Campaigning for Health

If you're looking for a good deed for the day, you could do worse than to log on to this petition and sign it. Rupert Murdoch already owns a huge swathe of the press - there is no reason to give him any more of it.

disclaimer: contains swearing of a Fr Ted nature..

The wonderful 'To Miss with Love' is no longer with us on the blogosphere and each year she used to post this video. I'm carrying on the tradition. And because we all need one. A Merry Christmas and a Happy New Year to you all..

In my previous post, I wondered who or what it is, that is creating the relentless push for euthanasia; if this is something that is directed or if it is a general zeitgeist that is prevalent at the moment. It isn't the first time that something like this has happened and in the early 1900's a similar discussion was taking place amongst the chattering classes and had enthusiastic support from left and right. Many people whom we now term as great were involved in it. I'm talking of eugenics and the campaign to introduce compulsory sterilisation for 'defectives' in the 1912 Mental Deficiency Bill.

The starting point for this debate was in the 1840's with Francis Galton, a cousin of Darwin. He studied the hereditary lines of 'great men' and concluded that unless something drastic was done, the breeding of degenerates was going to outstrip the breeding of more worthy people. From this, the seed of eugenics and sterilisation of the poor and the mentally ill was sown.

By 1905 this idea was reaching its peak. The main opponents to it were GK Chesterton and Josiah Wedgewood (another cousin of Darwin's) who did a filibuster of 150 speeches sustained by barley water and chocolate. (His modern descendent, Tony Benn, is also against euthanasia). But it's the people who were for it that make the interesting reading.Leonard Darwin, George Bernard Shaw, Winston Churchill, Beatrice and Sidney Webb, the Fabian Society, Arthur Balfour and none other than William Beveridge. There are more here. It also gained support from the Archbishops of Canterbury and York and Dean William Inge, Chesterton's bete noire. These people did the rounds of the Fabian Society, used their influence in church and government to promote it and gave professorships at universities to supporters.

Today it seems almost inconceivable that this happened. And to be fair to those who supported it, we have the benefit of hindsight. The horrors of the Nazis Aktion T4 programme had not been realised. But nevertheless the fact remains; for nearly 40 years, this idea was common currency amongst the brightest and best of our society. America, Sweden, France and Germany all enacted sterilisation laws. The UK escaped by the skin of its teeth. Good men may be mistaken. Great men may be mad.

Chesterton devoted an entire book to arguing against this bill. Amongst other things he said was this;

It is necessary to point out the essential fact which the eugenists seem to have forgotten all over again. We breed cows for milk; and not for a moral balance of particular virtues in the cow. We breed pigs for pork. . . . Therefore we cannot, and do not, criticise them in the way in which we criticise our fellow creatures when we call them feeble-minded; or when we betray our own feeble-mindedness by calling them Unfit. For the very word Unfit reveals the weakness of the whole of this pseudo-scientific position. We should say that a cow is fit to provide us with milk; or that a pig is unfit to provide us with pork. But nobody would call a cow fit without naturally adding what she was fit for. Nobody would call up the insanely isolated vision of the Unfit Pig in the abstract. But when we talk about human beings, we are bound to break off the sentence in the middle; we are bound to call them Unfit in the abstract. For we know how varied, how complex, and how controversial are the questions that arise about the functions for which they should be fitted.

In this argument, Chesterton puts his finger on the fallacy behind eugenics and what I believe is the fallacy underlying the assisted dying debate. The assumption underlying the legitimacy of those in favour of such things, is usefulness. A person has worth if they are industrious, make money, stand out, are independent and not a burden; they are useful. By contrast, if they do not have any of these attributes then they are not useful, therefore they have less worth. It is a seductive argument, because we need people to work and produce and pay taxes. And it is particularly appealing to people who work hard, make money and are independent. All their perception of their worth is tied up in being useful. And that is the glamour that is seducing the likes of Terry Pratchett, AC Grayling, Zoe Wanamaker and others to supporting this.They cannot bear the thought of being dependent on others or being limited by illness or disability. But the darker side of that view is how it affects their perception of others. If your worth is measured by these things, how do you then measure people that aren’t useful?

One of the things that has nagged me about this debate is this; the people who are promoting this bill are people of independent means with powerful friends. Whether or not euthanasia gets passed, they will go when they will and not a second before. If they want to take a poison, they have the friends to obtain it for them and to protect assisting relatives in any court battle afterwards. Which means in short that this bill isn’t about them. It’s about ‘helping’ other people. People that they don’t see very much of, that ‘aren’t the same’ as them, who aren’t very useful; at least not as useful as they are to society. And they do not seem to be aware of that value judgement. It underlies the feting of Susan Boyle and Stephen Hawking; they are celebrated, not simply because they are disabled, but because they are disabled people who are also useful. But the girl who lives near me with the same condition as Susan Boyle is not being feted or celebrated. Nor is anyone else with disability.

This post has wandered somewhat, but to get back to the point; what and who is driving this? I think that in part this is a fashion, a way of being avant garde. Sex is no longer taboo; death still is and the breaking of it holds a fascination. It’s also to do with the political climate. We are in a time of austerity and a growing elderly population. And the great unspoken debate going on underneath this is how they are all going to be provided for. These two forces are feeding off one another and creating a maelstrom into which the poor, the old and the disabled are being sucked into. As indeed they always have done. Those who speak of putting down animals in pain should reflect that we also put animals down when they are too old to work, too expensive to keep and when they have too high a medical bill. But what may save us is what saved us the last time; the experience of others. We have not yet enacted this legislation. Others have and we may benefit from their misfortune. In March this year, a petition with 100 000 signatures to allow those over 70 who consider their life 'complete' assistance to die, was presented to the Netherlands parliament. Let's hope for all our sakes that this doesn't succeed.

So the End of Life Assistance Bill gets rejected by 85 votes to 16. A day later Lord Falconer sets up a commission on the subject of assisted dying. A certain ethicist had a wee trip up to Scotland during the evidence hearing. This, to paraphrase Margo McDonald, ain't going away. So what happened and what's going on?

I confess I have more questions than answers. Although I expected the bill to be defeated, I didn't expect it to be quite so comprehensive. There were several obvious reasons for its defeat. First and foremost, it wasn't going to do what it said on the tin. It was called 'End of Life Assistance' when in fact the bill allowed those who were not at the end of their lives, but who could not live independently (whatever that meant) and found life intolerable, to avail themselves of this. Politicians had been given comparisons with Oregon, when it actually should have been compared with the Netherlands and they don't like being misled. Secondly, Care Not Killing played a big role in leading the opposition. It is a combination of religious and non religious organisations and includes amongst its membership the National Palliative Care Council for Great Britain and Northern Ireland, Inclusion Scotland and RADAR, which is an umbrella disability organisation representing 900 disability groups. So the opposition got their sh*t together. Finally, Margo McDonald herself didn't perform well. She spent most of her opening speech attacking Care not Killing and made this comment;

According to Care Not Killing, elderly people in care will feel that it their duty to die. Some elderly people stuck in below-standard care homes do wish for an early death, but the bill's provisions do not cover them. I hope that we do not hear a litany of sanctimonious remarks about improving care provision. We have had more than enough time to do that.

The vote was a free one and I expected it to go against the bill, as I say. But I didn't expect 85/16 (and it would have been 87 if Karen Whitefield and Elaine Smith, my local MSPs hadn't been snowed in and who had declared their intentions). And it has left me with an intriguing problem. I thought that all the media attention and sympathy for euthanasia was being driven by the political classes. But in this vote, the political class has turned its face against it. I'm not sorry to be wrong on this, but it leaves me asking; who is driving the media on this? Who invited an English ethicist to a Scottish committee? Who ensured that the programme 'A Journey to Switzerland' was shown twice up here during the bill's passage? Who ensured that cases like Stafford and Dr Jane Barton got the minimum of coverage whereas Diane Pretty and others got the maximum? Who is doing this?

It may be that there is a difference between Scotland and England on this. We do have a higher church -going population, but Holyrood is quite capable of ignoring opinion from the churches. It is also quite capable of ignoring opinion from disability groups. There is a huge financial reason to legalise euthanasia; as it said in the explanatory notes to the bill;

Cost of means required to assist in death
97. The costs required to deliver an assisted death will be minimal and will inevitably be less
than those associated with providing ongoing medication and care.

Mike Rumbles did give a hint as to what had happened. He quoted Burke in his speech

As parliamentary representatives, we must resist the temptation to legislate because of opinion polls. In a representative parliamentary democracy such as ours, we are required to use our judgment. As long ago as 1774, the classical liberal Edmund Burke said:
"Your representative owes you, not his industry only, but his judgement; and he betrays ... you, if he sacrifices it to your opinion."

But this ain't enough. So - any thoughts? Is it the media class themselves running this perhaps? Or them, plus some political friends? Or is this perhaps a zeitgeist, a debate that surfaces every generation, when we have forgotten all the reasons why we do not and should not go down this path? That will be my next post..

There's a favourite puzzle of mine, called 'Two Guards, Two Doors.' It goes like this; you have died and you find yourself in an antechamber with two doors and two guards. One door is the door to heaven, one door is the door to hell and they look exactly the same. Each door has a guard. One guard always lies and one guard always tells the truth. You are only allowed to ask one guard one question to find out which is the right door. What question would you ask?

I'll give the answer at the bottom of the post. But I like this puzzle, because it illustrates that just because someone has a fixed position, does not mean that they will give a fixed answer. It's all about asking the right question.

So why am I pondering this? Well, the reason is the student protests. What has intrigued me about them, is not that they're happening, but that they're being reported and televised. Do you remember the junior doctors' march of 2007 that had the Queens' surgeons in it, no less and 17 000 others? You wouldn't unless you were a doctor. There was virtually no coverage of it on the TV; some even said that the government had slapped a D notice on it (this is usually reserved for military sensitive info). Whatever happened, it went past with barely a murmur from the press. But the student protests are getting coverage. And it's in this that I think I can see a chink of hope for the NHS.

Here's the received wisdom on the future of the NHS. We have three main parties; Lib Dems, Conservatives and Labour. Those of us who keep a close eye on politicians, know that practically speaking, there is barely a fag's paper worth between the three parties on the NHS and that they are being leaned on to at least part privatise it. Therefore, the obvious conclusion is that the NHS is doomed and there is no point protesting. But what has not been asked is; why is this the case?

The reason that this is the case is because all three saw that favouring private enterprise, or at least keeping your mouth shut on it, was the key to power. In the case of New Labour, cozying up to big business provided money for their electoral campaign of '97 and attracting voters from business. For the Conservatives, favouring the market is their natural position. For the Lib Dems, keeping their mouth shut on awkward issues is their key to sharing power with the Conservatives.

So what, I hear you say. But the point is this; to two of those parties, the privatisation of the NHS is a secondary concern. Their first concern (as is the first concern of all parties) is gaining and holding onto power. The other thing is that all of these parties have a vested interest in appearing to favour the NHS as a public service. If the public really understood what was happening, they would be shot down in flames.

When Labour was in power, NHS campaigners were in the worst of all possible positions. We had a party in opposition who favoured the market and we had a party in power who were meant to favour the NHS as a public service, but in reality were favouring the market. This meant in terms of media reporting that the view was pretty monolithic; changes in the NHS were either hyped up as the best thing since sliced bread, or just not reported on at all. Those of a left wing leaning were faced with the dilemma of supporting the NHS, or supporting their party.

Now the position has changed. The Conservatives are in power. It's generally understood they favour the market. Labour are out of power and campaigning for the NHS against privatisation is very much their kind of stamping ground. There's a lot of votes in it, especially from those who voted Lib Dem to avoid voting Conservative. It's just working out whether sticking with their market pals, or supporting the NHS, is their road to electoral success. And the coverage of the student marches may indicate that protest is popular again in left wing circles.

I think now might be a good time to protest. To send letters to Labour MPs about the White Paper. To have marches through London.It might have a chance of getting TV coverage this time.To remind Nick Clegg and Vince Cable that they signed up to the junior doctors' march back in 2007. And we might at last get the message out to the public about what's really going on in the NHS. When we manage that, we will have a chance of saving it. And it may turn out, contrary to all expectation, that having a Conservative government in power will be the saving of the NHS, rather than its demise.




Oh, and the answer to the riddle? You say to the guard,'If I asked the other guard which door was the one to heaven, which one would he point to?' Then whatever door he points to, you take the other door. Think about it..

This is to me, what the whole purpose of music and art is about; to take something drab and ordinary and make it special. And what a choir! Esp the guy at 00.41 and he's not bad looking either..

Have been pigging out on Yes Minister clips on You Tube. While doing this, I came across this. Is Ian Duncan Smith channelling Yes Minister? Or did he simply get the idea watching old clips?

So which book had this stingingly elegant introduction to its Fifth Edition? The Oxford Textbook of Medicine. Note to politicians; when you get critised in exclamation marks, no need to worry. When you get critised in subordinate clauses, semi colons and colons, be afraid. Be very afraid..

What august tome has the following as its preface in this, its Fifth Edition?
I'll give the answer tomorrow, if you don't already know.


The Teaching and Practice of Medicine; A Fine Tradition Betrayed

Irrespective of the political dimension of medicine, the care of patients and the prevention of disease depend on practicing clinicians; the medicine of the future relies not only on scientific advances but on the education of doctors. Since the last edition, leaders of our profession have presided over, and in some cases acquiesced to the partial dismantling of arguably one of the finest systems of medical education. The implementation of a national process for the appointment of junior doctors has disaffected many trainees and their clinical mentors, who feel they have become pawns in a bureaucratic political game..

More important if they understood the full implications, we believe the British public and patients would be horrified. Within Europe, matters have been compounded by implementation of the European Working Time Directive, which threatens the professional apprenticeship and mentoring relationships between junior and senior doctors that best nurture young colleagues. The frequently heard mantra of the ‘consultant led service’ is all very well, but the ideal will be short –lived if training is put in jeopardy.

We, the editors of this textbook, learnt how to practice as clinicians from such ‘hands-on apprenticeships and ask : how can young doctors accumulate adequate working knowledge and acquire essential skills if their clinical work is restricted to 48 hours each week? One might pose the question: would a patient prefer to be treated by a fully rested but inexperienced doctor whom they had never seen before, or a tired doctor with immense medical experience who know them and their illness? We know whom we would prefer. Short hours and other radical changes in the organisation of clinical teams impair the continuity of medical care, an element of key importance for the patient but also critical for clinical education through time honoured individual experience. Many countries are seeking to improve their systems of medical education but for those who might consider adopting the current UK training timetables, we humbly offer advice- don’t. It would be better to provide their medical students and young doctors with sufficient time and resources to acquaint themselves with the principles and practice of modern scientific medicine that are emphasised in this book.

Bureaucratic Targets

Well chosen targets are a good way of managing complex systems, but there is grave danger when those who set targets for clinical practice are intrinsically suspicious of doctors, take very selective advice, choose inappropriate limits and compound the error by specifying crude and inappropriate mechanisms by which they should be achieved. What is being measured becomes of overwhelming importance, and the patient with the most pressing clinical need may not get the priority that he or she deserves. Many will suffer unless this state of affairs is remedied.

When I was a young man I carried my pack
And I lived the free life of a rover
From the Murrays green basin to the dusty outback
I waltzed my Matilda all over
Then in nineteen fifteen my country said Son
It's time to stop rambling 'cause there's work to be done
So they gave me a tin hat and they gave me a gun
And they sent me away to the war
And the band played Waltzing Matilda
As we sailed away from the quay
And amidst all the tears and the shouts and the cheers
We sailed off to Gallipoli

How well I remember that terrible day
How the blood stained the sand and the water
And how in that hell that they called Suvla Bay
We were butchered like lambs at the slaughter
Johnny Turk he was ready, he primed himself well
He chased us with bullets, he rained us with shells
And in five minutes flat he'd blown us all to hell
Nearly blew us right back to Australia
But the band played Waltzing Matilda
As we stopped to bury our slain
We buried ours and the Turks buried theirs
Then we started all over again

Now those that were left, well we tried to survive
In a mad world of blood, death and fire
And for ten weary weeks I kept myself alive
But around me the corpses piled higher
Then a big Turkish shell knocked me arse over tit
And when I woke up in my hospital bed
And saw what it had done, I wished I was dead
Never knew there were worse things than dying
For no more I'll go waltzing Matilda
All around the green bush far and near
For to hump tent and pegs, a man needs two legs
No more waltzing Matilda for me

So they collected the cripples, the wounded, the maimed
And they shipped us back home to Australia
The armless, the legless, the blind, the insane
Those proud wounded heroes of Suvla
And as our ship pulled into Circular Quay
I looked at the place where my legs used to be
And thank Christ there was nobody waiting for me
To grieve and to mourn and to pity
And the band played Waltzing Matilda
As they carried us down the gangway
But nobody cheered, they just stood and stared
Then turned all their faces away

And now every April I sit on my porch
And I watch the parade pass before me
And I watch my old comrades, how proudly they march
Reliving old dreams of past glory
And the old men march slowly, all bent, stiff and sore
The forgotten heroes from a forgotten war
And the young people ask, "What are they marching for?"
And I ask myself the same question
And the band plays Waltzing Matilda
And the old men answer to the call
But year after year their numbers get fewer
Some day no one will march there at all

Waltzing Matilda, Waltzing Matilda
Who'll come a waltzing Matilda with me
And their ghosts may be heard as you pass the Billabong
Who'll come-a-waltzing Matilda with me?

The British Medical Association has weighed in on the new Prime Minister David Cameron’s health care proposals.


The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.

The Gastorenterologists had a sort of a gut feeling about it but the Neurologists thought the Administration had a lot of nerve.

The Obstetricians felt that they were all labouring under a misconception.

Ophthalmologists considered the idea short sighted.

Pathologists yelled, ‘Over my dead body!” while the Paediatricians said, ‘Oh, grow up!”

The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.

Surgeons decided to wash their hands of the whole thing. The ENT specialists wouldn’t hear of it.

The Internists though it was a bitter pill to swallow, and the Plastic Surgeons said, “This puts a whole new face on the matter..

The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.

The Anaesthesiologists thought the whole idea was a gas and the Cardiologists didn’t have the heart to say no.

The Wheelchair service and the Prosthetists thought that it couldn’t stand on its own feet.

In the end the Proctologists won out, leaving the entire decision up the the a***holes in London.

It was with great dismay that I read that NICE is to be divested of its power to act as regulator for drugs for the NHS. This is to be handed to GPs as part of the commissioning deal and will leave NICE as a pretty toothless organisation, ready to be thrown on the quango bonfire.

Those who read me regularly will know that I have a chequered attitude to NICE. On the one hand, I was furious about the blatantly political attempt to remove all dementia medicines from prescriptions. At the same time, I do recognise its value as a negotiator with pharmaceutical companies about the price of their drugs. Drugs in America can cost five or six times what they cost here, because there is not a national regulator between the companies and the patients. Removing this guard dog is going to make the price of drugs in Britain shoot up and place GPs in the invidious position where they might reject one drug, but the GP next to them might prescribe it.

But there is another element to this move. Some time ago I did an post on the European Cross Border Directive and the dangers inherent in this for the NHS. One of its proposals was for prescriptions written in one country to be recognised in another. I wondered aloud how this would work given that NICE did not permit the same drugs under prescription that other countries did. I think we have just been given our answer. The removal of a national regulator to be replaced with local ones, is turning the NHS into a group of health care organisations along the lines of the American HMO. Many GP practices are run by the likes of United Health and Atos; they also have their favourite drugs companies who pay them big bucks to promote their brands. This move is more dangerous than it looks.

Europe marches on. The franchising of the NHS marches on. The vultures are gathering..

Pat Diver, the tinker, was a man well-accustomed to a wandering life, and to strange shelters; he had shared the beggar's blanket in smoky cabins; he had crouched beside the still in many a nook and comer where poteen was made on the wild Innishowen mountains; he had even slept on the bare heather, or on the ditch, with no roof over him but the vault of heaven; yet were all his nights of adventure tame and commonplace when compared with one especial night.

During the day preceding that night, he had mended all the kettles and saucepans in Moville and Greencastle, and was on his way to Culdaff, when night overtook him on a lonely mountain road.He knocked at one door after another asking for a night's lodging, while he jingled the halfpence in his pocket, but was everywhere refused.

Where was the boasted hospitality of Innishowen, which he had never before known to fail? It was of no use to be able to pay when the people seemed so churlish. Thus thinking, he made his way towards a light a little farther on, and knocked at another cabin door.

An old man and woman were seated one at each side of the fire.

"Will you be pleased to give me a night's lodging, sir?" asked Pat respectfully.

"Can you tell a story?" returned the old man.

"No, then, sir, I canna say I'm good at story-telling," replied the puzzled tinker.

"Then you maun just gang farther, for none but them that can tell a story will get in here."

This reply was made in so decided a tone that Pat did not attempt to repeat his appeal, but turned away reluctantly to resume his weary journey.

"A story, indeed," muttered he. "Auld wives fables to please the weans!"

As he took up his bundle of tinkering implements, he observed a barn standing rather behind the dwelling-house, and, aided by the rising moon, he made his way towards it.
It was a clean, roomy barn, with a piled-up heap of straw in one corner. Here was a shelter not to be despised; so Pat crept under the straw and was soon asleep. He could not have slept very long when he was awakened by the tramp of feet, and, peeping cautiously through a crevice in his straw covering, he saw four immensely tall men enter the barn, dragging a body which they threw roughly upon the floor.

They next lighted a fire in the middle of the barn, and fastened the corpse by the feet with a great rope to a beam in the roof. One of them began to turn it slowly before the fire. "Come on," said he, addressing a gigantic fellow, the tallest of the four--"I'm tired; you be to tak' your turn."

"Faix an' troth, I'll no' turn him," replied the big man.

"There's Pat Diver in under the straw, why wouldn't he tak' his turn?"

With hideous clamour the four men called the wretched Pat, who, seeing there was no escape, thought it was his wisest plan to come forth as he was hidden.

"Now, Pat," said they, "you'll turn the corpse, but if you let him burn you'll be tied up there and roasted in his place."

Pat's hair stood on end, and the cold perspiration poured from his forehead, but there was nothing for it but to perform his dreadful task.Seeing him fairly embarked in it, the tall men went away.

Soon, however, the flames rose so high as to singe the rope, and the corpse fell with a great thud upon the fire, scattering the ashes and embers, and extracting a howl of anguish from the miserable cook, who rushed to the door, and ran for his life.He ran on until he was ready to drop with fatigue, when, seeing a drain overgrown with tall, rank grass, he thought he would creep in there and lie hidden till morning.

But he was not many minutes in the drain before he heard the heavy tramping again, and the four men came up with their burthen, which they laid down on the edge of the drain.

"I'm tired," said one, to the giant; "it's your turn to carry him a piece now."

"Faix and troth, I'll no' carry him," replied he, "but there's Pat Diver in the drain, why wouldn't he come out and tak' his turn?"

"Come out, Pat, come out," roared all the men, and Pat, almost dead with fright, crept out.

He staggered on under weight of the corpse until he reached Kiltown Abbey, a ruin festooned with ivy, where the brown owl hooted all night long, and the forgotten dead slept around the walls under dense, matted tangles of brambles and ben-weed.
No one ever buried there now, but Pat's tall companions turned into the wild graveyard, and began digging a grave.Pat, seeing them thus engaged, thought he might once more try to escape, and climbed up into a hawthorn tree in the fence, hoping to be hidden in the boughs.

"I'm tired," said the man who was digging the grave; "here, take the spade," addressing the big man, "it's your turn."

'Faix an' troth, it's no' my turn," replied he, as before. "There's Pat Driver in the tree, why wouldn't he come down and tak' his turn?"

Pat came down to take the spade, but just then the cocks in the little farmyards and cabins round the abbey began to crow, and the men looked at one another.

"We must go," said they, "and well is it for you, Pat Diver, that the cocks crowed, for if they had not, you'd just ha' been bundled into that grave with the corpse."

Two months passed, and Pat had wandered far and wide over the county Donegal, when he chanced to arrive at Raphoe during a fair.Among the crowd that filled the Diamond he came suddenly on the big man.

"How are you, Pat Diver?" said he, bending down to look into the tinker's face.

"You've the advantage of me, sir, for I havna' the pleasure of knowing you," faltered Pat.

"Do you not know me, Pat?" Whisper--"When you go back to Innishowen, you'll have a story to tell!"

Back to normal, or something approaching it. I thought I'd start by reviewing Tony Copperfield's book 'Sick Notes' which I promised to do before events overtook me.

There's been a lot of reviews of this book, some complimentary and some less so. It's a breeze to read. It ain't Dr Findlay and it's not high literature. But what it actually is, is a very useful book. This book paints in squirming detail the day to day idiocies of the modern NHS that have resulted from policies on high, and the endless battle to try and find a human path around them. From the form filling, to waiting list protocols to choose and book; Tony Copperfield gives the worm's eye view of them all and therein lies the book's true value.

The accepted books on the politics of the NHS are Allyson Pollock's NHS PLC and John Lister's 'The NHS at 60; for Patients or Profits'. But neither of them are easy reads. 'Sick Notes' is, and of the three books, this is the one that I would give to a lay person or MP to read as an introduction to the present chaos within the NHS. (Then I'd give them the other two).

This is a political book that's easy to read. Give it to your non medic pals the next time they start moaning about GPs. Give it to your MPs. Send a copy to Andrew Lansley. They'll read and understand. And maybe, just maybe, they might do something about it.

Just to say thank you for all the condolences that I received, both by blog and email. It truly is a comfort at this time. Normal blogging will resume in the next couple of days, but in the meantime, have a listen to Paulo Nautini's rendition of Autumn Leaves, a song about his grandfather. And have the Kleenex ready..

You may or may not have noticed that it is a while since I did a post. There's been a reason for this - just after the last post that I did, my mother, whom I had been caring for, passed away. She had been pretty ropey since March and I had been expecting it, but it was a shock just the same. I was going to do a blog post and then I couldn't. Neither did I want to move on as if nothing had happened and casually drop it into the blog somewhere as if it was of no consequence. So I waited until I was ready.

The past few weeks have been pretty weird. Up until a few weeks ago, I had a solid identity as Mum's carer. The house was like Hotel Central, with a steady procession of district nurses, carers and doctors dropping in and out. I had a limited amount of time in which I could go out and always had to be back for a certain time. Now they have all melted away and I feel like a satellite that has dropped out of orbit. Life has rewound to thirteen years previously, when I had finished my degree and diploma in music and I didn't have a clue where I was going with it. And yet..

And yet, how different the landscape looks. How different I am. Thirteen years ago, I would have never thought of getting involved in politics. Now I can't imagine not being involved and wonder why other people take no interest. How many fears that I had, seem childish now. And how I have learned the value of everything. There is nothing like the suffering of another, to teach you what's important and what's not.

In being a carer, I have learned to care. In some ways it's not a very pleasant thought. I wish that I could have learned this without the ugly twist of fate that gave my mum Alzheimer's. Nonetheless, it happened and I and others are changed as a result. And it has been a comfort that Mum herself never wasted a moment of the life that she did have. She was something rare; a great teacher and was the difference for many people who could have gone either way. That is her legacy.

So as I say I am back (and not back) to where I am. And I turned 40 last week. Does life begin now? Where am I going? We'll see. But this time round, I hope I have the tools to make better choices than I did back then.


It's a dangerous business, going out your door. You step onto the road, and if you don't keep your feet, there's no telling where you might be swept off to.

Rest in peace Mum. You should; you've no regrets. And keep an eye out for those of us still travelling along..

Inbetween all the argy barging, politics and serious stuff on the net there are those sites that aren't trying to change the world, but do add to the gaiety of the nations. (Not that England will be feeling this way after their drubbing by Germany. And I think it's time to tell Wayne Rooney to make an effort when he's playing internationals or at least to look less ugly.) But in the general gloom, her Majesty (we are led to believe) tweeted this message;

'I tweet to you now as your Queen. And thus I say to you, this country is still great. Have heart. Or at least a pimms. God bless you..'

God bless, your Majesty. Mine's a Blossom Hill. I'm cheap that way..

After all the gloom in the blogosphere, I thought it was time to have some good news for a change. John Winton, who is part of our campaign network and who was running in the health board elections in Fife, won a seat. Not only that, but he was the first to reach the quota (after 35 counts, dear God.) This means that there is now at least one honest person on Fife Health Board.

Here's the list of those who were elected with the count stage they were elected at;


John Winton - Scottish Health Campaign Network 35
Elizabeth Adams -fundraiser for Maggies, Victoria hospital 37
Ann McGovern – leader of Fife council (labour) 51
Peter Adams – UKIP 52
Harry Blyth - councillor who represented Leven (labour)54
Susan Archibald – disability discrimination campaigner 54
Dave Stewart – chairman of NHS Fife’s operation division 54
Jayne Baxter 54
Margaret Harper- worked for Tayside NHS as a nurse; now in clinical governance 54
Ian Lowles- retired consultant 54
Arthur Morris- consultant plastic surgeon 54
Norma Wilson – medical secretary 54

And here's some of those that weren't elected;

John McKenzie Kirkaldy councillor (labour)
Fiona Purdon Glenrothes councillor (labour)
Harry Wills – Lib Dem candidate
Carole Patrick – deputy manager of CVS Fife
Ad Johnson – racial equality service based in Kirkaldy
Antony Payne – chairman of the Ecology centre in Kinghorn
Steven Marwick – son of Tricia Marwick , MSP

So what can be learned from these results and what do they mean for future health elections? I think the following conclusions can be drawn;

1) Belonging to a political party helps, but it is not a shoo in. Being a councillor or a candidate in another election doesnt mean you're going to get a seat on the health board. You need to be well known, as well as have the party rosette. Anne McGovern was the leader of Fife council; she also cared for her husband who had MS and died in 97.

2) Belonging to a campaign group helps, but only if it has a connection with health. John Winton from our group, Elizabeth Adams from Maggies and Susan Archibald who won a famous disability discrimination case got seats. Carole Patrick of Community Voluntary Services, Ad Johnson of the Racial Equality Service in Kirkaldy and Antony Payne of the Ecology Centre, didn't.

3) People like doctors. Two retired consultants, Ian Lowles and Arthur Morris got in. I'm told by my spies that they're good guys.

4) Being someone's relative is not a guarantee of a seat. Steven Marwick, son of Tricia Marwick MSP, didn't get in.

5) The Health board has influence but doesn't have as much in terms of bodies to vote as it thinks it does. None of their candidates made it into the top four, probably due to their crowding the paper with candidates and splitting their vote.

6) Crowding the paper with candidates doesn't work for either politicians or the health board. Politicos should take note of Peter Adams the UKIP candidate. He won a seat, because his vote was united. Labour and the health board lost seats, because they put in too many candidates and split their vote.

So what Fife have ended up with is a pretty eclectic bunch from all areas of the health and political spectrum. There's a fair balance between users, campaigners, professionals, politicos and management. That's actually how it should be. This is actually an election with a level playing field and I think NHS Fife will be much better as a result. It will mean that the flow of information will improve to all these sectors of health and that the health board will no longer have the ability to slap 'commercial confidentiality' on PFI projects and the like.

What of the turn out? 13.9% in Fife; 22% in Dumfries and Galloway. Slightly disappointing, but it was a trial run, with a huge ballot paper (60 candidates in Fife, 70 in Dumfries and Galloway). I can see the ballot papers getting smaller and the vote getting bigger as people get used to it.

Anyway, congratulations John. I'm sure there was a universal groan from the health board management when they heard the result and that's how it should be. Go gettem..

Some months ago I was in Summerlee Museum in Coatbridge. It's an industrial museum and charts the rise and fall of the steel and coal industry in Coatbridge, which was one of the biggest producers in the UK. It goes further than that though; it also charts the day to day life of the workers who earned their living from these industries and their struggle for a basic quality of life. The banner above comes from those times.

I found it a very sobering visit. I always knew that conditions had been bad and that mining was dangerous but somehow it got under my skin. It was stark and understated and that made it all the more shocking. And I asked myself; in those conditions, where people were dying every day from injury, from disease and from neglect, how could they ever imagine that things could get better? How could they not have the spirit crushed out of them in those conditions? How did we get to the stage that we did have a health service, a mininum wage, health and safety and so on?

The answer? Those who dreamed of those things accepted that they probably would not have them for themselves. But it was enough for them that those coming after them would and so they put the changes in place, stone by stone. Lawrence of Arabia once said that the people to watch for were those who dreamed with their eyes open. And so they are. They are the builders of cities and the sowers of ideas. And all that we have, we owe to those who went before us, who did not lose hope, even in the despair that they worked in.

This has been a bad couple of weeks for the blogosphere. We have lost Jobbing Doctor for the time being and Rita Pal has a story about a friend who has been pursued by the GMC for four years and ODd. They pulled through, but we are in hard times for the NHS and sometimes it just doesn't seem worth it. We cannot imagine things getting better or that we make a difference. But we do. History shows it. All progress depends on those who hope and work to make their dreams real.

We may not see the fruits of what we do in our time. But it matters for those coming after us. Let's hope. Let's continue. And let's not let the bastards get us down.


Say not the struggle naught availeth,
The labour and the wounds are vain,
The enemy faints not, nor faileth,
And as things have been they remain.

If hopes were dupes, fears may be liars;
It may be, in yon smoke conceal'd,
Your comrades chase e'en now the fliers,
And, but for you, possess the field.

For while the tired waves, vainly breaking,
Seem here no painful inch to gain,
Far back, through creeks and inlets making,
Comes silent, flooding in, the main.

And not by eastern windows only,
When daylight comes, comes in the light;
In front the sun climbs slow, how slowly!
But westward, look, the land is bright!

Thanks to Obnoxio the Clown for the link..

Just come across this article from the Beeb. Andrew Langsley is relaxing the 48 hour target on seeing a GP and the four hour target in hospitals. He says this is to cut down on management costs and that quality of care matters more than targets.

Health Minister? Common sense? In the same sentence?

I'm totally flabbergasted...

There's a guy I know who's a doctor. He doesn't go shopping in the supermarket himself, but his wife or daughter does it for him. He's not a chauvinist pig or anything like that; it's just that when he goes in, people look in his trolley to see what he's buying and it really hacks him off. Now in the last analysis, maybe it doesn't matter, but it is one of those fingering, cozying up to you kind of serial killer fascinations that can really freak you out. You know the kind of thing;

Jean Van Damme 'Are you going to release my wife or am I going to make a film about tracking you down and killing you in a really cool way?'

Mad Serial Killer ' I know you have Kellogg's Crunchy Nut Cornflakes for breakfast every day and you were the only person to buy Kellogg's Pop Tarts when they brought them out. And you have cheap shoes as well..

I don't have a Tesco Clubcard for this reason. I would like to tell you it's because I'm a fugitive from justice or a danger to the state, but in reality it's because I-do-not-like Tesco knowing what I buy every week. I don't want them to know that I always buy chicken portions for Saturday, mince for Sunday and that I convert the mince into a chilli con carne for Monday. I don't want them to know that I always buy Orange and Mango juice and avoid their own brand at all costs. And if I am weak and give way to a packet of Milk Chocolate Buttons at the checkout or buy a bottle of Oxford Landing to get blootered on, it's my business. Not Tesco's. Not the companies that buy this info from Tesco to sell you holidays and insurance and all the rest of it. And if I end up a fugitive from justice, it's none of their frigging business either.

So why am I telling you this? Well, I had the bright idea of having my weekend shopping delivered. So I went online to set it up, only to find that I had to sign up for a Clubcard or the deal was off. It was put in quite a sly fashion. It wasn't actually marked as a mandatory field but with a slightly posher wee kind of sword mark that you know means trouble. And when you tried to ignore it, a message came up saying that if you ticked this box, you either filled in your Clubcard number or registered for one. If you didn't tick the box you would return to the home page.
I decided that I wasn't having it. So tomorrow I will be chuntering round Tesco at 12.30 along with half the population of Coatbridge and I will stand at the checkout and confess to the assistant, that a) I don't have a Clubcard b)I am not collecting points for Sport for Schools c) I forgot my long life bags yet again and d)yes I would like 7 of your non eco friendly bags and could you double up on the bag with the Oxford Landing in it?

I hate Tesco...

Two months ago, Dr Crippen, the daddy of medi bloggers retired. It wasn't entirely unexpected - he had had a couple of breaks from blogging before and was showing signs of fatigue. But now Jobbing Doctor has 'taken a break' from blogging, just a few hours after doing a routine post about shoulder injections. He has taken down all his posts and has even removed Sam and Frodo, his two cats from the page.

One medi blogger could be an accident. Two looks like carelessness. Three? Who's going to be next and what is going on?

Dr Crippen and JD weren't any old bloggers. They were the best and there's a feeling that something a bit more sinister is going on here. Are they getting picked off? And if they are, what can we do to support them?

Some years ago, I visited a country with a repressive regime. The food and clothes were very cheap. But the books were the same price as they are here, which made them six times more expensive for the people of that country than they are for us. The thing that a government prizes and fears above all is the flow of information. They do not take kindly to areas that they have no control over and that is the blogosphere. It is a compliment that we are now attracting this kind of unwelcome attention, but we now have to move and ensure that that conduit of the unvarnished truth does not get blocked.

People as eloquent as JD are not going to be left in peace to speak out. We need to work out a way of letting them do this without being identified. Maybe we need to band together on one blog with several authors. Maybe we need to get non medics to host blogs and post for them. But we cannot allow our fellow bloggers to be silenced in this fashion.

JD, if you're out there and something has happened, let us know. Maybe it's not what we think, but if it is please tell us. We cannot let this happen and let the grey men in suits whom you detested, shut us down. Haste ye back.

Two patients limp into two different medical clinics with the same complaint.


Both have trouble walking and appear to require a hip replacement.

The FIRST patient is examined within the hour, is x-rayed the same day and
has a time booked for surgery the following week.

The SECOND sees a family doctor after waiting 3 weeks for an appointment,
then waits 16 weeks to see a specialist, then gets an x-ray, which isn't
reviewed for another week and finally has surgery scheduled for 6 months from then.

Why the different treatment for the two patients?

The FIRST is a Golden Retriever.




The SECOND is a Senior Citizen.


Go figure...

The first ever Health Board elections are running in NHS Fife at the mo. It's going to be very interesting to see how this turns out. The ballot is a postal one, rather than polling booths. The papers were sent out three weeks ago and they have to be returned by 4pm on the 10th June. There are 61 candidates for 12 seats and it's being done on the single transferable vote.

It's gratifying that there's been so much interest. But a quick check down the candidates reveals a good number of ex councillors and health board members. Now I know the sceptics amongst you are going to say that this was bound to happen and so it was. But there is a value to this. People other than councillors and health board afficianados can apply and get voted in by the public. The previous system was that all the candidates for the health board were ex councillors and health board afficianados, and they were appointed. Jo Bloggs didn't get a look in, so this is an improvement.

So who should you vote for in NHS Fife? There's only one man for the job and that's John Winton. John has been the conscience of NHS Fife for the past seven years. He is part of the Local Health Concern group and has harried the board over several issues, esp over the slippage on the Diagnostic and Treatment Centre at the Queen Margaret in Dunfermline. NHS Fife hasn't had its troubles to seek recently; the A&E at the Victoria in Kirkaldy has gone part time due to a shortage of doctors, something they were warned about months ago. It was also one of the three health boards caught up in the Stracathro fiasco, an independent treatment centre that took £15 million for a set number of hip and knee replacement operations, and then said that it wasn't going to operate on anyone who was a risk. As most people receiving such replacements are over 65, it meant that at times occupancy was running at only 50%. This has now been claimed back by the NHS and its future is still to be decided.

John is part of the Scottish Health Campaign Network and is genuinely independent. He knows what the issues are and what he's talking about. More importantly, he knows what the solutions are. If you don't want to vote for a placeman, vote for John and I can assure you that he will get his teeth into the job (and into anyone that needs it).

Have just been on Grumpy RN, where it appears that civil servants from Westminster have taken a jolly to New Zealand to look at their voting system. Now, the voting system that New Zealand works is the same as the Scottish one; a mix of FPTP and a regional top up vote. (The New Zealand local elections are on this year, so I suppose that's why they went there to see it in action.)Does this mean that Westminster are considering STV after all?!


PS New Zealand also hold elections for their District Health Boards, so maybe some of our MSPs and health board CEOs should take a trip out and observe..

So now that the Lib Dems have sold their soul to the Conservatives for PR, what are they actually going to get for it? There's talk that the Conservatives might agree to AV, (Alternative Vote). It's being touted as proportional representation. It's not. It's a slightly more sophisticated FPTP system and will not usher in the new politics for Westminster if it's introduced. Let me explain why.

The problem with the FPTP system is that the country is divided into discrete parts, or constituencies. Each constituency is only allowed one MP, so regardless of how many votes that the Lib Dems may get across the country, that's not going to translate into seats.

Under AV, a vote can be transferred to another candidate. AV is the system used by political parties to elect their leader; it's also known as 'Instant Run Off'. The voting goes through several rounds, the least popular in each round dropping off until one candidate holds 50% or more of the vote. Now here's the problem. If you vote first preference for one of the big parties; Labour or Conservative, your second, third and fourth preferences will be unavailable to other smaller parties. It is only when your candidate is eliminated in a round, that it transfers to someone else. And because there is only one seat available and thus only losers that get eliminated, this means that the biggest parties hold on right until the final round. So votes will transfer from smaller to bigger parties, but not the other way round and thus you are in much the same position as FPTP.

The single transferable vote system is different. Under this system, there is more than one seat available in each area,(a multi member system) and when a candidate reaches a certain number of votes, they get elected,drop out and their surplus votes pass onto the next round. So what a party has to do is to reach a quota of votes through the rounds, say 20%; once they have accumulated that, they gain a seat and drop out. This would make a substantial difference to Westminster; the Lib Dems would have far more seats and it would be much more representative of how Britain actually votes.

So why aren't the Lib Dems pushing this? One of the factors that they may be considering is that using STV in a multi member system does tend to lead to a larger number of MPs. This is because you are trying to balance a national preference for a party, with a local preference for a particular candidate. For example, the BNP got enough votes regionally in London to get an MP under PR, but who would that MP represent? And what area would want them? The way we get round this in Scotland is that we have a 'mixed member system'. This means that 73 candidates are elected in the traditional FPTP system and then 56 are elected on the larger regional vote. But this means we have 129 MSPs, compared with 59 MPs. That's more money and more expense. Westminster would probably double in size if PR proper was brought in and in the wake of the expenses scandal, that ain't going to be popular.

The Lib Dems have some choices to make. Increasing the number of MPs is not maybe the way to win friends and influence people just now and so introducing electoral change gradually, looks more attractive. But given that they have gone into coalition with the Tories and alienated a large section of their vote, they may not get another chance to change the system and noone is going to thank them for replacing one form of FPTP for another. It's now or never for the Lib Dems and it has to be STV or bust. If they manage it, it may be the only benefit that the UK receive from what has been an uninspiring and negative election.

So, it's begun. The cuts are coming and one month from now we are having the budget. Here in Scotland, Greater Glasgow Health Board have cut 500 frontline jobs and more look set to go.

Now, we know that cuts have to be made. And you might argue that the government has no control over what a health board or trust does with its budget. But actually it has.

Here's my genius idea for anyone to take up. If the government is serious about keeping frontline staff, then it should legislate for it. That is, have a minimum legal staffing requirement in hospital wards. Also have a minimum nutrition requirement and expenditure. That way, trusts will have to turn their attention to the top heavy administration to find savings instead of skimping on nurses and food. And then maybe we might get an NHS that works and some of the waste that does go on might be eliminated.

Dear Dave; use the rapier for cuts. Not the broadsword..

The Scots are two peoples. There are those who stay and those who leave. For most of them, the high road to England is the natural departure point and as I write this I reflect that of my family, three of us have stayed and three of us have left. It's only natural - after the Union of Crowns and Union of Parliaments,all power worth a damn went to England. Those wishing to better themselves all took the road to England and for this England is envied and despised in turn; envied for the opportunity it offers, but despised for beggaring Scotland of its brightest and best. Even Bonnie Prince Charlie could not resist its lure; he did not stop at chasing the English out of Scotland, but set his sights on London. One wonders what would have happened if he had contented himself with the Scottish Crown instead of pursuing the English one as well.

In 1999, things changed. We got a parliament of our own. At the time it was disparaged as 'the wee pretendy Parliament' and 'a parish council' by the likes of Billy Connelly, but it was a shift. For the first time in 300 years, the Scots had a say over their own government. It was limited, some of the politicians weren't great (the talent had gone to Westminster as usual)but it did things.The different views on the health service, free personal care and the way that Holyrood ran itself; all these started to slowly but surely snap the leading strings between Scotland and England. We looked on bewildered at the expenses carry on in Westminster. In Scotland, all MSPs expenses go online and their interests. David McLetchie had to resign over taxi fares fraudulently claimed. In Westminster, MPs were quite happily handing out dosh for clearing out moats and building tennis courts. Henry McLeish's status as First Minister did not protect him from being called to account over the rent of his constituency office. It's not perfect but Holyrood does think and run differently from Westminster.

So why am I rabbiting on? Well, this week another change took place. The Lib Dems united themselves with the Conservatives, and unless Nick Clegg is really stupid, did so in the sure and certain knowledge that the Lib Dems in Scotland will be completely wiped out for this in the Holyrood elections next year. In all the possibilities that I had considered for the outcome of a hung parliament, I never once considered a Lib/Con pact. And I didn't, because in Scotland it would be absolutely unthinkable, political suicide. We do allow the SNP and the Conservatives to vote together on issues and bargain; but a formal pact would be completely out of the question.

I can see it from the Lib Dem point of view. No matter who they aligned themselves with, they would lose voters. Gordon Brown was discredited as a leader and any alliance with Labour would dissolve within a few months as a result. They wanted to be sure that they would get a PR referendum through before this happened, and the only way of doing that was to align themselves with the Conservatives, who are united. But ideologically, the Lib Dems have now gone to the right and there is a gaping hole on the left wing of the political spectrum in England. Labour went that way with Tony Blair in 1997; now the Lib Dems have followed.

This move has consolidated a general train of thought in Scotland; that the only truly left wing party in Scotland is the SNP. Many voters who are not inclined to nationalism are turning to the SNP because it represents the socialism that Labour used to offer. And in that respect we have been leaving England for a while. But with this move, England has left us. The past couple of days have had a quality of unreality about them as we watch at a distance and wonder where we go now.

Westminster feels old and tired and far away. And those of us who care about the NHS are asking ourselves whether the moment has come to cut loose and leave the English NHS to sort itself out. There isn't a single political party in England that we can vote for to help it; all we can do is to vote to save our own. How sad that an institution that was the vision of a Scot, given political shape by a Welshman and implemented by the English, should be on the ropes. And how ironic that three of Scotland's sons who took the high road to England; Blair, Brown and Cameron, should usher in the beginning of the end of the Union that they espoused.

We returned to our places, these Kingdoms,
But no longer at ease here, in the old dispensation,
With an alien people clutching their gods.

This is the end of the Union coming. And I thought I wouldn't care, but I do.

So, the phoney war is over. The doors have been knocked, the babies kissed, the hands shook, the leaflets posted and all the campaigners will be heading home for a good nights sleep before their vigil at the polls. There are a number of things that can happen tomorrow.

1.) It could be the last time that we have a FPTP poll; we could be switching to PR.

2) The BNP and UKIP could win their first seats.

3) The Tories could win, signalling the start of a break up of the UK. Nothing will boost the SNP in next year's Holyrood elections like a Tory win.

4) The SNP and Plaid Cymru might hold the balance of power and we might see some sensible policies on health (no privatisation) and PFI (get rid of it).

5)We could have a Lib Lab pact and have a fairly non -descript government for a couple of years, followed by a PR election. This would be the equivalent of a huge enema for Westminster and would get politics, real politics moving in the way it has in Scotland instead of all the yah boo rubbish.

The butterflies are fluttering above the path and depending on which one we tread on, we will end up at a different destination. There isn't that much in it.

In all of this I have been reflecting on the importance of hope in politics. Hope isn't the dream of fools - it's the very stuff of politics. It's the determination that you will get to a particular destination regardless of the difficulties. And it's about doing all the small things, seemingly insignificant in themselves, that lead there.

Tomorrow we need to do that small insignificant thing. We need to vote. We need to choose our direction as a nation because if we don't do it, rough men will choose it for us. And we need to have that quality of hope to do it. Outcomes aren't inevitable. Bad doesn't always have to triumph. Sometimes things do happen for the best. Sheelagh Pugh sums it up in her poem 'Sometimes'


Sometimes things don't go, after all,
from bad to worse. Some years, muscadel
faces down frost; green thrives; the crops don't fail,
sometimes a man aims high, and all goes well.

A people sometimes will step back from war,
elect an honest man; decide they care
enough, that they can't leave some stranger poor.
Some men become what they were born for.

Sometimes our best efforts do not go
amiss; sometimes we do as we meant to.
The sun will sometimes melt a field of sorrow
that seemed hard frozen: may it happen for you.


May it happen for you and the country tomorrow.

I'm speechless..

It's strange how you convince yourself that you have a broad view of things, that you have a wide and eclectic range of friends and that you have an appreciation of every angle in healthcare. And then a new planet swims into your ken.

I was putting on some patient blogs tonight, courtesy of Benefit Scrounging Scum's blogroll and I came across this essay called 'The Spoon Theory'. I have a feeling that it is probably as popular as 'Footprints' is in the religious community, or Kipling's 'If' is in British poetry, but it's completely new to me. I felt like a very small person standing in a very big world reading it. You should read it too.

Now, just in case you guys think that I've run out of steam and have thrown in the towel already, to mix my metaphors, I haven't. I've been working my way through some paramedic and nurse blogs tonight; it's just that the blog rolls that I grabbed were very out of date. It made me reflect on my own blog and how many of the links have fallen into disuse. I really need to refresh.

I've run into a lot of American blogs. I really don't want to make a rod for my own back, but I think that I'm going to create an American page as well. This is an important time for US health and it wouldn't be bad to have a snapshot of how it's progressing (or not). And the final thing that convinced me that an American page would be a good idea was this blog, 'Storyteller Doc'

Some blogs make it because they post early and often. Some make it by raging against the machine in colourful vitriol. And some, like this blog, make it because they are quite simply beautiful to read.

More tomorrow.

Whew!

Do you ever wish you'd never started something? It's 12.10am and I've just finished doing the outline for Mediblog UK and Mediblog Student UK. It's all been a bit of an eye opener.

First, I realise how many blogs I don't know about. I suppose that there's only so many blogs you can look at a day and so many that you'll like, but it's a bit of a surprise. The prize for the most eclectic taste in blogs must go to Angry Medic; I started on the student section of his list; there was about fifty odd on that alone and I haven't even begun on the other sections. *Groan*

Secondly, a lot of blogs have gone defunct. I'm thinking about creating an archive for some of the better ones, like Dr Rant and Dr Crippen. It doesn't seem right that they should just disappear into cyberspace.

Thirdly, I think I've found a vocation. There's something intensely satisfying about seeing the blogroll operating and the activity that's going on all the time in the blogosphere. But maybe I'm just boring..

Favourite blog name of the day? It's got to be 'Extremely Lonely Medical Student'. At the moment it's standing all on its own at 'E' and I'm loathe to put anything with it, it seems so appropriate. One is the loneliest number..

Right, to bed. More blogging and dragging and dropping tomorrow..

Since NHS Blog Doctor retired two weeks ago, there has been a discussion as to where medi bloggers go next and whether it's worth it. There have been discussions as to how many of us there are, and how we make the government sit up and pay attention.

My own reaction to Dr Crippen's retiral was one of guilt. He was the one you could always rely on to post every day, to give informed comment and splendid vitriol that didn't just go near the bone, but sawed right through it. And we sat back and let him get on with it. If we didn't blog, we knew he would. And he would say it far better than any of us. His retiral is like the sudden death of a healthy rumbustious uncle; the one that drinks and smokes and makes the riske jokes and always has the word 'dreadful' attached to his name by prudish aunties. It feels like the day you wake up and all the heat has gone out of the summer.

We all need to try harder now and I have started a new blog in response to some of the questions getting raised. I've been thinking about it for a while and it's based on a model used by other groups on the web. I've called it Mediblog UK and you can find it here.

It's a fairly simple set up. You send me links to medi blogs that you like, and I put them on this site, together with a blog feed. It means we can see at a glance how many sites are active. As soon as you post you go to the top of the blog feed. This way people will become aware of blogs they normally wouldn't know about or read. It means info gets round more quickly and it also means that if several people blog on the same subject, you can get a variety of angles.

I'm going to work on this for the next wee while and refine it. In the meantime, if you want on this, or know a blog that should be here, send it to me and it will be added. It's time to gird our loins and stick together...

There’s a book called ‘The Naming of the Dead’ by Ian Rankin. The title comes from a section in the book when Rebus the detective, contemplates his job and concludes that most of what he does is naming the dead. To name who died, why they died and who was responsible. Sometimes it can seem pointless, but it’s not. Naming someone means that they matter. Telling what happened to them and who was responsible is basic justice. And when I get weary of blogging and wonder if there is any point, I remind myself of that. At the very least, record what happened. Why it happened and who was responsible. It means that when things go belly up like they did at Stafford, everyone will know why it happened and who was responsible. And so in this post I record what is happening to mental health services in my area, North Lanarkshire. Who is slipping through the cracks and why.

It all goes back to a document called ‘A Picture of Health’ that NHS Lanarkshire (NHSL) brought out in 2005. The main bone of contention was the downgrading of Monklands Hospital from a level 3, to a level 2 hospital, but in amongst the bumf was their proposals for mental health. The basic plan was to build two new 112 bed wards, one for North Lanarkshire and one for South Lanarkshire. This was very quickly modified to two new 55 bed wards, then one new build and one refurbishment. In addition to that there were plans to shut Hartwoodhill, which takes patients with long term severe psychiatric disorders and brain injury. Where they were going to go was anyone’s guess; it was mooted that they would be found places in the community and in nursing homes. When I asked the then health minister Andy Kerr what nursing homes were going to take these people, he didn’t know and neither did his civil servant, which is when you really have to worry.

All of this happened before May 2007, which was the Holyrood election. When the SNP got in and reprieved Monklands as a level 3 hospital, NHSL had the perfect excuse to cut mental health services. And this is what they are going to do.
Acute mental health needs 153 beds. NHSL are going to provide only 130. In addition to that, 20 of those beds are going to be set aside for alcohol/drug rehab. NHSL used to buy this service outside the authority; it is now going to provide its own beds, but at the expense of 20 acute mental health beds. So we actually only have 110 beds for acute mental health.

Hartwoodhill and Caird House, which both take the same kind of patients are closing. There are 72 patients altogether from these institutions. 27 have been moved into Coathill, which is a hospital for the elderly; the elderly have been moved into the orthopaedics ward in Monklands hospital, and orthopaedics has lost 27 beds.
For the rest a new facility is being built called Beckford Lodge. It will be a medium secure unit and it will have only 27 beds.
So as I said; there are 72 patients. 27 beds at Coathill + 27 beds at Beckford Lodge = 54. 72 -54 = 18 patients with brain injury/severe psychiatric disorder without a place to go.

So how many beds are we losing in total? 43 beds in acute mental health and 18 + 8 unoccupied beds from long term psychiatric care. That adds up to 69 beds lost from mental health services altogether or 27% of capacity.

Where will these people go? Who is going to look after them? That’s anyone’s guess. Most of them will end up in the hinterland between the NHS and social work funding pots, known as ‘care in the community’. Some might be lucky enough to be adopted by a local church; my own church gives employment and protection to a group of adults with learning difficulties that live in sheltered housing near the church hall. Others will simply fade into the anonymity of the community will all its casual cruelties to anyone who doesn’t ‘fit in’. And some will slip through the cracks altogether, turning up in the ‘death by misadventure’ statistics.

How sly we have become with ourselves. How the mind will manoeuvre itself so that cuts become rationalisation, abandonment becomes care in the community, negligence becomes death by misadventure. God know what is going to happen in Lanarkshire when these measures fully kick in. But I record here and now what has happened and I ask NHSL, the media and all ; is it nothing to you, all you who pass by?

Connecting for Health has come to Scotland. Well, not exactly, thank goodness, but the debate surrounding electronic medical records has. Our group debated it on Saturday and a letter was sent into the Herald. This is it here, and sums up our position on the matter.

Please read this letter, courtesy of Rita Pal, that the Gosport campaigners sent to the GMC. Then sign the petition for Elsie's law. This abuse must stop.

Twelve reasons why assisted suicide should not be legalised;

1.)The number of elderly beds in hospitals has been reduced from 27 000 - 21 000 over a period of five years, a reduction of 25%.

2.) Mid Staffordshire Hospital

3.) From 2004 - 2008, the number of specialist nursing homes for dementia sufferers has been reduced by 389, a drop of 9%.

4.)£289 per head per sufferer is spent on cancer research. £11 per head per sufferer is spent on dementia.

5.) NICE tried to remove all dementia medicines from presciption. After protests, it reinstated them, but only to be prescribed in the later stages of dementia when medicines like Aricept would be useless. Doctors now have to lie about what stage a dementia sufferer is at, so that they qualify for a presciption.

6.) Martin Ryan, a Downe's sufferer, died after being left for 26 days without food or water in hospital. Mencap reported on this and several other cases of neglect of people with learning difficulties in hospitals.

7.) Martin Amis is using the issue to promote his latest book launch.

8.) The worst health secretary in living memory and failed Labour coup leader is supporting it.

9.) Dr Jane Barton injected her elderly patients with doses of diamorphine and killed them. The GMC let her keep her registration.

10.) Margaret Haywood blew the whistle on neglect in an elderly care ward and got struck off the nursing register.

11.) The pro-euthanasia bioethicist Dr. Helga Kuhse said:
"If we can get people to accept the removal of all treatment and care—especially removal of food and fluids—they will see what a painful way this is to die and then, in the patient's best interests, they will accept the lethal injection."

12.) Hippocrates said:
"First do no harm."

Ay, fight and you may die, run and you'll live. At least a while. And dying in your beds many years from now, would you be willing to trade all the days from this day to that for one chance, just one chance to come back here and tell our enemies that they may take our lives.... but they'll never take our FREEDOM!!



Sometimes you wish you could just close your eyes and wish it all away.



That is how I have felt for the past three weeks since Terry Pratchett, one of my favourite authors, came out in favour of assisted suicide. I held my head in my hands as I listened to him lightly dismiss the 'possible abuses' that could result from such a law. I haven't blogged on the subject yet, despite the many posts from others, because I didn't feel able to. That has changed, and what has changed it was Archbishop Vincent Nichols's comments on a 'lack of compassion in the NHS'. My first reaction was the same one that I had to Terry Pratchet; a face palm, looking out through my fingers to see the inevitable cavalry charging towards what was on the face of it, an incredibly naive remark. My second reaction was; 'Actually, he's right.'

How we have arrived there is complicated. It was a process that started many years ago and crept into something far more sinister. Some have been more willing than others in this process, and medi bloggers like Militant Nurse are at pains to record just exactly what is going on with staffing and the like. But the original charge remains; however we arrived there, however we have protested, the NHS is losing its compassion, especially towards the elderly. And we have now reached the point of doom with this process; assisted suicide, the place where all these small steps have been moving towards, is now on the agenda and the pressure is relentless. When people like Martin Amis talk of a silver tsunami and old people stinking out cafes and restaurants, things are getting serious.

Creep is not new. There is a book called 'Defying Hitler', a memoir of Nazi Germany from the 20's right up until 1938, when the writer Sebastien Haffner moved to Britain with his Jewish wife. It is an account chilling in its ordinariness; Haffner charts the whole process from the Nazis being regarded as boors and clowns by the German middle class, to the acceptance that they were going to run the country, to the acceptance that they were going to war. But it is the details that make this book; the day that Haffner arrived at the court that he worked, to find that all the Jewish lawyers had been removed and a young clueless Nazi had been given the job of judge; his attempts to stay friendly with people in his company who also happened to hate Jews; a relationship with a Jewish girl that went on far too long simply because he wanted to defy the Nazis about non-Aryan relationships; the boot camp he was sent to, to undergo 'training' by the Nazis and the humiliating vulgar games that they were forced to play. But the overriding sentiment of the book is disbelief at what is happening, reinforced with a reluctance and perceived helplessness to stop it.

So it is with the assisted suicide debate. We have gone to an initial disgust at the idea, to an understanding of the idea, to an acceptance of its possibility, to a desire to implement it. Underneath the debate is the sly subtext of the 'growing elderly population', 'pensions timebomb', 'silver tsunami' and the solution is waved wordlessly in our faces. And medical staff have been bullied into accepting the unacceptable in hospitals, because they cannot wave a magic wand to make more staff appear. Whistleblow and you're sacked. Report what's happening to the media and it will not be printed. 400 -1000 people dead in Mid Staffordshire? We don't want to talk about that do we? Let's get that nice chap with the fedora hat and funny books on, to talk about euthanasia instead.

As a health campaigner and a carer, I find myself torn. I know what's going on behind the scenes. I understand what is happening with staffing, with bed reductions, with care homes being shut. I understand that elderly care has been getting dismantled. And yet, as a carer, I have seen things that would make your eyes water. I have seen people starved in hospital. They were related to me. I have seen nurses that don't care, doctors that are too busy or unavailable to deal with the situation. I have complained to a manager while they chewed gum all through my protestations. I want it to stop. And it is only going to stop when enough people at the rockface come forward and complain.

I don't underestimate what I am asking here. I am a non-medical medi blogger, an outsider, and I have a cheek to ask it. But I am asking now, at this point, because I understand that if enough medics do not come forward now and crush this, it will be all over bar the shouting. If you want assisted suicide to remain illegal, if you want an elderly care system, if you want people like Jane Barton to be put in jail, then it has to be done now.


In 1945, the Americans and British liberated the concentration camps. Their disbelief and anger at the conditions contrasted with the panicked rationalisation of the camp guards, who were only doing their job, who were a cog in a vast wheel of consequences and who could not see a way to refuse to do the job they were asked to do, unless they wanted to take a trip to the Russian Front. In the same way, Archbishop Nichols has spoken from the simple uncluttered view of an outsider seeing the NHS with a clear eye. It is madness rationalised. We are leaving people starving and thirsty. We are turning a blind eye to malpractice. We are letting people die in agonising circumstances like Martin Ryan. And we are doing so, because we are afraid; for our jobs, for our loved ones being treated in case they get worse treatment, for our families in case they are punished as well.

We must speak out now. We must put aside our fear and hopelessness and dare to imagine a different outcome. We must because, unlike the concentration camps, there is no cavalry on the way. We are the cavalry. This depends on all of us; medics, journalists, clergy, carers and celebrities speaking out with a clear voice. If we are afraid, we need to remember that this is going to come to us all, because we all grow old. War is upon us, whether we like it or not.We cannot choose the times that we have been born in; but we can choose how we react to them. It is time we looked our enemy in the eye and marched out to meet him. We will not get another chance to do so.