"Keep your mitts off my NHS"

Last week there was a speech at the Labour Party conference which, in my opinion, knocked the spots off any I've ever heard from a politician of any colour. I know politicians usually enter politics out of conviction, but they nearly all seem to get sucked into the slimy world of focus groups and spin. Power,  or the love of power, does corrupt. It was beautifully constructed and delivered by 91-year old war veteran, Harry Smith. He described his childhood in depressed Barnsley and the death of his sister of TB, as the family couldn't afford treatment for her. "My childhood was not an episode from Downton Abbey." Watch it here: Harry Smith on the NHS

I was reminded of this when I went to our local surgery on Monday. I wanted to ask my GP some things, and I needed a regular blood test. First it was to the phlebotomist (the nurse who specialises in blood tests). Not only did she take it to test my drug level and liver function, but "Why not do these others while we're at it?" she said. I lost count of them. Then she said to Jane and me, "Have you had your flu injections yet?" The answer was no, although Jane had had her letter. "Would you like me to do them now - get them out of the way?" And so she did.  And saved us an expedition.

Then we sat in the waiting room for a bit, until the doctor came and summoned me. The major question I wanted to discuss was about the pneumococcal vaccine. As I'd written to my friends who have slow forms of MND, "I've received a letter from my local surgery, headed 'Pneumococcal Vaccination'. It says, 'Our records show that in the last month you had your 65th birthday, congratulations!' Then it goes on to explain it's usually a one-off jab to protect against a number of infections including pneumonia. 'We would like you to be vaccinated now....' In the old days, pneumonia used to be called 'the old man's friend'. (As Net Doctor puts it, 'pneumonia is called the old man's friend because, left untreated, the sufferer often lapses into a state of reduced consciousness, slipping peacefully away in their sleep, giving a dignified end to a period of often considerable suffering.') I'm not sure whether I want immunity from pneumonia. I wouldn't mind dying sometime. I'm inclined to say yes to the yearly flu jabs, but no to a lifetime pneumonia one. I wonder what others think about this." My GP listened and heard exactly what I was saying. I don't imagine she had ever had a patient with MND raising that dilemma before. She didn't hurry to reply. In the end her answer reassured me. The vaccine doesn't give complete immunity and by the time I'm ready to pop my clogs it will probably be even less effective. In the course of our conversation we talked about whether I would want treatment and resuscitation at the moment, were I to get an infection - to which the answer was Yes. Life may be limited and frustrating, but it's definitely good, and I'd like to enjoy this gift while I may. There will no doubt come a time when I say, "Don't interfere anymore, thank you," - which, you will appreciate, is entirely different from, "Please have me put down."

I also had three others things to ask her, including about respite care. At no point did I feel she was clock-watching. She was focused on me. We concluded at the end that I would have the pneumonia jab, and Jane had the good idea that I might have it then as well. So we asked the receptionist if there was a chance. And there was. She fitted me in with a nurse. Thus I left, after about an hour, having had blood tests, flu and pneumococcal jabs and a consultation with my GP. Now that's what I call service. And at the point of delivery, it cost me nothing. Of course I and my employers have contributed over the years. But it's worth it. That's the National Health Service. The practice, by the way, is Newbury Street Wantage.

I gather that one of tabloids had a leader comment today which started: "With dreary predictability, GPs’ leaders have raised objections to David Cameron’s hugely welcome plan to restore that most basic mark of a civilised society – the right to see a family doctor at any time, morning to evening, seven days a week...." Besides being transparently part of a policy of squeezing small practices out of existence - surely The Daily Mail looks back further than ten years to the golden days when one- and two-man practices were the norm? - , I reflected my elderly in-laws' experience over the past fortnight. Their sizeable GP practice lists 111 as its out-of-hours number. My mother-in-law has had resort to it three times in the past fortnight, and according to her the service has been excellent. It sounds as though it was in every way - keeping her informed, the doctors visiting, the follow-up and the quick coordinating with their GP. I recall receiving a visit from a lovely emergency doctor a few years back on Christmas Day. The system works now. I can see no way in which Mr Cameron's plan will not soak up any new money he offers - and more. Thus we shall end up with fewer resources spread more thinly, and worn-out doctors with even less time to spend with each patient.

As veteran Harry Smith ended, "Mr Cameron, keep your mitts off my NHS!" And that applies to all of you meddling politicians. Keep your mitts off our health service - and our education service.

PS I'm told I should have mentioned how nice our practice nurses are. They are very good. My second jab was quite pain free.

Do not resuscitate

You might have thought that the implication of something I wrote yesterday about the Paralympic legacy was a bit alarmist. I said, "Nevertheless it is to be hoped that the high-achievers will have dispelled the myth once and for all that disability renders you less of a person, with less dignity and worthy of less respect. This recognition has implications for both ends of life."

Today the news outlets contain a story which suggests that this is already a real matter of life and death. The case is reported of a 51-year old man with Down's Syndrome who had a DNR ("Do Not Resuscitate") notice attached to his hospital notes without his, his family's or his carers' knowledge or consent. It was only discovered when he returned in good health to his care home. The reasons given for not resuscitating the man were: "Down's syndrome, unable to swallow (Peg [percutaneous endoscopic gastrostomy] fed), bed bound, learning difficulties". For learning difficulties and Down's Syndrome to be given as reasons not to save someone's life is chilling.

Obviously we don't know Margate hospital's side of the story, as they won't comment on a sub judice case. But on the face of it their treatment of AWA, the patient, and his next of kin was shameful. Sadly it's not an isolated case. The comment of Mark Goldring, chief executive of learning disability charity Mencap, is worth quoting: "We are very disappointed to hear about this case, but unfortunately, we believe that DNR orders are frequently being placed on patients with a learning disability without the knowledge or agreement of families. This is against the law. 

"All too often, decisions made by health professionals are based on discriminatory and incorrect assumptions about a patient's quality of life.

"People with a learning disability enjoy meaningful lives like anyone else. Yet... prejudice, ignorance and indifference, as well as failure to abide by disability discrimination laws, still feature in the treatment of many patients with a learning disability.

"Health professionals need to understand their legal duties when treating people with a learning disability, and be held to account when they fail to do so." 

Source: BBC Health News