Be Nice

I have just returned from a long weekend in my favourite city, New York – part vacation, part healthcare fact-finding. The good news – it was Fleet week with thousands of sailors, marines and coastguard in the city as part of the Memorial Day programme, celebrating the forces and honouring the fallen. Not so good – it was very hot and although any City looks better in the sunshine – downtown Manhattan felt pretty sticky.

I had planned for the first blog on my return to cover some pressing healthcare issue, comparing either side of the Atlantic. Plenty of those to follow in future postings but my flight home has prompted this missive on customer service and behaviour.

Most people with a modicum of emotional intelligence know that behaviour begets behaviour. Forget instant Karma for a moment, even if you don’t believe that – you will have experienced that if you are grumpy and rude, you are less likely to get sunshine and roses in return.

And so it was with my flight home from Newark with Continental Airlines. The ‘red-eye’ overnight flight from New York to London is rarely fun but the passengers generally seemed a cheery lot as we all waited at the gate to board.

The bubble of bonhomie was quickly and irrevocably burst as a sour faced woman with a miserable countenance and ugly aura barked orders at her captive audience, warning us only to board when called. One got the impression that this ground stewardess would, given half the chance line any offenders up against the nearest wall to be summarily shot.

I was transfixed as the dark cloud hovering over this person’s head cast a shadow over all before her. Not once did she look at a customer as she checked their boarding card. Not one smile, acknowledgement, pleasantry and not a trace of goodwill or good manners. Her partners in crime were no better. Like the snake haired Medusa with her two Gorgon sisters in Greek mythology - ‘hated by mortal man’ – I felt that this trio of airline staff could turn any one of us to stone with just one glance as they ushered us through the gates of Hades.

It was therefore unsurprising that the mood in the cabin quickly turned nasty as people fought for space in overhead lockers and hustled to get to their seats. For a few minutes – this 7 hour flight looked as though it was going to be a very unpleasant experience. I have never witnessed so much angst and discomfort among passengers on an on-time schedule and I have no doubt that the assault on our senses pre- boarding was directly responsible.

Sadly, two of the cabin crew weren’t much better. When I advised the stewardess that I had no pillow – she looked at me as though I had either eaten it or sold it at great profit. Grudgingly she found one for me. Another stewardess appeared not to have smiled for at least a generation and her facial muscles had probably lost the art.

Luckily, two out of the four cabin staff that I encountered were actually quite pleasant and managed to diffuse potentially inflammatory situations as we all tried to sleep over the Atlantic.

This is a classic example of how individuals engaged in the activity of ‘service’ can influence the environment for their customers. This is especially relevant in healthcare and leisure.

There is a very simple solution. Be nice. It’s good for you, it’s good for your customers and it’s good for business.

Drip-feeding victories?

It’s a familiar scene from any medical drama – ER, Casualty, Grays Anatomy. The earnest young (and usually very handsome) doctor says in a grave tone to the loved ones - ‘The next 24 hours are critical’ followed an episode later by a wide smile and ‘the patient has turned the corner – he should be fine now’

Are we at that stage with the NHS Reforms, I wonder? Have we turned a corner? Andrew Lansley (remember him – the Secretary of State for Health) announced a few days ago that Cancer Networks have received a stay of execution beyond 2013, a u-turn from his previous plans for this specialist service. The networks are seen by many as crucial in maintaining the highest standards of cancer care regionally, in addition to ensuring that primary and secondary care stays up to date in this fast moving branch of medicine.

One of the major fears voiced by critics of the Health and Social Care Bill is that expertise may be lost from the commissioning process, and service improvements could become the first casualty of ill-informed commissioning boards. So any change of direction that acknowledges the need and value of this expertise is welcome.

Oprah Winfrey once said – ‘The key to realizing a dream is to focus not on success but significance - and then even the small steps and little victories along your path will take on greater meaning’

Are the little victories beginning to add up? Subtle but significant diversions from the original path?

Wounded from the recent Lib Dems local election defeats Nick Clegg, the Deputy Prime Minister may be the source of many little victories to come, starting with his insistence that hospital doctors and nurses should be included in GP commissioning boards.

Those of us who hope for a major turn-around in many of the aspects of these reforms don’t mind whether the motivation is political, pragmatic. ethical or clinical. We don’t mind if the victories are little, and announced quietly.

Just as long as they keep coming.

NHS Future Forum ‘engaging and listening’ seminar (4)

My final report from the event held on 18^th May.

Please see previous postings for the first 3 instalments of this report.

Liz Kendall MP: The Shadow Health Minister dashed in just before she was due to speak, over-ran, stayed for a few questions and dashed off. In her defence, she was rushing to get to Prime Minister’s question time in the House of Commons and she apologised sweetly for her brief attendance. I have been impressed with Ms Kendall’s performance in parliament, usually clear and concise in making her point. But I was underwhelmed this time. She constantly fidgeted with her hair, tucking and re-tucking it behind her ears and flicking the ends (of her hair not her ears). This was incredibly distracting. That aside, it was a very flat presentation – and reviewing my notes – I have written ‘Is she missing a trick here?’ I think she was.

Each of the other speakers left me with a very clear idea of their views and their personal ‘deal breakers’ associated with the Health and Social Care Bill. Not so Ms Kendall. Personally engaging but bland when it came to content. She demonstrated her knowledge but didn’t really come up with anything new, ‘You need to bring the people with you’ to implement reforms successfully. She referred to the ageing population and long term conditions as key challenges for the future. She said there needs to be a change in emphasis but I wasn’t clear how she would recommend this could happen.

I was delighted that Ms Kendall referred to the success of the NHS London with the implementation of the Stroke Strategy. This initiative, based on targets, performance measures, mandatory staffing levels, expertise and training has had an incredible impact on stroke care in the capital. This NHS improvement strategy was initiated by the Labour government and if was her I would have made more of this and other service improvements over the past decade. Ms Kendall wisely bemoaned the fact that expertise is being lost daily from the Primary Care Trusts. She was generous in her support of independent service treatment centres and the introduction of competition based on outcomes. In fact for a moment I thought she was Tory.

Janet Davies: Executive Director of Nursing and Service Delivery, Royal College of Nursing (RCN) had the toughest slot – speaking just before close of play and after the big guns had been and gone. With a wry smile she mentioned that no doubt the audience was pretty clear where the RCN stood on these reforms (following their recent vote of no confidence in Andrew Lansley, UK Secretary of Sate for Health). Ms Davies stated that the RCN are not against reform but they believe that the Bill will fail to deliver the necessary improvements. The RCN represents nurses from ‘Bedside to Board’ – great phrase, as well as ‘clinical is good and management is bad is wrong’. She summarised her wish list for reform, noting that even the best minds were struggling to understand the Bill:

1)     Modelling. Test the theories before implementation

2)     Risk Assessment. Where are the fail-safes in Lansley’s strategy?

3)     Evidence. Where is the evidence to justify these reforms, and who is evaluating the pathfinders.

Ms Davies mentioned that the RCN have written to pathfinder GPs about their strategy for ingoing evaluation. No reply.  She would like to see her nurse on every commissioning board and feared that Consortia were putting their ‘favourite’ nurses on their board, even though they have no commissioning expertise. I do like to hear a straight talker, and Janet Davies is a fine example.

Baroness Young: Brought the meeting to a close, reminding us that patient choice should not be about ‘shopping’, but ‘informed decision making’. Sounds good to me.

And so my first, and possibly last, NHS Future Forum came to a close. I felt very privileged to be part of the select audience. The questions and observations from the floor were all pretty much in line with my feelings about the proposed reforms, and we can only hope that our voices have been heard and our comments noted. As I reflect on the event, there were no real surprises, although I was a little shocked at the apparent desire for world domination by the GP lead of the NHS Alliance.  

I fear that despite the extreme good sense spoken by many of the speakers, this Bill will continue on its potentially destructive path, cutting a swathe through much that is good about the NHS and driving a divisive wedge between primary and secondary care.

NHS Future Forum ‘engaging and listening’ seminar (3)

My report from the event held on 18^th May continues..

Niall Dickson: The Chief Executive of the General Medical Council, in my opinion, provided a comforting voice of reason and mediation after the GP, Dr Michael Dixon’s polarised views (see previous blog). I was encouraged and impressed to hear Mr Dickson’s (confusingly similar surname to the previous speaker) clear summary of the priorities to be addressed – namely ethical issues, quality and safety, and structured ongoing education. Hallelujah! At last someone speaking specifically about the key elements of patient care needed to deliver tangible improvements. He outlined the concerns regarding conflict of interest with GP consortia having to balance use of resources and desire for profit with best practice and the impact in patient care. I agree absolutely that a worrying skills shortage within these consortia may be financial management and leadership.

On the issue of quality and safety, the GMC insists that effective regulation and possibly incentives have a part to play in maintaining standards. Niall outlined plans for re-validation of doctors. All doctors. Possibly controversial but highly desirable. Mr Dickson intimated that this personal and professional accountability would be measured through a five yearly process and patient feedback may play a part in the revalidation system. Tricky to implement but potentially a useful channel for patient power.

I was particularly pleased to hear that a need has been identified for improved professional development for junior doctors, seen as a priority in the ongoing education of the medical workforce.  This is something that I have found when creating patient pathways aimed at improving safety – so often a key skills gap emerges in this group of clinicians.

Perhaps the most potent sound bite of the entire event came from Mr Dickson’s presentation: ‘Doctors have the capacity to do enormous harm and enormous good’

I would have happily spent the rest of the morning taking part in a discussion with Niall Dickson and Michael Dixon. The apparently opposing views of the organisations that these two influential individuals represent epitomise everything that I believe is wrong with the Health and Social Care Bill. It is proving to be diversive by creating conflict between clinicians working at different stages of the care pathway. Regular readers of my blog may be sick of me continually stressing the point, but every clinician at every stage of the patient treatment pathway has a voice that needs to be heard. And I’m not just talking about doctors.

David Worskett: The Director of the NHS Partners network made a good point saying that the NHS may be in the brink of ignoring one of the levers that can help achieve the challenge of improved efficiencies, i.e. competition from the private sector. He spoke in support of the increased powers of Monitor, the NHS Regulatory body currently at the centre of heated debate within the coalition. Mr Worskett believes that Monitor could be ‘the solution and not the problem’. In order to minimise the danger of ‘cherry picking’. He stressed that expert understanding of tariffs was required as a generalist regulator, such as the Office of Fair Trading would not be helpful.

I got the impression that, like so many other elements of the Bill, the public perception of the government’s aims differ from the intent. Reasonable competition, effectively monitored can, in my opinion, be a very positive force in enabling cost-effective, high quality delivery of care.

The commentary on this forum is turning into a bit of an epic, but there was much to be reported.

The last gripping instalment will be posted tomorrow. In the final episode I’ll summarise the good, bad and ugly, comment on the way Liz Kendall, Shadow Secretary for Health constantly fiddled with her hair during her presentation (maddening) and attempt to predict whether there will be a happy ending to this intriguing tale……

NHS Futures Forum ‘engaging and listening’ seminar (2)

How do you fit 7 presentations into a 500 word blog? The answer is – I couldn’t but I shall take you on a whistle stop tour of the packed agenda of the NHS Future Forum I attended on 18^th May (see previous posting)

I’m not sure how I found my way onto the guest list, possibly because of this blog, maybe because I am one of the many hundreds who posted a comment about the Health and Social Care Bill on the Department of Health website. Either way, it was a good opportunity to hear what was being said, with political, personal and professional views in abundance.

The Rt Hon. Stephen Dorrell MP: The Chair of the Health Select Committee was first up. I was pathetically grateful that he didn’t launch into Lansley-speak ‘patient at the heart of everything we do – nothing about me without me, etc etc’. I was the first person to pose a question to the former Secretary of State for Health and I thanked him for sparing us the political rhetoric normally offered by his successor. This brought one of the few laughs of the morning. Mr Dorrell spoke briefly about the fact that the goal of producing a 4% efficiency gain for 4 years running in the context of a 4% increase on demand for health services year on year, is a holy grail ‘never achieved by a health system anywhere’. He believed this is achievable through the ‘greater integration of services we deliver’.

I asked Mr Dorrell if he felt that by handing 80% of the budget to only one part of the service delivery pathway would lead to bias, hindering integration rather than encouraging it. He felt that the government’s plans had been badly positioned (with the inference that he would have handled the whole thing differently) and that GPs would not have the level of power that people perceive. He stressed that GP led consortia must be ‘publicly accountable’.

Dorrell continued that too much time had been spent on ‘form’ and not ‘function’. This issue has been at the heart of the majority of criticism aimed at the Bill. I shall await the content of the select committee report, due to be published early next month, with eager anticipation. Pity he left after only half an hour though.

Julie Moore and Dr Kathy McClean: Representing the NHS Future Forum as Education and Training Lead and Clinical Advice and Leadership Lead respectively. Both speakers basically said they were here to listen. Fair enough.

Dr Michael Dixon: Chair, NHS Alliance. Oh dear oh dear oh dear. I must be very careful how I put this but Dr Dixon’s presentation fuelled my worst fears about the effect of these NHS Reforms. He started his talk with ‘I am an independent contractor, like a plumber’. I could imagine David Cameron squirming if he ever reads the transcript of the presentation. Nice home goal – so the lion share of the NHS purse IS going to private contractors then?

Dr Dixon undoubtedly has good intentions but I do not agree that a GP normally knows what is best for his patient when it comes to specialist care. He made no secret of the fact that a desired outcome of the reform and GP led commissioning was to migrate services away from Hospital Trusts. He continued – and I quote, as near as my notes allow, ‘I’ll be moving stuff from hospital to my practice and I’ll get money for it, therefore there needs to be total transparency’.  Baroness Young (the chair of the event) was brilliant as a devil’s advocate with her careful wording. She asked Dr Dixon his view on the fact that many patients, especially those with long term conditions do not wish to be ‘discharged’ from the care of their specialists to be handed over to a general practitioner. Not sure we got an answer to that one.

Neither did we get an answer to my question. Dr Dixon quoted a figure that 30% hospital admissions are avoidable. Confusing, as the statistic quoted by Stephen Dorrell earlier was 40%. I asked Dr Dixon if perhaps that figure could be due to the fact that patients couldn’t get in to see their GP and how would GP commissioning improve this state of affairs. For a moment I thought he had morphed into Andrew Lansley as the question was effectively side stepped. When I queried the impression that he didn’t want specialists on ‘his’ commissioning board, he clarified that he doesn’t want hospital specialists on the board who are ‘trying to protect their budget’.  A phrase that springs to mind includes ‘pot and ‘kettle black’.

I fear that this interpretation of ‘control’ given to GP consortia will disenfranchise the hospital consultants and the Foundation Trusts. They are, and must continue to be, crucial in the delivery of a major part of many care pathways.

But the coup de grace was delivered just before Dr Dixon finished speaking. Referring to his desire for autonomy and lack of interference, he said ‘GP’s don’t want to be managed – we want to be seduced’

Mmmm – same goes for all of us doesn’t it?

More on the event tomorrow, when I shall summarise the rest of the speakers.

NHS Future Forum ‘engaging and listening’ seminar

I attended a seminar in Westminster today, part of the ‘pause and reflect’ stage of the Health and Social Care Bill. The speakers (and in theory, listeners) represented an impressive line-up including:

Baroness Young: Chief Executive of Diabetes UK

The Rt Hon. Stephen Dorrell MP: Chair of the Health Select Committee

Liz Kendall: Shadow Health Minister

Niall Dickson: Chief Executive of the General Medical Council (GMC)

Dr Michael Dixon: Chair, NHS Alliance

The event was a full morning of presentations interspersed with comments and questions from the floor.

Frustrated but fascinated, confused and concerned, enlightened and encouraged. This is the usual mix of emotions that I experience every time I confront the enigma that is the Health and Social Care Bill and today was no exception. Two main strands of thought permeated my consciousness throughout. Firstly – is anyone who counts REALLY listening? Secondly this is so much material for my blog …

So where do I start? I think an overview of the event is called for, and as I am acutely aware of the average attention span of any reader, I shall write in more detail about the speakers in my next posting.

I have a confession – I now have a girl-crush on Baroness Young. She is beautiful, smart, chic, authoritative, knowledgeable, even-handed and serene. In fact, everything I hope to be when I finally grow up! Baroness Young provided the independent, firm chairmanship that is so essential to a successful event.

Most of the speakers were eloquent, focussed and didn’t over-run. The audience was a stimulating mix of professions with varying degrees of vested interest.  The questions and comments were, in the main, sensible and constructive. My favourite session was a brief Q and A with Niall Dickson (GMC) and Michael Dixon (NHS Alliance). Michael is massively in favour of GP Commissioning and leads a pathfinder GP practice. He was in my opinion (I must be careful not to upset my lawyers) positively salivating at the prospect of complete control of a big chunk of the NHS budget. I found his talk of a café in his practice, his views on specialist representation and his apparent lack of empathy with secondary care quite worrying. I do agree with him that there should be complete transparency in all consortia dealings.

Niall Dickson (GMC) on the other hand, filled me with hope, focussing on ethical issues (including conflicts of interest) safety, quality and education. Hear hear!

Which brings me nicely to the ‘listening’ bit. Stephen Dorrell spoke a lot of sense, and mentioned that the committee only have a few more days to produce their report. But he left immediately after his presentation and a brief Q and A, so was only in attendance for one fifth of the morning. Niall Dickson and Liz Kendall also left early. 

I certainly enjoyed the seminar but was anything achieved? There was plenty of talk, not much listening and probably nothing actually being heard. 

Plus ca change.

So many stories – so little time

According to Harold Camping, head of a network of 66 radio stations in the U.S., the end of the world is nigh. May 21^st in fact, according to the Californian businessman is ‘Judgement day’. In Los Angeles, some of his hoardings announcing Doomsday have been embellished with graffiti providing a helpful countdown noting the number of shopping days till the end of society.

There are several other interesting stories in the news today – all linked with our survival and the quality of life during our time spent on planet earth. So in the very remote likelihood that Mr Camping is right – I thought I would cover some of them in this blog – so I can rush out and do some shopping while I still have the chance…..

‘Free salad bid to cut obesity’

Presumably, in an attempt to placate the healthy eating lobby and to endorse its commitment the wellbeing of society in general, Pizza hut is offering customers unlimited free salad with their meals. This is part of the ‘responsibility deal’ with Andrew Lansley, UK Secretary of State for Health, aims to increase industry’s role in encouraging the nation to eat more healthy food. Very laudable. Just one point, other well known food outlets in the UK (and probably elsewhere) already offer  ‘all you can eat’ salad deals with their menus. And that’s just what the obese do – they will pile their plates with salad, croutons, oily dressing and then down them alongside their pizza, burger and plate of chips. Nice gesture but could do better. Hot news - salad with Pizza doesn’t make you thin. Salad INSTEAD of calorific and fatty foods will help you lose weight.

Alzheimer’s test for all over 60’s

A very emotive subject and as the daughter of parents who both suffered from severe dementia for some years before their deaths, a matter very close to my heart. The government is suggesting that everyone over 60 could be tested for Alzheimer’s. Now that there are drugs that appear to halt the progression of this distressing disease, there may be some merit in this, especially if early diagnosis can prevent irreversible decline. But this is also fraught with difficulty. Alzheimer’s is the most common cause of dementia, but not the only one. So if someone is given the ‘all clear’ for Alzheimer’s, that doesn’t mean they won’t suffer dementia caused by for example, vascular problems. The drug treatments for Alzheimer’s don’t cure the disease, but may delay degeneration and provide a family with extra precious time to interact and be recognised by their loved one. The balance between benefit of early diagnosis compared with the distress of knowing early on what you may be facing is a hard choice to call. I’m really not sure about this plan but will keep a close eye on the debate.

Bonus plan for curing addicts:

Chris Grayling, employment minister has suggested that a new approach is needed to deal with the crack cocaine and heroin addicts who cost £1 billion annually in benefits. Grayling is suggesting that organisations that can wean addicts from their habit and help them find employment should be paid bonuses for their achievement. Why not? It seems like a good plan and a win-win situation. I know from years working in sales and business development that bonuses generate success so good luck to all concerned.

Back to the Apocalypse:

So how will you spend your last days? I’m working on it, and apart from the essential, of course, time spent with my family – there will be three other things that must receive some attention. The handsome young man, a gin and tonic and some chocolate. Or should it be chocolate, gin and young man – or gin, man, chocolate….

One thing can be sure, my last days won’t involve salad or an Alzheimer’s test.

The Institute of Directors – Annual convention 2011

Whenever I attend a conference or convention, I am happy if I achieve the following:  Meet interesting people whom I would like to get to know better, learn something – hopefully to do with work, but life lessons are just as important, and finally – hear a view or comment that exercises my intellectual reasoning and continues to chip away at my thought processes after the event.

The IOD Convention earlier this week didn’t disappoint.

As a new member – this was my first convention and I was pleasantly surprised to note that among the 1400 delegates there was a wide variety of professions and personalities. Not the old fogeys that I had expected! We were treated very well – this is grown-up stuff, not a tacky carrier bag in sight. Instead we were treated to lightweight briefcases and ‘lunch boxes’ that were a far cry from the marmite sandwiches and carton of drink from my schooldays.

Networking opportunities abounded, but the key focus of the day was an impressive succession of speakers, including Chancellor of the Exchequer, George Osborne, his opposition counterpart, Ed Balls and a variety of entrepreneurs and business leaders.

The agenda was a little too full for my liking, with long uninterrupted sessions in the morning and afternoon. I guess a full agenda is better than a sparse one – but six presentations on the trot is asking a lot of any delegate. I was amused to note that the colour of the backdrop and the introductory music changed for each speaker but felt that T Rex ‘Children of the revolution’ and a red background was a little tacky for the General Secretary of the Trades Union Council (TUC) Brendan Barber! George Osborne was, of course, treated to a blue background but had the good sense to question the choice of The Beatles ‘Can’t buy me love’ as his backing track!

I really liked Brendan Barber’s style. Bearing in mind he represents 6.2 million members, the majority of whom do not agree with the government’s stance on public sector cuts and fiscal policies – he described his attendance at this event as a ‘difficult away fixture’. Miles Templeman, the Director General of the IOD, threw some tough questions at him which he handled calmly and eloquently.

George Osborne has an impressive natural way of presenting- but delivering the usual party line wasn’t especially interesting. I felt comfortable with the fact that both the government and opposition chancellors clearly have a constructive and cordial relationship with the IOD.

In my opinion, and judging from the ‘networking chat’ – the two speakers that especially inspired were Jonathan Edwards, the Olympic Gold medalist and Wilfred Emmanuel-Jones, founder of The Black Farmer (a successful food range, supplied from his own farm). Both men spoke with genuine passion and candour about their single minded focus on their ‘compelling vision’.  Jonathan to achieve the ultimate in his chosen sport and Wilfred to one day own a farm – an inconceivable dream for a young Jamaican immigrant living in inner city Birmingham in the 1950’s.

Both achieved their goals by concentrating not only on their desired success but as importantly – ‘the quality of the process’. Successful entrepreneurs appear to have these two key characteristics in common. A clear vision of the end game and a commitment to reaching their dream in the best, but not always the easiest, way possible.

Great stuff.

And the view that got me thinking? Miles Templeman commented that NHS reform was ‘outside the reach’ of the IOD. Sorry, Miles but I don’t agree. Good health is good business. Business leaders and the private sector should have a vested interest in the health and wellbeing of employees and the health of the nation in general. We should work with the coaltion to ensure that the NHS reforms create a sutainable way forward to achieve this.

Another view from the front line

It’s not often that a blog post gives me a sleepless night, Never - until now in fact. But I have been stewing for nearly a week, trying to work out how best to report on a conversation I had with a GP recently. I have decided that the best thing is to write in as much detail as I can, exactly what she said.

This is an excellent family doctor, experienced, knowledgeable, caring and pragmatic. When I told her that I write a healthcare blog this is what she said. (as near verbatim as I can)

GP: ‘I’ll give you something for your blog. I really want you to write this. Let them know what we think. GPs don’t want this reform. There is a conflict of interest if we have to commission services and refer patients for those services. What do I do if a patient wants a treatment that my consortia doesn’t agree to commission? According to the reform, the patients are free to choose their treatment. Does a GP decide on treatment according to patient choice, clinical need, profit for the consortia? I didn’t sign up for this – relationships with patients will be damaged.’

The GP then became uncharacteristically emotional. ‘We lost a brilliant gastroenterologist last week.’

I asked her if the consultant had just ‘had enough’.

GP:’ He wrote to me last week about a patient, explaining why he hadn’t been able to fit the patient onto his list quickly. It was a bit if a rant, about how he was far exceeding the European Directive on time at work, how the cuts in his hospital trust meant that he was short staffed, so he was undertaking junior doctor duties as well as his consultant role. He sounded at the end of his tether. A few days later he dropped dead. 53 years old. Please, write this in your blog’

I cannot, and would not, comment on whether the stress of the budget restraints that hospitals face a shift of funds, contributed this consultant’s death.

But what I can say, without doubt, is that this GP believes  this is just the start of potentially devastating situations, impacting on patients and staff, that will evolve as these unworkable reforms are implemented. And as the Royal College of GPs have stated today that 'patients may be harmed' as a result of the Health and Social Care Bill- surely these are voices that simply must be heard.

Preventative drug treatment based on age – a slippery slope?

A new study issued by the Wolfson Institute today recommends that all those over 55 years of age should be offered drugs to lower cholesterol and blood pressure.

The authors state that age is the biggest risk factor for cardiovascular disease such as stroke or heart attack and suggests that blanket treatment is the most cost effective way forward.

The study was a theoretical comparison between the effects of screening just by age, with whether someone is a smoker, or has raised cholesterol or blood pressure. It concluded that the detection rate would be similar and ‘false positives’ (i.e. treating someone over 55 to prevent a disease that they would not have developed or wrongly diagnosing risk through screening) were also the same.

The suggestion of a pre-emptive strike based purely on age is brave and surely has some merit. Simply offering preventative measures to an age group at risk of life-threatening disease has been compared with childhood vaccination programmes. But there is a significant difference here.

Is this the start of the slippery slope I wonder? The slope that ignores the degree of personal responsibility that we need to impress on patients and the general  public? You cannot stop the sands of time, and however much botox, nipping and tucking goes on, the years rush by. The statistics demonstrating that risk of cardiovascular disease increase into middle-age are undeniable. But so is the fact that a healthy lifestyle, good diet, exercise, and avoiding smoking can also have a significant, positive effect on risk factors.

Do we really want to encourage a pill popping generation? Every medicine has it’s risks and statins, used to reduce cholesterol are no exception. If a general practitioner is going to routinely prescribe these drugs to all their patients over 55, they should routinely screen them as well. So why not stick to the system of screening in the first place?

I agree that every stroke and heart attack prevented is pain and suffering avoided and should be welcomed. But how much better to encourage people to take measures that will not only reduce the incidence of cardiovascular disease, but also all the related nightmares of smoking and obesity such as diabetes and cancers.

Changing the nation’s psyche and attitude to healthy living is far more beneficial than handing out medication to at least 21% of an age range who don’t actually need it. Closing the door after the horse has bolted is one thing – but barricading the stable when the horse was either in no danger of going anywhere or could be taught to behave is another.

I’ve had my say – have you had yours?

Thanks to Easter and the Royal Wedding we have enjoyed the ‘pause’ recommended by Andrew Lansley but I must confess that I have spent very little time ‘reflecting’ as I focussed on a calorific Easter, alcoholic Royal wedding and the tense progress of Manchester United towards a Premiership/Champions League double.

But alas reality bites and we are back at the coalface tomorrow. A quick trawl though the newspapers and other news channels suggests that a shift may be gradually starting.

A piece in the Daily Telegraph focuses in a GP who earned over £600,000 last year, alongside several more high earning GPs. The BBC website also featured a story outlining that NHS foundation Trusts will be tasked with higher efficiency savings than expected. The implications of the lion share of power to primary care is beginning to reach the public consciousness.

However cynical one may feel towards this ‘listening exercise’ – this really is a chance to at least try to get your opinion noted. A GP I spoke to recently said that just because he attended the meetings about a new consortia in the area – it didn’t mean he approves. He told me that he goes as a ‘damage limitation exercise’ but he fears that ‘they’ (whoever ‘they’ are) see his attendance as compliance and agreement.

With the Alternative Voting system debate expected to gain momentum in its final stages, we are being given an opportunity to express our views through a referendum. This will not be an option for the Health and Social Care Bill so the NHS Future Forum maybe our best chance to get our voice heard.

I am not a member of any union but could not fail to be impressed by the Unison (public service trade union) TV advert a few years ago. It has been heralded as one the best ads ever created. A cartoon bear sits in the middle of the screen, happily ignorant of a very small ant trying to get his attention. Then another ant joins, and another, and another. Until finally they all shout together and the bear jumps out of the way. Simple, wonderful representation of how a lone voice may be inaudible – but you multiply that voice manifold, and even the worst listener in the world cannot fail to hear.

I’ve never been compared to an ant before – but at least I have posted my comments and constructive suggestions on the Department of Health Website.

Have you?