Hands off the NHS

I just put this (above) together... if only I had the artistic skills to create the poster below - which appears to be for a real film but seems reasonably appropriate.

If we could issue every nurse with a machine gun I'm sure the world would be a better place.*

* Not Green Party policy.

Update: due to popular demand (well, one person's suggestion) I have reworked the top poster. One day I'll be rich enough to contract this stuff out to someone who knows what they're doing...

Ben Goldacre on Placebos

I thought this was a very interesting short talk from Dr Ben Goldacre on the placebo effect.



The thing that surprised me the most was when he described how even animals feel the benefit from the placebo effect. I'd love to see the proof of that because it sounds absolutely bonkers.

I particularly like the way that he describes how placebos work but, because it's unethical to lie to patients we should not use them - but we should use the fact that they work in order to make pre-existing, proven treatments even more effective.

(h/t Neil)

Give that man a medal

Good to see Stephen Hawking getting a Presidential Medal of Freedom from the Obama administration.
Obama said of the recipients of the honours; "What unites them is a belief... that our lives are what we make of them, that no barriers of race, gender or physical infirmity can restrain the human spirit, and that the truest test of a person's life is what we do for one another."

Quite.

It must be particularly welcome because Hawking has been used and abused recently by the Investors Business Daily who, in the course of an anti-health reform rant, said "People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

Of course, they've taken that bit out now but the problem is obvious. Not only does Hawking live in the same town as me (Cambridge, UK, where I sometimes spot him wheeling around) and has had top notch care from the NHS all his life, the idea that in the UK, unlike the US, the health care system evaluates your worth before treating you is the exact opposite of the truth.

It is the US where your worth literally makes the difference between life and death. What's interesting is the IBD did not change their editorial position of spouting rubbish about the NHS, they just edited out the bit where they made themselves look like fools.

Hawking has now had the opportunity to wade in to defend our national health system rather than one based on rationing by wealth. "I wouldn't be here today if it were not for the NHS, I have received a large amount of high-quality treatment without which I would not have survived."

All treatment offered to him regardless of his ability to pay. Can the US system that rations the poorest say the same? Of course not. Maybe those Democrats who are wavering about reform might learn a lesson from the great man - it's not the size of your wallet that matters but the size of your ambition.

Consent under watchful eyes

Over at the Curvature there is a very interesting post on the case of a son separating his father (95) from a woman (82) who had become his lover in the old people's home that they shared. Things blew up after he apparently walked in on them whilst she was, um, having "dinner beneath the bridge". Because both the father and his new friend both had dementia the son split up the couple, making his father's choices for him.

Cara says that "I feel that everyone has a right to sex, albeit one that stops at another person’s right to not have sex. I don’t feel that’s something that ends with old age or with disability." Well, I'm not going to get pedantic about the "right" to have sex but I totally agree that no one should have the "right" to stop others having consensual sex.

But the issue becomes clouded when we bring in other factors. There are groups such as OAPs, disabled people or kids[1] that we are meant to see as completely desexualised. However, just because respectable society pretends someone is not sexually active does not actually make it so. The issue becomes even more "horrifying" when the participants are not all from the particular desexualised group (issues with an 85 year old woman with a 22 year old man anyone?).

One of the comments under the original post talks about how a son and his wife decided not to take a mother's vibrator with her to the OAP home even though she was asking for it and getting quite distressed. Old women, mums no less, just can't be allowed to be sexual beings. I think you get this quite a lot when real flesh and blood people come into contact with those who are both there to "care" for you and effectively make decisions for you, no matter what the touchy feely PR might say.

I think it can become particularly difficult when the ability to give consent is impaired. It's clearly right to have a concept of appropriate and inappropriate behaviour on the part of staff, "service users" and their families. But as one comment put it, this leads to a situation where people become "touch starved" and that can't be good for you. In other words perhaps protecting someone can become abusive when official policies become the way you have to live your life.

I used to work with people with learning disabilities and mental health problems and the issue of consent was something that came up quite regularly. After all my job only existed because some people find it difficult to make decisions for themselves without either doing themselves serious harm or behaving in a way that is dangerous or very unpleasant to others. I was there to help people live as nice a life as possible whilst protecting society from some of the worst aspects of their challenging behaviour.

Often that meant doing things that the "client" does not want the worker to do, or stopping the client from doing things they wanted to do - in their interests and in the interests of those they might harm or distress. There were clear cases where this role was overstepped and became an exercise in power over someone more vulnerable than the worker(s). There were also cases where ethical decisions that had to be taken were intolerably difficult.

For instance, a young couple with learning disabilities where the man was basically a bit of a git. No, more than that, he was a horrible person - and, such is the way with these things sometimes, the woman wanted to keep going out with him despite the fact that he was fleecing her of her money and she was very, very unhappy due to his various cruelties.

Absolutely no one *wanted* her to go out with him and although people often spoke to her about it (perhaps too often in my opinion, putting her under a pressure she found difficult to cope with) because she continued to want to continue their relationship it had to be "supported".

Unfortunately I think that was the right decision. Whilst I'd love to have the power to break up relationships that I thought were *wrong* I just don't have the right to make that kind of life chaning decision for someone, even when their ability to make their own decisions were hampered.

The thing is, an institution that forbids you to be sexual can't abolish your sexuality by edict, but what it will do, without any doubt, is effect how you see your own sexuality. That it's wrong, or something that only be done in secret, or something that you learn not to talk about with those who have power over you. It can also make it a source of rebellion, leading to extremes of anti-social behaviour. The sexuality does not disappear, but the message is that this is something that is disapproved of and verbotten.

It's my belief that in secure units and other places where people are held for "their own good" the staff are at far more risk of institutionalisation than service users. There is a whole unconscious process of manufacturing the consent of their charges, often for the best of motives but ultimately breaching the boundaries of a professional relationship. We stray into denying the ability of fellow human beings to try to have a half-fulfilling sex life because our institutions don't fit to you - you have to fit to them.

[1] I thought about taking kids out of this equation - but then thought nope, it's true so let's leave it in. My caveat is that there are issues involved that I'm not dealing with here, I am not arguing that kids have an adult sexuality nor do I think it's appropriate for adults to have sex with children. So there.

Target to spin

Among my recent tribulations with the health service has been two appointments to the eye clinic at our local hospital, Addenbrookes.

Each time I've gone they've given me an eye test, you know the sort, big letters at the top, getting smaller each line down. Not just me, absolutely everybody who comes into the department for an appointment gets an eye test, no matter what their ailment.

Now, the fact is, my eye sight is not impaired and I was not at the hospital for anything to do with my sight - my eye related difficulties are of another nature. This makes the test superfluous, but you don't complain do you? We all just allow ourselves to be led off and tested - our results marked down for posterity on the all important clipboard.

When they tested my eyes the second time I did start thinking, "This is a bit of a waste of your time and mine isn't it? You know what my sight is like already." I mean it's great to have someone pay attention to you just minutes after arriving, but seeing as it took me another two and half hours to get eventually seen for my five minute appointment, well it's frustrating and silly.

It was then that it hit me. Every time I go I get seen within ten minutes - even though my stay actually consists of literally hours of waiting about in a joyless waiting area. Forget the fact that I'm seen for a totally unnecessary test whose results are not even looked at by my specialist - I have been seen.

Target met.

My two and a half hours goes on the records as ten minutes - magic - and they actually employ someone to do this instead of something useful. Another great New Labour way of using important resources on pointless statistic-distorting tasks.

Cough, cough

Who'd have thought you could get pneumonia from a fire? It's one of those conditions that I associate as being like a terrible, even fatally bad, flu - but of course you can, as I can testify.

Due to great skill and cunning I managed to gulp down huge amounts of smoke on Saturday night and have been rather poorly ever since. I was going to the doctor's yesterday anyway so I mentioned it in passing. She asked me to take my shirt off (any excuse these people) and after a few seconds listening to my lungs I was given the rather surprising news and a slip of paper for Amoxicillin.

I'm looking on the bright side as always, it's a great excuse for all the things I haven't done. Pneumonia is one of those reasons you can give that don't usually get the reply "But can you still come leafleting tomorrow morning?" or "So *when* are you going to help me on my allotment then?" Although I must be careful not to milk it.

The real news is the other thing the doc told me about my much needed specialist appointment. Waiting list at Addenbrokes approx 52 weeks... that's, like, years! Just to see someone!

New Labour... I'm not happy about this "best year ever" thing. Not happy at all. It's not like you've even got pneumonia, which would at least have been an acceptable reason.

NHS day of action

There was a regional demonstration in Cambridge today as part of the day of action to defend the NHS called by the TUC's NHS Together. It was immediately preceded by a trade union organised "conference" in a venue yards from the start of the march.

The conference had places for just one hundred participants and (apparently) consisted of being talked at by a representative of each union to say how bad everything was with no chance of discussion, planning or debate. Why were there only a hundred places "because that's the size room we booked" ummm.... Not the most worthwhile way to while away a few hours, but never mind.

The demo was rather more successful in that a few hundred turned out from around the region, Cambridgeshire (obviously), Ipswich, Colchester, Norwich, Chelmsford and Stevenage had all sent people down (and no doubt a few others places) and the march was reasonably lively and good natured.

It was noticeable however that a large portion of those who'd come from afar were left activists and in fact I recognised most of the Cambridge people too... whilst the demo was respectable in size it did not extend into the communities. Whether that's because people are pessimistic about the prospects for change or it had not been built seriously (a combination of both I suspect) who's to say. There was certainly a feeling that the unions themselves had not backed the day of action that they themselves had called.

However, as I mentioned before, it's clear that people feel very deeply about the state of the national health service and we need to translate that concern into something more substantial than a march of a few hundred people, that makes worthy statements but has no prospect of effecting change.

That's one of the reasons why it was so disappointing that the union conference, which had spent time and effort bringing rank and file trade unionists together to discuss the NHS, did not use the opportunity to get them talking. A rally where we hear things are bad just don't cut it.

We need to re-energise the health unions, tap into the community anger over the cuts in services and attempt to build a real progressive movement in defence of public services. Going beyond the existing left (which the Cambridge demo certainly did not do) is essential for any campaign to be effective and whilst its nice to be able to pick up a copy of Socialist Appeal, The Socialist and/or Socialist Worker all in one place (or be handed a copy of the notorious "What we're doing") this is not what's required, and whether the left always contributes as much as it detracts is a point we can debate all night if we're so inclined.

This day of action could have been a start but it just feels like the health unions are more worried about rocking Labour's boat than stepping up to the plate in a serious way. God knows how you make them do that though when health workers themselves often feel disempowered and demoralised.

Liam and Duncan, Life with Leukaemia, Greenman and Phil have all posted on the day of action (comment with a link if you've also posted on it and I'll add you to the list) Also the BBC, LibCom, News & Star (Cumbria), TUC