Parking Mad

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

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

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

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

A Broken Trust- the Pamela Coughlan Case

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

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

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

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

Two Cows

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

Very Courageous, Minister

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

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

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

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

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

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

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

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

Straws in the Wind

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

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

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

Time For the Grey Revolution

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

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

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

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

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

Time to Clean up

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

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

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

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

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

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

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


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