I am Shaking with Fright

Today, I decided that, having kept Molly indoors or on the 'safe' balcony for a month, it was time to introduce her to the other terrace. This is a long terrace, three floors up. Friends had said that I was being overly protective. Cats, they said, can cope with all that. They do not jump off terraces and kill themselves. I was sure that being able to sit out in the sun would be agreeable, so I poured myself a glass of wine, opened the door, and sat at the table. Molly followed, although rather suspiciously.

At first, all went well. She explored, stayed off the walls, came when I called her, sniffed at the plants and retreated into the flat regularly. I was happy. This was going to be a doodle, I thought. I could sit outside, with the door open, and she would wander in and out without any worries.

After a while, she got up on the garden table. I was less happy. It is an easy jump from there to the wall that has nothing between it and the ground. I watched carefully. She wandered, returned, jumped off again. I breathed a sigh of relief.

Two seconds later, she was on the edge of the wall. I was terrified. I did not want to go too near in case I frightened her into jumping. I tried calling her, but she was engrossed and uninterested in me. She wandered nonchalantly along the wall, occasionally leaning over with one paw poised. My blood pressure must have been about 700/500. I still have a headache. I was terrified.

She gradually meandered around the whole edge, before attempting to get on to the tiny rail above the glass. I could not take any more. I went forward and managed to grab her.

She is now very cross that she cannot go outside. And I think I may have a stroke or a heart attack tonight. If so, can somebody please look after Molly?

Pensions: Does Government have an ulterior motive?

To be honest, I never really questioned this. I swallowed the line that pensions had to be brought under control and just thought that doctors were not flavour of the month because of the opposition to the Health Bill. However, it has been pointed out to me that there might be a more sinister motive for this.

Sinister? That is a strong word. How can it be sinister? Let me put a case to you: NHS pensions are a good deal; nobody disputes that. For years, they have been taken into account when negotiating salaries, because doctors realise that they are a real benefit. We are not unreasonable; we have accepted that we should bear any further costs. So why is the Government doing this?

Is it even faintly possible that there is an ulterior motive? Well, having thought about it, YES! Private companies do not want to be saddled with good pensions for staff they are taking on. Indeed, that might be a real disincentive to the private sector. So, in a world where the Government is trying to get more private sector involvement in health, it is conceivable that said government might wish to reduce said pension burden. I don't wish to be a conspiracy theorist, but suddenly I am wondering how much of this battle is actually to do with the privatisation of the NHS. The pension pot is healthy. There was a tough but fair negotiation in 2008. Why would the government re-open this issue if it did not have an ulterior motive? Please let me know if you know the answer.

Industrial Action is Almost Impossible

As I said yesterday, I decided, after much soul searching, that I would participate in the day of action called by the BMA for today. I listened, in increasing despair, to the coverage on the Today Programme, with the biased reporting, the lack of evidence, the refusal to countenance that we might have a case. If anything, it increased my anger and determination.

As instructed, I presented myself at my usual place of work, determined to do only those things that were not urgent. But how do I assess urgent? I am a Public Health physician. I do not actually see patients. This afternoon we had the Individual Funding Request Panel, and I took the view from the start that attending that constituted the equivalent of urgent patient care for me. The problem was all the other things.

I have spent the rest of the day trying not to break the industrial action without being too idiotic about it. I have examined IFR requests that could be construed as having some urgency, but have left the cosmetic ones to next week; I have answered emails that might disadvantage patients if not sent, but have left the rest.

I am left with an overwhelming sense of futility. I do not believe that we have achieved anything today. The public will not understand, the government is intransigent and the impossible changes to the NHS continue. I despair at what I see as the wholesale destruction of what I hold very dear. And I continue to look for a job.

Tomorrow is Industrial Action Day

For years I have said that nothing would ever bring me out on strike. I am a doctor, a professional, dedicated to the population I serve. I would never put self-interest above the needs of my patients. Yet tomorrow I am preparing to take the, admitted very limited, industrial action called by the BMA. Why? What has caused this change of heart?

I must first say that it is only very peripherally to do with the actual pension, although I believe that doctors have been treated appallingly. The things that have made me decide to withhold my labour are:

1.    The NHS has been decried, vilified, and disorganised to within an inch of its life. The Government that got elected at least partly on a ‘no top down reorganisation of the NHS’ betrayed us quite deliberately and has set in motion changes that will not work and that will undermine the very ethos of the NHS.

2.    Public Health has been particularly badly treated, with a wholesale shift into Local Authority, fragmentation of the work force, and a total disregard for health services public health.

3.    The pensions point has been spun to a point that can only be called dishonest. The taxpayer (of which I am one) does not ‘pay for our pensions’, we do. We make contributions and have agreed to bear any increased costs. The pot is healthy and easily sustainable. There is no pensions crisis for doctors. This is pure politics, and is grossly unfair because it is not being applied to other public sector workers like Senior Civil Servants and Government employees, all of whom have similar arrangements but whose contributions have not increased and who are not facing a real cut in pensions.

In short, I am angry at the unfairness, the disregard for those of us who have given a lifetime to the NHS. And I can think of no other way of making these points. So, I apologise in advance to anybody who feels disadvantaged tomorrow, but I shall be taking industrial action.

The Delights of British Rail

Or, rather, East Midlands Trains. This morning I dragged myself from my bed at least half an hour earlier than I liked to catch a train to London for a meeting. I loath these early starts,particularly on Monday mornings, when I am never at my best. As usual, I ran late and rushed from the house, leaving both book and laptop behind. Fortunately, my trusty iPhone and iPad are with me. I arrived at the station with about five minutes to spare and heaved a sigh of relief. The front portion of the train was already there, but we were waiting for the rear portion. So we waited. And waited. And waited. Apparently there were 'signalling problems' earlier. At last, the train pulled in, about ten minutes late. A flood of humanity poured forth, rushing, jostling, irritable. Those of us on the platform stood back politely, waiting to board. We knew the drill: the doors would be locked again while the two trains were coupled, then we would be let on. Unfortunately, the trains had other ideas. They would not couple. There was much rushing of personnel up and down, an ever-growing collection of people stood at the coupling point talking and staring down. Still, it appeared, t he trains would not couple. Then suddenly, miraculously, and for no apparent reason, they tried again and this time it worked. The doors opened, we clambered aboard and we were off. We are running seventeen minutes late. I shall, again, be late for my meeting. You just cannot trust the trains in the morning.

The Further Adventures of Molly the Cat

Dear patient friends, those of you still bothering to check my blog when I have been so silent, today I return to the subject of Molly. Do you remember the syndrome I identified some time ago of Inexperienced Cat Owner? Well, I can tell you, it is very real and very dangerous. Also, humiliating. You may recall that Molly and I were locked in a battle of wills about her litter tray. Although she would enter it to wee, she was leaving solid offerings all over the bathroom floor. I tried everything: vinegar on the carpet, strong detergent, many explanatory talks. Wise cat owners told me not to bother - I was going to lose. But I couldn't afford to lose this battle. Two days ago, I surrendered. We now have a new litter tray and different litter, and for the last two days all has been well. But, you see how pernicious is the inexperience? I am now not sure whether the litter, the tray or the combination was the problem. So tomorrow, we start experimenting again. Because, truth be told, the present combination does not please me at all. It goes all over the place and the bathroom is a constant mess. Added to which, the rather stylish hand held vacuum I bought for the specific purpose of clearing spilt litter is no use for this bigger variety. So far, therefore, I have a beautiful and expensive but useless cat carrier, which has been replaced by a cheap but functional version that I can drop her into from the top; many large bags of the World's Best Litter, which she won't use; collars, harnesses and seat belts she will not wear; expensive toys she turns her nose up at, only being interested in feathers on sticks and squeaky mice. I am thinking of writing a book: The Beginners Guide to Owning a Cat. That's after I've put all this stuff on eBay, of course.

My Girl Thursday

Once a week, a young A level student comes to help me with my post and my filing. She is extremely efficient and I am lucky to have her. She is bright, intelligent and obsessed with fashion - what 17 year old isn't? When I suggest that the bag she carries around is far too heavy and that a back pack would be less damaging, she snorts in derision: back packs are not fashionable. Despite my age, I can remember the reality of that.

My Girl Thursday is immensely reliable: she turns up, does all and more than I ask of her, and helps me with Molly Cat. I have never seen her without a smile. She also leaves me endless lists of things I must do, which takes a certain nerve.

So, is there a problem? Yes. I could have offered her minimum wage. She could have been virtually slave labour. This would have been grossly unfair, given her talents and personality. Yet there is nothing to stop this. Surely we ought to treat our young people properly when they serve us well?

Conflicts of Interest for Public Health

Over the last few weeks I have become increasingly concerned about the potential conflicts of interest inherent in the new arrangements for Public Health for those of us who work in Health Services PH.

As you will all be aware, the majority of PH is being moved to the Local Authority (LA). From the very start of this upheaval it was clear that those who were designing the new system did not understand PH at all. In particular, they had no understanding of the three pillars of PH. I have explained before that these are Health Protection, Health Improvement and Health Services Public Health. I may even have intimated that only Health Services PH would be really disadvantaged, but the more we have learned the clearer it has become that this is not so.

Health Protection is that branch of PH that attempts to protect the public from both communicable and non-communicable health hazards, like the Legionnaire's Disease that we are hearing so much about at the moment. It also encompasses, however, the screening and immunisation programmes. It is clear that the Government equated this with the work that is currently undertaken by the Health Protection Agency (HPA) and it was of the view that it could be picked up and dropped into Public Health England (PHE) with a minimum of fuss and trouble. What the powers that be completely failed to take into account is that much of the day to day activity takes place, not at the HPA, but in the PH departments of PCTs. The result has been a shambolic rush to attempt to find a way to safeguard the screening and immunisation services, to attempt to define lines of accountability that will work in the new system, when half the staff will be in PHE (a branch of the Civil Service) and the others will be in Local Authority. In private, even Department of Health officials will admit that this is a real problem area.

Health Improvement is largely to do with lifestyle choices: smoking, alcohol, obesity. All of this is going to LA, where there will be interesting opportunities for collaboration. There will also, however, be opportunities for reducing budgets. It will, I suspect be very dependant on the strength of the Director of Public Health and local relationships, with the result that it will work very well in some places and very badly in others. I thought we were trying to improve the system, not make it worse.

Health Services PH is that branch of the specialty that deals with commissioning NHS services and dealing directly with requests for individual funding packages. This, we are told, will be provided by PH consultants employed by LAs but 'offered back' to the NHS though the Core Offer. It sounds fine, until you start to think about the detail. One of my responsibilities is Continuing Care: looking after the most vulnerable in our society because they are elderly, or terminally ill, or have a mental health issue, or have a learning disability. The rules are complex, but essentially there are ways of assessing whether an individual is entitled to Continuing Health Care, or whether the package of care needed to look after the individual should be jointly funded by health and social care. If somebody qualifies for Continuing Health Care, then the NHS picks up all the costs, even those that are essentially social care.

Am I alone in seeing the huge potential for conflict of interest here? Already I receive letters from both MPs and Local Councillors about individual constituents asking that we 'reconsider'. As it stands, that is fine; I can assess the case and decide whether there is a problem. But when my salary is being paid by the LA, there will be a far greater pressure to do what LA councillors want. I believe that is unconscionable. I am surprised that our elected representatives are incapable of seeing the problem.