What's Up Doc?

The essential difficulty with the National Health Service is rather like that of caring for grandma in your own home. Whatever you want to do, hope to do, intend to do or have to do she is always there to complicate matters.

So all the complaining about how Cameron and the Coalition should have put the NHS on the back burner while they tackled other major issues is nonsense. The NHS is so big, so complicated and so challenged by changing demographics never mind developments in the science and technology of medicine that it cannot be given a lower priority for attention and decision.

It is a very long while ago since the 1970’s and there was the local Area Health Authority which had to be attended. There similar tensions then. These were compounded by Westminster coming up with “initiatives” and “programmes” to paper over the most obvious cracks.

These came with funding for the now but not later which the politicians wanted to grab at. The mutterings of the financial man about who this might impact on future budgets were brushed aside; as were the reservations of the medical people about how these highly spun things fitted what were foreseeable added demands.

In the meantime at Westminster there were elections to be fought and personal reputations at stake. Survive at Health and you might make one of the choicer offices of state. Get a shed load of bad publicity and off you went, if you were lucky The Lords, if not to Brussels.

Our current Health minister, Lansley was always on a loser. The serial wreckage inflicted by the Private Finance Initiatives, lumpen reorganisations and the application of the fetich of modern finance and business models of the previous government were bad enough.

That the gross misspending had made it all much worse is almost impossible to sort out. Whether the ideas embodied in the present legislation will do much good is a question.

Just how far are the ideas that lie behind the assumptions out of date or no longer tenable by the time of the third decade of the 21st Century? Just how much will any government be able to spend? Who will it be spent on?

If the bill is simply yesterday’s soufflé presented at the behest of a government department over run with consultants, lobbyists and commercial interests then little or nothing has changed. We will just stumble from one chaotic form to another.

With a Coalition Cabinet infested by a Liberal Democrat party already running for cover, a spectacular lack of awareness or reliable information in the media, the protectionist stance of the existing professional bodies and a public whose understanding and information is very limited there are all the signs of yet another grim and costly debacle in a major public responsibility.

Like having grandma to stay we may be arriving at a situation where there are no answers and our NHS becomes something of a continuing major liability nagging away, wrecking the budget, impossible to deal with and to which there seems no end.

So what do we do with the extra grandma’s and grandpa’s never mind the many others who were never planned for? Did we ever expect extensive liver problems amongst so many younger people?

Is your knee beginning to play up?

Rickets, A Return To The Past

This, unusually, is a guest post. I am only obeying orders.

Quote:

In the early/mid 20th Century it was recognised that the disease Rickets was caused by a deficiency of Vitamin D. As it was known that the Vitamins A and D are soluble in animal fats and fish oils, it was clear that a diet which includes such foods would provide the necessary amounts.

Food was less plentiful then and took a large part of household incomes so it became Government policy to ensure that the population acquired these nutrients.

Margarine, as a manufactured product, was fortified with vitamins A and D. Cod Liver Oil and orange juice (Vitamin C) were sold at modest prices in Mother and Child clinics, along with baby formula mil powder.

Mothers were encouraged to give these daily and during the Second World War and beyond, when food was scarce, these measures proved successful in preventing the disease.

Also, children were encouraged to exercise and to seek fresh air and sun as far as possible. In more recent times people have been discouraged from consuming animal fats in all forms. Skimmed milks, vegetable oils, “low fat” products have all been heavily promoted.

Whole milk, eggs, butter and other animal fats have been discredited in an almost hysterical way aided by the commercial promotion and marketing of a wide range of food products playing on those fears.

Perhaps this is a very good reason why the incidence of Rickets is increasing so alarmingly.

Unquote.

Food for thought.

Government By The Woodentops

With all the complicated debate going on about the National Health Service and the positions being taken up by the very large number of interest groups and lobbies I have been lost in the fog as far as personal thinking goes.

As someone who remembers life before the NHS and the period of transition from local/mutual/private provision into a “national” service it is not difficult to feel that more than once we have lost our way.

Patrick Dunleavy, however, has provided a longish, informed think piece on the latest round of proposed reorganisations, reshaping and refinancing. He is very pessimistic on the costs, organisation or lack of it and the potential for disaster in the future.

The NHS clearly cannot stay the same, clearly cannot be just a vehicle for those currently employed and yet has to deal each year with a large proportion of the population. Amongst the patients the patterns of disease and illness will not remain the same.

Quote:

In her much quoted book "The March of Folly", the historian Barbara Tuchmann noted that:

“Wooden-headedness plays a remarkably large role in government. It consists in assessing a situation in terms of preconceived fixed notions while ignoring or rejecting any contrary signs. It is acting according to wish while not allowing oneself to be deflected by the facts.”

Unquote.

Link:

http://blogs.lse.ac.uk/politicsandpolicy/2012/01/24/hsc-bill-policy-fiasco/#more-20045

Given the rapidity of change, medical and technological let alone demographic, it is all too likely that in 2012, as in 1948 and 1974, we are embarking on a period of reform on the basis of ideas that already out of date.

And the money that was assumed would be available will not be and cannot be.

The NHS, Grist To The Mill

After staggering through torrential rain, luckily just ahead of the shunt that closed the motorway, we arrived at the hospital. Again, we had no letter or e-mail; the new booking service has yet to inform us as promised.

Phone calls had been made, but it was apparent that critical advice that should have been in place wasn’t there. Other than all this admin’ things went as they should do; which made a change.

So we were less than happy when we put on the TV when we returned to see Dave At The RSA doing his serious concerned chap routine to convince us that it was all about “Change”, he alleged for the better. What does he think has been going on for the last sixty odd years?

In the thirty five years before the inception of the NHS, ten had been in major wars and around another ten in serious economic difficulties, counting the bad time after 1918 in with the better known Great Crash.

There was a mish mash of local, Poor Law, private, academic and various forms of community services that had tried to cope with the demands of an increasingly urbanised population.

All in all, it was not in good shape and without the resources or means to deal with the mounting health problems and the pace of development in the science and the technology of medicine.

As the creation of the NHS was a political act, at the beginning it was organisational, financial and control systems that mattered. The medicine and the underlying stresses were low on the agenda, being taken for granted.

Since then we have seen roughly two full generations of the NHS and are now into the early years of the third. The first generation lasted until 1974 when the Edward Heath inspired major changes were made in organisation, again largely politically and financially based rather than in the context of the period and what amounted to a take off in medicine, science and treatments.

I recall in the late 1970’s in our meeting before the Area Health Authority met looking gloomily down the agenda as the Senior Community Medical Officer and I contemplated the problems we were going to have with the politicians who preferred to listen to accountants and “executives”.

We agreed that it wasn’t working well and was becoming more and more disconnected with the reality of the work to be done.

So in the 1980’s Ken Clarke, looking at the problems through his haze of cigar smoke, decided to throw it all up and the air and see how it came down before addressing many of the more intricate issues.

After then in the period of Mrs. Thatcher’s decline and fall and the Major years of trying to get the Tory party to agree to anything, we had years of indecision and uncertainty.

Worse there came to be an increasing reliance on haphazard initiatives, all sorts of schemes, largely promoted by non-medical consultants and worse endless spin and obfuscation of the difficulties and needs for radical re-provisioning and rebuilding.

Then came New Labour, who arrived at what was soon the start of the third generation. By this I mean a period when medical and technical technology were being transformed and research and knowledge were advancing far more rapidly, especially in the new context of immediacy in the transmission of information and knowledge.

So what did they do? One thing was ever more spin and a deliberate policy of “turning” the NHS into a bedrock agency of Labour ideology and beliefs. Also, they let loose the money men in PFI etc., hordes of management consultants from The Big Four and others and financial advisers of all shapes and sizes.

The professionals, doctors and nurses, essentially were bought off to subject them to the new disciplines and there was never ending change and reshaping. What did happen was major distortion of medical provision according to political demand rather than real need.

The funding and organisation of computer services for basic recording and service has been an expensive disaster.

It was all to be paid for by the new boom boom bust free economy. Now there is an expensive mess that apparently we can no longer afford. Also it bears the burden of huge financial liabilities that will extend for two generations beyond that of the present one.

Treatments may or may not be available for many conditions that are not “sexy” or spin worthy. Political criteria will govern who does what where. The mood of the moment is likely to continue to be key to decision making.

It is sometimes in the detail that you see how things are lost. There are many people with dangerous conditions that may cause them to collapse with little or no warning. You may well know one or two.

There is nothing in the NHS to deal with this situation and no system of recording or recognising those who live with such risks. Those than can afford it can sign up with a private service which has a 24 hours response and advice line. But large numbers of NHS are not aware of the meaning and nature of the dog-tags and bracelets.

Nor are police or fire or other services that may be dealing with people who have gone down and in difficulty. Typically, a police officer who sees someone writhing on the floor or not entirely coherent will simply assume drink as will almost all the public. It is the reason why so many now are dying where they fall or in police hands.

Yet the cost of this compared to many things is absurdly cheap, as is the cost of creating awareness both within the services and in the general public of what are high risk conditions and what might need to be done.

And these conditions and needs have been known ever since the NHS came to exist.

Health Care

Above is a diagram of the USA Health Care System. You will see that it is all much simpler and no doubt more efficient than our own either now or in the foreseeable future. Has anyone the time or patience to do one for England or for other parts of the UK? A months holiday in the padded cell of their choice to the winners.

Popping The Pills

The UK Government White Paper on Health is a centre of attention at the moment. Perhaps we ought to be looking equally hard at other aspects of health provision.

The 1300 word item (it can be skip read) from the New York Times below is about major defaults by a UK company, Glaxo Smith Kline. This is an industry that is supposed to be tightly controlled and regulated.

How strange that this story is little covered the UK media, perhaps advertising revenues are a consideration. Even stranger is what could be happening with other companies peddling untested and unregulated common chemical products for daily use, also providing advertising revenue.

Quote:

New York Times
Glaxo to Pay $750 Million for Sale of Bad Products
By Gardiner Harris and Duff Wilson - Published: October 26, 2010

GlaxoSmithKline, the British drug giant, has agreed to pay $750 million to settle criminal and civil complaints that the company for years knowingly sold contaminated baby ointment and an ineffective antidepressant, the latest in a growing number of whistle-blower lawsuits that drug makers have settled with multimillion-dollar fines.

Altogether, GlaxoSmithKline sold 20 drugs with questionable safety that were made at a huge plant in Puerto Rico that for years was rife with contamination.

Cheryl D. Eckard, the company’s quality manager, asserted in her whistle-blower suit that she had warned Glaxo of the problems but the company fired her instead of addressing them.

Among the drugs affected were Paxil, an antidepressant; Bactroban, an ointment; Avandia, a troubled diabetes drug; Coreg, a heart drug; and Tagamet, an acid reflux drug. No patients were known to have been sickened, although such cases would be difficult to trace.

In a rising wave, recent lawsuits have asserted that drug makers misled patients and defrauded federal and state governments that, through Medicare and Medicaid, pay for much of health care.

Using claims from industry insiders, federal prosecutors are not only demanding record fines but are hinting at more severe actions.

Suffering a research drought, drug makers have laid off thousands of employees. Some of those dispatched have in turn filed whistle-blower lawsuits that can lead to criminal investigations.

Justice Department officials announced the settlement in a news conference Tuesday afternoon in Boston, saying a $150 million payment to settle criminal charges was the largest such payment ever by a manufacturer of adulterated drugs. The outcome also provides $600 million in civil penalties.

The share to the whistle-blower will be $96 million, one of the highest such awards in a health care fraud case. When asked whether any individual could be charged in addition to the corporation charges, Carmen M. Ortiz, the United States attorney for Massachusetts, would say only that the investigation was not yet complete.

GlaxoSmithKline released a statement saying that it regretted operating the Puerto Rico plant in violation of good manufacturing practices. The company said the problem had involved only one plant that was closed in 2009. American shares in the company fell 0.35 percent on Tuesday.

Tony West, the assistant attorney general in charge of the department’s civil division, said hundreds of such lawsuits were awaiting federal review.

“We’ve opened more investigations, we’ve recovered more taxpayer dollars lost to fraud, we’ve had more convictions, higher penalties and fines in the last two years than we’ve had in any other two-year period,” Mr. West said in an interview.

Whistle-blowers who win earn a cut of the eventual fine. Ms. Eckard will collect $96 million from the federal government, and she will collect additional millions from states.

The suits, all filed under seal, have for years been rising in size and scope, but the collective threat to the industry has been largely unnoticed because the growing mountain is obscured by a wall of judicial secrecy. Each successful claim begets more suits, with more being filed almost every week.

The suits are filed under a federal law originally intended to stop Civil War hucksters from selling rancid meat to the Union Army by paying bounties to tipsters. The pharmaceutical industry has become the law’s most successful target because the government now buys far more pills than bullets, and because fraud in health care is common.

Health care cases accounted for some 80 percent of the $3.1 billion recovered by the Justice Department under the false claims act last year, the Taxpayers Against Fraud Education Fund, a nonprofit whistle-blower advocacy group in Washington, reported on Monday. Most of the money is typically returned to the programs in which false claims were filed, like Medicaid and Medicare.

The Food and Drug Administration and the inspector general of the Health and Human Services Department both announced recently that they would pursue charges against executives personally under a strict liability provision of the law, something that has not been done since 2007 when the three top executives of Purdue Pharma were convicted, sentenced to probation and personally fined $34 million while Purdue paid $600 million.

The rule allows executives to be prosecuted and barred from government sales even if they were not aware of specific violations.

Legislation could make such claims easier to win. Last month, the House of Representatives passed a bill that permits executives to be barred even if they have left the company where the fraud occurred and that permits the inspector general to prosecute parent companies for the sins of subsidiaries.

Pfizer alone has settled four whistle-blower cases since 2002, and it paid a $2.3 billion fine last year, the largest in history. Whistle-blower cases have become so routine that Wall Street no longer takes much notice of individual suits, while the growing trend remains hidden.

When GlaxoSmithKline announced in July that it was setting aside $2.4 billion for legal costs, including enough to pay for the investigation into its Puerto Rico problems, the announcement was greeted with a yawn.

Still, the case may lead to a collective industry shiver because it opens a new frontier for whistle-blower suits. Nearly all previous cases against the industry involved illegal marketing. This is the first successful case ever to assert that a drug maker knowingly sold contaminated products.

“This case will change the way drug makers run their factories,” Ms. Eckard’s lawyer, Neil Getnick, said.

Some of the antidepressant Paxil CR produced at the plant was ineffective because a layer of active ingredient split from a layer of a barrier chemical during manufacturing, the government said, and some lots contained only the barrier chemical.

“The harm is really in the public’s confidence in the health care industry,” Ms. Ortiz said. “When you go to a pharmacy and you buy a drug, you expect that drug is what it purports to be and you don’t expect it to have any micro-organisms or not be sterile or not have the power or have too much power.”

Ms. Eckard’s role in the case began in August 2002 when GlaxoSmithKline sent her to Cidra, south of San Juan, to lead a team of 100 quality experts to fix problems cited by an F.D.A. warning letter a month earlier. This was GlaxoSmithKline’s premier manufacturing facility, producing $5.5 billion of product each year.

But Ms. Eckard soon discovered that quality control was a mess: the water system was contaminated; the air system allowed for cross-contamination between products; the warehouse was so overcrowded that rented vans were used for storage; the plant could not ensure the sterility of intravenous drugs for cancer; and pills of differing strengths were sometimes mixed in the same bottles.

Although F.D.A. inspectors had spotted some problems, most were missed. And the company abandoned even the limited fixes it promised to conduct, the unsealed lawsuit says.

Ms. Eckard complained repeatedly to senior managers; little was done. She recommended recalls of defective products; recalls were not authorized. In May 2003, she was terminated as a “redundancy.”

She complained to top company executives, but she was ignored even after warning that she would call the F.D.A. So she called the F.D.A. and sued. The agency began a criminal investigation and used armed federal marshals in 2005 to seize nearly $2 billion worth of products, the largest such seizure in history.

Unable to fix the plant, GlaxoSmithKline closed it in 2009.

Unquote.

Keep taking the pills?

Bed Blocking For Dummies

Another from the personal archive; from 2005 and this is reflected in some parts of the text. It is 1500 words I’m afraid but it does cover the issue. Bed Blocking is now exciting the BBC and other media because of the spending review. We have been here before but then the issue attracted less attention and tears.

In the last dozen years the pre-conditions for serious problems have been in place but have gone critical only a couple of times, mercifully avoiding the worst. Whatever planning may have been done in the past there have been some significant developments quite recently so the figures have been going the wrong way. This means that critical phases will occur more often. Just when the tipping point might occur into chaos/collapse/catastrophe is an open question.

Quote

WHEN DID YOU LAST SEE YOUR GRANNY?

The ambulance arrived in the early hours of the morning, a routine event; recently there were four visits by paramedics and ambulances in one day. The reason is not mobs of drunken yobs beating out each other’s brains or local addicts overdosing, it is a quiet, well behaved, ordinary and indeed gentle group of neighbours who fall or have a medical crisis.

The problem is their longevity and its consequences. When the block of retirement flats in which they live was first occupied a decade ago, it was different. It was designed for the active retired, pensioners who were mobile, needing little care, who preferred to avoid the costs and problems of running a too large a house and garden.

They wanted to cash in on their former home to keep more of their pension for their own pleasures or protection, and to enjoy a bit of quiet easy comfort, as well as cheap warmth.

It is not just that the original occupants have grown old; there has been a substantial turnover, as in other sectors of the housing market. It is that the most of the new people are older, frailer and more dependent on personal support.

The carers come and go from 6 a.m. to midnight, and so do the medical and emergency services. Once, none had the call pendants provided for those at high risk, now there is a dedicated communications aerial to cope with the number needing this precaution.

Nationally, the number of call-outs for the ambulance services has increased sharply in the last decade; this is one reason for the added demands. Perhaps the number of man hours and the real costs involved for the 50 or so occupants of the flats is now roughly the same as for a 100 Bed Residential Home.

The wider problems in the NHS have compounded the problems. Ladies who once rivalled each other in their fashion sense and men in competitive sports now try to cap each other’s trolley horror and medical disaster stories.

They are many and various, one who visited her Family Doctor for a routine prescription discovered that the local hospital had declared her to be deceased and all her medical records had been deleted from the relevant NHS systems; so the undead stalk the land.

A desperately sick man died quietly on his trolley after a 72 hour wait. Treatment that is nearly too late, or long delayed, complicates long-term recovery, and when attention is given for the immediate issue they are packed off back to their flats as quickly as possible to manage and recover as best they can.

The local hospital has enough trouble with bed-blockers. Some soon return to the hospital, often as an emergency case. Where have all the convalescent facilities of former decades gone?

The granny-stacking flats put up by developers are rarely equipped for the disabled, nor are they staffed to deal with anything other than buildings and site management. The bungled attempt to regulate residential homes more closely by New Labour, that caused so much personal damage and distress, wiped out a huge number of temporary and permanent beds and accommodation for the elderly infirm when the owners decided to take the money and run as property prices rocketed.

In the meantime the major erosion of the income of the old by stealth taxes through the machinery of local government and national finance means they are less able to care for themselves. The effects of other regulations, Health and Safety and Euro inspired instructions and admonitions have added to costs and prices.

The petite elderly lady who lay on the floor for hours had several full grown healthy young people in attendance who were forbidden by their conditions of service to lift her onto her bed.

She had a lot to say on the subject later. Apparently, the one ambulance in the area of the Trust that was equipped with the relevant lifting gear was busy with a long list of potential clients. The cost of that little business was estimated at £900, and she does fall over quite often while waiting for her wonky knee to be looked at.

In all the planning for new housing demanded by the government, intended to be in the hands of the forthcoming Regional Governors and their development directorates, the bit that is missing is what to do about the old.

The provision of half-way house accommodation, developments of self contained units, but with built-in support services and meals provision, and the further stage of residential facilities for those requiring rather less than full nursing home needs is absent from any visible state thinking.

Those in the retirement flats are often the lucky ones, where there is at least some company and administrative support, because for every one of them there may be twenty or more living alone and in virtual social isolation in houses that few can manage or maintain. Some will succumb to hypothermia because of the heating costs; others will suffer from malnutrition or dehydration.

The vagaries of the housing market add to the complexity of the problem, as do the serious dangers of boom and bust. In boom, there is a tendency to hang on for the best possible price, and that is always a little too long. In bust, the old who cannot cope also cannot sell their homes in the new situation.

Because of what has happened already it is possible that one way or another over the last few years the number of ordinary houses and properties effectively removed from the market and occupied by single old people needing daily care is more than the numbers of new properties demanded by New Labour as vital for “new needs”.

A lot of these “new needs” arise from the expansion of the holdings of second and third homes and the buy-to-let sector fuelled by cheap credit. The people who benefit from this surge in property buying are subsidised, probably, through the tax and benefits system far more than the struggling pensioners, and the ones who benefit from the ramp include almost all of the current political and media elite.

It is not surprising that New Labour seem to care so little for the old. One of the prime industrial dispute tactics of some of them during the 1978-79 Winter of Discontent when they were young militants promoting the Workers Revolution was to have lightning strikes of care workers in local authority nursing and residential homes and in special schools, where the deaths could be written off as “necessary casualties”.

We know that the slow disintegration of the pensions system since 1997, part of the assault by Brown and New Labour on the Lower Middle Class, the “peasants” as they engagingly call them, will create intricate problems in the decades to come.

More pressing for the immediate future is a disaster about to happen; one serious pandemic of influenza could be enough. Although the government may well put it down to a necessary conjunction of statistical trends relating to demographic factors inherent in the age structure of the population, the electorate may take the view that the state has a responsibility.

Given the state of the A&E and geriatric facilities in most hospitals, the serious and growing problems in community medicine and general practice, the tipping points from pressure to crisis and from crisis to disaster are perilously close to daily experience.

To add a stomach churning thought the limited provision of mortuary, pathological, coroners, and burial and cremation services could resurrect in the present the nastier effects of the great plagues and geophysical disruptions of the past.

There may be worse, for the increasing numbers of the criminal elements that prey on the old already with no fear of arrest, or of being troubled by Police Forces who have other targets to meet, will be very active, stripping the bodies and ransacking their homes while the dead lie and decompose for days or weeks in their isolation.

This would not be new, during the Second World War Blitzes the looters often arrived at the scene first. In the summer of 2003 in France, that paragon of social welfare provision and human rights, a long hot spell during the holiday season did for thousands of the old who were living alone. In the USA, Hurricane Katrina taught a few sharp lessons in complacency.

The only considerations that will worry the government, of course, are the poll ratings amongst those able to vote, the question of how the young voter will react, and the serious worry that the sudden availability of up to a hundred thousand houses could crash the property market in the run up to the next general election. In the meantime we give almost all our attention and thoughts to the media excitements of the day.

In the night, the ambulances come and go, and the carers wake long before the dawn.

Unquote.

Christmas is coming.

Burnham To Dunce Inane

The annual performance of The Scottish Play has now taken place at Manchester Central Station that was. Things did not run according to the timetable. Also, this year we had a dearth of Scottish performers for the lead parts. Ed made an unconvincing Macbeth making sure all the blood was on other hands.

David could not make up his mind whether he was Duncan or Banquo’s Ghost. Either way he may choose to disappear in a cloud of eco friendly carbon dioxide.

Harriet might have been expected to be more convincing as Lady Macbeth but seemed to be auditioning for Titania, Queen of the Fairies in another play. As for the three witches, at one time Labour had a marvellous choice of candidates.

This year I felt that Darling , Johnson and Straw would have to do the parts as transgender social outcasts. Interesting, but not good to watch.

The BBC, frantic for a pretty Labour face to give the spiel without upsetting too many people let Andy Burnham have a large chunk of their news bulletin. As an Everton supporter whose team are bottom of The Premiership and looking bad he may not have been the best choice.

Anyhow, he did try to make us weep for all the dire hardships he and his fellow candidates for the Labour leadership have suffered for the last few weeks. My little heart bled for them.

Burnham predictably went banging on about the NHS and what disasters awaiting the old. This caused my twitch to start up. He represents Leigh in Lancashire. A relation of mine had his father land in Leigh Hospital a decade ago. The man was diagnosed with dementia.

The family had no discussion with any doctor and indeed were denied access to one but were simply instructed by a junior local government official that he was going to put into a care home and his property sold.

The family went to the Court of Protection, see Anna Raccoon’s blogs, to try to sort out the alternatives. Unluckily the relation landed in hospital in an emergency and while he was there the official forced the father, near blind and stone deaf as well as suffering dementia to sign documents authorising the sale of his property.

The Court of Protection did nothing, but we now know that they would not challenge politicians.

As well as selling the property at well under value over the family’s heads the relevant local authority took a large chunk of money as administration fees. This was Wigan, who once had Hazel Blears as one of the legal officers. Of course she will have had absolutely nothing to do with devising these procedures.

Curiously, some of those involved in the buying and selling were attached to local Labour Parties. Gosh golly, and you would have thought they would have been much too busy coining it in from Pathfinder and other Labour redevelopment wheezes.

Meanwhile, Andy told the BBC that the Coalition had produced a “White Paper from nowhere.” about the NHS. This is unlikely unless the Three Witches had been at work for the Tories as well as Labour. Perhaps Andy is clueless about where they come from normally.

Perhaps Andy is clueless because when he was in charge of Health the civil servants might actually have been thinking beyond the next sound bite or appointment at the hairdressers for the colouring and styling.

Perhaps Andy is clueless because he sees the NHS as just a big jobs and property racket for the various members and funders of his party.

Perhaps Andy is clueless because nobody told him that there was something called The Treasury that might be looking for different ways of funding services and that was always going to include Health.

On the other hand, perhaps he really is just totally clueless.

Are You Feeling Tired?

This one may be of interest for its implications. I have forgotten where I found it so apologies.

Quote:

Post Contamination Syndrome

Post Contamination Syndrome (PCS) is a period of reaction, shorter or longer, that manifests itself as weariness, physical or mental or both. It is a reaction to contamination by a substance that impacts on the immune, respiratory or brain function with allied effects on mental and body performance.

The length and strength of the PCS reaction will depend on the extent of effect and the nature of the substance, complex or simple, and the impact of the initial and following reactions in relation to the state of general and other health of the person affected.

In those cases where there is awareness of the contamination and measures are taken to either avoid or to reduce risk and impact the effect may be contained within a few hours. Often it will be more prolonged, perhaps days, if the PCS reaction is severe and/or measures to contain and control it are delayed.

Successive waves of contamination occurring in series that are not diagnosed or realised will result in prolonged PCS reactions and issues entailing a persistent debilitating condition that may be mistaken for illness arising from other causes.

A complication is that where a substance or product containing those substances is chemically designed to impact on the sense of smell and effectively either negates or significantly degrades its capability then there is a major risk that the lack of both awareness and ability to take avoiding or controlled measures will occur with more prolonged and severe reactions.

Other issues arise where it is not immediately evident that contamination is present because the PCS reactions might be delayed. This can arise in many instances. One type is where an individual may be subject to a chemical reaction and is not aware of the extent of the chemical haze now common in many public areas and facilities.

These mostly arise from personal and other products with synthetic aromatics, carrier, dispersal and penetrating agents. In those cases where nanotechnology has been applied to the relevant substance in the products the contamination may occur at a distance that makes avoidance and recognition difficult.

In cases where an individual may be subject to other either severe asthmatic reactions or anaphylaxis the PCS onset may occur after an unpredictable period of delay that will make identification more difficult.

The causes of the initial onset of vulnerability are normally complex and can arise from a variety of medical situations. Consequently their impact and diagnosis is often complex and requires rigorous and detailed analysis of the relevant conditions.

One area that presents difficulty is the role of virus infections. The illness may create vulnerability and as the virus trace remains in the blood it is easy to assume that the PCS reactions to contamination by one or more chemicals represent a persistent and difficult to treat feature of the virus.

The virus will have affected the immune or other body system in such a way that its resistance to certain forms of contamination is then weakened. This is hard to predict and the effect of a virus may lead to a range different reactions including PCS in different people.

As modern living and movement enables the wider spread and greater variety of virus infections and the levels of chemical contamination in the immediate environment of the great majority of the population have substantially increased the incidence of virus infections, subsequent chemical reactions and PCS will have risen progressively.

The increased rapidity of the application of new synthetic chemicals, techniques of manufacture and marketing together with the increased impact and power of products in the competition for market share will have outstripped the capacity or capability of modern science and medicine to recognise, diagnose or deal with the extent of the effects on human systems.

Unquote

It might explain a few other things as well.

The Madness Of Prime Minister George

As speculation launched on the net about the Prime Minister’s health, and as I am certainly not disposed to be kind to him, many would have thought I would have been amongst the first to cut to the chase. But it may not be that at all, it could be quite complicated. First, the simple question, ‘ang on a bit squire, what do we know? It is said that there is a list circulated in Whitehall circles about what the PM can and cannot eat or drink. A medical man has seen this and deduced that it is consistent with someone who is on early generation anti-depressants, which have significant dietary and other side effects because recent generation ones cannot cope with the alleged condition.

What else do we know? Well the PM is getting older by the day, who isn’t? Also, he is in a very stressful job, all those idiots he has working for him. Moreover the job entails extensive travel and contact with people from across the world. Enough to put anybody’s immune system under severe strain, but this does not make him mentally ill. It might make him unpredictable, exhausted, and very grumpy, all those idiots again, but no more than I am on a bad day after dealing with the bank, the insurance company, and trying to persuade a plumber to come.

So what else can happen that entails a diet list as long as your arm, and as complicated as the list of contents on a supermarket food package cheap offer? As many people become older, all sorts of glitches can affect the body. Many begin to react to gluten, others to dairy foods, some to both. Others begin to have skin issues, and other reactions to common products, entailing visits to dermatologists and others specialists. The really unlucky can contract multiple chemical sensitivity.

Recent research had identified a brain reaction to this complaint, which apparently also occurs with Chronic Fatigue Syndrome and ME, Gulf War Syndrome, US Vets Agent Orange reactions, some true Allergy, and perhaps others involving synthetic chemicals, notably fragrances. Along with fragrance issues can come severe reactions to a related chemical family, that is synthetic flavourings and flavour enhancers. As for synthetic fragrances, do not forget, they are engineered to hit the brain hard.

These synthetic chemicals in the food and around the house have become hugely stronger in recent years. So, read your food packaging lately? Wondered why the tummy rumbles after the breakfast sausages? In addition, there are some chemicals added to wines as stabilisers that do not suit some people.

Unless you are at the wrong end of some of these complaints you cannot know how much they disrupt your lives, require constant vigilance about diet, and how they add to life’s difficulties. Those in busy demanding jobs have real trouble. If the PM’s immune system is affected, and if he had had severe inflammation of the gut etc. it will take a lot of effort, and a good deal of rest to deal with it.

The real problem that many people face when they have these problems is that the doctors they deal with haven’t a clue about such complexities, they just give the problem a convenient label, often tell them it is in the mind, throw some inappropriate medication at it, and tick the boxes. In any case there are few specialists in the field and it is very difficult, often impossible, to get a referral.

So, is there anyone you know who is having problems and the pills don’t work? If so, please do not assume that it is all in the mind. Remember, for two hundred years King George III was said to be mad, now it seems that it was likely to have been porphyria. Something his doctors knew nothing about, and few modern doctors are aware of or know how to treat.