts before you start. Read a good book about blogging. This will be time well spent and really give you a head start. ‘Problogger’ by Darren Rowse and Chris Garrett is perfect. I won’t repeat all the tips in this book as they are many and wide reaching –my best buy for a long time.

·      If you are technically challenged, get a friend to help. Starting a blog is incredibly easy, and you are bound to have several friends who could help you with this.

·      Make sure your blog looks good. Especially if this is linked to your professional life. The design should mirror the content.

·      Listen to advice from friends and family. Another perspective on design and content is always worthy, especially from those who know you well.

·      Get someone to check your first few postings. Pressing ‘publish post’ is incredibly nerve-wracking if you really care about your blog. Ask someone you trust to be your editor in chief – this takes some of the pressure off. Once you find your natural rhythm this won't be necessary and you will find the words start to come much more easily. My daughter proof-read my first few postings and I still run blogs past her if I have doubts about the content or quality.

·      Be careful. Not everyone will share your views – in fact a good blog should promote ‘healthy’ debate – but try not to offend or upset people unnecessarily.

·      Be careful again! Stay within the law, and make sure you do not print anything libellous, defamatory or inciting anyone else to break the law. (I had to reword my posting about Sepp Blatter and FIFA with this in mind!!)

·      Write about what you know. And stick to your natural style. This will save you a lot of heartache and means that your postings will ring true and will be of value to your readers.

·      Try not to get obsessed with the stats. I originally planned Finchers Blog with the UK and USA in mind, and became increasingly excited every time I saw that a new country comes ‘on line’. I will admit to having a world map in my office showing my global reach so far, but the key to a successful blog is content….

·      Content is king. Use the stats to help you understand the best times to post your blog, the type of title that attracts attention and the content that generates most interest and comment.

·      Don’t be shy to promote your blog. There are some very useful tips about this in Problogger. I still have a lot to learn, but I emailed anyone who may be interested when I launched, which was a good start with a friendly audience.

·      Twitter is fantastic! I am getting to know some of my readers and it is a wonderful way to keep in touch with the blogosphere in general.

·      Trust in karma. Be generous in promoting others’ blogs or websites and you can be sure you will receive good in return in the long run.

·      Don’t stress about every posting. You are only as good as your last posting, but accept that they won’t all be perfect, and you can over-edit to the stage where you won’t even use the posting. Likewise, if you publish something that you think is exceptional, accept that it won’t be seen by all your readers and will be archive fodder before long.

·      Stay true to your beliefs. I am very aware of the diversity of my readers and if I tried to please all of them all of the time I would be in serious need of medication! So I stick to what I know and what I think will be of interest to the majority of my readers.

·      Enjoy. If you enjoy writing your posts, your readers should enjoy reading them. When it ceases to be a pleasure, time to walk away from the pc.

·      Don’t let blogging rule your life. Well, not too much anyway..

Aspirin – Wonder drug or a danger lurking on supermarket shelves?

A study recently published in the Lancet www.thelancet.com  claims that a small regular dose of aspirin can reduce the incidence of cancers from 30% (lung) to 60% (oesophagus). How exciting that a dirt cheap drug, first recommended by Hippocrates in 400BC (he used the bark of a willow tree – which contains salicylic acid, related to the active ingredient to aspirin) could be the ‘magic bullet’ to prevent killer diseases. But I do hope that the ‘general public’ will not rush to the supermarket to buy this wonder drug before seeking medical advice.

It is already well documented that aspirin has beneficial ‘blood thinning’ properties in the prevention of heart disease and stroke and the good news is – this is a cheap and easily available drug. But the bad news is – this is a cheap and easily available drug.

For over 40 years my grandmother took an aspirin tablet, in the larger pain-killing dose of 300mg, every night as she believed it helped her to sleep. She lived in relatively good health to the impressive age of 99 and I have no doubt that the anti-platelet effect of this regular medication helped to stave off stroke and potential heart attack.

A young friend of mine also took aspirin regularly, on an empty stomach first thing in the morning for a hangover and another friend took the drug every day at the low dose of 75mg as a preventative measure to counteract the heart disease that killed her parents and a sibling.

All three of these people bought the tablets over the counter and all three experienced serious side effects. My grandmother suffered a dramatic, life threatening gastric bleed and my two friends are currently being treated for stomach ulcers.

This little tablet, like so many medicines, has powerful effects and these are not all good. In America, where 15 billion aspirin are sold annually, it is estimated that 20,000 people a year die from haemorrhage or gastro-intestinal bleeding due to its use.

I believe that there is little justification to sell aspirin over the counter in the pain relieving dose of 300mg when there are safer, more effective painkillers available.

If this drug was new to the market today, I very much doubt that it would be awarded a licence for pain relief as the benefits versus potential side effects ratio would not be sufficiently high. However, it is proven as a valuable aid to the prevention of some cardiac disease and stoke

If, as this research is confirmed, aspirin truly does have a significant value in preventing deaths from cancer then a concerted effort must be made to educate the public of the appropriate dosage and use of this drug.

This may be a good case for the ‘Nanny State’ method of protecting the health of individuals and we should proceed with caution.

Just because a medicine has been unregulated for years, it could still warrant some kind of regulation now. This could be a fantastic good news story as an old favourite emerges as a potential life saver. But let’s not forget that ‘the devil you know’ can still cause harm if used in the wrong way.

NHS Cuts – now it’s getting personal…

A few days ago I wrote about some of the behaviours that are emerging with the NHS as people start to watch their backs and wonder where the axe may fall.

Staff within Primary Care Trusts are particularly sensitive at this time as in theory, their organisations will be replaced by GP consortia. Rather than throw the baby out with the bath water, it is expected that GPs will recognise that there is a great deal of valuable expertise within PCTs and will employ many of the experienced personnel to assist with commissioning and quality assurance initiatives. Basically the same people could be doing the same job, but with a different line manager and different title.

But where should the cuts take place? Andrew Lansley (UK Secretary of State for Health) is actively targeting ‘layers of management’ and as Providers (Hospital Trusts) and all bodies associated with provision and monitoring of care try to achieve these savings, the use of business consultants and interims comes under scrutiny.

As pressure on cost containment increases, resentments and bias may come into play.

I experienced a perfect example of this at a party last weekend attended by several family members and many friends who work within the NHS, private healthcare and insurance organisations. At dinner I sat next to a charming consultant physician from a London teaching hospital who agreed with me that we can be proud of many achievements in secondary care over the past few years. He was very interested about my work with pathway mapping and service improvements and was concerned about the shift of so much ‘power’ to GP consortia.

A little later I was introduced to another guest, an equally charming GP who is just about to retire. Naturally the conversation turned to healthcare and we discussed his plans for part time work with his practice and my recent project aimed at improving the patient pathways for TIA (‘mini stroke’). This gentleman was very impressed to hear that this project resulted in the adoption of new improved pathways by nearly 100% of emergency departments and 80% of GPs across North West London. ‘Yes – there has been some fantastic progress with Stroke in the past few years’ he enthused – ‘and which PCT are you employed by?’  I explained that I had been working as an interim manager.

The genial expression turned to more of a sneer as he quipped – ‘so you are one of those very expensive consultants that we shall enjoy getting rid of…’

Ouch!

Lesson re-learned – do not mix business with pleasure. But I didn’t let it spoil the party.  Great wine, great food, great music, and in the main, great company!

2018 World Cup Bid - more questions than answers…

Oh dear – it really hasn’t been a very good week here in the UK.

Firstly a massive cold snap deposited unprecedented (at least for 45 years) amounts of snow on this island, then the transport system grinds to a halt. Then Andrew Lansley (UK Secretary of State for health) tells us we must breastfeed, not smoke, not drink and that our children will be rewarded for walking to school. We then find out that England only gained two votes for their World Cup bid.

I would not presume to get into a major discussion on our transport system and I have already posted a blog about Lansley’s la la land of Public Health so I am going to turn my attention to the World Cup bid as this failure has significantly, but probably albeit briefly, dampened the wellbeing of many of us.

A few weeks ago I posted some questions to Obama and Lansley about each of their healthcare plans so now I am affording myself the luxury of posting some questions to Sepp Blatter (President of FIFA)

Questions for Sepp Blatter:

·         When are you going to retire?

·         Why did only two votes go to a nation with

- An existing network of world class stadia

- A long history of a love of the game of football

- Fantastic training facilities for visiting clubs

- A transport infrastructure ready for an Olympics

- A high score for the technical assessment

- The best presentation (‘remarkable’ – you called it)

And who fielded a future King, a football god and a Prime Minister?

·         If you and your voting panel were intending to give the vote to ‘developing football nations’ why did you let Spain, Portugal, The Netherlands, Belgium and England waste their time and money and the time of a future King, a football god and a Prime Minister?

·         When are you going to retire?

·        Why did you and your voting panel give the 2018 cup to a nation with sparse existing facilities, with a poor technical assessment and whose Prime Minister didn’t even have the courtesy to attend, when England fielded a future King, a football god and a Prime Minister

·         When are you going to retire?

·        Why did you and your voting panel give the 2022 cup to a nation with an average temperature at the time of the cup at 100 degrees? To a nation who will use obscene amounts of fuel cooling massive stadia? What about global warming? (Although I will grant you that the Qatari bidding team were delightful but not as delightful as the combination of future King, football god and Prime Minister)

·         When are you going to retire?

·         If your system is not corrupt, why did you instruct the voting members to remember what the British press have been doing and saying? Surely the vote should have been on the merit of the bid alone?

But let’s look at the positives….

Eddie Afekafe, a young Manchester lad who turned his life around thanks to football, was incredible as the master of ceremonies for the English bid. He spoke clearly, slowly and with great warmth. Our future King, football god and Prime Minister also put on an impressive show. David Cameron spoke eloquently as always without notes, David Beckham is a god wherever, whatever he does in my book, and I thought that William looked as though he could cry when our bid failed. These four lions really did us proud.

And finally….

We’re doing very well in the Ashes test at Adelaide so far…..

Let’s hope the BBC doesn’t try to scupper that too.