Reflections on World Club Foot Day

There they are, in all their misshappen, scarred, unfiltered, modern Prometheus-like glory - my two club feet. The challenging appendages at the end of my pale, corgi legs, the body parts that cast a shadow across every aspect of my life. 

I was both fortunate and dead unlucky to be born in Australia in 1976 - fortunate because Mr Peter Dewey, an excellent orthopaedic surgeon happened to live and work in the town where I was born. He started work on my feet from the time I was a baby, right through to when I was 18 and 19 for my final surgeries, for which he came out of semi-retirement, in between doing amazing work with land mine victims in Cambodia.

Without him - or if I was born in a less developed era or lived in a less developed country - I probably wouldn't be able to walk. I would have been doomed as a sad, crippled girl who would not have had the opportunities to get educated, travel the world, drive cars, work as a journalist in three different countries, meet the love of my life in an Abu Dhabi newspaper office after chasing boys with varying levels of success, and generally have a pretty amazing time. I still laugh when I think of the time my friend Stephen said I could open a bar, call it Club Foot and the slogan could be "Club Foot: Where you get down and fall down". 

But since 1976, the Ponseti Method has come a long way and I will never know if it could have prevented me from having to go through 13 reconstructive operations, involving long stints up to my knees in plaster, multiple stitches on the tops of my feet, the sides of my feet and up the back of my ankles, internal clips, and heavy scarring.

Even with Mr Dewey's brilliant work on my feet, I still get intense swelling in extremes of hot weather (or even on this mildly warm British day...), ironically white-hot pain in cold weather, arthritis has bedevilled my left ankle to the point where I cannot be trusted to safely operate a clutch, the way I walk affects my knees, hips and back, it can can enhance my inherent clumsiness, and sometimes I have to sit down or lie down or take painkillers. Or I simply might not leave the house because it's too uncomfortable and I don't always trust my feet not to seize up on public transport or while trying to walk somewhere. It won't get any better as I get older.

Despite the desperation of a mansplainer on Facebook the other day who presumed to know my own reality better than I do, my experience of club feet is not a "minor condition". Forty-two years of experience with these damn feet means I know how to manage the condition but it's something that I am aware of every single day to a greater or lesser degree.

On a superficial level, I get frustrated when trying to buy vaguely attractive shoes - I can walk in plenty of ugly shoes but buying shoes for special occasions is a nightmare. If one more person, no matter how well-meaning, tells me I simply haven't found the right high heels or I just need to buy really expensive high heels, I cannot be responsible for my actions. I cannot walk in anything higher than about an inch and I do not need people telling me that I would suddenly dance about like a gazelle if only I bought Manolo Blahniks or had a pair of heels especially made for me. Trust me, I have tried and failed to wear heels and I am less gazelle and more stumbling, newborn foal. My feet are held together with clips and cannot bend into the unnatural pose required to convincingly wear skyscraper shoes. Leave me the hell alone with your obsession with getting me into shoes that will only cause me needless misery. I am at peace with my huge collection of flats.

But I write this not to wallow in self-pity - such innovations as DSG gearboxes, good painkillers, carrying Deep Heat and Deep Freeze in my handbag, cute flat shoes, kitten heels, physiotherapy, strapping for my ankles available at any pharmacy in the land, and simply being affluent enough to afford a warm, comfortable house and bed are among the things that improve my life. Even though I am too old to take advantage of the less invasive Ponseti method for club feet, I do not want the next generation of club foot patients to miss out, no matter where they are in the world.

In the UK, the Ponseti method is available on the NHS and Great Ormond Street Hospital and the Robert Jones and Agnes Hunt Orthopaedic Hospital in particular do great work in this regard. I met a beautiful little boy at a friend's baby shower a few years ago. He was resplendent in a pair of bright blue boots as part of his Ponseti treatment - and it was an absolute joy to reassure his mother that life with club feet will not hold him back. It would be amazing if this good fortune was global and therefore merely the way things are rather than a matter of luck in life's lottery.

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To find out more about club feet and to ensure club feet patients everywhere here are some helpful links:

Steps Charity

The Robert Jones and Agnes Hunt Orthopaedic Hospital

Miraclefeet

Cure Clubfoot

Global Clubfoot Initiative

On fatness

Heather Heyer is dead, mown down by a car at the age of 32 in a counter-protest against white supremacists.

Twenty-year-old James Fields, an unambiguous supporter of Donald Trump and neo-Nazism, has been charged with second degree murder. Amid the many respectful tributes paid to Heyer, Andrew Anglin, the vile editor of the vile Daily Stormer website decided to stick his vile head over the moronic parapet and write a truly disgusting obituary. In his vomiting of hateful bile, he called her a "fat, childless, 32-year-old slut".

People like Anglin, who look upon The Handmaid's Tale as a manifesto rather than a stark warning, hate women when they don't marry as blushing young virgins so they can breed the next generation of arseholes. But it's his use of "fat" as an insult that I want to examine.

Why is it so awful to call someone, especially a woman, fat? Surely fat women simply need to toughen up, put the doughnuts down and lose some damn weight, right?

It's awful because what Anglin and his ilk are saying to women when they resort to "fat" as a criticism is that they are repelled by us, we are difficult, we refuse to conform to a stereotype, we have the temerity to take up too much space. And if we are outspoken as well, we are reduced to being good-for-nothing, fat, mouthy bitches who should shut up and quite literally shrink away. It's a sexist form of shorthand.

Of course the swift defence of anyone who routinely calls women fat is that they are merely worried about their health, as if fat people don't know they are fat, as if the health risks associated with being overweight are a state secret, as if the reasons for gaining weight don't vary, as if people put on weight deliberately to piss off the slender and sylph-like. Oh, please. Just stop. The "I'm just worried about your health, Fatty" is concern-trolling, justifying an unconstructive insult directed at someone who is probably well aware of their own body.

Even The Economist was disappointing in the wake of Heather Heyer's death. Amid an otherwise well-written obituary, the writer felt the need to mention her weight and her appearance in a way that would never have happened if it was a man who died that day in Charlottesville.

The obituary said: "She was bubbly, funny, strong-minded and, at 32, happy with herself, even if she put on weight too easily (cigarettes helped with that), and even if her hair had too much natural curl (she’d found products that really worked to sort the hair out, until some of her profile pix drew “Wow!” and “Saaaaaamokin!”)."

Jesus, really? What a reductive and depressing load of crap. How is the conversation following the events in Charlottesville advanced by mentioning Heather's weight, or that she resorted to cigarettes to control her weight, or that she used hair products to restrain her naturally curly hair until she was rewarded with the ultimate accolade of the Facebook age, of being told one's profile picture is hot? 

Why perpetuate the grim narrative of women's bodies, right down to the hair on our heads, being things that need to be controlled, even when you are protesting against goddamn neo-Nazis?

The news cycle moves on from Heyer's death, even if the story of race relations in the US and whether people need to see statues of Confederate generals in public to stop themselves from enslaving people rages on. Amid the noise, there was the story of actress Gemma Arterton claiming that she was sent a personal trainer on location in Morocco, put on a ridiculous diet, and filmed in the gym so that studio bosses were reassured that she was losing weight in order to meet the required standard of hotness deemed suitable for starring in The Prince of Persia.

Obviously, this led to comparisons with male stars going to great lengths, including unhealthy methods such as dehydration, to become muscle-bound, six-pack-owning gods for film roles, in the usual attempts to minimise what a woman had to say on the matter. 

Firstly, pointing out what women are forced to go through to meet a silver screen ideal does not negate the experience of men who are put in a similarly unhealthy position. Christian Bale nearly died when he lost weight to play a desperate insomniac in The Machinist and people were, rightly, shocked when they saw his skeletal form in the film, 

Secondly, it is the disproportionate numbers that make the situation especially absurd for women. When men lose weight or bulk up for roles, it's pretty much always integral to the role, such as Robert De Niro as a boxer in Raging Bull, Russel Crowe in Gladiator, or Robert Downey Jr for the Iron Man series. 

Actresses are, however, forced to lose weight, usually off already slender bodies, to play lawyers, waitresses, teachers, stay-at-home mothers and so on and so forth... It's not the same as losing weight to play a ballerina or a gymnast. It's pathetic that this is considered simply part and parcel of being an actress, as if people will stay away from the cinema in droves if the lead actress is anything bigger than a size 8. 

We never heard Tom Hanks pontificate on losing weight via a diet of dried apricots and birdseed for Bridge of Spies or Liam Neeson forcing himself to hit the gym for several hours a day to play a single dad in Love, Actually.

Whether it's about slagging off a woman for paying the ultimate price for protesting, or actresses whittling themselves down even if there is no real reason in the script for doing so, it's still sexist bullfuckery. It is about keeping the focus on women's bodies, regardless of their size, when there are more important things to be discussing - but woe betide the woman who discusses the important things while not being in possession of a wasp-like waist or cellulite-free thighs. 

It's about putting women in their place - and that place is a skinny box where they are inoffensive and quiet and, above all, not disruptive.




Photography by Georgia Lewis     

   

No winners in the tragic case of Charlie Gard

It is impossible not to be moved by the plight of Chris Gard and Connie Yates, parents of Charlie Gard, the 10-month-old baby suffering from infantile onset encephalomyopathy mitochondrial DNA depletion syndrome (MDDS). It is a cruel condition which causes progressive muscle weakness and brain damage. We have no real way of knowing if Charlie can feel anything because he can't see, hear, move, make any noises, breathe without the help of a ventilator or receive food without a tube. He is epileptic and his heart, liver and kidneys are failing.

At present, there is no effective cure for MDDS. However, specialists in the USA offered Charlie's parents hope in the form of an experimental treatment called nucleoside bypass therapy. Chris and Connie launched a fundraising appeal with a target of £1.3 million to cover the costs of treatment, which it passed after 83,000 donations came in.

But British courts and now the European Court of Human Rights (ECHR) have ruled that it is not in Charlie's interests to travel to the US for this treatment. This means that palliative care, including removing life support systems, allowing Charlie to quietly slip away, is the next step.

All courts which have heard the case have examined extensive medical evidence and have all come to the conclusion that nucleoside bypass therapy would have no real prospect of extending or improving Charlie's life. Those who are using this case as a stick with which to beat the EU are being absurd - if the Conservatives make good on their pledge to withdraw from the ECHR as part of the Brexit process, this option is gone forever. Without this court as an option, it is highly likely that Charlie would have passed away already.  

Nucleoside bypass therapy has never been tried on anyone with Charlie's gene before. In theory, the treatment could repair Charlie's mtDNA and help it synthesise so he is given the compounds his body is not producing naturally. So far, it has only been used with very limited success on patients, such as Arturito Estopinan, whose condition is not as serious as Charlie's and whose affected gene is not the same as Charlie's. 

The treatment is an oral medication which would be taken over a six-month period. A large proportion of the £1.3 million cost would involve the risky and highly specialised procedure to transport a gravely ill baby who cannot breathe on his own from the UK to the US, along with whatever the hospital would charge, and the costs incurred for Chris and Connie to stay in the US for the duration of the treatment. Money is also required to pay fees to the GoFundMe website, which has hosted the appeal - something for anyone considering an online fundraising campaign to take into account.

However, the neurologist who would be overseeing the treatment told the Family Division of the High Court that Charlie is in the "terminal stage" of his illness. He also said that the treatment will not reverse the brain damaged which Charlie has already suffered, and that he had not at first realised the full extent of Charlie's condition. The sad reality is that even if Charlie survived the trans-Atlantic journey, by the doctor's own admission, his life expectancy is heartbreakingly short and the treatment does not represent a cure.

Pope Francis issued a statement from the Vatican's Academy for Life in relation to Charlie's case which outraged many Roman Catholics, although I think he showed a combination of compassion, humanity and realism. The statement acknowledges that there are still limits to modern medicine saying that we do "have to recognise the limitations of what can be done, while always acting humanely in the service of the sick person until the time of natural death occurs". The statement goes on to refer to Encyclical Evangelium Vitae in regard to "avoid[ing] aggressive medical procedures that are disproportionate to any expected results or excessively burdensome to the patient or family".

I do not for a moment think the British or European justice systems are in the business of wanting to exterminate babies. And neither is Great Ormond Street Hospital, the excellent children's hospital which has been treating Charlie. It is one of the world's best paediatric hospitals and every day, it does wonderful work, saving the lives of children, and offering the very best palliative care for those who sadly will not make it to adulthood. Depressingly, people have publicly stated they will no longer make donations to the hospital because of the Charlie Gard case.

The Ashya King case has been cited as an example to follow in the case of Charlie Gard - that was the 2014 case of the parents of Ashya King removing him from a British hospital and taking him to the Czech Republic for proton beam therapy for a brain tumour. But in that case, Ashya, then aged five, was able to travel to Prague without medical assistance and the treatment was effective. The farce of an international manhunt for Ashya's parents was not a high point in crime fighting but as a result of the successful treatment Ashya received, the UK is to get its first proton beam therapy machine at a cost of £17 million. It will be installed at the Rutherford Cancer Centre and is expected to treat 500 people each year.

That is a wonderful legacy and the best possible outcome of the Ashya King case. The legacy of Charlie Gard will most likely be his parents starting a charitable foundation with the £1.3 million in donations - if this means further research for mitochondrial conditions can take place in the UK, who knows what amazing scientific advances might be achieved on British shores? 

For now, Charlie's case represents an awful intersection between the right of parents to seek medical treatment for their children and the often devastating realities of what is medically possible. Pope Francis again said it well in his statement when he said that "the wishes of the parents must be heard and respected, but they too must be helped to understand the unique difficulty of their situation and not to be left to face their painful decisions alone."

The case also exposes the astronomical costs of American healthcare for the uninsured, along with the decisions which balance finance with medicine faced on a daily basis by NHS trusts across the UK. Neither health system is perfect and, based on medical evidence, neither system is currently in a position to help Charlie beyond making his last days comfortable, peaceful and dignified.

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Here is the link to the Supreme Curt judgement

Here is the link to the Court of Appeal judgement

Here is the link to the High Court judgement

Photography by Lindsey Turner/Flickr

The day after the NHS march...

As most people in the UK are probably aware by now, there was a rather large march for the NHS in London yesterday. Most people know this because it actually was covered by the much-derided mainstream media, including the BBC, ITV, Channel 4, the Mirror, the Daily Mail, the Daily Express, the Evening Standard, the Guardian, the Telegraph, Sky News and Metro.

This did not stop the internet lighting up with people claiming the march was not covered or seeking out conspiracies where none exist.

"It's the mainstream meeja's fault!"

On the Big Up The NHS Facebook page, one person thought it was suspicious that the Evening Standard and the Mail Online used the same photograph, even though it was an agency photo which would be available to any major news outlet with a PA subscription, which is all of them. 

On the same page as well as on Twitter, multiple people pounced on the inverted commas used by the BBC in an online headline about the march, with "hospital cuts" in inverted commas. If anyone bothered to read the story, they would see that the inverted commas are used to refer to quotes from the protesters rather than any specific cuts and it is, therefore, accurate journalism, but the left-wing media bashers are not interested in accuracy or learning about how journalism works. They'd rather scream about media conspiracies, as if we journalists spend our spare time in a darkened bar, smoking unfiltered cigarettes, drinking whisky neat, and colluding with each other about how to create a Tory dictatorship. 

This is a shame because such paranoid nonsense only serves to distract from the very real issues facing the NHS. And speaking of distractions, one of the biggest and dumbest banners at yesterday's march, bafflingly, said: "SICK OF MEDIA LIES ABOUT JEREMY CORBYN". 

Firstly, Jeremy Corbyn's address to yesterday's march was very well covered, including by the right-leaning Daily Mail, Express and Telegraph. The brutal truth is that marches are usually not that interesting to cover unless violence breaks out. In terms of media coverage, you have images of marching, shouting people with placards and banners, footage or quotes from the speeches and, er, that's about it. From a journalistic point of view, it is pretty limiting as to what can actually be said about a march before it gets repetitive. So for yesterday's march to glean the coverage it did should be seen as a positive. Whining about media conspiracies makes campaigners look certifiable.

Secondly, that banner is absurd at a march specifically about the NHS. Campaigners who want people to seriously focus on the many things that are bringing the NHS to its knees and want to attract people of all political persuasions - as well as the apolitical and apathetic - need to look outside the Corbyn-loving echo chamber in which many of them are stuck. These people (and I hasten to add this is not all NHS campaigners) need to realise that NHS campaigns which come across as Corbyn fan clubs, when he is simply not resonating with people outside the Labour Party and Momentum in particular, will not be effective.  

And then it gets complicated...

On top of all this, the Health and Social Care Act 2012 devolved all responsibility for health services to local Clinical Commissioning Groups (CCGs) and that is where the real lobbying and engagement needs to take place, with elected MPs and local councillors along to ask hard questions about where money will be spent in their regions. In theory, CCGs make sense - the healthcare needs of a seaside retirement town will be vastly different to an inner city borough of young families, for example, so one size does not fit every area. 

That said, the basics such as accessible A&E, cancer treatment, and GP services should be available to people equally across the country - although in the case of GP services, this also varies between different areas. The retirement town won't have the same demand for GP services on evenings or weekends that the inner city area full of time-poor working people will. 

If the message that engagement is required locally at CCG level as well as nationally has not been properly communicated to the wider community as a result of the march, better communication from campaigners is required. This is also needed from Labour at all levels if they are serious about being a proper opposition and forming a government at the next election. 

Yes, the future of the NHS is about adequate funding at the Westminster level, where plenty of MPs have vested interests in private healthcare, just as much as it is about CCGs being financially responsible and lobbying the government if there are local shortfalls, particularly if people cannot be discharged from hospital because of inadequate social care. The financial interests of CCG members are as important in this equation as that of MPs because right now there is nothing to stop members commissioning from businesses or non-profits in which they have an interest.

It is complicated and it is not simply about throwing money at the NHS if it will only end up mismanaged at a local level and the CCGs are not held accountable. 

Do not be naive - we will have a Conservative government in this country until at least 2020 and therefore we will have CCGs at least until then.

So, what next for the NHS?

What happens next for the NHS will depend on what is seen as politically expedient because, like it or not, the NHS is political. 

It is pretty clear that there is an appetite for destruction when it comes to the NHS under Theresa May's government. If she genuinely cared, one of her first orders of business would have been to ditch Jeremy Hunt, the failed marmalade mogul who has been play-acting at the Health Secretary job since September 2012.

The government is smart enough to know that British voters will not stand for a complete replication of the American system. While there are always calls to charge so-called health tourists for NHS services, the free-at-the-point-of-use mantra has been effective. Except it has been effective for the Conservative Party and this is a hurdle for the opposition.

The privatisation conundrum

As long as health services remain free at the point of use and people are not filing for bankruptcy because of medical bills, it is really hard to get people to care about whether the services are being provided directly by the NHS or the NHS has farmed it out to a private company.

On top of this, Corbyn's rhetoric about stopping all NHS privatisation is simplistic. For starters, GPs have always been privateers. Any attempt to nationalise GP services, forcing GPs to work certain hours and potentially reducing the flexibility for GPs to work part-time, will result in a shortage, particularly among GPs who are parents - this will disproportionately affect women GPs so hardly a great victory to be had there. 

The big financial pressure here is the cost of administering the tender process, with estimations between £4.5 billion to £10 billion per year. But if we keep farming out services - which can be anything from cleaning the loos to cancer treatment - the government has to run a proper tender process, which is not cheap. Thus the government needs to acknowledge that this will be the case as long as services are open to tender - this is not an expense it can pretend doesn't exist.

Additionally, the NHS is not subjecting private companies involved in bidding for contracts to the same freedom of information rules that government departments are subjected to - so this makes transparency much harder. Indeed, I tried and failed to get solid information from my local hospital trust on whether the rise in MRSA infections had anything to do with farming out the cleaning services to a private company, but I was stonewalled. This government is not going to do anything about this given it already has form in trying to restrict existing FOI access. 

Similarly, there doesn't seem to be any bans on companies being able to bid for or keep contracts after catastrophic events. G4S should have been banned from any government contract after the Olympics security debacle and they continue to run the patient transport services at my local hospital despite killing an amputee in one of their vehicles owing to insufficient staff training. Virgin, meanwhile, has also done an abysmal - and lethal - job of running the Urgent Care Centre at Croydon University Hospital, yet continues to hoover up NHS contracts, including a £700 million contract over 200 hospitals late last year. 

These are fundamental problems with the way things are run at the moment but even if all NHS services were returned to the NHS, the NHS still has to procure stuff it can't make itself. 

It is absurd to expect the NHS to set up its own factories for bedlinen, cutlery, crockery, windows, uniforms and the thousands of other things it needs to purchase in order to function. 

While one idiot once said to me with a straight face that the NHS will indeed make all its own things once the workers control the means of production, that is clearly ridiculous. Instead, the NHS should use its huge purchasing power to get the best possible deals on all it procures. There is no excuse for waste here and the NHS will continue to buy stuff from private companies. Sorry, it will. It's just that the procurers should do a better job of it.

The technology conundrum

Actually, this should not be a conundrum at all. If there is good technology out there that can contribute to saving lives, money and time in the provision of healthcare, the NHS should look into procuring it for the best price possible. 

I have noticed a rejection of technology among elements of NHS campaign groups. There was a placard at yesterday's march that said "TECH IS CHEAP BUT AN APP CAN'T WIPE YOUR BOTTOM". This is very true - there will always be a need for human beings in hospitals to perform such tasks but if there are apps that can improve the way care is provided, this should be looked into.

I've seen NHS campaigners complain about advances such as telemedicine, even though it can be used as a way to improve access to care and relieve pressure on GP surgeries. Again, it cannot always be used as a substitute for an in-person physical examination but it can play a role and this sort of thing should not be dismissed out of hand.

I suspect nostalgia for the good old days of the NHS comes into play here instead of recognising that society has changed since the NHS was established in 1948, the population has increased, amazing advances have been made in medical science, and technological changes have happened and a modern NHS needs to be about making all this work for everyone.

And again, if there is technology that can be used to improve patient care, it will have to be purchased from private companies. Like I said, Corbyn's anti-privatisation rhetoric is simplistic.

The Australian model?

As I said, if services are still free at the point of use, there are millions of people who won't care if the services are provided by a private company.

What I do see happening is a move towards the hybrid Australian system rather than an all-American system, with a mixture of public and private services side by side. I dared to suggest this on a local campaign Facebook page last year and was howled down. I never said the Australian system was perfect in my comments, merely that, as someone who has experienced both the Australian and UK systems, I could see the trends happening over here.

It is important to bear in mind that just as we have postcode lotteries with care in the UK because of differences in how CCGs spend their money, the American system is actually multiple systems on a state-by-state basis - so to simply say: "We're going all American!" is also simplistic. We will see more involvement by American companies in the NHS, particularly if we are left wide open to this in a post-Brexit trade deal with the US. It is important to remember here that American companies are very nimble and thus good at adapting to trading in diverse markets. 

From McDonalds varying its menus across cultures to big oil companies making money in countries with a wide range of tax and regulatory systems, it's what American companies do. Healthcare is seen as no different by American companies.

Like America, Australia has differences in health systems between states but with public-private hybridisation across them all. I can see this Australianisation happening in microcosm form at my local hospital, St Helier.

St Helier could well lose its A&E department in the near future, which will be disastrous, forcing people to spend longer in ambulances or in traffic or on public transport seeking medical attention. 

But I predict it will keep its maternity unit, bolstered by its expanding assisted conception unit. Currently, IVF patients undergo pre-IVF testing and appointments as well as egg extraction at St Helier but the eggs are fertilised at Kings Hospital. The transfer of fertilised eggs also takes place at Kings. When St Helier's assisted conception unit expands to include its own embryology department, it will become a one-stop shop for IVF patients. Under local CCG rules, one round of IVF per patient is funded on the NHS but there is nothing to stop St Helier from receiving paying private patients - this should prove a handy source of income for the hospital and I suspect we will be seeing more and more of this across NHS hospitals all over the country. This sort of thing is not unusual in Australia and the funds raised from the private business helps keep the public services afloat.

The IVF example is an interesting one because, like privatisation but services being free at the point of use, it is also an example of what the public will tolerate here in the UK. In Australia, there are some Medicare rebates on fertility services but, by and large, it is an expensive undertaking with plenty of couples spending thousands in their quest to have a family.

It would not surprise me if, in the coming years, IVF on the NHS becomes virtually unheard of. I believe this is something the public will tolerate overall. Breast implants, unless they're for mastectomy patients, is another service I can see being chipped away, along with transgender procedures. Prochoice activists will also need to be vigilant about any attempts to limit abortion access - Jeremy Hunt has publicly said he'd like to see the time limit reduced to 12 weeks and if the government thinks it can save a few more pennies this way, or give the impression of being fiscally sensible, without taking too much of a hit on election day, I wouldn't put it past the May regime. Hunt was shot down in flames by people across the political parties last time but that was 2012. Britain has become a more conservative place in just five short years. 

I am not saying any of this is right - especially as such cuts would target women disproportionately - but it is the kind of thing this government can get away with if it doesn't anticipate harm at the ballot box. Hell, you've only got to look at Labour's catastrophic humiliation in the Copeland by-election, losing a safe seat to the Tories at a time when local maternity services are under threat to see what resilience this government has right now in terms of withstanding removing NHS services. 

The other Australian trend that has already gained plenty of traction here in the UK is increased take-up of private insurance. The advertising is ubiquitous, the deals often sound affordable, there is an increase in employers offering private cover as part of the package for staff. Around 50% of Australians have private health insurance, compared to an estimation of around 8.7% of people in the UK. Figures up to the end of 2015 show a surge in uptake of private health insurance in the UK. Again, plenty of people will not see this as a bad thing, especially if they find they can be treated faster if they go private.

Apologies for the long blog post

I have ranted for longer than usual this time but it is a complex subject. Just as there needs to be follow-up after the women's marches in the wake of Trump's election, there is a long road ahead if the NHS is to be preserved. I do not expect the NHS to survive in its current form and, despite yesterday's impressive march turnout, there is plenty that voters will tolerate in terms of cuts particularly if it doesn't affect them directly. Too old for an abortion? Not a woman? Intolerant to transgender people? These are the people who probably will turn out to vote in 2020 and they might not seek to punish the Tories over the NHS. 

It's a massive issue and none of it fits nicely on a placard.

Photography: Loco Steve/Flickr

The great Beach Body backfire

Bright yellow advertisements for weight loss products have improved/degenerated the commute for Londoners on the tube network in the past few weeks. These ads scream the stupid question: "ARE YOU BEACH BODY READY?" at us alongside a picture of a woman in a bikini looking both slim and impressive of bosom all at once. In other words, she possesses a body type few of us have thanks to Mother Nature, some of us will attain through assorted methods, and most of us will never have.

In reality, if you share the model's waist size, you are more than likely to be small-breasted. If you share her generous cup size, the rest of you may well be in proportion too. Of course, there are exceptions as there are no hard and fast rules when it comes to body type - and that is why it is ridiculous that body types go in and out of fashion over the decades.

The obvious answer to the stupid question is: "Yes, I am beach body ready. I have a body and I am capable of taking it to the beach where I will be ready to do beach-related things."

There has been an outcry over these ads. The Advertising Standards Authority received more than 200 complaints. The posters have been improved/vandalised by protesters. I saw one on the tube tonight that had "Stop objectification" written on it.

So what has happened as a result of the brouhaha? Sales of the weight loss products went up.

Of course they did. Proving that any publicity is good publicity, the winner is Protein World. Which sounds like the worst-ever amusement park.

The two most likely reasons for this sales spike are equally depressing. If people have decided to spite those awful feminists by buying Protein World products, they are a bit sad. They are probably the same idiots who hijacked the #FeministsAreUgly hashtag on Twitter.

And the other equally depressing reason why Protein World got a boost in sales is that people wanted to see what all the fuss was about, decided they were not "beach body ready" and, as a result, have been conned into buying a completely moronic product. We are talking about capsules and meal replacements. Short-term quick fixes.

It is a get-rich-quick scheme for Protein World that does nothing to promote learning to prepare healthy meals or the benefits of regular exercise. These shysters are selling crap like "green tea extract powder" for £12. You can buy 80 green teabags for £2.80 today at Sainsburys. They're even fair-trade teabags.

So it would seem Protein World is appealing to snide feminist-haters, uneducated consumers and people desperate for a quick fix rather than a healthy lifestyle change.

Changing your lifestyle is boring but it works out cheaper and more effective in the long run than replacing meals with a £62 package of "The Slender Blend" meal replacement potion and multivitamin capsules.

If you bought Protein World products because you hate feminists, the joke is on you. You are now the proud owner of stupid, overpriced supplements all because you wanted to make a pathetic point. If you were fooled by the advertising campaign and truly think replace meals with overproduced slop in a glass is the way forward, I feel sorry for you. You have been tricked by a marketing campaign where not only does the model have a rare body type, she also has the benefit of good lighting and possibly the miracle of PhotoShop.

Protein World and similar companies will continue to use such models for their campaigns. Of course they will. Let's be realistic. Ann Widdecombe will not be the next face and body of Protein World.

But that does not mean you have to be an idiot consumer. All this beach body brouhaha has demonstrated is that many people are easily fooled. And that is most depressing of all.




Photography by Gerhard Lipold

The three-parent baby panic

ZOMG! END OF DAYS! THREE-PARENT BABIES ARE NOW A THING!

To be more measured and less hysterical, the House of Commons and the House of Lords in Britain have passed amendments to legislation that will pave the way for fertility clinics to use a process during IVF called mitochondrial donation. Babies conceived this way would have biological material from three different people: a mother, a father and a female donor. The baby would have 99.8% of its genetic material from the mother and father and the remaining 0.2% would come from the donor. The donor would be anonymous and have no parental rights concerning the child.

Of course there are the inevitable howls about "designer babies", about how the inevitable outcome is vain parents greedily creating some sort of dystopian but very attractive master race. The reality is that the rules will apply to a very narrow range of genetic conditions. With careful regulation, this will help eliminate mitochondrial diseases that make people's lives horrific, as well as saving on healthcare costs. This is a good thing.

The 50 concern troll MEPs who wrote a letter calling on the European Commission to look into Britain's supposed "lack of compliance" can, with respect, bugger off. Likewise, the group of Italian MPs who urged the House of Lords to vote down the proposals can also take a long walk off a short pier.

What is particularly vile is the 50 MEPs claiming this amendment will "violate the fundamental standards of human dignity and integrity of the person." I urge these people to tell muscular dystrophy patients that their lifelong pain and drastically shortened life expectancy is essential to their human dignity. Perhaps sufferers of Leber hereditary optic neuropathy simply need to embrace the loss of eyesight from a young age for the good of their personal integrity. Maybe Leigh syndrome patients could learn to enjoy the dignity of respiratory failure and seizures.

Newcastle University's Wellcome Trust Centre for Mitochondrial Research has been instrumental in making this amazing medical breakthrough a reality. The research team, led by Professor Mary Herbert and Profesor Doug Turnbull, should be a source of immense pride for the north-east of England and for Britain as a whole.

Photography by Anna Langova

An open letter to anti-vaxxers

Dear anti-vaxxers,

I know you think you mean well. You probably even fancy yourselves as nice people. Indeed, if I came across you as I was going about my business, we would probably have a perfectly pleasant interaction as long as the exchange didn't involve a discussion on vaccination.

But your willful ignorance, your desperation for a conspiracy theory, your refusal to listen to a world of science from incredibly smart people who do not actually have vested big pharma interests, and your obscene, privileged posturing make you and your ilk terrible people. Sorry, but by refusing to understand and accept the importance of herd immunity in eliminating horrible diseases, you are being dreadful.

By promoting your selfish, anti-science agenda, you are putting vulnerable people at risk. Children with cancer. Anyone with a compromised immune system. The elderly. Newborn babies. People with allergies to vaccine ingredients. Children who are in between vaccinations, such as the series of injections for whooping cough. A story I wrote as a young reporter back in 1996 was about a child who contracted whooping cough in between shots in rural Australia. The sound of her little lungs struggling with a cough that sounded like someone choking a puppy is not something I ever want to hear again.

Do you feel good about yourself now?

You are pontificating from a place of modern privilege. You probably don't remember the awful era when entire families were wiped out by measles. Or when polio forced children into iron lungs. Or when the horrific menace of smallpox killed millions of people. Or when there were no rubella vaccinations to prevent children being born with life-altering conditions? In the last week, people in Britain have been moved to donate more than £300,000 to help a 67-year-old man who was mugged outside his house. His name is Alan Barnes and he suffers from serious sight, growth and bone problems because his mother contracted rubella when she was pregnant in 1947. But ensuring girls are vaccinated against rubella prevents these conditions being passed on during pregnancy.

It is because of vaccination that you probably don't know anyone who has suffered with polio or smallpox. It is because of vaccination that measles hasn't killed any children in your street. It is because of vaccination that child mortality is low in the developed world. Vaccination has made the world a better place.

But diseases such as measles and whooping cough are making a comeback that is about as welcome as a new Dennis Waterman album.

Spare me your lies about vaccination causing autism. It doesn't. And even if there was a connection, which there isn't, it is appalling that you'd rather have a dead child than an autistic child.

Spare me your citing of the Merck case as a reason to not vaccinate. I know that Merck overstated the efficacy of vaccines. But Merck is not the sole manufacturer of vaccines. And this case does not mean all vaccines should be banned. Your own exaggerations are like calling for all cars to be banned because one car manufacturer had a recall.

Spare me your whining about the evils of big pharma. I am not an idiot. I know drug companies make money from vaccines. But so many eminent scientists who are not on big pharma's payroll have conducted study after independent study on vaccine safety and risks (and yes, I acknowledge that, like any medicine, there are risks but the benefits far outweigh any risks). Immunologists and epidemiologists know what they are doing. They know that while you are freaking out about formaldehyde, they know exactly how much is required to make a safe vaccine and they know that not all vaccines contain formaldehyde and they know there is more formaldehyde in a goddamn pear.

Spare me your "I didn't vaccinate and my kids are perfectly healthy!" rhetoric. You fail to comprehend causation and correlation. And if your anti-vax dogma stays with them into adulthood, they may not be perfectly healthy if they travel to a country where travel jabs are highly recommended and they contract something delightful such as typhoid or cholera. Perhaps if your kids go to places where diseases that are largely unheard of in your backyard - and contract those diseases for themselves - they might learn the error of your ways. But, Christ, what a way to learn that lesson.

Spare me your "But if your kids are vaccinated, why are you worried about my unvaccinated kids?" crap. Please at least try and understand herd immunity instead of being content to wallow in the arrogance of ignorance.

Do I come across as a bit rude? Do you feel as if I am shaming you for not vaccinating? Good. I am not here to spare your precious snowflake feelings because you are ignoring people of science who are way smarter than you or I, and you are instead devoted to a movement popularised by bloody Jenny McCarthy, and fuelled by stupid websites such as Natural Health News, Health Impact News and Mercola.

If explaining the importance of vaccinations to you through the lessons of science and history is not going to work on you, then I have no qualms about making you feel ashamed. If parents of vaccinated kids don't want your kids around, perhaps you can take the time you would have spent ferrying them to playdates to think about what you are doing to your kids and to other people.

You should be seen as a pariah, as someone who is on the wrong side of science and history.

Yours sincerely,

Georgia Lewis, a successfully vaccinated member of society since 1976.

Happy Australia Day to London's newest paramedics

To the Australian paramedics who are marking Australia Day by starting work for the London Ambulance Service, I say thank you. My hat is off to you all.

I'm sure you don't need me to tell you that there will be tough days ahead, that you will see awful things, that you may be called on the save lives in the event of another terror attack, and that you are not going to be resting on your laurels. You will also meet some amazing people who will restore your faith in humanity, both among your patients and your fellow staff members.

Some of you may not last the distance in the job and that is OK - working for the London Ambulance Service is one of the toughest jobs in this city. And I predict many of you will excel over here and go on to achieve incredible things even under trying conditions. I really hope you get to enjoy the great things about living in London on your days off - you will have earned that night at the theatre, the trip to the pub, a walk along the Southbank or whatever it is that floats your boat.

Twice I've had to call ambulances for people here in London and on both occasions, I was so impressed by the professionalism, compassion and skills of the staff. I saw paramedics quickly calm and revive one of my neighbours as she collapsed at a bus stop after a stressful time in her life, and treat another elderly neighbour who suffered a mini stroke with the good humour required when someone is ailing but does not want to go to hospital. I am proud that fellow Australians will be joining these dedicated people at a time when the London Ambulance Service is under immense pressure.

Indeed, A&E services in London and across the whole country are under pressure and many are under threat of closure. This will add to the stress of the job for the Australian paramedics who may find themselves having to treat patients in ambulances while queuing up for a cubicle at an overworked A&E department. This group of Australians will be joining the everyday heroes who already keep London's emergency services working perhaps as well as can be expected in this era of austerity, NHS mismanagement from on high, and abrogated responsibility from the Health Secretary.

It is impossible not to politicise this story for it is politicians, along with Clinical Commissioning Groups, who are making the decisions that will impact on the working lives of London's newest paramedics. Anyone who shuts down discussion on A&E departments on the grounds that it should not be a "political football" is usually someone who is responsible for undermining said A&E departments.

Here's hoping the Australian paramedics, along with those who are already working for London Ambulance Service, can just get on with doing their jobs. To see Australian paramedics on the news this morning starting work was a wonderful Australia Day alternative to the archaic, cloth-eared idiocy of Australian Prime Minister Tony Abbott awarding an "Australian knighthood" to Prince Philip. On the upside, as a republican, I hope this bizarre decision is just the boost the Australian republican movement needs after last year's royal visit led to Prince George being called "The Republican Slayer". Sorry, monarchists, but something has gone tragically wrong if someone who is not yet toilet-trained is influencing opinions on the state of the Australian constitution.

But I digress. Today is not a day to dwell on Tony Abbott's latest ridiculousness. It is a day to welcome Australian paramedics to London. May they love living and working here as much as I do.

20 ways to not be a dick in 2015

Happy new year! Here are a few tips on how to not be a dick in 2015. You're welcome.

1. Do not mistake UKIP for the party of free speech. They will only publicly defend your right to free speech if you agree with them or say something racist, sexist or homophobic because that means you have the "courage" to say what we are all really thinking. Apparently. This is also a party that is desperate for its members to stay off social media lest someone says something stupid.

2. On the same token, UKIP members can use their freedom of speech to say something stupid. Indeed, anyone can use their freedom of speech to say something stupid. Always remember that you have the freedom to ignore anything someone says that you find stupid. If you are seeking to silence someone, ask yourself whether this is because you feel threatened by what they are saying.

3. If you succeed in getting something banned that you don't like, do not act all surprised if something you do like also gets banned.

4. If you walk down the street with your face in your phone, do not get all indignant if you walk into someone. It is not their fault.

5. Before you blame immigrants for any problems with the NHS, bear in mind that the real cost pressures are coming from rancid PFI deals and the astronomical costs of administering the tender process for contracts.

6. If you whine about "BBC lefty bias", you will sound like a weapons grade bellend.

7. Vaccinate your kids.

8. Do not interrogate women without children about why they don't have children or when they might have children. It is none of your business.

9. If you are an MP, consider not giving yourself another massive pay rise this year. You also might like to consider paying for all manner of stuff yourself. Such as meals. And home maintenance.

10. Londoners! Unless it is the last tube of the night, there is no need to run for it or barge open the doors with an enormous bag of shopping just as they are beeping closed. There will be another train.

11. Refrain from eating oranges or mandarins on public transport. It's gross.

12. I am sure your children are adorable. They will be even more adorable if they do not ride scooters in supermarkets with narrow aisles and will be more likely to celebrate another birthday if they don't ride said scooters at speed on busy high streets. This and point number seven comprise the full extent of my parenting advice.

13. If you live somewhere like Dubai, a pet husky is a stupid idea.

14. The Duchess of Cambridge is not amazing. If you think she is amazing, you are too easily amazed.

15. Do not get all your news from one source. This will turn you into a moronic caricature.

16. I know it's an embarrassment of embarrassments rather than an embarrassment of riches when it comes to the talent of many MPs or potential MPs in Britain but it is still smart to vote. You never know. Your vote may even make a difference, especially if your MP has a tiny majority.

17. Don't whine about the death of the high street if you never actually use the shops on the high street.

18. Detoxing is a myth. We detox every day by doing a poo. But there is no money to be made in telling people this. Eat well, everything in moderation, et cetera et cetera. Boring but effective.

19. Similarly, if you don't eat sugar/gluten/meat/whatever food is declared lethal this week, that is your choice. But don't bore me with your sanctimony. I will continue to eat all of the above in varying quantities.

20. If another person's sex life is consensual, mind your own business. They probably don't want you to join in.

A draft speech by Jeremy Hunt that *might* have been found on the Cloud...

Good afternoon, everyone. Good to see you all looking so well in spite of it all.

I am here to announce a revamped NHS. In this age of the internet [NOTE TO ASSISTANT: DO WE STILL CALL IT THE INFORMATION SUPERHIGHWAY OR WILL THAT MAKE ME TREND ON TWITTER FOR THE WRONG REASONS???], we need to harness all the technology we can to save money [NOTE TO ASSISTANT: SHOULD I SAY "IMPROVE PATIENT CARE" HERE???].

As such, the NHS now stands for National Health Syberspace. [NOTE TO ASSISTANT: WILL THAT SPELLING CAUSE QUESTIONS TO BE ASKED ABOUT GOVE'S EDUCATION REFORMS???]

I am sure you have all heard about our cutting-edge plans for GPs to do more consultations via email and Skype. This country is the birthplace of the English language, of fine literature that has influenced the world over the centuries, so I know everyone will be able to describe their symptoms to their GPs over email with an almost lyrical level of descriptiveness. Indeed, I fully expect that one day an enterprising GP will compile his or her most eloquent patient emails for a most entertaining book. [NOTE TO ASSISTANT: WOULD THIS REPRESENT AN ENORMOUS BREACH OF PATIENT CONFIDENTIALITY???]

So I am fully confident that the people of this country will be able to describe such complex conditions as motor neurone disease and cardiac dysrhythmia with effortless ease!

And what could be better than only going as far as your webcam for a cheeky Skype consultation. In keeping with our fine tradition of saucy comedy, I am sure everyone is as excited as I am at the hilarious prospect of a friend or family member walking in just as you are bent over the iPad showing your doctor a particularly tricky anal boil or a booming yeast infection. Benny Hill would be so proud.

But, make no mistake, we are not stopping at email and Skype with the National Health Syberspace.

We will save millions of pounds [IMPROVE PATIENT CARE???] by launching a hashtag. Why should you be limited to seeing just one trained medical professional at a time when you can ask the opinion of millions of Twitter users across the world. Yes, tomorrow we will get #WhatIsWrongWithMe trending worldwide. This way, it will be easy to send your symptoms out to the whole world for easy diagnosis. Be sure to attach a photo for maximum retweets.

Send your photos of irritating rashes out to the Twitterverse! You will know in no time if it is a heat rash, measles, acne, chicken pox or shingles.

And who doesn't love a good Facebook video? The ice bucket challenge has been a jolly jape and we can't get enough of videos of someone else's kids dancing on the kitchen table to a middle-of-the-road radio station. So we will also be saving millions of pounds [IMPROVING PATIENT CARE??? HELP!] by simply urging you all to post videos of yourself, your family and your ailments.

We know there are some things that cannot be properly captured in a photograph or email so if you have a wheezy cough, a weeping sore or you are having a suspected heart attack or bipolar episode, just video it, post it on Facebook and tag the friends whose opinions you value the most. I am pleased to report this has already been happening to a certain extent, whether it is a clueless parent updating their status to inform the world their baby is running a temperature of 39º rather than going to straight to one of the A&E departments we have closed down, or an attention-seeking idiot posting something about a terrible headache in the hope of getting a lot of "u ok hun?" comments.

So why not go one step further and share fun videos of your symptoms on your Facebook page? Your friends and family care about you so they are best placed to advise on whether you really need to see a GP or go to hospital.

We want to embrace the internet as the NHS's main diagnostic tool. After all, who hasn't turned to Doctor Google in the middle of the night to self-diagnose a potentially life-threatening condition? And we can save even more money [DO I MEAN TO SAY "IMPROVE PATIENT CARE" AGAIN HERE? THIS IS TRICKY] by hoping and praying that more people's health-related Googling leads them to homeopathy websites where they will simply spend loads of money on insecure websites buying useless potions or discovering the healing power of rainbows.

It is an exciting new future for the new, improved National Health Syberspace. If you have any questions about this state-of-the-art initiative, please tweet me and I will not bother to respond because, frankly, I am too busy tweeting patronising bunkum about how I spent an afternoon with the "hardworking staff" of an A&E department in a safe Tory seat at its least busiest time.

The great NHS game of whack-a-mole...

Yesterday was a somewhat astounding day. I'd been interviewed by the Sutton Guardian as part of a campaign I am involved in to keep the services of St Helier Hospital, a hospital which has been serving my community since 1938. A local Liberal Democrat MP, Tom Brake, blocked the Twitter account, @Save_St_Helier, which I manage as part of the campaign. Apparently, this strategy seemed like a more reasonable course of action for Brake in lieu of answering our questions about his online petition and his voting record in the House of Commons.

The media loves a good Twitter spat these days and the Sutton Guardian ran an article with a rather unfortunate headline - a throwaway line I'd uttered in which I likened Brake's behaviour to that of a schoolgirl became the lead. Cue an angry mob who clearly wanted to burn me as a sexist witch. Sigh... Thankfully, there are enough sensible people out there who joined in the comments at the end of the article and were able to steer the discussion back to real issues about Brake's lack of accountability.

I spent a lot of yesterday regretting that I'd put my mouth into gear before engaging my brain but I certainly do not regret calling out Tom Brake on his avoidance of perfectly reasonable questions. And, frankly, if me likening him to a schoolgirl is enough to get open, uncensored conversations happening about the questions he refuses to answer properly and publicly then so be it.

Brake has been running his online save-the-hospital petition for such a long time now that it is addressed to a group that now has a new name but he hasn't updated it. Brake has not answered our questions about exactly who will receive the petition, when this might happen, where it might happen or what he does with the data of people who have signed in good faith.

Likewise, he has not explained why he believes voting for the Health and Social Care Act 2012 or Clause 119, both of which have led to St Helier Hospital's services being under threat as part of the top-down reorganisation of the NHS which represents yet another broken election promise by David Cameron.

If you truly believe that a Conservative-led coalition is a win for smaller government and less bureaucracy, you are deluded - the NHS is now more bureaucratic than ever and, as a result, my tireless but tired band of campaigners in South West London are fighting to make people aware of Clinical Commissioning Groups (CCGs), because they hold the aces here when it comes to closing or downgrading services such as A&E, maternity, renal and children's intensive care.

It is really damn hard to make people concerned about CCGs and the powers they have.

And trying to get straight answers out of CCGs, not to mention hospital trusts, about our services and how they are spending/wasting our money is frequently akin to getting blood from a stone. And then there is the challenge of trying to distill the information they put out into plain English so we can raise awareness as to what is going on.

Then there is the narrative of austerity - that the only way we can afford the NHS is to make cuts - and, in the meantime, hospitals are being run into the ground. Your local hospital may not be cleaned as often or as thoroughly as it was before because cleaning contracts have been outsourced to companies that are more concerned with making a profit than preventing MRSA outbreaks. You may not be served by nurses who work full-time at your local hospital because they may have been supplied by agencies. And, even when staff are working hard and trying their best, they may be overstretched.

And then people complain. They don't necessarily complain via the official channels because these days many people would much rather just whine on social media instead. And in the meantime, it creates a public appetite for closing hospitals. Or merely apathy. And apathy is all that is required for essential services to be slashed without resistance.

You might not notice at first. But the system is being chipped away. The easiest way to do this - and for government to wash their hands of accountability - is to outsource services to the private sector. This has led to the awful G4S - the company whose attempt to run security at the 2012 Olympics was embarrassing and led to thousands of British Army soldiers being drafted - nabbing millions of pounds worth of NHS contracts. After the G4S Olympics debacle, I have no idea why this company would be trusted to run a pub raffle, let alone anything as important as healthcare services. Indeed, G4S is running the non-emergency ambulance service at St Helier Hospital and this has already led to an unnecessary death.

And private companies are exempt from Freedom of Information requests, so this adds another brick wall for anyone trying to find out how our money is being spent.

The CCGs in my end of London used the services 20/20 Delivery, a consultancy firm, when they were involved in the wasteful Better Service, Better Value (BSBV) review of local healthcare provision. BSBV cost taxpayers at least £8m and more than £1m went to 20/20 Delivery but when I tried to find out exactly what 20/20 Delivery did that cost so much public money, I could not get any answers.

Congratulations if you've read this far. Are you wondering why I am telling you all this if you don't live anywhere near St Helier Hospital? It is because the same story of CCGs proposing cuts and downgrades is probably happening near you too.

I have been in touch with other campaigning groups across the country and the same stories keep cropping up - unaccountable CCGs, childish Twitter blocking, very real threats to cut A&E and maternity services, cuts that will result in people spending longer in ambulances, cuts that will result in women in labour having to travel further to give birth, services being outsourced to substandard private companies, private companies that make political donations winning contracts, private companies in which either politicians or CCG members have vested interests winning contracts...

Across the country, campaigners are dealing with the same convoluted mountain of nonsense - it is deliberately convoluted because the powers-that-be do not want people to be aware of what is happening. It can be hard to know where to direct your wrath when the Health Secretary is a remote figure in Whitehall, unless the failed marmalade entrepreneur decides to activate Clause 119 and close your local hospital within 40 days.

It is a giant game of whack-a-mole and it is being played with our health services.

Then there is the big distraction of health tourism outrage. It makes for lovely Daily Mail headlines even though it only costs 0.06% of the total NHS budget. Sure, there is a case for ensuring people who are not entitled to NHS care pay for it but some perspective is needed.

And as long as the health tourism drum is beaten on front pages as if there is a queue of illegal immigrants demanding free breast implants at every hospital, that takes the focus off the real financial drain on the NHS - PFI contracts. These Private Finance Initiative contracts were introduced under John Major, their inking went nuclear under Tony Blair and Gordon Brown and the current government is in no rush to stop them being signed. These result in the public footing the bill for one hospital for the price of many, over and over again, across the country. This, in turn, renders PFI hospitals too big to fail and other nearby hospitals end up facing cuts.  A full public inquiry into these rotten contracts is the only way forward here. Do we dare to dream of this appearing in the manifesto of any of the major parties?

But I suspect the powers-that-be know that it is hard to maintain the energy for campaigners to fight for their local services while maintaining the rage about the bigger, wider issues, such as expensive PFI contracts. The little battle going on in my backyard is one of many across the country and those who are still raging that I likened Tom Brake to a schoolgirl need to get a grip. There are bigger fish to fry and if Tom Brake's apologists cannot see that he is trying to stop the fish even making it to the pan in the first place, we are going to lose vital services.






Photography by George Hodan

10 reasons why I am maintaining the hospital rage

Back in May, I wrote about the threat to St Helier Hospital in my pocket of South West London. Under the "preferred option" cobbled together by a group under the Better Service, Better Value (BSBV) umbrella, we have the prospect of both St Helier and Epsom hospitals losing A&E and maternity units. St Helier would also lose its renal unit and paediatric intensive care and its hip fracture clinic, considered the best in the country by the National Hip Fracture Database, is also in danger because it is attached to the A&E unit.

Nobody with even a passing interest in the politics of the NHS would be surprised to know that this is all about money, in particular, saving money across a swathe of hospitals that serve an area of London where the population is both growing and ageing.

Since May, there has been a small victory. The consultation period was going to take place over the summer holidays, when people are often away and when consultations such as these are not meant to take place. This has been postponed until at least November. At this rate, it might just keep getting pushed further and further back until the next election rolls around and it may then become a moot point.

But this is not a time for complacency. It would be an anti-climax if it did become a moot point. However, the whole sorry process may not be abandoned and campaigners need to maintain the rage and keep up the pressure. Since May, the @Save_St_Helier Twitter feed has been very busy with challenging questions being asked of whoever manages the BSBV Twitter feed.

These 10 points are reasons why I am still angry as are so many people in my area.

1. BSBV claims that existing staff will be better deployed rather than either any investment in new staff or any job losses to save money (despite the whole process being about saving money). This may sound reasonable until you realise that it wouldn't matter if there was one gigantic hospital to serve the area or there was a little hospital on every street, the fact remains that there simply are not enough members of staff. The whole plan does nothing to address the issue of not enough junior doctors going into emergency medicine.

2. BSBV is extremely GP-heavy in its membership. While the rhetoric about more care in the community and a smaller number of A&Es again sounds laudable, one of the biggest issues is, quite simply, access to GPs. It is easy to bash GPs as lazy but when people have to wait a week for an appointment, it is obvious why many non-urgent cases end up overburdening A&E departments. We need more examination of innovative solutions such as group consultations for patients at risk of diabetes. This is working well at a GP clinic in Smethwick and it is this sort of creative thinking that prevents more cases of diabetes and reduces pressure on A&E departments.

3. If St Helier and Epsom lose A&E and maternity departments, the already-overburdened St Georges Hospital in Tooting will receive a massive multi-million pound upgrade. If you ever visit St Georges, you will find that parking is a nightmare and it is hard to see where the hospital can expand significantly without the compulsory acquisition of neighbouring homes. When asked how the cost of such a huge upgrade was arrived at, we were simply told "capital estimates". There has been no response to the question of whether these estimates were based on real quotations from architects or construction companies. We have been told that such massive work will "pay for itself in five years". We are still not sure if this is five years from now or five years from 2016, when St Helier and Epsom are slated to be downgraded under the preferred option, or five years from whenever construction might start at the already chaotic St Georges site.

On nine occasions in one 12-month period, St Georges had to divert ambulances to St Helier because it could not cope - BSBV is alarmingly calm about this and claims that the upgrade to St Georges will mean this won't be a problem if St Helier is A&E-free. I wish I knew where they keep their crystal ball.

And remember, the money needed to upgrade St Georges so it has any hope of coping with an increased flow of patients is taxpayers' money.

4. The plans to upgrade St Georges are made even more farcical by the fact that St Helier is in the midst of a massive upgrade. Already, £5 million has been spent on St Helier's A&E and £2 million on maternity and there is a big banner across the front of this Art Deco monolith proclaiming the hospital is in the midst of a £219 million upgrade. There have been no satisfactory answers as to what will become of this ongoing project if St Helier is downgraded. The giant banner really needs to come down with much fanfare as it is lulling local residents into a false sense of security about the hospital's future.

And remember again, the money already spent upgrading St Helier is taxpayers' money.

5. Mr Hassan Shehata is one of the best obstetricians in the country. He is the Joint Director of Women and Children's Services for the Epsom and St Helier NHS Trust. He has been instrumental in the creation of RCPG guidelines for maternal care. Yet he is being ignored by BSBV. This is probably because he has repeatedly and publicly stressed the urgency of getting women in labour to hospital quickly, especially when things go wrong. Here is a letter he wrote for the local paper about how in some cases, five minutes can be the difference between a good and bad outcome for some women. But if St Helier and Epsom lose their maternity units, women in labour, an event that can change for the worse very quickly, will have to travel for much longer than five extra minutes to get to a maternity unit.

Indeed, just last week a local woman gave birth in the car park of Epsom Hospital where she was then fortunate to be taken in to receive excellent medical care by that hospital's maternity unit. BSBV have not responded to my question as to whether she would have had the same outcome if she had to travel all the way to St Georges. Maybe the BSBV crystal ball wasn't working that day.

6. One of the oft-repeated comments from BSBV is that there are better outcomes for some patients if they spent longer in an ambulance and are taken to specialist A&E units, such as specialist stroke, trauma or cardiac units. This is already happening. It won't be something new that will suddenly start happening after St Helier and Epsom lose A&E units. But for the many, many cases, such as asthma attacks, bumps to the head or serious but not necessarily life-changing fractures, the nearest A&E is generally the best place to be. It is all well and good to constantly cite the case of star footballer Fabrice Muamba as an example of a patient surviving because he went to a specialist cardiac unit further away from where he collapsed - but his is an extreme case. And any similar cases to his are already being treated in this way.

7. If St Helier and Epsom lose A&E departments, they will be downgraded (and it is a downgrading, no matter which way you cut it...) to Urgent Care Centres (UCC). It is hard to get a clear definition from the NHS website as to exactly what treatment you can expect from a UCC. When I asked Dr Marilyn Plant, joint medical director for BSBV, about when patients should go to a UCC, she replied that this should happen when a patient "feels" their condition is not life-threatening. Right. So bad luck if you rocked up to the UCC rather than an A&E because you "felt" that your chest pain was a spot of nasty indigestion when it was in fact a heart attack. Whoopsie!

8. And while we are on the subject of these UCCs we can expect if St Helier and Epsom lose A&E, they may not be open 24/7 like A&E departments are. Understandably, this has scared a lot of people. So I asked BSBV about this. Here's the really freaky news - BSBV cannot guarantee that any new UCC will be open 24/7 and it is up to local Clinical Commissioning Groups (CCG) to determine opening hours based on "clinical need". Firstly, BSBV is, as they are fond of reminding us constantly, largely made up of CCG members across a number of trusts but at the same time, BSBV is not prepared to commit to a guarantee of 24/7 opening hours. Secondly, it again seems like a case of the BSBV crystal ball working overtime. The minimum requirement for UCC opening hours is just 12 hours a day. It is intriguing that BSBV is confident people might not need urgent medical attention outside of certain hours. Because that's how it always works in real life...

9. As we are maybe - or maybe not - leading up to the consultation period, it has also become difficult to get any straight answers about what this means for the ongoing privatisation of the NHS. Croydon Hospital, one of the hospitals affected by the BSBV review, already has an UCC run by Virgin. But if anyone dares ask if St Helier or Epsom will also have privately run UCCs, the answers are vague and unclear. Indeed, Dr Marilyn Plant herself was interviewed on video for the local paper and she kicked off proceedings by saying she didn't want to talk about privatisation. We get told that any facilities will still be free at point of use for patients but we are not getting any confirmation as to whether such facilities will end up making people like Richard Branson even wealthier. Many CCG members across the trusts involved in this saga have declared interests in companies such as Virgin, Assura and Harmoni. Is it a crazy coincidence that these people are decision-makers who are involved in determining how money is spent?

Once again, this is taxpayers' money.

10. Finally, the cost of the whole BSBV programme is a bone of contention that campaigners are, quite rightly, not prepared to bury. I aksed for a breakdown of costings - with a figure of £11 million being bandied about, I wanted details. But instead I was given a very basic breakdown of phases two to five of the programme, a grand total of a not-insignificant £6 million pounds but no breakdown of the first two phases. I asked again today about this and got another load of fobbing off - I was told this information wasn't kept by BSBV (because, hey, why would they bother to keep a record of how they're spending our money - that's just nuts!) and that it was on an old website but not the new website and then I was told to make an FOI request. Which isn't always free and can take at least 20 days. Finally, I received word today from BSBV that they would soon share this information.

This is the tweet they sent:

"It's a perfectly reasonable request though, so will access and publish phases 1 and 2 figures on our website."

Good to know that is is "a perfectly reasonable request" to access information about how taxpayers' money has been spent on a programme aimed at saving money in ways of which many clinicians are raising serious doubts.

I eagerly await this full breakdown of how £11 million has been spent. I do wonder if the salaries of the communications team will be outlined in this breakdown. This would be the team that blocked a local doctor's Twitter account but is not explaining why. Good to see that people being paid with our money are stifling free and open discussion at our expense.

If you have read this far, congratulations. I just hope that at least one journalist on a national newspaper or the BBC or Channel 4 or Sky News picks it up and runs with it too. I can only do so much from my little blog but I couldn't simply do nothing.



Image courtesy of Noel Foster.