Sun Beds, Premature Skin Aging and Melanomas.

Katie Price

I have a colleague at work who is twenty years younger than I am.  She is a sun bed addict.  She had crow's feet at the age of twenty five and now at the tender age of ??? – but definitely under forty! - she has more lines on her face than Clapham Junction.  I find it difficult to give her eye contact in that I am horribly obsessed with and focus on the deep lines on her face.

We have had talks in the past with her obsession with sun beds and I have pointed out to her that she is at high risk of melanomas as she is fair skinned, freckled and has many moles.  She has taken this on board but is unable to halt her addiction.  Oddly enough, even though I can discuss with her the high risk of skin cancer – I am unable to tell her that she looks old!

Last nigh I watched Grand Designs and I love this programme.  Youngest son has had his eye on a listed building in the city where I work and it is his dream to own it.  It is unoccupied and would make great upmarket flats.  I have taken on his passion and I want him to own it too – but it will need a lottery win!  A big lottery win!

However I digress, the female partner (who is incredibly beautiful) of the two who were breathing new life into a listed building, has the hallmarks of sun bed abuse.  The crow's feet and the lines around the mouth - and she could only be under thirty.

Why oh why do people – especially females – do this to themselves?  Today's 'suntan' is tomorrow's premature aged skin.

I am not 'into' vacuous celebs – but I know some (many?) folk are, so I would ask you to consider the vacuous Katie Price who at the ripe old age of thirty-four is to cease modelling – (hallelujah) as she considers herself old, wrinkly and fat.  Katie is a self-confessed sun bed addict who resorted to Botox in her late twenties in an attempt to eradicate the skin damage caused in her quest for a continuous tan.

Are you the next Katie?  Please read these articles re sun beds at Scot Sun, Cancer Research,  and the World Health Organisation  Read and learn!

If you are a sun bed addict – you may be lucky enough to escape melanoma – but it is highly likely that you will suffer premature skin aging.

Do you really want to look sixty in your early forties?

Anna :o] – the pale faced and almost wrinkle free one.

Romance Is Dead

Banquet Scene with a Lute Player
Nicolas Tournier, 1625

Our maiden

She now quite perplexed,

For he, her suitor,

Some months afore,

Appearing vexed

Had declared

"Madam!  Romance is dead,

For thee my lady, me

Up the garden path hath led!" 

And with that had strutted off

Leaving she (poor child)

With such sore emotion,

For why he had left

She had not notion,

Knowing only that

Her heart was broken.

Yet this morn

His calling card he had sent,

Her heart still full of him

(Which he suspected),

She did relent

And had accepted

This invitation for his banquet feast,

(An explanation she sought at the very least).

Perplexed was she

By his returned affection,

Why he had left

He would not mention,

Instead proclaiming

Undying love for her.

Wine flowed forth,

His tongue much loosened,

Blaming his departure

On dire financial straits. 

("A temporary nuisance,"

Was his pretence,

Stupidly mentioning

Her new

Inheritance).

Alert now to his cunning plan

Our maiden, now much wiser

(She would not be used by any man)

And as he knelt upon one knee,

Proffered a ring and kissed her hand

"My lady wouldst thee honour me

And thee me wed?" 

"Me?  Why no sir," she sweetly smiled

"For in my heart romance is dead!"

Anna :o]

With thanks to Tess at Magpie Tales for the inspiration

2015 "It's the NHS Jim, but not as we knew it."

My Hero - Not!

Judgement day came and went!  Phew!  Not the end of the world then - but unless we act quickly - as sure as eggs is eggs, pretty soon it will be the end of the NHS as we know it.

So yet again folks I would draw your attention the The Health and Social Care Bill or if you like, NHS reforms.  Only two weeks of the sham NHS "listening exercise" left and then we are doomed!

I know I keep nagging on and on and on and you may be bored to death of it, possibly don't even care - but it is up to YOU general public to get your fingers out, brush off the apathy and get YOUR voice heard!

A recent YouGov poll commissioned by 38 Degrees showed that 95% of the public have no idea how to get involved in the "listening exercise" and 1 in 5 believe that Lansley isn't listening.

I would go a bit further by informing that when attempting to discuss NHS reforms with my colleagues last night - not one of them knew what I was talking about.  Depressing isn't it?

38 Degrees are asking for donations to run ads in The Times, The Mail and The Guardian to alert YOU as to how Lansley has ignored the Save Our NHS campaign.  Donate, do SOMETHING!

Read this article that shows the "listening exercise" is a stunt, read who is worried, read these excellent blogs:
Bad Medicine, The Cockroach Catcher, Witch Doctor, A Betternhs's Blog and all blogs directed to on these same blogs.  Read and learn!

Please do SOMETHING because as sure as eggs is eggs, if you don't, come your dotage and you need your hip replacement - you won't get it!

PRETTY, PRETTY, PRETTY PLEASE - DO SOMETHING!

Anna :o]

Denial

I don't have a problem with drink,

She has a problem with my drinking.

It is her problem, not mine.

I can take it or leave it

But why should I leave it?

Whisky, whisky my friend in a bottle

Warming and welcoming,

Never judgemental,

Soother of stress

And calmer of chaos.

She has her white tablet,

Her friend in a bottle

That she takes as she says

She is depressed by my drinking.

The miserable bitch

Blaming me for her problems.

Could I take her or leave her?

It would be easy to leave her.

No wonder it is that I visit

My friend in a bottle.

Always warming and welcoming

And never judgemental,
My friend in a bottle.

Anna :o]

With thanks to Poets United for the inspiration
and also apologies as it just needed a title!

With very special thanks to Addy at Alcoholic Daze
and Linda at Immortal Alcoholic for increasing my understanding
of sharing your life with an  alcoholic.

The Open Door

The open door
Reveals
A Wandering Jew
Bathed
In artificial light.
Its trailing leaves
Touch dusty books
Like searching
Fingers,
Eager for
The knowledge
That lies
Within.

Anna :o] 

With thanks to Tess at Magpie Tales

Obsessive Compulsive Disorder

Rituals

Rituals, rituals,
Damn, damn rituals!

Must get out of bed on the right side,
Quilt folded just so, pillow fluffed.
Gotta do it!  Gotta do it!
Why have I gotta do it?
I really don't know.
But if I don't...
O God it doesn't bear thinking about,
Something terrible will happen...
But what I don't know.

Open bedroom door with elbow.
Hands bad luck.
Knock twice on the architrave.
Must get the rhythm right!
Must get the rhythm right!
Touch picture on wall with right index finger
(Then twice left cheek).
Four steps forward, two steps back.
Four steps forward, two steps back.
Made it to bathroom!

Open door with elbow.
Hands bad luck.
Knock twice on the architrave.
Must get the rhythm right!
Must get the rhythm right!
Turn on taps, wash taps,
Wash soap, wash me.
O God it takes an eternity.
Wash me, wash soap, wash taps, wash sink.
Wash me, wash soap, wash taps, wash sink
Over and over again.
Done!

O God the stairs!
Touch wall with right index finger for luck.
Four steps down, two steps up.
Touch wall with right index finger for luck.
Four steps down, two steps up.
O God this is screwing me up!
Will I make it?
I can't bear the thought of going back up
And starting again.
Touch wall with right index finger for luck.
Four steps down, two steps up.
Touch the wall with right index finger for luck.
Four steps down, two steps up.
Finally made it!

O God!
I need to go to the toilet!
I have to go back up!

Obsessive Compulsive Disorder (OCD) presents with obsessional thoughts - words, beliefs, ideas; doubts - e.g. did I turn the tap off(?); rituals - e.g. repeated hand washing; convictions, ruminations, impulses, images, all of which lead to an anxious and/or depressed state.

OCD rarely occurs in early childhood.  The age of onset peaks at 12-14 and 20-22 years old.  The onset is usually earlier in men and very few - men or women - develop OCD after the age of 35.  Onset may be insidious or acute and a precipitating event is clear in approximately 60% of cases.

Minor obsessive-compulsive symptoms account for 17%.  Personally, books are placed on shelves in order of height and content, dishes on the drainer by order of height, clothes hung in the wardrobe as divisions of colour and crookedly hung pictures drive me nuts!

Is this minor OCD or just part of who I am?  Looking at a bookcase now - books half read are not placed back where I took them from, there are dead leaves on the trailing plant on the bookcase top - and it doesn't bother me.  But what if it did?

When you double check whether you have locked your front or car door or wonder if you have let the cat out, set the alarm and so on - consider what it must be like to filled with doubts all the time.

Anna :o]

With thanks to writer's island for the inspiration.

Superstition:  a credulous belief or notion, not based on reason or knowledge.
                     Some superstitious actions are said to bring good luck:  such as
                     knocking on wood, crossing fingers, etc.

Holy Poverty

St. Francis of Assisi
Patron Saint of Animals
Merchants & Ecology

Magpie 65

St Francis of Assisi

Born in Assis in Umbria, in 1181, the son of an affluent cloth merchant, Francesco Bernardone, as he grew, enjoyed a very rich easy and permissive life.

Aged twenty-five he had a dream in which God told him his direction in life was wrong.  Across the years he began to shed his life of privilege and adopted a life of poverty.  He became a preacher - never a priest - but was not a reformer.  He preached of returning to God and obedience to the church.

His life of poverty led to ill health and he became blind.  He responded to his blindness and suffering by writing the Canticle of Brother Sun.  He never recovered from his illness and died in 1226 at the age of forty-five.

Francesco had never sought to eradicate poverty - rather make it Holy.

It could be argued that to achieve Holy Poverty, Francesco depended on the goodwill, charity and toil of others in that they provided for him - thus their toil and labour denying them this same Holy status.

Millions are born into abject poverty each day - does this make them Holy by misfortune of birth, or to achieve this Holy state, impoverished as they are, do they have to relinquish what little they have?  Their life?

St. Francis endorsed a very specific kind of poverty that only Christians of means could embrace - so does this mean that he encouraged the stealing of the one spiritual advantage, that is, their poverty that only the poor could have?

A Mother's Prayer

Brother Sun                                                                   

You shine down

Upon us

Scorching this arid land;

Bringing

Drought and famine.

O Lord
I beseech thee.
Cry for me
And all your children.
Let your tears
Fall as rain
And bring life
To Sister Earth
To sustain us.

Lord I entreat thee;
Save my children
From Sister Death.
Deliver my children
From the despair
Of their lives
And make this their
Heaven on Earth.

O Lord
How can I pardon You
For the sickness and trial
They bear as they
Die a lingering death?
How can I
Endure in peace?

Lord show me the way.

Amen.

This perhaps controversial take on the prompt was never intended - it just happened that I remembered having the same unanswered questions as a child and wonder what your thoughts might be.

Anna :o]

With thanks to Tess at Magpie Tales 65

Time Is Running Out

NHS REFORMS

C'mon folks - time is running out!  Only 290883 have signed the 38 Degrees 'Save the NHS' petition so far - what a miserable amount!

Okay reforms are required - but not as envisaged by our dear coalition government.  Don't be fooled by Nick's sudden U-turn - listen to this little snippet of Mondays Today programme and learn of the Lib Dems real plans for our NHS.

Don't be fooled by Labours supposed interest in our NHS and their failed motion - New Labour were the original architects of steady NHS privatisation.

Don't be fooled by the 'Pause and Listening' exercise - the reforms will progress unless we shout out and stop it!

Follow the Guardian's NHS Reforms live blog to discover the real news.

Support your GPs.  Listen to the Chair of the Royal College of GPs Dr Clare Gerada here voice her concerns and visit here to learn more - click on 'accompanying report.'

Most importantly support your NHS by signing the petition.  Email it, Tweet it, put in on FaceBook.

It is time what we the general public got off our backsides and fought for something precious - have you got off yours?

Anna :o]

My Son

Smoldering Fires.  Clarence Hallbrook Carter
1904-2000.  Columbus Museum of Art

My Son

You were born into poverty
Where every crumb on the table
Is torn from the flesh
And toil of your father;

Where each penny ill-spent
On the needs of today
Is at the cost of tomorrow;

Where every tomorrow
Is more daunting
Than the hell of today;

Where hope is just a dream
And hopelessness
A reality.

Mother Nature
Spewing fire from her mountain;
Our vista a vision of Hell.

Misery, all pervading
Casts a long shadow
And we become as one.

Anna :o]

With thanks to Tess at Magpie Tales

"The Living and the Dead" (2006 film)

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.

Anna :o]

DNAR does not equate to DNT

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.

Anna :o]

Perceptions

Perceptions

Restless ever changing hues
Shift endlessly
The colours of our lives.
Dark clouds morph
Into summer blues;
Livid reds dissolve
In sun-lit streams
And cascade
Into our fickle dreams.

Complex,
We shape ourselves
Upon the medley of our past;
Reasoning
Contrasting
With contingent facts.
Our future so well or ill defined
Hewn in the colours
Of our mind.

Complex emotions,
Self-denial
And delusions;
We perceive ourselves,
Our lives
In grand illusions.

Anna :o]

With thanks to Tess at Magpie Tales

Sunny Side Up!

Sunny Side Up!

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!"

Anna :o]

PS "Have you heard the joke about the three eggs?"
      "No."
      "Too bad!"

With thanks to Tess at Magpie Tales

Life and Death before the NHS

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.

Anna :o]

NHS Reforms and Apparent Apathy of the General Public

This post is very different from the original draft and this is with thanks to Dr No and his recent post The Patient on the Clapham Omnibus

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."

This is my proposition:  We email our concerns to http://www.info.doh.gov.uk/contactus.nsf/memo?openform   We email all our friends and colleagues and ask them to do the same and request (they) email their friends and colleagues and so on into infinity.

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.

Please help save our NHS and email Andrew Lansley at http://www.info.doh.gov.uk/contactus.nsf/memo?openform and let him know your opinions.  Please forward this to all your friends and colleagues and ask them to do the same.

The only way to be heard is to speak out!  Please help save our NHS!

You could also start a petition limited to your street and send it to:

The Rt Hon Andrew Lansley,
Secretary of State for Public Health,
Department of Health,
79, Whitehall,
London,
SW1A 2NS

C'mon folks - lets do it!  Let's save our NHS!

Anna :o]

ADDENDUM.   Having received an automated reply from Andrew's constituency offfce - the above directions have been changed.  

Arousal

Arousal

As old as my years,
Embittered by memories,
I did not expect to be
Romanced by you.

Joie de vivre re-awakened,
We drink from loves chalice
With passions as florid
And as full-bodied as wine.

Heart full and heady,
I watch you lie sleeping,
My heart in safekeeping,
I know you are mine.

Anna :o]

With thanks to Tess at Magpie Tales

Summary Care Records

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.'

Anna :o]

Link: The Witch Doctor "If you have nothing to hide..."

One Night Stand

One Night Stand

An elaborate ritual,
You dance behind
My shower screen.

Intimately connected,
I watch
As you wash away
The memory of me.

Cleansed,
You leave,
Passing me
Without recognition.

Anna :o]

With thanks to Tess at Magpie Tales

In Praise of Psychiatric Services?

What does a Community Mental Health Team (CMHT) actually do?  Of course I do know what the remit of their existence is:  Meeting the needs of people with mental health problems who don't need a psychiatrist.

But what if your GP decides you do need the input of a psychiatrist, why isn't her/his decision acknowledged, respected and action taken, rather than the CMHT swoop down on you instead?

We have a sixty year old resident ('Winnie') with complex mental health problems including ongoing addiction.  You might think we are being remiss in not addressing her addiction but our hands are tied by Safeguarding Vulnerable Adults (SVA) and Deprivation Of Liberty Safeguards (DOLS) legislation, and of course, importantly, whether this legislation exists or not, Winnie has the right to choose her own path in life.

Winnie presents as quite a strong character with a seemingly happy disposition, but there are strong suggestions (of late) that all is not well.  I love my job and see my main purpose as that of promoting well-being and being 'there' for the residents.  I have regular daily chats with many residents and these chats, quite rightly represent the bulk of my work.

Winnie is one of these residents.  We chat about everything past, present and future.  As said, of late, there are obvious signs that all is not well and our chats have taken on a deeper nature.  She talks of a deep depression that she hides under her happy veneer and indeed, my last post is based loosely on that she has disclosed - the real Winnie.

Her depressions is something that she has coped with for the majority of her adult life.  She receives antidepressant medication and it has been enough - along with her own self-medication of alcohol - to control her symptoms until a recent event led to feelings of helplessness and hopelessness that dogged her in her early twenties.

We contacted her GP who is a good GP who visited Winnie in the home and spent time with her, listened to her, increased and augmented her antidepressants and referred her to psychiatric services.

Psychiatric services initiated a CMHT visit, although which professionals were represented in this team we do not know as we were not privy to this information.  Why might this be - perhaps the bad reputation of care homes and the assumption we would not be interested?  If this is the case - it is bad practice.

The team spent half an hour with Winnie and left - no staff being approached to give input into Winnie's situation.  A few days later, my manager was contacted by a psychologist (who had not been part of the team) to advise that the home was to be reported re SVA and DOLS issues in relation to Winnie.  Flabbergasted my manager asked why and the reason given was incredible.  He asked why he had not been contacted previously as to enable the team to be aware of the true facts and was met with an embarrassed silence.  We were not reported, nor did we receive a cc of the letter to the GP which is good practice and good manners as we are very much involved in Winnie's care.

Winnie continued to deteriorate both mentally and physically and my manager contacted the CMHT again requesting further input, only to be told that their work was done.

What is their purpose?

The good GP is bringing together a CMHT of her own making and being a good GP visits Winnie weekly as she shares our concerns.  In the meantime Winnie continues to suffer.  Hopefully, somewhere in the near future, Winnie will receive the input of a good psychiatrist, emphasis on good as we have four psychiatrists who serve the residents in our home.

One is a good psychiatrist - the old school variety of 'doctor knows best' who listens to and understands the real needs of his patients and follows up their care regularly.  His patients have the best outcomes.

The remainder are of the newer breed who offer choice-ism.  "Which tablets do you want to take?" and/or "I hear you attempted to strangle X - can we discuss this?" (if "No" to the latter it is not addressed!) and is all well and good until  you display florid psychosis and/or come very near to actually strangling X and are sectioned.  What kind of care is this?

You are never offered the choice of mental ill-health - but hey, even if you lack insight you can choose your medication based on the knowledge you acquired while being a medical student!  You were not a medical student?  You don't have a degree in psychiatry?   Never mind, your mental health issues may not be addressed - but hey, you do have choice!

You may think from the above that I believe those with mental health problems have no rights at all - but this is not the case as I am very BIG on the rights of residents, as is my home.  I believe they have a right to the best of treatment and not the superficial fluff of caring they receive now, although as said, even receiving superficial fluff takes an awful lot of time to get to as there is an awful lot of hoops to jump through first.  And you continue to deteriorate.

What say you?

Anna :o]

Depression

You watch me
Through those damn dewy eyes
That torment my soul
And steal
The very heart of me.

The warning growl
Through snarling teeth;
The putrid breath
Feeding despair
And souring hope.

You're are my black dog,
Forever vigilant.
There is no escape.

Damn your dewy eyes.

Anna :o]

The Art of Death

The Art of Death

I paint in brilliant red;
Swift indiscriminate brushstrokes
Rend the canvas
Of my battlefields.

You hang me like some
Clumsy masterpiece.

Strip away the security
Of my shield
And see my stark imagery,
My epitaph
Of battles won
And lives forever lost.

I am Death
Cold and clinical.

Anna :o]

With thanks to Tess at Magpie Tales

Saving our NHS Forest

I love my NHS.  It is probably true that I love it less than I did.  The steady privatisation, fragmentation, low staff moral, the illusion of choice has left harshness, a coldness that is felt by patients.  It is also true that within the NHS there are many good people who genuinely care and in themselves are part of the healing process.

The NHS that I knew and loved is so eloquently described by Dr No in Alma Mater.  I was so taken with it; I emailed it to David Cameron's election HQ, then naively believing that the Conservatives would indeed look after our NHS and perhaps even attempt to recover the NHS as it once was.  Whether he read it or not - I don't know.

Of course I wasn't a doctor and not yet a nurse then in the NHS that Dr No described, but a patient.  Several admissions during childhood and for the delivery of my own children, I was aware of the warmth and camaraderie for it indeed rubbed off on patients.  Times have changed and changed the NHS, the sense of temporarily belonging to that family during admittance is very seldom apparent.  Yet the NHS is still worth saving and I am grateful that it exists.

The NHS can be likened to a great oak that stands proudly in an ancient forest existing on the peripheries of our lives; not a constant requirement - but there when we need it.  Its great branches supporting its lush green canopy offering us shelter when we are diseased or injured; its roots searching and probing for life saving cures; its leaves providing us with the oxygen we require for our very existence; its fruits offering new life; its whole self offering a place of refuge in times of need.

Our real forest have recently been under threat, the coalition government planned to sell 15% of the public forest estate by 2015.  Critics objected to the sale on the grounds that it might be more difficult for the public to gain access to them, and even wildlife and the very existence of forests themselves might be threatened as timber companies and developers took control - unfettered by the protection of public management.

The public were up in arms and in a short space of time, a cyber petition gained over 500,000 signatures and our forests were saved.

The very existence of our NHS forest is under threat under the guise of the White Paper: Equity and excellence: Liberating the NHS.   Its apparent aims appear laudable: putting patients at the heart of everything the NHS does; focusing on continuous improvement and empowering and liberating clinicians.

In reality, I believe the White Paper to be a terminal illness masquerading as a miracle cure; its true aim to be that of opening the NHS to privatisation; where the very NHS will be threatened as private providers take control, destroying all that is seen as unprofitable, unfettered by the protection of public management.

The public (as patients) will find in increasingly difficult to gain access - especially if presenting with an illness that threatens the confines of a budget.  GP Consortia - unless a true commercial enterprise - will be doomed to failure and be swallowed up by the private sector.  The NHS as we know it will cease to exist.

You would think that the medical and health professions and all in healthcare would be up in arms about the destruction of our NHS forest - but no, bar a small few!  You would think that the general public would be up in arms about the destruction of our NHS forest - but no!  A Save our NHS petition has only gained a mere 37,489 signatures.

A recently published survey commissioned by the BMA would suggest that the great majority of the medical profession have great concerns re NHS reforms.  It is a fact that the key findings are a sham with less than 9% of doctors contacted even bothering to respond.  Amongst its real findings are: under four in ten do not understand what the reforms mean to them individually; over a third are waiting to see what happens; 11% of GP practices have taken no steps in preparing for the reform; 37% know very little or nothing at all about current NHS reforms; 33% of doctors (excluding GPs) have taken no steps to prepare for reform - and so it goes on.  Read the real results of the survey here: Ipsos Mori.  Read it (the downloads!) and weep!

If those in the medical profession and indeed those in nursing and allied professions do not appear to care - how in hells name are we going to engage the general public?

Some of us care and I am thinking here of all the good doctors who blog: Dr No, The Witch Doctor, Dr Grumble, The Cockroach Catcher et al, Militant Medical Nurse and the lovely Julie at Campaigning for Health - but are these fine bloggers truly representative of their professions - or are they the voice of the minority, the majority just waiting to see what happens?  I would hope that they are not and would echo Julie's sentiments in that all who work in health professions - and care about the NHS - should not just 'stand there and moan - do something!'

When we mourn the death of our NHS in years to come, we will throw our hands in the air and exclaim "Why didn't somebody do something?"

Anna :o]

Addendum:  I have been made aware of another petition that seems to be enjoying more success.  Please visit 38degrees, sign and help save our NHS.  (These are the folks whose petition saved our forests!)