I admit it. Within me is a gormless idiot who likes to be scared to death! In view of this - when I finally get bored rigid with the computer - I watch movies on TV. Last night was a time of ennui and I settled myself down to watching some movie - I can't even remember its title - on the Horror Channel. Yawn! I like high quality dross you see! So I switched to Horror Channel Plus and came across The Living and the Dead and was awe struck by the genius of it. If there was ever a film misplaced by genre - this was it!
It is a masterpiece!
Its genres are a mixed bag - placing it under drama, horror, thriller and mystery. It is these entire plus more. Its tag is that of 'Terror by good intentions.' For it to be shown on a horror channel is a travesty of justice.
The Living and the Dead details a period in time of the life of Donald Brocklebank (Roger Lloyd Pack) - a man of aristocratic background living in fear of bankruptcy in a rundown country manor. His wife, Nancy (Kate Fahy), requires constant care due to a terminal illness.
His son James (Leo Bill) is schizophrenic and also requires constant care. James is overprotected by his family leading to an exacerbation of symptoms (and I know this to be true as some with mental illness overprotected by families experience serious personality damage and now reside in our home) but is intent on proving himself as 'the man of the house' during his fathers absence.
The Living and the Dead presents a vision of the nightmare of mental illness. I implore all those who have an interest in mental ill-health to watch this disturbing jewel. You may see a preview here - but it gives you nothing! If you read the reviews - ignore the Neanderthals speaking of 'retards' and seeking blood and gore.
It is a gut wrenching masterpiece! It is wonderfully awful in its honesty. Okay if you watch it, you may think that there are gaping plot holes - and perhaps there are - but buy it, watch it, for if you don't - you can never truly understand the devastating effects of mental illness on those who suffer it and its effects on family members.
Images courtesy of Quiet Earth I recommend you 'click' on Quiet Earth as it gives an excellent review.
Please read this article in the Colchester Daily Gazette. It details a row that has erupted after Colchester PCT advised care homes not to automatically dial emergency services when a resident is dying.
I presume care homes in Colchester have become involved in the national drive to 'sign-up' en masse residents to Advance Decision to Refuse Treatment (ADRT).
Residents and relatives of those residents not deemed to have mental capacity are being coerced by Link GPs and indeed care homes (who wish to proudly boast they have achieved Gold Standard) to Advance Care Planning.
It has happened in my area with devastating results, many residents being highly offended and highly confused by this unrequested approach and relatives feeling pressured into making decisions they do not want to make.
What really concerns me about this article is that the family of Ellen Williams seem unclear as to exactly what they have signed, believing that she has been "put on the Liverpool Care Pathway "do not resucistate" plan." What is this? Clearly from the article she (Ellen) is not "on" the LCP - but clearly, her future (lack of treatment) is well mapped out.
I can only assume that the link GP discusssed placing Ellen on the LCP when she is in the process of dying and during this discussion the family requested or agreed to Do Not Attempt Resuscitation (DNAR).
However, it is important to state that DNAR decisions only apply to CPR (cardiac massage and artificial respiration) and not to any other aspect of treatment - such as comfort measures: antibiotics, analgesia, hydration and feeding (any route), oxygen, hospital admission and suction. DNAR does not mean Do Not Treat (DNT).
Four residents in my home have ADRTs in place - three requested by relatives when their loved one was 'in the process of dying' and the fourth when the GP requested to see the relatives for the same reason. All have a DNAR in place, relatives have requested no hospitisation for two of these residents and all relatives have requested active treatment should their loved ones become ill. All of these residents are still alive!
So the question needs to be asked that if the GPs were wrong in these instances why nurses are deemed to have the skill of recognising 'dying' when it suits a PCT. If I am concerned about the health of a resident - something which can't wait until a GP visit in the morning - I phone Out Of Hours (OOH) Services and often, when giving details I am informed that I should contact emergency services - because they can't be arsed to come out! If I felt emergency services were required I would have done this.
Of the four residents mentioned previously, if thought required, I would contact emergency services for two of them. The remainder I would contact OOH. Nursing home nurses are between a rock and a hard place - with regards to requesting GP input - they are damned if they do and damned if they don't! I will not take risks with a residents life - I am not a doctor. Woe betide me if I sat by and did nothing should a resident become critically ill - I am a hundred percent certain no PCT or GP would back me up! I would be hung, drawn and quartered!
I am concerned re Dr Shane Gordons statement, feeling he has totally missed the point that there is a lack of clarity, a lack of understanding of Advance Care Planning and an unawareness of the ramifications of signing same.
I wonder if he has read "This paper desribes the protocol of a multidisciplinary study that will provide timely and essential insights into an area of end of life care, ACP, which has become policy driven within the UK despite a weak evidence base."
Advance/Anticipatory Planning (formerly Living Wills) is fine and dandy if it is a choice you make yourself. If I had a terminal illness - I would request and sign one myself. Okay dementia is terminal, but it is not a tomorrow thing. Until it reaches end-stage you have a right to treatment.
We all get old some day - even doctors and those who manage PCTs.
Peggy had become quite exasperated since Egbert had been laid off permanently at the pig farm. He continuously moaned on about how unfair life was. Moan, moan, moan, moan, moan! It wasn't as if he got the sack, she thought, the miserable bugger!
Initially she had been compassionate, clucking like a mother hen, taking him under her wing and trying to make wrong things right. Now, overburdened as she was by his misery, she felt as if he had thrown a yoke round her neck, continuously dragging her down. Living with him was akin to treading on egg shells.
Peggy had a reputation of being hard boiled and indeed she was. Well, was, until she had taken in Egbert as a lodger. Over time she had warmed to him, becoming softer in herself, her life no longer overshadowed by self-imposed isolation. Why, she had even dipped into her nest egg to buy him a new suit for interviews!
Egged on by Peggy, Egbert had attended countless interviews only to be disappointed by the battery of rejection letters - the rejection exaggerating his low self worth. Moreover, Peggy noted, he was becoming a mere shell of his former self. "I shall phone Mr Williams (the pig farmer)!" she announced, "I hear business is picking up!" Egbert just looked at her!
Two mornings later, both at the breakfast table, the familiar plop of letters falling on the door mat was heard. Peggy scrambled to her feet and ran to the door, returning, beaming, and handed a letter to Egbert.
Egbert's face lit up as he read the contents of the letter!
"Well, I guess you'll be bringing home the bacon again Egbert?" Peggy smiled.
Egbert eyed the bread on his plate and raised it up. "A toast to you Dear Peggy!" he grinned. "As sure as eggs are eggs, I will! As sure as eggs are eggs!"
PS "Have you heard the joke about the three eggs?"
Before the NHS the provision of healthcare was very different from today. Infectious diseases were rife and thousands died of pneumonia, diphtheria, tuberculosis, meningitis and polio every year.
Infant mortality was around one in twenty and there was little the healthcare system could do to change it.
Healthcare was not a luxury everyone could afford. Those who could, paid for doctor's fees and medicine. Workers who earned under a certain amount were covered by the 1911 National Insurance Act and paid a few pennies each week and received free treatment "on the panel." Some woman and children could see a 'Club Doctor' as they paid into a 'sick club.'
Millions, the most needy and vulnerable were not entitled to free care - children, the elderly, women not at work and the unemployed.
Often, among the very poor a decision had to be made between buying necessary medicine or a loaf of bread. The loaf of bread usually won.
The poem below is firmly based on a story a resident (now deceased) used to relate to me often. He told of life before the NHS and we both shed tears whenever he told it.
The Coal Black Night
Short pants, scuffed knees, no warmth of coat,
I ill-dressed in drenching rain,
Panic in my heart tossed ragged coal
At Dr Humphries window pane.
Window opened he stretched a tired "Yes?"
"Dad's having one of his heart attacks!"
I screamed and he hurried forth
Hand clasped round his humble bag.
We raced into the coal black night
'Til we could run no more.
Breathing so hard it pained our chest
We found mother at the door.
"Hurry doctor!" she implored through tears
"I fear he is very near to death!"
Father clutching tightly at his heart,
Fighting dear for every breath.
I, cleared from the scullery
To the good room with baby Sis,
That dearest fragile scrap of life,
I gave her a frightened kiss.
I heard the wail of mothers cry
So anguished my blood ran cold.
Dr Humphriess came and hugged me tight -
His heart as good as gold.
"I'm sorry son, your fathers gone,"
His voice crackled with compassion.
Mother entered as if in a dream
Looking old, destroyed and ashen.
I ran to her shouting "No! No! No!"
My heart full of disbelief.
She crushed me deep into her arms
And we were joined in grief.
Embraced within my mothers love
We cried until our tears ran dry,
And deep within that shroud of grief
We heard the doctors anguished cry.
Tears streaming down his tired cheeks
Distraught and so distressed
He cradled Sis within his arms
Close to his heaving chest.
Baby Sis had been born to die,
So fragile, so small and weak.
We took her from the doctors arms
And left kisses on her cheeks.
The three of us stood empty then
No tears left to cry,
For death was not a stranger then
And rarely passed us by.
The draft focused on this interview with Andrew Lansley in which, when asked "Do you think you have done a good job of explaining these reforms?" he replied "... ... Yes" and later that he had "... absolutely engaged with people" and had indeed listened to all GPs! My! That is a lot of conversations with GPs - how does he find the time?
How strange it is then that one week later on 13/04/11 he, Dave and Nick were holding a round-table session with voluntary health organisations to help reassure the general public that NHS reforms are "not about privatisation."
How strange it is that the afternoon of the very same day he apologised to nurses for poor communication of his health reforms. How strange it is that he did not have the guts to address the RCN congress, instead meeting a select 60 for a Q&A session to 'listen.'
The rest of the post rambled on about the poor uptake (9%) of docs to the BMA commissioned Ipsos MORI poll, that it appears that GPs are to be frozen out of the NHS board and that there is no unity, no single voice representing 'health professionals' and because of this, I fear our fight is doomed.
However, my thoughts were diverted to Dr No's post and his last sentence: "Perhaps it is time we medical bloggers found a way to sing to a wider audience."
Below is an example of what your original email might be - but you can word it as you like:
Saving our NHS
As you must be aware, the very existence of our NHS is under threat, yet there does not appear to be a groundswell of resistance from the general public, that being US!
We take the NHS for granted as it is there when we need it - but what if it was no longer there? Admittedly it may have a few warts, even several that are in need of treatment - but is an effective treatment to destroy the host?
Unless we unite we will lose our NHS, it morphing into some strange unfriendly beast that offers no asylum to those with complex and expensive medical conditions.
Last week two little envelopes plopped through the letter-box - one for me, one for husband. They contained an information leaflet and an opt out form re the NHS Summary Care Record (SCR).
SCRs are computerised data of patient information containing demographic details, medications, allergies and adverse reactions; information that could make all the difference when a patient needs emergency or unplanned care. Well, that's what the blurb says!
The SCR has a chequered history, concerns being aired with regards to those who might gain access (porters, Mrs Miggins the domestic, etc) and thus the security of personal computerised data and also the pace at which it was being rolled out.
Those who like IT (and the then government) were hell bent on reaching critical mass before end of March, 2010; the government to push its baby through prior to the election and the five Strategic Health Authorities taking part in the hurried roll out becoming eligible to take advantage of central funding.
This haste despite researchers at UCL finding inaccuracies in stored data, i.e, failure to indicate allergies or adverse reactions to drugs or indicating that patients did have allergies or adverse reactions when they didn't or listing 'current' medications that were no longer taken. The researchers found that no patients suffered harm - but purely because doctors didn't trust the information and double checked it.
There was no evidence that records led to safer care although access to the database could reduce rare medication errors. No clear evidence either that consultations were quicker and in some cases the use of the SCR made consultations longer.
The BMA expressed concerns about the speed of the roll out meaning that patients were not adequately informed about electronic records. An independent evaluation of the early adopter areas found that seven out of ten patients were not aware of the SCR and therefore did not realise that they had given consent (by not opting out) and that their interesting little medical details were available for all and sundry to access.
Come the coalition government the whole SCR kerfuffle came under review, things looking good as in 2009 the Conservative party pledged to 'dismantle central NHS IT infrastructure' replacing it with local systems and Liberal Democrat health spokesman Norman Lamb called last year to an end to the 'obsession with massive central databases.'
But politicians aren't well known for keeping their word and honouring pledges, are they? So the SCR has been given the green light again and it is go baby go! The mass mail out has begun!
This time around it will be clearer that you can opt out. I suggest that you do - for do not believe what you read in the pretty little leaflet. I don't. During my research today, I was lucky enough to find Summary Care Record Info - an eye opener by the excellent Dr Neil Bhatia - read and learn! Home in on how your 'core' details will be added to! Home in on everything!
Worried about security, will Mrs Miggins (the domestic) be reading your private data and selling the sordid details to The Sun? Possibly yes! Read this interesting article in Pulse which informs that celebrities (the most important people in the universe), politicians and other patients with 'sensitive' information will be excluded from SCRs. Wonder why that might be?
While you're at it - you might as well read this! Gives you a hint of who might be able to access your details in the future! 'I don't have specific reservations about giving pharmacists access to SCRs - it could have benefits in the future - but I'd actually be more interested in getting the basics right first.'