NHS Public Health reforms.... empowering or undermining?

" After April 2013, public health budgets will be protected for the first time, with local authorities taking the lead for improving the health of their local communities. This will help drive local efforts to improve health and wellbeing by tackling the wider determinants of poor health."

(GOV UK website)

This shift of responsibility in the NHS reforms has created a turmoil of different feelings for me, and I am hoping this blog post will allow me (and you) understand why! 

This government quote suggests that public health campaigns tackle 'wider determinants of health'. Nature vs nurture? As we all know, although our genes may create a rough blueprint of how we suffer from ill health, it is the increasing number of unhealthy lifestyle choices that can kick us down in the future.

Public health is therefore a preventative technique that tries to tackle the cause of ill health. If it works, it should reduce the demand on GP's and hospitals and other forms of care. 

This is what bothers me about this responsibility shift - preventative measures are SO important, and the responsibility has been shifted to local authorities that do not have the medical expertise that the NHS has at its finger tips. 

This isn't to say that I like the idea...bottom up governance systems are usually more sustainable, local empowerment and all that, but have they not got enough on their plate? 

A great example of preventive medicine at work is in Cuba. During the US embargo, access to medicines was extremely limited so the government relied on preventative measures. It seemed to work, with an increase in life expectancy, but it cannot be ignored that a reduction in food and the need for a agricultural sustainability base greatly improved the populations lifestyles. There present day health system is very interesting, and I plan to dedicate its own blog post to it. 

The local authorities have not been left with the public health budget without plenty of guidance. NICE (National Institute for Health and Care Excellence) have produced briefings on the main subjects such as smoking, alcohol, obesity... check the website out for some rather worrying stats! There is also close cooperation with local GP surgeries and research using the life course approach (a multidisciplinary paradigm). 

Looking at all this information I think I still believe that the NHS may be best placed to tackle public health, but the local authorities have enough information and access to health care professionals that I am sure they can shoulder this great responsibility, and hopefully promote and create healthier living for all British people. 

Why O Why A Wendy House?

Taking a walk today I had one of my many 'why' moments to frequent me in my day. I saw a lovely 'Wendy House', the perfect garden scene with giggling children in their imaginary world - but where does the name come from? 

The first owner of such a house was Miss Wendy Darling from J.M. Barrie's Peter Pan. Wendy is shot down by a naughty lost boy Tootles and so Peter and his pals build a little house around her singing:

'I wish I had a darling house

The littlest ever seen,

With funny little red walls

And roof of mossy green'

In the original play John's hat was the chimney and a slipper donned the door as a knocker. The Wendy House has become a traditionally British children's garden toy. Today you can find all sorts of Wendy Houses, from the simple plastic or wooden shed type to eco-friendly woven with willow, or according to my google searches the extravagant mini-me house with appropriately well dressed children (what has the world come to!)

Barrie's inspiration for the original Wendy House is claimed to be an old washhouse behind his childhood home in the Scottish town of Kirrimuir in Angus (also made famous for having the narrowest public footpath in Western Europe, measuring only 40cm... what a claim to fame!). 

Looking at the rather larger Darling household in London, this was based on No 31 Kensington Park Gardens, owned by the Llewelyn Davies family between 1897 and 1904. He met the family whilst wrestling with his giant St Bernard dog who had decided to jump up onto its hind legs, a funny sight to see due to Barrie's small 4ft 10inch stature. A friendship began and he helped the family financially before the children were sadly left orphans and he moved in to look after them. The house is now split into flats and each one is priced over £1 million, lucky for some! 

Walking down the canals of the Lee Valley today, I couldn't help but thinking of Wind In The Willows...I have decided to read/re-read all the classic British children's stories... Peter Pan, Alice In Wonderland, Winnie-the-Pooh, Wind In The Willows... any other suggestions? Maybe I will find the origins of some more well used words and phrases! 

Medical marvel and the humble sausage

I have been looking into the social implications of medicine and came across Rudolf Virchow (1821-1902). This guy has become a bit of a legend in my books. He is seen as a 'father of modern pathology', recognising the cell as the basic building block of the body. He also was a avid promoter of social medicine, something I myself am hugely interested in. 

Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution… The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.

Rudolf Virchow

From my understanding, what Virchow is saying here is that the effects of social society at large on health are innumerable. That cannot be denied when looking at the incidence of disease and the effects of poverty at the micro UK level and macro developing/developed country level. It is therefore the medical world that provides much of the evidence of social inequalities. With such apparent implications there is however no simple fix, and politicians need to fight for an answer [Await a blog soon on the preventative health measures of the NHS]. Coming from a geography background these disparities from place to place are of huge interest - cause of illness can be looked at from all scales, from genes to cells, organs, systems, to outside the body itself into society. 

So what does this all have to do with the humble sausage? 

Virchows liberal views rivalled the famous Otto von Bismarck in the german political scene of the late nineteenth century. Challenged to a duel, Virchow, allowed to choose the weapon, was typically german and opted for the pork sausage. He niftily loaded his porker with the Trichinella parasite which would have put Bismarck in his place (or more accurately, on das Klo [the loo]). Bismarck ironically turned down the duel unwilling the risk to his health. I just can't help but laugh to imagine a modern day scenario, Ed and Dave circling each other in the house of commons with their loaded forks. I don't believe they, like Bismarck, they would have the guts (no pun intended) to, another reason why Virchow is a bit of a legend. 

Extending those conversations!

Welcome to my new blog!

The basis behind this blog is to allow me to muse and extend on those ever loved conversations/debates/arguments we all have with each other, but at that time do not have the information available to make a good judgement. I always come home and look things up, but never get the chance to really come back and carry on the debate - so here is my chance!

This blog will probably be very random. I am just about to enter the NHS, so I will be writing about its ups and downs. I will also be looking back at the huge number of things I would have loved to have written about when I was travelling, involving some history and politics, social and environmental justice. At the moment those are my ideas, but lets just see where it takes me!

Please do comment if you agree/disagree or have anything to add or question - I do not pretend to be an expert on any of these subjects so I am very open to peaceful debate.

NHS Reforms: Inspiring Sustainable Governance?

As I launch myself into the depths of the NHS I am unveiling its mysteries to myself, and I thought I would share it with you. The Health Care and Social Act 2012 came into effect in April. Except for the large amount of press on failing care in a few NHS hospitals, the effects of the structural change it self have not been obvious to us as service users.

What has changed? Primary care trusts, led by health managers are being phased out. GP led clinical commissioning groups are now in charge of the NHS budget (£108.9 billion 2012/13) – each GP surgery is linked to a specific group. The idea is that GPs have a greater idea of the needs of patients, in a way it is empowering at a local level. It is a good sustainable idea in principal, but…

-   Only a small number of GPs will actually choose to get involved, and therefore their decisions may not actually reflect local needs.

-   Do GPs have the correct skills to administer the NHS? Are they not better used for patient care as they were trained?

-   Empowering GPs at this level runs the risk of money and costing becoming a priority over patient care – profit based decision-making.

This last point is my main worry. Clinical Commissioning groups under the new act are free to choose to outsource and spend NHS resources on privately sourced services, for example sending patients to private hospitals to receive routine operations. Is this a secretive slippery slope to the privatization of the NHS? This competition-based system will create increased conflicts of interest at all levels. GPs may even have shares or own the clinics for which they refer their patients to. Will (or for the pessimist, when) they begin to make decisions based on their own business interests and financial gain rather than their patients needs? Will financial competition come out on top over patient interests? Monitor, a newly set up regulator is supposed to oversea these public/private transactions. This is one huge task, especially in what seems an increasingly complicated system. I just hope it doesn’t create confusion and conflict within and between all these governing bodies.

So I have only just scratched the surface of the NHS reforms; do they seem to be paving the way to a sustainable governing system to you? I will delve into some particular parts of the NHS in further posts.

Here are some good links if you want to read up a bit more about it:

http://www.bbc.co.uk/news/health-19674838

http://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactive

A great video from Channel 4 on the conflict of interests: http://bcove.me/xf1xp322