Click to listen highlighted text! Powered By GSpeech

Home » Shibley’s Own (Page 2)

If Labour wishes to make pledges that do not cost anything, why not an all-out attack on private insurance?

August 3, 2014 8:16 pm / 4 Comments

Ed Miliband

 

 

The narrative goes something like this.

Personal health budgets are the stepping stone to private health insurance. You’re given a fixed amount of money, which, as time goes on, is not nearly enough to pay for your health and social care needs. But not to worry, you can top up the budget, like you top up your pay-as-you-go phone account. And if you don’t want to spend your budget in the NHS, you can transfer to private insurance firms like a voucher.

The typical media question, in fact used by Robert Peston last week on Newsnight on Andy Burnham last week, is: “Do you have any fundamental objection to healthcare, as long as its cost-effective and of high quality, being provided by the public sector?”

An answer to this normally involves an answer which revolves around transfer of resources from the public sector to the private sector, or a bit of a fudge saying there’s no ideological objection to private providers, so long as there’s a NHS “preferred provider”.

Labour is obsessed about one thing: the deficit. From this, Labour is prepared to swallow all unpopularity, such as not spending money on pay increases in the public sector, or spending money on benefits (even if the benefits are totally legitimate).

When Ed Miliband was asked later in the week about the “funding gap” on LBC, Ed Miliband gave an answer in the style of ‘some of my best friends are midwives’, and then gave the customary fudge-answer on how he would like the NHS to make better use of the money it’s got.

Except, this won’t wash. There are currently more papers in the business management press along the lines of ‘why belt tightening still won’t make you fit in your trousers’ than Ed Miliband’s been to friends’ bar mitzvahs.

And yet the more blunt way of saying we will preserve the NHS is to go out for an all out attack on the City or private insurance. Labour supporters have to ask why he won’t do this. Is it because Ed Miliband does not wish to be seen to be anti-aspiration? To give you some context, Labour is planning to give hedge fund boss, Michael Farmer, a top honour.

Labour, in saying it does not wish to promote private insurance, does not spend any money. It might though nark off previous Secretaries for State for Health in the Labour Party who work for private healthcare funds.

People pay into the National Health Service, knowing that it is there for them. There is a genuine sense of solidarity and pooling of risk, and equity: free at the point of need. It’s a moot point whether the service is as comprehensive as it could or should be.

But Simon Stevens in bigging up personalised medicine has nailed his colours to the mast without saying so.

Many have alluded to, as indeed the previous CEO of NHS England – Sir David Nicholson has, the fact that knowing the precise risk of a condition with a strong genetic contribution, such as in rare causes of dementia, would mean that that person and their family would end up paying much higher premiums than in the National Health Service.

Ultimately it seems voters want to go for the least costly option – which is why Ed Balls and Ed Miliband would rather wire themselves up to the National Grid than to discuss with Andy Burnham how social care is going to be funded comfortably.

So if Labour tells voters in an all out private insurance system some people will be paying through the roof, and the NHS will go to pot, this will play very nicely to those people who are dead against private insurance in the country’s healthcare.

It will play nicely: if Labour actually mean it.

How do you solve a problem like Andy?

July 29, 2014 8:28 pm / 1 Comment

AB

When I first met Andy Burnham MP at the Methodist Central Hall, Westminster, in 2010, where I was later to have a University graduation, he wasn’t as I expected him to be.

He was there for the leadership debate for Labour’s leader. And I remember thinking what a good idea a National Care Service would be.

I have now met Andy on several occasions, and he always waves and says hello. But it’s hard to describe the quality he has to somebody who’s never met him.

He has exactly the same quality as HM The Queen, whom I remember meeting in 1987. I had just been awarded a scholarship to Westminster School, and her husband asked me, “So tell me Shibley, what do you spend my wife’s money on? I bet you it’s booze, fags and wild women.”

The quality I mean is that the Queen has a real ability, despite her status, to make you feel completely at ease. Andy Burnham has this quality too. The thing you end up being struck by is his considerable gravitas.

Having met him, I’ve tuned into this in how he deals with TV interviews or shows such as Question Time. He speaks as somebody who knows the brief backwards, and who doesn’t need to say a lot to impress people.

You get this feeling when you hear a report that Sir Bruce Keogh has apologised to him for the alleged smear attacks. You get this feeling with Sir Andrew Dilnot writes to Andy over the latest statistics screw up.

But I concede it must be driving the Conservative Party potty. The Conservatives trump card is there is a groundswell of opinion that Labour ‘crashed the economy’. While not true, it’s been an opinion which has been hard to shift.

I don’t doubt the NHS will be at least number 2 on the list of factors affecting most people’s voting intentions, but opinions tend to divide amongst people who’ve experienced the NHS and those who haven’t.

There are people who’ve had a terrible time which they will never forget. At another end of the spectrum, there are some people who’ve had a positive experience, but think perhaps ‘they’ve been one of the lucky ones’.

So how do you solve a problem like Andy if you’re a Conservative? Extremely tricky, as Andy Burnham by a long margin is one of the most popular members of the Shadow Cabinet.

Whilst his speech in Manchester was a litany of the current Government’s failings, and the usual critics of Labour piped up to say “what about PFI?” and all that, Andy does not have to say much to impress further people who believe in him.

There’s a group of people who feel that they can never vote for Labour ever again, due to where Labour has taken them in the past. But it’s not at all clear how they will vote, given that the most likely outcome is that Labour will be the largest party at least.

There are people in other NHS campaign groups who really are not convinced that Labour ‘mean it’, and not nearly going enough to address their complaints about the NHS. But they will need at some stage to collaborate with Andy Burnham, not compete with him, if they wish to go anywhere.

Andy Burnham said today, “By starting to bring social care into the NHS, we will build a health service for the whole person.” One suspects that Burnham will have to bring in a person-centred approach, encouraging professional communication between different disciplines looking after a person with, say, dementia, but not go anywhere near personal budgets which have turned out to be a poisoned chalice.

And one of his examples was particularly telling.

“So what happened? The trust launched a private treatment service for varicose veins – using NHS facilities – as they were permitted to do under the new freedom to earn up to half of their income from treating private patients.”

Nye Bevan is possibly the most outstanding Secretary of State for Health which the Labour Party has ever had.

In 1951, Bevan was moved to become minister of labour. Shortly afterwards he resigned from the government in protest at the introduction of prescription charges for dental care and spectacles.

I complete understand the staunch skepticism that Labour is any different to how they used to be under Blair, with Hewitt and Milburn as the Secretary of States for Health.

Lynton Crosby has advised the Conservatives that they should play ‘on their side of the pitch’.

Fine – and it could be that many voters are still concerned about the economy.

But as Carville himself said, “It’s the economy stupid, but don’t forget about healthcare.”

Time for a new regeneration. The New Secretary of State for Dementia.

July 27, 2014 3:53 am / 2 Comments

3SOS

Ed Miliband looks a bit awkward eating a bacon sarnie, or simply looks a bit “weird”. This man doesn’t look like your next Prime Minister?

But switch back into the reality. A cosmetic reshuffle where the present Coalition had to ditch a Secretary of State more toxic than nuclear waste from Sellafield to transport in a catwalk of tokenistic young hopefuls, “governing for a modern Britain”.

And engage a bit with my reality: where English law centres have been decimated, nobody is feeling particularly “better off” due to the cost of living crisis, GPs have been pilloried for being “coasters”, criminal barristers have gone on strike, or you can’t get your passport on time.

Whisper it quietly, and nobody wants to admit it, that despite all the concerns that Labour will front another set of middle-class neoliberal policies, Labour is in fact going to walk it on May 8th 2015 as the new UK government.

This will obviously be quite a shock to the system, and you can already feel the Civil Service behind the scenes mentally preparing themselves for a change in flavour for the dementia policy.

The current dementia policy had “Nudge” fingerprints all over it. “Customer facing” corporates could become dementia friendly so as to allow market forces to gain competitive advantage for being ‘friendly’ to customers living with dementia.

The Alzheimer’s Society got thrust into the limelight with the Prime Minister’s Dementia Challenge, ably supported by Alzheimer Research UK, to offer the perfect package for raising awareness about dementia and offering hope for treatment through basic research. This private-public partnership was set up for optimal rent seeking behaviour, with the pill sugared with the trite and pathetic slogan, “care for today, and cure for tomorrow.”

Except the problem was that they were unable to become critical lobbying organisations against this Government, as social care cuts hit and dementia care went down the pan. Dementia UK hardly got a change to get a look in, and it looked as if a policy of specialist nurses (such as Admiral nurses) would get consigned to history. They are, after all, not mentioned in the most recent All Party Parliamentary Group report on dementia.

It is widely expected that Labour’s NHS policy will be strongly frontloaded with a promise of equality, which the last Labour government only just managed to get to the statute books. Insiders reckon that this policy will be frontloaded with an election pledge with equality as a strong theme.

In the last few years, it has become recognised that caregivers feel totally unsupported, people get taken from pillar to post in a fragmented, disorganised system for dementia with no overall coordinator, and there are vast chasms between the NHS and social care treatment of dementia.

The next Government therefore is well known to be getting ready for ‘whole person care’, and it now seems likely that the new Secretary of State for Health and Care under a new government will have to deliver this under existing structures. This will clearly require local authorities and national organisations to work to nationally acceptable outcomes for health and wellbeing through empowered Health and Wellbeing Boards. This will help to mitigate against the rather piecemeal patchwork for commissioning of dementia where contracts tend to be given out to your friends rather than the quality of work. Health and Wellbeing Boards are best placed to understand wellbeing as an outcome (which can become missed in research strategies of large corporate-like charities which focus on care, cure and prevention).

And the switch in emphasis from aspirational friendly to a legal equality footing is highly significant. The new policy for dementia under the new Secretary of State will be delivering what people living with dementia have long sought: not “extra favours”, but just to be able to given equal chances as others. Environments will have signage as reasonable adjustments for the cognitive disabilities of people living with dementia in the community under the force of law, rather than leaving up to the whim of a corporate to think about with with the guidance of a fundraising-centred charity to implement.

With the end of the Prime Minister’s Dementia Challenge in March 2015, which has been highly successful in places in delivering ‘dementia friendly communities’, a commitment to improved diagnosis rates and improved research, it is hoped that the next government will be able to take the baton without any problems. It will be quite a public ‘regeneration’ from Hunt to Burnham, but one which many people are looking forward to.

My medical career finished along ago, but the GMC FTP procedures for ill doctors are still far too dangerous

July 26, 2014 5:23 pm / 2 Comments

Illness
One of the ways that the General Medical Council will try to pin you down is if you appear blasé in any sense about your own behaviour, or lack insight into its repercussions.

I have a psychiatrist in West London who oversees my recovery. I am a barn door alcoholic now in recovery. One of the wisest things he has ever said to me is that it is impossible to ignore the distress I caused to friends, family and others. I think about this every day of my life in fact. It has left an indelible trace on Google, which I do not wish to forget. That’s why I have never asked for it to be removed.

I get upset that the BBC considers my tragic case of erasure from the Medical Register as ‘entertainment’. Behind this titillating story was someone who was in massive distress, and to some extent continues to be in distress.

I have learnt the General Medical Council (GMC) is only doing its job. Reports, like the latest damning one by Civitas on how the GMC treats sick doctors badly, come and go. And nothing really changes.

But I remember all too well what happened to me. I repeat that I find my behaviour then, as a different person, disgusting and unacceptable. But things came to a head when I was blue-lighted in at the beginning of June 2007 with an asystolic cardiac arrest which I was very lucky to be resuscitated out of. I then spent six weeks in a coma. I was fighting for my life, with drips, a central line, and the full army of Intensive Care machinery. The Consultant at the Royal Free warned people I was not expected to leave the hospital. I was clearly a very sick man.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My late father came to visit every day when I was learning how to walk and talk again at the National Hospital for Neurology and Neurosurgery. That’s where I had spent six happy months, while healthy, learning about general neurology and dementia. It’s where I developed a lifelong interest in neurodegenerative disease, which pervades through my post-doctoral fellowship at the Institute of Neurology thereafter, my mention in the Oxford Textbook of Medicine, and my own book on wellbeing in dementia.

I am happy now that, having learnt how to walk and talk, I was invited to the Alzheimer’s Association International Conference in Copenhagen last month, and I went to the Alzheimer’s Show in Manchester and London this year.  My friends include people living with dementia, and they tell me what’s important in policy now.

I remember though the days of having to hide my name on blogposts or my Twitter account. I remember how I was frightened to show myself in public in the last few years. I remember how my circle of friends completely collapsed, though I am happy with the very small number of very close friends I have now. I still continue to get trolled, like no tomorrow, with words like “Disgusting” and “How do you live with yourself?”

I do also remember how the General Medical Council took years with their investigations. I remember the torrent of newspaper articles explaining how likely it would be I would be struck off. I remember thinking how this was an inglorious end to my ten years training to be a Doctor, a profession which I still feel honoured to have been in once.

But the General Medical Council protracts out their investigations. The GMC never got round to appointing a clinical supervisor (very odd) even though my independent clinical examiners had concluded that I had a severe alcohol problem. So it rumbled on for a few years with my mental health in free fall. Dynamite.

This is extremely risky – dangerous – for the sick doctor. If you lack insight or if you’re in denial you can be finished (as indeed the numbers of people reported to have committed suicide while waiting for their Fitness to Practise sessions show).

I remember how I totally ‘lost it’ in 2005 a year before my final hearing. I had long left a medical job, but I just fell apart while still waiting for my GMC hearing. I went on a massive bender sat alone sobbing into my drink in a pub in Notting Hill very close to Portabello Road, ended up being sectioned, and then was suspended by the GMC.

A year after I was erased, with no job and no family or friends virtually, my life really did take a nosedive. I sat in pubs all day from opening time to closing time. I was done for drunk and disorder offences.

But I woke up after a six week coma, newly disabled, but with a new purpose. I did three books on postgraduate medicine, and I became regulated by the Solicitors Regulation Authority. I have three degrees, my Bachelor of Law, my Master of Law, and my Master of Business Administration, as well as my pre-solicitor training.

I didn’t get very far when I bothered going up to Manchester for my restoration application. The GMC hadn’t bothered to do a basic conflicts session, so the meeting was adjourned after one day. My friend Martin Rathfelder made it to support me. He like Jos Bell and Kate Swaffer are true friends.

It’s a miracle that I didn’t have a relapse being in the City where I had been with my late father, where I was erased, with plenty of bars and restaurants, with plenty of memories. It’s like you’re being set up to fail by the GMC – or else they are incredibly incompetent when it comes to dealing with people with mental health issues.

But I did get as far as asking the panel if I could hold the hearing in public this time. I want to explain to the whole world why and how alcohol destroyed my life, and caused distress to others.

I think the GMC did the right thing in getting rid of me from the medical profession, but I am still bemused why one consultant in West London asked me to sort it out by giving me a phone number of the Priory, did not refer me to Occupational Health, and did not offer me sick leave. I am bemused why various consultants described me as looking dishevelled and alcoholic, and yet allowed me to finish my medical jobs in London, without referring me to Occupational Health.

By the time I was erased, the GMC had been given five reports from five independent doctors stating clearly that my primary problem was a severe alcoholic dependence disorder, and that I desperately needed help.

I never received this help until the NHS saved my life a year later.

The GMC will wish to ‘win their case’ and I strictly speaking am not allowed to bring any of this up in case it reaks of bitterness.

The GMC opposed my application to explain all this and my recovery in public. The panel rejected the GMC’s case.

In my view, Clare Gerada’s “Practitioner Health Programme” is a necessary lifeline for those are sick Doctors, and who fall under the London jurisdiction.

Prof Gerada is a true inspirational NHS leader.

Needless to say, I’ve never had an alcoholic drink for more than seven years, since my coma. I’m one of those guys who has no off switch after one drink, such that I’ll either end up in A&E or in a police cell.

My case will now be held in Manchester beginning August 20th 2014. If you want to begin to understand how sick doctors cope, or do not cope, please feel to come along.

Fighting each other on the left is a waste of resources

June 27, 2014 3:00 pm / Leave a Comment

arm wrestle

We keep on being told that there is a finite amount of resources to share. So why on the left are we not channeling our energy into things we care about?

Among the various things I have been witness to in the last year have been endless discussions on procedure and constitution. Such discussions while possibly well intended by some have virtually ended up being circular and being presented in summary in an incredibly unimpressive manner.

There are serious matters afoot. There was a draft Bill proposed by the Law Commission, which didn’t make it into the Queen’s Speech, on the regulation of clinical professionals. This promises to be a landmark piece of legislation, and has now been bounced into the next parliament’s lifetime. Clearly this Bill will prioritise patient safety, on which there was not a single clause in the Health and Social Care Act (2012) apart from abolition of the National Patient Safety Agency.

Many of us have allowed the narrative to be articulated in terms of ‘sustainability’, in other words we can’t afford the National Health Service – but curiously can afford war, and afford a lengthy inquiry into the legality of it. We have allowed a ‘there is no alternative’ closure of ‘failing’ hospitals, but have not addressed the principal issue of how clinicians and patients can be in charge of their own services without a firestorm by the Trust Special Administrator.

We have lost time on how we can make the health service function nationally, not in a piecemeal fragmented way like the privatised railway industry. We have lost time on implementing serious methods of keeping vulnerable frail patients out of hospital, or people living with dementia, in cases where they’d be better off with some proactive intervention out of hospital.

It is simply impossible to have this sort of discussion of what the left wishes to do in terms of solidarity, justice, equity and equality, while certain people are at each other throats. Whilst I am not a big fan of Tony Blair by any stretch of the imagination, it cannot be said that the previous Labour administrations can be the root of all of the ills of the National Health Service.

Basic things being done well matter a lot to people, like seeing their local GP or being attend an A&E unit in a timely matter. Andy Burnham MP has a golden opportunity to make sure medical records are shared freely between one part of the health and care service with the other, to prevent reduplication and poor medical decision-making based on information asymmetry. There is a key chance to break down barriers between health and social care, so urgently need, for example, in my academic field of living well with dementia.

There are many people who are now publicly concerned about the effect of competition in English health policy. Margaret Heffernan, of ‘wilful blindness’ fame, is just about to have a bestseller on her hands on this subject.

So can we cut the incessant concerns about how the Labour Party is still a cover for corporate Britain? That Labour hasn’t learned anything from the past, which includes John Major activating the private finance initiative initially before badly negotiated contracts under the early years of the Blair administrations?

It is impossible to divorce the needs of physical and mental health of a person from social care needs. So we can we put a sock in the movement that integrated care of any variety can only be a Trojan Horse for privatisation? There is a possibility that a future Labour government might be able to provide a fully funded national care service, if there were a momentum of public support.

Labour’s position on personal health budgets (“PHBs”) for the last few years has been clear. Whilst there are noteworthy successes, there have been a plethora of concerns, including safeguarding issues for people with dementia. It was never intended that they should be compulsory, despite the subject of PHBs at all being promoted previously by some very senior in the Labour Party.

There’s a battle to be fought indeed, but the outcome of that battle should not a Conservative-UKIP coalition. You’ll find that they will not be the answer to all your concerns about the NHS.

As regards the NHS, Dave Cameron is also being a tad economical with the truth

June 19, 2014 7:05 am / 1 Comment

money

 

We keep on being told from the right wing that “money does not grow on trees”, but the Chilcot Inquiry on the Iraq War has so far cost millions (the actual war was costly in many senses too.)

These are #pmqs from my 40th birthday.

Nick Brown MP asks the Prime Minister about the underlying causes of the £2bn forecast deficit for NHS Trusts, and what the remedies might be.

This topic hit the headlines big time yesterday, but it had been copiously discussed by John Appleby by the King’s Fund in one of their documents previously.

The exchange as reported in Hansard went as follows:-

Nick Brown

Specifically, the Prime Minister contends that, “money has been ploughed back into better patient care in our NHS.”

This is likely to be true as a half-truth as he does not say “the” before the word “money”.

But where did the money actually go?

It appears it has traditionally gone to HM Treasury, NOT directly to the Department of Health budget.

Everyone knows that the pay settlement for the NHS was tight this year, given the pay freeze discussed at the #RCNCongress this year.

Crispin Dowler reported in the HSJ in October 2012:

“The Department of Health has returned nearly £3bn of its funding to the Treasury over the past two years, despite facing its tightest financial settlement for five decades.

“A Treasury spokesman this week confirmed to HSJ the department had handed back around £1bn of the funding it was allocated for health spending in 2011-12. Just £316m of the £1.4bn that the DH left unspent last financial year has been carried over for it to use in 2012-13.

“The final sum clawed back from last year’s health allocation is double the £500m estimate that was published in chancellor George Osborne’s March Budget.”

Sofia Lind in the Pulse magazine reports a similar story in 2013.

My brief Twitter chat yesterday with @DaveWWest went as follows.

Andy Burnham MP has claimed that the Prime Minister no longer wishes to talk about the NHs in the run up to the general election on May 7th/8th 2014.

There did seem, however, to be a record number of questions on the NHS in #pmqs?

Yesterday we broke the record for most views of the @SocialistHealth blog website

June 16, 2014 12:20 am / Leave a Comment

Here are the official figures for the most ‘viewed’ blogposts yesterday (15 June 2014).

 

My experience of being a sick Doctor 2,286
The Black Report 1980 74
Home 69
Home page / Archives 63
The five core messages of ‘Dementia Friends’ are consistent with the current literature 51
Black Report 6 Explanation of Health Inequalities 50
National Insurance a bad way to pay for the NHS 34
Like Nick Clegg, I was taught by ‘unqualified teachers’ at the same school. His hypocrisy stinks. 27
Black Report 10 Summary and recommendations 24
Aneurin Bevan and the foundation of the NHS 22
Other posts 546
Total views of posts on your blog 3,246

 

It meant a lot to me having so much positive feedback from people in the #Twitter community on my blogpost which was the first time I’d blogged on my experiences of being a sick doctor in such a public forum.

I reproduce a sample of these tweets here.

It was a really big deal for me to write this, but I wrote it entirely spontaneously this morning. I’ve been churning around these issues every day of my life since waking up from my coma in 2007, and of course on #FathersDay it is impossible to ignore how awful it must have been for my late father.

My experience of being a sick Doctor

June 15, 2014 7:18 am / 17 Comments

thermometer

 

“Anything can happen to anybody at any time.”

This one principle does guide what I think about people and health.

It’s what I think when a friend of mine living with dementia suffers a bereavement. It’s what I think when a friend of mine gets told he has bladder cancer.

It’s also how I come to rationalise my six week coma in 2007 due to acute bacterial meningitis. I was rushed into the intensive care unit of the Royal Free Hospital Hampstead, having been resuscitated successfully by somebody I used to work with in fact. He knows who he is.

His team stopped me fitting in an epileptic seizure. His crash team got a pulse back on their third cycle of jumping down on my chest after I had been flatlining in cardiac asystole. He managed to put a tube down me as I had stopped breathing.

I then spent six weeks in a coma, and my mother and late father came to visit me every day in intensive care, and in the neurorehabilitation unit (Albany Ward) at the National Hospital for Neurology and Neurosurgery, London (a hospital in which I had worked in 2002 in a rotation which included an interest of mine, dementia).

I am now living with physical disability. I can now walk, and I remember my protracted time in a wheelchair. I remember people’s reactions to you in the street. I remember how ‘available’ black cabs would simply drive past. I was, in effect, taught how to work again by inpatient and community physiotherapy.

Due to my meningitis, I could barely speak; the “speechies” helped me with that. I had difficulty planning a cup of tea; the “OTs” helped me with that.

I can relate to all the current NHS concerns how you become stripped of identity in the modern NHS: you become a bed number, or at best a surname.

But in many ways, as my late father kept reminding me shortly before his own death in November 2010, that meningitis in a way saved my life.

I then engaged properly with the NHS as a patient. I used to see my GP regularly.

As a medical student, I had felt as if I was too busy to see my own GP. Big mistake.

As a young house officer in hepatology, I used to be surrounded with very pleasant patients; but for whom I had to perform an abdominal paracentesis, as they were often bright yellow due to liver failure (but awaiting a liver transplantation).

I slowly became alcoholic and isolated. I have often been asked when did I start to drink heavily. This is very difficult for me to place, as most people like me go through a phase of problem drinking.

My official diagnosis for the alcoholism is severe alcohol dependence syndrome in remission. I have now not drunk alcohol for seven years. I know I am an alcoholic as it is unsafe for me to have an alcoholic drink. If I have an alcoholic drink, I would either end up in A&E or in a police cell. I am incapable of having a social drink.

Receiving a medical diagnosis for my mental health condition, in my particular case, helped me to rationalise the cause of my problems which had caused so much distress to others including especially my mother and late father.

I was listening to LBC last night and the presenter was joking that he had a listener rung up “I am an alcoholic. I haven’t had a drink for 35 years.” But seriously folks, it is like that.

I am now regulated by the legal profession. I spent 9 years at medical school, doing my basic degrees for medicine and surgery, and my PhD in the early diagnosis of frontal dementia. As a junior in the medical profession, walking around as the most junior member pushing the Consultant’s trolley and writing in the notes, the thought that you might be ill did seem an alien one.

And yet I was extremely ill. For all people in addiction, there becomes a time when you are in complete denial and lack complete insight. That’s when it is impossible for you to be regulated.

I also have a lot of sympathy for the regulators who regulate people who I think can be best be described as a “dry drunk patients” – i.e. they spend months or even years dry before relapsing. They are, I feel, “living by the seat of their pants”, or “whiteknuckling” it.

The alternative is recovery – where you are not merely abstinent, but where you embrace a life which is utterly content, but in the absence of your addiction of choice.

I indeed find this hard to explain to people who have never experienced addiction. I do not wish to compete with ‘patient leaders’, or think tanks who go on and on and on and on about patient involvement.

But I do wish to recommend to you, if you are in their catchment area, the Practitioners Health Programme (PHP). An incredible ambition of Prof Clare Gerada, the programme is a lifeline to doctors who are ill.  It’s been shown in numerous numerous surveys that an ill doctor under-functions as much ‘use’ as a doctor who is completely out of the service. I would simply say to anyone who is ill in the medical profession, put your own health ahead of your career. Your patients deserve that too. Do not be blinded by your own career. I am proud to attend regularly PHP.

I don’t do much apart from hundreds of blogs for the SHA, or campaigning for people living with dementia. But I am at least at last content.

 

 

 

Update: I (Dr Shibley Rahman) was returned to the GMC Register for the UK 26 August 2014. I had been in recovery from alcohol since the onset of my coma due to meningitis in June 2007.

 

Labour’s living on borrowed time. And there’s less than one year to go.

June 3, 2014 3:41 am / 2 Comments

miliband_620_1982934a

You cannot predict the quality of HM Government by the way in which its leader might currently eat a bacon butty.

The Labour leader was photographed in the unflattering pose as he battled the butty in public as early as 6.30am.

Unfortunately it does feed into a feeling of a person who is not on top of his game. Labour did much better in the local elections and the European elections than one might first expect from the BBC news headlines. Miliband has not been a regular guest on the Nigel Farage Show in its various guises, whether it be BBC1 on a Thursday evening or Sunday morning.

But there is a feeling with Ed Miliband that ‘He’ll do’. There are fewer than 365 days until the general election to be held in the UK on May 7th 2015. As yet, we have no idea what Labour will do about the purchaser-provider split, or what it will do about the private finance initiative (PFI) compromising NHS hospital budgets up and down the land.

In as much people welcomed Tony Blair back into their hearts, it was less about the content of what he said, although the message of taking UKIP on curried favour with many, but more about the clarity and vision with which he articulated it. Ed Miliband, for the decency of the nation, could let us in on his secret vision for the UK, irrespective of his intentions to win the general election.

It should be obvious what he wishes to do about the national living wage – whether he wishes to legislate on it or not. It should be clear that he will commit to increase spending in parts of the agenda, such as the National Health Service, if the economy benefits from a financial recovery.

If Ed Miliband fails to make headway on this, it won’t be long before Labour is listening carefully to the views of Stella Creasy or Chuka Umunna as future Labour leader. Tbe ‘progressive left’ can’t wait to get going, Big Society fans and all. The Department for Work and Pensions job could sink Rachel Reeves, as indeed it sunk fellow ideologue James Purnell, if Reeves is seen to be a vernacular wonk who doesn’t ‘get it’ as far as disabled citizens are concerned.

Ed Balls is living on borrowed time. Fair or unfair, some people do associate him with being Gordon Brown’s “henchman”. While he is not quite the Quasimodo of Labour, his willingness to stick to a failed austerity agenda does not make him far off in the eyes of some.

Labour’s offering for many will have to be  more substantial than whether it is going to spend more money on the National Health Service. It will have to be a case of not spending more money overall, but spending more money on the right people. Whilst people may not resent money being spent on good managers spending money effectively in the NHS, people are less forgiving about money being used to service PFI debts and implement unsafe levels of staffing.

Whilst people might be less concerned about the details of the English dementia strategy or the success of standardised packaging for cigarettes, Labour’s vision on all areas of policy has to be water tight. A philosophy of ‘less is more’ may be enough to win (just) a general election, through harvesting of Liberal Democrat votes, but it is striking how Miliband has failed to be loved yet.

This is a similar predicament to how commentators in the Telegraph had identified how David Cameron was more tolerated than loved as a leader of the Conservative Party. But Ed Miliband’s offering is pictured in the eyes of many as “wonky”, “weird”, “synthetic”, “forced” or “wooden”, or “intellectual”, rather than being “inspiring” or “passionate” or “clear”.

All of this is not a ‘good look’ for Ed Miliband, but unless Miliband’s team begins to be seen to get it right on policy or delivery, it will be more than the bacon butty that is deeply embarrassing.

 

 

Living well with corporate capture. What’s the future of the English dementia strategy?

May 28, 2014 10:20 pm / Leave a Comment

“Citizens have become consumers with status proportional to purchasing power, and former public spaces have been enclosed and transformed into private malls for shopping as recreation or “therapy.” Step by step, private companies, dedicated to enriching their owners, take over the core functions of the state. This process, which has profound implications for health policy, is promoted by politicians proclaiming an “ideology” of shrinking the state to the absolute minimum. These politicians envisage replacing almost all public service provision through outsourcing and other forms of privatisation such as “right to provide” management buyouts. This ambition extends far beyond health and social care, reaching even to policing and the armed forces.”

And so write Jennifer Mindell, Lucy Reynolds and Martin McKee recently about ‘corporate capture’ in the British Medical Journal.

Alistair Burns, England’s clinical lead on dementia, recently concluded a presentation on the clinical network for London with the following slide:

Reminyl Speaker Training Showfile

Alistair clearly does not mean ‘Dementia is everyone’s business’ in the “corporate capture” sense. Instead, he is presumably drawing attention to initiatives such as Brighton and Sussex Medical School’s initiative to promote dementia awareness at all levels of an organisation (and society).

 

Microsoft PowerPoint - H1 Dementia Care Event

 

The comparison with diabetes is for me interesting in that I think of living well with diabetes, post diagnosis, as conceptually similar to living well with dementia, in the sense that living well with a long term condition is a way of life. And with good control, it’s possible for some people to avoid hospital, becoming patients, when care in the community would be preferred for a number of clinical reasons.

Where I feel the comparison falls flat is that I do not think that it is possible to measure outcomes for living well with dementia easily. Sure, I have writen on metrics used to measure living well with dementia, drawing on the work of Sube Banerjee, Alistair’s predecessor.

It might be possible to correlate good control with a blood test value such as the HBA1c, and it steers the reward mechanism of the NHS for rewarding clinicians for failure of management (e.g. laser treatment in the eye, foot amputation, renal dialysis), but the comparison needs some clinical expertise to be pulled off properly.

The issue of breaking down ‘barriers’ between primary and secondary care is an urgent issue, and ‘whole person care’ or ‘integrated care’ may or may not help to facilitate that.

But the question of who gives the correct diagnosis of dementia, or even verifies it, won’t go away.

Having done Dementia Friends myself, a Public Health Initiative delivered by the Alzheimer’s Society, I feel the initiative is extremely well executed from an operational level. I think it’s pushing it for a member of the public to think that an old and doddering lady crossing the lady might have dementia and requires help, as medicalising ageing into dementia is a dangerous route to take.

The £2.4 million programme is funded by the Social Fund and the Department of Health. 

There are a number of important clinical points here.

People with dementia need to be followed up across a period of time for a diagnosis of dementia to be reliably made, and ‘in the right hands’, i.e. of a specialist dementia service.

Some people have ‘mild cognitive impairment’ instead, and will never progress to dementia.

There are 149,186 dementia friends currently. This number is rapidly increasing. The goal is one million.

Furthermore, there are many people given a diagnosis of dementia while alive who never have it post mortem. And the diagnosis can only be definitively made post mortem.

Seth Love’s brilliant research (and he is an ‘Ambassador’ to the Alzheimer’s BRACE charity) is a testament to this.

This policy plank for me will also go back to the issue of whether policy is putting sufficient resources into the diagnostic process and beyond. Stories of people being landed with a diagnosis out of nowhere and given not much further information than an information pack are all too common. A well designed system would have counselling before the diagnosis, during the diagnosis, and after the diagnosis.

Ideally, an appointed advisor would then see to continuity of care, allowing persons with dementia to be able to feel confident about telling their diagnosis to friends and/or family. The advisor would ideally then give impartial advice on social determinants of health, such as housing or education.

But all this requires money and skill. There is no quick fix.

The areas of action for the Prime Minister’s Dementia Challenge are: dementia friendly communities, health and care and improving research.

The term ‘dementia friendly communities’ is intrinsically difficult, for reasons I have previously tried to introduce. A concern must be the ideology behind the introduction of this policy in this jurisdiction. The emphasis has been very much on making businesses ‘business friendly’, which is of a plausible raison d’être in itself.  This, arguably, is reflected in the list of chief stakeholders of the dementia friendly communities champion group.

Dementia friendly communities board

It happens to fit very nicely with the Big Society and the ‘Nudge’ narrative of the current government. But it sits uneasy with the idea that it is in fact a manifestation of a small state which bears little responsibility apart from overseeing at an arm’s length a free market.

And meanwhile, the care system in England is on its knees. Stories of drastic underfunding of the care system are extremely common now.

An army of millions of unpaid family carers are left propping up a system which barely works. There appears to be little interest in guiding these people, with psychological, financial and/or legal burdens of their own, to reassure them that all their hard work is delivering an extraordinary level of person-centred care.

But this for me was an inevitable consequence of ‘corporate capture’. The G8 World Dementia Council does not have any representatives of people with dementia or carers.

That is why ‘Living well with dementia’ is an important research strand, and hopefully one which Prof Martin Rossor and colleagues  at NIHR for dementia research will give due attention to in due course. But all too readily research into innovations, ambient assisted living, design of the ward, dementia friendly communities, assistive technology, and advocacy play second fiddle to the endless song of Big Pharma, touting how a ‘cure’ for dementia is just around the corner. Yet again.

So what’s the solution?

The answer lies, I feel, in what happens in the next year and beyond.

The Prime Minister’s challenge on dementia was developed as a successor to the National Dementia Strategy, with the challenge of delivering major improvements in dementia care, support and research. It runs until March 2015.

Preparatory work to produce a successor to the Challenge from the Department of Health (of England) is now underway in order that all the stakeholders can fully understand progress so far and identify those areas where more needs to be done.

The Department of Health have therefore commissioned an independent assessment of progress on dementia since 2009.

There are a number of other important pieces of work that are underway, which will provide information and evidence about progress and gaps. For example the All Party Parliamentary Group on Dementia chaired by The Baroness Sally Greengross OBE are producing a report focused on the National Dementia Strategy, and the Alzheimer’s Society has commissioned Deloitte to assess progress and in the autumn will be publishing new prevalence data.

Indeed the corporate entity known as Deloitte Access Australia (a different set of management consultants in the private sector) produced in September 2011 a report on prevalence of dementia estimates in Australia.

Deloitte themselves have an impressive, varied output regarding dementia.

But of course they are not interested in dementia solely. “Deloitte” is the brand under which tens of thousands of dedicated professionals in independent firms throughout the world collaborate to provide audit, consulting, financial advisory, risk management, tax, and related services to select clients.

Apparently, once all this work has been concluded a decision will be made on the focus and aims of the successor to the PM’s challenge.

The current Coalition government has been much criticised in parts of the non-mainstream media for the representation of corporate private interests in the Health and Social Care Act (2012).

I believe people who are interested in dementia, including persons with dementia, caseworkers and academics, should make their opinions known to the APPG in a structured articulate way in time. I think not much will be achieved through the pages of the medical newspapers.

And only time will tell whether the new dementia strategy will emerge in time before the next general election in England, to be held on May 7th 2015.

It could be a case of: all change please.

 

 

This blogpost first appeared on the ‘Living well with dementia’ blog.

 

Post navigation

← Older posts Newer posts →
Click to listen highlighted text! Powered By GSpeech