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".

My "London face"

I was introduced to a fascinating idea the other day from a colleague who was visiting London for the day. He had at one time worked in London and then had moved to the West Country. Whilst we waited for the meeting to commence he told me that he hadn't been in London very long that day and he had found himself re-adopting his "London face". I was intrigued by this and asked what such a face looked like. He told me it was essentially a blank stare and he proceeded to demonstrate it to me.
It was as he said blank. In some ways similar to the blank expressionless stare that some people with Parkinson's disease have. Devoid of expression and at the same time a bit threatening.
We discussed what the purpose of such a stare was. He considered it was to avoid contact, in particular to avoid interactions with people who are trying to sell or beg. I was familiar with the tricky issue of eye contact on the Tube and how that took some managing on a busy trip, but this really interested me. Was it a way of keeping to oneself, or a means of keeping people away.
A look that says "don't bother me".
As I was making my way to the Tube at Oxford Circus I noticed that all three Big Issue sellers I had passed didn't offer me their magazine.
I became worried, was I wearing my very own "London face"?

Jack Nicholsons finest moment?

Well was it in Easy Rider, or in "The Shining" (who will forget his cry of Here's Johnny)? I think for many people his most exciting or indeed mercurial performance was in the movie adaption of "One flew over the Cuckoo's nest". He plays the part of one Randle McMurphy sent to an institution for evaluation. The rest is well known and I won't repeat it here. Suffice to say the adaption of Ken Keseys book (also a top read) won many plaudits and awards.
Its influence has been vast and for many that depiction of 1950's institutional care has become synonymous with mental health care "full stop". I was once interviewed for a place on a Masters Degree in mental health and the first question to me (as a nurse in particular) was "Why do you think Nurse Rachet behaved as she did"?
I watched the film (and enjoyed it) and I guess filtered it through a nurses values and culture. I saw clear brutality of a subtle and insiduous nature on behalf of Nurse Rachet. and also the actions of the male orderlies (am I right in remembering one using a cosh?), were really grim. They seemed to be not only institutionalised but also willing to engage in pretty forceful and dehumanising actions.
The patients themselves, well again pure drama and a good drama to, but a more sensationalist collection of stereotypes you couldn't hope to find. Does it have merits though? I guess it does, its pretty realistic in some senses, Its critique of psycho-surgery to ameliorate difficult behaviour is pretty accurate and the numbing routine of a neat and tidy ward is captured well. Perhaps this was because it was filmed in an actual hospital location.
There's much to commend the film as drama, my problem comes when its the main point of reference for peoples understanding of mental health services today.
Don't get me started on the infamous "Titicut follies" whatever you do. Well perhaps another time!

Form an orderly queue

I was intrigued to see a book review recently that referred to the author (British) as an "orderly" in a mental health secure unit. It is an account of his time in a service in the 1980's and is apparently a cracking read. My curiosity was aroused so I read the review a little closer to see who he was. As I read further I found he is also referred to as someone who had been "nursing" and doing so in his capacity as a "nursing assistant"! So now this poor fellow has had three tiltles foisted upon him and quite possibly only one he would have chosen for himself.
I guess its pretty obvious that the strap line containing the term "orderly" was considered more attention seeking and indeed a better fit for the tone of the book. Yet its so very unhelpful and to those in the "trade" an absolute howler of a mistake.But what effect was the copy write of the advert trying to gain?
When I hear the term I think of films such as "One flew over the cuckoos nest" (OFOTCN) and orderlies in white uniforms with bow ties and a penchant for coercive approaches. It leaves me cold and at the same time cross. I consider it a real distortion of what we do.The topic of OFOTCN will be a blog subject later on as i consider it a really damaging movie.
So the effect sought? Probably that of a spectre of locked rooms, secrets and howls of anguish.
Sorry to dissapoint the advertiser but the only howl of anguish was mine!

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!!

Orgone accumulator

"I've got an Orgone accumulator
and it makes me feel greater
its a one man isolator
made out of orgone"
So sang Robert Calvert on probably Hawkwind's greatest album "Space ritual" , and if you haven't heard it I thoroughly recommend it (in particular the original  fold out sleeve is an exercise in 70's excess)
But this was a song based on an actual device that you were supposed to sit inside and somehow it would not only isolate you but capture Orgones and do you good (sorry about the lack of precision here). I came to think about this song (which I really must place on my I Pod) when I was on one of my usual long commutes to London to do RCN business. I am always impressed how we as humans choose to not engage with each other. In fact I would argue we seem to live in fear of the "other". Opprtunities to isolate the self in a public and indeed crowded place are now more numerous than ever. I like most commuters/travellers on the long haul to London have in my possession an I Pod and a Kindle (and probably a Guardian as well), and like a lot of others I probably use my IPod to erase or exclude the sound of the "others" around me. There is something really strange about being party to private conversations in public places facilitated by mobile phones.
We travel forced by circumstance to be with strangers and isolate ourselves by means of technology.
I wonder is this isolation healthy?