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The 'Narnia NHS'

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Western Morning News December 2018

Each successive generation introduces new words to their vocabulary, often making the language they speak impenetrable to their parents. So let’s begin with a vocabulary test to see how ‘woke’ you are. If you are ‘woke’, you will also almost certainly understand the meaning of the word ‘snowflake’. This term is used to describe oversensitive young adults who are more prone to taking offense and less resilient than adults in previous generations, or are too emotionally vulnerable to cope with views that challenge their own. In order to protect vulnerable ‘snowflake’ students, some universities have created safe spaces on campus where they can escape to avoid emotional upset. And lecturers are encouraged to warn students about potentially disturbing content in their course, allowing the students to skip that bit in case it may ‘trigger’ an unpleasant emotional response. Invited speakers with contrarian views have been greeted by (sometimes violent) demonstrations by students whipped up into a state of moral panic. Even Dame Jenni Murray, presenter of the BBC’s Woman’s Hour has recently been ‘deplatformed’ by Oxford University students because of her views on transgender issues. If you make a seemingly innocent comment with no intention to insult, such as asking a person of colour ‘where are you from?’ you are guilty of ‘micro aggression’ by implying that they are not truly British

So it is tempting to conclude that the reported rise in mental health issues in young people is simply a consequence of their emotional fragility or a modern manifestation of the age-old problem of teenage angst. Doing so ignores the wealth of data highlighting the rise in young peoples mental heath problems. Eating disorders (such as anorexia), anxiety, depression, and self-harm are all on the rise. An article in Psychological Medicine in September showed that between 1995 to 2014 there was a tenfold increase in long-standing mental health conditions in 16-24 year-olds. According to The Mental Health Foundation 10% of children and young people aged between 5-16 have a clinically diagnosable mental health condition yet 70% of those will not have received appropriate, timely treatment. In its latest annual report, The Children’s Society found that self-harming behaviour is at alarming levels with 22% of 14 year-old girls deliberately injuring themselves. Almost half of children who are attracted to the same or both genders self-harm. Although some of these figures may represent an increased readiness to talk about mental health issues, this would not explain how the number of students taking their own lives has increased by over one fifth in the last decade.

It seems clear that the crisis in young peoples’ mental health is very real. And it is not that difficult to see why this is happening. Pressured from an early age by schools forced to focus on relentlessly testing rather than educating. Overprotected and indulged by parents unwilling to expose their children to any risk, raising them to believe they are entitled to whatever they want, whenever and however they want it. Increasing exposure to social media that paradoxically leads to increased social isolation – they may have hundreds of virtual friends in cyberspace but interact with none of them in real life. Confusion and peer pressure about conforming to gender stereotypes. A university education that leaves students facing the prospect of a lifetime of debt. And now the opportunity to move freely to live, love and work across 28 European countries is being snatched away by a Brexit that the overwhelming majority do not want. As with all health related issues there is an economic gradient: poverty being the key predictor of poor mental health. A decade of austerity has led to increasing numbers of children and young adults living in poverty. We are witnessing the inevitable decline in their physical and mental health.

But is it fair to label our young people as the snowflake generation? In a recent poll by YouGov/Prospect in the UK, two out of three respondents agreed with the statement: “Too many people are easily offended these days over the language that others use.” choosing this option rather than: “People need to be more careful about the language they use to avoid offending people with different backgrounds.” There was remarkably little variation by age, and the youngest age group of 18 to 24-year-olds was slightly less ‘politically correct’ than the population as a whole. A parallel study in the USA found similar results. So there appears to be little generational variation in ‘snow-flakiness’. Perhaps the perceived rise is simply due to increased media coverage. Just because you feel vulnerable and sensitive, it does not necessarily follow that you are not prepared to make a lot of noise about it. But the evidence that there is an increasing problem with mental health issues in children and young people is overwhelming. Yet the services they desperately need are in pitifully short supply and have been hit very hard by cutbacks in public spending. You do not need to be very ‘woke’ to appreciate that.

Western Morning News September 12th 2019

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Crisis, What Crisis?

Posted on January 18, 2017 at 11:40 PM Comments comments (0)

It’s a black alert, a humanitarian crisis, a major incident, exceptional measures are demanded. Where in the world could this be? Syria? Sudan? Or perhaps a terrorist attack in a major European city? No, it’s just a normal working day at your local hospital in January. No one, even those of us who have served the NHS for a long time (38 years for me) have witnessed anything quite like it. We are underfunded, understaffed and at the moment, desperately overstretched. In comparison with other European countries we have fewer beds, fewer doctors and nurses and fewer scanners. But when challenged the prime minister and the health secretary repeat the same mantra about the huge amounts of extra cash the NHS is receiving. You may feel that The Red Cross have overstated the problem by labelling this as a humanitarian crisis, but if you end up dying in A&E after waiting 36 hours on a trolley for a bed to become available, where is the humanity in that? If you wait months for an operation, only to have it cancelled at the last minute, or see your elderly relatives looked after on inappropriate wards by exhausted staff, you may well wonder whether this is a humane way to run a health service. None of this happens because of a lack of compassion amongst those in the hospital, it has been allowed to happen by depriving them of the resources they urgently need. As a member of the council of the Royal College of Physicians, representing Devon and Cornwall I am a co-signatory on an open letter to the prime minister laying out these facts.

Since the government says it is not their fault, who is to blame? Well, the boss of the NHS, Simon Stevens, has been sharply criticised for failing to make the necessary efficiencies and for pointing out the rather inconvenient truth that the government has got it’s sums wrong and there simply isn’t enough money to fund the NHS. The doctors are also to blame for striking last year and for failing to provide a full 7-day service, although the government has never been clear what it means by this. And of course, it’s your fault. Yes, you – for going to the Accident and Emergency department for problems that are neither accidents nor emergencies and wasting our precious resources. If, like me, you are a trifle sceptical about Jeremy Hunt’s handling of statistics, you would not be surprised to hear him claim that 30% of A&E attendances are unnecessary. But it is often difficult to say whether a hospital visit is needless until the patient has been fully assessed. Every day I see a number of patients with suspected heart attacks that turn out to be nothing more than indigestion. They are not at fault; they are not wasting our time or resources. It is far worse when people think they have indigestion and only come to hospital after munching handfuls of Rennies to no effect, by which time it is often too late to effectively treat their heart attack.

Over the last 14 years the number of beds in the NHS has fallen by over one third while the number of admissions has risen by over 50%. How have we coped? By reducing the length of stay in hospital. When I was in training 40 years ago a minor operation such as a hernia repair would require three to five days in hospital. Now the vast majority are day case procedures. But the intention is to cut the number of beds even further with the expectation that admissions will fall. The musical La La land may well have swept the board at the Golden Globes, but anyone who believes this plan will work should receive a special ‘cloud cuckoo land’ award. It is doomed to failure. Every attempt to reduce the number of emergency admissions has failed, the numbers rise relentlessly year on year.

I am sick to the teeth of hearing that the NHS is simply inefficient and would run like clockwork if it were reorganised. What, again? For pity’s sake, we are only just recovering from the fiasco created by Andrew Lansley’s reforms in 2010. The NHS is like a battered leather football, kicked around by each new government in turn. If anything what we need is to de-politicise the NHS and let the professionals run it.

The NHS deficit in Devon alone is expected to exceed £500 million by 2020, the highest in the country. But the financial crisis in the NHS is not bad news for everyone. Some believe that the underfunding is a deliberate ploy by the government to kill off the NHS by a death of a thousand cuts then sell it off to the private sector. Indeed, the chief executive of the private health company Spire said; “…as the gap between supply and demand grows, by nature people will turn to a private product.” So, if the NHS perishes, the vultures from the private sector, already circling overhead, are ready to pick off the juicy bits from the carcass.

Of course, the government denies this is their plan and reaffirms its commitment to a publicly funded, comprehensive national health service. They also claim that they have provided enough extra money to sort out these ‘winter pressures’. And at the time of writing this article, it is clear they do not intend to give any more. But the UK is the fifth largest economy in the world and spends less than almost all of its European neighbours on health. We would need to spend an extra £45 billion by 2020 to catch up with the average European Union health expenditure. I don’t want the NHS to fail, so I have written to ask for a meeting with my local MP (so far no reply), why don’t you do the same?

Western Morning News 19th January 2017

The Era of Stupidity

Posted on November 25, 2016 at 10:05 AM Comments comments (0)

Debate should be based on facts, not hearsay or ideology

I am normally a good sleeper. But twice this year I have awoken from a peaceful slumber into a nightmare about clowns; it’s always clowns. In one of my nightmares I am a passenger on a plane where the pilot dies and a professional clown with a terrible comb-over and absolutely no experience with flying an aircraft takes the controls and prepares for a crash landing. Those of us in the back realise that there are quite a number of passengers on board who are fully qualified pilots, but the clown’s friends block the way to the cockpit and say he is undoubtedly the right man for the job; he told them so. Meanwhile we are in a rapid descent and the runway is fast approaching.

The second nightmare involves another clown, also with hair issues, who says he has a fortune to spend on our beleaguered health service as long as we join his campaign to cut ourselves adrift from continental Europe. It sounds like a great idea, so we do it. But when I wake up in a cold sweat I hear his fellow circus performers on the radio announcing deeper cuts in NHS spending. When the clowns wipe off their make up, it is clear both nightmares are reality. On both occasions the polls said I could sleep easily, on both occasions the polls were wrong. But what disturbs me the most about the outcome of the EU referendum and the election of Donald Trump is that we now appear to be entering an era of stupidity where mere facts can be swept aside by a fool’s opinion. And that, more than anything else, is likely to keep me awake at night.

The next US president will be a man supported by the Ku Klux Clan who has smeared his black predecessor in the harshest, indeed racist manner and who will now be in possession of the nuclear weapons codes. His narcissism, temper tantrums and manner of speech make him appear like a child trapped in a man’s body. But his rudimentary grasp on even the most basic facts of politics would make a ten-year-old of average intelligence blush with embarrassment. I suspect almost all politicians distort the truth to some degree, but this man’s habitual lies and disordered thinking is something that I have seldom witnessed outside a mental institution. His cabinet is a clown car packed with ideologues and religious fanatics. He has been a punch line in jokes for decades.

Donald trump is contemptuous of science and proudly announces that climate change is a hoax generated by the Chinese to undermine US trade. He has appointed Myron Ebell a leading climate change skeptic to lead the Environmental Protection Agency. He intends to repeal the Affordable Care Act (or ‘Obama care’) and replace it with…well, nothing. Effectively depriving up to 22 million Americans of access to health care insurance.

Back home, before the EU referendum Michael Gove said: ‘people in this country have had enough of experts’ and last month criticized ‘experts’ such as Mark Carney, the head of the Bank of England for ‘wreaking all kinds of economic disasters’. He is not alone in his distaste for expertise. The secretary of state for health, Jeremy Hunt who has been heavily criticised for using false statistics to impose a new junior doctor contract said at the Conservative Party conference: ‘let’s not argue about statistics’. But the correct application of statistics is fundamental to science and there is an intimate relationship between science and democracy, scientific thought flourishes in democratic countries and withers in autocracies where the tyrant replaces the expert. Like everyone else, I have my areas of ignorance. But when these are exposed I seek information from reliable sources, from people who have knowledge and experience to fill that gap. It is healthy to be skeptical about statements from experts until you can satisfy yourself that they are indeed experts and that the evidence base for their comments is sound. Debate should be based on facts, not hearsay or ideology.

Yet distrust of expert opinion is not uncommon, many people take so-called ‘complementary therapies’ even when there is not a shred of evidence that they have any medical value beyond the placebo effect. And many parents have put the future health of their children at risk by withholding vaccines based on discredited evidence that the MMR vaccine may lead to autism. The overwhelming majority of climate change scientists are of the view that the earth is warming up at an alarming rate and that this is related to greenhouse gases, but they are just the experts and surely anyone is entitled to their own opinion? Many people subscribe to the vast number of conspiracy theories they read about on the Internet and believe in the ‘fake news’ from websites that pay their writers by the click of a mouse rather than the integrity of their journalism.

If you disagree with me and share Michael Gove’s contempt for experts: good luck when you allow the clown to take control of the cockpit.

Western Morning News 25th Nov 2016