Wednesday, 6 July 2011

Black Dogs

Today my black dog bit me. Not the actual lurcher thing that wombles around my home and needs taking for walks, but the one on my shoulder. For the third time this week I woke from a nightmare, and didn't dare go back to sleep. I tried that the first night and it kept returning so tonight and the other morning I got up at 6am. That means, ironically, that I'm short on sleep and high on stress this week, from a symptom of a disease where if I'm short on sleep and high on stress, I trigger it.

Nothing in my life is going wrong. I have a job I love and am passionate about. I have a marvelous set of friends and family. I have hobbies. I exercise. I eat regularly and healthily. I am even losing weight successfully. I am depressed.

I have a theory that there are two types of depression - acute and chronic. Acute comes from something in your life, a trigger, something that you have to be depressed about - a loss, a death, a job problem, etc. Chronic is the type I have. It reoccurs seemingly at random. It has a set of triggers that I do know about and other times it will trigger for no apparent reason. I know if I don't sleep, if I get stressed, if it is winter, if I forget to eat, I get depressed. So I know I will make sure I sleep and eat, use my lamp in the winter and manage my work stress carefully, using my manager and clinical supervision to support me. But it, like other diseases, can just appear for no reason I know about.

Today my black dog bit me and I got up out of bed. I did some housework, I ate and then I sat down and I vented on twitter. I reached out to a couple of online friends who I knew to be awake and asked for distraction and support (and received it from one good twitter friend and one good friend in the US - thanks both). I managed my disease.

Depression isn't something to be ashamed of, to hide, nor does it make me unstable for work, or dangerous to my patients.

It doesn't, at this level, even make me dangerous to myself, as long as I monitor my food and sleeping patterns.

I don't (anymore) get an urge to self harm or kill myself.

This is a disease, like diabetes, like heart failure, like any of the others millions of people live with. It can go from mildly difficult to disabling. There is no shame here.

I will go in today. I will see my secretary, my colleagues, my manager, my workmates, and my patients. And to all but the latters, I will smile ruefully, admit this is biting my arse. Why? Because if I do that, I get the support I need, and I have no reason to feel more ashamed of my disease than someone whose sugars are playing them up, whose mobility is not good that day. Why should I be?

Tuesday, 3 May 2011

Care to be a nurse?

A friend on twitter linked me to this knowing how I feel about my job.

There were points in it which made me really angry, and others which I agreed with.  So lets start with the angry, shall we?

No, as a nurse, (and I do only speak for myself, being as we are people and all that) I don't wish to be put on a pedestal and worshiped for doing my job.  I'd like good working conditions, I'd like to be able to do my job to the best of my ability, to not work in a malignant culture, to not play games with other professionals to get the best patient care.  I'd like to get paid an equivalent salary of other professions with a similar level of responsibility and education.   But pedestals? Angels of mercy?  I'm not into that.

The bits I agree with make me deeply sad about my profession.  When the culture of a ward or a team goes bad in nursing, it becomes toxic.  It becomes deeply, horribly malignant and will take a good nurse, who cares deeply about her job and slowly wear her down to become the type of person the author of that clip described.  Someone who puts complaining about their job overwhelm doing their job, letting the bitterness about it all take away their chance to make the difference we go into the profession to make.

Now, I think I'm a good nurse - no-one goes to work to do less than their best, with the knowledge and tools they have.  I do my continuing professional education, I seek out information and ways to better support my patients.  I often get told I'm too passionate about it, risking standing on toes at times and I accept that.  Better passionate than bitter.

There is a saying in nursing literature - we eat our young.  I've seen this over and over and I think it is linked with the professions thing.  Nursing isn't viewed as a profession, we are supposed to be vocational angels, born and not made.  Which is obviously bollocks because nurses need to be taught how to nurse, how to give a bath, how to care for someone in pain, how to be an advocate and how to listen.  If you've ever spent time with nurses, you can be certain we are many things, but angels we are not.  But to gain recognition as a profession, we have to act the part and that means cutting out the eating of young, the bitchy bullshit that happens on toxic wards and the belief that we can do no wrong because we are the angels.  We have to get the blend of academic knowledge and compassionate hands on care right.  For me, I'm a specialist nurse, it is easier than on a ward or in a community team, I suspect.  People expect me to spend time reading journal articles, but when I worked on the ward, there was no time made for that.  And so I didn't understand the value of bathing someone as a period of time when I can properly assess their skin, pain levels, mood, abilities, mobility, and so on.  Because I didn't have the underpinning knowledge to help me see beyond a strip wash.

I think we need to look at our practice, reflect on it minute by minute, consider the evidence for our actions, be honest with our patients and our colleagues.  For each patient their experience will be with them for life.  We have to do the best we can for every single patient, and to do that, we have to do the best we can for each other - teaching, supporting, encouraging.  The patients I work with will likely die during my time in my job - I work with a life limiting long term condition.  Their loved ones will also carry that last week, that last moment with them and it has to be a good death - pain and fear free, in a place of their choice, if we can do it.  We can't always but we do always try to do it.

Nursing is, and should be, about doing your best to meet the needs of those in your care all of the time.  It shouldn't be about bitterness of pressures on the service, or irritation at a colleague, but of course those things impact on your mood.  It is vital that we do put patients first.  And for the speaker in that clip, I'm really sorry that someone didn't stop, think and show you some kindness during those days.  I'm sorry you will carry that with you.

Monday, 4 April 2011

Skeptics, Politics and Religion, oh my

A year or so ago, I thought I'd start a twitter account.  Not a big deal in the grand scheme of things, I would think.

A year or so ago, I knew very little about politics* and cared very little.  If pushed, I'd identify as lib dem.  I was focussed on my work, studies, and gaming frankly.

A year or so I identified as Buddhist in a vague way, meditating and trying to be mindfully compassionate where I could.

A year or so ago, I objected to being named a Skeptic on someone's twitter list.

These days, I write to my MP so often that I swear he groans at the sight of my email.  I actually went to meet with him to tell him what a complete cock up I thought they are making of my beloved NHS.  I've signed petitions, debated politics at work, and am torn at a choice on voting day, since none of the major parties seem to have the capacity not to be liars.#

These days, I identify as an Atheist, as a Skeptic, co-organise a quietly growing Skeptics in the Pub group (known to my work colleagues as my Cynics Group), and find myself with growing concerns that my beloved NHS is being sold off for parts, that my beloved patients will find themselves with a choice of nothing useful to them, having lost that which they valued but could not speak up for themselves.  Who would cherry-pick our patients as money making routes?  We're a service that looks after complex long term conditions, where time is spent on the patient's needs rather than a production line version of it which would apply a sticky plaster to their lives, instead of a person centred approach, allowing them time and space to express their needs.  When it may take 15 minutes to get a word out, you need time.

So I realised sometime in the last year that, if I want politicians to hear my patients, it has to be me that shouts for them.  I don't know when that first started.  I do know the moment I shifted from identifying as Buddhist to Atheist and that was at QED conference.  It wasn't during the talks, although those were wonderful.  I was standing in the bar at the back of the main room, with several people and Prof Bruce Hood.  It was rather late into the evening and he made a comment about personality, beliefs and souls being biochemistry.  Something in my brain went clunk and I thought, "That is the most comforting thing I have ever heard."  I see it daily in my patients - a change in medication equals a change in personality and behaviour.

So here I am, this year, Atheist, Skeptic, Political.  Next year?  Who knows.

* I make no claims that this has changed but my awareness of my ignorance now exists
# Insert comments about NHS top down change, uni fees and the Iraq war here.

Wednesday, 2 March 2011

IS NOT BIPOLAR - a followup to a rant

I asked my new GP to check through my notes and find out where this bipolar diagnosis came from.  She has done so and the results are in.

Fascinatingly, my old GP seems to have read the letter from the consultant psychiatrist I saw back at the start of this all, which said something along the lines of "Jin Shei is concerned with her mood swings, but I can confirm that she definitely does not have bipolar, which would be an extremely serious diagnosis to make."  He then wrote "Bipolar" on my notes, which leads me to believe he only scanned the letter, saw the single word and failed to notice the word "not" in front of it.

Either way, I now have IS NOT BIPOLAR written in four places in my notes.  I do like this new GP.

Should I write a letter to the old one to complain, to highlight his poor practice in this incident?  Things I am considering include the fact that I still have to work with this man in my professional practice - it might impact on that care of his other patients.  The fact that our service's commissioning isn't safe yet, that things are still so unsettled in the NHS.  I may wait until commissioning is done.  It does give me an insight as to why my patients rarely complain about their GP, consultants or other health professionals - the power imbalance.

Friday, 4 February 2011

You are not a higher being, or sharing information with patients

I'm a professional, most of my time.  The rest of the time I'm someone's patient.  As I've said before I've had mental health problems, I still do have mental health problems.  I have Seasonal Affective Disorder.  I manage it pretty well with lamps, food, exercise, sleep and so on.

Ten years or so ago I visited my GP with a mild depression due to losing a friend and my grandfather.  Events spiraled, and I was put onto SSRIs.  Now, these work great for some people and less great for others.  I don't get along with them, I felt worse and worse.  Being signed off and sitting at home did no end of harm to add to the situation and by the time I finally got a mental health referral, I was in a bad way.  I saw a psychiatrist and he took me off the SSRIs and sent me back to work.  I recovered quickly.

Having put that behind me, and moved on with my SAD each year, managing it well, living a full life, I changed GPs finally.  Imagine my surprise when I found out that he had, without talking to me, diagnosed me with bipolar.  Not only had he not discussed the implications of his diagnosis with me but he hadn't mentioned it.  At all.

Now, ten years down the line, I'm in shock.  But a question that had been echoing around in my professional life has just come crystal clear in my personal life.

What right do you have not to share their diagnosis with your patients?

I am, even in the throes of depression, a rational and intelligent being.  Most of my patients are too.  We manage our day to day lives without your intervention and decision making on our behalf.  With information, I can make informed decisions and frankly, with that GP, I spent a good deal of time informing him (Yes, PCOS exists, yes, SAD exists, No, smears shouldn't make people scream and so on).  I willingly accept that GPs differ and that many are marvelous beings who update their knowledge - I work with a good deal of those and they rock.  This one doesn't and isn't.

So where do people get the right to decide what a person knows about their medical life?  In any other part of their life?

Obviously, new GP and I are going through the process of changing the label on my notes to protect me from any future legal issues.   I'm also going to consider writing to the Old GP to reflect my  experience of his practice.

Saturday, 29 January 2011

Believers of all kinds...

Yesterday a colleague of mine, who I like and respect - who is a wonderful nurse, brilliant at her job, someone I learn from and whose advice I actively seek - gave me the card for her friend and colleague in her other job.  She is a reflexologist.  She felt that, with my SAD and my stress levels, I could benefit and, even if I couldn't, she thought I might know patients who might.

A moment of complex ethical conflicts right there!

I don't refer my patients to friends of any type.  Plumbers, electricians, etc.  Because my role places me in a position where my words carry more weight and so I am cautious and try to speak carefully!

But mostly, in that moment, I was torn between the thought that I don't believe reflexology does more than give someone a quiet space, someone listening to them, and a nice foot massage.  That is my belief.  Her belief is that it releases all kinds of emotions, that it truly does help.  Both of us base our beliefs on our perceived evidence - mine on the studies that I've seen, her on her experience and her reading.  We've not discussed it - she is someone I'll discuss patients with, topics to do with work and families but I wouldn't get into a debate about scientific methodology, or skepticism.  I mention my SitP work in passing but I don't press her to attend.

I don't think that causing friction there would produce a change in her views in the long term and I'm 99% certain she won't change mine.  We do have a long term working relationship in a very small team to consider and so, even if she doesn't respect my views on it, I will make an effort to treat her views with respect and avoid shoving mine down her throat.

Now, the Skeptic in me wants her to understand that she is wrong, that it is placebo and having the space, the time, being heard that does the emotional impact.

I should add that I'm a vegetarian.  I do have a religious belief which I refer to as my "working hypothesis" - there is no evidence for or against currently but I feel sure that one way, it will be proved in a fairly final experiment.  I don't plan to come back and blog about it, however.  I also don't shove those beliefs down the throats of the people around me - I buy and cook meat for Mr Jin Shei because that is his choice and that is the compromise we worked out, I try to practice the religious belief of my choice in a quiet way.

My point is that when people believe, attacking those beliefs isn't always the most productive place to start.  Understanding their belief might be the most useful first move.  I say "might" because everyone judges a situation depending on the evidence of their life so far and responds accordingly.  So we end up with a range of approaches in every group of people, which is a good thing, I think.

Why didn't she just leave him?

I've read two articles today about abused women and after both there is someone asking "Why didn't she just leave him?  She stayed X years, so it can't have been that bad.  Why didn't she just call the police or tell social services?"

I warn you now that this post contains massive amounts of personal information (from my past - Mr Jin Shei now is a lovely gentle man) and may get emo/woeful.  Like the one about my mental health, I'm not writing it so much for you as for me.

I know the answer to that question, or at the least I know why I didn't leave until the situation and time were right for me to see that he was truly abusive.

Abuse doesn't start as an avalanche.  It comes in a trickle, here and there, and always for me there was a promise that if I was good, he would love me and treat me well.  The majority of the abuse was, like the lady in the court case, mental abuse.  There were some incidences of physical abuse that stick in the memory well but the side effects of those only took a few years to fade.  Now, 13 years on, three therapists later, I still get flashes of what I mentally tag "Steve Thoughts".   Mental abuse persuades you that you aren't good enough to be treated well, that you are too stupid/fat/ugly/unlovable to be treated well and to leave and ever be loved again - after all, why would anyone want you?  Start with someone who is already unsure of their ability to be loved, liked, appreciated, whose ego and self esteem is already barely there.

So I didn't leave.  I didn't leave when he knocked me out (year 1), when he nearly broke my wrist (year 2), when he slept with other women (pretty much all along - he did hit on my sister even), when he beat me, when he put our baby in hospital.  Now that last is something I still feel intense shame over.  I should have turned to the nurse who asked me if it was possible and told her that yes, not only was it possible but probable.  Why didn't I?  Good question.  I keep asking myself this one.  I was frightened of him.  Now, safe, sane and well, I can't work out what he could have done but then I had made one attempt to tell someone - the day he beat me so badly I could barely walk and I made it to his Corporal's home (yes, army base), and told him what happened.  He told me to go back and be more supportive and understanding of his needs.  I went back and it was so much worse for having tried.  So when the nurse asked me, gently giving me a space to say, to ask for help, I didn't.  The shame of being abused, when you are there and when you are still recovering, is wholly yours.  For me, at the least, by that time I saw it as something I deserved, that I was so unutterably unlovable.

So to the question is my answer:  I didn't leave because I was terrified to do so, felt responsible for the situation, truly believed I was too ugly, stupid, fat and unlovable to do so.  Because my abuser made sure I felt like that, because otherwise who would stay?

Why didn't she tell someone?  Because maybe, once she tried, and it made things so much worse.

I left when he slept with my "best friend" and told me I could put up or shut up.  I had a moment of clarity and phoned my father in tears.  He drove to our house, picked me, the baby, the dog and all our worldly goods up and took me home to my mother.

14 years on, I still have moments of huge, massive self doubt.  I am aware that I come across as confident and sure of myself.  I'm good at faking this now, and I even have some belief in myself.  I don't like crowds, loud places, confrontation, aggression.  I am hugely anxious and nervous of people.  But I do know why neither of those women left.  Abuse scars don't fade easily, and for me, they fade the slowest when it is "just shouting", just words.  Because words are part of the things we carry with us.

Little things can trigger a response that brings those feelings to the front.  A friend's throw away comment, a criticism that isn't fair, a social situation, confrontation... any number of things.  Therapy taught me to rationalise it into submission but some days the Steve voice does ring loudly.

Tuesday, 25 January 2011

Cheltenham Skeptics: Dean Burnett - Nervous Laughter

Tonight Dean Burnett kindly talked to our little Skeptics in the Pub group in Cheltenham.  I have to say we were impressed by the turn out for only the second event we've run, which put us way over the room's supposed capacity.  Everyone cheerfully moved back and packed together around three times, and beanbags were deployed for some folks to lounge at Dean's feet, which he handled admirably!

His talk drew both thoughtful looks and laughter, and he kept our bunch thoroughly entertained.  I personally particularly liked the brains at the beginning - could only be improved by dismantling a brain to show us but that might be going beyond the call of duty, particularly for the person whose brain it is.  Anyhow, I digress.

The Q&A session was a little quieter, but none the less interesting for it - people did find questions to ask on neuroscience though!

As a comedian, I found him funny (which is a good start), intelligent and not needing to stoop to "shock" comedy.  The journey from neuroscientist to comedian to a combination of the two was well presented, amusingly done and I particularly liked the bit about the TV show.

Am I being too vague?  Then you should go and see him perform.  Well worth it.  Would book again!

Tuesday, 11 January 2011

The stigma of mental health, or "She gets loopy"

I'm a health professional and I spend my working life talking about depression and anxiety.  I spend every winter dealing with it in my personal life.  I have SAD.  I use a lamp, I make sure I eat and sleep and I quietly thank my mother for the herbal remedies and, after an appropriate period, I bin them.  I have had, in the past, complete melt downs and time off work because of this.  I look forward to a future of spending a quarter of my year experiencing it.  We're discussing moving to some place that has enough sunlight for me.

But there is a massive stigma to mental health problems that there isn't for physical diseases.  Consider the following:

Due to my diabetes I had to take an hour out of my afternoon and go to lie down for a time.  
Due to my broken leg, I have to go and lie down for an hour.

Now change diabetes for anxiety/panic attack/depression and people respond totally differently.  I've been told "go for a walk, that'll help", "Just pull yourself together, what do you have to be depressed about", and several other things that indicate to me that people actually aren't getting the problem.

I don't like to go to my (new) GP with this, because hey, those are his patients I see in my professional life and so far, various (old) GP's responses haven't convinced me that they "get" mental health issues - no, I know I have a great job/family/life.  I still have seasonal depression.  No, I don't really think medication is the answer for me - it works well for other people, my experiences of it have left me as a manic zombie.  Yes, therapy has helped.  A huge huge amount, because it gave me ways to challenge my irrational mind (people won't miss me, nobody likes me, etc).

You can deal with having mental health problems by hiding them - as I do in my work life with my patients and many colleagues - or by being up front about them.  I do this in my personal life, and with close colleagues.  My manager knows, and my closer colleagues do.  My friends know, and my family (although they treat me as if I'm incredibly fragile over the things I could handle easily, and as if the things I do struggle with shouldn't be a problem so haven't quite got it).

But stigma.  It is there, and people make huge assumptions.  It would be easier to have a physical thing I could wave at them and say that I have a disease, and be believed.  And not be treated as if I might be dangerous.

Depression and mental health problems are just as much a problem as if it were a wholly physical thing.  They are no less valid as a problem.

Monday, 10 January 2011

Homeopathic advisers, or dangerous advice


Listening to BBC Radio Two at lunchtime is, I have decided, bad for my blood pressure and my mood.  Today they had a lovely GP called Sarah something, whose advice had me nodding along and someone called Hazel, who has written a book but has no medical qualifications as far as I can tell, giving advice on the homeopathic, natural remedies for flu and winter problems.  She enraged me.  I had to pull over in the car and text in:

"Correlation is not causation, there is nothing in homeopathy, get vaccinated!"

Before I was able to drive and visit my patient, who it turned out had been listening too and been equally enraged.  But that is beside the point.

I understand the need for balance in stories where there is some dispute, and I know this has been said before, many ways, many times but homeopathy has been proven not to do anything beyond placebo.  The BMA has said "stop funding it", the NHS has started closing hospitals of it and refusing to pay for it.  How is this a balance issue?  It is like saying "Yes, we have proven that walking out in front of cars might get you hurt, but lets hear from George who often does so and tells us he never catches flu".

I wonder.  Did they pay her for that "advice"?  If so, since it is public money, can I have a say in this?  I don't want my money spent on homeopathy, or tictac, or flavoured water instead of medicine in the NHS, nor do I want it spent on letting some homeopathic believer spout their nonsense on prime radio time.


Sunday, 2 January 2011

The Importance of Being Patient Centred

My role is almost entirely patient lead.  I'll get referrals from anywhere but once I see that patient, I'm lead by what is troubling them most - the symptom that is impacting the most on their quality of life.  Because, whilst I can look at them and make clinical observations, it is how that symptom impacts on their life that truly matters.  Most of the time it is the non-motor ones that are most problematic - pain, fatigue, and so on, and I can't quantify those without listening and understanding how it feels.

Why is this important on the wider scheme of things?  Patients who are feeling they are being heard by their health professionals tend to improve more, they highlight issues for me earlier allowing a referral or a change in meds before it turns into a fall or a hospital admission (thus saving us money and loss of quality of life).  Patient centred care is associated with better recovery, better emotional health and less diagnostic tests/referrals.  In my area of work, people recover from symptoms, not from the disease itself, but that matters a huge amount to them.

Previously, I worked with a high number of dementia patients and there patient centred care is vital.  Anyone who has ever read any of Tom Kitwood's work will more easily understand what I mean there but I'll do my best.  If I have a patient who is lost in time and space - not sure where they are, trying to make sense of it and believing they are in a certain time (which is not now!), then the response needs to be patient centered.  Does the time/place distress them?  I've had a patient who believed they were in a bomb shelter in London - because of the care home bells and trying to make sense of them - and that wasn't a nice place to believe she was in, so we bought her back to our time with gentle reminders that it is 2010, that she is in X home.  I've have another who thinks she is on a cruise so the home enter her reality and once a month she eats at the captains table.  Wonderful!  To understand their care needs, you have to understand the patient there.

How does this sort of thing extend to hospital wards, or routine operations?  I've had some operations where I felt informed, in control and relaxed about it.  I've had another fairly major one where I didn't understand the process, was frightened and uninformed.  I spent a lot of time being talked over by both doctors and nurses, and had a list of symptoms where I just wanted to say "Is this normal?"  I needed answers and when I finally asked a sympathetic nurse "is this bit normal" she said "No" and I ended up with a few units of blood.  I would have been discharged a day earlier if someone had given me the space and time to ask those questions on the first day after my operation, or thought to look properly at me and not assume I was just being a wimp post-op.  That moment would have saved the NHS the cost of that night, and certainly would have saved me the fear and anxiety that went with those extra days of shortness of breath and exhaustion.

Information is a huge part of patient care and if you need the specific level of information your patient needs, then they feel more able to control the processes around them, to understand the choices being made for them - and to disagree or refuse them if necessary.  That isn't to say that all patients want all the information you have - I've had ones that do, and others that don't even want the name of their diagnosis for fear of knowing the prognosis, and I spend a lot of time saying "We don't know."

All of this is a delicate process that requires time.  I spent 90 minutes with my new patients, working all the way from the practical information through to religion, spirituality, strong beliefs, strong feelings over end of life care.   During that time, I make silent observations on how much information they want, how much they understand.  I do a lot of education about the complex symptoms they are experiencing, about the disease, about how things in their health care team will work. I might think the primary thing they need me to do is to sort out their equipment, their meds.  They might think it is respite, or helping them source a mouse so they can operate their computer.  I'll prioritise their choice because it is their life and their body.

 There isn't space or time for  that in a hospital ward and it isn't necessary for them to know their single visit, simple issue patients as well.  But  it is necessary that the hospital staff know that their patient is willing to sit back into their hands and trust them, or is a paranoid control freak who knows enough to know that their BP is too low, that their pulse shouldn't be that fast and be frightened and distressed by the lack of information on what is happening to them and what they are doing to make this better.  It is necessary to understand that the pain bothers some people more than others - and pain is what the patient says it is, when they say it is, and how they say they experience it.  It is necessary that the staff understand that a simple hip operation in a fit person in their fifties is a very different matter to one where the person looks to be a fit person in their fifties but has X underlying disease which is asymptomatic with their meds.  Because it might  stop them taking their meds from their control, and putting them in the ward round instead of the hugely complex medication routine we have worked out - because doing that will impact hugely on their ability to recover from the operation.  Yes, your patient is stiff and unable to mobilise.  You haven't given him the right meds at the right time.

It is about viewing and dealing with the person in the bed, not the diagnosis, operation or symptom.  It is about listening and hearing, and not about numbers.   The NHS struggles with this because it is a medicalised system, and most of the time that works well enough.  In elderly care, in mental health, it doesn't work well enough, and those areas tend to be Cinderella services - not enough money and staff to meet those patinet's complex needs.  Those people aren't able to seek out someone to express their feelings and we should make the space and time to allow them to do so.  Not least because it will help their recovery and discharge from the acute sector, improve their chances of improvements post discharge and reduce the risks of revolving door admissions.

Person centred care is important because we are dealing with people, at the heart of things.  Because people are all different and a hip operation is not just a hip operation.  It can be a fit, relatively younger man who is going home with enough support to manage but is able to process information and make choices, or a confused frail person who needs to have extra support, reassurance, and who needs support to make her own choices.  Not just a hip operation in bed 5.

Sunday, 19 December 2010

We’re in Their Homes and in Their Heads and We Haven’t The Right....or Politics and the NHS

This may ramble.

As many of the people on my twitter feed know, I'm a NHS employee, and a quietly skeptical person who accidentally fell into co-organising one of the Skeptics in the Pub.

As most of the world is aware, the Conservatives and the Lib Dems, having stood on a platform of "protecting the NHS" are now in the process of making it possible for private companies and individuals to make vast sums of money as the NHS is dismantled for parts, rather like a beautiful classic car taken apart for the junk value.  Over the last ten years, whatever else Labour did, the NHS has reached (for the most part) high levels of patient satisfaction, with investments into community services like the one I work for making it possible for it to be responsive to needs of individuals at the point and time of need.  Waiting times have dropped from months to weeks.

I've experienced it from both sides this year, and become a little bit more politically aware - firstly by investing my hopes into the Lib Dems and secondly by having those hopes crushed repeatedly since the election.  Twitter has gone a good deal to make me aware of the things that are going on out there in the wider world, past my essay and the chocolate overdosing allergic dog and the other things happening in my own life.  The libel campaigns for science, the wikileaks issues, and the NHS changes.

Frankly what we need in the NHS is some peace and quiet to get over all the changes people keep making.  If  you meddle with a service, even a small team, it takes time to embed, to thrive if it is going to.  I've worked in the same area for around fifteen years now, and I've worked for five organisations, all of them actually the same one, as people make changes.  Stakeholder funding, PCTs, health boards.  Here comes a new boss, same as the old.  What we have in this area is working and working well.  Dismantling it and putting it into a system that sounds so much like the one we had three changes ago (which we changed because it failed and badly) makes no sense.

The government don't seem to be listening to the people who work in the NHS nor to those who actually understand how it works and my sense is that this is someone seeking glory, someone who wants to put their name and mark on it without understanding the needs of those receiving care or those providing it, or how well the system currently works.  A person's ego should not be able to drown out all the people who spend their lives using our systems, nor those whose daily lives are spent trying their best for their patients every single day.  I know nurses, doctors, physios, OTs, accountants, management types, and not one of those does less than their best - sometimes in some difficult circumstances - understaffed wards, lack of funding for pieces of equipment and political people that meddle and can't leave us alone.

Stop meddling and let us do our jobs without spending all of our working lives worrying about losing our jobs and failing our patients.

This has been an unproofread rant bought to you by the letters C and B, and the number 4.