Archive for July, 2011

FOX & ANGEL ON THE MOVE

Wednesday, July 20th, 2011

We have been taking a break for a few months due to my house move, (impending), an office move and a general re-grouping.

I have discovered that it takes months to empty a family house after nearly a quarter of a century and that this is not compatible with thinking or writing.

Hazel, (who moved house last year) and I are starting on our next book in September in our new office in Winchelsea.

In the meantime if anyone out there is interested in buying a beautiful two hundred years old house on the Ashdown Forest with a wild-life garden home to 25 species of birds, not to mention foxes, badgers, toads and newts please get in touch!!

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NHS REFORMS

Wednesday, July 20th, 2011

When I visit my local GP practice I see a busy well-run surgery. What I don’t see however is a lot of GPs with time on their hands sufficient to run new consortium. My GPs seem to spend every minute of the day seeing patients, visiting patients, organizing referrals as well as involving themselves in training. If they did have more time I am sure both patient and doctor would like them to be able to extend their appointments beyond the usual 7 minutes. As a patient you are severely under pressure to explain symptoms and receive considered advice in this narrow time-frame.
Since GPs are fully stretched already presumably they will be ‘outsourcing’ and ‘franchising’ (to use common parlance), if they are not to abrogate their existing responsibilities, (unless there is a stealth plan for GPs to run consortiums while cheaper nurses take their places in the surgery?). As far as I know there is no new and keen as mustard band of managers available to take up these important positions. Therefore the existing NHS managers will be being fired or made redundant by whatever legal mechanisms possible, in order to be redeployed by the new bodies. It wouldn’t surprise me to find out that some of these bodies will be lead by managers currently heading up existing hospital funding, although since it is deemed in urgent need of reform presumably they are thought not to be doing it very well?
However the changes work out we can safely assume that there will be a lot of hokey-cokey: people will be scrabbling for new jobs or hoping to hang onto their old jobs, and for some months will not know if they have a job or what it will entail. There will be stress and malfunction and loss of moral. For quite some time nobody will have a clue who they are answering to and there will be endless and drawn out computer glitches as nobody will tell the boffins what changes are needed because they don’t really know. During the mayhem this fluid situation will be an open door to collusion and cronyism and will be, certainly in the short term, extremely unlikely to drive up standards as is hoped.

So, if the man in the street is sceptical it is because he is right to be. Lansley, in spite of writing one of the longest and most convoluted government documents in history, (so much so that no-one has apparently actually got to the end of it) has not explained how his reforms will address the problems in the NHS that people actually worry about. What is the connect between his reforms and the reality on the ground such as long waits, nowhere to park, lost notes, uncertainty about which doctor you will see and their level of competence, (the funny thing about being ill is that you are usually not well enough to scour the internet comparing death-rates of individual doctors and hospitals as has been suggested we might like to do), poor staffing levels, over-worked (and often unfit & overweight) nurses and mid-wives, poor quality hospital food and no one to sit you up or help you eat, not enough staff to take you to the toilet and fears that you will be consider a bother if you ask, no joined up thinking and collaboration between departments, (essential for the elderly who almost never present with a single issue), and poor communication between other government agencies. (All the child abuse scandals have been exacerbated by different departments, sometimes even in the same hospital, just hanging on to their bit of the jigsaw).

In addition it is unwise to be unwell during school holidays, especially August, and hospitals barely function at weekends and bank holidays even though people are ill at the same rate. The cost of agency nursing is scandalous as is the use of foreign doctors, (often of doubtful provenance with poor language skills and inadequate checks) to fill the gaps in the out of hours service that we should remember GPs gave up to the benefit of themselves but to the detriment of their patients.
If all the safeguards the government promises are put in place there will no longer be “the competition to drive up standards” as hoped, (they can’t have it both ways) and if they are not put in place the danger is that straightforward medical procedures will be cherry-picked and patients with complex problems will be shifted from pillar to post, possibly ‘outsourced’ to the point of invisibility. Governments have a shocking record when it comes to regulators in any event, who are initially enthusiastic but ultimately toothless and are unable to protect the public.

Medicine in hospitals should be team work with everybody from the cleaner to the consultant working towards one simple goal, a good outcome for the patient. Knowledge should be freely shared and all concerned should be able to speak the truth as they see it without fear of reprisal. This is the culture that the government should be promoting. A new philosophical approach is needed not more business-speak. Most doctors do not want more initiatives, they just want to get on and do a good job.

If the government had truly wanted to help the health of the nation it should have should have instead instructed Lansley to take on the food and drinks lobby which would do much more to save money by keeping people out of hospital in the first place.

As it is Cameron has taken fright, Clegg has watered the bill down and now nobody knows what, if anything, is to happen after all.

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LET HIM SPEAK

Wednesday, July 20th, 2011

(as seen in the Guardian & The Week December 2010)

Sir: Every time the Prince of Wales raises his head above the parapet there sounds a cacophony of outraged voices who ask what right he has to tell us how to live. Well, when it comes to planning, it seems we need some help.

You only have to lok at the tawdry shopping malls, unimaginative housing and the acres of identikit out of town supermarkets to see that something has gone seriously wrong in the last forty years. Planners, architects, councils and builders have lost all aesthetic sense in the rush to make money. Much regeneration is exactly the opposite, already out of date, stale and run-down.

If this is the best they can do, it is not good enough and I for one do not want the Prince of Wales to be silenced on this particular issue. It is pretty obvious that when it comes to planning, big business and featureless corporations have leverage and pay lip service to the supposedly democratic process.

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