Better Health, Better Care - Anticipatory Care (1)

Collette Douglas Home has written a very thoughtful piece today on the introduction of vaccination for the HPV virus;a virus that can cause cervical cancer in women. This was one of the SNPs promises for health and it is in this particular chapter of 'Better Health'.So all credit to the SNP for bringing it in.

However, I wondered why another common STD was not mentioned, which in its own way can be just as devastating to a woman - chlamydia. This is one of the commonest STDs in Britain, is symptomless, and causes inflammation of the fallopian tubes, leading to infertility.One estimate that I saw was that one in ten women have it.If that is the case then we have problems. But the amazing thing about it is that outside of medical circles, very few people know about this disease. Why?

Some time ago, I had the misfortune to have the tv on when a public health advert came on. It consisted of a guy sitting in a shower crying, with flashbacks to 'the night before'. The theme of the advert was that he had given his girlfriend an STD. But the disease wasn't mentioned, the effects weren't mentioned, treatment wasn't mentioned. It was useless. And here's the odd thing. In an age where we will quite happily have 'FCUK' blazoned across a T shirt that we're wearing, talking about STDs is done in whispers. There is a taboo attached to this subject that there isn't to other areas of sexuality.

There are a number of options for combating chlamydia. One would be to include a swab for the disease along with the cervical smear test at Wellwoman clinics.As chlamydia is symptomless (until it's too late)I would say this is essential. Chlamydia can be treated, and caught early enough,it will not cause infertility. The other thing that the government should seriously consider, is liasing with some of the programme makers for the likes of Eastenders and River City and asking them to run some story lines on chlamydia. It would get the message across in a way that a thirty second advert that's preaching to you, doesn't.

One in four couples in this country now have problems with their fertility. For the sake of our future, we must do something to change this.

Better Health, Better Care- Taking Responsibility (2)

So much for drink. Now onto exercise and sport.
This report concentrates mainly on sport; providing sporting facilities in schools, having two hours of PE every week and so on. But providing sport in schools isn't just about providing facilities; it's also about providing the backing in which sport can flourish.

Back in the '70s, there was lots of school football clubs. On Saturday mornings, when there was matches between them, every official on the pitch got paid for attending. Everyone that is, except the PE teacher. They did not get paid, either in their wage, or on the day, for attending that match. It was a petty economy that proved to be very costly. When the teacher's strike happened in 1985, the teachers went to a 'work-to-rule'. Many of these clubs went to the wall, and Saturday activities in general. The ship was lost for a ha'penny worth of tar.

Again, the rise of child legislation and the associated red tape has led to a drop off in volunteers, especially in sport. It is a high contact activity and unfortunately there are so called 'children' who are very savvy about complaining of abuse if a teacher simply annoys them. A friend of mine was at the receiving end of a complaint like this. His name was dragged through the paper, while the little darling who had complained was not named, becuase they were too young. When the procurater fiscal threw it out, nothing was done about the complainer. If a complaint is patently malicious, then it should be pursued, otherwise we are going to lose all our volunteers. There are few teachers now who will take schoolchildren on a day out or abroad. It's a shame, becuase it means the decent kids are losing out. If we are serious about sport, we have to provide protection for those run the clubs. Adults should be vetted, but it should be made plain to children that if they raise a false complaint, that they will be censured.

One thing missing from this section is exercise. Not all of us do sport, and not everyone is welcome at a gym. But lots of us walk and one area that should be considered in this, is the provision of parks.
Think of a young mum looking after her child. She can't go to the gym, because the child won't be allowed in, and it's probably too expensive anyway. But she can put the child in a buggy and go down to the park. She can meet other mums there.
The same goes for the elderly. They may not fancy going on a treadmill or weightlifting, but they can always go for a walk in the park. They can buy a dog and join the doggy fraternity. I was totally unaware of this, until my mum got a dog and I went for walks in our local park. There is a whole community down there and there's all kinds of spin offs; coffee mornings, sponsored walks, dog training etc. Also,if someone is missing, it's noticed; people in this group look out for each other.
It's not just mums and elderly; our park is popular with runners, because it's a mile square.
Parks are a real asset, but unfortunately, some are getting houses built on them; others are getting sporting facilities that only a small section of the population are going to have access to. We need to revise this.
Also, it's time to bring back park wardens, to ensure that parks are used properly and not as a place to drink or shoot up. Just a small amount of low level supervision in public places would cut out a lot of vandalism, drinking and suchlike and simultaneously free up places that we could exercise and smell the flowers. There you are. The solution to public drinking and lack of exercise in one. How about it, Nicola?

Better Health, Better Care- Drink!

Ok, as the French say, 'nous revenons a nos moutons' or let us return to our mutts. I was going through this document before I was so rudely interrupted by NHS Lanarkshire and a wee trip to Malaysia,(not connected) but now that I'm bright eyed, bushy tailed (and sober) I will tackle the third section of this document which is called ' Taking Responsibility'.

This section of the document deals with what you would call public health issues. Smoking, alcohol, exercise and so on, are dealt with in this section. The title of this chapter begs the question; who is responsible here? The answer ain't simple and this section needs a couple of posts to itself. So I'm going to start with drink.

There are those who will always drink, no matter what you do. There are those who will never touch a drink. But if you want to know if there is a problem with drink you look at the middle section of drinkers; the moderate drinkers. These are the folk who will maybe have a beer or a glass of wine after work, will have the odd blow out of a weekend, but will get a taxi home and back to the grind come Monday morning. Are they in trouble? The short answer is yes, they are. Alcohol related disease is up especially amongst women; so is obesity, which is linked. What's gone wrong?

Here's a challenge for you. Go down to your local supermarket. Imagine for a minute that you have a drink problem. See how long it takes you to find a drink. Was there a display at the front door? Probably. Now, go along to the section where you buy pizza or cheese. I'll bet you a cheeky Chardonnay that there are bottles of white wine to go with them. Now go to the drinks section proper. Try to find a bottle of wine that is under 13% strength. I can guarantee that you will be looking for a very long time. Now try to find a non alcoholic brand. Yep, down at the bottom stuck at the back of the shelf and it tastes like mouthwash. That is one of the main reasons that we are having such problems with alcohol just now.

There is a deafening silence about the role of the drinks industry and the supermarkets in this problem. Just why has table wine gone up in strength from 10%, which was the average a few years ago, to 13%? It certainly doesn't add anything to the taste, unless you like having your tongue scorched with raw ethanol. It is particularly dangerous for women; it means that after only one drink of a very average sized glass of wine, they are over their limit. The whole point of having a legalised drug is that it can be controlled, but it patently is not at the moment.
A number of table wines have gone to 14% and I saw one at 14.5%. That's just 0.5% off a fortified wine. Some very hard questions have to be asked of the drinks industry about this.

And what about the supermarkets? Why are they setting up their stores in a 'C'mon, take a drink' fashion? Cut price boxes of Budweiser at the door, displays scattered at various points through the store so that you couldn't avoid it even if you wanted to and that wee salve to their conscience, 'If you look under 21 you may be asked for ID.' Whoopee. We all know that it's only people under 21 that have drink problems.
Now, I am aware this is turning into a bit of a rant. Perhaps you are chuckling to yourself as you read this. So let's sober you up. Is there anyone out there reading this, that does not have a friend, a relative or a neighbour with a drink problem?
We all know someone. And it's not funny. Something's got to be done about it.
Here's some suggestions.

1. Ban supermarkets from having front door displays. There's no excuse for this. Limit them to having only one place in the supermarket from where drink is sold, so that it's not an obstacle course for people with a drink problem.

2. Get the drinks industry to print the number of calories contained in a drink, on the side of the bottle. This will discourage women from drinking too much, and might even make an inroads into discouraging teenage drinking of alcopops from fashion conscious girls.

3. Don't just charge on broad bands in taxing drink. This means that an 11% wine gets charged the same as a 14% wine. Have some flexibility within the band, so that a wine with a higher percentage, gets charged more tax.

4. Look at local licensing. In Canada, drink only gets sold at a liquor store; nowhere else. That means that teenagers have no excuse to be in the shop, people with a drink problem can more easily avoid their addiction, and their relatives and friends can work out sooner that they have a problem, because they can't shop round to conceal it.

Right, I think I'll go and have a drink..of tea. Cheers!

Knowledge is Power

Am just back from holiday, and have come back to the glad news that NHS Lothian has been forced to disclose the running costs of the Royal Infirmary of Edinburgh. This is very significant; up until now, anything that had 'Commercial confidentiality' slapped on it did not come under the Freedom of Information act, even if it involved the spending of copious amounts of public money. At last we might be able to trace just exactly where all our money is going, and how much is going into the shareholders' pockets.

It wasn't mentioned in the report, but the fact that the 'Save St John's hospital' campaign now has a councillor on the health board, meant that the game was a bogey for NHS Lothian anyway. He would have access to that information, even if it didn't make it into the general public domain. I'm sure that this lead in no small part to the decision to make this information public. So three cheers for The St John's' councillors; this could be a real turning point for scrutiny of expensive and wasteful PPI projects. Prepare to be shocked by the real cost when it comes out.

Quis Custodiet...

Tay health board have just recently come bottom of a 'mystery shopper' survey of health boards, which consisted of people phoning up and asking for various services. They were then marked on friendliness, efficiency, accuracy, etc. Tay board's reaction to this? They have formed a committee. Its name is the 'Conscience Committee' and the people on it are called 'Conscience Keepers' and they are to make sure that Tay Health Board keeps all its promises.
Bet that took a very expensive media committee a morning to think up..

Bad Practice - South Nimmo Takeover

Ok,i've learned my lesson. The last time I started a series of articles praising a government document, the MMC scandal hit the roof. I start a series on 'Better Health, Better Care' and NHS Lanarkshire excels itself. This time it's a GP practice- South Nimmo practice to be precise.

The story goes like this. In March a Dr Carlin retired due to ill health from his practice in Adam St in Airdrie. He had not organised for a partner to take over. In such a case, the responsibility for the practice falls to the local health board. The premises at Adam St needed repair, so Dr Carlins practice was moved to South Nimmo St, where there was another doctor's practice, and a bidding process was started by NHS Lanarkshire.

The practice had been run by locums while Dr Carlin was ill, and two of them, a Dr Ahmed and Dr Shah wanted to bid for the practice. When they asked, they were told that they could bid, but only if they resigned as locums. So Dr Shah stood down as a locum to bid on behalf of himself and Dr Ahmed. He was then told he could not bid, because he was not part of a practice! When the invitations for tenders were sent out, they were sent out to all the GP practices, but Dr Shah and Dr Ahmed were not sent one.

In the meantime, two practices put forward bids. One of them was Wellwynd practice, which is based in Airdrie Health Centre. It already has 15 000 patients and only 4.5 doctors. Airdrie Health Centre is also falling to bits and is overcrowded because several other practices are in there. (By this time, Adam St had been refrbished and was ready to be re-occupied).However it became apparent that for some unknown reason, Wellwynd was the preferred bidder. It was awarded the bid, is not taking on Dr Ahmed with the bid, so that means that at the moment they have 17 000 patients and only 4.5 doctors.

This is the third time that NHS Lanarkshire has behaved in this fashion over a GP practice. First there was Rowallan GP practice, then Harthill, now South Nimmo. Once might be an accident, twice a coincidence; but three? Looks like carelessness to me. We are in a situation where single practices are being subsumed into bigger ones and if I put my cynical thinking cap on, that means they can employ fewer doctors, bring in nurse practitioners instead and possibly even bring in a private company to run the staffing? Bigger practices are more attractive than smaller ones, and the more patients you have on your list, the bigger your global sum. This is money awarded per patient. Wellwynds latest acquistion will bring in £120 000 by my reckoning.

If there are any South Nimmo patients out there, there is a campaign group attempting to take on the health board; their address is http://southnimmo.org/. In the meantime, if you live in Lanarkshire, do try not to fall ill; you'll need 10p if you want to phone someone that cares..

Better Health ,Better Care - Best Value

This is the shortest section in the document, but perhaps the most important. It is all about money; how it is being used at present, and how it could be used better. It also looks at staffing and the spread of services between acute care and primary care.

This is a section that can be read in a number of ways. For example what exactly is meant by this phrase, 'Challenge traditional boundaries between public sector organisations, sharing premises and resources with other organisations where this makes sense.' Does this mean sharing premises and resources with private companies or does it mean sharing with voluntary organisations, such as Maggies or St Andrew's Hospice? And if you share your budget with a private company and it wastes it, how accountable are they going to be? As I said in the previous post, private companies that spend public money, need to be held accountable in the same way as everyone else. That means that information on their budgeting should be publicly available, not filed away under 'Commercial Restriction'.

Further on, the document states, 'Use the contractual levers at our disposal to ensure that patietns and the public purse get the best possible deal from private sector suppliers.'
We should start to look at changing the rules regarding refinancing of PFI debts. This is a practice where the debt is sold onto a concern that offers the loan at a lower rate of interest; millions can be made from this. But the millions go into the shareholders pockets, not those paying the debt.

One important area that is not discussed, is the relationship between the NHS and Social Work. If, as the document states, they want to shift the balance of care from hospital to community based services, then it has got to have an agreed way of working with the local authority. Central government has also got to look at a way of allocating a budget for community care that involves both parties. Primary care budgets in the NHS have a nasty habit of disappearing becuase they are not ring fenced.

This section does touch on staffing issues and perhaps this is a time to consider what kind of model we want for GP practices. If the government does not want private health care providers in GP practices, it is going to have to change the GP contract that allows this option. It is also time to consider how appropriate the introduction of nurse practitioners is in primary care. Nurse practitioners in triage in A&E can ease the strain; if someone can be seen and bandaged, given pain relief and allow a doctor to see someone else, then that is appropriate. But if someone phones up a GP parctice with long term symptoms that could be anything at all, is it appropriate to book them in with a nurse practitioner, as is becoming increasingly common?

Again, in ''Agenda for Change' there are moves to merge the roles of district nurse and health worker. These are two very distinct roles. District nurses do things like wound dressing and 'messy stuff'. Health workers tend to visit families that have children, esp new born babies, and watch out for signs of childhood diseases or abuse. Is blending these two roles advisable?

Finally there is a mention of flexible working hours. This is common sense, especially where care in the community is concerned. Your average care worker is female and has children or a partner that they are looking after. Yet some care companies are considering ending flexible hours for their staff. This would lead to a huge drop-off in available staff. It must be re-considered.

More tomorrow!