Hospital car parks

Contentious things aren't they? we have all visitted someone and resented the scrabble for change, or even how much we have to pay for visiiting someone frequently and how much it costs. Some people find hospital car parks a very useful metaphor for many issues. Here's one i really like. Hospitals are just like car parks because .......as soon as you build one it fills up.Well I guess that does hold up as an illustration. We are often told there is an over provision of beds in some sectors, yet the beds are all full.I suppose if you restrict parking then people find other means of getting to places, and the belief is that if you close beds and transfer the funds to community services then lo and behold the beds just aren't needed. I suppose as occured in the massive down sizing of psychiatric provision in the 80's.
Hospital car parks are another useful indicator of activity. If you go to your average District General Hospital at the weekend , what do you find? The consultants car park with its designated spaces will of course be largely empty, likewise the admin peoples. Yet the nurses car park (if there was such a thing) will be full as usual. Why so? Probably because patient need doesn't keep office hours and acutiy doesn't drop off at 5pm on a friday. In fact we are now told that mortality rates rise by up to 10% at the weekends due to the non availablity of senior medical staff to advise their junior colleagues (although available on a phone). It has been suggested that this needs to change.
Perhaps we will see all the car parks starting to be as full as the nurses' one?

Keep Calm and Carry On

The slogan that has probably been most read for years, and the product of a campaign that thankfully never was. I like many people I am sure have seen it on T shirts, posters, television presenters and even on on a coffee mug! Perhaps we will never know who penned this amazing instruction to the British people in the event of a German invasion, but it seems to sum up an approach to life that is pretty timeless. You can actually imagine for most people this would not have been to difficult to do as it's so close to the national mind set. I can actually envisage that life would have gone on as it was and that people would have adjusted to the awful circumstances that would have arisen following an invasion. The new rules, the sense of helplessness and the real hope that all would have been over ridden by a positive force that was awaited.
Pretty much like the staff in the NHS at present really, stoically carrying on quietly with their duty. Remaining calm and carrying on in the hope that the present invasion of cold political imperatives will pass them by.Of course they remain calm as its essential for the people they care for that they feel safe in a situation where they are vulnerable,
I  really hope that they and indeed all of us who care about the NHS do not feel they are being told as in my other rather more up to date alternative coffee mug slogan to "Shut up and deal with it".

NHS in shock evidence based revelation!!!

I guess like most people you have been told about the "wasteful and unproductive" NHS. Indeed the current "reforms" (like stripping out £20Billion over the next 4 years) are predicated on this kind of rhetoric. How unfortunate then that a paper profiled in todays press that has been published in that organ of leftist dissent The Lancet by Prof Nick Black  (I jest about the political leanings of that august journal) gives the lie to that assertion. In fact it produces evidence quite to the contrary. I quote from todays Guardian online.
" Black produces a slew of evidence that questions the analysis of the Office of National Statistics used to work out the productivity of the health service. The ONS looked at the return for taxpayers by comparing public expenditure with how much patients used the health service and what the outcomes were.
Black's work, the first of its kind, argues that the measures the ONS used do not reflect the substantial improvements in NHS care. It points out that between 2000 and 2009, such were the advances that a baby born in 2009 could expect to live three years longer than one born in 2000.
Black says far fewer people were dying in specialist procedures in the NHS. He notes declines occurred in adult critical care (2.4% a year), dialysis (3.3% a year), and coronary artery bypass surgery (4.9% a year).
Patients' experience of how they were treated also improved. There were annual relative increases in the proportion of patients treated within four hours in accident and emergency departments (2.5% a year) and in the numbers operated on within 28 days of their operation having been cancelled for non-clinical reasons (10.4% a year).
Such was the NHS's popularity that in the annual British Social Attitudes survey, 70% of respondents reported they were overall satisfied with the NHS. This was the highest figure ever recorded by the long-running survey – the lowest was 34% in 1997, at the end of the Conservatives' 18-year tenure in office."
An impressive record is it not? 
If all that seems a bit technical then cast your mind back to how long people waited for a hip replacement in the 80's. it seemed quite the norm then to wait 2-3 years.Now we seem content with a wait of 18 weeks.
Could this paper herald  the advent of evidence based policy? Now that would be a breakthrough!!

Can someone explain this to me?

Interesting piece in the propoganda war that now surrounds the NHS Bill, you know what I mean , all of a sudden research and reports are produced that support a certain view. All published under the guise of  news. I was really fascinated by this piece in the online Guardian today. It reports that a collection of NHS directors are arguing the elevation of the private commercial earning ceiling to 49% will benefit NHS patients. they say......
"Examples of these benefits include developing treatment innovations and specialisms - such as complex paediatric treatment, robotic surgery, and employer-funded mental health treatment - and mean that trusts will be able to provide services on the NHS that can no longer be commissioned or are now rationed, including IVF."
Now my eye was drawn to the term "employer funded mental health treatment". What could that treatment be I wonder. I assume its psychological therapies that are currently delivered by Employer Assistance Programmes and which engage with independent contractors. Now this could be an absolute fillip to the psychology services couldn't it? They could recruit more and more psychologists and their assistants and  deliver an IAPT style programme for the employers who would pay well for such a service.
But hang on Clin Psychs are a very small group and the low and high intensity workers are being trained to provide IAPT, and in particualr we are now working on a plans to develop that service into greater provision to people with a label of Serious Mental Illness, and indeed Young people.
Could there be a potential diversion of resources here? Could we see a client group neglected because there is more revenue (and less hassle maybe) in treating those employee clinets stressed out as they struggle with the impending recession
I think we need to keep a very careful eye on this one, it would be a real tragedy if a client group that has consistently called for such services sees the promise of delivery lost.
But hey thats the "Market" for you!!!

We've only just begun

Now I am pretty sure that was the first line of a Carpenters song in the 70's, and was probably about the commencement of a new relationship or something equally slushy (as I am sure I thought at the time). It also is true if the Guardian can be believed true of another relationship. According to an article last week by Polly Toynbee (who still gets ribbed by her call for readers to vote Lib Dem in the Election of 2010), we are also at the start of something else, another less welcome relationship. A relationship with Austerity. According to her article only 6% of actual public sector cuts planned have yet occurred. thats right readers, only 6%. Now there was no citing of sources, no references (Geneva or Harvard), so maybe she got it wrong. Say for arguments sake she's out by 300%, so  approximately 20% of projected cuts have occurred.
With a public sector payfreeze and an expensive reorganisation (marketisation) of the NHS occurring then what does this hold out for us? I wager its a bit more serious than the chatterati camping outside their Libraries in North London or indeed twice weekly bin collections.What will it actually look like? How we can envisage a rolling back of services at such a scale? How will it look in the sleepy hamlet where I live. Well mabe the libary is at risk, maybe the local schools will miss out on maintenance, day services for the vulnerable, or possibly a lessening presence  of police. Could be rubbish collection, street cleaning, or public amenities will start charging like parking at the beach . Small stuff maybe, but an eroding feeling, public morale can be vulnerable to such an approach.
To push through this we all need a belief that it can be endured, that we can tolerate the hardships (bit like winter really), and that maybe its in some way tolerable because its inevitable or even fair (just like winter).
So is this approach fair , tolerable or even something that the ordinanry citizen has caused and should pay for? If the answer is no then where will the feeling of injustice go? Here in the UK the usual pattern is to internalise distress , that could mean calls for help to  services that no longer exist. It really has only just begun.

Powerless victims?

Sometimes I catch a persons name, and especially one I haven't heard for a while and I think "I wonder what happened to them". Of course now with Google and other sourcers of information they can be tracked down if you wish. So it was with real pleasure I read an article online in Mental Health Practice by Prof Michael Traynor. It is called "Constrained by impossible ideals" and it offers (wait for it) a psycho-dynamic perspective on nursings apparent inability to resolve some of its more bedevilling contradictions. Indeed an old friends name (not Michaels...but a reference to Freud) is duly mentioned.
One of his four points to illuminate his argument he refers to is nursings apparent pleasure in "a stance of powerlessness and victimhood". This is evidenced by behaviours that are self defeatting and exhibited in that familiar process we often refer to as "wingeing".He supports this by reference to the Death Drive that Freud saw as part of his Pleasure Principle (not to be confused with the Gary Numan album of the same name), and further more this behaviour provides a degree of pleasure and relief from the conflict and tension that the role possesses.
The author really does have a valid point in his argument that nursing faces in many ways an impossible ideal, and as we know today an ideal that is the benchmark against which all nurses are judged, and publically so. Also it sems quite plausible that a powerless workforce that engages in such behaviour is of course more malleable and convenient to direct (guide, bully,influence.....take your pick)
Sigmund Freud certainly a name from the past in many ways but an interesting theoretical insight none the less
Oh just in case you think this is mere psychobabble then remember the work of Isobel Menzies in the 1960's ,quoted by many in reference to task allocation but predicated on the same underpinnings.

Collective grieving and the NHS reforms

A while ago I read an analysis of the public reaction in Greece to the austerity measures where it was argued that the nation was grieving. It wasn't an outburst of sadness or anger but a progression through the stages proposed by Kubler -Ross all those years ago. you probably remember how it goes (Denial Anger Bargainning Depression Acceptance). The commentator was asking whether the reaction of the Greek public was more than attributable to a mediterranean temprament but in fact the Anger phase of the Kubler -Ross model. Since then publication of the suicide figures for Greece would indicate that collectively they are in a state of malaise.
Could the application of that model be applied here in the UK as we face a momentous change to a nationally cherished system of health care from which we all have probably benefitted? Its hard not to see the events of the last few weeks as not a hardening of self interested stances but a real move to a phase of Anger.As any student of Kubler -Ross's model will tell you , it's not necessary to progress through the stages in a ordered sequence. So just perhaps the preceived failure of Bargainning may take us back to Anger in a way never experienced before in the history of the NHS.