Oh, My, Gawd...

I'm speechless..

The Spoon Theory

It's strange how you convince yourself that you have a broad view of things, that you have a wide and eclectic range of friends and that you have an appreciation of every angle in healthcare. And then a new planet swims into your ken.

I was putting on some patient blogs tonight, courtesy of Benefit Scrounging Scum's blogroll and I came across this essay called 'The Spoon Theory'. I have a feeling that it is probably as popular as 'Footprints' is in the religious community, or Kipling's 'If' is in British poetry, but it's completely new to me. I felt like a very small person standing in a very big world reading it. You should read it too.

Another Update

Now, just in case you guys think that I've run out of steam and have thrown in the towel already, to mix my metaphors, I haven't. I've been working my way through some paramedic and nurse blogs tonight; it's just that the blog rolls that I grabbed were very out of date. It made me reflect on my own blog and how many of the links have fallen into disuse. I really need to refresh.

I've run into a lot of American blogs. I really don't want to make a rod for my own back, but I think that I'm going to create an American page as well. This is an important time for US health and it wouldn't be bad to have a snapshot of how it's progressing (or not). And the final thing that convinced me that an American page would be a good idea was this blog, 'Storyteller Doc'

Some blogs make it because they post early and often. Some make it by raging against the machine in colourful vitriol. And some, like this blog, make it because they are quite simply beautiful to read.

More tomorrow.

Mediblog Update 12.10am

Whew!

Do you ever wish you'd never started something? It's 12.10am and I've just finished doing the outline for Mediblog UK and Mediblog Student UK. It's all been a bit of an eye opener.

First, I realise how many blogs I don't know about. I suppose that there's only so many blogs you can look at a day and so many that you'll like, but it's a bit of a surprise. The prize for the most eclectic taste in blogs must go to Angry Medic; I started on the student section of his list; there was about fifty odd on that alone and I haven't even begun on the other sections. *Groan*

Secondly, a lot of blogs have gone defunct. I'm thinking about creating an archive for some of the better ones, like Dr Rant and Dr Crippen. It doesn't seem right that they should just disappear into cyberspace.

Thirdly, I think I've found a vocation. There's something intensely satisfying about seeing the blogroll operating and the activity that's going on all the time in the blogosphere. But maybe I'm just boring..

Favourite blog name of the day? It's got to be 'Extremely Lonely Medical Student'. At the moment it's standing all on its own at 'E' and I'm loathe to put anything with it, it seems so appropriate. One is the loneliest number..

Right, to bed. More blogging and dragging and dropping tomorrow..

Whither Medi Bloggers? Try Here..

Since NHS Blog Doctor retired two weeks ago, there has been a discussion as to where medi bloggers go next and whether it's worth it. There have been discussions as to how many of us there are, and how we make the government sit up and pay attention.

My own reaction to Dr Crippen's retiral was one of guilt. He was the one you could always rely on to post every day, to give informed comment and splendid vitriol that didn't just go near the bone, but sawed right through it. And we sat back and let him get on with it. If we didn't blog, we knew he would. And he would say it far better than any of us. His retiral is like the sudden death of a healthy rumbustious uncle; the one that drinks and smokes and makes the riske jokes and always has the word 'dreadful' attached to his name by prudish aunties. It feels like the day you wake up and all the heat has gone out of the summer.

We all need to try harder now and I have started a new blog in response to some of the questions getting raised. I've been thinking about it for a while and it's based on a model used by other groups on the web. I've called it Mediblog UK and you can find it here.

It's a fairly simple set up. You send me links to medi blogs that you like, and I put them on this site, together with a blog feed. It means we can see at a glance how many sites are active. As soon as you post you go to the top of the blog feed. This way people will become aware of blogs they normally wouldn't know about or read. It means info gets round more quickly and it also means that if several people blog on the same subject, you can get a variety of angles.

I'm going to work on this for the next wee while and refine it. In the meantime, if you want on this, or know a blog that should be here, send it to me and it will be added. It's time to gird our loins and stick together...

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.