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The story of me



I’ll be giving a talk on Thursday 25th September 2014 on my personal experiences of alcoholism and interacting with the GMC, at a meeting called “Regulation, Respect and Health Practitioners” in London.

This is a draft of the text of my talk.

** Please check against delivery. **

alcoholism

Thank you for inviting me to speak for about 15 minutes on my viewpoint of the creation of a healthier regulatory process to benefit doctors and patients.

My speaking here comes at a time when there is a genuine drive for care and compassion in national policy in healthcare.

I believe that there should be a mutual respect between junior and senior clinicians, and the clinical regulator. In fact, I think this respect should be cherished and nurtured.

Last month, I had a hearing arranged by the Medical Professionals Tribunal Service (“MPTS”) to hear my application for restoration to the GMC register. This was just weeks after my 40th birthday.

I was asked by one of the panelists there what I had learnt most from my time off the register.

It is, of course, a necessary requirement that all Doctors on the GMC register have kept their skills up to date. This is so that Doctors can fulfill their obligations of performance, skills and knowledge. One of the benefits of having had at least five years out is that I’ve read the doctors’ code of conduct, “Good medical practice”, very many times. But I gave an answer which I don’t regret now for a moment.

I said, “Most of all, I finally know what is like to be a patient.”

I was erased in July 2006. At the time, it was uncertain what my ultimate diagnosis was, but a number of psychiatrists were in no doubt that I was suffering from an alcohol dependence syndrome. After I erased, I then spent heavily drinking alcohol a year in a pub. I used to go to local pubs at opening time, and leave at closing time. They say that unemployment is a big risk factor for mental illness.

Not being regulated at all by the medical profession was a big part of losing what I had perceived to be my identity. There was absolutely no structure or goal to my life. My life hit rock bottom. But, as an alcoholic, you soon realise that, however low you have gone, you can always go even further.

I had been first referred to the GMC a few years earlier. At the beginning of the process, no-one ever told me how long the regulatory process would last. This uncertainty about the future was a huge part, I feel, in my subsequent precipitous decline in mental health. I was erased ultimately for deficiencies in conduct and performance, and poor health, in 2006.

Whilst I was not punished for being ill, it was clear that the professional regulator could in no way condone my undisputed shortfalls in conduct and performance. The question about whether the clinical regulator views health to be intimately linked to professional conduct and performance is an important one. I do.  This matter is also relevant to ‘revalidation’. I feel a junior must not ignore his own personal ill health first selfishly, above the needs of patients.  He needs to get help as soon as possible. With the benefit of hindsight, I so wish I had sought help sooner.

When I was erased, I felt I became “public enemy number one”. However, they say that self-pity is a huge risk factor for drinking relapse. It was at one level a private shame . My father, who later passed away in 2010, was deeply humiliated by the whole experience, even though he had caused none of it. My father had been a GP for about 25 years. Therefore he adored the GMC. He felt GMC was “God”. But God moves in mysterious ways? As a loving father, he stuck by me throughout. As did my mother, with whom I still live.

The whole thing was, however, also a very public shame.  You can still find reams and reams of it adorning Google. The avalanche of news reports about this, while creating a moral panic, virtually invariably never mentioned my severe alcohol illness. But that, as such, doesn’t matter to me any more even though I am keen on one aspect. I am still keen to remind myself of the distress I caused while I was powerless over alcohol. That’s why I have never asked for any of it to be deleted off Google in this jurisdiction.

I’ve never had a salaried job for the last eight years following erasure. In the only two job interviews I had for legal posts I was asked about my Google footprint of the GMC case.

On a day at the beginning of June 2007, I was ‘blue lighted’ into the Royal Free. I had had an epileptic seizure, but the crash team lost my airway. They tried to intubate me, but I then had a cardiac arrest, from which I was successfully resuscitated. I literally owe my life to the NHS.  I was kept alive for six weeks, while completely unconscious in a coma. When I woke up, I could not walk or talk. I became newly physically disabled. But the neurorehabilitation team at the National Hospital for Neurology and Neurosurgery, where I was in fact a junior doctor, then taught me how to walk and talk again. I remember how the occupational therapist taught me how to shop in a supermarket. I learnt, from scratch, how to perform basic tasks, such as making a cup of tea.

I always had loved medicine. I got the second highest First in neuroscience in my undergraduate course in Cambridge. I got my PhD in 2001 in identifying an innovative way of diagnosing behavioural variant frontotemporal dementia. I later passed my diploma of the membership of the Royal College of Physicians. I have published three books for junior physicians negotiating each of the three components of this demanding examination for core medical training.

My late father, however, emphasised to me that that coma, in many respects, saved my life. I agree with him now. It heralded the start of my period of abstinence from alcohol. I have now been in recovery from alcohol continuously for seven years. I take one day at a time.  I am content now.

Since my coma, I have obtained my Bachelor of Law, Master of Law and my Master of Business Administration, and completed my pre-solicitor training. I adore the law as well, and I am fully signed up to the legal doctrine of proportionality, where the law must balance competing interests where they exist. I became regulated in 2011 by the Solicitors Regulation Authority after an extensive due diligence process.

Last month, my application for restoration onto the GMC Medical Register was approved.

This is not, however, by any means the ‘endpoint’ to my new life. I am not only keen to learn lessons for myself from the experience, but I am now also keen to help others. This is why I regularly attend, voluntarily, the ‘suspended Doctors group’ for “The Practitioner Health Programme”. I am under a psychiatrist, whom, without being hyperbolic, I feel saved my life.

I look back on the psychiatry reports of me when I was ill during 2004-2006 with utter disbelief. I was hugely in denial – had no insight into all how I at all junctures minimised the catastrophic effects of my active drinking. The “paradox” for dealing with a drink problem is that you cannot ‘do it’ on your own, and yet you must get help for the problem and realise your powerlessness over it.  For me, it’s very simple – I can’t ever have a casual drink ever again. One alcoholic drink is one too many, and yet one drink is never enough. It ruined my life.

For me, the critical key to success is having a close circle of people in a social network, including an after care group in my local hospital, would be able to spot and intervene early in problem behaviour. For the first time in 2007, after my coma, I fully engaged with my General Practitioner. I had numerous ‘false starts’ in dealing with my alcoholism between 2004 and 2007.

I personally found the pressure of being investigated and dealing with my illness, during this period, unbearable. A part of me wishes, in retrospect, that I had been “better managed” in terms of performance at the time. Witness statements report me as looking ‘alcoholic’ and ‘dishevelled’ while on the wards, when my performance was clearly poor. A part of me wishes I had been “made to go to occupational health”, when these problems first surfaced.

But a part of me strongly resists my transference of blame onto other parties. As I admitted to my restoration panel, I made plenty of mistakes of my own: for example, I never engaged properly with my own G.P. until my coma.

I was most obviously, prior to my coma, a clear threat to patient safety. And it states clearly in s.1 (1A) Medical Act 1983, the GMC must promote patient safety. So I strongly believe the original sanction was the correct one.

But now, next month, as a different person, I’ll be presenting my research, based on an online survey, on the funding of dementia care. This will be at the prestigious Alzheimer’s Europe conference in Glasgow. This January, I published a popular book entitled, “Living well with dementia”. I feel that, with my truncated medical training thus far, and my postgraduate degrees in law, medical research and business management, I can be an asset to the public health and health policy arm of the medical profession.

For me, my return to the GMC register, after completion of the identity check, will be a huge privilege.

Sadly, it can be rather too easy for colleagues to gang up on individuals and ringfence problems, rather than solving the problems at root to make the health and care services better. I am sure that many juniors feel: “there for the grace of God go I”.

One cannot away from the enormity of the problem of unwell Doctors in the NHS, however. I felt totally abandoned during the regulatory process and could have done with more support at a time when I especially needed it? In conclusion, the public including staff would like to have pride in the medical profession and its regulator. I too would like to see this goal come to fruition one day.

Death might not be inevitable in Ed Miliband’s “leader speech”, but taxes might be?



cigarettes

 

Tobacco use is expected to kill around 5.4 million people worldwide a year.

It is undeniable that the state of the NHS is directly linked to the overall state of the economy. Austerity has posed a challenge to patient safety, though the official line is that “efficiency savings” have not impacted on safety in England. Nonetheless, it is a fact that unsafe levels of staffing have often been at the root of shortfalls in clinical safety.

The “Keogh review” could not have been a clearer example of this.

The public tend to be most concerned about the NHS if there is an identifiable event, such as Mid Staffs, or breaches of the four hour wait.

It is no big secret that Labour intend to make the NHS THE big issue of the general election campaign of 2015. This is despite the Conservatives’ electoral strategy Lynton Crosby not wishing to discuss the NHS.

But like a Marlboro cigarette, the issue of the link between Lynton Crosby, Philip Morris International Inc. (“Philip Morris”) and smoking policy has been a slow burn in the last year or so.

Labour has always wished to paint the picture that the Conservatives do not come with “clean hands” to the discussion of smoking and health.

There has always been the question: are the public aware of the financial problems facing the NHS? And, despite an universal consensus for low taxes, would they wish something to be done in the specific case of the NHS?

A new dawn for NHS campaigners was the relief that the media, who once a upon a time had been respected, were conflating “unsustainable” and “unaffordable” in their discussions of NHS funding. The NHS is, as they will tell you, should be comprehensive, universal, and free at the point of need. It is hard to know precisely where this confusion had arisen from. I remember vividly complaining about this on this SHA blog in October 2013.

In yesterday’s speech, the Shadow Chancellor Ed Balls made the direct link between income from taxes for the Government and the NHS.

“‘Next year, after just five years of David Cameron – with waiting times rising, fewer nurses and a crisis in A&E – we will have to save the NHS from the Tories once again,’ he said. ‘And we will do what it takes.’”.

Also in October 2013, the Local Government Association published a pamphlet entitled, “Changing behaviours in public health – to nudge or to shove?”.

And there is more than a cigarette paper between the two main political parties here on this ssue.

The current government has made exploring the potential of behavioural change a priority. In fact, the coalition agreement itself made direct reference to the issue, stating that the government would be “harnessing the insights from behavioural economics and social psychology”.

But likewise it has also clear that tools available to government include more draconian approaches as shown by the fact that consultations were carried out on plain packaging for cigarettes (a shove) and minimum pricing for alcohol (a smack). However, neither policy has subsequently been introduced.

I, over a year ago, wrote on this blog on the topic of changing behaviour in relation to smoking.

Ed Miliband has been banging on his “cost of living crisis”  drum for some time. And, in fairness to him, it is an issue which resonates with the general public. For socialists, such as Owen Jones, the issue does particularly resonate as an example of how privatised companies with vested interests have protected their profits at the expense of their customers. They are able to do this due to markets, which have not failed from the perspective of the shareholder, but which have clearly failed from the perspective of the end user.

And a noteworthy consideration here is that such providers have been able to rely on robust demand, for example the need to drink water or to make a phone call. Likewise, certain luxury brands have not seen their profit margins dented by the global economic recession.

Indeed, on May 12 2009, it was reported that tobacco use would continue, possibly grow, during recession, according to experts at the time.

Death and taxes may be inevitable according to the famous Benjamin Franklin quote. But Lord Stewart Wood, advisor and friend to Ed Miliband, is known also to be petrified that Labour once again becomes known as THE “tax and spend” party. Whilst Labour might have been flirting with sexier and covert ways of working things to their advantage, such as “predistribution”, an epiphany lightbulb moment came when Labour realised it could get away with taxing entities rather than people, provided that it did not offend the neoliberal virtues of competition and enterprise.

In an economic downturn, products seen as giving comfort in the midst of stress tend to sell very well. In the U.S. and abroad, tobacco is no exception. That’s why taxing a commodity which does not become popular, and which could damage your health, is such an attractive political policy.

“It’s not well understood, but as people lose jobs, the unemployed and others affected by tough economic times may rely on ‘affordable pleasures,'” Eriksen has said.

“The irony is that the more deprived someone is, people will rely on simple pleasures that are unfortunately deadly pleasures.”

Just under a year ago, in October 2013, Ben Page as Chief Executive of Ipsos MORI  presented a talk: “Public opinion: What price the NHS?”.

79% of the general public were reported as opining that the NHS should be protected from cuts (as opposed to other areas such as policing, benefits or schools).

88% of people agreed that the NHS “would face a severe funding problem in the future”.

Lack of resources and investment in the NHS is way above (42%) is way above other factors which could be posited to be “the biggest threat” to the NHS (including, for example, not enough doctors or nurses, or too much management).

Fast forward to now, and in a September 2014 report from “The Health Foundation”, entitled “More than money: closing the NHS quality gap”, the authors Richard Taunt, Alecia Lockwood and Natalie Berry considered that the NHS faces a significant financial challenge is well known and much discussed. This ‘financial gap’ has been projected to reach £30bn by 2021. This is due to the disparity between the pressures on the NHS and the projected resources available to it.

In the leader’s speech later today, Ed Miliband is ex[ected to put the nation’s health at the centre of a 10-year plan for Britain’s future on Tuesday, front loading the NHS with funding from a novel windfall tax on the profits of UK tobacco companies and the proceeds of a mansion tax on homes worth more than £2m.

A windfall tax normally has its critics because it’s considered to be a very short term measure that risks really damaging the relationship between government and big businesses.

But here is a windfall tax somewhat like no others – as the demand for cigarettes, despite the threat from e-cigarettes, is largely sustainable, and Labour if it is at any war with business is as at war with big businesses abusing markets.

In his final Labour party conference speech before next year’s general election, Miliband will tell sceptical voters he can bring the country back together and offer six ambitious goals, including changes to the NHS, designed to overcome “the greatest challenges of our age and transform the ethics of how Britain is run” over the next decade.

A mansion tax could raise £1.7bn, and had originally been earmarked by the shadow chancellor, Ed Balls, to fund a 10p starting rate of income tax, but that is now due to be funded by abolishing the marriage tax rate.

The poorest twenty per cent of households in Britain spend an average of £1,286 per year on ‘sin taxes’, including betting taxes, vehicle excise duty, air passenger duty, ‘green taxes’ and duty on tobacco, alcohol and motor fuels. In addition, they also spend £1,165 on VAT.

“Sin taxes” have generally been unwelcome by proponents of the free market, such as the Institute of Economic Affairs (“IEA”). In October 2013, the IEA published a report entitled, “Aggressively Regressive: The ‘sin taxes’ that make the poor poorer”.

In this report, the IEA made their disgust for ‘sin taxes’ clear.

It is said that, despite significantly lower rates of alcohol consumption and car ownership, the poorest income group spends twice as much on sin taxes and VAT than the wealthiest income group as a proportion of their income.

It is possible for the Conservative Party to mount an argument that tax is the single biggest source of expenditure for those who live in poverty, and indeed indirect taxes are a major cause of Britain’s cost of living crisis.

The average smoker from the poorest fifth of households spends between 18 and 22 per cent of their disposable income on cigarettes. The tax on these cigarettes consumes 15 to 17 per cent of their income.

And tobacco remains one of the world’s most profitable industries. Current data suggests that smoking is still a huge part of the global  consumer landscape and that the habit is not going to die out anytime soon.

Philip Morris is currently the leading international tobacco company, with seven of the world’s top 15 international brands, including Marlboro, the number one cigarette brand worldwide. PMI’s products are sold in more than 180 markets.

In 2013, the company held an estimated 15.7% share of the total international cigarette market outside of the U.S., or 28.3% excluding the People’s Republic of China and the U.S.

On Sep 14th 2014, it was announced that the Board of Directors of Philip Morris on the NYSE/Euronext Paris PM), increased the company’s regular quarterly dividend by 6.4% to an annualized rate of $4.00 per share.

But cigarettes contain more than 4000 chemical compounds and at least 400 toxic substances.

Cardiovascular disease (disease of the heart or blood vessels) is the main cause of death due to smoking.

Smokers are more likely to get cancer than non-smokers. This is particularly true of lung cancer, throat cancer and mouth cancer, which rarely affect non-smokers. The link between smoking and lung cancer is clear. Ninety percent of lung cancer cases are due to smoking. If no-one smoked, lung cancer would be a rare diagnosis – only 0.5 per cent of people who’ve never touched a cigarette develop lung cancer.

Other types of cancer that are more common in smokers are bladder cancer, cancer of the oesophagus, cancer of the kidneys
cancer of the pancreas, and ervical cancer.

Chronic obstructive pulmonary disease is a collective term for a group of conditions that block airflow out of the lungs and make breathing more difficult.

So, in a weird way, smoking may come to be saviour of the NHS due to a perversion of market forces. It might be the latest brand of “left populism”, leaving Ed Miliband to want to have another puff. It is hard for the Conservatives to criticise without appearing to come down heavily on the side of tobacco companies such as Philip Morris, but Philip Morris are unlikely to forget this in a hurry if the Labour Party are responsible for denting their profits.

Public health was never a sexy campaigning issue for the Labour Party, despite the best efforts of some, with popular newspapers coming down heavily on the side of the consumer than the “interfering state”. But the whole concept of the ‘responsible state’ has become tarnished with neoliberal governments increasingly outsourcing state functions to companies embroiled in inefficient practices and allegations of fraud practices. A windfall tax on cigarettes, despite giving off an unattractive odour of Labour “going back to its taxing roots”, may be, however, just what the Doctor ordered at this particular time in the history of the service.

And, as all politicians know, you can’t please all of the people all of the time.

After today, Labour might be feeling like (a) whole (person) again.

Burnham announces plans to implement a National Health and Care Service over ten years



gp reception

The Constitution of WHO (1946) states that good health is a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity.

The Shadow of Secretary of State for Health, Andy Burnham MP, says that he has tried to produce an answer ‘which people can believe in, and which people can buy into’.

This is particularly timely, as it is well known that Labour intend to make the NHS a major general election issue next year.

The Conservatives and Liberal Democrats are now deeply unpopular over their management of the NHS, as evidenced, for example, by the campaigners who converged on Trafalgar Square recently on behalf of the “Darlo Mums”.

Over successive governments and most recently, the finances of social care have suffered massively.

Speaking at a fringe event for the Fabian Society in Manchester yesterday, Burnham felt that things are not satisfactory as the response to an ageing society has been through a medical model.

Burnham’s problem is that he is about to be bequeathed a fragmented illness service, not a national health service; and that the system is patient-focused on ill people not person-focused on people through health and illness. Burnham feels that focusing on people will enable a greater focus on friends and families too.

Burnham feels that the “ever-increasing hospitalisation” of an ill ageing population will not work, and that hospitals are becoming increasingly dysfunction all the year round due to a social care system which has been malnourished over successive governments.

“This failure piles pressure on the acute system”.

Burnham further adds that people “are battling in caring for people with complex needs”, and that “these silos are not ones which can afford any more”.

This policy is anticipated to bring in housing, education, and leisure strands in due course.

But the urgency for Burnham is to deal with people having to avoid recounting their personal stories repeatedly to different people; and that professionals are often making clinical decisions on the basis of incomplete information.

The intention is, ultimately, to bring together systems for physical health, mental health and care. Sir John Oldham had earlier in the fringe event observed that the general public can have a poor understanding of the word “social” in relation to ‘social care’.

Burnham intends to set out a ten year plan for a whole person care, fully accepting the findings of the Oldham Commission, and which “endorses” the findings of the Barker Commission from the King’s Fund.

Such a plan will be strongly attractive to those vociferous critics, such as Sir David Nicholson the immediate predecessor of Simon Stevens as the CEO of NHS England, that health policy has traditionally been adopted on the basis of the electoral cycle.

This system will be a “National Health and Care Service”, which will realign an activity-based tariff for episodes of illness to produce a single ‘year of care’ budget for each person covering his or her physical, mental or social meeds. This, Burnham feels, will support prevention and wellbeing.

At first the idea was to have a pooled integrated budget across health and care, but, in the subsequent question/answer session, Burnham made extremely clear that he was mindful of the need to move away from privatised fragmented care; and to move away from compulsory personal health budgets which had not been proven to work well.

Burnham, instead, signposted plans to be announced later this week that he would instead advocate a general ‘rights based approach’, where citizens could be given realistic expectations of the development of personal care plans according to their needs.

Burnham emphasised that he remained unconvinced that personal budgets were the sole instrument that could achieve this aim.

He is of course extremely mindful of the public’s overwhelming lack of appetite for the marketisation, outsourcing or privatisation of the NHS.

As an example of ‘market failure’, Burnham cites how councils in their wish to compete to keep council tax bills low end up failing on high quality care.

Interestingly, he also feels that this plan has the potential to be ‘radical’, allowing people can be supported to care, enabling full personalisation.

Such a system will involve a “care coordinator”. This has already been mooted publicly very recently by the Shadow Minister for Care, Liz Kendall MP, as a point of contact for the elderly to navigate themselves through the maze of information including care information.

Such a rôle, it is felt, might not be for general practitioners, but possibly for specialist nurses. The voluntary sector, such as Dementia(UK) which developed the innovative specialist “Admiral” nurses programme, might be well placed to act as these coordinators.

In the alternative, social care practitioners might be particularly well suited for a care coordination rôle for people with dementia, as they command expertise in decision-making and capacity. Social care practitioner leads in this context would help to overcome a barrier to cultural integration, furthermore; this is especially important given the often perceived hierarchies of the professions involved.

“Carers will no longer be peripheral to the system, but central to the development of a care plan.”

This plan would be established over a ten year period to integrate services around the individual, not through a sudden ‘top down reorganisation’.

A potent steer for this would come from the Health and Wellbeing Boards.

It is expected that the Labour Party will also use their party conference this year in Manchester to emphasise its intention to repeal the Health and Social Care Act (2012) in the first Queen’s Speech of an incoming government in 2015.

Jackie Ashley, Sir John Oldham, who chaired the Oldham Commission, and Kate Barker, who chaired the Barker Commission of the King’s Fund, panel members yesterday evening, all agreed that it was unlikely that politicians would openly wish to pledge to raise taxes for health and care. The way in which this had been politically debated in the 2010 UK general election, it is felt, had been unimpressive.

Nonetheless, the general sentiment was that the public would appreciate an open discussion of how sustainable funding for health and care systems could be  achieved.

Jackie Ashley, who writes for the Guardian, explained the difficulties in the news media approaching this topic, when headlines consistently remained fixated on crises in the NHS.

The general policy trend has been try to support people who wish to live and to be cared for at home independently.

However, Ashley alluded to the need to avoid a narrative that hospitals are necessarily bad and non-hospitals are necessarily good.

It is felt that when the NHS was originally set up it was not designed to be catering for people in their 90s with their multiple clinical care needs.

Nonetheless, Oldham urged the need for NHS England to move away from the needs of hospitals, and urged, as an example, a greater number of representatives from local authorities (currently involved in commissioning social care) on NHS England.

For a condition such as one of the dementias, citizens have the perception of their care needs being financially punished through the need to pay for care; this is, for example, in contrast to a condition such as one of the cancers, where the NHS appears willing to pay for expensive medications often.

Equity, equality, fairness and justice will therefore be key aims of this new National Health and Care Service.

“These are some silos which we desperately must get rid of”, exhorts Burnham passionately.

Finally, Burnham wishes this to be a plan for the National Health and Care Service fit for purpose for a 21st century, synchronising at last the wishes of the public, professionals and politicians.

@legalaware

The Scottish referendum was, predictably, a disaster for Westminster’s historic view of the NHS



Scotland

Scotland’s decision on its future, everyone knows, was as much a referendum on the past performance of the Westminster governments to date. In human resources, a guiding principle is that a candidate is likely to behave in future as he or she has down in the past, unless there are exceptional circumstances.

Andy Burnham MP was quoted himself many times as warning against the creeping privatisation of the National Health Service in England. While the ‘No’ campaign consistently explained the Westminster government had protected the NHS budget, it was widely known that the statistical authority has rebuked David Cameron for stating incorrectly that NHS spending has increased in recent years.

The ‘no’ campaign nonetheless did put up a valiant fight, with exceptional campaigners Clare Lally and Johanna Baxter, for example. These campaigners, against some formidable abuse, tried to explain why the leverage of being united with England was especially important for Scotland to withstand future economic pressures resiliently, and why it was in fact intensely patriotic to keep Scotland as part of the United Kingdom.

Whatever Andy Burnham promises as the Shadow Secretary of State for Health, it is a fact that the efficiency savings in the NHS and the private finance initiative loan repayments have put enormous pressure on the operations on the service. Managers, who all too often behave in a divorced way to frontline clinicians, do not appear easily accountable for poor staff shortages impacting on clinical patient safety.

The efficiency savings operate on the assumptions that nobody wants to pay any tax to fund the NHS properly, and that the economy is not growing. Labour, whilst rightly drawing attention to how the ‘cost of living crisis’ is damaging the wellbeing of people, cannot easily claim that people are so unwilling to fund the NHS properly. Nor can they easily dismiss that the GDP of the UK might now be improving.

The resulting democratic deficit which has happened in Scotland is therefore an extreme serious one. Whilst it is the perception that New Labour and the Conservatives, at least, have paid more attention to their friends in the City of London rather than their workforce, there has been a lack of trust between voters and the mainstream parties. Today, UNITE decided it would go on strike. Labour has not yet given a clear indication of what intends to do about the private finance initiative.

In a way, the decision for Scotland was in fact very simple. It was about making a firm decision on separating from England, rather than subjecting Scotland to another eighteen years festering with Devo Max prior to another vote. But of course, we all know it was far from simple. Whatever one’s views about Johanna Lamont or Alex Salmond, the answer of many voters is a response to David Cameron’s original question, “We can’t go on like this.” Gordon Brown’s uttered the famous words yesterday, “And proud that with the powers of the Parliament we can guarantee that the National Health Service will be in public hands, universal, free at the point of need, as long and as ever as the people of Scotland want it.”

But will the general public believe Westminster any more?

It is clear that the Westminster governments totally underestimated the passion and drive of the ‘Yes’ campaign. If Gandhi had been subject to rolling news, one wonders how the Indian independence would have turned out. But the gut feeling of many ‘Yes’ campaigners was a blatant abreaction to lies and misinformation by people who were supposed to be acting in their best interests.

Predictably, Big Business were all mobilised to depict the #iScotApocalypse #ProjectFear scenario. Unfortunately, it had Westminster’s fingerprints all over it. The Westminster delegates, including Danny Alexander, George Osborne and David Cameron, looked utterly unconvincing in raising a populist case. And the media as per usual totally screwed up the reality of the economic contribution to the rest of the UK, which is quite a formidable one albeit not as strong as London and the South East.

When Margaret Thatcher reached Downing Street in 1979, she said, “And I would just like to remember some words of St. Francis of Assisi which I think are really just particularly apt at the moment. ‘Where there is discord, may we bring harmony. Where there is error, may we bring truth. Where there is doubt, may we bring faith. And where there is despair, may we bring hope’ … and to all the British people—howsoever they voted—may I say this. Now that the Election is over, may we get together and strive to serve and strengthen the country of which we’re so proud to be a part.”

England currently is deeply divided, between rich and poor, between employed and unemployed, and, as a result of the ‘welfare reforms’, between able bodied and physically disabled. September 18th was a chance for Scotland to have a ‘clean break’.

The question is, however, will Scotland go Alex Salmond’s way?

It is a massive honour to be able to return to the GMC Medical Register. A dream come true.



Facundo looking sideways

Yesterday, I went for lunch with my friend and colleague, Prof Facundo Manes. Facundo kindly wrote a Foreword to my book ‘Living well with dementia”, an essay on the importance of personhood and interaction with the environment for persons living with dementia. We were just a stone’s throw from all those bars and pubs in Covent Garden I knew well in a former life.

I spent nine years at medical school, and very few as a junior doctor.

I’ve now been in recovery for just over seven years.

But in that time I do remember doing shifts starting at Friday morning and ending on Monday night. I remember the cardiac arrest bleep in Hammersmith at 4 am, and doing emergency catheters at 3 am in Norfolk.

I had an unusual background. I loved medical research at Cambridge. In fact, my discovery how to diagnose the behavioural variant of frontotemporal dementia is cited by the major international labs. It is in the current Oxford Textbook of Medicine.

Being ensnared by the General Medical Council in their investigation process devastated my father. He later died in 2010. I remember kissing him goodbye in the Intensive Care Ward of the Royal Free, the same ward which had kept me alive for six weeks in 2007.

I of course am completely overwhelmed by those events widely reported, especially in the one in 2004. The newspapers never report I was blind drunk. The media when they do not mention my alcohol dependence syndrome are missing out a key component of the jigsaw.

Until I die, I will never be safe with one alcoholic drink. I will go on a spiral of drinking, and that one event I am certain would either see me in a police cell or in A&E.

One event did change my life. I was blue lighted in, after a year of heavy drinking after I was erased by the GMC in 2006, having had a life-threatening epileptic fit. The crash team attempted emergency intubation, but I ended up having a cardiac arrest which was successfully resuscitated.

I do not wish to enter any blame games about what happened a decade ago. It turns out that the Trust which reported me as dishevelled and alcoholic, and having poor performance simultaneously, is in the Daily Mail this morning for a running a ‘chaotic’ A&E department.

It also turns out that another Trust in London which reported me as dishevelled and alcoholic, and having poor performance simultaneously, had its A&E department shut down this week.

I have written previously here about my experience as a sick doctor.

I was in denial and had no insight. Hindsight is a wonderful thing, but I needed sick leave and a period of absence and support. But I do not wish to blame anyway for those events I wish had never happened some time ago.

But the GMC referrals were absolutely correct. I had a proper medical plan put in place for me when I awoke from my coma. I followed religiously my own GP’s advice too.

I am now physically disabled, and have had no regular salaried job since 2005. But I am content. I live in a small flat with my mother in Primrose Hill. I regularly go out to cultural events. I maintain my interest in dementia, going to a fourth conference this year for Alzheimer’s Europe in October, where I have been chosen to give one of the research talks. It’s actually on an idea which David Nicholson inspired me over.

I’ve done four books on medicine, including one on living well with dementia. The Fitness to Practice panel in their judgment note my contribution there, which I am pleased about.

The Panel also crucially made the link in their judgment that my poor performance in conduct and competence coincided with my period of illness, the alcohol dependence syndrome, for which I am now under a psychiatrist.

I go to AA sometimes, and the weekly recovery support group at my local hospital. Being in contact with other people who are starting the same process of getting their life back continues to inspire me. I also attend the suspended doctors group for the Practitioner Health Programme, which helps me understand myself too.

I believe that there is no higher law than somebody’s health. I understand the pressures of why trainees preventing them from seeking help in the regulatory process.

But I do have an unusual perspective. First and foremost, I am a patient myself, and proud of it.

Secondly, I am regulated by the Solicitors Regulation Authority. I can become a trainee solicitor, if I want to be. I had a careful due diligence process in 2010, and I thank the legal profession for rehabilitating me.

Thirdly, I will now be regulated once again by the General Medical Council pending a successful identity check on October 7 2014. Having my application to be restored to the UK medical register is a massive honour for me. I caused a lot of hurt to others during my time with the medical profession last time, and this time I would like things to be different, and be of worth.

This, I hope, will mean a lot to my late father.

I am grateful to all the people at the Medical Practitioners Tribunal Service, and to the GMC prosecutor for presenting a fair case on behalf of the GMC who need to promote patient safety.

I am encouraged that the GMC’s new Chair, Prof Terence Stephenson, “gets” change for the better for the profession, and has an excellent track record as a clinical leader.

I genuinely feel it’s only a matter of time before the giant supertanker which is the medical profession changes its bearings to acknowledge that sick people in their profession exist. Dr Phil Hammond has done a superb article on this.

I love my law school, BPP Law School. They got me through this. I have become a non executive director of their Students Association now. There’s a lot of work to be done there, but I am lucky that there are two colleagues there of mine who are simply the best: Shahban Aziz and Shaun Dias.

I am now about to be regulated by two professions. I could not be happier.

Thanks for your support. I couldn’t have done it without you.

The Kailash Chand Factor



Dr  Kailash Chand (9) (1)

In terms of experience and knowledge about the NHS, this is no time for a novice.

Dr Kailash Chand OBE, to put it politely, is old enough to be Dr Dan Poulter’s elder and wiser uncle. Whereas Poulter gives the impression of being a hapless junior on a ward round who hasn’t had enough time to tabulate all the recent full blood counts, Chand behaves like a senior consultant who is also worried about whether the patient had a good night sleep.

The problem for the Labour Party is wondering what on earth they have ended up with. At first, Labour promised to abolish an internal market, only to re-introduce one in the form of the iconic ‘purchaser provider split’. Chand is more than aware of budget sheets being crippled by the private finance initiative loan repayments, even though this policy was introduced to improve the infrastructure of the service.

It is all a curious mystery how the Labour Party became so keen on harmonising procurement legislation with Europe. It could of course be coincidental that Tony Blair was President of the Council of Europe for July – December 2005, just before the Public Contracts Regulations popped out in 2006. It is equally unclear to what extent New Labour was keeping the bed warm for the private providers who wanted a slice of the “NHS nooky”.

Labour cannot be blamed for wishing to campaign on the NHS, but the NHS chimaera that exists today cannot be said to be divorced from the policies introduced by Labour in its period of government. The NHS, overall, has suffered, as Chand puts it himself, from ‘death by about thousand privatisations’.

I can never remember whether Kailash Chand has been a member of Labour for over 25 years, or has been a GP for over 25 years. But either way it doesn’t matter. Both facts are on the public record, so is Chand’s commitment to fighting the current Coalition government on policy which he claims vociferously is not in the best interest of patients.

I, of course, like the fact that he regularly contributes to the medical press, and has held various offices of responsibility; but I should like the Labour Party to make full use of his formidable intellect, preferably with the Labour Party in government from next year; and his enormous undoubted popularity with the driver of his democratic ambition, people who are fed up to the back teeth with his Government.

I don’t happen to agree with Dr Gordon Brown on some things, such as wishing to be so intensely relaxed about the City of London (I am of course vicariously attacking Brown when this was a remark made by Lord Mandelson).

But as regards Kailash Chand’s full potential – no doubt there will be lots of new talent next year in think tanks and so forth, but this is possibly no time for a novice. Chand needs to be at the heart of decision making.

There’s no point striving for economic integration if we’re sustaining political and social disintegration



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When Margaret Thatcher spoke on the steps of Downing Street, about to escalate eleven years of unforgettable government, a New Jerusalem was pictured of a country at ease with itself. Not reliant on any sense of collectiveness, but a group of individuals who could seek and achieve success.

And indeed her star pupil, Tony Blair, was the best product from this era for Thatcher. Ed Miliband later proudly admitted that he ‘believed in’ the sense of aspiration to be inherited from the late Baroness.

Except this nirvana was anything but heavenly. Far from liberalising people, the Hayekian market enslaved working people who did grew further apart from the fruits of their productivity.

Inequality ‘never had it so good’ in governments during Thatcher and beyond. Ed Miliband in his recent speeches for the Labour Party conference has had to refer to ‘responsible capitalism’, citing specifically how consumers’ bills have rocketed due to energy suppliers almost acting like a cartel.

The fact that Rupert Murdoch was backing the ‘No’ campaign was therefore bound to cause disquiet, as was the backing by BP. It seems that all the multinational corporates know which side their bread is buttered on, having been given a strong lead from Barack Obama.

So therefore the idea that Scottish citizens were rejecting the privatisation of the English NHS was a profound embarrassment for the Westminster parties. All parties, especially the current Coalition parties, have vehemently denied that there has been any privatisation in recent years.

The current Government adamantly state that the percentage of private provision in the NHS has gone up from 5% to 6%. Critics of section 75 of the Health and Social Care Act (2012), argued to turbo-boost the outsourcing of NHS contracts through competitive tendering, are continually told about New Labour’s drive towards the growth of independent sector treatment centres.

Tony Benn left people thinking that it did not as such matter which party you now voted for, as they all effectively have become frontmen for globalised multinational corporations. That nobody actually votes for the World Bank or the European Commission legislators led Benn to do a pilgrimage to Strasbourg which he proudly hated.

For Benn, it was more important that a citizen could achieve influence through a single vote in democratic socialism, than to buy influence as part of a lobbying organisation. And of course we see a profound failure of democracy in the springing of the Lansley Act and the “hospital clause” from nowhere.

The spectacle of Miliband, Cameron and Clegg marching up from Westminster to Glasgow made many of my Scottish friends to vote “Yes”. But for them their solidarity has been a reaction to a different ethos being inflicted from above.

Whatever the appearance of economic integrity there might be in the United Kingdom, even with the use of the Pound Sterling in Scotland, or Eurozone avoiding a currency crisis, the victory appears somewhat Pyrrhic if there has been in fact been decades of social and political disintegration.

If Scotland votes to be independent, Labour could end up losing MPs who instead become ‘foreign nationals’. Ed Miliband has a relatively united party behind him, but it is likely that many in the Conservative Party will want to get rid of him.

This is especially likely if Cameron’s party enters the farcical situation of wanting to opt out of Europe having lost Scotland. David ‘Little England’ Cameron would then, even beyond the Labour Party, would become the worst Conservative Prime Minister to have ever existed.

But, if Scotland votes no, then it is possible that the UK general election will occur ‘on time’, i.e. early May 2015. The truth is that, even if Scotland votes yes, it possibly is too much hassle to shift the date of the election pursuant to the Fixed Term Parliament Act.

Then it might become business as usual, where the UK Labour Party promise to halt the privatisation of the NHS. The Conservatives have adopted the position where they wish to deny absolutely any existence of privatisation of the NHS, completely unlike their position on the utilities or Royal Mail. So, presumably, if the Conservatives win the election, the ‘non-privatisation’ of the NHS will continue.

But, in addition to the goal of economic integration, an incoming Labour government does have a hope of political integration with an albeit devolved Scotland. The greatest challenge will, nonetheless, be an England at ease with itself, which does not have different groups of people pitted against each other.

There is much work to be done in English health policy, including review of PFI, the purchaser-provider split, abolition of the Health and Social Care Act (2012), exemption from TTIP, a properly funded health and social care system, and fair pay for NHS staff, as well as implementation of “whole person care”.

If, on the other hand, Whitehall organises a painful ‘conscious uncoupling’ of Scotland and England, that could take up a lot of effort which might be better used up elsewhere.

What is Clive telling Andy and does Andy need to listen?



I had the pleasure of going to two events at the weekend. On Saturday, I went to the event at Trafalgar Square for the #999CallfortheNHS #DarloMums arriving after their 300 mile-long walk across the country. Thanks to Jos Bell for inviting me, for which I am deeply grateful. The following day, I went to the National Health Action Party for their Annual Conference in Conway Hall, Red Lion Square, London. I enjoyed that afternoon as well.

The National Health Action Party are putting up parliamentary candidates for the General Election 2015, the vast majority of whom are known friends of mine. I am proud of them, and I really do wish them well. They give people a chance to vote for a party which has an established position against privatisation. The party is led by Dr Clive Peedell and Dr Richard Taylor, and they clearly have a strong position against privatisation of the NHS, and various manifestations of the NHS market including the private finance initiative and the EU-US free trade treaty.

They have made substantial progress this year. One of their challenges as a new party is having people recognise what they stand for, and this is clearly going to be hampered if the mainstream media do not give them a fair opportunity. Nonetheless, there have been noteworthy successes, such as appearances on Sky, LBC and “The Evening Standard”. And there is no doubt about the intensity of emotion in support of the National Health Service. A challenge is funding, and, whilst the party is in fact running a healthy surplus, having more funds will allow them to present a greater number of election candidates; an inevitably costly process.

It was very nice to chat with Dr Clive Peedell both before and after the event. I understand the misgivings about previous Labour policy, and indeed whether Labour can be said to be doing enough on abolishing the market. There are clearly strands of Labour policy which made room for private providers, but likewise it is also the case that the Lewisham judgment in the high court clearly stated that legislation under the present Government had been a clear departure from previous law under the last Labour government.

So it is not a surprise that many of the key pledges of the National Health Action Party will also be of concerns of some Labour voters with a keen interest in NHS policy. A slide of these were presented yesterday.

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It is easy to underestimate the pernicious effect that the private finance initiative has had. Whilst it may have had good intentions of improving the infrastructure of the health service, one cannot deny how ‘cost savings’ allegedly in places have led to dangerous threats to patient safety, such as hospital infection, or in actual staffing numbers cannot be tolerated, not least by the general public and the clinical regulators. Whilst not all the problems can be held responsible from that desk behind Whitehall, the removal of the Secretary of State’s duty for the NHS is clearly symbolic. And Clive Efford MP perhaps would do well to learn from Peter Roderick, a public interest lawyer by training, and Prof Allyson Pollock, a world respected expert in public health.

Andy Burnham MP undoubtedly has a lot of goodwill too, and it is now likely that Labour will be the largest party of an incoming government at least under the leadership of Ed Miliband; they could win an outright majority, also, if the policy mix is right. Burnham has explicitly stated his desire to repeal the Health and Social Care Act (2012), but it is clear that a huge amount of work will be necessary to clear up the regimes for Trusts in financial distress, and for getting rid of competitive tendering tendering as being the default option.

It is not easy to let the Liberal Democrats ‘off the hook’, though it is clear that there are MPs such as Andrew George who have been strongly critical of the NHS reforms and indeed the “Bedroom Tax”. It is undoubtedly clear that the National Health Action Party will not be the main party forming Government next year, but they have never had aspirations to. They do allow the main political parties to be held to account, and their supporters are enthusiastic and well informed.

One of the critical tests for Labour will be letting go of the more neoliberal twangs to its policy, and to represent those people who had gone on the modern day NHS Jarrow march. It is not simply good enough to riposte every attack with ‘yeah but the NHS is free at the point of need’. There are genuine problems with solidarity, equity, justice, and comprehensiveness in current ethos, and a whole raft of problems which have arisen from indisputable marketisation and privatisation of the National Health Service.

It would be a mistake for Labour to discount the National Health Action Party as an insignificant blot on the landscape, when many of their concerns should be genuine concerns for Labour too. Andy Burnham is a highly skilled politician, but he has a strong vested interest in making a Labour government work properly for the NHS, and that might include for example not holding its staff to ransom yet again on a pay freeze. Andy as critical part of a Labour Government might wish to find a way to fund the NHS properly, especially since the economy is apparently making a recovery?

Whilst the present Coalition Government may seem ‘catastrophic’ to many of us, it has in fact been a blazing success for the Coalition parties. They have been able to do a lot of damage in the name of ‘austerity’. The evidence base for such policies is extremely poor, and indeed there is quite a lot of evidence that the welfare benefit ‘reforms’ have done a lot of damage to the mental health of citizens particularly those with disabilities.

Dr Clive Peedell has much to tell Andy, and – for what it’s worth – I do believe Andy needs to listen. And I have every confidence he will.

Clive Andy

A triumph of optimism defeats cynicism as the Darlo Mums arrive in Trafalgar Square



The stench of sleaze from the backdoor lobbying culminating in the Health and Social Care Act (2012) was unable to overcome the sheer sense of euphoria and triumph of optimism defeating cynicism yesterday. Yesterday was history in the making, as all political parties were put on notice:

“Whose NHS is it? It’s our NHS”.

Whilst numerous governments have elaborated at length about the politics of ownership of public services, the message from the crowd of five thousand or so, within hearing distance of the Houses of Parliament, was loud and clear.

Many famous Labour members of parliament could be seen watching proceedings as the afternoon progressed, including Diane Abbot, Clive Efford, Jeremy Corbyn, Sadiq Khan, as pictured here.

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It was a very sunny day here in Central London. There was a charged sense of energy, optimism and solidarity as about five thousand people attended a pro-NHS rally in Trafalgar Square, the culmination of a 300-mile march organised by a group of mothers from County Durham.

The group from Darlington, the Darlo Mums, are opposingthe privatisation of the NHS. It was very emotional when Rehana Azam announced the names of the Darlo Mums, “the most amazing people I’ve just spent the last three weeks with.”

The warmth of the #999CallfortheNHS campaign was evident throughout the whole afternoon. The event was immaculately organised, and was a thoroughly enjoyable event for all.

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About 30 people had taken three weeks to march the full 300 miles from Jarrow in South Tyneside, organisers said.

Darlo Mums founder Joanna Adams said: “It’s been magic really. You only have to look over there [at the protesters gathered] to see people are behind the NHS and support what we’re saying. Joanna Adams described the mums as “ordinary”, but I beg to differ – they are entirely extraordinary in my opinion.

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Andy Burnham MP, Shadow Secretary of State for Health, broke off all prior arrangements to attend, emphasising the indecency that would have occurred had he not come to represent the political party which had legislated for the birth of the NHS in 1945. Burnham’s speech was equally positive and optimistic about the future, speaking of the need to remedy public over privatisation, integration over fragmentation, people before profit, and collaboration over competition. Again, as is usual for Burnham who has great political gravitas, there was a sense of the current Government simply treading water in office until a person with substantial experience resumes office once again.

Burnham emphasised yet again that an incoming Labour government will repeal the Health and Social Care Act (2012) in its first Queen Speech, and said that it would then negotiate the UK out of TTIP, the transatlantic US-EU free trade treaty. Currently discussions are held in secret.

Sadiq Khan MP said the #Darlomums were the best England have had since 1966. As the MP for Tooting, Khan has been an ideal position to witness the effect the NHS changes have had on the nation’s capital.

Clive Efford MP described his Private Member’s Bill to repeal the damaging competition rules that the Tory-led Government inflicted on the NHS in its Health and Social Care Act 2012. The speech was very well received.

Clive Efford

Even Dr Clive Peedell, Co-Chair of the NHS Action Party, called Andy Burnham’s speech “great”, having run 66 km himself to be there. It was announced that Dr Louise Irvine, an inner city GP and BMA council member, would be standing against Jeremy Hunt MP in the South West Surrey seat. Dr Peedell has of course seen at first hand the impact his specialty (oncology) has had on national politics, in the case of Aysha King.

And in the court of public opinion, according to the Daily Mirror last night, Dr Irvine was significantly more popular than Jeremy Hunt. We do know, of course, that the Daily Mirror do not comprise natural friends of Jeremy Hunt.

Irvine poll

‘We keep on being told the NHS is unaffordable. THAT IS A LIE.”, said Rufus Hound. This lie has of course been one of the most powerful tools of the media who have called the consistent underfunding of services “unsustainable”.

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Billy Bragg warned against blaming all cynicism on what one read in the media, saying that much cynicism was in people’s hearts – and this remained an obstacle for change.

Rehana Azam, as one of the marchers, NHS campaigner and leading light in GMB, and working mum, was one of the stars of yesterday’s event, explaining the necessary steps to get the NHS back on track.

Andy Slaughter, MP for Hammersmith and Fulham, recounted the demolition of his local NHS services, whilst Grahame Morris gave his account, as MP for Easington, of the fight against the Tories to protect the NHS. Andy Slaughter of course has a huge following in West London, and one of the key organisers of yesterday’s event Jos Bell was obviously pleased with the success of the event together with Andy Slaughter.

Andy and Grahame

And finally, Question Musiq explained how he owes his life to the fast action of the Lewisham Hospital A&E in diagnosing his burst appendix, and performed his catchy rap song. Proceeds go to the Lewisham campaign.

A huge well done to everyone! A truly inspiring and memorable event.

Photos from the event

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The Barker Commission is helpful, but regulatory capture is an obstacle for dementia



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I welcome the hard work from the Barker Commission at the King’s Fund taking yet another look at how the health and social care systems can be brought together.

I agree that the continuation of this would be to reinforce a somewhat historical relic, when the evidence in my own field dementia is that the silos of care are indeed unhelpful in our direction of travel.

Our direction of travel in dementia is to move away from someone somewhere prescribing an ‘anti-dementia drug’ such as a cholinesterase inhibitor which has a limited time window for its effect on symptoms in dementia (and no robust evidence for slowing disease progression).

And the direction of travel is to move towards to thinking how to improve the wellbeing of a person with dementia. A person with dementia only becomes a patient when he or she is ill, and the wish of the services I feel will be to try to look after a person long before he or she has a medical crisis.

Too often the debate about the fusion of health and social care system has been entrenched in the all important debate about merging a universal and means-tested system. I do not wish to deny that.

But on the other hand, it would, I am sure, for a dream to be realised that the National Health Service could look after the health of a citizen in a national way, rather than for the needs of a person to be ‘dealt with’ in a piecemeal, fragmented, way, where profit before people may be an overriding principle.

For me, personhood in medicine and social care is about understanding that person, the person’s past, present, and future, and in relation to the environment and community.

This means that there will need to be some retraining of the workforce and reconfiguration of the health and social care systems, but there should be intelligent kindness to a beleaguered workforce part of which has just had to cope with a £2 bn reorganisation through the Health and Social Care Act (2012).

Too often the focus for a person who has received a diagnosis of dementia is on the correct pill to prescribe.  But clearly this is not good enough.

I am told all the time that what people want is some idea about the nature of their condition, how it might progress, what adaptations to their home might be necessary, what benefits might be available, what legal advice they can get ahead of the crucial time when mental capacity is lost, how the community will help if at all (for example banks), or how the environment can help (good signage if people are prone to navigation problems).

I do not wish to take the wind out of the sails of the important, valuable work by my medical colleagues in thinking about what factors might prevent dementia (e.g. intense social networks, exercise, certain foods), nor the search for medications which can interfere with the progressive biology of the conditions.

But people living in the here and now wish a practical, joined up solution in health and social care system, where information is freely shared in a necessary and proportionate way, mitigating for risks of sharing of personal information.

There are a number of obstacles to making this happen, but there is no doubt for me that ‘parity of esteem’ is a crucial factor. We have got to get out of the mentality of thinking of mental health and social care as unimportant compared to medical care.

This is a longstanding problem in policy, and there has been important progress in this. However, if we are to go down the route of making each pound count in the current NHS spend, in the avoidance of extra taxes or copayments, we should be bold enough to think of whether an adapted phone with big buttons and redials is  more cost-effective than a pill for improving the quality of life of a person with early Alzheimer’s disease.

In the early stages of Alzheimer’s disease, the most common type of dementia worldwide, people living with dementia typically might experience problems particularly in short term memory and learning.

I think the regulatory capture of bodies such as NICE, and medical regulators, will help to perpetuate the medical approach to dementia.

But if we had unified regulators, including one which could directly compare the cost effectiveness of a pill with that, say, of advocacy advice, with a view to improving the outcome of a quality of life of that person, rather than the effect on two points on a memory screening instrument, this would be progress.

This will require political nerve, and leadership from people in the field. I hope all concerned are up for the challenge. But the Barker Commission is an useful start, I think.

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