Friday, 28 December 2012

Spotting the Signs

There is a new plan to spot abuse victims. It seems that hospital professionals did not have enough information and a new database will identify children who are at risk of abuse. According to one doctor this information is long overdue. Compare that with the news before Christmas that the health minister was 'disgusted and appalled' at NHS failings in Worcestershire which included patients going hungry and thirsty. In one case an 84-year-old man  starved to death in Redditch.

You don't need a degree or even an A level to recognise when someone is thirsty. You don't need a great deal of training to recognise abuse. What you do need is the confidence and authority to raise a concern. An increasing reliance on computers may relate to increased authority but it doesn't add to confidence. Has the professional checked all the information that is available to them? Do they have the time to check all available avenues of information? One answer is that they have to make time. Another answer could be that the signs of abuse are in front of them.

Taking a child from a parent is a really difficult decision and not one to be taken lightly. Maybe knowledge about a child's history would help but what the new database certainly does is add pressure to the work of the professionals. What it doesn't do is remove the necessity for making a decision, especially where the signs are there for all to see and all the database does is to add corroboration where none may actually be needed.

Pressure is added to the care role (see my blog on the pressure on nurses and the suicide of Jacintha Saldanha written on the 14th December) and that means the professional will find it more difficult to evaluate the patient's signs and symptoms. You don't need a plan to spot abuse victims just like you don't need one to feed patients. What you do need is a professional with the character to act. What we get are professionals who hide behind protocols and plans and forms that are filled.

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Tuesday, 25 December 2012

Piers needs our help

I was paying for some petrol last week and had a brief conversation with the person taking my money. She could not believe that Americans had gun laws that were partly to blame for the killings that took place in Connecticut. I agreed but mentioned that guns had their supporters and Michael Moore met up with Charlton Heston who was president of the NRA when he made his film Bowling for Columbine. He didn't get anywhere with Charlton and she had to be careful because gun owners in this country may not be in total agreement with her.

Yesterday Piers Morgan was not as careful and managed to upset gun owners. He got in trouble for criticising the views of Larry Pratt, director of Gun Owners of America on American TV and now 31,000 Americans have signed a petition calling for him to be deported. That's a lot of people. There is some reassurance in knowing that this is less than 1% of the American population but the NRA does have 4 million members. Even more worryingly "there were 88.8 firearms for every 100 Americans in 2007"

We need to show solidarity with Piers. He needs our help. We need a petition from the whole UK population saying that we don't want him back (nothing to do with his gun law views).

Merry Christmas

Sunday, 23 December 2012

All in this together

There are signs on the M6 that tell you whether traffic is flowing freely on the toll road and these signs are just before you have to make your decision as to whether you pay the toll. The toll road is usually free of traffic jams because most drivers choose to avoid paying and take their chance with possible jams.

There are other signs elsewhere in the motorway system that tell you how quickly you will travel over the next few junctions but this information is not available near the toll road. Choice is hardly informed but you do know that you will be certain to avoid a jam by paying the toll. This is not a problem if money is no object. In this case the toll road has to be the best choice.

The news is that the government is looking at tolls to fund new roads so those who can afford to use them will pay for them. When David Cameron tells us that we are all in this together he must not be thinking of toll roads.

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Friday, 21 December 2012

The NRA's Considered Thoughts

The National Rifle Association, the NRA has spoken. Well they have left it a whole week since the  terrible shootings in Connecticut so there has been time for them to gather their thoughts and speak rationally.

According to the NRA's chief executive, Wayne LaPierre "The only thing that stops a bad guy with a gun is a good guy with a gun,"and he felt quite strongly that there should be an armed officer in every American school. He needs to apply more logic. No good guy with a gun stopped Adam Lanza. No good guy with a gun would have helped those in the first classroom even if they have been in the school. However it may be that the good guy isn't quite as good with a gun as the bad guy and the good guy is killed too.

This was an elementary school. Think how many gunmen America would need. They have holidays and sickness like everyone else. They also need support staff. Don't forget the activities after school and multiply the costs to ensure a good guy is present at all times. Let's say the NRA get their way and there are thousands of armed police. Now think of another institution, any institution. What happens if a gunman goes there?

The NRA have gathered their thoughts and this is the best that they could come up with.

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Thursday, 20 December 2012


Would you be more concerned if your child used the F word or a word like pleb? I find it hard to believe that Andrew Mitchell's friends are trying to say that an injustice has been done because there may be doubts about whether a police officer acted as a witness. Mr Mitchell has never denied using the F word. He should count himself lucky that he was not arrested as there are many who would have been for using this type of language.

According to the BBC, 'senior Downing Street source told the BBC that Mr Mitchell was in a "much stronger position" following the latest developments in the plebgate story' but this report also tells us that there was "no reason to doubt the accounts of officers directly involved in the incident".

Let's guess that Andrew Mitchell actually said "plod", and the policeman misheard. Mr Mitchell would have been glad of that because it allowed him to say, correctly, that he had never used the word "pleb", while diverting attention away from the true issue which was his swearing and his denigration of a police officer just doing his job. The media, in turn. would have been happy to run with that because they could hardly call it f*'%#£&gate.

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Friday, 14 December 2012

Time to support nurses.

I almost wrote a blog last week about the suicide of nurse Jacintha Saldanha, but as is my wont, I looked to my advisory group for their comments (I spoke with a couple of people) and the advice given was that my blog should not detract from criticism of the hoax callers in Australia. Now you see how each of my blog entries is carefully crafted. My emphasis was not on the mistakes made in Australia. The hoax callers were wrong. Every time someone pulls a prank it may not be appreciated by the person on the receiving end. Many pranks are harmless and funny, for example Candid Camera and Dom Joly, but what would have happened if the mask came off to reveal Jeremy Beadle and the practical joke ended in a heart attack? In this case the hoax callers had done something much worse. They say they didn't want to hear confidential information but they did, and then the radio station used it. They should have known that hospital management would have to act against their staff.

Everyone knows that the Australian DJs went too far. However my emphasis in the blog was with the reaction from the King Edward VII Hospital. Something wasn't right. We were continually hearing reports that no disciplinary action was being taken and the hospital had shown full support to their staff. Why? Their significant errors meant that private information was given out. The nurses should have faced some action from management. I didn't wish to criticise nurses but this is why I was given the advice not to publish. I wanted to highlight the underlying pressures caused by general working practice.

Every breach of confidentiality is important but when the hospital deals with celebrities then confidentiality becomes so much more important. Errors will always happen however good the training and protocols but you would expect a greater emphasis on this sort of training in a hospital like King Edward VII. How often are nurses in this hospital trained to deal with possible journalists? Sometimes a patient will not want other members of the family to know what is happening to them. There must be protocols to identify how information is given out. I would even expect codes to identify those to whom information may be given. Personal contact or no phone calls to the hospital may be needed for the specific protocols related to celebrities including members of the royal family. And that's what was odd. The hospital must be partly to blame. Nurses work under a great deal of stress as it is your life in their hands. Management have a duty to their nurses but they surely have a higher duty to their patients and confidentiality must be high on that list.

On Sunday Andrew Marr interviewed Peter Carter of the Royal College of Nursing. It wasn't about the royal hoax but Peter was briefly asked about the suicide. He had no wish to speculate on this particular case but immediately blamed the hoax callers. What about the significant level of pressure that all nurses work under? What about the denial of pressure by hospital management? What about the Peter Carter's answer which deflects blame and doesn't recognise this pressure?

Nurses make mistakes. If the mistake is big enough then it will end their career. Nurses do an excellent job but they are under pressure. It won't be helped when hospital management doesn't recognise it or at least refuses to acknowledge it.

And the reason why I am writing now? It is because Jacintha left a suicide note which criticised the way the hospital treated her following the hoax call - and this is the same management that said it was fully supportive. Time to recognise what support for nurses really means.

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Ed on the wrong track

Later today Ed Miliband is going to talk about integration. He may say a lot of sensible things but what is making the headlines is that public sector workers should speak fluent English. The trouble here is a definition of fluent because speaking easily and accurately is often difficult to assess and we don't have pass or fails when we speak with others. I can get my points across in French. You may think that makes me fluent but others may not. There are many words in French that I cannot translate. Conversely there are many words in English that I don't understand.

 It would not be difficult to trip up anyone regarding their command of English. The main problem is not a definition of ease and accuracy, and we are all on a sliding scale of ability, but how the general public feel about immigration. The first reaction will not be whether you have a stutter or whether you have a wide enough vocabulary to deal with the public. It will be that foreigners are coming here, they can't speak English and they are taking our jobs. If this is Ed's intention then he has succeeded. The trouble is that these 'foreigners' may well speak a better standard of English than many who are born in this country.

Everyone will have a story where they have had trouble communicating with someone whose first language was not English. Ed is tapping into this difficulty and may well win votes. He won't improve racial tensions.

The answer is firstly to treat people on merit and to ensure that people in a public sector role have all the essential skills for that role. The second answer is to treat people as you would wish to be treated. I was a physiotherapist for many years and if I had wanted to work in France then I would have to ensure that my language skills were good enough. I was not barred but if Ed had powers over Europe then he may well want to put a stop to my freedoms.

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Thursday, 13 December 2012

The frack is back

Fracking is back today in the UK. It has been reported that earthquakes were caused by fracking, so fracking was halted. New restrictions are in place to minimise the risk of seismic activity but it would be interesting to see the details of these restrictions as earthquakes are notoriously difficult to predict. It must be less difficult to attribute cause because that is what has been done with shale gas exploration. As for the restrictions, are they going to just create little explosions so that we don't get earthquakes? Are they going to gently 'inject' water, making it sound like a doctor is using a hypodermic needle, or will they still be using the phrase hydraulic fracturing which doesn't sound quite as nice.

Listening to Radio Lancashire this morning one listener felt we had to listen to facts, not opinions and then told us that water supplies would not be affected where the drilling is taking place because water does not run upwards. The contaminated water will simply drain away. However these are exploratory wells and there will be many more sites if drilling is successful - and water is contaminated in the USA. At some point the fields of shale gas must impose on water supplies.Yes water comes from the sky and falls on the ground but high pressure is moving water and gas to places where they shouldn't be going.

I have just read Schumacher's book Small is Beautiful which was written in the 1970s. He is an economist and looks closely at the environmental aspects of our planning. Generally the environmental aspects are ignored and success is based on whether a product is cheaper. We don't appear to have learned much in the last 40 years and we don't appear to be calculating the cost of seismic activity.

Is shale gas going to lower bills? This isn't likely as energy prices are controlled by global factors. If energy prices go up then shale gas prices will go up and profit will go to the private companies. In fact George Osborne is considering tax incentives for drilling companies

There are environmentalists who have many concerns about fracking. There are scientists who support  fracking who tell us that we have to use the shale gas resource. Schumacher's book made a lot of sense to me. He would be asking us to put a value on the environmental costs but these costs appear to be ignored. We continually strive for an expanding economy with expanding energy demands whilst using more and more of our limited resources. The standard answer is that those resources are there for using but we need to have reservations about the direction in which society is heading. Just because an energy supply is cheaper (without calculating the cost to the environment) doesn't mean that we have to take it.

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Tuesday, 4 December 2012

Animal Experimentation

I was listening to Victoria Derbyshire on Radio 5 this morning and she was presenting the show from an animal research laboratory. We heard descriptions of procedures that were being carried out and we heard the views of those who supported animal experimentation and those who didn't. Those who supported the experiments said they were useful but didn't mention any experiments that had been a waste of time. Maybe they think that negative tests are useful too. Those against said that testing wasn't useful and we shouldn't be using animals anyway.

Well either animal experiments are useful or they are not. There doesn't seem to be any middle ground here so it is surprising to hear this level of argument. Dogs were used to discover insulin so if you have diabetes, and even if you don''t then you may find yourself on the side of animal experimentation. The counter argument may be that dogs were not required but I would find this a difficult case to argue.

There was great discussion as to whether mice had to die in order to experiment on their embryos. Could an operation be carried out that allowed them to live after donating embryos to research? I had an image of teams of surgeons and anaesthetists working on thousands of mice but Victoria felt this was a valid question. Mice have short lives anyway, and in the outside world the end would normally come painfully, from a predator or disease or a mousetrap or poison. Think of the absurdity of surgically saving these mice at great expense, only to euthanize them shortly thereafter.

There appears to be stringent criteria to animal experimentation. The main argument against the tests is that we should not be treating animals in this way but I would find a stronger argument against the way we treat farm animals. Protestors have chosen to concentrate their efforts on laboratories rather than farms because here they hope to find more public support, not because animals face worse treatment.

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Should we ban fracking?

It can be argued that the earth has plenty of reserves of energy. We have enough coal for many many years and gas and oil are plentiful too. This may mean that we have to search further and further afield to get to these reserves but they are there. Then it can be argued that the date when we run out of fossil fuels can be put back because we will use other forms of energy like nuclear. Well there are much less reserves of uranium but they'll help to keep our lights on until the day we invent new forms of energy even if there are significant disadvantages to using nuclear fuels or for that matter to using fossil fuels.

Regardless of the advantages and disadvantages we see everything as viable if it costs less than the alternative, and as cheaper sources of energy go, the oil and gas produced by fracking is viable. Well it is if you believe the Cuadrilla Resources, the company involved in fracking in the UK. At the moment fracking is banned in the UK because it was blamed for two earth tremors in the north west in 2011. If you pump water and chemicals into shale rock at high pressure to extract gas then there must be at least a possibility of an earthquake. However earthquakes occur at any time at any place so I suppose Cuadrilla can blame the earth moving on an act of God.

Whether we have Cuadrilla supplying us with gas and oil depends on the cost. On Sunday their spokesperson said "Britain is spending tens of billions of pounds importing gas...We don't have infinite patience and our investors don't have infinite patience." In general economic terms, we don't want the company to lose patience because they are hoping to provide us with cheaper fuel. However if those two earthquakes are down to fracking then I presume that the company would have to pay for any damage.

I live in Morecambe and I felt one of those earthquakes that came from Blackpool where the drilling was taking place. If you need some pointing doing then there would be a small cost. If a new wall is needed for your house then costs would be significant. Drilling has not been going on for long but I have never felt any other earthquakes and I have always lived in the north west.

It seems that money is the big motivation for energy policy. I think there are more important considerations like the damage to the environment but even if you don't agree with me then you have to quantify the affect of driving water at high pressure into rocks that may move and then give that bill to the company.

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