Einstein – we need you!

At the end of a political week in the UK with a quality of pantomime farce about it, there is a fascinating  story about Albert Einstein’s views on the Universe. In a statement which I wouldn’t dare to pretend to understand, scientists at the National Astronomy Meeting in Manchester announced the results of a new test, comparing the current size of the universe with the dimensions six billion years ago. This test proved, with ‘incredible accuracy’ that Einstein’s theory of relativity accurately predicted the expansion of the Universe. What a stunning brain this man must have had.
I would act with some confidence in taking advice from Albert Einstein. And how I wish he, and more like him were around to dish out some sound guidance in the UK right now.

If it wasn’t so annoying it would be laughable. Earlier this week a government minister announced to the general public that there may be a petrol tanker drivers’ strike. There may be a disruption in delivery service. There may be a petrol shortage. So what does he advise us to do? He advises us to stockpile petrol. To fill up jerry cans and store it in our garages. So, surprise, surprise, panic buying ensues, queues stretch along roads leading to petrol stations, fisticuffs break out at the pumps and hundreds of idiots put their lives at risk by storing an inflammable material in unsafe conditions. Nice work.

How would Einstein have reacted I wonder? If the public needed to know then Einstein would have no doubt advised us that the conciliation talks hadn’t started yet so stockpiling is the last thing we should do. Hardly rocket science is it?

‘Pastygate’ is another spot of whimsy. It has been announced that hot Cornish pasties (and other hot take away pies) will now be subjected to value added tax. Not a big deal until the press decided to focus on whether members of the coalition actually ever ate pasties, and if so, when. Then Ed Milliband, leader of the opposition decides to ‘pop in’ to the branch of a well-known bakery to buy some sausage rolls – and of course there just happened to be a camera team handy to make sure the photo opportunity is exploited.

What nonsense. Where is Einstein when we need him?

Come to think of it – it’s not Einstein’s immense intellect we need right now. We need some politicians with a modicum of common sense.

 Ah well – a girl can dream…

Dementia – a most heart-breaking disease

The Prime Minister’s announcement yesterday, promising to double the funding of research into dementia is most welcomed, but will only scratch the surface of ‘a crisis on the scale of HIV’ as described by the PM himself.

If obesity and diabetes are a public health ticking time bomb, dementia is a minefield already detonated. In the UK there are currently 800,000 sufferers of the degenerative and distressing disease. This figure is set to reach 1 million within the next decade. The Alzheimer’s society reckons that 1 in 6 people over 80 suffer with dementia and as we continue to live longer this isn’t something that’s going to go away.

The sum allocated to research, £66 million is a fraction of the estimated cost of dementia – running at around £20 billion each year. It is also estimated that patients with some form of dementia occupy a staggering 25% of NHS hospital beds at any given time.

Although research is vital and desperately needed, community provision of care for these most vulnerable of patients is a priority right now. As the daughter of two parents who suffered from dementia for the final ten years of their lives, I would like to highlight another priority – to educate the general public in how to respond to an elderly (and sometimes not so elderly) sufferer.

It is very easy to become frustrated with someone who keeps repeating the same question over and over again, who forgets who you are and wanders off the minute your back is turned. It’s very easy to feel embarrassed as your father or mother talk nonsense to strangers and invade the personal space of shoppers/sightseers/diners as they go about their own business. It’s easy to get cross as someone who used to be your world and your rock just picks things up in shops and walks out without paying or says incredibly rude things to your friends.

As my father became lost in his own private and confusing world, he could remember every code he used as a signalman in submarines during the Second World War, but he couldn’t tie his own shoe laces. My mother, who was sociable, funny and kind, alienated so many friends and neighbours as her sense of appropriate behaviour left her but could still recall her children’s greatest personal achievements.

But there were wonderful moments too – as a window occasionally seemed to open briefly and bring my precious people back to me for the most fleeting of time. Just before my father finally needed to be admitted to a nursing home, my daughter, about ten years old at the time, baked her granddad a birthday cake and decorated it with loving care with chocolate buttons. Daddy, who at that stage could barely string a sentence together, let alone make sense with words, beamed at the sight of this gift and said ‘Ellie – if I win the lottery – I’ll give you the lot!’ Dementia sufferers may seem very odd and a little frightening at times, but the person you knew and loved is still in there – somewhere.

As the dementia ‘crisis’ was discussed on television yesterday, a lady suffering from Alzheimer’s spoke with great eloquence and some difficulty. At the end of the interview, she was asked if there was anything else she would like to say and her powerful and emotive words should be noted by us all.

‘Love us for who we are and be with us. We are normal people with special needs’

The Health Bill isn’t the death of the NHS, but it will delay recovery.

As expected, the controversial Health and Social Care Bill is now set to become law within the next few weeks. The UK press have sensed that the public are fairly bored with the protracted political wranglings and in the wake of the Chancellor of the Exchequer’s budget announcements yesterday, the Health bill passed the finishing line with little ceremony.

Only one newspaper, Daily Mirror, seemed to prioritise the story and dedicated its front page to the NHS reforms with a picture of a tombstone headline ‘RIP NHS 1948 – 2012’

As Mark Twain (very much alive at the time) said after seeing his obituary prematurely published ‘Reports of my death are greatly exaggerated’, this is not the death of the NHS. But it’s certainly not very well. The comedian Spike Milligan’s grave stone reads ‘I told you I was ill’ (really – it does!) and this would have been a more appropriate headline for any newspaper. It isn’t competition that will do the most harm, it’s giving GPs too much money, too much responsibility and too much power. It’s ignoring the importance of quality nursing care and the value of performance based targets for both staff and clinical regimes. It’s the loss of priceless expertise in Strategic Health Authorities and Primary Care Trusts and introducing new layers of beaurocracy, despite claims to the contrary.

We know that it’s not just the patients in our hospitals and health centres who need treatment, we know that the health system needs fixing. No-one argues with this fact. This Bill won’t kill the NHS but although Andrew Lansley’s diagnosis was right, his recommended treatment and his unrealistic prognosis is way off course.

Mothers – if you do just one thing today…

It’s Mothers Day in the UK today and like most mothers I shall be spending it with my family. I often feel that I should give my daughter and step daughters a gift rather than the other way around as it continues to be such an honour and joy to be blessed with this incredibly important role.

What gift could a mother give their children? A news item today recalls the sad story of Jade Goody, a TV reality star and mother of two little boys who died on Mothers Day three years ago aged just 27 years. Jade died of cervical cancer, after ignoring an invitation from the NHS to undertake cervical screening (PAP smear) and delaying seeking medical advice despite some severe symptoms. By the time the cancer was diagnosed, her disease was very advanced and she was given little hope of survival. Jade’s public persona was easy not to like. The press branded her as loud-mouthed, ignorant and racist. But she approached her terminal diagnosis with great courage, determined that other young women would not suffer the same fate and she put a considerable amount of effort into educating women of the importance of cervical screening.

Jade’s efforts paid off, and in the year after her death, cervical screening in the UK, especially in younger women, increased by a staggering 384,000(12%). As is so often the case, celebrity endorsement hit home. Three years on, cervical screening figures are still pretty impressive, with nearly 79% of women undertaking their regular tests as advised. But sadly the peak of 2008/9 has not been repeated and 250,000 less women took up their screening invitation last year. It would appear that the 'goody effect' has worn off.

Hopefully, in the future, thanks to the HPV vaccine, cervical cancer may become a thing of the past, but there are still several generations of women who need regular screening to facilitate early diagnosis, intervention and cure.

Cervical screening is free in the UK, offered to all women aged between 25 and 64. Women of any age with relevant symptoms, will also, of course be tested as needed.

So if you are a Mum who could be at risk of cervical cancer, one of the best gifts you can give your children is to be regularly tested. And if your daughters are eligible, you have a responsibility to ensure they take up their screening invitation when it pops through their letterbox. After all, looking after yourself and keeping your kids healthy must be one of the most important things a mother can do.

Happy Mothers Day!

Why giving GPs £80 billion worries me – straight from a horse’s mouth..

Opposition to the Health and Social Care Bill is becoming old news and even the Royal College of GPs has offered an olive branch to the government in an attempt to make the inevitable reforms somehow work.
Despite ongoing bewilderment as to how legislation is being implemented before it reaches the statute books, the reforms are well under way.  Some GP’s are knee deep in commissioning plans, primary care trusts have accepted their fate as they shed staff and hospital trusts face a confusing and cash strapped future.

A BBC interview with an apparent supporter of the Bill polarised all my fears about these changes in the space of just three minutes this evening. As I was listening to the interview with Dr Rishabh Prasad, a GP from a Leicester medical centre, for just a few moments I was nearly swayed into thinking that perhaps giving GPs a very large slice of the NHS cake could work. The enthusiastic doctor explained how he believed that the reforms could promote innovation and how frustrated he had been previously in trying to set up a local study into deep vein thrombosis. But then he admitted that patients may not be happy with the changes that GPs’ new responsibilities may bring

The BBC health correspondent mentioned in her report that practices were already having to provide extra cover to free up GP time for commissioning projects. Dr Prasad then continued (and I quote) ‘As we pull GPs away from front line clinical work, there may be a disruption of service, not less of a service, but you may not be able to see the doctor you want or you normally see because they will be doing other things…..as a GP I can’t be in two places at once… I can’t be chairing some meeting and be here seeing patients. It will be interesting to see what happens in the next 5 years’

Mmm, chairing some meeting or seeing patients? – I know how I would rather my GP spent his or her time.

I do agree with Dr Prasad on one point though.  It will be interesting to see what happens in the next 5 years. Very interesting.

NHS Risk Register: To publish or not – which is the biggest risk?

I am a Prince 2 practitioner, trained in running projects using the ‘process based method for effective project management in controlled environments’ so popular in the public sector and favoured by the NHS. Much of the training course is plain old common sense, but the formal structure given to key elements of project design ensures that errors and omissions can be avoided and, most important of all, risk is managed.

Within the Prince 2 manual, the purpose of the risk theme is to ‘identify, assess and control uncertainty and, as a result, improve the ability of the project to succeed’. Just the sort of actions one would take when restructuring or re-forming a major institution such as the NHS.

The training goes on to help project managers:

Identify risks that could affect the projects objectives
Assess likelihood, immediacy and impact of each risk
Control responses to the risk, assign risk owners, execute and monitor responses. (i.e. take remedial action)

As the Information Commissioner placed an order to the Department of Health (DOH) to publish the Health and Social Care Bill risk register, it is reassuring to know that such a document exists. However Andrew Lansley, UK secretary for State for Health still won’t confirm that the register will be published and despite the fact that a recent tribunal has rejected the DOH’s appeal against this publication, the Coalition continues to drag its heels.

I have some sympathy with the view that it is not ideal for risk registers in general to be made public. To the ill-informed eye, such a document could be misinterpreted and the risks overestimated. But with such a major political and social issue, surely refusing publication will do more damage than exposing the flaws of a Bill that is already so blemished and devalued.

So one must ask – why? Why doesn’t the ‘nothing about me without me’ mantra apply to the risk register? The risks of top down re-organisation have already been discussed ad nauseam. Any change involves risk and as long as this risk is ‘identified, assessed and controlled’ then the likelihood of success will be greater. So shouldn’t the publication of the risk register reassure us that all bases are covered?

I suspect that the risk register won’t tell us anything new, but it will probably prove one thing. That Andrew Lansley was fully aware of the identification and assessment of major problems with his legislation even before the Bill was presented to parliament. But he went ahead without taking the controlled responses required to actually succeed and achieve the ultimate project goal. To improve the NHS.

What does compassion really mean when it comes to improving the NHS?

In one of his more obtuse replies to opponents of the Health and Social Care Bill, David Cameron is apparently going to tell the Tory faithful that ‘true compassion means taking tough decisions’.

As cliché’s go - that’s right up there with ‘no pain no gain’, ‘you always hurt the one you love’ and ‘it isn’t you, it’s me’. Compassion is a strange choice of words to explain what should be a decision based on fact, evidence, expert opinion and realistic forecasting. Unfortunately, just because a decision is tough, it doesn’t mean it is right.

And what about ‘true compassion’? The Oxford English Dictionary defines compassion as ‘sympathetic pity and concern for the sufferings and misfortunes of others’. I guess therefore that true compassion must mean true sympathy.

But what should compassion really mean in the context of NHS reform?

For patients: To be treated with dignity, care, courtesy and respect by every member of the medical profession, allied health professions and administrative staff.

For NHS staff: To be valued, informed and supported. To have your voice heard and your views respected noted and considered within the planning process.

For GPs: To recognise that not all GPs support the Bill. For those who want to form Clinical Commissioning Groups , clear guidelines, soft control, information, education and support. For those who don’t, to be valued for their expertise and commitment to patients, even if they don’t support the Bill

For Medical Colleges (such as Royal College of GPs and Royal College of Surgeons): To stop patronising them or ignoring them and to listen, note and act on their recommendations and concerns.

For consultants: To recognise that they are a vital part of the care pathway, that they are experts in their field and, like most GPs, care deeply for their patients and their clinical teams.

For Andrew Lansley:To accept that he means well but let him down gently and give him the tools (i.e. an experienced, pragmatic and influential team) to sort out the mess of his creation.

For David Cameron: To acknowledge that he thought he was doing the right thing when he handed a £100 billion budget to an intransigent Minister of Health, without realising that he would pass most of it on to just one link in the healthcare chain.

For the general public: To be reassured that their loved ones will be cared for properly, that budgets will be allocated sensibly and that quality will be the driver in every change applied to their state funded health system.

Maybe this on-going conflict between politics and care explains why compassion fatigue is high on the list of contagious diseases right now.

The NHS Reform sitcom - in homage to Blackadder goes forth

This week there’s been yet another debate on NHS Reform in the commons, BBC’s Newsnight programme did a Healthbill special, and just about every political programme continues to follow the tale of misinformation, misery and mayhem. Yes the Health and Social Care Bill is taking on the persona of a confusing sitcom, with three of the key players, The PM, Deputy PM and Health Secretary sticking true to character throughout.

The Health Bill sitcom scripts aren’t great and the characters not particularly appealing but I can see some similarities to the brilliant satire, Blackadder, especially series 4, based in the trenches during the first world war. Captain Blackadder, a battle weary, worldly wise leader struggles to keep his troops in line, fighting a war he doesn’t understand and facing a particular battle that he knows he is unlikely to survive unscathed. Captain Darling, similar in rank but lacking is good sense and paying lip service to his paymasters away from the front line is an unwelcome but compulsory presence in the trenches. And then there’s the unpalatable batman, Private Baldric – who has his own warped version of reality - diligent, loyal but, to be frank, living on a different planet to his colleagues. A good example of Baldric’s ‘brilliance’ is to shoot a pigeon so that Blackadder will have meat for supper. The only problem is – he shot the carrier pigeon used to relay vital information to and from the command post…

I shall leave you to decide who should play each character in my version of this tale…

Blackadder: ‘We need to improve the NHS – it’s too expensive, badly run and unsustainable. I have pledged that there will be no top down reform but we need to improve services and efficiency’

Baldric: ‘It’s OK Captain Blackadder – I have a cunning plan…’
Blackadder: ‘Good – I’ll leave it to you then.’
Baldric: ‘The patient will be at the heart of everything we do. The lion share budget will go to GPs. Nothing about me without me…’
Blackadder is distracted and doesn’t really listen - ‘Good, good …. Carry on…’

 A year passes and the troops don’t seem to like the Health Bill very much. They decide to try a new tack..

Blackadder: ‘No-one knows more about the NHS than Baldric’

Darling: ‘No-one knows more about the NHS than Baldric’

That doesn’t seem to rally the troops – in fact – it seems to irritate them.

Blackadder: ‘Baldric – this doesn’t seem to be going very well – most of the NHS staff, the medical colleges and even GP’s themselves don’t seem to be very keen, even your cunning plan of pausing and reflecting doesn’t seem to have distracted the troops enough, there might even be some desertions – what do you have to say?’

Baldric: ‘…many, many GP’s I’ve spoken to support the Bill…’
Blackadder: ‘Great! Where are they…?’
Baldric: ‘…nothing about me without me…. The patient at the heart of everything we do….’
Darling: ‘Can I help?’
Blackadder and Baldric look round to see where the noise has come from and at last realise that it’s Darling who doesn’t really say or do very much in the trenches.
Darling: ‘Why don’t I write a letter to all my troops and advise that I want a few more amendments and then we can discuss the Bill again in the commons and then I can pledge my support for the Bill and…’

That plan, which was carried out this week, didn’t work very well either.

The series ends with our three heroes preparing to go over the top to fight a major battle. As haunting music accompanies freeze frame shots of our characters leading their troops into the abyss we know how this is going to end….

Badly.