Campaigning for Health

Urban le Grandier dropped me a line to let me know that Dr Crippen is not dead; he has been the subject of a rather cruel hoax on NHS Blog Doctor. Someone calling themselves Dr P falsely said that he had died in a road accident,and then posted on another blog saying it was all a hoax.

I'm delighted that John is alive,furious at the idiot who did this to him,and feeling slightly sheepish,because I wrote him an obituary.

But hey, you shouldn't wait until someone's dead to let them know what you think of him, so I'm just leaving it up.Hope you enjoy it John. Please post soon. And as to what I think of the person who pulled this stunt, it's just as well I have my parental filter on...

It is with great sadness that I pass on the news that John Crippen aka NHS Blog Doctor, has passed away.

John made his last post in mid October. He did not post for a while and we wondered what had happened. He had already taken a break from blogging and we thought that maybe he had simply burnt out. The dreadful news came yesterday in a post put on the blog by his fellow practitioner that he had died in a traffic accident. By this time there were 128 comments on his blog asking where he was; a mark of how revered he was amongst medical bloggers.

John's blog was funny,vitriolic,bilious and insightful by turns. Above all it was fearless and it made a difference. He was the first to report on the loopholes in the MMC scandal; he wrote touching posts about mental health and he raged against the destruction of his profession which he was passionate about. He wrote the kind of posts that got thundering denunciations and standing ovations at the same time. The blogging world will be very much poorer without him. The rest of us have a class act to follow.

John, I hope where you are there are no PFI hospitals, crap IT systems, joke turds undusted and no Patricia Hewitt. We will miss you dreadfully. Put in a word with the Big Man for those of us who are still carrying on the fight. And enjoy your rest - you've had your share of hell already. RIP.

It's mid November and not a key struck in the old blog. So what's been up? Well, firstly I've been finishing off a response to the 'Better Health, Better Care' document, which is due in tomorrow. Secondly, I've had the cold. And last but not least,my broadband is b****d at the mo.

I thought at first this was a virus. It was actually a 'you've-been-on-overdraft-for-one-nanosecond-you-dumb-stupid-peasant-so-we'll-muck-up-your-direct-debit-charge-you-£20-for-a-5p-envelope-and-the-spittle-that-the-dumb-blonde-uses-to-seal-it-and-then-we'll-pay-your-next-invoice-but-not-the-last-one-to-really-muck-things-up' virus, courtesy of Halifax.
So I phoned up Demon to put it right. The chap on the other end apologised and said that he could not fix it, because- wait for it- their computer system was down.

Demon. Broadband. Computer Engineers. Broken Computer System. Someone join the dots please?

Collette Douglas Home has written a very thoughtful piece today on the introduction of vaccination for the HPV virus;a virus that can cause cervical cancer in women. This was one of the SNPs promises for health and it is in this particular chapter of 'Better Health'.So all credit to the SNP for bringing it in.

However, I wondered why another common STD was not mentioned, which in its own way can be just as devastating to a woman - chlamydia. This is one of the commonest STDs in Britain, is symptomless, and causes inflammation of the fallopian tubes, leading to infertility.One estimate that I saw was that one in ten women have it.If that is the case then we have problems. But the amazing thing about it is that outside of medical circles, very few people know about this disease. Why?

Some time ago, I had the misfortune to have the tv on when a public health advert came on. It consisted of a guy sitting in a shower crying, with flashbacks to 'the night before'. The theme of the advert was that he had given his girlfriend an STD. But the disease wasn't mentioned, the effects weren't mentioned, treatment wasn't mentioned. It was useless. And here's the odd thing. In an age where we will quite happily have 'FCUK' blazoned across a T shirt that we're wearing, talking about STDs is done in whispers. There is a taboo attached to this subject that there isn't to other areas of sexuality.

There are a number of options for combating chlamydia. One would be to include a swab for the disease along with the cervical smear test at Wellwoman clinics.As chlamydia is symptomless (until it's too late)I would say this is essential. Chlamydia can be treated, and caught early enough,it will not cause infertility. The other thing that the government should seriously consider, is liasing with some of the programme makers for the likes of Eastenders and River City and asking them to run some story lines on chlamydia. It would get the message across in a way that a thirty second advert that's preaching to you, doesn't.

One in four couples in this country now have problems with their fertility. For the sake of our future, we must do something to change this.

So much for drink. Now onto exercise and sport.
This report concentrates mainly on sport; providing sporting facilities in schools, having two hours of PE every week and so on. But providing sport in schools isn't just about providing facilities; it's also about providing the backing in which sport can flourish.

Back in the '70s, there was lots of school football clubs. On Saturday mornings, when there was matches between them, every official on the pitch got paid for attending. Everyone that is, except the PE teacher. They did not get paid, either in their wage, or on the day, for attending that match. It was a petty economy that proved to be very costly. When the teacher's strike happened in 1985, the teachers went to a 'work-to-rule'. Many of these clubs went to the wall, and Saturday activities in general. The ship was lost for a ha'penny worth of tar.

Again, the rise of child legislation and the associated red tape has led to a drop off in volunteers, especially in sport. It is a high contact activity and unfortunately there are so called 'children' who are very savvy about complaining of abuse if a teacher simply annoys them. A friend of mine was at the receiving end of a complaint like this. His name was dragged through the paper, while the little darling who had complained was not named, becuase they were too young. When the procurater fiscal threw it out, nothing was done about the complainer. If a complaint is patently malicious, then it should be pursued, otherwise we are going to lose all our volunteers. There are few teachers now who will take schoolchildren on a day out or abroad. It's a shame, becuase it means the decent kids are losing out. If we are serious about sport, we have to provide protection for those run the clubs. Adults should be vetted, but it should be made plain to children that if they raise a false complaint, that they will be censured.

One thing missing from this section is exercise. Not all of us do sport, and not everyone is welcome at a gym. But lots of us walk and one area that should be considered in this, is the provision of parks.
Think of a young mum looking after her child. She can't go to the gym, because the child won't be allowed in, and it's probably too expensive anyway. But she can put the child in a buggy and go down to the park. She can meet other mums there.
The same goes for the elderly. They may not fancy going on a treadmill or weightlifting, but they can always go for a walk in the park. They can buy a dog and join the doggy fraternity. I was totally unaware of this, until my mum got a dog and I went for walks in our local park. There is a whole community down there and there's all kinds of spin offs; coffee mornings, sponsored walks, dog training etc. Also,if someone is missing, it's noticed; people in this group look out for each other.
It's not just mums and elderly; our park is popular with runners, because it's a mile square.
Parks are a real asset, but unfortunately, some are getting houses built on them; others are getting sporting facilities that only a small section of the population are going to have access to. We need to revise this.
Also, it's time to bring back park wardens, to ensure that parks are used properly and not as a place to drink or shoot up. Just a small amount of low level supervision in public places would cut out a lot of vandalism, drinking and suchlike and simultaneously free up places that we could exercise and smell the flowers. There you are. The solution to public drinking and lack of exercise in one. How about it, Nicola?

Ok, as the French say, 'nous revenons a nos moutons' or let us return to our mutts. I was going through this document before I was so rudely interrupted by NHS Lanarkshire and a wee trip to Malaysia,(not connected) but now that I'm bright eyed, bushy tailed (and sober) I will tackle the third section of this document which is called ' Taking Responsibility'.

This section of the document deals with what you would call public health issues. Smoking, alcohol, exercise and so on, are dealt with in this section. The title of this chapter begs the question; who is responsible here? The answer ain't simple and this section needs a couple of posts to itself. So I'm going to start with drink.

There are those who will always drink, no matter what you do. There are those who will never touch a drink. But if you want to know if there is a problem with drink you look at the middle section of drinkers; the moderate drinkers. These are the folk who will maybe have a beer or a glass of wine after work, will have the odd blow out of a weekend, but will get a taxi home and back to the grind come Monday morning. Are they in trouble? The short answer is yes, they are. Alcohol related disease is up especially amongst women; so is obesity, which is linked. What's gone wrong?

Here's a challenge for you. Go down to your local supermarket. Imagine for a minute that you have a drink problem. See how long it takes you to find a drink. Was there a display at the front door? Probably. Now, go along to the section where you buy pizza or cheese. I'll bet you a cheeky Chardonnay that there are bottles of white wine to go with them. Now go to the drinks section proper. Try to find a bottle of wine that is under 13% strength. I can guarantee that you will be looking for a very long time. Now try to find a non alcoholic brand. Yep, down at the bottom stuck at the back of the shelf and it tastes like mouthwash. That is one of the main reasons that we are having such problems with alcohol just now.

There is a deafening silence about the role of the drinks industry and the supermarkets in this problem. Just why has table wine gone up in strength from 10%, which was the average a few years ago, to 13%? It certainly doesn't add anything to the taste, unless you like having your tongue scorched with raw ethanol. It is particularly dangerous for women; it means that after only one drink of a very average sized glass of wine, they are over their limit. The whole point of having a legalised drug is that it can be controlled, but it patently is not at the moment.
A number of table wines have gone to 14% and I saw one at 14.5%. That's just 0.5% off a fortified wine. Some very hard questions have to be asked of the drinks industry about this.

And what about the supermarkets? Why are they setting up their stores in a 'C'mon, take a drink' fashion? Cut price boxes of Budweiser at the door, displays scattered at various points through the store so that you couldn't avoid it even if you wanted to and that wee salve to their conscience, 'If you look under 21 you may be asked for ID.' Whoopee. We all know that it's only people under 21 that have drink problems.
Now, I am aware this is turning into a bit of a rant. Perhaps you are chuckling to yourself as you read this. So let's sober you up. Is there anyone out there reading this, that does not have a friend, a relative or a neighbour with a drink problem?
We all know someone. And it's not funny. Something's got to be done about it.
Here's some suggestions.

1. Ban supermarkets from having front door displays. There's no excuse for this. Limit them to having only one place in the supermarket from where drink is sold, so that it's not an obstacle course for people with a drink problem.

2. Get the drinks industry to print the number of calories contained in a drink, on the side of the bottle. This will discourage women from drinking too much, and might even make an inroads into discouraging teenage drinking of alcopops from fashion conscious girls.

3. Don't just charge on broad bands in taxing drink. This means that an 11% wine gets charged the same as a 14% wine. Have some flexibility within the band, so that a wine with a higher percentage, gets charged more tax.

4. Look at local licensing. In Canada, drink only gets sold at a liquor store; nowhere else. That means that teenagers have no excuse to be in the shop, people with a drink problem can more easily avoid their addiction, and their relatives and friends can work out sooner that they have a problem, because they can't shop round to conceal it.

Right, I think I'll go and have a drink..of tea. Cheers!

Am just back from holiday, and have come back to the glad news that NHS Lothian has been forced to disclose the running costs of the Royal Infirmary of Edinburgh. This is very significant; up until now, anything that had 'Commercial confidentiality' slapped on it did not come under the Freedom of Information act, even if it involved the spending of copious amounts of public money. At last we might be able to trace just exactly where all our money is going, and how much is going into the shareholders' pockets.

It wasn't mentioned in the report, but the fact that the 'Save St John's hospital' campaign now has a councillor on the health board, meant that the game was a bogey for NHS Lothian anyway. He would have access to that information, even if it didn't make it into the general public domain. I'm sure that this lead in no small part to the decision to make this information public. So three cheers for The St John's' councillors; this could be a real turning point for scrutiny of expensive and wasteful PPI projects. Prepare to be shocked by the real cost when it comes out.

Tay health board have just recently come bottom of a 'mystery shopper' survey of health boards, which consisted of people phoning up and asking for various services. They were then marked on friendliness, efficiency, accuracy, etc. Tay board's reaction to this? They have formed a committee. Its name is the 'Conscience Committee' and the people on it are called 'Conscience Keepers' and they are to make sure that Tay Health Board keeps all its promises.
Bet that took a very expensive media committee a morning to think up..

Ok,i've learned my lesson. The last time I started a series of articles praising a government document, the MMC scandal hit the roof. I start a series on 'Better Health, Better Care' and NHS Lanarkshire excels itself. This time it's a GP practice- South Nimmo practice to be precise.

The story goes like this. In March a Dr Carlin retired due to ill health from his practice in Adam St in Airdrie. He had not organised for a partner to take over. In such a case, the responsibility for the practice falls to the local health board. The premises at Adam St needed repair, so Dr Carlins practice was moved to South Nimmo St, where there was another doctor's practice, and a bidding process was started by NHS Lanarkshire.

The practice had been run by locums while Dr Carlin was ill, and two of them, a Dr Ahmed and Dr Shah wanted to bid for the practice. When they asked, they were told that they could bid, but only if they resigned as locums. So Dr Shah stood down as a locum to bid on behalf of himself and Dr Ahmed. He was then told he could not bid, because he was not part of a practice! When the invitations for tenders were sent out, they were sent out to all the GP practices, but Dr Shah and Dr Ahmed were not sent one.

In the meantime, two practices put forward bids. One of them was Wellwynd practice, which is based in Airdrie Health Centre. It already has 15 000 patients and only 4.5 doctors. Airdrie Health Centre is also falling to bits and is overcrowded because several other practices are in there. (By this time, Adam St had been refrbished and was ready to be re-occupied).However it became apparent that for some unknown reason, Wellwynd was the preferred bidder. It was awarded the bid, is not taking on Dr Ahmed with the bid, so that means that at the moment they have 17 000 patients and only 4.5 doctors.

This is the third time that NHS Lanarkshire has behaved in this fashion over a GP practice. First there was Rowallan GP practice, then Harthill, now South Nimmo. Once might be an accident, twice a coincidence; but three? Looks like carelessness to me. We are in a situation where single practices are being subsumed into bigger ones and if I put my cynical thinking cap on, that means they can employ fewer doctors, bring in nurse practitioners instead and possibly even bring in a private company to run the staffing? Bigger practices are more attractive than smaller ones, and the more patients you have on your list, the bigger your global sum. This is money awarded per patient. Wellwynds latest acquistion will bring in £120 000 by my reckoning.

If there are any South Nimmo patients out there, there is a campaign group attempting to take on the health board; their address is http://southnimmo.org/. In the meantime, if you live in Lanarkshire, do try not to fall ill; you'll need 10p if you want to phone someone that cares..

This is the shortest section in the document, but perhaps the most important. It is all about money; how it is being used at present, and how it could be used better. It also looks at staffing and the spread of services between acute care and primary care.

This is a section that can be read in a number of ways. For example what exactly is meant by this phrase, 'Challenge traditional boundaries between public sector organisations, sharing premises and resources with other organisations where this makes sense.' Does this mean sharing premises and resources with private companies or does it mean sharing with voluntary organisations, such as Maggies or St Andrew's Hospice? And if you share your budget with a private company and it wastes it, how accountable are they going to be? As I said in the previous post, private companies that spend public money, need to be held accountable in the same way as everyone else. That means that information on their budgeting should be publicly available, not filed away under 'Commercial Restriction'.

Further on, the document states, 'Use the contractual levers at our disposal to ensure that patietns and the public purse get the best possible deal from private sector suppliers.'
We should start to look at changing the rules regarding refinancing of PFI debts. This is a practice where the debt is sold onto a concern that offers the loan at a lower rate of interest; millions can be made from this. But the millions go into the shareholders pockets, not those paying the debt.

One important area that is not discussed, is the relationship between the NHS and Social Work. If, as the document states, they want to shift the balance of care from hospital to community based services, then it has got to have an agreed way of working with the local authority. Central government has also got to look at a way of allocating a budget for community care that involves both parties. Primary care budgets in the NHS have a nasty habit of disappearing becuase they are not ring fenced.

This section does touch on staffing issues and perhaps this is a time to consider what kind of model we want for GP practices. If the government does not want private health care providers in GP practices, it is going to have to change the GP contract that allows this option. It is also time to consider how appropriate the introduction of nurse practitioners is in primary care. Nurse practitioners in triage in A&E can ease the strain; if someone can be seen and bandaged, given pain relief and allow a doctor to see someone else, then that is appropriate. But if someone phones up a GP parctice with long term symptoms that could be anything at all, is it appropriate to book them in with a nurse practitioner, as is becoming increasingly common?

Again, in ''Agenda for Change' there are moves to merge the roles of district nurse and health worker. These are two very distinct roles. District nurses do things like wound dressing and 'messy stuff'. Health workers tend to visit families that have children, esp new born babies, and watch out for signs of childhood diseases or abuse. Is blending these two roles advisable?

Finally there is a mention of flexible working hours. This is common sense, especially where care in the community is concerned. Your average care worker is female and has children or a partner that they are looking after. Yet some care companies are considering ending flexible hours for their staff. This would lead to a huge drop-off in available staff. It must be re-considered.

More tomorrow!

This first section of the document has my favourite statement 'There will be a clear policy presumption against centralisation'. Glory halleluiah! So many of the problems that the NHS has been dealing with at an organisational level have been based on the wrong assumption that bigger is always better. It also has a specific promise to bring in a Local Healthcare Bill, which will include direct elections to health boards.

Some people are against the idea of health board elections. They think that this will mean that people who are not qualified to comment on health, will stand. What is not generally realised is that on healthboards, there are actually quite a lot of people who are not experts in health and the only reason that they are there, is because the ruling political party has put them in. So you get retired councillors, election agents and all manner of connected people who have no connection with health, but have plenty of connections with politics.

If elections were brought in for about half of the seats on the health board, as was mooted in the original Bill Butler bill, people who have an interest in health could stand. Retired doctors and nurses could apply. People from carer's forums could stand.It would actually throw the door open to the professionals who work at the coalface, not the office desk. And it would mean that we would have meaningful consultation on health policy changes in a local area. If you have a vote, you have a voice.

Going on, this section touches on the fraught area of independent scrutiny within service change. It states that proposals should be 'robust, evidence based,patient-centred and consistent with clinical best practice and national policy.

Two areas have to be tackled to make this possible. Firstly, the issue of commercial confidentiality. Health boards have taken to slapping 'Commercial Restriction' on every document that they don't want made public, especially when it involves something contraversial. So when NHS Lothian were asked if Stracathro was value for money, (an ACAD run by a private company that has been contracted to do operations on behalf of the NHS) the information could not be obtained because it came under commercial confidentiality. This cannot be obtained by the Freedom of Information Act either.. Now, if public money is being spent on something (in this case £15million) then those spending it should be publicly accountable.

Connected with this,is the status of health care providers in relation to the General Medical Council. If you are an individual GP, you are accountable to the GMC. If you work for the NHS, you are accountable. If you have been sub-contracted by a private company to work for the NHS, (ie staff at Stracathro) you are not accountable to the GMC. This means that if there is malpractice, a court action has to be raised; there is no middle ground. It is also undermining the regulatory function of the GMC. It must be addressed.

Otherwise, a very good chapter. More tomorrow!

First, apologies. I do realise that I have not blogged for a couple of weeks. This is because rather a lot has been happening at this end and I have been running around like a blue -bahookied fly. But time to get back to blogging and my bedside reading just now is this document - 'Better Health,Better Care'. It's a discussion document that was brought out by the Scottish Government in August and submissions are due in November.

Documents like this are tricky to get right. Too much detail,and you are accused of having already drawn your own conclusions. Too little, and you are accused of having nothing to offer. This document has got the balance just right.

There are several specific targets

Abolition of prescription charges; direct health elections;an end to hidden waiting lists; free school meals;a new dental school in Aberdeen; a waiting time no longer than 18weeks from referral to appointment;

It has a specific policy direction

The document has statements like 'There will be a clear policy presumption against centralisation'.

It is ambitious

This is a wide ranging document. It is looking at every area of healthcare and has the feeling of ambition about it. In modern politics it's very difficult to have a big idea or big government. Politicians are accused of bringing in the nanny state when they do this. If they fail in any of their objectives, then this is forever cast up to them. Politicians have therefore been careful-too careful in my opinion, to go for it, and attempt make a real difference; they end up picking around the edges of legislation, rather than attempt something that may leave them exposed to criticism. This document throws that approach out of the window. It is a breath of fresh air.

It is in plain English.

Not a sign of 'synergy' anywhere. Need I say more?

I will be discussing this document over the next few posts, and how the aims in it might be achieved. Watch this space!

You have just finished writing a sarcastic post on bureaucracy terms. Then you learn over at Aphra Benn's, that the Department of Health has just brought out a document on the MMC scandal. It was printed on 12th September. They want comments and submissions in by the 25th September, So they want feedback, but not that much,then.
You couldn't make it up..

Your intrepid blogger found this little book of terms on the health board chief's desk..

Conference - a dull day at a hot hotel, talking hot air, but it's not work and there's Black Forest Gateau.

Synergy- a really exciting word peppered through boring documents.

In synergy with - you have just been yoked together with a department that has nothing to do with you, wants nothing to do with you and which is sharing half your annual budget.

Consultation- the management have decided what they want-now the management will decide what you want.

Downsizing - you're all fired

Facilitator- that big 20 stone bloke with the earpiece

Synergy - a really exciting word peppered through boring documents.

Fit for the 21st century - a new building of plasterboard, half the needed size, but with a kettle.

Fit for purpose - An old building, given a lick of new paint, with a kettle.

Fit for use - An old building, given a lick of leftover paint, without a kettle.

The latest in computer technology - works if you switch it on and off a couple of times.

Merger - You're all fired.

Pay Rise - never heard of it.

Synergy - a really exciting word peppered through boring documents..

Powerpoint - the guy didn't know enough to write a paper on the subject, so he did some slides instead.

Public Meeting - held at 6 o'clock teatime, in a boarded up building, in the part of town where the police dogs go in twos.

Preference Scoring - can you guess which department we're shutting?

Rationalisation - you're all fired.

Re-organisation - half of you are fired. The other half are getting their pay cut.

Review - we tried to shut you down. You threw half bricks at us. We'll try that one again..

Synergy - a really exciting... ok, you get the idea..

Another bit of welcome news - Nicola Sturgeon announced today that there would be a review of car parking charges at hospitals. I was a witness at the Health Committee meeting that was held about this last June in Holyrood and I was distinctly unimpressed by the reasons given for having a charge in the hospital car parks. Basically, the argument went that there was all these fly parkers going in so the charge had to be imposed. The fact that the fly parker would pay for his ticket and then leave it there for the rest of the day, didn't seem to bother Consort. All suggestions about having a barrier, car park tokens, showing your appointment card and all the things that are used at public buildings as a matter of course to prevent this problem, cut no ice with the car park owners. Staff that were travelling to the hospital, were having to pay; in effect having £500 docked from their wages before they even crossed the threshold of the door. There was a suspicion that these charges esp at the Royal Infirmary of Edinburgh, were being used to pay for the interest on the PFI loan that built the hospital.

However, this problem is rather more complicated than it would first appear. One of the features of modern hospitals is that they tend to be built out of town. This is because some years ago, capital charging was introduced on NHS properties, to encourage the NHS to get rid of buildings that it wasn't using. So if you had a hospital in town ie Glasgow Royal Infirmary, then the capital charge on that would be prohibitive. If however, you had a hospital out in the middle of nowhere like Hairmyres, then the capital charge would be much lower. So the NHS started building out of town.However the downside is that many of these hospitals do not have good transport links and the only practical way to get to them, is by car.

One of the worrying features of this, as I mentioned in a previous post, is what would happen if you needed all your staff if there was a major incident. By definition, none of them would live near the hospital, and all of them would have to travel a considerable distance to get to the hospital. If the incident occured on say, the M8 and you had to travel along it to get to the hospital, what then?

If the hospitals want their staff to leave their cars behind, they are going to have to rethink their transport links, and on a wider scale, the government is going to have to rethink the whole centralisation issue. Bigger isn't always better. However, there is one thing that could be done fairly easily to encourage people to travel by public transport; re-man railway stations at night, and bring back bus conductors. It would make everyone feel a lot safer, and cut out most of the boorish behaviour and vandalism that we have come to accept as normal on trains and buses. You don't believe me? Well, when I was going to school in the eighties, I travelled on the trains when the stations were manned; there was very little bother on them. When they de-manned the stations, within weeks, gangs of neds appeared on the trains and by the end of the year every station from Coatbridge to Glasgow had been burnt down. Its time for a review of this, and time for a review of transport in general.

Last November, the Scottish Health Campaign Network met with Andy Kerr to discuss various health issues. I was with them, and for that particular meeting I chose to ask a number of questions on mental health provision and care in the community. One of the questions I asked was; what was happening about the funding of people who were moved from continuing care beds in hospitals, into care homes in the community? The reason that I asked this question was because of the Pamela Coughlan case down in England, which became a benchmark case in health care.

Pamela Coughlan(above)was severely injured in a road accident some twenty years ago. She needed professional medical care, as well as help with feeding and dressing, which came under the title of personal care. At first she was placed in an NHS nursing home which specialised in long term care of this type. However, when plans were mooted to shut the nursing home and move the patients into local authority residential homes, Pamela was told that the funding of her care was no longer the NHS's responsibility. The social services were to provide funding and this would be means tested. Pamela challenged this decision in court, and to cut a long story short, she won. The court decided that the NHS trust had acted unlawfully and that they were responsible for the funding of Pamelas medical care. The social services would be responsible for personal care.

This issue is now coming to Scotland. In my own area, Lanarkshire, Kirklands hospital which catered for people with severe learning disabilities is closing. Hartwoodhill, which dealt with brain injury and psychiatric disorder, is closing. And the number of continuing care beds is being reduced. In short, there is a considerable number of people with significant medical needs being put into the community or nursing homes. But is the funding going to follow them?

Last week Frontline Scotland attempted to come up with an answer to that and they found that, like England, we are seeing a situation where people like this are being asked to fund their own care and they have no idea that the NHS should still be funding them. . This involves huge sums of money; medical care is more expensive than normal nursing care and the only way that the person can fund it is to sell their home. The buck for funding these people has been passed from the NHS, to local authority, to the person themselves and it's completely illegal. But because the NHS up here has not been challenged on this point, it is still following the old guidelines and hoping to get away with it. It's time it was challenged.

Do have a look at Barry Monk's latest post, 'Two Cows- Political Analysis for Beginners'.

Last week, David Cameron promised Labour 'a bare knuckle fight' over the closure of A&E and maternity units down in England. Usual front page stuff in preparation for the next election you might think. Well, actually it isn't. Despite everything that has been going on down in England, the plight of the NHS has not made it onto the front pages until now. You don't believe me? Well, lets check out your knowledge.

1. Did you know that 20 000 junior doctors marched on Westminster in March, including the Queens own surgeons? If you did, did you see tv footage of it? I did, it was on for about 10 seconds and it was the third item in the news that day. On the later bulletein, the tv coverage was not shown; the story was simply read.

2. Have you heard of Chai Patel? Of course you have; he's that guy that was involved in the 'cash for peerages' scandal. But did you know that he owns the Priory Group? This is a private health care concern; they go round buying up nursing homes, GP practices, brain injury clinics and day hospitals. They are part of extensive privatisation going on in primary care down in England. Did you hear anyone mention this? Nope.

3.Did you know that every cabinet minister in Westminster has either a cut or closure in health care going on in their back yard? Don't you think this might be newsworthy? Did you hear anyone mention it on the news when David Cameron was setting out his stall? Nope.

4. Did you know that all those A&Es were under threat down south before last week? Bet you didn't.

The truth is that the NHS is bouncing like an unexploded grenade round the corridors of Westminster. None of the major parties up until now, have wanted to touch it. This is for two reasons. Firstly, they are afraid of the private healthcare companies. They are very influential and can do all kinds of rotten things, like withdrawing adverts from papers that aren't pleasing them, turning papers against politicians that aren't pleasing them, withdrawing investment and so on. Secondly, there's the whole problem of PFI. If Cameron is serious about tackling A&E closures, he has to be serious about tackling PFI and this means central government taking on PFI debt from the local authorites. This in turn means that the money will have to be found to pay these debts, which will mean either a rise in taxes or a cut in public spending. Neither is popular with the voter.

Maybe Cameron is playing a cleverer game. The Tory party is not in good shape just now, there are votes to be won in A&E closures and maybe he is hoping to pick up a few seats, without actually having to worry about what has to be done to stop the closures. Nobody wants to be holding the grenade when it goes off.

Whatever happens, Cameron has put the NHS on the map. His declaration of policy will force the others to declare their position as well. It also means that the NHS cannot be kept off the front page for much longer. It's not going away. Whatever David Cameron might feel about his 'courageous decision' he has done the NHS a favour and all those who are campaigning for it. I never thought I would say this to a Tory, but; thank you, David!

In the last two weeks, while all the shenanigans about who was going to be the next Labour leader was going on, a smaller but very significant battle was going on in NHS Lothian. John Cochrane, who is one of three councillors elected on a hospital ticket for St Johns in Livingston, had been nominated to the health board. NHS Lothian objected furiously. Nicola Sturgeon intervened and the health board backed down. John is now on the board and there is nothing NHS Lothian can do about it.

Why is this so important? It's only one vote after all, and ultimate authority lies with central government.
It is important because it means that the health board can no longer conceal information about PFI contracts and the like from campaigners, under the catch-all of commercial confidentiality. It means that public money that is being spent on these contracts, will be publically accountable. It is a huge step forward. All due credit to Nicola Sturgeon for supporting them.

Some months ago, Bill Butler put forward his Health Election bill, which our group was involved in. It was to allow people to be elected directly onto their local health board, instead of the board hand picking them from the usual suspects. The board would have a majority of elected members, but would have seats set aside for medical experts. Not surprisingly, it lost, but maybe there will be a re-appearance. But good on St John's. They've cut to the chase, and I predict that in the next couple of years this will be seen as one of the most significant moments in the health battle. Go gettem John!

The National Institute for Clinical Excellence (NICE, and it's not nice, I can assure you) won its case today to allow them to limit the prescription of dementia drugs, to the later stages of the disease. This is not really surprising; there is a considerable amount of controversy over what drugs should be on prescription, especially when they are expensive, but this is a real blow for the elderly and flies in the face of evidence about these drugs. The way that NICE carried out its 'research' about the effectiveness of these drugs, was highly questionable.

My mother is on Aricept for Alzheimers. Aricept, like the other dementia drugs, does not improve cognition. What it does do, is it holds back deterioration of the mind for a while. It also helps to reduce the more distressing effects of dementia such as aggression, depression and hallucinations. This is very important for the patients quality of life and also the carers quality of life. It's the difference between someone staying in their own house and going into a home. What did NICE ask questions about? Whether or not the drug had an effect on cognition. We all bloody know it doesn't have an effect on cognition and the people at NICE know that, or else they're not fit for their job, so why ask? Why make that the parameter for the effectiveness of the drug?

Then they say that they'll allow prescription of the drugs in the later stages of dementia. Again, they know damn fine that Aricept really has to be prescribed in the early stages of dementia to be effective. If it's prescribed later, it isn't any use. So you might as well not prescribe it.

Then there's the cost. Now, Aricept ain't cheap. It costs £1000 a year. Then we have the ominous statement that is becoming more common 'We have a growing elderly population, so it's getting more expensive, so...' and then they leave the sentence dangling. So what? So, we need to think about providing more care for elderly people? More help? More medicines? Or was your thinking going another way? Why is it, when it involves old people that we whine about cost? Someone receiving £70 per week from the Social, costs £3500. Do we moan about that? It costs £5000 to send a child to state school. Do we moan about that? So what's the problem with the oldies? Do we just wish they would do the decent thing and die when they're 65, so that we don't have to pay out their pension?

Join the dots. Three nursing homes are shutting per week. Dementia medicinces are being restricted. Continuing care beds are being reduced. Old people have to sell their home to pay for care. Lord Joffe is trying to introduce a euthanasia bill. Where is this going? You work it out. In the meantime, I think it's time to get mad, like the granny above..

A friend of mine who was a teacher, used to complain bitterly that there were only two professions where everyone thought they knew better than the professional; the police, where you always had some Jessica Fletcher eejit running round, and teaching, where everyone thought they knew how to teach because they had been to school. Now we have a third to add to that; healthcare. The Herald reported on Monday that a new research project called the Scottish Infection Research Network (SIRN)had been launched. Their mission is to find out the source of hospital infections and to search for new treatments. So far, so good. The bit where I groaned out loud 'Haw naw', was when I read that there will be behavioural scientists and psychologists on the team. They will try to work out what prevents staff from washing their hands after every patient contact. Then they will try to come up with programmes to change staff behaviour,. If I know anything about these kind of programmes, it will probably involve a conference with lots of flip charts, brain storming diagrams, clicky pens and an eighty page handout. Can I save you a lot of bother, guys? Just ask the staff and they'll tell you what's up. In fact they have been trying to tell you what's up for the past few years, but nobody listens to them.

Let's get one thing out of the way. There is such a thing as a bad medic, who can't be bothered doing the right thing. If staff are not washing their hands, they should be disciplined, not 'understood'. A hospital is the most infectious place there is and there is no excuse for staff who behave like this. But the real problems of infection control are more complicated than that.

1. Under staffing. You are a hospital cleaner. You have six rooms to clean, and not enough time to do it in. You can clean three rooms properly and not clean the other three at all. Or you can clean six rooms with a lick and polish. Which are you going to do?

2. You are a ward sister. The rooms in your ward are not being cleaned properly. You complain to the manager of the private cleaning company to whom the cleaning services have been contracted out to. He tells you that the cleaners are working to contract, and their contract has different expectations from yours.

3. You are the manager of the cleaning services. You have been given a certain amount of money to purchase bleach for the month. It is not enough for the whole month and you have been refused any more money, because the hospital is over budget. So you tell the cleaners to water down the bleach.

4. You are the named nurse for a certain patient. At visiting time, you have been given the job of standing by the Hibiscrub to get visitors to wash their hands as they come in. Some of the visitors are relatives of your patient and they need to speak you urgently. There is noone to cover for you. So you hope that the visitors coming in, will follow instructions and you go to deal with the relatives.

5. You are a visitor. You need the loo, so you go to the visitor's loo in the foyer. The loo has an automated flush which you trigger by waving your hand in front of the 'magic button'. The handbasin has a similar button. You take a paper handtowel, dry your hands and attempt to put it in the pedal bin. Only the pedal doesn't work. So you have to lift the bin lid manually to put the towel waste in, as every other visitor to the hospital has done before you, and you carry the germs through all the manually operated doors and lift buttons up to the ward that your patient is in. (I haven't made this one up; this is from my experience and the bin is still there, broken. Gauny do something about it?)


Guys, I promise you, at the end of your research it'll be a psychiatrist that you'll need, not a psychologist..

This is an example of why primary care amongst infants is essential - well, that and we just thought it was cute.

Have been browsing through NHS Lanarkshires latest offering; their board meeting from 27th June. After telling us solemnly for a year and a half, that the proposed downgrade of Monklands was nothing to do with money, it seems like they've changed their mind and have taken a hissy fit. So they have decreed that the following will be under review;

Airdrie Resource Centre
Hamilton Resource Centre

Cancer Centre

Cumbernauld Community Casualty unit
Lanark Community Casualty Unit
Clydesdale Community Hospital

Kilsyth Health Centre
Wishaw Health Centre
East Kilbride Civic Development

Monklands Acute Mental Health Unit
Hairmyres Acute Mental Health unit

Oh yes and

Acute redevelopment, Hairmyres, Monklands and Wishaw.

Now, what is the purpose of this big long list? The purpose of this big long list, dear reader, is to make campaigners like myself feel guilty about campaigning for retaining all our A&Es in Lanarkshire. SO! Sacrifices will have to be made, thanks to those do-gooders who don't know the agonies we go through to make these decisions, who have no knowledge of the financial and logistical implications, and they smell as well..'

But do I feel guilty? Should I feel guilty? Lets take a closer look at this list.

First up; cancer centre. Oh yes. That cancer centre, that was going to work along with the Maggie Centre in Wishaw, then was going to be on the same site as Maggies, then was going to be placed at Monklands along with Maggies. Monklands is the only hospital in Lanarkshire that doesn't have an MRI scanner; the lab services that a cancer centre would need, were going to be up at Wishaw. Hmm. Was it ever going to happen, boys? I don't think so. I think it was just going to be Maggies. It shure ain't going to be the Beatson.

Community Casualty Units.

For those of you who don't understand NHS gobbledegook, a Community Casualty unit is a minor injuries unit, or a wee diddy casualty unit when they've taken the real service away. Note the areas they were going to be in; Cumbernauld, Lanark and Clydesdale. These were planned because the downgrade of Monklands would have meant that those areas were not covered either by NHS Lanarkshire or the neighbouring health boards. Now that Monklands retains its A&E, we should not need these units.

Monklands Acute Mental Health Unit
Hairmyres Acute Mental Health Unit

Oops- NHS Lanarkshire's favourite game; spot the mental health unit. Easy target, cos it's a cinderella service anyway and nobody cares about mental health except those who have to deal with it.
These proposals started off like this;

Two 112 bed stand alone units at Hairmyres and Monklands;

then

One 112 bed new build at Monklands and use ward in Hairmyres;

then

One 112 bed new build at Hairmyres; refurbishment of wards in Monklands (how on earth that was ever going to pass muster with health, safety and dignity regulations for mental health, I don't know)

now

Both units 'under review'. So what's new?

However, as foundations have already been laid at Hairmyres, I would say the smart money would be on option 3.

Oh yes, and not a pipsqueak about Kilbride hospice and the provision of hospice beds. NHS Lanarkshire was originally going to give the Kilbride Hospice Trust, land to build their hospice at Hairmyres, then reneged on it, tried to take the £1.4 million that people had saved up over 5 years for the hospice, and then made a vague promise about 'provision' of hospice beds somewhere else. Where, exactly?

So what does that leave? The health centres. Will these happen? My guess is yes. It brings all those pesky independent GP practices under one roof that belongs to the health board (or the PFI consortium that's building it) then reduce the number of GPs in the health centre and use nurse practitioners to plug the gaps, maybe bring in some private companies to run the health centre with salaried GPs and use it as a shop window for big bucks from the pharmaceutical companies and get rid of all those sick people that clog up the files and cost lots of money.

So, do I feel guilty? Do I ****. Oops, a good act of sorrow for swearing...

Do you remember this guy? The one that promised four days ago that the NHS would be his priority?

Well, it has been his priority- for a whacking great cut. Gordon Brown's bum has barely warmed the seat of number 10, and he has just cut the English NHS buildings and equipment budget by £2 billion- just over a third of the total budget, the Financial Times reported. Not only that, but the Times is getting rather heated over at Roy Liddles, because Scotland and Wales' budgets have not been cut in the same fashion. This is because health is a devolved issue, and Gordon Brown doesn't have direct control of health, of course, but you can't blame them for being hacked off about it.

I told you I didn't like Gordon Brown. Now you know why. Grr..

Last night, after musing on the naffness of Kirkcaldy High's school motto, a verse from my childhood floated into view.

'I promise that I will do my best;
To do my duty to God;
To serve the Queen and help other people;
To keep the Brownie Guide Law.'(Brownie Guide Promise)

Does that mean that Gordon is a secret Brownie?

Gordon Brown gave his inaugural speech today as Prime Minister. He talked about his willingness to serve and how he had been at Kirkcaldy High and had taken their motto to heart. We waited with bated breath. The motto? 'I will try my utmost'. Gee whizz.

It brought to mind the 'There's a lot Glasgowing on' that died a death approximately a week after it was launched; 'What's it called? Cumbernauld' and my personal favourite, the 'Cote-du-Bridge' campaign for Coatbridge, that was accompanied by a picture of the canal with a swan on it. (They just managed to keep the shopping trollies out of sight.)

Whatever happened to arrogance? Insouciance? Confiance? My old schools' (and no, i'm not going to tell you what one I went to) mottos were the thoughtful 'Not for school, but for life we learn'; the magnificently arrogant 'I was born for greater things' and Coatbridge itself has the very Calvinist motto, 'Laborare est orare' ,'To work is to pray'.
C'mon Kirkcaldy, you can do better than that. Get some fire in your belly. Send your suggestions in here.

Ok, I have finally succumbed to vulgar popularism, to add my thoughts on Gordon Brown's appointment as Prime Minister. What is it going to mean for the country and the NHS?

I am afraid that I do not like Gordon Brown. I do not like him, because in 1997, he introduced double taxation on company pension shcemes; that is, taxing pension contributions as they were paid, and then taxing them again on maturity. He removed at a stroke, £5 billion per year from pension funds and overnight, people were left with pensions that were not worth the paper they were written on. Some of the Clyde workers found their pensions reduced by 80%.What was this money used for? Tax cuts and our membership of the EU.

I also do not like him, because he is holding onto National Insurance contributions, while the NHS is crashing down about our ears through PFI debt. At the moment there is a £37billion surplus in NI. That surplus is not static; it has increased year on year by £4-6 billion.

Having said that, I do not envy him. Brown has been handed a poisoned chalice, both in terms of Iraq and the NHS. It is interesting that he has singled out the NHS as one of his priorities for government. But it leaves him in a uniquely difficult position.

At the moment, every member of the Cabinet has a hospital cutback or closure happening in their constituency. Four of them are Scots; Gordon Brown, Alasdair Darling, Des Browne and John Reid. Labour has just been thrashed at the polls in Scotland and Remedy UK, the new junior doctors protest group, is gathering momentum, as a possible threat and source of political challenge. If he does not address the closures in these constituencies, Labour could lose very badly. But the only way that the situation is going to be remedied, is if Brown grasps the PFI thistle, and makes central government take over the funding for PFI projects. That is going to cost a lot of money. So what will he do?

Well, the answer's right here. Use the £37billion NI surplus. Use the £50 billion from pensions and give us a decent health service. And do it before PFI spirals out of control. Never mind tax cuts at election time Gordon; give us a decent NHS with some decent spending on it. And please lose your friends from the private health sector like Chai Patel, who have not done you or your party any favours. Who knows, you might win the next election on it, if you're lucky.

Hi there,

Back after a few days away from the blog. I was looking at NHS Blog Doctor and the latest post is on Madeleine McCann. Or rather, some of the blog posts that have been left about Madeleine McCann. Some people are getting bored with the story. Some think her parents should give up and go home. Some think it was the parents' fault anyway for leaving her alone, so why bother us with it? You should just accept just punishment and not bother the rest of us with your grief. Blog Doctor thinks this is attitude stinks and so do I.

We in Coatbridge know only too well the price of complacency with regard to child abduction. 40 years ago, Moira Anderson, a wee 11 year old girl disappeared in a snowstorm. She had gone to buy a Christmas present for a relative at Woolworths and she took a Baxter's bus for this journey. She was never seen again and her body was never found.

At the time it was put about that it was a stranger abduction. Motor cars were becoming popular and it was generally thought that some paedophile toff had whisked her away. Life moved on and the Andersons were left alone in their grief, not knowing what had happened. It looked like Moira would be forgotten, until in 1992, Sandra Brown, a woman who had grown up in Coatbridge at the same time as Moira, went to a family funeral. A chance remark about her father, Alexander Gartshore and that he had been a suspect in the Moira Anderson case, led her to investigate and reopen the whole issue.

The trouble was people didn't want it. When a friend of Gartshore's, Gallogley, died in jail in 2003 and left behind a detailed dossier saying that Gartshore had murdered Moira as part of a paedophile ring operation, the police wouldn't release it. Apparently some of the people named included figures in the police and the Crown office and they wouldn't have it. Gallogley named a burn called the Tarry Burn, as the place where Moira's body had been dumped. The police made a half hearted attempt to drag it over two days, and then gave up on the excuse that it would take a month to drag the burn properly and they might not find anything. Moira had been missing for 36 years at this point, and they couldn't take a month to check out a fresh lead. Now there are calls again for the dossier and the case notes to be made public; it's high time they were.

As it was with Moira, so it is with Madeleine. This is quite obviously an abduction; the window of the room that she was sleeping in was forced open. It has obvious that this was an organised operation; the McCanns were checking on their children every half hour; someone must have been watching and waiting for a while, before they moved. And yet we have people who say that we should all give up, that it happens, what's the point, I'm bored with this story and that wee girl's face. This, despite the evidence that this is an organised ring that struck.

But there is something deeper at the bottom of this laissez faire attitude to child abduction.Child abduction and paedophilia is the crime with no name. Up until the 1960's, it was only hinted at in fairy tales about changelings and wicked stepfathers. As we progressed, we first blamed strangers, then people at one remove such as teachers, clergy and social workers. We still have not admitted that the abuse and murder of children is usually visited upon them by someone they know. And that is why we don't like to talk about it. You can warn a child about stranger danger, but how do you warn them against danger from a relative or friend? How do we cope with this kind of evil within? It is 2007 and we still have not faced up to this; we have not looked this evil squarely in the eye.

Moira Anderson was let down by by our town and I am ashamed of it. The same will happen to Madeleine McCann if we do not keep her in the public eye and insist on answers. I am going to add my own poor effort to the search by posting her picture on this blog, and it will stay there until she is found. I am also adding the Moira Anderson website to my blogroll. Maybe, at the last, justice will be done.

One of the main themes of the Selfish Pig, is that people, including carers, do not regard caring as a real job. It's done in a house, not an office, so it's not a real job. You don't get paid for it, so it's not a real job. There are 'professional carers' who do caring as a 9-5 job and get paid for it, unlike the unpaid carer, who does it all hours of the day and night, so they are a professional and you - well, you're not, are you?

This got me to thinking about caring as a job. What skill set goes with being a carer, and what would a carer's CV look like?

I am a quick thinker in potentially lethal situations.
Examples; Shutting the passenger door of a car that has been opened accidently while driving at 70mph on the A9.

I have highly developed extra-sensory perception.
Example; If a gale is blowing outside, I'll sleep through it. If a pneumatic drill is going outside my window, I pay no attention. If I hear the sound of water running through the pipes, I am out of my bed and downstairs in two seconds, before the turned-on taps flood the bathroom.

I am an expert on buying and selling.

Example;Houses, antiques, car boot sales, property makeovers; I can tell you anything that's on daytime telly.

I am very good at multi-tasking.

Example; Can eat own meal with one hand, feed mum with the other and use my third hand to hold onto the dog, so that he doesn't steal all of Mum's food.

I am very good at diplomacy.

Example; how we managed to get out of Spar without that brickie punching us, when Mum said his face needed a good wash, I'll never know.


Ok Sir Alan; am I hired or fired?

Another short post, but if you are a carer and you haven't come across this book, then go get it now! It's a life-saver and it's the only carer book I have read that doesn't patronise and doesn't leave things out -it goes into all the dark corners of caring. You can flick through the book here.

Just a short post to recommend this blog to you. Cate Devine is a columnist for the Herald, her mum has dementia, and she is keeping a blog on the subject. The posts so far are sensitive, funny and true. Have a look.

This week, 11th-19th June is Carers' Week. Bet you all knew that. Nope? Well, as the devil said to the damned, ye ken noo. Seeing as I'm one of the army of 800 000 who look after someone, I thought I would do some posts on caring and so my natural starting point was- Katie Hopkins.

For those of you who have been living in an igloo at the North Pole for the past few weeks, Katie Hopkins is the bullet crunching Thatcher's child off the Apprentice. She admitted that she would lie and cheat to get her way, that she had an affair with a married man because she wanted him, and bitched about every contestant on the show with her. And yet..

Last week, Katie fell on her own sword. She had been offered a place in the final, and Sir Alan had turned to the other two contestants, when he noticed that Katie was looking down in the mouth. He turned to her and said, 'You look rather glum for someone who's got to the final.' Earlier on, he had questioned her about her willingness to move, along with her two children and her parents, to where he wanted her to work. She had initally said that she could do it, but was beginning to realise that she couldn't. And dramatically, Katie withdrew from the Apprentice, because she couldn't juggle the two commitments. Katie the bitch, 'lips shaped for sin' is a carer.

If you care for someone, whatever you do, has to be related to those you care about. So you become vulnerable and in short, you lose control of a part of your life. In our society, care is valued, but the people who do the caring are not. They are looked on as society's losers. Because your life is not completely under your control, because you don't earn a high income, you are weak, you are a loser.
If you don't believe me, look at the way that carers are portrayed on BBC dramas. They are ugly,sexless, wear shapeless stripey jumpers and always end up getting shafted. There's one particular actress called Janet Dubovski with bulging eyes, and she always plays those kind of parts. If I ever see her in the street, I swear I'll banjo her with a box of
Attends...

Anyway, back to Katie. All through the show, people wondered about her motivation. What was an alpha female like Katie, on £90k, doing on the Apprentice? Quite simply,it was beneath her. I realised as soon as she started to talk about motherhood. She said how much she hated the image of motherhood, 'all flousey and blousey'. It's what you do when you've got nothing better to do. It's what you do when you're not a high achiever. It's what you do, because you're not good enough for anything else. Katie was out to prove them wrong. Her reason for being on the Apprentice was to show that what she was doing was a choice. She would not endure pity from anyone. She would shaft the others especially the men, win the Apprentice and then walk away.

The only person who really understood her was Sir Alan. He saw the motivation, the full motivation and got her to bow out. He's been called sexist, but I don't think he is. I think to the contrary he saw where she was coming from, let her prove what she wanted to, and then gently pushed her back.

I wish Katie well. She may not like where she is just now, but I think over time she will realise that being a mother, a carer, is the one thing that has kept her human.It's a cliche, but it's a true saying, that who we are and what we become, is shaped by those we love.

Don't mean to boast but..

Well, ok seeing as you're dying to know, I was on the front page of the Herald today, along with two doughty women who were on our campaign, Morag and Mary. They might look sweet. I can assure you they would make grown men cry. Anyway, one wee incident made me laugh. I went down to Tesco to get my shopping, and at the newstand, a pile of Guardians had very carefully been placed on top of the Heralds, obscuring the paper. So I looked round, then very carefully placed the Guardians on top of the Sun (it was needing obscured, believe me) and turned the Herald the right way up. Haven't run into this, since uni, when the Christian Union had running poster battles with the Socialists, to see who get one (poster)over the other..

The sun was shining, the birds were singing, Monklands and Ayr got reprieved and Andy Kerr had a face like a sour meat pie. Perfect!

However, this is where the real work begins. Why Monklands and Ayr? What about the other A&Es being downgraded? Grant on Tartan Hero was asking about Stobhill. He's right. It would be madness to shut Stobhill; it acts as an overspill for the Glasgow Royal. How about St John's Livingston? Vital for accidents on the M8 and severe cases of trauma. What about the Victoria, which is being downgraded and replaced with a wee diddy ACAD posing as a hospital?

Then there's the economics. Where's the money going to come from then? We get a block grant from Westminster. Will they increase it or can we find a way of reorganising services up here that will allow things to run properly? Here's the way I look at it.

1. We have a surplus of doctors chasing specialities at the mo. It really should not be a problem getting staff, if we really want them.

2. If we stop using PFI for everything, we can save a lot of money. It would mean that hospitals would not need to employ the army of administrators, lawyers and accountants that go with being in private business. It would mean that if you have to change a lightbulb, you can do so without advertising in the European Journal for a lightbulb changer. It would mean that we would not get tied into stupid contracts like Stracathro, where the private company gets £15 million over the next 3 years, whether they do the set number of operations or not.

3 At some point, central government is going to have to bite the bullet on PFI payments and take fiscal responsibility for them, off local authorities and health boards. There's no way round it. Local authorities have been paying for these debts in kind, by selling off land and day hospitals. Now they're at general hospitals. It's got to stop here. The government should assume responsibility and do some serious re-negotiation over the contracts, especially where companies have made a fortune by re-financing and not passing on the benefit to the hospital.

4. Re- consider the position on capital charging. This is where a hospital is charged tax on the value of their buildings and land. The effect this is having, is driving hospitals out of central city sites (ie Yorkhill and the Queen Mum in the West end of Glasgow) to relocate on the periphery of civilisation (the Southern General, beside the sewage works).

Right, now that I've sorted the NHS, I'll go and bake a cake..

Your intrepid blogger and friends were at another conference recently and came across several crates of the pictured beverage. After drinking several bottles, we found that we could talk for two hours without stopping, snarl convincingly at hecklers, tell porkies without blushing or blinking and have an urge to use words like 'synergy','rationalisation','unity in the community' and 'fit for the 21st century'. We would highly recommend it to anyone who needs to announce job cuts- sorry, 'rationalisation'.Sadly we drank it all, but we have decided to launch a weekly 'Arrogant Bastard' award on this blog, to whoever catches our attention for all the wrong reasons(or all the right ones, if you're a right arrogant b****.) The honour of our inaugural award, goes to Patricia Hewitt,the health secretary, for sheer vindictiveness on insisting on court costs from Remedy Uk, the junior doctors' pressure group. Cheers Patrica!
Send your nominations in for next Friday, for people who you think are worthy..

Now, I know that I promised to go into more detail on the BMA paper 'A Rational Way Forward'. That was before I was so rudely interrupted by Patricia Hewitt suing the ass off Remedy UK for- well, existing. I will go back to 'A Rational Way Forward', but couldn't let the recent discussion on waiting lists pass without comment.

I'm glad that Nicola Sturgeon has committed to a more honest form of recording waiting times, instead of having lists within lists. But once they've done that, I hope they will tackle the problem of waiting lists itself.

It should be simple. The number of acute beds in many hospitals has been reduced. Fewer beds means fewer operations. If you don't have a bed to put someone in, you can't do an operation. Not unless you have one of those 'Early Discharge Teams' with baseball caps and matching teeshirts, who load you into a catapult and fling you from the roof of the hospital building, two hours after your quadruple bypass. So, to reduce waiting lists we need more beds. Simple? No.

A lot of our hospitals are smaller. That is because- yep you've guessed it- they were built under PFI. Because PFI is so expensive, the buildings were made smaller to save money. So we need more capacity.

Operations and the stay in hospital afterwards, cost money. If a trust is short of money, they will reduce the number of operations in a month to try and stay within budget. In particular,- yep you've guessed it- PFI buildings are paid for out of a trust's clinical budget and severely affect their finances. So what Nicola Sturgeon needs to do as a matter of urgency, is to sort out- yep, you've guessed it- PFI. Good luck Nicola, don't envy you, but this particular thistle has got to be grasped.

So why has the government brought in MMC? Before I go on, I think it's only fair to issue a paranoia warning. I'm taking the worst possible read on the situation, but I just don't see anything else that fits. I think that this whole process can be summed up in one word - dilution. What we are witnessing is the creation of a low skills workforce that can be paid less, bossed round more and scared into doing what they are told, because there is a surplus of them. This is how I reached that conclusion;

1. Why did the government shorten the period it takes to become a consultant, while at the same time making it more difficult to apply for a speciality?
If the purpose of the exercise was to increase the number of consultants then it makes no sense. If however, the purpose was to produce the same number of consultants, but with less training (whom you can pay less money) then it does make sense.

2. Why did the government choose to make doctors apply to a deanery, rather than allowing them to apply to a trust or a hospital? If there was a shortage of doctors this would make sense, because it would ensure an even distribution of doctors across good and bad areas. But there is a surplus of doctors; there is no need to do this from a distributive point of view.
What this does do is place the doctor entirely at the mercy of the deanery and take away their security. If you're lucky, you might get a post near where you call home. If you're unlucky, you will be uprooted and placed in an unfamiliar setting, in a place that you don't want to work, and where you have no support, because you don't know anyone there.

3. Why was each successful candidate only offered one interview from the deanery? Some candidates are better than others and should therefore get offered more interviews.

Again, this is all about control. A candidate cannot rely on his/her ability; they have to rely on the deanery, and if they don't like the interview they're offered, tough.

4. Why did 75% of the marking system go to answering 150 word vignettes and only 25% to academic qualifications, experience and references? This makes no sense if you want to create a the highest possible standard of doctor.

The government doesn't want a high skilled workforce. It wants a workforce that will just pass muster, that it does not have to pay lots of money to, and which it can control from central government, rather than be subject to the medical colleges. That is the whole raison d'etre of MMC.

The government has run into trouble because of the combined effect of the European Work Time Directive, combined with the cost of PFIs. The only area in which it can save money at the moment in the NHS is on the wage bill and the only way it is going to do that, is to create a situation in which the person is not entitled to a high wage and where they can frighten them enough to comply. Unemployment is a good way of frightening people.

Ok, do you think I'm paranoid? Do you think this couldn't possibly be? Well, it's happened before; this is what happened to the teaching profession. It was gradually broken down over a period of 40 years; now its the turn of the medical profession. Take a lesson from the teachers, docs and get up and fight before it's too late..

So what is MMC?

I would recommend that anyone who wants to know more about this, should read Aphra Benns explanation, which I have put in the links column. But let me summarise in a nutshell.

MMC stands for 'Modernising Medical Careers'. It was a new system for junior doctors to apply for specialities, leading to consultancy posts in hospitals.

The differences between the old system and the new are striking.

1.Reduced Training Period

Under the old system, a doctor would go through approx fifteen years training before reaching a consultancy. Under the new system, this has been fast tracked to seven years.

2.Deanery Allocation of Interviews Under the old system, doctors could apply to a trust or a hospital for a job. Under the new national Clearance system, they had to apply to a deanary area. They could be offered a job anywhere in this area. When you consider that all of Scotland was one deanary area, you get the idea.

3. Medical Training Application(MTA).

Under the old system, you had to provide a CV, good academic qualifications, evidence of work in research ie academic papers, and references. You would be interviewed.
Under the new system, applicants were given a series of questions to which they had to provide 150 word answers. 75% of marks were given to these questions; 25% given to references, experience and academic suitability. A good test of writing skills, but not a good test of whether you were a suitable candidate. This was done online on a computerised system whose security was breached and crashed shortly after it was set up.

4.No Second Chances

Under the old system, if you were not successful in applying one year, you could apply the year after. This year, it was decided that unsuccessful applicants this year would be excluded from applying again. That means that if they want to specialise, they will have to leave the country. At the moment, 8000 doctors who applied look like they are going to be left out in the cold. That is a fifth of our future workforce.

So why has all this happened? I'll tell you in the next post.

I knew it was going to happen. There I was, starting a series of posts about 'The Rational Way Forward' and saying something nice about the BMA, and the next thing that happens is the judgement against Remedy UK, who took the Department of Health to court over the MMC (Modernising Medical Careers) scandal.

Remedy UK are a pressure group that was set up by five junior doctors because they felt that the BMA was not taking the concerns of junior doctors over MMC, seriously enough. They organised the big march of junior doctors down in London in March (17 000 attended, including the Queen's Surgeon) and have basically been doing all the things that BMA should have been doing over the past few months with regard to MMC instead of sitting in a corner uttering feebly 'I protest.'

I'll explain a bit more about MMC in my next post, but it was an absolute shambles of a system which has left 8000 doctors careers in the balance, and has led to the resignation of James Johnson, the chairman of the BMA. The DoH was warned and warned that the system would not work, but didn't listen. Remedy's case was that the system was unfair to the point that it amounted to an abuse of power on the part of the DoH. It was a complicated case, but they lost and now the DoH is demanding costs. Even the judge suggested that the DoH's counsel reconsider on this point, but they made it clear that there was to be no discussion on this. The judge has capped costs at £45 000, which Remedy will have to find from somewhere, or it will go bust. It is a singular act of vindictiveness on the part of the DoH, just because Remedy stood up to them, and clearly intended to bankrupt them. I would urge every right minded blogger to click on the Remedy link at the right hand side here, and contribute. I certainly will be doing so. It's time to stand up to this bullying.

I was watching Andrew Marr's 'History of Modern Britain' The subject that he was tackling was post war Britain and the creation of the NHS. Beveridge's report was actually written during the war, and copies of it were dropped over occupied Europe as propaganda. When the Allied forces entered Hitlers bunker, they found a German report on Beveridge's proposed system and it said it was far superior to any social system that the Germans or any other country had thought of.

I think it's so important to understand that the NHS is first and foremost a vision. It was no coincidence that it came at the end of the war, at a time of crisis. People looked at Hitler's Germany and decided that they did not like his ideals. They did not want a society where only the strongest survived and where the poor, the sick and the old were pushed to the wall. It was set up at a time of extreme austerity. Britain borrowed heavily from America during the war, and it borrowed £4 billion from America to set it up. It only paid off the last of that debt in 2006. But it didn't matter. It was something we did, because it was the right thing to do, because to us, a civilised society was a fair society, where everyone had equal access to healthcare and where need, not wealth, was the determining factor.

This is what I like about this report. Right at the start, it calls for a return to that vision, to the core values of the NHS. It states
'The NHS should provide care that is:

1. Free at the point of delivery
2. ethically rationed by clinical priority
3. equitably resourced
4. funded from general taxation (Appendix 2)

People might be apprehensive about statments 2 and 3. But what the BMA is referring to, is how central government has really devolved a financial responsibility that should belong to government, to local trusts and private operators. For example, if you need money to build a new hospital and the only way you can get that money is to take out a PFI contract and pay the debt out of your existing clinical budget, that is not fair. Local health boards don't have the money to finance these contracts. The money should be available from the Treasury, because it is a major financing project in the public interest.Moreover, PFI is not value for money. But the government persists with this, the health board goes into debt and gets accused of mismanagement.
What should happen is the government should take responsibility for major capital projects, assessed on clinical need and it should be funded from general taxation.

Now there will be those of you out there saying this is old socialist dinosaur stuff. But the reality of PFI is that we have actually created a new national debt through this system and it will land at the government's door sooner or later. We just have to decide whether we want the debt paid off through national taxation, or paid off in kind, through the shutting of A&Es, nursing homes, day hospitals, rationing of doctors and consultants and closure of mental health services. We have to decide as the last generation did, whether we think the NHS is something worth spending money on. Your punt..

The BMA have just issued a report called, 'The NHS; A Rational Way Forward'. I had heard about this on the news and I initially was sceptical about it, but I looked it up and was gobsmacked. This is a giant of a report;it's not just a list of ailments of the present NHS, but offers an in-depth analysis of what has gone wrong and more importantly, how it can be put right. It calls for a complete return to the original philosophy and ethos of the NHS, an end to bit part privatisation, elected health boards, proper integration of primary care, hospital care, and public health; more money for care in the community and properly trained staff for mental health; for decisions to be based on clinical need, a list of core services that should be available to all, and not for sale;a constitution for the NHS; a proper long term commitment to medical schools and an end to PFI. And that's just for starters. You can read it here at > www.bma.org.uk/ap.nsf/Content/rationalwayforward . There's two versions; the full monty or the wee diddy version for those of us who haven't got time to plough through the whole thing, but I will be discussing it in the next few posts. Happy reading!

Right, lets start with a multiple choice question. Which phone service costs 40p for the first minute and 26p for every minute thereafter? Is it,

A. Who Wants to Be a Millionaire (it won't be you, stupid)
B. Professional Girls for Professional Men
C. Patientline for NHS patients in hospital.

I am sorry to tell you that the answer is C. This is what is being charged by Patientline; 26p a minute, or to put it in perspective, £2.60 for a ten minute call. Bear in mind that we are told that you cannot use mobile phones in hospitals for fear of interfering with equipment, but you can have an all singing all dancing internet connection, tv and phone- at a price.I'm sure that they will have an inbuilt radio jammer and aluminium lined walls.

Perhaps we should be grateful that the days of patients fighting over 'Stars in Their Eyes' versus Scotsport Highlights in the hospital lounge are over, but everyone seems to be making a profit out of the NHS at the moment except the NHS. I think it's time to phone 'Complaints' or 'Kindly Recommendations' or whatever they're calling it these days.

Do you remember that pious bill that got passed in 2004 about smoking in public places? The one that was meant to be good for our health? Well, amidst all the back slapping and congratulations, a wee section slipped through unnoticed called 'Joint Ventures'. This was a change to the GP contract and on a first inspection it looked like it was a good deal for GPs. However, it wasn't. Before 'Joint Ventures', health boards arranged direct contracts with GPs and GP practices. What this contract says is that the health board can arrange a contract with a 'health care provider'. This could be anything from a GP to a multinational company. Yep, you've guessed it. Multinational companies want to buy up our GP practices and run them for their own profit. This has been going on in England for quite some time and it's basically very bad news for anyone going to the doctor who's ill. Because chronically ill patients cost money to look after, these practices don't want them, because they reduce the profits for shareholders. This means that cherry picking is inevitable. These practices are also used as shop windows for large pharmaceutical companies, who pay big bucks to anyone who will help them meet their drugs sales targets. This means that decisions are taken less on clinical need and cost effectiveness, and more on profit. So it's bad news all round.

The first attempt to introduce this in Scotland was in my neck of the woods; Hartill GP practice in Lanarkshire. The partners had fallen out, and NHS Lanarkshire prepared a tender paper that allowed SERCO, which is a utilities company, to bid. Many protests, letters to the Herald and tackety boots later, they backed down. But you can expect to see more of this from now on. See all these shiny new health centres that are being built? This is a subtle way of removing GPs from their own premises, to one that is owned by the health board or PFI consorti. This then makes it very difficult to protest, if they bring these companies in.
Carolyn Leckie was trying to get through a bill to reverse this. Are there any good MSPs out there, who will run with this, now that she is out of office?
In the meantime, give up smoking everyone. You don't want to fall ill in case your GP refuses to treat you on grounds of ill health..