I Survived!

The chocolate was appalling; this morning was difficult; but I survived. I was able to get to work and the migraine was containable. Nevertheless, I hope never to do that again. There is something deeply upsetting to the stomach about too much chocolate!

Much more importantly, I survived the day. We had another Away Day. I have become cynical about such things, but this one was useful. We talked with more openness than we often do, and I found myself drawn into the discussions and into the reality of the difficulties that we had to confront. The truth is, each of us in Public Health has to make some pretty tough decisions. Many of us are trying to decide whether to leave Public Health completely. A considerable number of us have already decided to do so. I do not know a single medical public health colleague who is not looking for an alternative.

Is this what the Government intended? Did the Secretary of State really want to get rid of many public health professionals, and certainly the majority of medical public health people?

Sadly, I don’t know the answer. I really do not know what is in the mind of our lords and masters. What I do know is that public health is facing a crisis far more intense than any I have known. The question that I should so like an answer to is: do they know what they’re doing? Or is this just a terrible mistake? If they know, it is unforgiveable. If it is a mistake, it strikes me as a Greek tragedy. Either way, the next generation will be deprived of the NHS that we have known. And that is a tragedy.

Tonight, I have eaten chocolate!

Now, I realise that this is very wicked. Chocolate is up there with terrorist attacks and necromancy. The problem is, I like chocolate; and, once in a while, I allow myself to be tempted into a small amount of it.  Which I have always thought of as fine, until today.

Today, there was nothing ‘small’ about the amount I consumed. For some reason, I could not stop eating it. I delved into a box of Lindor with surprising delight, and did not stop. I am now feeling deservedly sick.

Why? That is the question I ask myself. Why, after years of abstention, did I suddenly revert to eating chocolate? Why have I suddenly been prepared to make myself sick and to risk the migraine that will undoubtedly ensue tomorrow morning?

I can’t answer the question. All I know I that I had better go to bed and that I may not be fit for anything tomorrow. Oh s**t! If there is no blog tomorrow, you will know.

Sexy Beast

Prince Rupert is back. What can I say? My life feels better. I am content.

Prince Rupert is my oh so beautiful car. He is a Mercedes 280 SLK.  He holds the road as if he was on rails. He is wonderful.

As you will know from an earlier post, we had a little accident. There was a dent in the boot lid that was not as it should be. I was mortified.

I am a BRILLIANT driver. I do not make that kind of mistake. It was an aberrant moment, a total fluke. I saw the stump behind me, but did not notice the branch coming out of it at an angle.

When he was in for repairs they leant me a car – an A class Mercedes.  Now, this is a perfectly reasonable car, but it does not stick to the road – it shimmies about. Also, its idea of acceleration is a pathetic approximation to what it should be. And I found myself sitting far too high above the road – I was scared!

However, there were plusses: there were four doors and a back seat; I had to drive more slowly because I was scared at every corner; nobody noticed the car.

Who am I trying to kid? Welcome home Prince Rupert. Tomorrow, we’ll go for a drive – just to make sure we are still in tune. And I won’t have to get up half an hour earlier on Monday.

There is a Beautiful Sky Tonight

There is a Beautiful Sky Tonight

I am sitting at my desk, in the study/spare bedroom, trying to work, but my eyes are drawn to the beauty of the sky outside. It is not a classically beautiful sky: there is little blue; but when I try to describe its colour, I find I cannot. There are so many shades from brightest white to deep grey and everything in between. And the light is luminous. It envelops me; caresses me. It purges my mind of the difficulties of the day.

I watch, mesmerised, as water drips gently from the leaves in the aftermath of the rain. I watch the slowly growing patch of blue, and become conscious of the sun glinting on the chairs on the balcony. The clouds move like majestic galleons across the sky. A crane in the distance is silhouetted against the sky, quiet and tranquil, its work done.

Then, suddenly, the birds are back, looking for food before bedtime. I am still, not wanting to disturb them. They chatter and chitter on the terrace, then fly home to bed.

And now the sky is almost wholly blue, but there are browny red patches at the edges of the blue. It is magnificent. Good night all. I am going to wallow in colour and light.

….. And Now the Rock & Roll

OK, so perhaps not quite Rock & Roll, but certainly a better day. We had another meeting (yes, I agree, I spend far too much time in meetings!) and the discussion felt positive and I started to think that we might be able to get round this ridiculous Act enough to enable me to do my job.

I have explained before that I am a Consultant in Public Health Medicine, largely concerned with commissioning NHS services. I have also told you that our jobs are being designed out of the system. All of this remains true. What I had failed to take into account was the determination of others in Public Health, with far more clout than I, to make sure that it continued. Understanding the importance of the function, they are helping us to build it into the new system.

So, am I less concerned? Well, yes and no. Yes, for me personally; no, for the NHS. The problem, you see, is that at the moment we have lots of people who understand all the various strands. They are conspiring (if that is the right word) to make sure that a reasonable amount of Health Services Public Health (HSPH) continues. However, many of us are approaching retirement; many more are choosing to leave. In five years time, who will carry the banner of HSPH?

That, surely, is my job; to ensure the continuation of training in this field and to pass the banner to the next generation. It is a daunting task, but one which I relish. So, if I’m not quite dancing, at least I have a little smile on my face.

Sex, Drugs and …. Silence

Today, I attended a meeting of the Public Health team to which I belong. It was an interesting meeting. We discussed the contracts for Public Health commissioned services that are moving to the Local Authority. These include things like Drug and Alcohol Services, Sexual Health Services, screening and many more. They are, in the main, unsexy but vital. They probably do more for the health of the population than many more ‘sexy’ services.  Just to be clear, these services have until now been commissioned by Primary Care Trusts, but with Public Health moving to the Local Authority this will have to change.

Now, I have no problem with change; indeed, I have a reputation for thinking out of the box and generally disrupting things. But, on the whole, I only do that if I think it will be an improvement and, as important, if I can make an evidence-based case for it. On this occasion, the evidence base is, at best, lacking. We are, however, commanded by our lords and masters that this must happen.

Do you remember the rhetoric that said ‘no decision about me without me’? Forget it. This is a top down decision. These contracts will move. DO IT.

Well, that is as may be, but the truth is that the infrastructure to support this is not there, that there has been insufficient thought given to it and that it is likely that these services will deteriorate. I worry that the services for those who are most vulnerable will not be sustained and that this will not be picked up fast enough. I worry that we will not be able to spot the problems early enough.

I became a doctor to look after patients – in my case a population. I am saddened that I am no longer certain that I can do that.