Welcome to the new NHS

Austerity and rationing: two words which are strongly reminiscent of Second World War years. However, add to them the phrases postcode lotteries, cut-backs, and year-on-year savings and one is rapidly brought into the modern day. A further phrase, the ‘Nicholson Challenge’, is one more familiar to those working within the National Health Service; nonetheless, it has the power to impact upon us all. For the NHS, the Nicholson Challenge is a descriptive phrase that sums up the biggest ‘efficiency drive’ in its entire history.

By the year 2015, the NHS is expected to have found at least £20 billion in savings. At present, that means reducing budgets by 4% per year. In an organisation that is already struggling to meet demands for health care for an increasingly aged population, incorporate the latest treatments, allow access to new drugs, and extend provision of trained staff (e.g. consultant cover at weekends), the savings are not easy to come by. To a great extent, that has been a driving force behind the new Health and Social Care Act; the remorseless reduction in administrative personnel (by closing Primary Care Trusts) and the drive to increase the managerial input from GPs.

‘Putting GPs in the driving seat’ may seem like a catchy, vote-winning strap-line to the latest reforms; in reality, it is ‘GPs in the firing line’. Those difficult decisions about whether a new drug or service can be offered to patients will now need to be taken by your GP through an organisation called the Clinical Commissioning Group (CCG). Many patients will understandably think that is good on the grounds that doctors are supposed to act in the best interests of the patients. The problem for GPs is that, in today’s austere financial climate, restrictions on prescribing have probably never been so great, and they are going to get worse. As a professor of public health research and policy recently told a conference of doctors, ‘you haven’t got any idea what is coming your way; it’s goodbye to professional autonomy’.

The latest news from the Department of Health is that the 4% efficiency drive will need to continue beyond 2015, which means a downward pressure on GP drug budgets for a decade. It is therefore understandable that CCGs greet the arrival of new drugs with dismay rather than clinical excitement. The situation is not helped by the NHS Constitution stating that ‘patients have the right to drugs recommended by NICE for use on the NHS, if your doctor says they are clinically appropriate’. Unfortunately for GPs, NICE (the National Institute for Clinical Excellence) makes its decisions on the grounds of drug effectiveness, not whether the NHS budget can afford it.

One recent example has been paraded widely in the national press. Dabigatran is a new drug that may offer an alternative to warfarin therapy for conditions such as deep vein thrombosis. In many ways, this would offer several advantages to patients and doctors. However, the price tag is steep. It has been estimated that its use will force drug costs up by 20% (£10 million pounds per year in some areas of the country). Set against the need for 4% savings, such a threat to the drug budget is causing widespread alarm, and CCGs are desperately looking at local prescribing policies in order to restrict the use of dabigatran.

The Health and Social Care Act may be here and GPs may well be in the driving seat, but the NHS is on a one-way track; attempts to turn it are equally likely to derail it and now that will be the doctors’ fault, not the politicians’ doing. The danger of failure is the imposition of large corporations in providing commissioning support, with private control of prescribing and referrals; welcome to US-style medical care.

There can be little doubt left that, as GPs, we are now firmly placed between that proverbial ‘rock and a hard place’.

(First published in the Scunthorpe Telegraph, Thursday, 12^th April 2012)

Is the NHS now on Death Row?

At the time you read this column it will be just over one month since the Health and Social Care Bill was passed by the House of Commons. It may be that the Queen has since added her signature and this badly thought-through piece of legislation has taken its place within the laws of our land, despite the collective opposition of most senior health colleges and organisations. Castigated by many for my early, publicly expressed opposition to the proposals, I am now metaphorically deafened by those who have awoken too late in the day to the reality of the destruction to the integrity of our National Health Service that this political axe now threatens.

However, we are where we are and, as with all previous NHS upheavals, those who are already tasked with providing the majority of the health care in this country will roll up their sleeves and try to make a silk purse out of a sow’s ear. I speak, of course, of the General Practitioners; those without whom the foundations of the NHS would simply crumble. I say that, not because I am a GP, but because it is a fact that 80% of health care is performed in General Practice. We are, in effect, the front line of the health service.

That said, it will probably come as no surprise to you if I say that the front line is under siege. The pressures on general practices around the country are already overwhelming, and the bad news is that it is about to get worse. If you have difficulty in getting an appointment to see your GP, thank the government for the mess they have created for us all. Not only are GPs already having to spend many more hours per week in running the health service (not forgetting that the Government shamelessly started to dismantle Primary Care Trusts even before the Bill was passed by Parliament), but a lack of investment in General Practice has left it in a perilous state, with smaller practices facing the potential prospect of closure, and larger practices having difficulty in recruiting new doctors as partners or associates. Even locum doctors are a fast disappearing commodity.

Across the country, an additional man-power crisis is looming. 10% of GPs are over the age of 60. In London, the figure rises to 38%, and in the West Midlands it is around 17%. Coupled with that, many GPs in their 50s are looking to an earlier retirement than previously planned; mainly as a direct result of the effect of Government policies on workload, reduction in primary care funding, excessive taxation and unwarranted meddling with pensions. However, recruitment to general practice has been flat since 2010 (running at a ‘growth’ of 0.2%). With the deepest of respect you, as patients, can complain all you like to our practice managers, and we as doctors can say ‘sorry’ as often as you can stand hearing it. However, without significant re-investment and the instigation of an immediate policy for creating more GPs, the situation is only going to go from bad to worse. As it is, general practice as you know and desire it to be is not presently sustainable for the longer term. In truth, the cynics amongst us wonder if that is really the Government’s ulterior motive. The Secretary of State for Health has now won his way; the question is at what future cost to the health of us all?

(First published in the Scunthorpe Telegraph, Thursday, 5th April 2012)

Reminiscences on a Train

It is raining.

Flecks on the glass become droplets,

coalesce into rivulets, turn horizontally

and gather pace as

the train outraces the rain.

The shower becomes a downpour,

then a storm. Spouts of water

bounce off passing streets; torrents 

gush from downpipes, overpowering gutters, 

converting roads to rivers. And 

with each moment the scenery changes;

the years roll back, until I sense the

cold, biting wind of a Yorkshire dale;

your hood-framed face smiling through

a curtain of dripping water.

I hear, too, the wind raging around

a cliff-top cottage on Lundy Isle,

as you sip wine by candlelight;

and I sense the humidity as you shower

outside amidst the heat of a Maldivian storm.

With every cloudburst, the dust

of the years is washed away, revealing

memory after memory until the

scene settles on two stone steps

within a Lincoln doorway, framing

an umbrella,

and two people, twenty years younger;

and I know the intensity of that

rain-soaked moment when

I knew.

© Copyright Robert M Jaggs-Fowler 2011

Growing up is hard to do

I think the line ‘growing up is very hard to do’ was part of the lyrics from the song ‘Heart of Gold’ by The Kinks (a 1960s London rock band, for those who think history is anything that happened before 1980). If having an octogenarian father who believes he is a perpetual teenager wasn’t enough proof of that proclamation, three recent conversations most certainly proved the point.

The most recent involved a professional conversation with an eighty year old lady, who declared upon leaving my consulting room that there was nothing wrong with her that a young man couldn’t fix. Unfortunately for that particular spirited lady, the local NHS budget doesn’t presently run to the provision of such therapies; at least not at present, but who knows what may be round the corner with the new Health and Social Care Bill?

Reversing in time, the second conversation was one overheard in a village pub in the Yorkshire Dales last week. Please picture two octogenarian men, both wearing cloth caps and tweed jackets, sitting at a small wooden table, and each supping a pint. In walks a third such character, with a profusion of hair protruding from beneath his cap and obscuring his collar.

           

‘You need a haircut, George.’

           

‘I had one last September,’ came the reply.

‘Just how old do you think you are?’

‘76 next birthday.’

‘Ah, a mere youngster. That’ll explain it then.’

However, those two conversations just added to what I had already perceived closer to home one month ago. The occasion was dinner with a friend, who is normally a respectable, suited, high-powered business man. For the sake of clarity, he is in his forties and I am in my fifties. We were dining in a rather splendid establishment in East Yorkshire when the conversation turned to an ‘App’ called ‘Foursquare’ that one can download for mobile telephones and other such devices. It allows the user to ‘check-in’ to wherever they are. This in turn allows their friends to keep track of their whereabouts. Points are gained for every ‘check-in’, and there is a table ranking one’s friends in respect to their week’s activity. In addition, if you have checked in the most times to a particular location, you become the ‘Mayor’ of that establishment; a fact that is then made known to the entire electronic world via Twitter, Facebook and any other social networking facility available. It is rather pointless and somewhat childish. It is also exceedingly good fun, and had us both near to hysterical laughter; especially when my friend discovered that I am now the Mayor of the Elsham Railway Crossing and also the Barton Recycling Plant.

Traditionally, 18 is considered to be the age we become adults. However, a survey by the financial company Scottish Widows concludes that we are more and more delaying taking on the roles and responsibilities of adulthood. Apparently, half the population didn’t feel like responsible adults until they were 25. More intriguingly, 49% of those who don’t presently feel like a grown-up think they will never do so.

The population of our country may be an ageing one, but it would seem that there is proof that the aged are getting younger, in mind as well as in body. As Bernard Baruch (American presidential adviser) wrote in Newsweek in 1955, ‘To me old age is always fifteen years older than I am’. It would appear that his concept has firmly crossed the Atlantic.

(First published in the Scunthorpe Telegraph, Thursday 29^th March 2012)

The Book of Genesis Guide to Pensions

I recently set myself the challenge of reading the entire Bible in preparation for a Master’s degree in Spirituality, Theology and Health.  Of course, I have read it through before; twice in fact; once when I was in my teens and again in my twenties. Thereafter, I have only dipped in and out according to need or the time of year. This time I am aided by a version called the Bible in One Year, which neatly divides it into 365 manageable chunks.

The first thing that struck me as I commenced my literary marathon, apart from being reminded of the difficulty presented by certain Hebrew names, is that Old Testament characters lived to an astonishing age. For example, we are told that Adam lived 930 years and Noah managed 950 years. Abraham only managed 175 years, but that is still fairly good going by today’s standards. Theologians will no doubt be able to explain this in scholarly terms. However, having read the latest dietary advice from HM Government, I have developed a theory of my own; but more of that later.

There is an old saying that proclaims ‘you are what you eat’, and we increasingly have the evidence to support such a bold statement. Few of us now cannot know that we should avoid unsaturated fats, reduce our cholesterol intake, increase dietary fibre, eat at least five portions of fruit and vegetables per day, moderate our alcohol consumption, and stop smoking if we hope to live to a healthy old age. It seems that the maxim ‘an apple a day keeps the doctor away’ is no longer enough for the modern era.

The latest exhortation from Westminster is that many of us still eat too much red meat. Of course, red meat has featured in the British diet for generations. Roast beef, lamb shank, steaks, sausages, bacon, burgers; they all feature high on the communal list of our nation’s favourite dishes. Changing such entrenched habits can take a lifetime. However, the truth is, not to do so can also cost a lifetime. The evidence is mounting, and in today’s parlance, carnivores are not cool.

The proof is in a paper recently published in the Archives of Internal Medicine. Researchers studied 100,000 people over a 28 year period. In so doing, they came to the conclusion that every 3oz of red meat eaten each day increased the risk of dying from cancer by 10% and heart disease by 18%. Processed meat holds even greater risks: for every two slices of bacon or one hot dog, the risk rises to 16% in respect to cancer and 21% for heart disease.

Scientists have for a long while studied what is generally known as the Mediterranean Diet, and have shown that this may well hold the secret to good health and longevity. Rich in fish, chicken, beans, nuts, fruit and low-fat dairy products, the Mediterranean diet does not contain a high percentage of red or processed meat; which brings me back to the Book of Genesis.

We know from the Bible that the diet of 4,000 years ago was typically composed of fruit, grains and fish; the ‘fatted calf’ was a precious commodity and as such was only killed on religious feast days and for other special celebrations. In essence, the likes of Adam, Noah and Abraham followed an ancient version of the Mediterranean Diet. Now, Biblical scholars may well show that there are disparities in the way they measured and recorded time in those days. However, one thing is for certain, the health of our early ancestors certainly seems to have prospered in the absence of a diet rich in red meat. It has just taken us a long while to remember that fact. So, if the Government wants us all to change our habits, perhaps the pension companies should also be warned to adjust their actuarial tables and take into account the Old Testament effect.

(First published in the Scunthorpe Telegraph, Thursday, 22^nd March 2012)

Space

It all started when I looked up to a clear night sky this week and was captivated by the proximity of Jupiter and Venus; two very bright planets surrounded by a myriad of small stars in a black sky of nothing much else. That led me to thinking about the subject of space, both in terms of the universe, and also at a more down-to-earth level in respect to the space between us as individuals; that ‘area of unoccupied ground’ as the Oxford English Dictionary describes it.

Space is very important; it gives structure and meaning to things. For example, without the small spaces between these words, you would not be able to easily read what I have written. Art galleries use space to display their works of art in a manner which can be appreciated; small objects often have a vast area between them and the next artefact, and this emphasises the beauty or intricacy of the item concerned. We also see space utilised in public, often with large garden areas, squares or parkland around important buildings in order to accentuate the grandeur of those buildings.

As individual human beings we also have a need for space. Whether it is the space around your favourite chair at home, your desk in the office, the nominated area of the car-park with your name on it, or that bit of the beach temporarily claimed for your family, we cherish those defined areas and easily become perturbed if something happens to erode that personal territory.

For humans, psychological spaces are equally important. Most of us understand that ill-defined distance that needs to be kept between two strangers if we are not to appear threatening to, or to feel threatened by, the other person. Being invited into that personal space is a sign of accepted friendship and increased intimacy. A hug or a kiss requires crossing that no-man’s land between you; a process which, in its infancy, is often a highly charged moment whilst each person weighs up the other person’s reaction to the apparent intrusion.

However, the opposite is also true. When people are too tightly bound to each other, it is possible for one or both to feel constrained and restricted; we speak of ‘breaking free’ from a relationship, or use phrases such as ‘I need some space’. It is notable that the dictionary also defines space as the ‘freedom and scope to live and develop as one pleases’. In ‘The Prophet’, the Syrian writer Kahlil Gibran, considering the subject of marriage, said ‘let there be spaces in your togetherness’. Just as with trees in a forest, human beings need space to grow and develop within a relationship. We also need space to be seen as the individuals we all are; just as with the objets d’art in the art gallery, or important public buildings.

Yet, though space is important, it can also work against us and cause social divide. The act of inviting someone into your space can be an important act of friendship. Such actions can even help to break down barriers between cultures and communities, and help to remove a sense of isolation that people often feel in the most crowded of places. Reaching out to someone from a different culture or social background, making contact across that psychologically dividing space, can have a profound impact and change lives for the better. ‘I was a stranger and you welcomed me’ wrote St Matthew in the Bible (chp.25, v35).

So, just a few moments of staring into a night sky led to several hours of re-evaluation as to how I see and treat the space around me. Do I have enough personal space to psychologically grow, and do I allow sufficient space around others that they might do likewise? Am I too protective of my space, erecting barriers to keep people out of it? Do I do enough to welcome people into my space? These are important questions if harmony is to exist within our lives and relationships. Space may be an area of emptiness, but I suggest that it is also one of our most valuable commodities, being worthy of our respect and consideration.

(First published in the Scunthorpe Telegraph, Thursday, 15^th March 2012.)

The Ultimate Charitable Donation

For many years, I have had the great fortune to travel widely in the world. However, on several continents I have very sadly been witness to a dissonant contrast between rich and poor within the same country. The scale of such poverty is fortunately far beyond what we now see within our own country, and almost has to be seen to be believed.

What has often struck me most in such situations is the manner in which the richer members of the given society almost blindly ignore their starving, ill and dying neighbours. Although opulent wealth, mansion-style houses, serviced swimming pools and expensive cars sit cheek-by-jowl with crowded slum dwellings in shanty-style townships, there is little evidence of organised relief from the rich to the poor. It is almost as though the high walls and fences that divide the two disparate populations form an invisibility cloak, allowing the poor to see the rich, but not the converse. As a result, the rich throw large quantities of unwanted, but perfectly edible, food away, not thinking to donate it to their neighbours and thereby perhaps salvage a human life or two. Meanwhile, the poor and destitute can only look on with pleading eyes and outstretched hands; watching helplessly, whilst what they need most is wasted and ruined in landfill sites or rubbish incinerators.

Sometimes the distressing images are shown on our television screens, albeit sanitised by distance and, quite significantly, the lack of smell. The immediate impact on our senses and emotions is therefore reduced. However, we still usually profess a sense of indignant shock, fuelled by the sight and knowledge of what is happening; often with a profound sense of disquiet and a resultant desire to help.

To our shame there is a poignant analogy in this country, which we choose to ignore. For us, it is not so much food that is blatantly thrown away in sight of those who are desperate for help in saving their lives; it is our bodies – our hearts, livers, lungs and kidneys; organs that are of no use to us once we have finished with them, but could be the difference between life and death for our still living, but seriously ill neighbours. Instead, many of us ignore their pleas for help and choose to bury perfectly good, functional organs in cemeteries or submit them to the incinerators of the crematoria. The analogy between our actions and the foreign scenes described above cannot be ignored.

In the UK alone, there is a 7,800-strong transplant waiting list. Sadly, every year some 400 people die in A&E departments without attempts being made to utilise their organs. Even sadder is the 35% refusal rate amongst families who are asked if their loved one’s organs can be retrieved. However precious that person was in life, their organs are no longer any use to them; but they could save the lives of up to four or more other people. Not to offer the organs to those in need is akin to throwing away a decent meal in front of a starving man.

As a result, the BMA has re-opened the debate on whether organ donation should be made compulsory, with the possibility of keeping dead bodies artificially ventilated until the organs can be retrieved. Clearly, this is a controversial move and will no doubt spark an intense ethical debate. It is, however, a debate that is urgently needed. Shamefully, many more of us say that we would be willing to receive a donated organ than would be prepared to donate our organs after death. That is a disparity which has to be morally wrong and we need to work hard and fast to alter our society’s double-standard and ensure that our own death gives life to those who still have a chance to live. Society may not be ready for the BMA’s debate, but it is one which is long overdue and must be had. After all, organ donation is the ultimate in charitable giving. For more information call the donor line on 0300 123 23 23 or go online to http://www.uktransplant.org.uk

(First published in the Scunthorpe Telegraph, Thursday, 8th March 2012.)

Cat Naps, Seasons and Body Clocks

‘The woods are lovely, dark and deep, but I have promises to keep, and miles to go before I sleep.’

The words of the poet Robert Frost will ring true for many readers who stretch the working day into the dark hours whilst others sleep. However, not even the most hardened workaholic or insomniac can run in the fast lane without the occasional pit stop. Our bodies are influenced by a circadian rhythm, whereby we experience a dip in our state of alertness twice in every twenty-four hours. This produces a state of sleepiness at some stage during the afternoon, bringing the urge to ‘cat nap’. The good news is that research has shown that the performance of those who sleep for less than six hours at night and then power-nap during the day is as good as those who sleep for longer at night. Indeed, a post-lunch nap improves work performance into the afternoon and early evening.

The circadian rhythm is influenced by how hungry we are. Our bodies have a mechanism whereby the brain keeps us alert when we need food; a mechanism which switches off when we have satisfied our hunger. That is a second reason why the urge to nap in the afternoon is irresistible for many, and explains why we have trouble sleeping when we are hungry.

However, our body-clocks have a greater influence than just affecting our state of alertness. The author Ernest Hemingway was showing more insight than he realised when he half-jokingly said ‘I love sleep; my life has a tendency to fall apart when I’m awake’. It is estimated that the body-clock controls some 15% of the activity of our genes; which means that disruption of the body-clock can affect a long list of bodily functions apart from sleep patterns. Our metabolism is very sensitive to such alterations, with the effect that insomnia, mood changes, heart disease, cancer and disorders of the brain can result. Because the body cannot fight infection until it recognises that one exists, we are more prone to infection at times of day when our metabolism and wakefulness is at its lowest ebb. Interestingly, research has shown that patients with septicaemia (blood poisoning) are at greater risk of dying between 2 a.m. and 6 a.m. This has in turn started scientists looking at what the optimum time is for antibiotic administration in order to fight infection with greater success.

When to give medication is also a question in respect to heart disease and high blood pressure. Both of these conditions are linked to high levels of a chemical called aldosterone. The latter is affected by the circadian rhythm, which means that drugs controlling blood pressure may be best targeted at specific times. Death in the early hours is an occurrence well known to doctors and funeral directors; and for those living near natural waterways, it is noticeable that the time of demise often occurs when the tide is out. Given the various research we are commenting on, this is perhaps not such a daft observation as previously thought.

Finally, the seasons also play a part in our well-being. Once again, research has found that blood pressure is better controlled during the summer, with the rates of heart attacks and strokes being higher in winter. This may not be just because of the cold weather, as people tend to exercise less, eat more, and increase weight during the winter. Diets during the winter months also tend to be higher in salt content.

All in all, it is increasingly clear that there are forces at play which influence us in more ways than previously imagined. Our individual lifestyle is a key factor, and armed with the knowledge of such research as above, it is open to us to take measures which may have a profound effect on our well-being. As Leonardo da Vinci said, ‘a well spent day brings happy sleep’. It may also bring health and a long life.

(First published in the Scunthorpe Telegraph, Thursday, 1st March 2012)

Decisions, Decisions, Decisions...

‘An empty book is like an infant’s soul, in which anything may be written. It is capable of all things, but containeth nothing.’

So wrote Thomas Traherne in the 17th century. Sadly, a converse situation arises for many older people. We end up as a full book but, for some, the capability to do anything in a meaningful or reliable way starts to wane and mental incapacity is the result.

Whilst well, we take mental capacity for granted. Certainly as adults, we decide for ourselves what time to get up in the morning, which clothes to wear, what to eat, where to go, how to spend our money, and so on. This is called ‘capacity’. Capacity means that we can make our own decisions in our own best interests. It is something which is considered a ‘right’ and is protected in law.

By ‘mental incapacity’ we mean the inability to make our own decisions. The causes are many, although the commonest for the elderly is dementia. That said, there are also conditions which affect younger people and affect their capacity to make decisions; congenital disorders, brain damage at birth, head trauma due to accidents, brain tumours, mental illness, severe physical illness, and the effect of drug or alcohol abuse are examples.

For some people, the loss of capacity may be a temporary state of affairs; for others it is permanent. Whichever the case, the loss of capacity can have a devastating effect on our lives. During such times, we rely on those we trust to make decisions on our behalf. However, there are some decisions which even one’s next of kin cannot take without the legal authority to do so.

In 2005, a law was passed called the Mental Capacity Act. The law is intended to protect a person who lacks capacity, and thereby ensure that decisions continue to be made in that person’s best interests and in accordance with what their own wishes would be if they were still able to make decisions for themselves. Five principles underpin this law. The first is that a person is assumed to have capacity unless proven otherwise. The second is that any decisions made on a person’s behalf must be as close as possible to what that person would have wanted. The third principle is that, wherever possible, a person should be assisted in making a decision for themselves (for example, by using very simple language or a different form of communication to explain the issue). The fourth principle is that a person has the right to make unwise decisions, as long as they understand the effects of such a decision. Finally, any decision made for a person should be the least restrictive and cause the least disturbance for that person.

Capacity is tested by the application of four questions: Is the information understood? Can the information be retained long enough to make a decision? Can the information be weighed up? Can the person’s decision be communicated in some way? The answer must be ‘yes’ to all four questions to prove capacity.

If a person lacks capacity, they need someone to act on their behalf. Many people will legally appoint a person to do this. That person has ‘Lasting Power of Attorney’. However, such a person can only be appointed whilst someone still has capacity. If no such appointment has been made, the person lacking capacity is protected by the Court of Protection, which will either appoint someone to act on behalf of the affected person, or will directly make decisions on that person’s behalf. Naturally, it is better if we appoint someone we know and trust, so we should all be granting a Lasting Power of Attorney to someone whilst we still have capacity, and regardless of how old we are or whether we are currently healthy or unwell.

A helpful leaflet on capacity can be downloaded from the Royal College of Psychiatrists’ website at http://www.rcpsych.ac.uk/mentalhealthinfo/problems/mentalcapacityandthemental.aspx. Further information can also be obtained from the Alzheimer’s Society, Mencap, MIND, your solicitor and GP.

(First published in the Scunthorpe Telegraph, Thursday, 23rd February 2012)

Medical War Zone

In 2000, I retired from the Royal Army Medical Corps. However, reading through this week’s medical journals, I had the distinct impression that I should be taking my uniform out of the mothballs; for it appears that a war is even now taking place; one that I am firmly embroiled in, whether I like it or not. The battle ground is the National Health Service, and it currently has several open fronts.

The most important issue is the saga of the Health and Social Care Bill, which at the time of writing has just entered the Lords for its final stage there. As readers of this column know, I originally voiced serious concerns at the content and intention of this Bill in one of my earliest columns back in 2010. At the time, I was one of the few who dared to break ranks and speak out against the Government’s plans. Many of my immediate colleagues were muttering behind closed doors, but few would pin their colours to the public mast of disquiet and dissent. However, I thought the public had a right to know what was going on. After all, the NHS is your service as well as mine and, if there are to be major changes which will adversely affect the way health services are made available and delivered to patients, then the public has a right to understand.

However, in recent months, the map of those organisations expressing foreboding and alarm at the content of the Bill has altered considerably. Despite a continued rhetoric from the Government that the medical profession is behind the plans, there is now clear evidence that the majority of the health care professions are against the Bill. Such organisations include the British Medical Association (BMA), Royal College of Nursing (RCN), Royal College of General Practitioners (RCGP), Royal College of Midwives, Royal College of Radiologists, UK Faculty of Public Health, Academy of Medical Royal Colleges, Royal College of Physicians, Royal College of Anaesthetists, and the Royal College of Surgeons. Many are calling for the Bill to be withdrawn completely, on the grounds that it will do irreparable damage to the NHS.

Of course, there has already been damage inflicted, despite the fact that the Bill has not been enacted. Even before the Bill had gone through the first stages, the Department of Health was re-organising the local Primary Care Trusts, with widespread redundancies taking place in anticipation of the Bill being passed by Parliament. These changes cannot be reversed even if the Bill now fails, as important people have been lost to the service; people with a vast experience of running the NHS. In my opinion, that in itself deserves a judicial review. It is a gross misuse of a government’s power when it brings about widespread fundamental changes well ahead of a Bill’s debate and enactment in law. It is political arrogance beyond belief.

As a distraction to the above, there is the less well-known roll out of a service called NHS 111. At its core, this is a good idea; a national number to ring when health assistance is required at times other than in an emergency (when telephoning 999 is appropriate). However, the pilots have raised serious concerns for patient safety. In all, there have been nine serious untoward incidents across four of the seven pilots, wherein potentially life-threatening delay has occurred in patients getting assistance. The view of the medical profession is that the service should not be rolled-out until it is safe. The Department of Health is, as usual, playing deaf.

Other battle-fronts include the intended abolition of practice boundaries, thereby increasing the pressure on over-stretched GP practices that already feel under siege. Then there is the significant reduction in funding for practices, a GP recruitment crisis with unfilled vacancies, the imminent GP Revalidation process, and the need to register practices with the Care Quality Commission. That is all before we mention the subject of pension fund changes.

A recent study found that four in ten GPs have emotional exhaustion, a sense of depersonalisation, negativity, and a reduced sense of accomplishment; in effect they are burnt-out. Sadly, that finding is not a surprise, but it should raise significant public concern.

(First published in the Scunthorpe Telegraph, Thursday, 16th February 2012)

Who Do You Think You Are?

‘Are you the poet?’

It was an interesting question; especially as it was posed towards the end of an entirely unrelated conversation. Well, it was towards the end of a medical consultation to be precise. I admit that it took me a little by surprise; not least because this heretofore unknown patient somehow knew that I write poetry. However, being something of a pedant, the question immediately raised further questions, particularly in respect to how I answered my inquisitor.

For example, the obvious difficulty for me was my patient’s use of the definite article. By using the word ‘the’, the implication was that there existed only one poet, which clearly wasn’t true if the question is taken in the context of the wider world of writing. However, to my knowledge, none of my medical colleagues in the surgery writes poetry, so the answer could be in the affirmative if that was the intended focus of the question.

The second conundrum was based on the concept of when is a person one thing as compared to another? For example, I think of myself as a doctor regardless of whether I am seeing patients or not. But am I a writer when I am not writing; or a poet when I am not physically writing poetry? Furthermore, can I be a doctor, a writer and a poet all at the same time? In our society, we tend to define ourselves and others by the person’s employment. So, for example, once a baker retires, he becomes ‘retired’; he is no longer a ‘baker’, and very rarely a ‘retired baker’. The fact that he is no longer baking tends (rightly or wrongly) to render the skill redundant when it comes to describing the person. So you can now see how such a small question can inadvertently lead me into a minefield of indecision in respect to giving a truthful answer.

Another question which now stumps me is ‘Where are you from?’ Until a few months ago, I would assume that the question was an enquiry into where I started life, in which case I would instantly reply that I am a Kentish Man. However, thanks to a research unit based in Cambridge University, I now have difficulty in answering even that seemingly innocuous question.

It is all Dr Peter Foster’s fault. He is the director of a research programme called Roots for Real (www.rootsforreal.com), which analyses a person’s mitochondrial DNA (mtDNA) and Y-chromosomal patterns and correlates the findings to a database linking modern-day man to the earliest of humans stepping out of Africa and, more specifically when, on their subsequent journey, their DNA mutated to its present-day form. The science is complex but fascinating, and I will leave you to read more on the website should you so wish. However, the upshot is that my Y-chromosomes (inherited through my father) originated 10,000 years ago from an area now known as northern Italy, at about the time of the last ice-age. As for my mtDNA (inherited through my mother’s maternal line), that is firmly centred on Crete and dates back some 40,000 years ago (yes, one of my great great etc. grandmothers knew Neanderthal Man). Furthermore, the same mtDNA has been identified in the remains purported to be those of the disciple, St Luke; thus making him a distant relative. St Luke, of course, was also a physician. So, when someone asks why I became a doctor, at least I can now honestly say that it is ‘in my genes’. However, it brings a whole new meaning to the question ‘who do you think you are?’ To answer honestly, I now need to know whether to take my reference from 52 years, 10,000 years or 40,000 years ago; for I now seem to be a Kentish Greco-Italian of an indeterminate age.

As for the original question, ‘are you the poet?’ I admit that I took the easy route. After a moment’s deliberation, I smiled and simply said ‘yes’.

(First published in the Scunthorpe Telegraph, Thursday, 9th February 2012)