Friday, 31 May 2013

A deep malaise at the heart of the NHS

Readers of this blog will know that I have been very unwell. I have already recounted some of my experiences as an NHS patient. I am slowly recovering and I have had several days now free from pain. In my journey through hospital and after care I found plenty of examples of compassionate and caring medical practice, but caring can break down if stretched to limits through insufficient resources.

This much I found in the care of the district nurses. One night when I was in severe pain I called to get attention. They were very busy covering a whole county but would try to get to me later. They kept me informed as the night progressed and in the early hours of the morning called to say they would be with me soon. Two nurses arrived. They had worked solidly through the night. Nevertheless they came with smiles and comfort. Sadly they couldn't do much to help me. It struck me how little information they had about my history. I was barely on their radar, and they had not the authority to do much to help me. That did not stop me getting a call from them later to find out how I was.

In desperation I contacted my GP. How could weeks have gone by since being discharged from hospital without any contact? All I had been told by the hospital was that I would receive a visit from the district nurse to remove a catheter. That happened two weeks later. By that time I was in considerable pain and infection had taken hold. My GP told me he knew nothing of my history. He had received nothing from the hospital. He had been unaware of my condition. He acted with efficiency and with care. He telephoned a couple of day later to ask how I was and to put me on another course of antibiotics. I had now lived with weeks of pain and painkillers that were slowly losing their effect. I felt isolated, the more so since I discovered I was not on anyone's radar. I only got attention if I called for it, and on each occasion I had to repeat my history because they had not received notes from the hospital.

These problems are not the result of a lack of compassion. They don't stem from inefficiency of staff. It is systemic. There is a deep malaise at the heart of the NHS. It results from underfunding and a reorganisation that has produce chaos and a lack of joined up care. It results in large part from savage cuts that have impacted dramatically on front line care. It will take this government no time at all to destroy the NHS; it will take decades or more to rebuild it.


Monday, 20 May 2013

Charity investing in talented scientists to boost hearing research in the UK

Action on Hearing Loss has launched a new initiative to support the early careers of scientists working towards new treatments and cures for hearing loss and tinnitus. This follows the merger with Deafness Research UK.

The new Pauline Ashley Awards are now open to applications from research scientists in the UK aiming to further their careers in hearing loss research. The research grants have been established in memory of Lady Ashley of Stoke who co-founded Deafness Research UK along with her husband Lord Ashley of Stoke.

Scientists from across the country can apply for funding to support research projects that will generate data to strengthen future applications for long term funding from national funding agencies.

Caroline Ashley, daughter of Lady Ashley said: ‘My Dad, Jack Ashley, described hearing loss as being like a bird, suddenly shuttered into a glass cage. He could watch the busy world go by, cut-off from its conversations and cadence. The family, and particularly my Mum, Pauline, witnessed the devastation of deafness and the massive energy and resilience required to keep going, keep up company, in the face of isolation.

‘Thankfully research into hearing loss bears fruit: cochlear implants provide some sound for some people. But so much more research is needed to find causes and cures. The Pauline Ashley grants will help ensure new talent is cultivated, building our chance for long-term treatment for all affected by hearing loss.’

Dr Sohaila Rastan, Executive Director of Biomedical Research at Action on Hearing Loss said: ‘As a result of merging with Deafness Research UK we are delighted to be able to support talented new scientists in the field of hearing loss research through the Pauline Ashley Grants Scheme. This is a great opportunity for researchers at the start of their careers and for scientists changing fields who often struggle to secure long term funding from the main national funders.’

To apply for the Pauline Ashley Small Grants Scheme, please visit www.actiononhearingloss.org.uk/Ashleygrants


On 31st March 2013 Deafness Research UK merged with Action on Hearing Loss (formerly the RNID, registered charity numbers 207720 England and Wales and SC038926 Scotland) with the aim of increasing awareness of and support for research into hearing loss and tinnitus. Deafness Research UK was set up in 1985 by the late Lord Ashley of Stoke and Lady Ashley of Stoke.

For more information about Action on Hearing Loss’s Biomedical Research programme, visit, www.actiononhearingloss.org.uk/biomedicalresearch
All applications must be received on or before Monday 15 July 2013 (5pm GMT). Further details can be requested further details, telephone 020 7296 8233 or email research@hearingloss.org.uk 

The scheme will support projects up to £30,000 and will be run twice yearly and as always, eligible proposals will be peer-reviewed by experts in the respective fields and ranked by an advisory panel, to be chaired by Professor Alan Palmer, Director of MRC Institute of Hearing Research, Nottingham. Applications are invited from areas including:

- medical devices, improved benefit from hearing aids and cochlear implants

- treatments to protect or restore hearing

- diagnosis of hearing loss

- treatments for middle ear conditions (such as glue ear)

- central auditory processing disorders

- tinnitus.

Deadlines - First round Application deadline Monday 15 July 2013 at 5.00pm GMT - Final decision: October 2013. Second round Application deadline: November 2013 Final decision: February 2014

Thursday, 16 May 2013

The UK is failing our most vulnerable children, says new BMA report

Poverty is one of the main reasons that the UK continues to underperform on child wellbeing and recent changes to welfare policy could set the country back even further, says a major new BMA report, Growing Up In The UK, released today (16/5/2013).

Growing Up In The UK is an update of the BMA’s 1999 report on children’s health and brings together the latest global research.

Although the BMA acknowledges that progress has been made since 1999, it is concerned that some government policies (for example cuts to welfare benefits and social care) could reverse these improvements by hitting the most vulnerable hardest, which would exacerbate child poverty and widen social inequalities. The report highlights research from Action for Children, The Children’s Society and the NSPCC which finds that changes to the tax and benefits system will have a negative impact on vulnerable households.

The BMA report highlights that the UK has moved up UNICEF’s league ratings - it came bottom in the 2007 table3 of child wellbeing among 21 wealthy countries but in a more recent UNICEF study moved to 16th out of 29 countries. However, there is concern that the improved rating may not reflect the current situation for children as the data relates to 2009/10 and does not reflect the impact of policies implemented post the 2010 election.

Chairman of the BMA's Board of Science, Professor Averil Mansfield, says:

“The BMA is particularly concerned that any improvements in tackling child poverty are in danger of being eroded by some government welfare policies. Children should not pay the price for the economic downturn. Every child in the UK deserves a start in life that will help them achieve their true potential. While there has been some progress I still find it shocking that for a society that considers itself to be child-friendly that we consistently underperform in international ratings.”

Other international benchmarks are far from satisfactory, says the report:
the 2012 'Report of the Children and Young People's Health Outcomes Forum' concluded that, despite important improvements, more children and young people are dying in the UK than in other countries in northern and western Europe
in 2011/2012 the highest number of children ever recorded in the UK were referred to local authority care, mainly for abuse and neglect (evidence shows that the future outlook for children in care is not good and the cost to the state is enormous).

A key message from the report is that intervention to improve children’s future health and welfare needs to begin before they are even born. This includes:
providing parenting classes
identifying at risk families (for example those where children will grow up in poor housing or where there is a threat of domestic abuse)
targeting children who will be born into households with unhealthy lifestyles (for example smoking, illegal drug use, alcohol misuse, poor nutrition)
improving maternal nutrition which will lead to healthier pregnancies and babies.

The report says that it is short-sighted to remove funding from health intervention projects as investing money to address the causes of social break down is far more effective than paying for the consequences. There is evidence that the cost of intervening early is much less than dealing with the health and social consequences later in a child’s life - the report highlights how every £1 spent on early intervention programmes for children and families, has been estimated to save £10.

Dr Vivienne Nathanson, Director of Professional Activities at the BMA, adds:

“Since the BMA published Growing Up In Britain in 1999, there have been improvements and these need to be acknowledged. Notably we called for an independent Children’s Commissioner to improve the UK’s poor record on child health and in 2005 Professor Sir Albert Aynsley-Green was appointed as the first Children’s Commissioner for England and he has been a champion of at risk children. However, we need to do more as we are failing our most vulnerable children. It is essential that we develop integrated policies where child welfare is central.”

Key recommendations include the following:
There is an urgent need for a health of the nation’s children annual report to review trends and assess what works best to improve child wellbeing
Tackling the poverty that lies at the roots of most health disadvantages, for example developing evidence based initiatives that reduce social inequalities such as Sure Start and improving the quality of social and other housing
Providing evidence-based parenting courses and raising awareness about the benefits of breastfeeding
Providing education and practical support on healthy eating. This includes ensuring that schools provide nutritional meals and compulsory cooking classes.

Labour must speak up for the poor

Labour must speak up for the poor. It would be easy not to. There aren't that many votes in doing so. The government have been allowed to 'win' the war on benefits. The recent study by the Rowntree Foundation shows that more people are inclined to blame individuals for their  poverty than to consider societal problems as the cause.

Two-thirds (66%) of the public, for example, are willing to believe that child poverty relates to the characteristics and behaviour of parents, compared to the 28% who say it is the result of broader social issues.

Even among Labour supporters there is an increasing view that welfare recipients are undeserving (from 21% in 1987 to 31% in 2011) and that the welfare state encourages dependency – 46% say if benefits were not as generous, people would learn to stand on their own feet, up from 16% in 1987.

Harold Wilson once said that the Labour movement is a crusade or it is nothing. We need that sense of crusade. Poverty in Britain is increasing. This we cannot tolerate. No fair and just society should  allow it. The government talks of fairness in its benefits reform, but hitting the poorest hardest is not fair. The poor are losers in good times and bad. The rich are winners in good times and bad. We need a new social priority. Labour has done little to set the agenda. It is afraid of its own shadow. But the argument can be won, if only it is put. 


Tuesday, 14 May 2013

Towards a new socialist Labour creed?

Socialism is a word rarely heard these days from the lexicon of Labour politics. But does it still have relevance, and should Labour rethink the contribution socialist ideas have to make to modern social and economic problems? I am not 'a socialist', but I do think that where problems are clearly social then there needs to be social solutions. The mistake of  New Labour was to buy too fully into the monetarist, 'free market' perspective of the right. It is a perspective that in the end failed. It was unsustainable. We need new perspectives. Not perspectives that fight old battles, but ones that address new problems. We must start by understanding that society is not simply an aggregate of self motivated or selfish individuals. When Mr Cameron, in opposition, started talking about 'broken communities' it looked for a short time at least that he had understood this. There is such a thing as society and it matters. Sadly, this new social Toryism lasted all but a few seconds, and was never a clearly thought out idea. But Labour needs a new 'socialism', and it needs to demonstrate why it is relevant to modern problems.

There have always been different 'shades' or ideas about 'socialism'. A socialist view that doesn't take account of the changing economic and social circumstances would be fighting old battles rather than new; dealing with old problems rather than those of contemporary society. There is, for example, no particular virtue in state ownership, and state ownership isn't in itself socialism; it is simply state ownership, and as communist dictatorships have demonstrated, it can be as oppressive and exploitative for workers as can privately owned companies. Nationalisation isn’t socialism. Public ownership, if that simply means ‘state’ ownership isn’t in itself socialism. It isn’t even a brand of socialism. It is simply a brand of ownership.

Socialism has a long history in the fight for the freedom of individuals through social justice. Early socialists realised individual freedoms had to be won through social unity and the creation of a social fabric that fosters and supports such freedoms, and gives empowerment to freedom of expression.

In economics, early forms of socialism recognised the function of markets; socialists were in those early days more concerned to establish 'share ownership' by workers and consumers, a million miles from state ownership. The cooperative movement is one such example. The emphasis of the cooperative movement is on share ownership by workers and consumers and the distribution of dividend, which is related to profit, or added value. Early socialists considered the distinction between the investment of capital and the investment of labour as being a false dichotomy; the one was on no consequence without the other. What they argued was that those who invested capital should not exploit those who invest their labour. The capitalist – worker relationship in a capitalist society is exploitative with the balance of power in favour of the capitalist.

These early forms of socialism recognised that production was a social activity and the objective of economic activity was social equity and distribution, rather than profit alone or simply the accumulation of wealth. This I think is the fundamental difference between the 'capitalist' and 'socialist' creed; the objective of profit over 'social equity'. Both, however, can be market oriented; both can see markets as a means of determining how much is produced and distributed. Socialism isn’t antagonistic to markets. It is however concerned with distribution of wealth and the exploitation that arises from it.

Free marketeers argue that 'social equity' is an ultimate consequence of profit, as striving for profit and competition in the markets produces efficiency. They argue that it creates jobs and opportunity. Politics in a democracy has always been about the balance between those two views and where and how the pivot of that balance should placed.

There are also some kinds of social needs for which markets with profit as the motive are not efficient at meeting. Much of health and social care is an example. It is difficult to run health provision as though it was a supermarket. In a supermarket it doesn’t matter if there is a shortage of bananas. In health care it matters if there is a shortage of health supplies. Setting priorities through markets in health would privilege certain kinds of health care over others. Again socialists argue about the balance between private and social health care, not whether there is such a balance.

Where the balance lies depends on the circumstances and the nature of markets and ownership. At one time, in the early days of capitalism, capital was owned by a few identifiable individuals and you could identify 'capitalists' and 'workers'; Marx recognised and argued that the interests of the two were incompatible and would inevitably clash - thus for Marxists, the nature of society was class struggle. Most socialists are not Marxists because most do believe a balance of interest can be struck between the interests of capital and Labour. Arguments in modern socialism are exactly about that balance.



Modern capitalism isn't so clear. Much of modern large businesses are owned not by individuals but by insurance funds and pension funds and a variety of different kinds of shareholders. We now talk more of institutional investors. It begs the question of who the 'capitalists' are. Modern capitalism has more of early socialism in it than ‘capitalists’ would care to acknowledge. The fact is, capitalism has changed and continues to change. Global businesses operating in global markets are economically more powerful than some countries. The economic environment is changing. The way businesses are financed is changing; the way they are run is changing. Indeed we all have a stake in the future of capitalism.

But modern capitalism still concentrates wealth into the hands of the few. It is not concerned with equitability or with fairness in distribution. It deals poorly with poverty, other than marginalising and using the poor as cheap labour.

Raw market ideas see 'society' as simply an aggregate of individual self-interest; the 'common good' if there is any simply comes from the pursuit of that self-interest. But we can see that there are problems that are 'social' in nature and require social solutions. This is clear if we consider those goods and services which we cannot produce as individuals but only through social effort or organisation. Again, we could argue about how much of that there is.

Economic and social priorities are not always in accord. Social prioritising can often mean lower profits. Free markets are not particularly good at setting social priorities. Some priorities may be abandoned altogether if there is little or no margin for profit. This is not to say that profit is not a ‘good’ motive; it simply recognises that it isn’t the only motive of human endeavour or human need.

All societies have a balance between private and societal spending. What differs is the ratio. All societies ‘interfere’ with markets. What differs is how and to what extent. This involvement in the market is often through its own endeavours; the building of hospitals, schools, libraries and other publically funded facilities or services. The state often enters the market where it is clear that private initiative and ‘free’ markets are not providing essential services or facilities, or government might contribute some kind of support or guarantee to a private initiative.

Private enterprise depends upon a social fabric. It also depends on an environmental fabric and an infrastructure, much of which will be provided by public bodies. In all history, governments that neglect this social fabric have ended with increasing street crime and other symptoms of urban decay. The 1980s is evidence enough for that truth.

This why tackling crime and disorder requires social solutions directed at rebuilding communities. It requires decent housing and health care provision; it requires educational and work opportunities. Modern socialism is more concerned with building this social fabric rather than with social ownership.  Empowerment is more significant than ownership. Issues of ownership and the way ownership is exerted should be more a consideration of how best people can take control of their lives.




Monday, 13 May 2013

Warsi's appalling response to tragedy

Here we go again. The government misunderstanding the concept of 'fairness', or at least a government minister justifying a cruel policy on the grounds of fairness. This time it is Baroness Warsi in response the sad news story of a grandmother committing suicide because of the impact of the government's 'bedroom tax'. The lady had to pay an extra £20 per week in rent to remain in the home she had lived in for 18 years, and in which as a single mother she had raised her children. It was money she simply didn't have.   Baroness Warsi saw fit to put this tragic consequence of government policy in the context of 'fairness'. It has nothing to do with fairness.

I have explained in a previous article why this concept of 'fairness' is flawed. It is based on the false premise that treating everyone the same regardless of circumstances is fair. It isn't. Quite the opposite. It is very unfair indeed. Justifying suffering or cruelty on the grounds that others are also suffering has always been a false prospectus. Making more people suffer does little to alleviate the misery of those who are already suffering.

If I find one person with a cut finger, it doesn't staunch the flow of blood if I cut the fingers of others. It simply increases the suffering. That is not fairness. What Baroness Warsi is referring to of course is that those in the private rented sector are already being penalised for 'spare' bedrooms. Indeed they are. That is unfair and it doesn't make it any fairer to punish those in the social sector.

There is that old adage: two wrongs don't make a right. It is one that Warsi and her government colleagues need to understand.

 

NHS hospital mistake - confusion

Some of my regular readers will have realised I have not been able to post much recently because I am unwell. I published an article last week about my experience in hospital refuting the absence of compassion in the NHS. I experienced a great deal of compassionate treatment. But I also saw at first hand some of the problems patients experience in hospital.

One of these was the number of different members of staff coming  in an out of the ward. To say the least it leaves a patient very confused about what they are doing and, more importantly what their position and functions are. You got to recognise a 'doctor' by the fact that they were the ones who didn't wear a uniform. In fact they were rather shoddily attired for the most part. It isn't that they don't introduce themselves, it is simply that a patient, certainly I and others on the ward, can't remember. On my ward it became a joke between us and the staff. They would ask us if we could remember, and few of us could. One member of staff found it very funny, telling us that "Mr Cameron wants us to tell you our names!" Frankly it is the last thing on our minds, yet it is important to know. It is certainly important to know what they are there for.

When a member of staff picks your notes up and starts looking through them it would be nice to know why they are doing that and what right they have to do it. After a couple of days I got to recognise some faces but I still could not recall what they were or did. Of course they wore badges with their names and position on them, but frankly I couldn't see what they said. Some nurses did not introduce themselves before taking my blood pressure. It would have been nice if they had reminded me (I am sure they must have told me at some time, perhaps). "Good morning, I am nurse Natasha Jones (or some such) and I am going to take your blood pressure this morning."  Some of them turned the machine away from me so  I could not see it.  I can read blood pressures; I know what it means. They took the measurement and walked away. Nobody ever told me whether my blood pressure was improving or getting worse, or whether it was going up and down. I would rather like to know.

I could not understand why it was necessary for the nursing assistant to look through my notes. He certainly did not tell me why he had done so, and I only realised he was a nursing assistant later. Frankly I don't want people wandering up and reading my notes without telling me why. In fact I don't want anyone reading my notes without telling me why, unless I am asleep and they have good reason to read them. I don't want anyone approaching my bed without telling me what they are doing there.

Being unwell can be accompanied with a great deal of confusion. But sometimes a patient's judgement is worth its weight in gold. This was brought home during my worst night in hospital when a nurse insisted on giving me an injection I did not want and had not had before and was convinced was not part of my prescribed treatment. I told her I was confused about it. She said I had had the injection before. I insisted I had not. I knew because it was intraperitoneal, injected in my tummy. I had not had that the night before as she had insisted. You had this last night she said. Oh no I don't think so I said. You will have to learn to do it yourself when you are discharged she said. Really? I asked. But nobody had mentioned it before. She gave me the injection and I had the most dreadful night. I had not had the injection before and nor was it on my notes and nor was I meant to have it. It was a mistake. The mistake could have been fatal. It would have been well for her to have listened to me, instead of simply assuming it was I who was confused. Indeed I was, but for the right reasons.  She should have checked. She was confused for the wrong reasons.

But there is another interesting thing about being a patient. It is that you become a patient. You trust the person at your bedside. I became so confused I was willing to believe I was ...confused. I was of course confused by being confused. It is a very muddling experience.

I am very grateful for the treatment I received. So much so that I have not taken further my experience with the mistaken injection. My family want me to take it further to ensure it doesn't happen again. Staff should learn from their mistakes. I am an ardent supporter of the NHS, there is nothing in my experience that has changed that. The staff work under considerable pressure and long hours.


Wednesday, 8 May 2013

Disappointment at omissions of public health legislation in Queen’s Speech

The government U-turn on their pledge to deal with tobacco and alcohol harm and the absence of any health agenda in the Queen's speech received strong criticism today from leading health groups including  the British Medical Association.

BMA Chair of Council, Dr Mark Porter, said he was “bitterly disappointed” that standardised packaging for tobacco and the introduction of a minimum unit price for alcohol were omitted from the Queen’s Speech today (8/5/13), and he urged the government not to shy away from introducing policies that have the potential to save thousands of lives.

He added:

“If the government U-turns on its pledge to deal with alcohol and tobacco related harm, we will have to question its commitment to protecting the nation’s health.

“The evidence shows that standardised packaging helps smokers quit and prevents young people taking up the habit and facing a lifetime of addiction. I am bitterly disappointed that the government has bowed to pressure from the tobacco industry whose only objective is to increase profits by encouraging more people to take smoke and become addicted to their products.

“A minimum unit price for alcohol would result in a decrease in thousands of alcohol related deaths. It is tragic that the government is not showing the courage of politicians in Scotland where a minimum unit price is due to be introduced.

“Ultimately taxpayers pay the price as the NHS picks up the bill for the damage to health and lives lost from tobacco and alcohol related causes.”

Commenting on the Care Bill, Dr Porter said:

“Reform of social care is long overdue and there are elements of the Bill that the BMA supports, such as greater collaboration between health and social care services.

“We note that the government has included new proposals in light of the failings at Stafford Hospital and it is right that there are moves forward to implement urgent and necessary changes. However, it’s necessary to ensure that the solutions deal with the real problems proportionately. There is a need to have better information about health performance and outcomes but there has been widespread concern that the use of ratings is too simplistic to deal with a very complex issue. The BMA will be feeding through these views during the Bill’s passage through parliament.”

Dr Porter also commented on the Immigration Bill:

“We need to see the detail of the government’s proposals to regulate migrant access to the NHS in the forthcoming Bill in order to assess whether they will be fair and workable for doctors and the public.”

Tuesday, 7 May 2013

No absence of compassion in the NHS

A week ago I was taken seriously ill. I was in excruciating pain. I had been ill all day. I had been in pain all day but fighting it because I had work to do. I was performing in the afternoon with the Oxford Trobadors. By the time I got home that evening I realised this pain was not going to go away. I could not sleep. I could not sit. I could not find comfort. I paced up and down feeling nauseous and dizzy. I knew I was in trouble. This was serious. I knew also that I had for so long ignored the early signs. At 5 am I couldn't stand the pain any longer. We called an ambulance.

The ambulance arrived it seemed within seconds and soon I was being driven at speed to hospital. The paramedics were wonderful, skilful and with compassion they reassured me. My blood pressure was very high, but my ECG looked normal. My daughter followed behind in her car. The ambulance crew told me she was with us, calming and reassuring.

There is something surreal about a ride in an ambulance it is as if it is the world that moves while you remain stationary. Soon we arrived at the hospital and it was not too long before I was given something to ease the pain.

The young doctor examined me with skill, respect and...yes...compassion. The nursing staff treated me with respect and...yes...compassion. I was allowed home but to return the following morning for a scan and more tests whilst they examined my blood and urine. With the pain relief I had a comfortable night. But the scan showed it was more serious than had been thought. I was admitted.

It is not necessary for me to give every detail. As a medical ethicist for the first time in a long while I experienced being a patient.

There are many things we could change in the NHS, but my experience taught me one lesson. It is wrong to generalise about an absence of compassion in nursing. The majority of those who cared for me in hospital did just that, they cared.  But there was also skill and dedication. There was no shortage of compassion.