Close Encounters of the Third Kind- the Growing Dilemma of the Voluntary Sector

It's not a good time to be in the voluntary sector in health. Maybe it never is, but two stories have been rumbling on over the past few weeks, which illustrate the perils of being in this sector just now. One is the story of Kinloch Rannoch community, whose GP opted out and then retired in 2006. Tayside Health Board's solution to this, has been to attempt to bring in First Response, a volunteer service that specialises in on-the-spot defibrillation treatment, to replace the GP. Not surprisingly, this has met with a right royal raspberry from the local community. The second story is St Margaret's Hospice in Glasgow, which was asked by Greater Glasgow Health Board to admit a wider range of continuing care patients; not simply people that are at the end of their life, but those with complex mental health problems, and also nursing care patients.St Margarets has refused to do this, and is now looking down the wrong end of a £1.2million shortfall, as GGHB threatens to withdraw its funding.

What is interesting about these cases, is how each organisation has dealt with the NHS. There are three rules for a voluntary organisation that accepts public funding;
1. Know your remit.
2. Know the government's remit.
3. Do not let the two remits coincide, even if it means loss of funding.

First Response has a problem with its identity. It was set up by an RAF pilot, Scott Bateman,after the death of his father from a heart attack. The original idea of it, was to provide on-the spot emergency treatment from a trained volunteer to a patient, while waiting for an ambulance to arrive. They have a strong bias towards difibrillation treatment, and they tend to be centred round RAF posts, which are rural and the volunteers originally came from the RAF. However, things have changed as they have evolved.
First Response now recruit not just military personnel, but civilian personnel called 'community responders'.

First Response are acquiring their own set of vehicles; cars with markings almost indistinguishable from a paramedic's car. They are also setting up a scheme called 'Life Bikes' for operating in connurbations and rush hour traffic. This is a move away from their rural setting.

First Response have been granted the title of 'NHS Partner' and they display the NHS logo on their website.

I do not think that First Response is deliberately setting out to undermine the regular ambulance serices. But I think that the health boards have led them step by step into a situation where they will find themselves doing that, and it has happened because of their inexperience and because they were not clear enough on what their remit was.

By contrast, St Margarets Hospice in Clydebank has never allowed themselves to be mistaken for the health board. They know their remit; to provide specialist palliative care to the dying and judging by these minutes, they are not afraid to say so.

Palliative care comes under the quicksand banner of continuing care for the elderly. This can mean a dozen different things from a long term condition like Alzheimers, to cancer sufferers, to elderly with complex mental health needs. Their life span can be anything from a few weeks to a couple of years. What many hospices do to avoid confusion, is that they simply deal with cancer sufferers and neurological conditions such as Motor Neurone disease. St Margarets is different, because it will take people with other conditions as well, the proviso being that they are in the last stages of their illness.

Glasgow Health Board like other boards, has a problem with continuing care beds, and judging by the number of beds currently being discussed for the new Southern General, is going to have even more of a problem with these type of beds in the future. Hence their efforts to get the hospice to change its remit to what would amount to a nursing home. St Margarets has stuck to its guns, even although GGHB has threatened to remove funding. They have not allowed the health board to dump its responsibilities on them, and have not allowed themselves to become subsumed into a diluted version of professional services.

Perhaps the main difference between St Margarets and First Response, is age. St Margaret's has been going for 70 years; First Response has only been going for ten years. But it needs to heed the wake up call from Kinloch Rannoch if it is going to survive another ten. As for St Margaret's? Well, it's run by nuns. As Fr Jack probably didn't say; be afraid, Tom Divers. Be very afraid.

Big Brother is Watching You

First the good news. Richard Branson the bearded one, has decided to abandon his efforts to enter healthcare for the time being, Pulse reports. He says the reason is the current economic downturn and that this is the wrong time to be heading out on a new venture.

Now the bad news. The government is considering giving access to the computer records containing the postcodes, addresses and medical conditions of every man, woman and child in England. They have made the rather quixotic concession that a medic will have to have permission from the patient, but those outside the NHS will have access.

The most prized commodity in commerce is information. And this is the kind of information that companies like Virgin will need, to run private health concerns. This is already done to a certain extent through loyalty cards in supermarkets; these record what you buy and compare it to your 'customer profile'. This information is used by the supermarkets themselves and is also sold on to medical companies, insurance, holiday operaters and all manner of businesses. But at least there is a certain amount of agreement involved. You don't have to enter into the loyalty card scheme if you don't want to. And the supermarket only has access to those who already shop in their store, so it has limits.

This idea, however,is in a completely different league and completely outrageous. Perhaps the most disturbing thing about this report, is that it is short and low profile. I sincerely hope that the media give this idea the kind of bad publicity it deserves and doesn't wimp out on challenging the government on this. The information age and big brother is truly upon us..

Scotlands Drink Problem in Pictures

Do you want to know why Scotland has a drink problem? You need look no further than you r local supermarket. This is the scene that greeted me at Tesco yesterday;















Yep, right at the entrance. Three big bins that you can't miss; make it wine, because more women shop in here than men. Put it on the right hand side; most folk are right handed and it'll make it even easier.

Ok. I want to buy a wide screen telly. Oh, there's some wine that I can buy instead. What was it I wanted?
















I promised wee Jamie that I'd get him a pair of roller skates. Oh, there's some wine next to them; really convenient, that'll go well with the skates..




















Right, some bacon for breakfast and a morning snifter to wash it down..

















Nothing like a cheap lasagne full of hydrogenated fats to go with some Chasse du Pape.



















Right, I'll get some ice cubes for the Coke and lemonade that I'm buying. Oooh, wonder what ice cubes are like in wine?
















Why do we have a drink problem? Why is the number of women with a drink problem increasing? Send to Johnny Tesco Walker,The Ministry of the Bleedin' Obvious, Chardonnay Aisle, St Budweiser's-in-the-Square, Glasgow PST ASA NEWT. And the prize is a bottle of wine..

Don't Worry - Be Happy

Coatbridge, where I live, is famed for many things. It has the highest rate of heart disease in Western Europe, is the home of deep fried Mars bars (could the two be connected?) and was given >the Carbuncle award (unfairly in my opinion) for worst town. However, things are looking up. Monklands (of which Coatbridge is part) has just been named in the top five 'happy' places in Britain. So has Cumbernauld and Kilsyth.
This conclusion was reached by a research team from Sheffield and Manchester universities, who took data from the British Household Panel Survey and used it to draw a 'happiness' map of Britain. This involved questions about peoples' sense of wellbeing, coupled with data about employment and environment. I haven't been so pleased since Albion Rovers came top of the league (the third division league, that is.)

Ps Cumbernauld and Airdrie (the other half of Monklands) have also won the Carbuncle award for worst town. Is there a connection between concrete and happiness?

Take a Drink?

I was on the NHS media monitoring site, when I came across this intensely depressing article about a child with Korsakoff's syndrome, (alcohol related dementia). Scotland has the highest rate of this disease and already has two nursing homes dedicated to younger sufferers of this, in Glasgow.

There's many reasons for our national drink problem, which I have discussed in other posts. But what worries me, is that guides to how much we drink are out-of-date. For example most of them base their calculations for wine on a 125ml glass at a strength of 12%. What most people are being served, is a 175ml glass at 13%. To give you an idea of the difference, look at the picture here. The glass on the left has 125ml, the glass in the middle, 175ml, and the glass at the end, 250ml.If you drink a 125ml glass at 12%, that is 1.5 units. If you drink a 175ml glass at 13%, that is 2.3 units.

I want people to enjoy themselves. But I also want people to be safe and healthy. So I'm putting this link, Drink Unit Calculator in the blog list, so that you can check how much you're really drinking. We really need to take responsibility for our health, and watch out for those in our company who have a drink problem and help them. Only when the culture changes and it's acceptable for people to take a soft drink without it being remarked on, will we really get to grips with this problem.

And Now for Some Good News

The Vale of Leven is back in the news again, but this time for a good reason; Greater Glasgow Health Board have agreed to retain its maternity services. And the Highland doctor who said some not-nice things about Dame Carol Black has had his suspension lifted. My only regret is that I would really have loved to have heard the case for the prosecution at the GMC hearing. Conduct unbecoming? Insubordination? Using foul language? Speaking what everyone was thinking? You wouldn't have been able to hear the evidence above the roars of laughter. Oh well, merde happens, as they probably don't say in France..

When You are Old and Grey and Full of Sleep..

This was going to start out as a natty wee post about the naff 'ageism' campaign that the Scottish Government is running just now (see above). It was going to be about how dementia funding has halved, nursing homes are shutting and health visitors and district nurses are going to be merged into one, to the detriment of the very young and very old. That is, until I heard the radio equivalent of this advert, where a young man is in the post office and an 'old biddy' is holding up the queue.He is muttering about what a pest she is, until he realises that the old biddy, is in fact his gran. My stomach did a flip at this advert. Why? Because it took me back two years ago, to when my aunt was in hospital. I had been going up to visit her, and one day when I went up, she had been moved to another room in the ward. I had walked past the room without recognition; she was just another old lady. When I was re-directed,I realised with a shock that that was exactly what my aunt was; an old lady, but it was the first time that I had seen her like that. She had just always been my aunt.

There's always been a separation between the young and the old. And the old and the very young have always been discriminated against. We pride ourselves on having progressed in this area, and certainly a lot of the casual ageist comments have gone. But what is underneath? Are we progressing, or has the separation, in fact become greater?

Let's take a look at the two professions that look after the young and old; parents and carers. Now imagine that you are one of these; that is all that you do. You are in company and someone asks what your job is. How comfortable would you feel in replying? And how much would you bet that someone would say, 'So you don't work then?'

Parenthood and being a carer, are two jobs that are admired in public and despised in private. Everyone acknowledges that they do an essential job, but noone wants to be the one to do it. Those who do, are regarded as losers who did it because they had no other choice in life. Who wants to look after screaming kids or old biddies, after all?

Why is it that we think this way? Why do we have nothing to offer them and feel that they have nothing to offer us? Without children we don't have a future, do we? And we all grow old, don't we? Are any of us looking forward to sitting in chairs in a home, being bawled at by nurses who think we're all deaf (and stupid?) Why do we think that's good enough for the elderly at present?

I still think this advert is naff. I do not want it to become a substitute for proper funding of care. But I do think there is a grain of truth in it. We need to look at our collective soul and ask if our society is losing its humanity, or if we can still see that life is more than food and the body more than clothing.