The Naming of the Dead

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?

Changing the Record - Scotland Enters the IT Debate

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.

Letter from Gosport Campaigners to GMC

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

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."

The Time is Now to Stop the Rationalisation of Madness

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.

The Tobacco and Primary Medical Services Bill (part 2)

So. Is this bill going to close the loophole that allows commercial providers in? Ye-no-ye-no-not-sure is the answer to that question. This was never going to be an easy bill to construct. It involved changing three pieces of primary legislation, and there was a danger that it was going to be in breach of European commercial rules. European commercial law means that if a contract is worth over £180 000, it must go out to commercial tender. There are no exceptions for health, despite health being a public service in so many European countries. The SNP approach to this problem was quite smart; the new legislation proposes that whoever holds the contract for the practice must be a health professional and be involved in the day-to-day running of the practice. The other shareholders must be individuals.This would appear to eliminate the likes of Serco, Tesco, Virgin and other non-healthcare providers of medical services so it's a good start. However, this starts to break down when you see the list of who is considered a 'health professional'. Their definition has been taken from section 25 of the National Health Service Reform and Health Care Professions Act 2002 and reads as follows;

(a) the General Medical Council,

(b) the General Dental Council,

(c) the General Optical Council,

(d) the General Osteopathic Council,

(e) the General Chiropractic Council,

(f) subject to section 26(5), the Royal Pharmaceutical Society of Great Britain,

(g) subject to section 26(6), the Pharmaceutical Society of Northern Ireland,

(h) until their abolition by virtue of section 60(3) of the 1999 Act—

(i) the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, and each of the National Boards for Nursing, Midwifery and Health Visiting, and

(ii) the Council for Professions Supplementary to Medicine and each Board established by or by virtue of the Professions Supplementary to Medicine Act 1960 (c. 66),

(i) any regulatory body (within the meaning of Schedule 3 to the 1999 Act) established by an Order in Council under section 60 of that Act as the successor to a body mentioned in paragraph (h), and

(j) any other regulatory body (within that meaning) established by an Order in Council under that section.

Or to put it another way, just about anyone in a white coat or blue tunic. Which leads me to this question;


What the hell is wrong with a GP contract being just that; a contract for GPs?

The answer lies in the debates around the bill. One of the words being bandied about is 'flexibility'. Having just one model of primary care is restrictive and there should be more 'flexibility' so that health care professionals other than doctors can hold a contract. Rural practices need more flexibility, it's argued, so it should be built into the bill.

I'm not really faulting the SNP here. Labour are breathing down their necks and the Tories have voted against the bill. They don't have much wriggle room. They are also boxed in by the fact that GPs are independent contractors, so the difference between them and say, United Healthcare in law is one of degree rather than kind. It's a hell of a big degree; it's like comparing the local grocer's with Tesco, but legally it's tricky.

So where do we go from here? To Europe is where I would suggest. All the trouble that we are having with this is Europe's refusal to recognise GPs as providers of healthcare in a not-for-profit healthcare system. Its insistence on applying commerical law to universal health provision is seriously mucking up health in not just our country, but in other European countries as well. And we all need to get savvy with Europe and what is going through it and who is responsible. The European Cross Border Directive is next and if that gets through, a whole new battleground in health is going to open. (Btw, it was one John Bowis from Britain who was responsible for it. And the wise guy has now retired.) To sum up; this is a good effort, probably the best that could be done under the circumstances in Holyrood, but I think we will be returning to it at some point. On of the big boys of private health is bound to challenge it and when it happens, we'll have to hope that the government in power is friendly to the NHS. Interesting times..

The Tobacco and Primary Medical Services Bill

The above bill is one of the most important bills to go through the Scottish Parliament in years. On it rests the future of primary care in the Scottish NHS, which makes up 90% of NHS services. It is an attempt to close the loophole in the original 2004 bill, that allowed commercial contracters into GP practices. It has passed stage 2 in Holyrood and now only has to pass stage 3, pending Royal Assent.

So why is so little interest being taken in it?

Of all the responses to this bill (and there are many) only nine refer to part 2 of the bill, which is the bit about GP services. One response from 32 local authorities (South Lanarkshire). Two responses from 15 health boards (Tayside and Dumfries and Galloway). One response from Edinburgh Uni and the Centre for International Health Policy (Allyson Pollock). One response from the BMA. One response from the RCN.One from Community Pharmacy Scotland. One from the CBI. And one from the Ayrshire and Arran GP subcommittee. (There are also individual responses, but it's not clear which part of the bill they refer to). So what's going on?

Part of this poor response is to do with the history of this bill. This is a classic Trojan Horse piece of legislation, where a very popular measure (measures to prevent the sale of tobacco to minors) was coupled with a far more dodgy one (opening GP practices to commercial providers). This made it very difficult to argue against and in the lead up to the bill being passed in 2004, the SSP were the only party to point out the GP bit. The tobacco part of the bill has continued to be a tin can tied to the tail of the Primary Medical Services contract; in reading the debates round the new bill, the irritation on the part of the debaters trying to split their time between two very different subjects is palpable.

Part of it is simply that many bodies are not aware of the debate surrounding the contract. The local authorities, including my own have taken a 'here be dragons' approach to part 2 of the bill and simply commented on part 1. The health boards have no such excuse; they have simply ignored the debate on the PMS contracts and commented on the friendly tobacco bit. I am however, very surprised and disturbed that only one university (Edinburgh) has picked up on the GP contract bit. This indicates that the politics surrounding medicine at the mo is not being picked up on. I don't expect a debate like this to make it into the public sphere that often, but I do expect it to be present in the medical schools of the universities that produce our doctors and on this showing, it's not. So what's happening with the bill and will it close the loophole in the GP contract? Time for another post..