Campaigning for Health

Today, a mentally ill man by the name of Akmal Shaikh was executed in China for drug smuggling. He never had much chance of a reprieve; China take a particularly dim view of drug smuggling and its history re the Opium Wars mean that they take an even dimmer view of British drug smugglers. This is the pop song that Akmal Shaikh had written for world peace. If anything illustrates his state of mind, this does.

But before we start critisising China, I think we should take a look at our own system. How do the mentally ill fare in it? Very badly, is the answer. This report illustrates just how many people who are mentally ill, end up in jail, because there is nowhere else for them to go.

At least there is reporting on it now. When Care in the Community was introduced and people who were in institutions were suddenly put in houses, there were many objections that they were not coping. Finally, a report was commissioned to check how they were doing and where they had ended up. The report left out prisons. At one meeting I was at, a doctor from one of the Glasgow institutions stood up and said that half of the people who had been at the institution he had worked at, were now in jail. It was totally unsuitable both for the patients and the warders, who were trying to do a job that they were not trained for.

If you want to do a good deed today, you could do worse than leave a message of sympathy for Akmal Shaikh. And mention Gary McKinnon while you're at it. Instead of cursing the darkness, it's time to light a candle of hope for the mentally ill.

The BMA has finally discovered that there are Bad Things happening to the NHS and that Market Forces have rather a lot to do with it. As a result they have decided to alert their members with this Christmas card and have set up a website to encourage us all to take action to preserve the NHS as a Public Service.

Ah well, they got there in the end.Bless..

Have just been on 'Fighting Monsters', one of my favourite social work blogs. Cb, the intrepid author, gives a very good explanation of how a clinician is meant to decide whether a patient should be treated under the Mental Health Act or the Mental Capacity Act. Basically, if you are treating the patient for a physical condition, then you treat under the MCA. If you are treating for their mental condition, then you treat under the MHA. Kerrie Wooltorton came under the MCA, because the condition that they were treating her for was physical (an overdose) although the condition that had caused it was a mental one. You can read cb's analysis here..

Apologies again for disappearing and not completing my posts on the Mental Capacity Act. One of my relatives has been in hospital for the past three weeks and I have been somewhat caught up. Anyway, I returned to the MCA and came across this. In the light of the Kerrie Wooltorton case, it has a particularly haunting quality to it..

Click here to find out...

Intrigued? Click here..

The sun, now it shines on the green fields of France,
There's a warm summer breeze that makes the red poppies dance;
And look how the sun shines from under the clouds,
There's no gas, no barbed wire, there's no gun firing now.
But here in this graveyard it's still no man's land,
The countless white crosses stand mute in the sand;
To man's blind indifference to his fellow man,
To a whole generation that were butchered and damned.

Did they beat the drum slowly, did they play the fife lowly
Did they sound the death march as they lowered you down?
Did the band play The Last Post in chorus,
Did the pipes play the Flowers of the Forest?


Ah, young Willie McBride, I can't help wonder why,
Do those that lie here know why did they die?
And did they believe when they answered the cause,
Did they really believe that this war would end wars?
Well, the sorrow, the suffering, the glory, the pain,
The killing and dying was all done in vain;
For, young Willie McBride, it all happened again,
And again and again and again and again..

First of all, apologies for the two week break. This has been partly due to my being away and partly due to the amount of background reading I had to do for this particular post. I've decided to split it into two parts; the background to the debate and the debate itself. So as the French say 'Nous revenons a nos muttons,' or 'let us return to our mutts..'

The food and fluids debate was by far the most heated part of the the MCA's passage. It concerned the re-classification of intravenous food and fluids as medical treatment as opposed to basic care. This meant that they could be given or removed as such. It also meant that there was a bias against provision of intravenous feeding; whereas a patient could insist on a drip being removed, they could not insist on a drip being inserted, because it was medical treatment and you cannot insist that a doctor provides a specific treatment. You can, however, insist on basic care.

Three high profile court cases provided the backdrop to the debate. The first was that of Tony Bland. Tony Bland was crushed in the crowd at Hillsborough and had been in PVS for four years. He was fed by intravenous drip. His family appealed to the High Court to allow them to remove the drips. The High Court agreed, but in its ruling it stated that the Bland case was not to set precedent and that any similar situations would have to be dealt with on a case by case basis by the High Court. After Bland, the High Court received a handful of these cases each year.

The second case was that of Leslie Burke. Leslie Burke has a condition known as cerebellar ataxia. When the condition becomes worse, Leslie Burke is likely to need hospitalisation and feeding by tube. Because of the Bland judgement, he decided to ask that he be guaranteed this when he could no longer help himself and could not express his wishes. He was told that he could not make such a request. Leslie Burke took the GMC to court and won; the Judge Justice Mumby ruled that not to provide the drips would be in breach of Articles 3 and 8 of the European Convention on Human Rights. These state;

ARTICLE 3

No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

ARTICLE 8

1. Everyone has the right to respect for his private and family life, his home and his correspondence.
2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

The Secretary of State and the GMC both objected to the ruling. It was overturned on appeal, just after the MCA was passed.

The third court case was that of an autistic man known only as L, and Bournewood hospital. L had been at a day centre and had become agitated. He w taken to the hospital and given a sedative but grew more upset. He was finally admitted to the intensive behaviour unit for observation and treatment. The hospital could have formally sectioned him under mental health legislation, but it chose to admit him informally as he was compliant. The hospital then banned his carers from visiting L in case he left with them, and told them that they would release L when they saw fit. In September 1997 (L had been admitted in July 1997), L's cousin sought a judicial review of the situation on the grounds the detention was unlawful. L was finally returned to his carers in December.

This case was very significant for those with mental capacity problems, because it meant that some very common situations, such as elderly being admitted to nursing homes or those with learning disabilities being admitted for medical treatment could be seen as unlawful detention, and the treatment as assault. This became known as the 'Bournewood Gap'. The MCA was meant to resolve this issue and clarify protocols for this type of situation and it did make some attempt to do so, though not entirely successfully. But the relevance of this to the food and fluids debate was that since drips were to come under the 'medical treatment' banner, putting in a drip without consent could be construed as assault. So the three cases, Bland, Burke and Bournewood all had a hand in the shaping of the debate that followed.

Suppose for a moment that you are a judge. A man who has stolen a loaf is brought before you . It turns out that he stole the loaf because he was poor and had nothing to eat. You would probably let him go. But you wouldn't then go on to make a law to say that stealing was ok. There are lots of cases where stealing is just stealing. And you probably wouldn't go on to write into the law that if a person was poor, that they were to be acquitted. If you did that you would have to legislate for lots of other exceptions and the law would become confused and unclear on the matter. Instead, you might provide guidelines as to what is to be taken into consideration in judging someone, but you wouldn't give it a statutory force. After all, what is a judge and jury there for, but to use their common sense?

This is the essence of law making. It's about knowing what to bind and what to loose. Good law gets the balance right. Bad law gets the balance wrong. The Mental Capacity Act got it wrong when it made advance directives legally binding.

Why did the MCA make advance directives legally binding? It really goes back to what originally prompted the law. People lacking mental capacity have less choice than anyone else over their life. Their medication, their clothes, the place that they live, their finances; all these matters are organised through their carer and what they actually want can easily get lost. The MCA was meant to be a way of making sure that the person's choice was respected and so the MCA's five principles were as follows;

1.
A person must be assumed to have capacity unless it is established that they lack capacity.
2.
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
3.
A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
4.
An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

5.
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

These seem a reasonably straightforward and laudable set of aims. They actually work quite well in everyday situations. But look what happens if you make advance directives legally binding. The balance between statement 3 and statement 4 is lost. The law becomes completely confused and it becomes impossible to make a decision based on it.

Then there's the bother of advance directives themselves. Now, most peoples' idea of an advance directive is a living will, carefully drawn up at leisure with witnesses in attendance. But an advance directive can be a suicide note, as Kerrie Wooltorton has just demonstrated. Or it can be a form that is handed to you as you're being wheeled into hospital with a stroke, stating that if you go into a coma, you don't want life sustaining treatment. Most people would sign that thinking that the hospital was referring to ventilators, whereas it also applies to intravenous drips. And this is where it all gets really messy. You have to start drawing up law for all the eventualities. For example, does the person really understand the implications of the directive? Do they know that they will not automatically be provided with an intravenous drip unless they specify it? If someone has a degenerative illness like Parkinsons and states they want treatment withdrawn when things get too much, and they don't keep their directive up to date, what do you do if a cure becomes available and they don't have the capacity to revoke their original directive? (This is entirely possible; there have been very promising results for Parkinsons in adult stem cell research in America and other single cell diseases like it). If a person can sign their name on the directive, does that mean they understand what they are signing? I can answer that one for you, because my mother signed up for a fitted kitchen when she was in the early stages of Alzheimers despite being too old to be granted a loan and despite the price being ridiculous. Only the fact that my sister was a lawyer and that we acted very quickly, saved her from losing a whole lot of money. The MCA does try to address some of these dilemmas but the bottom line is that it can't be policed. If something goes wrong with a directive, you can't override. It's got to go to court and there isn't always the time to do that.

If you make the advance directive advisory, all the confusion goes away. A doctor can use their discretion. If someone like Kerrie Wooltorton comes in, they can give treatment. If there's a relative hanging about looking for money and it's their signature as witness on the directive, they can ignore it. If it's someone desperately ill from cancer, they can treat palliatively but not aggressively. But make it legally binding and all discretion goes out of the window. It doesn't increase choice; it actually makes choice impossible.

Two years before the MCA started its passage, Scotland had already updated its law on this subject with the Adults with Incapacity Act. I'll say more about this, but in Scotland, advance directives are still advisory. And the law is much better for it.

Politicians have a number of ways of getting tricky legislation through. One method is to pass it just before Christmas or the summer recess, when noone's paying attention. Another is to couch the bill in obscure language that lasts for fifty pages and put the important bit somewhere in the middle where it won't be noticed. But by far the favourite method of passing controversial legislation is the Trojan horse method. You take an issue that everyone agrees on, and form a bill round it. Then you add on the legislation that you want to pass. People are then torn between voting on the part in the bill that they like, and the part that they don't like. Classic examples of the Trojan horse are the Tobacco and Primary Medical Services Act (Scotland) which introduced measures to prevent the sale of tobacco to minors, but also allowed GP services to be run by private companies; the Legislation and Regulatory Reform Act 2006 which became known as 'the abolition of Parliament act' for the draconian powers that it granted to the cabinet in an 'emergency; and the Mental Capacity Act itself, which was meant to provide a Court of Protection and an independent advocacy service for the mentally incapacitated, but ended up taking their rights away.

The original motivation of this bill was picking up on a previous bill that was championed by the MP Tom Clarke to provide an advocacy service for the mentally incapacitated. This bill went through Parliament in the Thatcher years, and an advocacy service was agreed to in principle, but with the caveat 'when costs allow'. Of course, the government decided that costs didn't allow them to set this up and so it sank without trace. But the other motivation was the Tony Bland case. Tony Bland was a football supporter who was crushed in the crowd at Hillsborough. He spent four years in PVS (permanant vegetative state) and his family went to the High Court to get his feeding drips removed, so that he could die.The judge ruled in their favour but made it clear that it was not to set a precedent for case law and any other cases of this nature had to go to court to be decided. These cases were relatively few; there were two or three applications each year to the High Court on these matters, but the Tony Bland case became the second driver for the more controversial stuff that was put in the MCA. These were;

1.) Making advance directives legally binding;
2) Re-classifying food and fluids provided by intravenous means, as medical treatment as opposed to basic care;
3.) 'Best interests' legislation which allowed death as one option to be considered;
4.) One that people haven't really picked up on yet; non -therapeutic medical research on the mentally incapacitated.

The Mental Capacity Bill (or the mental incapacity bill as it was known until the last year of its progress) was a long time in preparation. It was fifteen years in the writing before it finally started its journey through the various stages in Westminster. The person charged with steering it was David Lammy. David Lammy(pictured) is MP for Tottenham and was a rising star. He was the first British black to study law at Harvard. At this point he was Minister for Constitutional Affairs and this bill was a chance to prove himself. Backing him were an alliance of charities who had been involved in the consultation process of the bill and who desperately wanted the advocacy service. Those opposing were mainly church groups and the Parliamentary Pro Life Group whose main speakers were Jim Dobbin, Ann Widdecombe and Lord Brennan. So the stage was set for the debate and what a debate it turned out to be.

PS For the witches amongst us, David Lammy has a connection to DEMOS..

October is something of a reflective month for me. It's the time when I cut back the trees and bushes in the garden, tie up the branches and take them to the dump. I clear out all the rubbish that's gathered in the house. I get things mended, get the boiler checked and batten down the hatches for winter. And it's the time when I also look back at what has happened and assess where I've been going, and more importantly, where I'm going to end up.

This October has been more thoughtful than usual. It's now four years since the Mental Capacity Act was passed and the case of Kerrie Wooltorton has brought it to the fore. The MCA was a bill with significance for me, because it was the first time that I got seriously involved in politics. It changed my life and changed me. Although I had already looked after my mum for some time before this bill started its journey through Parliament in 2002, this was the point that I actually truly became a carer, because it was the point when I started to really care.

One of the advantages (if you can call it that) of looking after someone vulnerable for so long, is that you see the system as it actually is. Most peoples' experience of tertiary care is mercifully short; it will be a few weeks or months at the end of a relatives' life. That means that they don't get to know how it works and what the dangers are in that system. And that explains the total chasm in understanding between them and someone like myself, who has had to deal with it for twelve years. That is why, when I saw the mental incapacity bill, I nearly went off my head and other people could not see the danger. And that is why, four years from it being passed, we are sitting saying 'What happened? We didn't mean it to work like this!'

In the next few posts, I'm going to explain what went wrong and how we got there.

About a year and a half ago, a good friend of mine introduced me to the wonderful website Cakewrecks. Cakewrecks is the kind of eccentric gem that only the blogosphere can throw up and whenever I'm feeling a bit down, I click on the site. It never fails to leave me in fits of laughter. Now we have an NHS equivalent. Step forward, Traction Man (well, metaphorically at least, cos you're in traction) of the wonderful 'Notes from a Hospital Bed'. Traction Man is - well, in traction in a hospital somewhere. He is taking pictures of his hospital food, posting them on a blog and inviting people to guess what it is. The most puzzling one so far has been the vegetable moussaka above; noone was able to guess what it was.

What I found hilariously funny about this site is that it illustrates perfectly the old unwritten British rules about cuisine. It harks back to a time when spaghetti bolognaise was completely off limits and you could only buy one kind of lettuce at the Co-op. Rules like;

1. Colour. Safe foods are yellow, green or off white in colour. Custard, peas, greasy chips are all acceptable; bolognaise and chicken chasseur are not.

2. Vegetables should either be carrots or peas. Other vegetables should not be present on a plate unless they are covered in a cheese sauce or mashed.

3. Meat should be either brown or white in colour. It should not be pink in the middle; it's not decent.

4. The only sauce that should be put on meat is gravy. Meat should be able to stand on its own two feet. If it needs a sauce, it's probably off.

5.Meat and vegetables should not be allowed to mix. They should stand politely to next other on a plate. Cooking meat and vegetables together in the continental practice of casseroles is to be frowned on and not encouraged. Potatoes can be placed on top of meat, but again not mixed through.

6. Mushrooms are permitted if they are cooked until grey. Mushrooms that are still white are not permitted.

7. Processed peas are good; garden peas are suspiciously middle class; haricot verts
is what you get when a bunch of lazy French can't be bothered shelling the peas.

8. Foods ending in 'i' or 'a' should be avoided.

9. Macaroni cheese is an exception to '8'; its yellow and gloopy status classifies it as a British dish and fulfills equality, diversity and ethnicity regulations re food.

10. Potatoes should always be present on a dish. In the unfortunate event of a dish being a pasta dish (see '8') mashed potato should be added to neutralise it.

Do have a look at this blog. And support this guy; laughs apart, he might just get something done about nutrition in the NHS. If they don't get him first..

For those of you who have been living on Mars for the past year (or outside the UK) there is an election coming up. It's time for parties to polish up their policies and put their wares on display. As such, I thought it was time to examine Conservative policy and provide the following quiz; if it was a crime to be Conservative, would you be convicted?

1. You have inherited a multi million pound business from your father. On examination of the accounts, you find that the cost of administration has doubled from 6% to 12% over the past fifteen years. This can be traced back to a change your father made in bookkeeping, where he required the individual account of every customer to go through the main office instead of each office keeping its own accounts and reporting back. Your main rivals in Scotland rely on each office to keep its own accounts and its admin costs are 5%. Do you;

A)change over to the system your rival uses;
B) stick with the status quo?

2. You have a waiting list of customers that you cannot deal with alone. You decide to sub-contract work to another firm and pay them £15 million in advance for a five year contract. After you have signed the contract, the company come back and say that they can only do half of the work involved, due to health and safety issues, but the contract means that they keep the £15 million. Do you;

A) Consult your lawyers about possible breach of contract, sue the idiot who drew up the contract, and never do business with sub-contracted company again;
B) Shrug your shoulders, pay out the £15 million, and recommend this as a way of doing business?


3. You have an in-house cleaning team who are slightly more expensive than another company. You hire the new company, only to find that they will not clean the toilets, because their contract does not include cleaning up bodily fluids. Do you;

A) bring your old team back and tell the others to take a hike;
B) get some of your office staff to assume toilet cleaning duties in addition to their own work?


4. You want to build a dividing wall in one of your offices. Do you

A) Get a couple of quotes from local builders, take the lowest one and build it;
B) Take out an advert in the European journal?


5. A light switch is not working in your office and requires an electrician. You go to a local electrician, who, on hearing the location, tells you that he will have to charge you £300 for the job because it's in the contract tied to the building. Do you;

A)Accuse the business consortia that drew up the contract, of profiteering and hire another electrician;
B) shrug your shoulders and pay out?

6. You want to build a new office. You go to a group of lenders who borrow money on your behalf from the bank and they charge you a lending rate of 20% on the money. Two years later, you find that the bank has lowered its lending rate to 15% and the lenders have re-financed your deal, but they are still charging you 20% interest. Do you;

A)attempt to negotiate for some of the refinanced money;
B) sit back and let them pocket it all?

7. Some of your skilled workers have recently been unavailable for overtime. You find out that this is because they are moonlighting for another company. Do you;

A) Warn them that if they keep this up, you'll sack them;
B) Invite their company to take over part of your premises and allow your workers to prioritise their customers at the expense of your own?

8. The government decides to introduce a new tax for business that charges you 4% of the value of your land and property. This is a particular problem for your city offices where the land is much more valuable. Do you;

A)unite with other businesses to protest at this new and unnecessary tax that is forcing you to downsize;
B) close all your city offices and move into the country?

So how did you do? Well the good news is, that if you voted 'A' on all those questions you would not be convicted as a Tory. You would be handed the key to the cell and walk out the front door of the jail to a car with its engine running and a bottle of bubbly.Now I bet all you rank and file Tories are scratching your heads. Because 'A' is the answer that you would give to all these questions. Because they make good business sense. Because the market is about competition, minimum cost and minimum waste and providing a good service to customers. No one in their right mind would answer 'B' to any of those questions.

Except- that that is precisely what the Conservative Party has answered on all of those questions. The above are all true life scenarios from the NHS. They are all examples of how a small number of private companies have taken the NHS for a ride and pocketed its money. Private companies that are being supported by the Conservatives and Labour. They are not business men. They are profiteers. Normal business men understand the difference. And this is what I do not understand-why the hell is any self respecting Tory supporting this? If you are a Tory, you believe in the market. You believe that you should get good value for money, that things should be run efficiently without waste. Why do you not chuck these guys out on their neck? What sensible business man would deal with people like this and allow them to take him for a ride? Has the Tory party gone mad?

I know very little about the Conservative party, so I don't know how much of a split there is between the leaders and the rank and file. But if I were a Tory I would ask why my party was supporting policies that went against all sensible business practice. And why they were supporting the kind of cads,bounders and shocking bad hats that your old Tory grandee would not have put in charge of a farthing of the public money, let alone £75 billion.

The Tory party is meant to be the party of thrift and business. If you as a Tory believe this, truly believe this, then you must believe in getting rid of these companies. And if David Cameron wants to put some clear blue water between himself and Nu Labour he could do it by promising to get rid of all these leeches. Then a few of us who aren't Tories might vote for him. And even end up in jail for it.



PS the examples in order are;

1. The introduction of fundholding and the purchaser/provider split;
2. The independent sector treatment centre Stracathro;
3. The situation with most hospitals re cleaning; nurses have to do the cleaning of any bodily fluids, because the cleaners won't do it. Which is pretty useless in a hospital.
4. Most contracting work now has to be put out to tender in the European journal. This example comes from 'Can Gerry Robinson Save the NHS?'. They wanted to build a dividing wall to divide one operating theatre into two. They were going to have to advertise in the European journal. It was at this point Gerry Robinson decided he couldn't save the NHS..
5. Hospitals built under PFI are usually tied in to particular contractors. They charge inordinate amounts for maintenance work.
6. Again a feature of PFI. The consortia that borrow money on the NHS's behalf make millions through re-financing. The government tried to bring in a voluntary code where 30% of profits from re-financing would be given back, but it has been largely ignored.
7. This is the practice of consultants treating private patients ahead of ordinary NHS ones. In NHS hospitals..

8. This refers to the capital charge, a tax of 4% on land and property owned by the NHS. This has been a really big problem for the London hospitals, where the value of land has shot up. Hospitals are now being shut in cities and moved out to the country where the value of land is less. Which is bad news for city dwellers.

Now, I don't want to be cynical, but is it a coincidence that these figures have been released in Scotland, just a few days after the BMA called for action on alcohol advertising?

New figures published yesterday show 12,770 deaths were registered from April to June this year, a drop of 5.4 per cent compared to 2008.According to the General Register Office for Scotland, that was the lowest total recorded for “at least” 30 years, and just over 3,000 less than the same period in 1979.

And the number of Scots falling victim to the “Big Three” killers has shown a drop compared to last year.

Heart disease deaths fell by nearly 11 per cent, stroke deaths by almost seven per cent, and there was a 0.6 per cent decline in the number of people dying from cancer.


Scottish Daily Express

Well, maybe it is too much of a coincidence. But it's a very welcome one. Big government went out of favour in the eighties, but these figures would suggest the smoking ban is working and that there is a place for the 'nanny state'. Perhaps we should be less afraid of being censorious in our attitude to smoking and drinking. Break out the Schloer..

Yesterday, I was going through the BBC health RSS feed. Near the top was a report that in an honesty test, 58% of people thought it was ok for a care home nurse to persuade an elderly person to change the will in the carer's favour. The story was headlined with this statistic. I was going to do a post on it and then I was distracted. Some hours later, I came back to the feed and at first I couldn't find the story. That was because it was now headed, 'Women judge, but do they convict?' Today, I went back and found that the story was 21st on the RSS list, way below older articles on swine flu and others.

It's not the first time that this has happened with the Beeb. The Stafford story disappeared off the radar after two days. This story about people with learning disabilities being starved to death, was mentioned first in a news trailer and reported on third. Now this. I note it's also well below the article on assisted suicide; wouldn't want anyone to make a connection between changing wills and helping the old dears on to inherit, would we?

I don't know what's more shocking to me. The fact that nearly two thirds of people think it's ok to swindle an old lady, or the fact that somebody very well connected seems to be leaning on the Beeb to cover it up. The older I get, the more I understand the function of the court oath,' The truth, the whole truth and nothing but the truth'. To be dishonest you don't actually have to lie. It's enough to change a headline or move a story down the RSS list. This is one honesty test that the Beeb has failed miserably.

Do have a look at Allyson Pollock's excellent article on the McKinsey report. I found myself nodding like a punk rocker all the way through it. Why can't everyone be like her? Reminds me of something my dad's headmaster used to say;

'As Jesus Christ said and I very much agree with him..'

The esteemed consultants McKinsey recently held a stakeholder summit for management and staff from the NHS.Much fat,carbs and black forest gateau was consumed. The idea was to have a brainstorming session with blue sky thinking in order to effect a step change within the culture of the NHS. Or to put it another way, they wanted to know how to save money. The managers got together and made up one list. The staff got together and made up another. Yours truly was sneaked a copy of the result which I print below.

Managers list of Money Saving Ideas for the NHS

1. Sack 1.5 million staff by 2014, leading to a saving of approx £75 billion
2. Remove any patient from GP lists whose case notes are more than 1/4 inch thick.
3. Put all patients in hospitals, out into B&Bs in the community and let social work pay for them.
4. Let that nice man Richard Branson in to run GP practices with lots of nice potted plants and flip charts.
5. Pay out the £50 billion to managers for being so clever at doing all these things.

Staffs' List of Money Saving Ideas for the NHS

1. Sack anyone with the word 'facilitator' in their job title.
2. Sack anyone with the word 'Donaldson' in their name.
3. Firebomb all Darzi clinics.
4. Put a Doomsday virus into the 'Connecting for Health' supercomputer. On the other hand don't bother; it'll not be noticed amongst all the others.
5. Put in the Tower anyone who uses a beard, jumper or hot air balloon in an attempt to appear friendly and engaging.

There was also one other paper found, but nobody knows who wrote it, except that they signed it 'Cassandra'. Their list said,

1. Use the government's newly acquired control of the banks to give back the profits made on re-financing PFI deals;
2. Employ more frontline staff to improve productivity and ensure patients are not hanging about in hospitals when they don't need to;
3. Get the government to reduce the capital charge or abolish it altogether. This means that city hospitals especially are paying out an inordinate amount on the value of their property. At the very least, charge hospitals on the actual value of their equipment for the capital charge, not what it costs to buy new.
4. Provide some proper step-down beds and continuing care beds in whats left of the old day and continuing care hospitals and don't take up room in acute care.
5. Instead of trying to build a massive supercomputer that spotty faced teenagers can hack into when they're bored, build a number of smaller localised computer services in each county, like wot the Jocks are doing. And the next time Accenture breach their contract sue them for £1 billion, not £63 million.
6. Abolish the internal market in the NHS and bring back the health boards. That will get rid of the endless paper trail following every purchase, every patient, every tender and it will get rid of the accountants, lawyers, middle managers and alternative health care providers that know diddly squat about health that hang on to that system. All things being equal, you should be able to halve your admin costs from 12% to 6% by doing this.

Cassandra indeed..

Margaret Haywood, the nurse who blew the whistle on poor standards of care for the elderly on Panorama, has been shortlisted for the Patients' Choice for the Nursing Standards Nurse
Awards. You can vote for her here. If you do nothing else this week do this; Margaret Haywood lost her job whistleblowing and it's important that we show our support. And do pass the message on..

I'm a suspicious sort of soul. When choosing between cock up or conspiracy, I always go for the latter. It does mean that sometimes you are pleasantly surprised when things do not go as badly as you think; but more often it means that you're right and everyone hates you for it. So it came about that when the 'minor ailments' service was brought in in pharmacies, I began to be suspicious. On the face of it, it sounded like a good idea. GPs really don't like being phoned up every five minutes to write out prescriptions for Calpol and the like, and there's no doubt that it did take a burden off them. But it's what went with that. Consulting rooms. Prescribing powers. Hmm. Was this about convenience or was it the government's idea for further dilution of the GP service?

The answer came this week. Lloyd's the big pharmacy chain, has applied to be an 'alternative medical services provider.' It is going to set up consultation rooms where a patient can speak to a virtual doctor online. So instead of going to the doctor you can go to the pharmacist and at the same time you can buy all your lovely drugs from Lloyds instead of those boring generic ones you can get at the local dispensary. Great.

It's going to be particularly interesting how this is going to pan out in Scotland. The SNP has a policy against privatisation in the NHS and in 2007 the attempt to bring in SERCO for Harthill GP practice was closed down very quickly. This is opening up another front and is a direct challenge to the SNP's current attempts to amend the GP contract that allows this. There was always a danger that this would happen, because although the Scottish Government can change our legislation, European legislation states that any business worth more than a certain amount had to be open to tender. GP practices could get round this by being small and it was thought that the relentless march of the health centre and the resulting merging of practices would be the way big business would worm its way in. It looks like they've found a back door. Instead of having to deal with GPs and persuading them to shift to new premises they're doing the process the other way round. And we are going to lose GPs and dilute the service we have.

It was a conspiracy. I was right. And I hate that I'm right..

There aren't a lot of bright spots in healthcare at the moment, what with Daniel Hannan slagging off the NHS on American tv and the political parties rushing to its defence while simultaneously privatising what's left of it. But today there was a good news story. The Scottish government has brought in measures to restrict the sale of alchohol to one place in supermarkets, to ban irresponsible drinks promotions and loss leaders, and is following up with proposals to price drinks according to units instead of classification. This means that sights like this are going to become a thing of the past. I'm sure there are folks out there who are disappointed not to find their regular Lambrusco beside a pair of rolling skates in Tescos, but otherwise I think it's a good day for Scotland and a gold star for Nicola Sturgeon. It looks like we have someone fit for taking on the big drinks companies at last.

The Edinburgh Festival is in full swing just now and so are the comedians. The top ten jokes of the Festival were voted on the other day. The winner was 'Hedgehogs? Why can't they share the hedge?'

But the best worst joke was;

'I phoned up the swine flu line and all I got was crackling..'

Sorry. I'll just go and get my coat..

Twitter has been tweeting its head off this week as Republican rednecks queue up to have a go at the NHS. The NHS is to blame for absolutely everything according to them and I suppose it was only a matter of time before they got round to two of their favourite subjects - immigrants and terrorism.

American commentators have been pointing out that the terrorists that carried out the jeep attack on Glasgow Airport were IMGs (Interntional Medical Graduates). Therefore the NHS represents a terrorist security threat. What this view hooks on, is that some years ago, the government decided to take in more IMGs to deal with a shortage of staff. Those on the lower grades were allowed to work for a number of years without a work permit, but once they wanted to apply for a higher grade, they needed to get a work permit. This was one of the untold stories of the MMC debacle, where IMGs found that they could only apply for job situations if their visa extended beyond August 1st. As many of them didn't have a visa in the first place, it was the boat home for them. I've told the story here.

It's difficult to know where to start with such a ridiculous assertion. How about the Tube bombers who were born and brought up in Leeds? What happened to them? How about one of the bombers of the American Embassy in Nairobi, who went to Nairobi, stayed there for some years and even married a girl there, while preparing for blowing up two hundred people? How about the Madrid bomber Jamal Zougam, who ran a mobile phone shop in Madrid? How about the 9/11 bombers who entered America and trained in their pilot schools before attacking the Two Towers? If I was being really uncharitable, how would the American health medical organisations run without immigrants? From the country that lifts the lamp beside the golden door, it's really rich to lecture us about immigration policy and security.

The truth is, terrorists can find any way in they want. They don't need the NHS for entry and identity cards in Spain did not stop the Madrid bombings. There is actually only one way to stop terrorists and that is to have the moderate majority on your side. Terrorists don't work on their own. They need money, weapons, safe houses and people to look the other way. And when you demonise and ostracise the moderates, that's when terrorism thrives.

The NHS from its inception has relied on immigrants from the Indian medical colleges and others, to be able to function. It is the second biggest employer in the world, after the Chinese army. And for all its faults (and they are many)it is a great British institution. I will be saying more on this, but for now, it's time to tell those Texan peskies to take a hike..

For twelve years now, I've been a carer for my mum who has dementia, and for ten of that twelve years I have had carers coming to the house. I've had several different organisations come, and so I know that home support is a bit of a curate's egg. Good in parts and absolutely rank in others. Amongst those experiences was a very brief brush with Domiciliary Care. I won't go into details, but I suffice to say that I was not in the least surprised to see them appear in a half hour investigative programme filmed by the BBC.

To be fair to Domiciliary Care, the faults that were revealed could be found in any care organisation. Saying you'd been half an hour when you'd only been ten minutes; giving people sandwiches instead of a proper meal (and Quavers); not knowing how to move and handle or how to use a hoist, turning up late; these things happen to a greater or lesser degree in all care organisations. It was the sheer unremitting extent of Domiciliary Care's failings that made it the bogeyman of poor service. At the root of this malaise was South Lanarkshire's auction system for the care contract in their area. All those tendering had to log on to a webpage and the company that bid the lowest got the contract. Corners were cut and the service suffered as a result.

Step forward Arifa Farooq, investigative journalist for the Beeb. She went undercover as an employee of Domiciliary Care and unsurprisingly, did not state on her CV that she was a journalist. Last week she was arrested for providing false personal details. The NUJ are backing her and so are the BBC, but she is part of a growing trend of the persecution of whistleblowers in the area of elderly care. Remember Margaret Haywood? She was the nurse that filmed undercover for Panorama in an elderly ward to expose the abuse going on. She was struck off the nursing register for filming patients without their permission. The fact that she asked their permission to show the footage before it was broadcast cut no ice with the nursing board; she was sacked and without registration she will not be able to work in nursing again. Then there was Dr Rita Pal, who exposed abuse going on in an elderly hospital ward in North Staffordshire NHS trust. Her reward for that was ten years of persecution through the courts of the GMC. It's still not over and she is now working as a GP.

One could laugh at the sheer pettiness of the rage of these jobsworths. I laughed out loud when Arifa Farooq revealed that 'Lady' Mary Beattie who is the head of Domiciliary Care is in fact nothing of the sort; Burke's Peerage had no record of her honorific title. (I also thought Farooq would pay for putting in that detail and I wasn't wrong.) At the same time the sheer violence of the reaction to anyone exposing the faults in elderly care is disturbing. It is par for the course for jobsworths to try and trip up whistleblowers; it is not usual for them to succeed, as they did with Margaret Haywood and Rita Pal. I am keeping my fingers crossed for Arifa Farooq and I am hoping the fact that she is a journalist rather than a medic will protect her. In the meantime, it's a rough old world out there for whistleblowers,but we need them. It's time we gave them proper protection.

I have a confession to make. I read the Sunday Post.

Right, that wasn't as painful as I thought. C'mon, it's got The Broons, Oor Wullie and a decent political round up. And Francis Gay. On second thoughts, let's not go there.

But yesterday Homer nodded, or at least the editor doing the editoral was snoozing. He was making a comment on the EWTD directive coming into force, making weeks of more than 48 hours illegal. He said that it shouldn't be 'rushed into'.

Yes, you're quite right. The EWTD directive was agreed on in 1993. Our government and the medical colleges have had 16 years to prepare for this. Instead they have given us nurse practitioners and MMC.

Hell-o-o-o-o?

I love statistical studies. They are more or less useful according to what they have chosen to study, but they do add to the gaiety of the nations. The latest one hails from the Monash University in Melbourne and the University of Auckland and it concludes that; (drumroll)

Children that run around and play during the day fall asleep faster at night.

Well haud me back, as they say in this part of the country. But it goes on. Children that sit around take longer to fall asleep, but it doesn't matter if it's a book they're reading or tv; it has the same effect. Right, I'll ditch that copy of Winnie the Pooh and switch on CIS Miami instead. Don't have nightmares..

Here's my favourite statistical studies over the years;

One that concluded that people who were small and had tattoos were more likely to be football hooligans. How did they get near them to find out?

Students that drank a lot of coffee and smoked a lot did worse in exams; possibly an effect on the brain. Or possibly the fact that popping off for a coffee or a fag didn't do much for your study time.

More people got killed crossing railways than crossing motorways. Interesting- hang on. How many people actually attempt to cross a motorway?

You gotta love it..

Was just listening to the Scottish news. Nicola Sturgeon has decided not to have a dedicated swine flu telephone line as there is not enough demand.

See the Scots? See swine flu? See common sense?

Twelve years ago in 1997 a new government came to power in Britain under the leadership of Tony Blair. One of the first acts of the chancellor was to apply double taxation to pension funds, that is; taxing both the contributions and the lump sum on maturity. The government gained £5 billion per annum doing this. For pension funds it was a different matter. They suddenly found a huge hole in their funds and when there was a fairly modest downturn in the market in 2003, many of them went to the wall. The pension companies were faulted for this; it was said that they had not put aside enough money during the good times to cover a downturn. The reality was that government rules meant that if they did any such thing, they would be penalised by punitive amounts of tax. People suddenly found themselves with pension funds that were virtually worthless. Clydeside workers found that their pensions had been reduced in value by 80%. Who was responsible for this? Gordon Brown.

That is why I was so bloody angry to see this article today. We have paid and paid and paid for our pension and old age; it's just that the government regards that money as its own to do anything they please with. Who in their right mind believes that if they hand £20 000 over to the government just now, that they're going to get it back? I don't.

There's a simple and elegant solution to this problem of elderly care. Stop charging double taxation on pension funds. That way, the value of people's savings will go up 22%, it will go to the people who are actually planning for their retirement as opposed to those doing nothing, and as it is a targeted saving, it cannot be shifted or spent somewhere else. Simples, as Alexander would say. But we are not, repeat not, handing over any more money for it to disappear down the long alimentary canal that is the Treasury and have no say on where it ends up. You want a discussion on this guys. You're going to get it, I promise you.

Click to play

Here's the video of the election night. Listen out for the silence when Kilgarth and St Ambrose is mentioned..

You've got a three day dermatology conference in Glasgow. The world's leading experts in dermatology are attending. They offer free mole checks for the public. So what do you do?

You refuse, of course.

This was the quixotic decision made by Greater Glasgow Health Board yesterday, on the grounds that it would increase referrals to GPs and they would be unable to cope. Fair? Well, the last check that this group did was at the Chelsea Flower Show. They checked 500 people and found 17 cases of skin cancer, three of them serious. They could have probably expected a similar number in Glasgow. Now, would an extra 17 cases of skin cancer, spread across the numerous GP practices in Glasgow, caused a panic? I don't think so.

But where it might have caused a problem is the Beatson. The Beatson is the Cancer Centre for the West of Scotland. Its catchment area is 2.8 million people. It is absolutely overwhelmed just now, to the point that an extra seventeen people with skin cancer might make a difference. Greater Glasgow Health Board have really, really, really got to get to grips with this. This has been ongoing since the new building opened. It is good to have a specialist cancer centre, but if that is the way you plan cancer services, you need to make sure that you have enough capacity to cope with numbers. You cannot turn round to the world's leading dermatologists and tell them to withdraw their services because you can't cope with any possible referrals. It's bad form and if I were them, I would be taking my conference elsewhere next year. This isn't such a molehill as it appears..

Was in Tesco's the other day and saw this sign. Hurray! The Scottish Government is bringing in new legislation that means that supermarkets can only display drink in one area of the supermarket and not beside roller skates,television sets,ice cubes and bacon rashers as illustrated here.

To be fair to Tesco, they have over the past few months increased their non-alcoholic shelves to include ones that don't taste like mouthwash and are placing these drinks on the more prominent eye level shelves. This is the new market in drink and I would guess that in a few years time, we will be taking the same attitude to low alcohol drinks as we do to organic veg; we'll see it as the healthy ethical purchase.

So now that all those bins on the aisles are to be emptied of drink, what is Tesco going to put in its place? My guess is Doritos and mega bars of chocolate..

Over the past couple of days I have had more hits than I usually have in a month. Or two months. Or more. But that would be giving too much away about my only-just double figure traffic..

Anyway, I've decided to post up a link to Allyson Pollock's department and their response to this bill. The short version is that they think it's a load of privateering, dangerous bull****t. The longer, more elegant version can be found here. Many thanks to the department and Dr James Lancaster for enabling the link.

All my fellow bloggers are blogging about Europe tonight and I’m feeling slightly left out, so I’ve decided to write a post which I had put on the back burner for sometime. It’s regarding a rather obscurely named bill going through the European Parliament just now called ‘The Cross Border Healthcare Bill’ . Don’t be fooled by its fuzzy name. It is the most insidious, ill-thought out, dangerous bill since the NHS Improvement Plan, which left the NHS almost completely exposed to the private market. This bill is going to do much the same, but on a Europe wide scale and it is going to open a European battleground for health.

So what’s it about? Well, its basic premise is this; European citizens should be able to go to any country in the EU to receive medical treatment. If there is a waiting list in one country, then a patient should be able to travel to another to receive the treatment required.The member state that the patient comes from will fund the patient up to what it would cost in their own country; if it costs more, then the patient will fund the difference. This is an extension of ‘the four freedoms’; freedom of movement of goods, services, capital and persons. On the face of it, it looks like a good idea. It’s not.

Each country in the EU has its own social insurance system. The NHS in Britain is pretty monolithic, despite the government’s best attempts to break it down, but it is a health system that has relatively few variations in it and the burden of funding comes from central taxation and social insurance. This is not the case in other European countries. They vary far more in organisational structure, and a significant amount of the funding is employer based. The most popular structure is the Bismarkian system, which as the name suggests, originates in Germany. The Bismarkian system usually consists of several not-for-profit health organisations based round occupations; for example, there are farmers’ health unions, miners health unions and so on. They are funded by employers and the government also gives them money, but the burden is split between government and employer. Many of these not-for-profit organisations are in trouble just now, because of the rising costs of healthcare and also rising unemployment. In Germany Angela Merkel applied the blunderbuss approach to raising funding for healthcare; she raised the rate of VAT and she also allowed people to ‘opt out’ of health unions and buy cheaper private healthcare. The latter proved to be a very expensive mistake, as those who paid a higher contribution to the healthcare opted out and left the health unions struggling even more.

So what has all this got to do with this bill? Well, what this bill would allow these unions to do, is to take patients from other countries and charge the bill to the patient’s member state instead of to its own union. If it skimped on a few essentials, it could make a good profit on it. It would also allow them to tout for business in other European countries. In short, you would be turning a not-for-profit organisation into a private healthcare business. For struggling health unions at the moment, it must look irresistable.

What would it mean for us here? Well, we’ve got a waiting list. We could send off patients to cheaper countries in the EU to get treatment and pay less for them. Never mind that some poor Romanian isn’t going to get his operation because a rich Brit has turned up instead; in the EU all citizens are equal and therefore a patient that actually comes from the member state does not get preferred. And we could take patients from other countries and get them to cough up their own cash for treatment. This bill is going to involve the setting of tariffs and therefore the establishing of a private market in health by default.

It doesn’t stop there. Another of the proposals is the recognition of prescriptions issued in other countries. Now, the bill is rather vague on what this means. Does it mean that a prescription written, say in France will be valid here simply for medicines approved for prescription by NICE? Does it mean that it will be valid also for medicines that are not available on prescription here, and if so, who’s going to pay for them? The French, the NHS or the patient? I suspect it will be the patient.

Finally (and please don’t groan) no evil masterplan would be complete without a supercomputer. Yep, just when you thought the SH had been put into IT by ‘Connecting for Health’ along comes yet another super duper IT plan, but this time it’s going to be Europe wide. The EU are planning to set up a European IT system for the transfer of patient records, medical data and ‘e-health services‘, whatever the hell that might be. Microsoft are already bidding for the contract. You know, I thought that Doctor Who was being simplistic, when the goodies only had to find the master Dalek to kill off all of them, and that some baddie would work out that you shouldn’t connect them all to a central system. It seems that Dr Who was simply prophetic. How many times do these systems have to crash and how much money do we have to spend, before governments realise that big single servers do-not-work? Not to mention the implications for patient confidentiality. But hey, if you’re going to have a private European market, it makes sense to have European access to patient information so that you can pitch your services more effectively to the market, eh?

What is galling about this bill is how it denies all along that it is about undermining health social insurance systems. It is about freeing up the internal market, it will let private healthcare in, it will turn your prescribing into a cocked hat, it will build another big computerised Black Hole of Calcutta for all our money to disappear into, but it is absolutely, categorically, emphatically not about a European private health care market and absolutely not about letting in all those American health care companies take over not-for-profit organisations and allowing them to work cross border in Europe. No sir.

When I was about ten, my sister was given a Kermit frog as a Christmas present.
‘So are you going to call it Kermit then?’ I asked.
‘No’ my sister replied.
‘But it is Kermit.’
‘Well, I’m calling it Not-Kermit,’ my sister replied and went off. She grew up to become a lawyer.

There’s an awful lot of Not-Kermit about this Not-a-European-Private-Healthcare-Bill..

Well, it was a night to remember.

A higher than expected turnout, plenty of spoiled papers,six counts, a request for a recount and a win by 63 votes. Where was the centre of the action? Coatbridge North and Glenboig council by-election of course.

The evening started off fairly innocently. It was largely expected that Labour would romp home in the first round, and even although the turnout was 29% (about 6% higher than expected) noone thought it would get very far. As the papers piled up in Peter Sullivan's box,(Lab), people were already reaching for cups of tea, fags and other refreshments. But at the end of the first count, Sullivan was on 1529, Stubbs (SNP) was on 1276 and yours truly was on 557.

At this point Gavin Whitefield the electoral officer brought over the spoiled and doubtful papers. Some had put an X instead of a 1. Others had put two or three Xs and these were rejected. Then we were shown one that had a '7' written beside Labour and no other mark. We had been told in advance that any number apart from 1 in a box on its own would not be accepted.
'That's a squiggly 1,' said one of the labour supporters hopefully.
'It's a 7!' the rest of us chorused.
Gavin Whitefield rejected it. 'It's a measure of Labour's position with its voters; number 7,' said one of the SNP supporters.
Next paper, 7. Next paper 7. Next paper 7. All rejected. What was going on? Then a paper cropped up with a 5 beside my name, and another with a 4 beside the Green candidate. The penny dropped. Some people were counting the number of boxes down that their candidate was, and writing it in. So I was fifth on the paper order and got a 5, and Sullivan was seventh on the paper order and therefore got 7 beside his name. In all, something like 30 Labour votes were lost to this. Peter Sullivan looked on gloomily, no doubt reflecting that as a maths teacher, he had taught his constituents to count boxes, but not how to use a preference vote.
Onto the deliberately spoiled papers. There were a number of messages on these, some ruder than others, but the agreed favourite was the one that said, 'I could run the country better myself!'
They probably could as well. Gordon, watch out. Someone wants your job..

Second round. Fraser Coats from the SSP was eliminated, and his second preferences transferred. 1 to Hugh Banford; 2 to Stubbs; 8 to myself; 11 to Keane (Greens);13 to Sullivan. 4 were also transferred to the Conservatives. Are there closet Conservatives amongst the Socialists that were letting their inner Tory out, or was it a very clever tactical vote? We'll never know.

Third round. The Green candidate Keane got eliminated and I won the most second preferences off him with 39 votes. I felt a slight pang of guilt, having driven round to the count (just two minutes walk away) and having shopped at Tesco that week and forgotten my life-long bags as usual. Still, I was campaigning against a school being built on a dump and a landfill that wasn't properly sealed, so I reckoned it balanced out.

Fourth round. Hugh Banford, the other independent got eliminated and 218 votes were up for grabs. Stubbs got 50, I got 31 and Sullivan got only 19.

Fifth round. Things were getting serious. Burgess the Conservative was eliminated and Stubbs took 89 votes. Labour surprisingly managed 38 votes at this point. I took 95 votes and my total vote was therefore 730; 18% of the total vote.

Sixth round. Very tense. I was eliminated and my vote divided between SNP and Labour. Stubbs took 250 votes and Labour took 144. This took the vote to; SNP 1696 and Labour 1759. Only 63 votes in it and neither had reached the allocation of 2058. What was going to happen now?

The SNP asked for a recount. Gavin Whitefield refused, because it had been agreed that full recounts could only be requested after each round. As this had not been requested at any stage, he could only permit a bundle count. The two boxes were emptied and the counters flicked through the piles at speed as things grew tenser and tenser. Finally it was confirmed. Labour had won by 63 votes. The relief from the red corner was palpable.

So who were the winners and who were the losers in this? It was a good night for the independents like myself, because we turned the ward into a marginal and made the big boys scrap for it. It was also a good night for the SNP even although they lost. It was a bad night for Labour, who did not expect things to go the whole way in this count. Hopefully it will make them rethink their current policy on St Ambrose and Kilgarth, which has severely hacked off the local people here.

But the biggest winners? The stewards. The count went on until 1.30am which meant they got double time on their pay.

Guys, you owe me and Hugh a pint..

Some days are just absolute nightmares for door to door. Yesterday was one. The Scottish Cup final was on between Rangers and Falkirk from 3-5pm. Then at 6.45pm, Britain's Got Talent was on, with Susan Boyle as the firm Scottish favourite to win. That went on until 8.30pm, with the results announced at 9.30pm. Noone in their right mind would knock on a door at either of those times, so I only managed a couple of hours round doors yesterday and it resembled the Marie Celeste; only the gardeners were out in force.

Anyway, with the rest of the nation I sat down and watched BGT and like the good person I am, I used my vote. I was shocked when Susan Boyle got beaten, although Diversity were terrific and did deserve to win on the night. But it was the voting figures that caught my attention.

18 million people watched the show last night. Of that 18 million, only 4million actually voted. That works out at 22% of the vote, which is the predicted turnout rate for the Euro elections. Are people so scunnered with politicians at the moment, that they won't vote, not even for Susie Boyle? It's a sobering thought. Judging by the number of rubber ears that I'm getting at the mo, it might even dip below 20%. We'll see on Thursday, but it's at times like these that I think of countries that don't have a democracy. All we have to do to change things here, is go to a polling booth and put an X in a different box. In other countries, protest means jail and death. Politics is badly in need of change in this country, but it's only going to happen if people get up and fight for it, instead of giving up and not voting at all. It's a hard won right. We should use it with care.

About two years ago, Harthill became the centre of the media world in Scotland; or at least, the medical media world. A GP practice had dissolved due to a disagreement between the partners and NHS Lanarkshire had put out the tender on an APMS contract (Alternative Provider of Medical Services). Basically what this meant was, that not only could GPs apply to run the practice, but private companies could also apply and they did not even need to be health companies. As long as they maintained at least one GP in the practice, they could run it. The company that applied was Serco, which is a utilties company. Had they succeeded, the likely scenario would have been this;

1. Hollow out the practice. They are only legally required to have one GP; replace the others with nurse practitioners.

2. Bring in a pharmaceutical company. Pharmaceutical companies are always looking to promote their brands of drugs and pay big bucks to practices willing to promote sales. In Harthill's case, this was Astra Zeneca.

3. Slim down the patient list. A large number of elderly, chronically ill, or disabled is not good for profits. Appeal to the worried well, who are easy to look after and who do not eat into the shareholder profits.

Fortunately, Serco did not succeed. My own group, the Scottish Health Campaign Network and others got wind of it and we headed them off at the pass. But these companies have not gone away. They have been doing this down in England and even Richard Branson has been trying to get in on the act.

One of the difficulties in closing this loophole is European law. If a GP practice is small and is worth less than a certain value, then it does not need to be put out to open tender. If it is bigger and goes above a certain value, then it does need to be put out to open tender under European contract law. Guess what's happening. GP practices are merging and are coming together under one roof in big health centres. What's the next move? That's anyone's guess. But this battle is not over and I expect another attempt at a takeover in the next couple of years. Everyone needs to be alert to this, because primary care makes up 90% of the NHS and if this goes ahead, it will be the end of the NHS as we know it. If I am elected, it is something I will keep a very close eye on and oppose where necessary.

If you're a GP and reading this, try not to have nightmares..

Last Friday, I spent the morning putting up posters in the Main St in Coatbridge. Today I walked through the street and they had all been taken down. But I'm not unhappy about that. Firstly, it means that someone is running scared of me. Secondly, the person that did it, was dumb enough to do it in an area that has CCTV.If the person that did this gives me the posters back in the next two days, I might not pursue it. If you don't, I will pursue it. You have been warned..

Some of you may have already picked this up via the North Lanarkshire Council website and Votewise, but if you haven't, there's a council by-election in my ward and I'm running in it. I brushed the dust off the rosettes and cable ties today and started the campaigning in earnest today.

Why am I running? A number of reasons. Health is not going away as an issue and there are big things happening right now, which will affect us for the next generation. Depending on which way things fall,it will either be very much better or very much worse. I'll be talking about these things in the next few days. Secondly, there are a lot of things happening in our area right now that are going to be extremely bad for public health. At the moment our council are attempting to build a school on an old town dump,they have allowed a company to dig an enormous hole in another dump at the top of town and it is open to the sky and they have just passed a planning application for an incinerator in Greengairs, just beside the super dump that the Scottish Environmental Protection Ageny is never away from. Basically, things are rubbish in Coatbridge, both metaphorically and literally, and it needs to change.

But there's a deeper reason for this. It is time for a new way of doing politics in this country. We are seeing the same old tired faces, the same names, seats passing from father to son. Politics needs re-invigorated with some fresh blood and fresh ideas. Politicians need to have to do more to hold onto their seats; they should not be a sinecure for the party on high to bestow on loyal members. We have proportional representation in Scotland; give it time and local politics should be like Australia's, where local councillors tend to be independents rather than party animals. I'm in the minority just now, but in ten, fifteen years people like me will be the norm. We will compete. We will go round doors. We will know the people in our area. And we will be directly accountable to them; our loyalties will not be split between party and constituents. That's the future and it's time to embrace it.

Yep, wrote another letter to the Herald and it was published today. You can read it here. It's all about why we should not introduce an assisted dying law..

Everyone else has written about swine flu this week. I feel a reluctance to do so, really because we're at the eye of the storm here in Monklands and there's actually very little indication that there's much going on. Half of Monklands hospital has been cordoned off, there are taxi drivers going round with face masks and Dettol sprays and the local papers for once have had some decent news; it's not every day that a potential pandemic comes to your front door. But apart from that, we are not in the grip of fear. We are not panicking. Maybe we're just a little slow, but it all seems rather unreal.

My head tells me that the government are right to prepare. Since the introduction of xenotransplantation, (using animal parts for transplant in humans), there has been a debate about whether we will become more susceptible to animal disease. It was also part of the debate of the hybrid embryo bill, where scientists would be deriving stem cell lines from animal/human hybrids. But at the moment, there is a grey calm hanging over everything and Monklands is taking its place in the media sun with a phlegmatic shrug.

I just hope this post does not turn out to be like the postcard a Russian sent his relatives in Britain in October 1917;

'There's been some trouble in the streets, but there's nothing to worry about.'

Indeed.

Oops, I just sneezed...

Something very odd happened today on the Six O'Clock News.

The normal procedure for the news, is that they do a trailer of the three leading stories in order, during the title sequence. They then report those three stories in that sequence when they go to the newsreader in the studio.

Only that didn't happen today. They reported the three main stories, and then they did the second and third stories first of all, then did the first story third.

So what, you might ask. Well, this was the first story, and as I've been pointing out for the past few weeks, there seems to be editorial pressure on stories of this type; Stafford disappeared off the radar with just a little less than indecent haste, and so did the story of the six people with learning disabilities that died of neglect in hospital. Btw, the other stories were nothing special; one was a story on the financial crisis, and the other was on the mass walkout at the UN when the Iranian president called Israel racist. Important, but not worth disrupting a news bulletin for.

So what's going on? Who's putting the pressure on the Beeb and are they finally resisting it? We'll have to wait and see. I'm just glad that this stuff is finally getting reported.

This has just got to be an April Fool, but it gives me an excuse to put up a picture of George Clooney (sigh..)

Now that I've calmed down a bit, I've had a look at the six cases involved in the Ombudsman's investigation. They are all appalling, but one that strikes me is the case of Martin Ryan, a 43 year old who had Down's. He was taken into hospital following a stroke, and as is normal in stroke, was unable to swallow food or fluids because stroke tends to paralyse the throat muscles. The usual procedure is to attach a drip or peg for feeding, but this did not happen. Instead Martin had a nil by mouth instruction placed on his case, and he was left without food for 26 days. By the time other staff were alerted to his case and had arranged an operating space to insert a peg, Martin had developed pnuemonia. He died shortly afterwards. The Ombudsman ruled in his parents' favour and awarded £40 000 compensation. However, the staff involved were not named in the report and if his parents take this to court, they could have a fight on their hands. That is because of the Mental Capacity Act and what it has to say about food and fluids provided by intravenous means.

The Mental Capacity Act came into law in 2007. Initially it had started off as a bill with wide support, because it sought to provide advocates for people who were mentally incapacitated. As the bill progressed however, more bits were added to it. Two proposals attracted a great deal of controversy. One was that permission could be given for medical research to be carried out on the mentally incapacitated if it benefited them or the disease that they suffered from. All attempts to change 'or' to 'and', failed. The second proposal that caused a huge reaction was the proposal to redefine intravenous food and fluids from 'basic care' to 'medical treatment.' This meant that drips and the like were redefined as medication and therefore could be administered or withdrawn as such; it was no longer a sine qua non under the terms of basic care.

The case that fronted this debate was that of Tony Bland, who was in PVS for four years after the Hillsborough disaster, and the idea of this legislation was to allow those in PVS to die, if that was in their 'best interests'. But those who were opposed to the bill pointed out that in the case of stroke, where someone could not swallow and could not articulate what they wanted, that this legislation could be abused. The non-treatment of elderly people with stroke by leaving them without a drip was becoming increasingly common in hospitals and it was felt that this legislation would give legitimacy to this kind of abuse. I fear that that is exactly what happened to Martin Evans. The fact that he was 43 with Down's would have militated against him, because the average age of death for someone with Down's is 50. The report states that because he had learning difficulties, the staff felt that they would not be able to attach feeding apparatus. But they didn't even try, not once.
He was not even administed aspirin, which is a standard treatment for stroke.

Now here's the problem. This happened in 2005, so a court might rule that the law re drips as basic care comes into play, and that therefore the law was broken. But if a court uses the Mental Capacity act, then it can be argued completely differently. The drip is medical treatment, so there is no legal compulsion for its provision. The staff might argue that it was in Martin's 'best interests' to avoid the possible distress that trying to fit a peg might involve for someone of his understanding. They might also point out that he was 43 and old by Down's standards and treating him for his stroke was not in his 'best interests' either. Which just goes to show what a total crock of s*** this particular part of the Mental Capacity Act is.

Iain Duncan Smith predicted in one of the debates that the Mental Capacity Act would return to Parliament for amendment. I think he was right and that the legislators need to close this particular loophole, or we will see more of this and be unable to stop it. In the meantime, I wish Martin's parents well, and hope that they are successful in their campaign for justice.

I feel sick. Absolutely sick. Less than a week after Stafford, the Department of Health orders an inquiry into the deaths of six people with learning difficulties in hospital.This has been prompted by a report from the Ombudsman, which largely upholds the complaints made by relatives through Mencap's 'Death from Indifference' submission to the Ombudsman. One of those who died was left without food in hospital for 26 days.

So, how did the Fourth Estate react to it all?

At lunchtime, the BBC reported it as the third story on the news bulletin. On the six o clock news, the one that most people watch, it was reported towards the end of the programme. On its website, again it has not comment enabled the story; you can send an email to the Beeb, if you're brave enough to do so, which of course most people won't be. And it has no mention on the 'Have Your Say' page. Still, that was better than Channel 4, which did not report the story at all, but instead did a report on a paranoid schizophrenic who was convicted of the murder of a policeman in Luton. He was an asylum seeker as well, so that's two prejudices supported for the price of one.

I've still to do a trawl of other media sites, but I'm not holding out much hope. I can hear the furious sound of digging and I am sure that this story will be buried by tomorrow.

Two questions.

1.What has to happen for us to take abuse of the elderly, disabled and those with learning difficulties, seriously?

2. If a person who is elderly, disabled or with learning difficulties dies of neglect in a hospital and nobody reports it, do they make a noise?


The picture of the screaming tree is from the excellent Alexandre Jay art blog.