The Dying Keats (Book Review)

Author: Brian Livesley. Published by Matador, 2009

ISBN 978-1848761-711

The Dying Keats was written for the 20^th Biennial Keats’ Memorial Lecture in 2009. With 50 years of experience of caring for the elderly and the dying, its author, Professor Brian Livesley, has successfully researched and crafted a succinct argument for improved medical care for the dying; drawing on the distressing death of the 19^th century poet and apothecary, John Keats, in order to illustrate how doctors so often fail their dying patients.

Keats died at a young age from tuberculosis. Denied drugs such as opium to ease his terminal suffering, he experienced distressing symptoms up to his death; causing him to describe his final days as ‘this posthumous life of mine’. Livesley describes this as the ‘Keatsian Experience’ and compares it to euthanasia in the truest sense of its meaning; that being ‘a good and comfortable death’.

As the author points out, it is astonishing that today’s care of the terminally ill is often little better than that experienced by Keats; believing this to be due to the reluctance of doctors to consider death as a diagnosis that requires treatment, and reminding us that ‘dying should be a humane experience for us all’. A thought-provoking read for all clinicians.

(First published in Pulse Today, July 2012

http://www.pulsetoday.co.uk/main-content/-/article_display_list/14263504/book-review-the-dying-keats-a-case-for-euthanasia-by-brian-livesley)

So much for the Money; what about the Care?

The Government recently published the latest Social Care White Paper; which starts to address the problem of financing the care of elderly people. In outline, there will be a scheme whereby those receiving care will not be forced to sale their homes to pay for that care. Instead, they will be eligible for a council loan, repayable from their estate after death. With implementation postponed until 2014, the detail has yet to be revealed. However, if the recent Health & Social Care Act is an illustration, the ultimate Act stemming from this White Paper will be a hotchpotch of compromise, inadequately thought-through process and a few nasty surprises, which will fall short of appropriately addressing the real issues.

One of the real issues for me is not so much the money, but the quality of care. Having to sell one’s home to pay for care in a residential home may be emotive, but ultimately someone has to pay. After all, money is only a tool to obtain what we desire. When we are elderly and infirm, what we truly need is the security of knowing someone is properly looking after us. Sadly, for many people, that quest is an impossible one; particularly the closer we get to dying.

The physician and author, Dr Brian Livesley, addresses this issue in his book ‘The Dying Keats – A Case for Euthanasia?’. Livesley uses his 50 years of medical experience of caring for the elderly and combines it with a well-researched thesis about the circumstances of the death of the poet John Keats.

Keats, also a doctor, died in 1821 from tuberculosis at the age of 26. Well-aware of the availability of drugs such as opium, it is therefore an irony that he was deprived of medicines to relieve the distress of his final days. So distressing were his symptoms that Keats described the concluding period of his life as ‘this posthumous life of mine’; something Livesley describes as the Keatsian Experience.

Sadly, the Keatsian Experience is still endured. In 2008, 54% of the complaints about hospitals were related to the lack of care at the time of someone’s death. As Livesley states, dying should be a humane experience for us all. That the reality for many is so different is a sad indictment of the so-called ‘caring professions’. At the heart of the matter is the failure to treat dying as a clinical diagnosis requiring action.

The term ‘euthanasia’ is today frequently used as a synonym for assisted-suicide. However, the origin of the word is very different and means ‘a good and comfortable death’.  Keats lacked carers skilled in providing him with a good and comfortable death. Without those skilled carers, all the money in the world is meaningless to those in their twilight days if they are not being appropriately looked after.

So the message to the Government should be that the Keatsian Experience has no place in our time. Of course the problem of funding the provision of care in our final years needs to be sorted. However, the quality of care also needs to be considered. Getting the quality right from the moment we first need care will help ensure our closing days are also right. Without that, the Social Care Act will be yet another 21^st century political failing, and one we will all potentially suffer from as a consequence.

(First published in the Scunthorpe Telegraph, Thursday, 19^th July 2012.)

Be Careful What You Wish For

I do not normally consider myself to be a pessimist; although readers of this column may think otherwise, bearing in mind the inches of concern I have expressed over the past year in respect to the future of the NHS; I call the latter realism.

No, I am for all that, an optimist. I rejoice as each day dawns, regardless of the weather, the day of the week, or the latest damage the Department of Health might bring forth. I search for that hidden moment, event or experience that will bring a frisson of pleasure and make that day all the more worthwhile than the simple delight of being alive.

However, on three separate occasions recently, I have felt concern when others have felt joy. All three occasions have revolved around scientific ‘breakthroughs’; events which, as a scientist, I should be hailing with enthusiastic delight rather than guarded pleasure.

The first concerned the report that researchers have successfully predicted the entire genetic code of a baby. The process was fairly simple, and involved nothing more invasive than a saliva swab from the father and a blood test from the pregnant mother. ‘Magic!’ as a performing magician might say.

Being able to predict a baby’s genetic code means that it is now theoretically possible to screen unborn babies for some 3,500 disorders; which then raises the next question of what to do once we know that there is a problem. The morals and ethics of such investigations, along with the expected increase in the number of abortions, are far too complex for a short newspaper column. However, the vision of a future of designer babies does make me uneasy.

The second ‘breakthrough’ was the knowledge that it is now scientifically possible for women to store a small sample of ovarian tissue, and then have small pieces re-implanted over time in order to maintain their fertility beyond the age currently dictated by nature. Of course, the same process also delays the effects of the menopause. The latter may be welcomed by many women, and I do not blame them. However, does society really want or need childbearing by mothers in their 60s and 70s, or beyond? I will leave you to ponder your answer to that question.

Finally, quantum physicists have been rejoicing in the discovery of the long-postulated Higgs Boson, or ‘God-particle’ as it has been popularly known. This elusive particle apparently explains the force that holds the Universe together and enables stars and planets to exist. The discovery has evidently clarified one of the great mysteries of science and the world. It is one which will undoubtedly lead to other great advances in science, although exactly what is presently uncertain. Nonetheless, I feel that we should temper our excitement with a degree of caution, for mankind has not always been good at putting great scientific discoveries to the best of use.

If designer babies and fecund octogenarians do not as yet ring any alarm bells for you, then the Higgs Boson should. If you ask me why, I am not sure that I can presently give an erudite answer. However, I experienced the same pang of pessimism when reading about all three of these discoveries. The 18^th century clergyman-writer, Charles Caleb Colton, wrote ‘the greatest fool may ask more than the wisest man can answer’. In this context, I am not certain whether I am the wisest man or the greatest fool. However, I have no doubt that we should be very careful as to what it is we wish for.

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

The Delusional Art of Statistics

 ‘There are three kinds of lies: lies, damned lies and statistics.’

The quote is attributed to the 19^th century British Prime Minister, Benjamin Disraeli. What, I wonder, would he therefore make of the new iPhone app called ‘GP Ratings’, or indeed the expansion of statistical data now available on the Department of Health’s website, NHS Choices (www.nhs.uk)?

Statistics are only helpful if they compare like with like, compare data that is meaningful, and are sourced from unbiased data. Sadly, the aforementioned App and website fall down on all three counts, being drawn from a fundamentally flawed annual review called the GP Patient Survey. As a result, practices are now given a score out of ten based on patient experiences.

Now, speaking as a GP and from a personal basis, I have nothing I wish to hide from my patients or my peers. I strive to be the best GP I can. However, I am not, and can never be, perfect. That I frequently fall short of perfection is down to many different factors; an increasing number of which are totally outside of my control (lack of funding for the NHS, inflated Governmental and patient expectations, the number of hours in the day, imperfect therapies, and the mysteries of health and life that are yet to be answered by science, to mention a few). I therefore do not mind my work being compared to another GP, as long as the comparisons are fair and meaningful. Sadly, there is very little of that within the Government’s new ratings system.

Many writers in the medical press have condemned the new scores as simplistic, lacking detail and running the risk of overwhelming patients with unhelpful information. They are quite right. In many important areas, such as how well a doctor manages chronic or life-threatening illness, the information provided does not allow for meaningful judgements. Instead, the main comparisons are on factors such as how easy it is to obtain an appointment at a convenient time and how long one waits in the waiting room.

Not for one moment am I saying that these issues do not matter; of course they do. However, I would rather wait for an hour to see a doctor who is going to take my problem seriously, diagnose me accurately, treat me appropriately, explain the details to me in language I can understand, and, somewhere amongst all of that, show me a little compassion, than be whisked in and out on time, but left feeling that my issues have not been properly addressed.

Unfortunately, many of the issues the Department of Health measures doctors against are ones which are easily managed if one works in a well-resourced private institution, but will always be wishful thinking for large, underfunded, overloaded, NHS practices whose staff are trying to juggle the complex demands of patient care with training medical students and new GPs, commission local NHS hospital services, balance the NHS budget, and contribute to numerous other demands from the world of medical politics. Read the data by all means, but treat it for the crude information that it is. If it is of little use to me, in my capacity as the medical director for a Primary Care Trust, then I seriously question what real use is it to you as patients.

As Albert Einstein once said, ‘Not everything that can be counted counts, and not everything that counts can be counted.’

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

The Importance of Good Communication

Communication, according to the Oxford English Dictionary, is the action of sharing or exchanging information or ideas. What the dictionary does not say is whether communication includes the concept of understanding the message the informant intended to relay. Without adequate understanding the message being communicated is lost or misconstrued, sometimes with unintended consequences.

Of course, there are those who would claim that the opposite is also of value. Some might argue that misleading communication is an art well exercised by politicians to meet their own ends. As the American author Lionel Trilling said, ‘where misunderstanding serves others as an advantage, one is helpless to make oneself understood’. Examples of that were certainly seen last week during the battle over NHS pension arrangements.

However, the language used to communicate a message is equally important as the ideas being expressed. A favourite expression of mine is ‘words mean what words say’. Naturally, it is a paramount prerequisite for good communication that both the communicator and the listener understand the meaning of the words being used. I assume that Tim Loughton MP, was not being deliberately misleading last week when he said ‘I shall be speaking about it more fulsomely later.’ Referring to a report on missing children, he probably meant to give the impression that he would speak ‘in detail’ or ‘at greater length’, and that is possibly what most people took to be his meaning. However, the word ‘fulsomely’ is ambiguous. Properly interpreted as ‘lavishly’ or ‘extravagantly’, it can also convey ‘insincerity’ to the point of being insulting. To some listeners, his message would therefore have been received in a completely different manner to that which he probably intended.

Doctors need to be good communicators if patients are going to understand the health issues being discussed. For the majority of patients, there is no point in the doctor hiding behind erudite phrases, words in Greek or Latin, or medical jargon full of acronyms, if it is hoped that the message will be understood. According to recent studies, 43% of Americans have a literacy standard below that necessary to understand health issues (see www.nchealthliteracy.org for more details). In the United Kingdom, the figure is thought to be around 12%; although these figures assume that the message is being conveyed in a language suitable in respect to its origin, dialect, complexity and accuracy as befits the recipient. The phrase ‘health literacy’ is increasingly being used in reference to such matters.

‘LSD? Nothing much happened, but I did get the distinct impression that some birds were trying to communicate with me.’ The poet, W H Auden, was clearly speaking of his experience of using an hallucinogenic drug when it said that. Nonetheless, for many people, even the most caring of doctors can leave them feeling confused and uncertain. For them, a trip to see their GP or specialist may be as equally puzzling as Auden’s encounter with his feathered friends.

The problem is not just about whether someone can read and write, or whether they speak the same ethnic language as the doctor; our population is increasingly an aged one, and even very intelligent people start to lose cognitive ability as they get older. Defined by the World Health Organisation as ‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions’, health literacy must be taken into consideration and appropriately addressed if we are to achieve the desired health outcomes for our communities. Doctors must remember that patients will not always say that they do not understand; for their part, patients must not be ashamed or intimidated, and must tell the doctor if they do not understand what is being said. Getting the health communication wrong can be costly to the individual and society, in terms of deteriorating medical conditions, more expensive medical treatment, prolonged hospital stays, and increased risk of death.

That said, the French poet Charles Baudelaire once declared that ‘It is by universal misunderstanding that all agree. For if, by ill luck, people understood each other, they would never agree.’ Perhaps that is an apt statement for tautologous political circles, but not one for an effective health service. Unlike Sofia Coppola’s film, health messages should never be lost in translation.

(First published in the Scunthorpe Telegraph, Thursday, 28^th June 2012)

Standing up for more than a Principle

The medical profession is not usually considered to be a militant organisation. Frequently  coming high on the list of those members of society who the public holds to be honest, reliable and worthy of respect, doctors are generally considered to have a learned and caring vocation, whose voice is willing listened to with politeness and interest, even if only out of curiosity. In turn, the profession usually recognises and appreciates this esteemed status and, through the General Medical Council’s code of conduct, does much to ensure that the public trust is not undermined.  

That today, the 21^st June 2012, has been declared a day of industrial action by doctors is therefore of great significance. Of course, ‘industrial action’ is not necessarily the same as a ‘strike’; but the mere fact that it is happening at all is of great importance, with all the implications that it has to threaten the aforementioned public good-will.

The official reason given for the industrial action is the Government’s recent action in respect to the NHS pension scheme; action which effectively renegades on negotiations and an agreement in 2008 which was supposed to ensure the future viability of the pension scheme. Be that as it may, there is much more behind the situation than is immediately apparent. However, before I expand on the unwitting testimony, it is worth clarifying a few misconceptions that the Government is keen to promulgate.

First, the NHS pension scheme is not funded by the tax payer. The scheme is supported by its members; the doctors, nurses, ancillary staff and administrators who make the NHS work. The ultimate pension is in effect deferred pay, and has historically been on decent terms in recognition of the lower pay and substantial good-will of health workers; many of whom spend years of arduous training and contribute many unpaid hours to the good of society.

Second, is the fact that the NHS pension scheme currently returns a surplus of around £2billion per year to the Government; money that the Government then happily puts into the general coffers. Despite this, the Government argues that the situation is not sustainable and that, with the rising number of retired members, the scheme will not be able to support itself in future. However, that is what the negotiations of 2008 were all about. At that time, the medical profession, along with most healthcare workers, willing worked with the Government to bring about changes which would secure the inherent viability of the scheme and avoid it becoming a drain on the tax-payer. Nothing has changed since then to undermine those calculations; not even the change in the economy. Instead, the Government is set on unashamedly fleecing the NHS pension scheme whilst hiding behind flawed arguments and shameless lies, and that is what has angered the medical profession.           

Nonetheless, the institutionalised theft of people’s pensions is only the final straw of the unbearable load that has broken this particular camel’s back. As a body, doctors are tired of successive Governments meddling with the NHS, introducing badly thought-through policies, ignoring the profession’s opinion, increasing the workload to unsustainable levels whilst inappropriately raising public expectation of what should be achievable, and then publicly blaming the doctors for when it all goes horribly wrong. The profession is exhausted by inflated demands, frustrated by the focus on irrelevant outcome measures, weary of being the scapegoat, and demoralised by the determined destruction of the NHS. The theft of people’s hard-earned pensions is just a small part of this Government-built mountain of unrest.  

Today, for the first time in almost 40 years, some doctors will stop doing routine work for 24 hours. Urgent patient care will continue, and no patient should suffer as a consequence. That said, many of us will carry on as normal, strongly supportive of the need for action, but unable to put our own well-being ahead of those we have trained to help and serve. No doubt the Government will again ignore us and the popular press will vilify us. However, the population as a whole should take note. When a venerable profession is moved to such extremes, there is something very wrong with our world in general and its politicians in particular.

(First published in the Scunthorpe Telegraph, Thursday, 21^st June 2012.)

Humble Pie and Drawn Swords

One of the biggest rewards for any writer is knowing that the end product of hours spent slaving away in a draughty garret is actually being read by someone. I was therefore heartened to receive feedback from two eagle-eyed readers a couple of weeks ago, who noticed that Henry V (1386-1422) could not possibly have been responsible for the Apothecaries Act of 1815 without, as one put it, receiving divine intervention. How right you are, and you have my apologies for a spot of poor editing. What I had intended to convey was that, in order to suppress the quacks, Henry V issued a variety of decrees which ultimately became enacted, during the reign of George III, in the form of the Apothecaries Act of 1815.

Having now returned from an evidently much needed vacation, I am reminded of the words of Alfred, Lord Tennyson, who wrote ‘For man is man, and master of his fate’. Sadly, his optimism would seem misplaced today when it comes to the fate of doctors, with another of his lines being more apt: ‘So all day long the noise of battle rolled’. So it would seem from the recent headlines in the medical press. For example, GP Business informed us that Andrew Lansley is ‘launching his charm offensive’; surely a multi-layered contradiction in itself.

Elsewhere we are told that the Secretary of State for Health says ‘GPs have an ethical duty to cut costs’. Now, of course we understand that finance needs to be considered, but for us medical chaps that rather awkward ethical duty to treat patients keeps cropping up and getting in the way, Mr Lansley; but I guess that isn’t a concern that troubles you too much, as long as the budget breaks even. Whilst we accept the need for transparency in the way tax-payers money is spent, I am equally sure that tax payers do not want to be sold short when it comes to receiving the best treatment for their illness. If what I can offer my patients doesn’t equate to what I would find acceptable for a member of my family, then I am not fulfilling my primary role as the trusted physician. It is no coincidence Mr Lansley, that, when placed in alphabetical order, patients come first, physicians next and politicians last; and thus it should be so in terms of providing care.

Whilst I have been away, it has also been decreed that ‘practices must provide online booking by 2015’. Now, that is one where I am sure the proven ability of the NHS to come up with suitable computer software and associated security will not be found wanting. I jest of course. Seeing is believing, but I wouldn’t hold your breath just yet.

That the Department of Health has agreed to a 20% rise in GP training places by 2015 is obviously good news at face value. Nonetheless, it will take a further four years for those doctors to come out of the system as fully-fledged GPs. At present, the number of GPs is down to 1999 levels. With 8% of GPs leaving the NHS in 2010, 22% now being over 55 years, and consultations set to rise to 433million per year by 2035, there may be light at the end of the tunnel in terms of training, but it is still presently a very dark place at the coal-face, and that needs to be promptly addressed to avert a significant manpower crisis. So, unless something is done now to attract trained GPs back into the NHS, or to stop us older ones from running with the remnants of our sanity for the exits earlier than necessary, the current national shortage of GPs will continue for the next decade.

The one delightful piece of news ironically comes from an obituary for a paediatrician in the USA, who only retired at the age of 103. She died in April at the grand age of 114, which lends a hearty boost to my much-publicised intention to hold a 120^th birthday party in January 2080. Keep that date in the diary; though at this rate, I may have to couple it with a retirement party. 

(First published in the Scunthorpe Telegraph, Thursday, 7^th June 2012.)

Time to Decriminalise Drug Addiction?

Just the word ‘addict’ is enough to conjure up a negative impression in many people’s minds. Precede it with the words ‘book’, ‘telly’, or ‘exercise’ and it softens the perception. However, try ‘drug’ or ‘alcohol’ instead and the negativism drops off the chart. In western society, drug addicts are often perceived to be amongst the worst members of society, with alcoholics not that far behind. For many people, the concept invokes images of seedy squats, down-and-outs, crime, prostitution, discarded needles, HIV, hepatitis, wasted lives, early deaths…the list is endlessly dismal. Such people are perceived by many to be untrustworthy as employees and undesirable as neighbours.

However, what if your neighbour happened to be the author Jack London, famous for his books ‘The Call of the Wild’ and ‘White Fang’, who rewarded each 500 words written with an alcoholic drink; or the writer Robert Louis Stevenson (of Jekyll and Hyde fame), addicted to hashish, opium and cocaine, and who thought wine was ‘bottled poetry’? Alternatively, consider the poet Dylan Thomas, the mind behind such invocative poetry as ‘Do not go gentle into that good night’, and who rather pertinently said that ‘an alcoholic is someone you don’t like, who drinks as much as you do’. Then there was Aldous Huxley, the author of the classic ‘The Doors of Perception’, which was written whilst under the influence of the psychotropic drug mescaline. The list is endless, and includes the likes of poets and writers such as Thomas de Quincey, Lord Byron, Percy Bysshe Shelley, John Keats, Charles Dickens, Edgar Allen Poe, Samuel Taylor Coleridge, and Sir Arthur Conan Doyle, all of whom were addicted to the opium and alcohol mixture known as laudanum.

Now, not for one moment do I want anyone to believe that I am condoning the misuse of drugs and alcohol. Many of the aforementioned famous personalities died of illness brought on by addiction. My point is to illustrate that our perception of whether or not the addiction is generally acceptable depends on whom the person is, and how they deal with their addiction. For example, the controlled use of alcohol is accepted by most people in our society; being drunk in the city centre on a Saturday night is not acceptable to most. With some notable exceptions (such as the late Amy Winehouse), what also differentiates the acceptable from the unacceptable is the availability of money. Drugs tend to be expensive; mainly because of their illicit status. This in turn fuels the negative spiral of people turning to crime and dropping out of acceptable society to fuel their addiction. To compound the issue, in many areas the most successful rehabilitation centres are only available to the wealthy.

Drug addiction, as anthropological research has shown, has always been with us. It is equally true to say that it will never disappear, and it is not just a problem associated with the young. According to some studies, illicit drug use in those over 50 years has increased by a factor of ten since the mid-1990s. In London, for example, one in ten over-sixties regularly uses cannabis. Other drugs featured in these studies of the older population include cocaine, ecstasy, LSD, amphetamines, and tranquilisers.

Additionally, throughout the world the criminalisation of drugs is causing hardship in, and destruction of, whole countries; many of which are in South America. As a result, global initiatives are now taking place to consider drug policy reform. There is a very rational, public health argument for decriminalising drugs, and substituting litigation with appropriately resourced treatment for addicts. Increasingly, doctors are calling for evidence-based policies in respect to drugs. The evidence in respect to the potential health-gains for society is out there; we now all need to suppress our prejudices and encourage our politicians to effectively engage in this important debate.

(First published in the Scunthorpe Telegraph, Thursday, 31^st May 2012)

Time for More Compassion

All professional bodies have codes of conduct, expounding the ethical principles that underpin the manner in which its members are expected to act. For doctors, the code comes in the guise of a document called Good Medical Practice, published by the General Medical Council (GMC). Likewise, the House of Commons produces a guidance code for Members of Parliament, Funeral Directors have theirs, and the Press Complaints Commission operates a Code of Practice for newspapers. In Addis Ababa, Ethiopia, where the World Congress on Public Health recently took place, there was a publically displayed list of Principles of Ethical Public Service, listing integrity, loyalty, transparency, confidentiality, honesty, accountability, serving the public interest, exercising legitimate authority, impartiality, respect for law, responsiveness and leadership as pre-requisites for service. In America there is even a Code of Practice for Columnists. The interesting thing is that nowhere in these documents appears the word ‘compassion’.

The Oxford English Dictionary defines compassion as ‘sympathetic pity and concern for the sufferings or misfortunes of others’. In turn, ‘sympathy’ is the feeling of pity and concern for the affected person or people; it is showing that one understands their plight.

However, Kamran Abbasi, editor of the Journal of the Royal Society of Medicine, recently expressed the opinion that ‘compassion isn’t even a dirty word in the NHS…with clinicians too preoccupied with targets, efficiency drives, and restructuring to care for their patients’ (JRSM 105, p. 93).

Yet, according to a survey by the GMC, compassion, kindness and empathy are qualities which people feel are important and should be portrayed by doctors. Why then, do so many codes of practice leave out such important values? Is it that you can train people to act with all the principles expounded in the Addis Ababa example above, but cannot enforce a quality that comes from deep within one’s own personality?

The Dalai Lama, the Tibetan Buddhist spiritual leader, recently wrote on the social network site Twitter (@DalaiLama) that ‘even our personal virtues, such as patience and our sense of ethics, are all developed in dependence upon others’. He said ‘fear, hatred, and suspicion narrow your mind - compassion opens it’. In his view, ‘once you realize that compassion is useful, that it is something really worthwhile, you immediately develop a willingness to cultivate it’.

To those who are religious and profess their faith in their daily lives and actions, the concept of compassion is real and becomes second nature. Many would agree that compassion helps in effectively communicating with others. Such action can also be self-rewarding for, again in the words of the Dalai Lama, ‘if you become more concerned for the welfare of others, you will experience a sense of calm, inner strength and self-confidence’.

Of course, self-reward is not principally what serving humankind is all about. However, nobody should object to a free dose of the ‘feel-good factor’, and if it means that the behaviour that earned the reward is more likely to be repeated, then who should complain about that? The sad part about all this is that ‘tender loving care’ or TLC as it was often known, is no longer seen as an appropriate form of treatment on its own. Indeed, it is often completely lacking, even when every other treatment has been exhausted.

Even in the 21^st century, nobody has all the answers, and there is no cure for all ills. Compassion is often the most valuable tool left in the armoury and it should be deployed more frequently and effectively by all healthcare workers. It is also a tool that should be honestly wielded by everyone in public service (politicians take note), and indeed, by all of us in our daily interactions with each other. That said, it is not something that can be learned or fabricated; it needs to be felt. The starting point is to search deep inside oneself, find that hidden quality, and then bring it to the surface. The entire world would be a better place if we all put compassion into it.

First published in the Scunthorpe Telegraph, Thursday, 24^th May 2012.

Quote of the Day

'Not all those who wander are lost.'
J.R.R. Tolkien

Beware a Secretary of State Bearing Gifts

Today, I would like to remind you of a tale from Greek mythology. It concerns the city of Troy; a city that did in fact exist and whose ruins can still be seen today in northwest Turkey. Troy was the centre of the Trojan Wars, which occurred somewhere between 1200 to 1400 B.C. About that time, the ruling Royal family of Troy was King Priam and Queen Hecuba, and they had a beautiful daughter called Cassandra. Unfortunately for her, Cassandra had the power of foresight. I say ‘unfortunately’, as on many occasions nobody was prepared to believe her. One of her disregarded prophesies was the destruction of the city of Troy; something which indeed took place (remember the story of the Trojan Horse?). In modern times, the term ‘Cassandra Syndrome’ is used to describe the malady affecting those who disbelieve predictions of doom until the events actually occur.    

Now, on no account am I suggesting that I can be compared with an attractive lady of royal parentage. However, I do feel that I am one of a growing band of doctors who have the power of prophesy (solely, it must be said, in relation to the future of the NHS) but have up to now been largely ignored. I can almost hear you yawn at this stage, and I appreciate that it may be a little tedious, but I make no apologies for returning again to the subject of the new Health & Social Care Act. Please read on, because I have a job for you all to undertake.

The fact is that, although the Act has been passed by Parliament, the detail has still to be implemented. In this respect, we can all be influential and potentially alter the destructive power of this Trojan Horse that now stands at the gates of the NHS.

There are two major issues for us. The first is to save the ‘National’ in the NHS. In an attempt to form a shared vision of the future of the NHS, the Royal College of General Practitioners (RCGP) is trying to encourage the adoption of a set of ten ‘core values’, against which the Act will be implemented. These values are: greater involvement of GPs in shaping NHS care, a UK-wide agreement on free NHS services, integration of health and social care, reduced bureaucracy and increased efficiency, patient empowerment, respect for patients’ beliefs and valuing diversity, patient involvement in shaping NHS services, encouraging innovation, promotion of public health, and cutting inequalities.

The second major issue stems from one of these values; that is the need for a national approach to public health. Under the new Act, public health services are moving from the umbrella of the NHS to the local councils. With no disrespect to my local authority colleagues, there is a widespread concern that councils are ill-prepared for this change, especially at times of epidemics. Already, we have seen a diminution of national advertising campaigns (last year’s influenza vaccine campaign suffered as a result, and we had a higher death rate from influenza than most other European countries). The fear is that, with more decisions of this nature being taken locally, will the public be as well informed of major health risks as in previous years? Sometimes, national leadership is the most effect way to get a message across.

So, your task, readers one and all, is to join me, along with my colleagues at the RCGP, and start to question how the Act is being implemented. Talk to your doctors, question your MPs, attend local council meetings, get involved with patient participation groups, write letters to the newspapers; in essence, take control of the future of your NHS. Please do not become victims of the Cassandra Syndrome. The Secretary of State for Health has delivered a modern day Trojan Horse to the doors of the NHS; don’t accept it as the gift he likes to pretend it is. Look to see what lies beneath and neutralise its threat now before it is too late and the NHS becomes your Troy.

(First published in the Scunthorpe Telegraph, Thursday 26^th April 2012)