The classic example used to define chutzpah is a young man murdering his parents and then demanding that the court show mercy because he is an orphan.
This week, I think I’ve found another, albeit on a lesser scale, from some members of the health workers’ unions. I’ve just had an email from the NHS blood people - I get these from time to time thanks to a relatively uncommon and particularly useful blood type - inviting me to make a donation as soon as possible. Like all their communications, it’s heavy on the emotional blackmail -‘save a life’, ‘we urgently need your help’’.
This urgency, they say, is because stocks are very low indeed due to bad weather and ‘industrial action’. The email doesn’t indicate whose industrial action is to blame, but a quick search confirms that, sure enough, there were blood donation staff joining the merry throng of NHS workers on the picket lines in the recent strikes.
That is their legal right, of course, but, given the unions’ claims that the system is already over-stretched and operating with minimal margins, it seems a bit much on the part of those who walked away from this ‘vital’ process and missed a couple of days of legalised vampiring (as well as costing management time to deal with the disruption) to expect the public to rush to make up the resulting deficit.
The hiatus since the last post has much to do with the content of this one; in a recent search, I stumbled across something which I think worthy of comment but it’s taken a while to work out exactly how to approach it. The scale of the thing is so horribly daunting that it presents a major challenge to convey its nature in a mere handful of paragraphs.
This is, inevitably, the result of the number of people likely to have been involved in its creation; for anyone who has ever wondered what it is all those dozens of NHS Diversity Officers and Coordinators actually do, Ladies and Gentlemen, I present to you...*drumroll*... the NHS Northern Care Alliance Equality, Diversity and Inclusion Calendar 2022.
This document - which runs to 28 pages and is presumably the result of many weeks of work (and numerous meetings-with-biscuits) -
...‘has been developed as a resource for NHS staff to demonstrate a visible and supportive role which is committed to respecting and celebrating diverse communities, cultures and faiths.’
On the face of it, a calendar giving the main religious festivals of the year including fasts and observances sounds like a useful idea (especially in a medical setting) and I can say from experience that staff booking appointments aren’t always aware of public holidays. However, the compilers of this magnum opus clearly saw this as a mere preamble to the main event, a plethora of obscure celebrations, awareness days and campaigning opportunities ambitiously intended to:
Promote equality, diversity and inclusion
Break down barriers and foster an inclusive environment
Avoid wastage by ensuring appointments are scheduled accordingly
Ensure key events do not clash with major festivals.
Encourage wellbeing
All very laudable, I’m sure, but any member of staff hoping for a quick reference guide has to wade through a bewildering cornucopia of colour coding - orange for Buddhist, blue for Christianity, purple for Judaism etc - and irrelevant and inconsequential detail - since when was St Hilary’s Day a major festival? Why did they feel the need to dedicate a third of a page to the benefits of Dry January? And how many patients or staff intend to observe the Summer Solstice or World Humanist Day?
Anxious not to overlook even the slightest opportunity for virtue-signalling, the authors have given explanatory paragraphs for National Hijab Day, Gipsy, Roma and Traveller History Month and the bafflingly named International Day of Happiness (plus, of course, LGBT and Black History Months respectively) along with a bewildering variety of other causes. It is, in fact, so inclusive that any helpful information is completely smothered by a wealth of extraneous (and painfully self-righteous) froth.
And there’s one aspect which may have escaped the compilers completely (or perhaps not). In all my dealings with the NHS, I do not recall ever being asked about my religious affiliations (or lack of them). When the calendar says that out-patient appointments should not be scheduled for Pesach, Nirvana Day or Chinese New Year, do they mean only for those wishing to celebrate? And if so, how do they know?
Far more likely, I’d suggest from bitter experience, that an indifferent desk clerk will look at the calendar and simply avoid making appointments for any day marked with a circle, which, in October, would leave a grand total of six weekdays free from significant events - even though those circles mark, among others, the International Day of Older Persons, World Menopause Day and Halloween.
The overwhelming impression given by this epic work is of a bloated and unwieldy Diversity industry within the NHS intent on proclaiming and justifying its existence. If ever there were a case for the speedy construction of a Golgafrinchan B-Ark, surely this is it!
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I’ve often thought it odd that we should have all these weeks or months attached to particular issues, as if they somehow matter less at other times. To quote Tom Lehrer (again):
It seems that we are, at last, to have all of our medical data collected in one place with the expansion of a new system to cover all NHS regions, meaning that - at least until the next solar flare event/cyber hack/system failure - there is the hope that fewer pieces of important information will slip through the gaps.
For example, when one of the venerable ladies of Clan Macheath was recently bitten by her cat (little Sammy [or ‘Spawn of Satan’ to the rest of us] was decidedly miffed at having spent a week in the cattery), she phoned the surgery to check that her tetanus boosters were up to date.
After trying several times to fob her off - “We don’t deal with cat bites in the surgery; you have to go to A&E” - the receptionist grudgingly agreed to look. “You haven’t had one,” she reported back,”There’s nothing in the file”, which is odd, given that Granny has travelled extensively and visited the same surgery many times for travel vaccinations, including tetanus. The record of these jabs seems to have disappeared into the ether, possibly forever.
What is more disturbing is that my origins seem to have vanished in the same way. During a discussion with her GP, my mother discovered that her records said that she had never had children, despite our having been registered at the same surgery from early childhood. As the relevant section of her file was completely blank, the doctors had wrongly assumed that we were adopted and - with potentially dangerous consequences - made clinical decisions based on that assumption.
Now, it’s true that I made my entrance rather unexpectedly in the wild, as it were, and bypassed all the usual hospital formalities, but that’s not exactly unheard of and I suppose that someone must have made a note of the fact somewhere. A few decades on, however, as far as the NHS is concerned, I might as well have been found under a gooseberry bush.
It is to be hoped that this new record system, unlike its myriad mutually incompatible predecessors in the public sector, manages to coordinate information into a coherent - and accurate - whole. Unfortunately, I know from early temping experience that data input and filing, being neither well-paid nor prestigious, doesn’t always attract the most conscientious, competent or careful of workers.
If it is set up and maintained efficiently, the new system could help to prevent some, at least, of the administrative mishaps I listed in ‘10 Ways the NHS is Killing People’. However, as long as information continues to be lost and the system equates absence of evidence with evidence of absence, mistakes will inevitably be made.
Perhaps this is the kind of thing that will be tackled by Midlands NHS trust’s £115k ‘Director of Lived Experience’, but I’m not holding out much hope.
This blog has long documented my family’s experience of the shortcomings of the NHS, on the part of both the institution and individual staff members. I have not mentioned this incident before, but it is perhaps, worth recounting in the current situation.
It was in the depths of winter in hill country some years ago. Drifting snow had filled the narrow local lanes to the tops of the banks and hedges, cutting off a number of houses, among them the isolated home of an elderly relative of mine in the advanced stages of terminal cancer. For the best part of a week, the only vehicle to pass the house was a high-clearance tractor driven by the local farmer.
This is not an unusual state of affairs in a hard winter, so there was plenty of food in the house (and gas cylinders to cope with the inevitable power cuts), but, with over a mile to the nearest clear road, getting to the surgery or pharmacy for routine medical care and drugs was clearly not an option.
On the Sunday - her day off - the local pharmacist arrived on the doorstep, bringing repeat prescriptions and offering to do some basic health checks. She had loaded the morphine and essential drugs into a backpack and, leaving her car at the main road, walked several miles through the snow to deliver them to the homes of three patients who would otherwise have run out.
What makes this worthy of comment - apart from the altruism of the conscientious pharmacist - was that one of the GPs from the local surgery lived nearby and was also cut off by the snow. Several times during that week, she and her husband were seen (and heard) out on their cross-country skis, following the tractor ruts in an extensive circuit of the blocked country lanes with much vocal hilarity.
While the doctor was in no way obliged to knock on the door en route and enquire about the patients, it seems less than neighbourly, under the circumstances, to ski cheerfully past the doors of sick people trapped with no access to medical supplies or care - in a relatively small community, there was no question of her being unaware of their predicament.
Whether it was a lack of imagination, a fear of breaking rules or callous indifference, we’ll never know, but it’s an interesting illustration of how some GPs see their role within the community. As my relative pointed out, it highlights the unpalatable truth that, leaving aside community spirit and common humanity, the pharmacist had a far greater incentive than the GP to keep her regular customers alive and kicking.
Tradition has it that the ancient Chinese paid their doctors only when they were well. We aren’t going to turn careless indifference into altruistic concern but perhaps, among the much-needed changes to the NHS, we could incorporate some kind of motivation to preserve the health of patients in situations like this rather than picking up the pieces when things are allowed to go wrong.
As regular readers may recall, the Tavern inmates have more than a few reservations about the NHS (see the 2009 post ‘10 ways the NHS is killing people’), so I suppose we should not have been surprised at what happened this week to an 80-year-old relative.
While out walking a couple of days ago, she fell and badly twisted her ankle. It swelled up immediately and was too painful to bear any weight, so she called a taxi to take her directly to the nearest injury clinic.
On arrival, in considerable pain and still wearing her coat, she had her temperature taken with a forehead scanner. It was - unsurprisingly - ‘slightly above normal’; based on this single reading, she was immediately told that she was a Covid-19 risk and shunted into an ‘isolation room’, where she was left alone for twenty minutes without any medication or ice to relieve the pain - this despite the fact that even government sources admit that temperature testing is unreliable as a method of identifying the disease.
Finally a nurse appeared and, rather than taking a second temperature reading, gave the ankle a cursory look and announced that, because of the Covid risk, it could not be fully examined or treated. The patient should ‘go home immediately, self isolate and order a test online’. The hospital would check to make sure she had done the test; as long as the result was negative, she could return for an x-ray in a week’s time if the swelling had not gone down.
The word she used on the phone to describe the clinic staff was ‘heartless’, without the slightest warmth or compassion; how else could you describe refusing treatment to a woman of 80, in severe pain and unable to walk unaided, and sending her back to an empty house to embark on the complicated process of ordering a Covid test online? To add to the frustration, she took her own temperature after arriving home and found it was quite normal - as a second reading in the clinic would doubtless have shown.
Fortunately she has back-up - not that the nurses bothered to find out; a friend was able to lend her crutches (since the clinic would not) and the Spouse, having ordered the test on her behalf, drove 150 miles to help out and join her in isolation as long as necessary. Now we just have to hope that her ankle is not broken and that it will heal without complications.
And if, in the future, anyone asks this well-mannered and respectable lady whether she will join in applauding our wonderful NHS, I suspect the answer will be unrepeatable.
"Worried about your waistline while you watch the football? Concerned you might be piling on extra pounds as the tension mounts? Fear not, help is at hand!"
Now once again, spurred on by the 'obesity crisis', Nanny has girded her formidable loins and issued stern warnings to those of you intending to spend the next few weeks wallowing on the sofa in a calorie-induced stupor.
This time her organ of choice is not the Food Standards Agency - they are busy nagging us about the dangers of raw meat - but the spuriously-named NHS Choices website which has helpfully published its 'World Cup 2014 Healthy Snacking Tips'.
The advice is much the same as last time, starting from the interesting premise that British audiences are incapable of watching a televised sporting event without some form of hand-held sustenance.
While you are glued to the TV for a few weeks following the fortunes of Hodgson's men, here are 10 healthy snacking tips to make sure your diet stays match fit.
All the usual hair-shirt suspects are there - oven-baked low-salt crisps, reduced-fat humus and unsalted peanuts, along with some new additions like air-popped popcorn (no sugar, butter or salt, of course) and fat-free yoghurt.
It all rather begs the question of who is the target audience, since NHS Choices is largely preaching to the converted and the worried well. Those who trawl its pages are surely in search of medical advice -the site's valid raison d'être - rather than a condescending lecture on 'Living Well' - unless, of course, they are fully paid-up Puritans seeking tangible approval for their ascetic lifestyle.
Even the most optimistic healthy-eating evangelist could hardly expect that, having discovered the page by accident or design, readers who have eagerly stocked up on beer and Pringles will experience a Damascene conversion and rush out to buy rice cakes and low-fat humus instead.
What is really galling about this is that someone was presumably paid to write this patronising drivel - if write is the correct word to apply to a piece in which 'snack' is used as a verb. It's something to bear in mind next time you hear about reduced NHS spending leading to cutbacks in patient care.
Medicine has certainly come a long way since a doctor would reach his diagnosis by solemnly scrutinising a vial of your urine before sniffing and then tasting it (rather, I imagine, in the manner of a particularly pretentious sommelier; "I'm getting ...hmmm.... asparagus, with just a hint of fenugreek" ).
These days, assuming you have managed to pass the modern-day Cerberus sitting behind the reception desk, you are more likely to find your GP sitting at a computer terminal, ready to access a world of information for your sole benefit.
If it's in the right hands, this is excellent news; specialist appointments or prescriptions arranged at the touch of a button and your entire medical history instantly available without the need for lengthy explanations. In any case, the extent of medical knowledge has long since surpassed the capacity of a single human brain.
However, at least in the experience of friends and family, the availability of medical information online has tempted more than one GP into a lotus-eating lifestyle of intellectual idleness.
There are, it seems, many online diagnostic tools based on the flowchart principle, in which the answers to a series of questions dictate progress through the various options. Much the same things can be found in home health encyclopedias - with the notable exception that, when all else fails the encyclopedia blithely says, "See your doctor".
For the GP attempting to use the system, there is no such cop-out. The anxious patient in the consulting room requires some kind of intervention, so what to do?
In some cases, the answer appears to be run through the options in the chart in the given order, regardless of the individual history of the patient. And in one instance I know of, this course of action was very nearly fatal because these diagnostic programmes are designed by software engineers.
If something goes wrong with an IT system, you start by eliminating the simplest and most obvious faults - is it turned on? Is a cable unplugged? Only when you have removed all these from the list do you start to look at more complex potential problems, leaving until last the really drastic explanations that might require major intervention or even replacement.
This is the pattern of thinking that has dictated the structure of online diagnosis charts and, when doctors ignore the clear warnings to use the tool as an aid to practice and make it instead a substitute for rational thought, it costs lives.
In the hands of an idle or indifferent GP, a life-threatening illness can go undetected for months simply because the computer suggests eliminating all minor possibilities first, or fails to list it as an option because the patient does not fit the usual profile.
But, unlike ailing laptops, human beings have an inconvenient habit of becoming increasingly unwell and incapacitated if their illnesses are not correctly treated - or even dying.
Since the spotlight is currently on the shortcomings of the NHS, I am resurrecting this post from the archives which first appeared in 2010 under the title '10 Ways the NHS is Killing People'. What Subrosa has to say today on the Scottish NHS and the delays in treating cancer patients suggests that very little has changed in the intervening years. While I'm sure there are plenty of meetings going on among management staff, I wonder how much has been done to find out from patients exactly what is going on.
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Over the past few years, several close relatives of mine have been seriously ill in various parts of the UK. In each case, the chances of survival were seriously impaired by a catalogue of mismanagement and inefficiency. In particular, the delays in diagnosis and treatment, if other patients have had the same experiences, could be significant in the UK’s shameful cancer survival statistics.
'No shows' at consultant appointments cost the NHS many thousands every year. To the best of my knowledge, nobody has ever fully researched why patients miss appointments; they could start by asking members of my family, who, despite their assiduous efforts to attend every appointment, have experienced the following administrative errors:
1. A consultant’s hospital appointment letter sent to an empty house – the ‘client’ being a long-term in-patient in the same hospital at the time.
2. Several urgent appointment notifications received some days after the appointment date because, according to the staff on the appointment desk, ‘the hospital post-room only operates one day a week to save money’.
3. A vital letter which the consultant never saw – as is standard practice, it was opened by a secretary and placed straight in the filing cabinet.
4. An urgent explanatory letter from a consultant which did not reach the patient in time because his secretary took two weeks to type it up.
5. The receptionist who failed to mark the patient as having arrived for an appointment so the consultant went home without seeing her.
6. The receptionist who gave a cancer patient an appointment (requiring an 80-mile round-trip by taxi) on what turned out to be the consultant’s day off.
Of course, you have to get a referral to the consultant in the first place, which is not easy when you are faced with:
7. The GP who, for nearly 3 years, failed to diagnose a life-threatening medical condition because the non-smoking, non-drinking 7-stone patient ‘didn’t fit the profile’.
8. The GP who dismissed advanced cancer symptoms as side-effects of HRT, saying ‘if people bothered about side-effects, nobody would ever take anything’.
9. The GP who refused for 5 months to carry out a PSA test (an indicator of prostate cancer) because, he said, the problems were 'just normal statin side effects'– when the test was finally done, the cancer it clearly indicated was too far advanced for treatment.
And then again, there’s the careless lack of attention to detail:
10. The consultant who, we assume, gave a diagnosis of cancer to the wrong person. The actual patient arrived at the hospital to be told that her name had been ticked off the list earlier and she had already received her test results.
All of the events described here have happened to members of my family and have contributed to at least one premature death. I’m not going to say any more on the personal side here, but I have promised them that I will use any means in my power to publicise what has gone wrong while safeguarding their anonymity.
In today's news of hospitals 'full to bursting', one figure in particular caught my eye.
Up to 3% of beds are occupied by those with dementia and hospital care would have little effect.
While I can't claim extensive experience in the area, it entirely bears out what I have seen of a system that is far from ideal.
In the first place, the pressures on the system and the fact that some of the agencies concerned function on a geological timescale mean that it can take years to arrange help for someone with dementia, assuming you have actually managed to get a diagnosis.
As a result, the majority of admissions to dementia wards, at least according to nurses I have spoken to, are via A&E, after a fall or being found wandering outside in cold weather. Once they have been restored to physical health, the fun begins.
For those patients who need secure residential care, a place must be found in a suitable nursing home. Thus it was that I had the dubious pleasure of meeting a woman whose job was to match patients with care home places.
It began in a less than auspicious fashion. With a two-hour drive home ahead of me, I was looking forward to getting things sorted quickly; I didn't know then that she and her sort run on what I have since come to think of as 'public sector time'.
More than half an hour after the appointment was due, she finally hove into view at reception, brushing chocolate crumbs from her face. I was ushered into her office, where she resumed her half-drunk cup of coffee and unhurriedly produced a stack of forms.
Over the next quarter of an hour or so, I appear to have got the better part of the deal; while she managed to fill in barely three pages - mostly tick boxes - of my relative's details, I acquired a positive cornucopia of information on the small doings of her four-year-old daughter thanks to her constant chatter on the subject.
At 3pm precisely, she finished her (third) biscuit, drained her cup and stacked the forms on the desk, announcing she had to collect her child from pre-school.
"But what about a care home place?" This was, after all, the whole reason I was there.
She handed me a brochure from the desk drawer: "There's a list of homes in here," she said, "Just phone me when you've made up your mind which one". And with that, she was gone.
Fortunately the story ended well, but she left her mark on the case; one of those boxes she ticked so blithely - I think she was answering her phone at the time - turned out to have been the opposite of what I had told her; had we not been able to find interim funding, the care home place I arranged would have been lost as a result.
It's hardly surprising, therefore, that the dementia ward, according to the nurse I spoke to, was full of patients who should have left hospital long before.
I wish I could say my experience was unique; sadly that 3% suggests otherwise.
A member of Clan Macheath had a blood test last week as part of a routine check-up. Returning to the surgery for the results, she was told she had 'a risk factor of 15%'.
The nurse seemed surprised to be asked for an explanation; "Look, it's here on the chart: your cholesterol gives you a risk of 15%, see?"
"Yes, but a risk of what, exactly?"
Turns out it's a risk of dying of a heart attack in the next ten years. Now it's not the easiest thing to express without giving the lady's age, but generally speaking this looked like not unreasonable odds of survival (her words, not mine); in any case, like most well-educated people, she knows that medical statistics - like boiled eggs - are best taken with a substantial pinch of salt.
But the nurse had not yet finished; under the circumstances, she said, she would recommend a course of statins. Not a good move; the patient is firmly opposed to blanket prescription and has a particular aversion to the idea of statins - and she's not the only one (see my post Statins for all and a death sentence).
The nurse was clearly disappointed; "Then we'll just have to try and manage it through diet". Manage what? The cholesterol reading was well within normal parameters; either the word 'risk' seems to have triggered a knee-jerk response or the 'statins-for-all' movement is alive and thriving in the hands of blinkered zealots.
One thing that interests me here is that our relative was not told whether to fast before the test. This is presumably because a study in 2009 found that 'cholesterol measurements are at least as good - and probably somewhat better - when made without fasting'.
But if that is so, why does the NHS website - reviewed in 2011 - still clearly advise 'Do not eat anything and only drink water for 10-12 hours before having blood cholesterol tests'? Are doctors, in fact, actively seeking raised readings by ignoring this advice?
This suggests at least some difference of opinion - and implies that the cholesterol test is rather more of a blunt instrument that those acting on its results would like us to believe. Given the very real possibility that statin side-effects will mask the symptoms of serious illness, I would question the ethics of prescribing on these terms.
The complexity of the human body means that diagnosis is not a exact science; to reduce it to box-ticking and percentages on a chart is to act under false pretences and with a dangerous complacency.
Deaths from uterine cancer have increased by a fifth in the last ten years, data from Cancer Research UK has found. It means almost 2,000 women now die annually from the condition. (Telegraph)
Since they report that the number of annual diagnoses has risen by almost half since the mid 90's, this does mean that survival rates are improving. According to Professor Jonathan Ledermann, gynaecological cancer expert at Cancer Research UK,
"the chances of surviving the disease are still better than ever. It’s clear we’re making great progress, but we don’t yet fully understand what’s driving up cases of womb cancer, so there’s still lots more to do.”
Until they solve the mystery (and I hope they are looking very carefully at HRT and synthetic hormones, which the article doesn't mention at all), researchers are falling back on that old staple of weight loss and plenty of fruit & veg, reminding us that being obese 'more than doubles' the risk of uterine cancer.
This gives us some juicy headline statistics, conveniently forgetting that, obesity increases the risk rather than creating it and that lifestyle is far from the only causal factor at work. Yes, folks, it's that old false syllogism again:
Unhealthy lifestyles cause cancer
You have cancer ergo You have an unhealthy lifestyle
If Professor Ledermann and his team want to reduce the number of deaths, they would do well to consider the inversion of this argument, the application of which nearly cost a relative her life. As applied by her GP in the face of worsening symptoms for nearly two years, it goes roughly thus:
Obese women have uterine cancer
You are not obese ergo You do not have uterine cancer
With a healthy diet and plenty of exercise, there was, the GP said, no need to bother with an examination. In fact, when the patient complained that she was rapidly losing weight for no obvious reason, the doctor told her she was lucky; "But that's a good thing; I wish I could lose weight like that!"
The diagnosis was finally made by a second doctor at a point urgent enough for the patient to be rushed into hospital within hours for drastic surgery, but the original GP was unrepentant to the point of defensiveness; how could she be expected to diagnose the condition, she demanded, when my 7st relative didn't fit the profile?
Survival rates decline sharply as the cancer develops; the later the diagnosis, the less your chances of recovery. Professor Ledermann doesn't say what proportion of the fatalities are not overweight; it might be well worth his while to find out.
It's that time of year again. Britain's emergency services are issuing press releases about the time-wasting calls they have to deal with on a regular basis, South Central Ambulance Service among them:
In the past three months, call centre staff have dealt with a call from a young woman who had a headache after a night out, a man who wanted paramedics to treat his dog's injured leg and a man reporting that a hedgehog had been run over.
On New Year's Eve, a drunk man called for help to get up the stairs to his house.
A combination of excess alcohol, ubiquitous mobile phones and, in many cases, the cognitive skills of a crustacean has meant a perfect storm of this kind of thing; a large percentage of calls on Friday and Saturday nights, according to paramedics, are from people too drunk to get home.
It's an unfortunate combination, and one we've seen at work with the RNLI; an emergency response organisation with no alternative but to take each call seriously is forever at the beck and call of the thoughtless (not to mention intoxicated), who can summon assistance at the touch of a button on phones that may well, in some cases, be smarter than their owners (as described by the indefatigable JuliaM).
The quotes above are from a local paper's version of the story; there are similar pieces appearing around the country. What caught my eye with this one, however, is that the reporter includes not only the cost to the taxpayer of each call-out (£257, if you were wondering) but a memorable quote from an ambulance service spokesman:
"SCAS does not bill timewasters. That is not the NHS ethos."
It goes further than that, however; the ethos appears to be that no restitution of any kind is called for. Since it would be impossible - and expensive - to assess each case on merit, only persistent offenders are punished, while ambulance crews and paramedics are repeatedly diverted from their real purpose.
Now, I'm sure some of these calls are from people who genuinely do not understand the priorities involved - 'care in the community' has left many unfortunate souls struggling with the complexities of modern life - but it seems over-generous for us to foot the bill when a wobbly inebriate fancies a lift home.
There is an encouraging and heartwarming trend for those who have been plucked to safety by the RNLI to engage in subsequent fund-raising activities for the charity. There's no bill, no costly legal involvement, no compulsion; it's what you might well call an ethos.
The NHS ambulance service may not have the same need to raise cash, but wouldn't it be a fine thing if those time-wasters could be induced to do something in return?
I'll be the first to admit that, while I can more or less follow the reasoning of such Titans in the field as Mark Wadsworth (at least as long as he keeps explaining things so clearly), my grasp of the finer points is a little shakier than I'd like - I don't gamble, but if I did, I'd be the one standing in the bookies muttering "Each way? Er, is that r factorial divided by n minus r?"
Even I, however, have no difficulty working out from today's headlines that if just over 40% of cancers could be prevented by lifestyle change, then nearly 60% are determined by factors beyond the patient's control.
Unfortunately, this reasoning still seems to be beyond the grasp of some of those who work in the field. I make no apology, therefore, for recycling part of this post on the subject from last May, when similar statistics were published for breast cancer.
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The other 58% of cases may be linked to environmental or genetic factors or other causes not yet established. Information like this, however, proves a logical step too far for many NHS staff, for whom the mantra runs thus:
Cancer is caused by unhealthy lifestyles.
You have cancer. ergoYou have an unhealthy lifestyle.
In the past few years, several of my friends and family have been diagnosed with so-called ‘lifestyle cancers’, and, to a man (and woman) subjected to lengthy instruction by medical staff about their supposedly unhealthy habits despite a clear family history of the disease in each case.
Thus a friend who walks her dog several miles every day was advised to take more exercise; a lifelong non-drinker was repeatedly told to cut down on his alcohol consumption and, most bizarrely of all, a woman who has the healthiest diet I know of was constantly lectured on cutting down on fat and sugar and avoiding junk food – she weighs less than eight stone.
And each of these reported, with varying degrees of fury, a clear and consistent implication by hospital staff that they must have brought the cancer on themselves by their own failure to lead a healthy lifestyle. Their remonstrations were brushed aside - the cancer was proof enough.
It is no secret that doctors receive a ridiculously small amount of training in the interpretation of statistics, given the relevance of probabilities and incidence – I have mentioned before the GP who excused his diagnostic failure with the words, ‘97% of people with this cancer are obese; you aren’t even overweight, so there was only a 3% chance of you having it.’
That being so, how likely is it that the lower echelons of the medical hierarchy can correctly interpret statistical information, given the standard of maths in today's schools? It is a matter of record that numeracy skills are at a frighteningly low level across the population, and I doubt that hospital staff are any exception.
Tell them that cancer is linked to poor diet and lack of exercise and, unless it is clearly explained, some, at least, are going to go on with complete self-assurance to tell cancer patients that it is all their own fault.
Update: via Longrider, this BBC article includes an interesting show-trial interview with a woman brought out to make a public confession that her cancer was lifestyle-related.
Watch out for the interviewer posing the loaded question:
"Why was it you? What was it in your lifestyle that was wrong?"
Unison. Unite. I'm part of the Union. One out, all out. United we stand.
Once upon a time, there was a point to all this. Combination - acting as a united group to withdraw labour - allowed poorly-educated and exploited 19th century factory workers to negotiate fair pay and conditions by hitting the mill owners where it hurt.
But what did this week's strikers achieve, beyond illustrating exactly how little difference the withdrawal of their labour would make to the country? Well, I suppose they can congratulate themselves on a mass demonstration of support - at least by those who weren't spending the day Christmas shopping.
Certainly the BBC was happy to carry repeated interviews with staff who had never considered strike action before, and who were now being provoked into it by the actions of the coalition; the subliminal message was clear; these are decent, honest workers forced into an uncharacteristic joint rebellion.
But the united facade covers a world of differences. Take for example the staff I have been dealing with recently at a major hospital. One is an administrative officer; last time I saw her, she arrived half an hour late (wiping chocolate crumbs off her face), filled in the wrong form and insisted on telling me all about the birthday party she was planning for her child.
In the same building, in a secure dementia ward, I met a male nurse who works tirelessly with his confused and sometimes violent patients; breaks are few and far-between, but he appears to maintain a calm and reassuring presence throughout, however difficult or unpleasant his tasks.
The work these two people do has very little in common; the desk-bound administrator will probably be able to keep doing her job (or, more accurately, occupying her desk while surfing the net and eating biscuits) to a greater age than the nurse could meet the demands of his, and thus retire on a far larger pension.
Meanwhile, those head teachers who closed their schools have salaries that are, in some cases, double those of the classroom teachers they led out - with accordingly higher pensions. An average salary-based scheme will hit them hardest, since senior management entails a massive salary hike in most areas.
Those striking Victorian mill-workers, by and large, were doing the same kind of work and stood to lose or gain together. By contrast, some of those marchers last Wednesday (not to mention the thousands of public sector staff who went to work as usual) have far more to lose than others, and some are already putting in their all while others idle along.
So here's a thought; why not allow certain public sector workers to keep their current pension rights because they do jobs too difficult, unpleasant or stressful for the majority of workers to tackle and because they are likely to burn out earlier? These people are generally among the lower-paid in any case.
That takes care of the front-line staff who, according to Unison general secretary Dave Prentis, 'care for the sick, the vulnerable, the elderly. They wipe bottoms, noses, they help children to learn, and empty bins.'
Meanwhile, office staff, managers and administrators adopt the new proposals and save the state a fortune.
Of course, it would never happen; the unions wouldn't hear of it.
I can't help feeling that Jesus of Nazareth would get pretty short shrift if he turned up these days in Britain; not only would he have to deal with a lot of immigration paperwork but a certain sector of the population would have some very strong objections.
"Mr ben Joseph, I understand you have been turning water into wine without an appropriate licence. Now, quite apart from the legal implications, we are very concerned about the message this sends. Your actions could be seen to promote the unrestricted consumption of alcohol and run contrary to all our recent national anti-drinking campaigns.
We also hear that you have described your followers as 'the salt of the earth'; this attempt to portray a harmful substance in a positive light is something we regard very seriously indeed..."
Ah yes, salt. While not all the research agrees, the battle lines have been firmly drawn. As NHS Choices - Nanny's preferred organ of communication - explains:
You don't have to add salt to food to be eating too much: 75% of the salt we eat is already in everyday foods such as bread, breakfast cereal and ready meals.
There's a handy article explaining exactly how to cut down on salt particularly if you are elderly (it stops just short of a section on how to extract the nourishment from eggs) and finishes with the coup de grace - a video entitled 'Say No to Salt'.
Now, funnily enough, two people of my acquaintance did just that this year. Both conscientious souls in their eighties, they followed the NHS instructions to the letter and emptied their salt-cellars and banned it from their kitchens forthwith.
And both of them ended up recently needing medical treatment for the symptoms of salt deficiency - not at once, you understand, but after several weeks of increasing illness, debility, dizziness and mental confusion.
You see, the NHS merrily assumes that everyone eats the 'bread, breakfast cereals and ready meals' that supposedly supply 75% of the necessary daily intake. Like so many other NHS policies, it's one-size-fits-all, and I suspect the usual diet of NHS administrators bears little or no resemblance to the home-cooking and baking habits of the previous generation.
And what is truly frightening is that, until both of these people collapsed and the tests were done, all their symptoms were put down to the normal aging process with no further investigation.
This painting-by-numbers approach to healthcare risks damaging those who do not fit the preselected profiles. What is needed is a large helping of common sense in the NHS - but I suspect that would be nothing short of a miracle.
The recent figures on childhood eating disorders make chilling reading.
Over at Orphans of Liberty, Angry Exile points out - with his customary acerbity - that while the MSM are quick to point the finger at 'size zero' models and the celebrity culture, their own constant reference to the 'obesity epidemic' may well be playing a significant part.
Obesity has given the Righteous a mighty stick with which to smite the unbeliever and the righteous are wielding it with a vengeance; their new morality - derived, I suspect, from the slimming clubs attended by NHS administrators - is an easy one; fat = bad.
A while ago, I posted on NHS staff berating cancer patients for their supposed alcohol consumption or lack of exercise with no evidence whatsoever, justifying their action with the false syllogism:
Cancer is caused by unhealthy lifestyles.
You have cancer. ergo You have an unhealthy lifestyle
Never mind that the patient hates alcohol and her last drink was a sherry with the in-laws at Christmas, or that she walks seven miles a day with her dog; the gospel of Healthy Living must be preached.
These evangelical harpies recently struck again; a friend was in hospital when a bright-faced young woman came in and introduced herself as his dietician before launching straight into the First Lesson for the day; 'You have to cut down on red meat".
"How much red meat do I eat, then?" my friend replied. This puzzled her; " I don't know," was the baffled answer, "How could I?" Then she brightened up; "But you have to cut down, anyway."
My friend - a Cambridge graduate who has managed to feed himself well for decades while pursuing an active career - ran logical rings round her as she tried in vain to deliver her creed for Healthy Eating; eventually she gave up and went in search of easier prey.
Our secular society is in danger of creating a whole new priestly caste - the Nanny State embodied in an army of 'experts' loudly proclaiming their revealed truth of 5-a-day and reduced-calorie diets and casting out the unholy trinity of salt, sugar and fat.
The message is pitched at a volume designed to reach those whose lifestyles feature more television and takeaways than home cooking and exercise - subtlety is, I think it's fair to say, not the order of the day.The 'healthy eating' message, complete with graphic portrayals of the fate of non-believers, is delivered with aggressive evangelical zeal to even the youngest of hearers.
And, just as some children in the past became fervently religious, a few over-conscientious, sensitive children are taking this message to extremes. The 'odour of sanctity' reported in the cells of ascetic medieval saints was almost certainly ketosis - which produces sweet-smelling acetone in the breath - resulting from extreme fasting in the name of religion.
Who would have guessed we would see its re-appearance in the 21st century?
All cats have whiskers. This animal has whiskers. ergoThis animal is a cat.
Discuss
A classic false syllogism? Obviously untrue? Flawed logic? Well not, it seems, for some health professionals in Britain, if the experience of some of my friends and family is anything to go by.
And it can only get worse, to judge from this report concerning breast cancer:
A new report says that as many as 20,000 British women could avoid developing the potentially fatal disease each year, if they took more exercise, drank less and ate better.
So far I have no problem with this per se; I am prepared to agree that they have established links between breast cancer and obesity or lack of exercise and that somewhere between 0 and 20,000 women could avoid developing the disease by a change of lifestyle.
However, that’s not the end of the story: according to the Deputy Head of Science at the World Cancer Research Fund,
“It is very worrying that in the UK there are still tens of thousands of cases of breast cancer which could be prevented every year. Breast cancer can be prevented by cutting down on drinking, being more physically active and carrying less body fat.”
What she means is that breast cancer in cases where it is related to lifestyle can be prevented by a change of habits and losing weight – that is, by the WCRF’s own estimation, about 42% of cases overall.
The other 58% of cases may be linked to environmental or genetic factors or other causes not yet established. Information like this, however, proves a logical step too far for many NHS staff, for whom the mantra runs thus:
Cancer is caused by unhealthy lifestyles. You have cancer. ergo You have an unhealthy lifestyle.
In the past few years, several of my friends and family have been diagnosed with so-called ‘lifestyle cancers’, and, to a man (and woman) subjected to lengthy instruction by medical staff about their supposedly unhealthy habits despite a clear family history of the disease in each case.
Thus a friend who walks several miles every day was advised to take more exercise; a non-drinker was repeatedly told to cut down on his alcohol consumption and, most bizarrely of all, a woman who has the healthiest diet I know of was constantly lectured on cutting down on fat and sugar and avoiding junk food – she weighs less than eight stone.
And each of these reported, with varying degrees of fury, a clear and consistent implication by hospital staff that they must have brought the cancer on themselves by their own failure to lead a healthy lifestyle. Their remonstrations were brushed aside - the cancer was proof enough.
It is no secret that doctors receive a ridiculously small amount of training in the interpretation of statistics, given the relevance of probabilities and incidence – I have mentioned before the GP who excused his diagnostic failure with the words, ‘97% of people with this cancer are obese; you aren’t even overweight, so there was only a 3% chance of you having it.’
That being so, how likely is it that the lower echelons of the medical hierarchy can correctly interpret statistical information, given the standard of maths in today's schools? It is a matter of record that numeracy skills are at a frighteningly low level across the population, and I doubt that hospital staff are any exception.
Tell them that cancer is linked to poor diet and lack of exercise and, unless it is clearly explained, some, at least, are going to go on with complete self-assurance to tell cancer patients that it is all their own fault.
Professor Sir Nicholas Wald said prescribing cholesterol-busting statins and blood pressure pills based on age alone would be much easier and quicker than the current system.
However, concerns about the side-effects of the drugs mean that the proposal would be controversial. [...]Addressing the concerns, Sir Nicholas said the benefits would easily outweigh the risks.
Once upon a time, there was a fit and healthy man in his early seventies. At his GP's request, he visited the surgery for a check-up, where he was poked and prodded in the customary manner before being told that his BMI and cholesterol levels were 'rising' - not 'high' or 'elevated'; just slightly above the previous reading.
The GP prescribed statins - this was at the beginning of the statins-for-all campaign as media doctors got on the bandwaggon - and the man, being a cooperative sort, obediently took them.
This man had a healthy lifestyle - didn't smoke or drink, ate well and took plenty of outdoor exercise - and was seldom ill, so when he started to feel unwell soon afterwards he went back to the doctor.
'Side-effects, that's all', said the doctor, and changed the brand of pills. Things were no better, so the man went back again and asked the GP to investigate. 'No need', said the GP, 'It's just side-effects of the statins' and the pills were changed once more.
The symptoms multiplied and still the doctor refused to carry out further tests - 'It's just a case of finding out the correct dose'. For over a year, things went from bad to worse until, in desperation, the man sought a second opinion.
The second opinion was unequivocal - aggressive cancer, now so far advanced that there was nothing left but palliative care; with supreme irony, detailed scans showed that the patient's cardio-vascular system was in excellent condition. The statins, now replaced by increasing doses of morphine, had been completely unnecessary.
This cannot be an isolated case, yet I have seen nothing in the concern expressed about side-effects mentioning that they may mask the symptoms of cancer and other serious conditions. I suppose that is one of the risks that is 'easily outweighed' by the benefits of statins for all.
That's the trouble with the way Sir Nicholas and his kind think of patients; as figures on a chart - one unnecessary death from cancer set against the prevention of several heart attacks constitutes an acceptable risk.
Mathematically that may be true, but I wonder if he - and his family - would still think so were he the one?
Once upon a time, people had waists. In the days before shell-suits and tracksuit bottoms, the majority of skirts and trousers stopped firmly at a fixed point, held in place by rigid waistbands – none of this trousers-round-the-buttocks business or comfortable elastic.
And the wearers of these garments sat at dining tables to eat all their meals – something so rare these days that there are many homes without a table big enough to accommodate all the occupants.
Those inflexible waistbands had a noticeable effect at mealtimes – if the seated diner ate too much, they became uncomfortably tight, effectively discouraging the wearer from further indulgence. With a limited space to put food in, the result was a reduced intake. Sounds familiar?
With the NHS spending an estimated £32 million a year on gastric band operations (to say nothing of the ongoing care costs and potential post-op complications), perhaps it’s time to look at some more practical and less invasive solutions.
A television advert currently proclaims special offers on ‘jeggings and treggings for all the family’ – somehow the bastardised words perfectly suit the infantilised, unstructured pull-on garments with elasticated waistbands forgiving enough to accommodate a full meal and a couch-based evening’s grazing.
While much of the current reported obesity crisis can presumably be laid at the door of cheap junk food and lack of exercise, fashion, too, has played its part. The low-slung trousers seen on every high street are so far removed from the region of the digestive tract as to have no effect at all on the constant throughput of food.
So what’s needed is a form of external constriction – something that makes the overindulgent eater reconsider - and I think I have the answer. It’s even readily available in popular clothing outlets*.
There's no doubt that fashion retailers can engineer clothing trends, so why not get them on board now? Since the inexorable rise of sportswear dictates what is worn on the street, what is needed is a fashion for branded weightlifting belts worn tightly on the waist all the time.
Cheap, easy and safe for all - what's not to like?
*Excellent joke from Hugh Dennis (on 'The Now Show'): "This train will shortly be arriving at Birmingham New Street. For passengers wishing to change for Wolverhampton, there is a JD Sports opposite the station entrance."
If you start losing your marbles, you'd expect someone to notice. After all, even if you are blissfully unaware, your nearest and dearest will surely notice something is wrong.
But not, it seems, your GP. A report in the British Medical Journal accuses doctors of doing 'too little too late' to diagnose dementia. The Chair of the Royal College of GPs agrees, calling the study a 'wake-up call for GPs'.
So what happens when a relative gets more than a a bit forgetful and the family try and get something done?
First of all you ask the sufferer to go to the GP, but that's no good; they may get as far as the surgery, if you're lucky, but once they're in there, they forget what they were supposed to ask.
So you try again - ring the surgery and ask for help. Tough luck - there's the Data Protection Act: "We can't talk to you about another patient - it's confidential". The same thing happens when you ring Social Services, the local hospital and anyone else you can think of.
Eventually you've managed to convey the idea that something's badly wrong - so a GP actually turns up unannounced on the doorstep (not so good if you've advised your vulnerable elderly relative not to let strangers into the house).
The GP has a cursory look, checks blood pressure and asks whether your relative smokes (got to get those boxes ticked!), and then comes the crucial question; "Do you know who's Prime Minister?" Quick as a flash, back comes the correct answer. Excellent - job done! No need for more, all's well, goodbye.
Only News 24 is on in the background - and loathing of the current PM is one of your relative's favourite and more lucid topics. Had the GP enquired further, he might have been surprised to learn that Bobby Robson captains the England team - on a scandalous wage of £300 per week - and that beer has gone up to 8p a pint, but you mustn't grumble because the Secret Police are listening.
Off the record, a health worker tells me that almost all of the patients in his Dementia Unit come in via A&E, having had a fall, injured themselves or been found wandering the streets in a state of confusion.
If you hear about a dementia sufferer in this situation, spare a thought for the family who let things get that far; they may not be neglectful, indifferent or unkind, but just victims of seemingly unbreakable NHS red tape.
Macheath, the notorious highwayman, has retired from a life of crime and can now be found behind the bar of Peachum's Tavern, favourite haunt of the rakes, rogues and vagabonds of 18th century Newgate and setting of 'The Beggars' Opera'. Visitors are always welcome; help yourself to a virtual tankard of ale and read on...
