Heroes Not Zombies

It’s been a year since I wrote my last post here and I’m ready to start sharing my photos and writings again. I’m going to do that from now at a different address – bobleckridge.com If you have a look you’ll see there are different sections – things to see (my photos), things to read (my posts), things to listen to (readings a new podcast I’ll be starting) and things to watch (videos).

My idea is to have a self-hosted site (in case any of the particular internet companies go belly up!), using the world standard of WordPress, and make that be the place I express myself. I just want to capture some of my experiences, my thoughts, ideas and creations and I hope you might enjoy and/or be inspired by them.

I think every single one of us is unique and we all have a one time opportunity to share with others what our unique experience of living is, and has been, like.

Curiosity is probably my core instinct in life. I’m driven to explore, to notice, to learn about and to understand. I think curiosity makes me realise I never know enough, and that every single person is utterly fascinating. Really! I believe that! That’s what I discovered over four decades of work as a doctor. I never met a single person who I didn’t find fascinating, and I never met one who wasn’t unique.

I think uniqueness emerges out of the infinite web of connections and contexts from which we all emerge. In other words, what makes us unique, is the totality of the personal experiences, memories, thoughts, feelings and imaginings which occur moment by moment, in the environments in which we live.

Uniqueness will be the theme of my new website. I’d be delighted if you’d come and explore and I’d be even more delighted if you got in touch and shared your own, unique explorations with me.

Before I stop adding to “Heroes not Zombies” though, I’m sharing an updated version of last January’s post. Living in France now I experience the issues of delivering health care in two separate cultures and places – France and Scotland. There are striking similarities between the two countries but each is, surprise, surprise, unique.

Here it is.

Dealing with the crises in health care – a 7 point plan.

Wherever you live I bet there are at least three health stories you’ve been coming across pretty regularly. One is that “demand for health care is going up”, another is that “the country’s health services are struggling to cope with the demand”, and a third is, “it’s getting harder for patients to get help when and where they need it”.

What’s the problem?
Much of the media coverage focuses on the “demand”, by which they mean the sheer numbers of people going to hospitals for health care. In the UK there is a version of this unmet demand story in the number of people seeking GP consultations. In France, there’s concern about “désertification médicale”, which is the phrase used to describe areas of the country where there are too few (or no) local doctors.

The issue of waiting times seems to be a key story every winter in the UK. How long it takes to be seen when you present to the Emergency Department of the hospital (A&E, or “Accident and Emergency” as it’s called in the UK), or even how long you need to wait in the ambulance outside of the hospital. I don’t read those kinds of stories so much in France, but there are certainly more and more stories about how long people have to wait to get an appointment to see an ophthalmologist, an ENT specialist, a dermatologist or a gynaecologist.

Why are there problems with waiting times? Why can’t people get access to the health care they need in a timely manner?

1. There aren’t enough doctors and nurses.
There wouldn’t be long waiting times if there were enough doctors and nurses to attend to the patients’ needs. There aren’t enough, and if there were, they would be able to devote all the time necessary to each patient but there wouldn’t be a huge queue of people waiting to be treated. There’s another part of this story, because A&E departments (Emergency Departments) are not places where anyone is expected to stay. Everyone (at least everyone who survives) goes home, or is transferred to another part of the hospital for further care. Staff can’t move patients through A&E to inpatient care quickly enough because there aren’t enough inpatient beds.
2. There aren’t enough inpatient beds.
There are more patients needing inpatient care than there are beds to put them in. And beds aren’t enough. Once a patient is in a bed, they need to be cared for….by staff to keep the ward clean, staff to make food for them and feed them, staff to care for their daily needs and staff to manage their diseases and get them well enough again to go home.

So can we fix that first?

1. Increase the numbers of healthcare staff to the level where there are enough of them to meet the needs of sick people.

2. Increase the numbers of beds available in hospitals to cater for the needs of sick people.

Isn’t that the whole point of health services in the first place? To meet the needs of the sick in society.
All those patients waiting on trolleys for a hospital bed have been assessed as needing the complex care of a hospital because they have complex needs. However, not all those patients already in the hospital need the complex care of a hospital. Some of them are elderly, and/or disabled and unable to look after themselves at home. They need to be looked after somewhere else. Here’s the next item on the list.
3. There are not enough places available in care facilities which are not hospitals.
Places in care facilities, (nursing homes, residential homes etc), need sufficient numbers of trained and support staff to provide the care for their residents. There aren’t enough care facilities, and there aren’t enough care workers.
Another factor which adds to the pressure on hospitals is that time and again we hear that many people pitch up at A&E simply because they can’t get to see their local GP. They are told they have to wait several days, or even weeks, for an appointment so they go to the local hospital instead – with problems which could be, and should be, managed by GPs in the community. Why can’t people get to see a GP in a more timely manner?
4. There aren’t enough GPs.
There never have been.
The scourge of General Practice is not having enough time to treat each patient as well as the doctors would like to. Were five minute appointments ever adequate? Are ten minute appointments adequate? Do they give the patient enough time to say what they want to say? Do they give the doctor enough time to listen, to examine, to diagnose, to offer treatment, to give the patient enough information to give informed consent to the treatment, to allow enough time to discuss options and alternatives?
You’ll have a hard time finding someone who can answer yes to that.
There aren’t enough GPs. And there aren’t enough support staff in the GPs’ teams either.

Let’s turn to demand……..it’s going up!
And there’s absolutely not a shred of evidence to suggest it’s going to do anything other than continue to go up.
The proportions of the population over 60, over 70, over 80, and, yes, over 90 are all rising. All the evidence shows that older people have greater health needs. Demographics show us that, simply due to the fact of ageing populations, demand will increase. Although life expectancy is going up, disease isn’t going down. There are more people suffering from more chronic illnesses every year. There are more people suffering from two or more chronic illnesses every year. This is what doctors are referring to when they talk about increases in “complex problems and needs”.

The biggest delusion suffered by those who created the health service in the UK was that the NHS would make the population so much more healthy that eventually demand for it would shrink.

That’s never happened. And it’s not likely to happen.
The thing is, health care isn’t the biggest contributor to the health of the population. Health Services treat the sick, they don’t make the population healthier. What does? Arguably, it’s education.
5. Better educated societies are healthier societies.
Look at this, for example –

“ UNESCO reports that each extra year of a mother’s schooling reduces the probability of infant mortality by as much as 10% and that a child whose mother can read is 50% more likely to live past age five.”

Read that carefully. I read it several times. A child whose mother can read is 50% more likely to live past the age of five. 50%! There isn’t a drug, or an operation, or any other medical therapy which can make such a difference. I wanted to understand that a bit better. One of the best things I found was this explanation of how education can make such a difference. It describes how education can influence every one of the United Nations 17 sustainable development goals (“SDGs”),

However, the answers to these problems are not solely in the domain of education. If we want to reduce the demand by creating healthier societies, we need to address the causes of illness.
6. The causes of illness are primarily social, economic and environmental.

• We need to tackle the isolation of people in society.
• We need to tackle poverty.
• We need to tackle the constant stress of the “precariat” – all those without secure incomes, those on zero hour contracts, short term contracts, those employed for insufficient hours at insufficient levels of pay to meet their daily needs.
• We need to tackle the food industry, from farming methods, to factory production of foodstuffs, to marketing and sales of food.
• We need to tackle the chemical industry, to reduce the amount of CO2 in the atmosphere, the amount of plastic in the sea, the number of chemicals found in the blood of every newborn child, the number of chemicals found in drinking water, the number of chemicals in every household.
• We also need to tackle the Pharmaceutical industry. That industry which doesn’t exist to produce cures, but profits. There isn’t a drug on the market which increases health. At the very best a drug will support the body’s natural systems of repair and recovery. At worst drugs diminish symptoms without making any impact on the underlying disease.
• We need to tackle inequality which is rising fast and has been shown time and time again to inflict pain and suffering on millions.
• We need to tackle conflict, to be able to direct resources towards healthy lives instead of war.
• We need to tackle our political systems which leave so many feeling disempowered and forgotten. Democracy might be a great idea. Maybe we should try it. Not the pretend democracy of a vote every few years for someone to work in government, but real, relevant, responsive democracy which increases the engagement and autonomy of citizens.
• We need to find different ways to live together. Does the extreme individualism and competitive consumerism of the dominant capitalist, neo-liberal model serve us well?
• We need to look after our planet better – dealing with everything from Climate Change, to pollution, to de-forestation, dessertification and loss of biodiversity.

7. Finally, we need a different philosophy of health care, one focused on health not taking drugs.

That’s an awful lot. Daunting perhaps. But are there better answers? This is a toe in the water. There is no way to cover the complexity and extent of the issues in one short article. But can we make a start?

Oh, hold, on. I know. You’re going to say “where’s the money going to come from?”

Well, that, dear reader, is another subject. However, we’ll probably have to find a way to redirect the world’s resources away from the pockets and bank accounts of a handful of rich people, and apply them to solving the problems we think are worth solving. That’s going to involve some big changes in our current economic and political systems. There are some very exciting, innovative ways to do that, emerging as a result of the failures and crises of the current models. There are a number of economists and politicians suggesting wealth taxes, that is tax on land, property, stocks and shares. Financial Transaction taxes and the funding of National Capital Trusts with statutory percentages of shares in all Initial Public Offers (IPOs) could also contribute to the creation of healthier societies. Thirdly, there are also calls for more “progressive taxation”, taxing the highest incomes more heavily than at present. There are actually lots of good arguments and ideas showing how we could run our economies differently.

I’m particularly interested in the work of economist, Maria Mazzucato,  whose work, The Value of Everything, addresses the core of this issue and suggests the UN’s 17 Sustainable Development Goals as a good place to start https://www.un.org/sustainabledevelopment/
The other economist who has really caught my attention is Kate Raworth,  whose “Doughnut Economics” model is particularly exciting.

 
The Seven Point Summary

We need more doctors and nurses
We need more hospital beds
We need more care facilities and the workers to staff them.
We need more GPs
We need better education
We need to deal with the causes of illness.
We need a philosophy of health care focused on health not on taking drugs