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Lame and Limping

Friday 12 May 2017

We could have had "Weak and Wobbly", "Feeble and Floppy", or "Puny and Prostrated", but given the state of my left peg, the Ls have grabbed the title honours. Having shoe-horned eight Ss into a fourteen-letter title a few months ago, I've developed an aversion to anything beginning with S, and especially to "Strong and Stable". I doubt I'm alone. Following the PM's BBC interview with Andrew Marr, where she was discomfited when asked why nurses are going to food banks, I suggest that every time someone says "Strong and Stable", or "Coalition of Chaos", the immediate response from the person being bludgeoned into alliterative torpor should be a blurted "Nurses at Food Banks".

Stock phrases really get my goat, unless, obviously, it's one that I've made up. It probably stems from my experiences in a round Britain and Ireland yacht race in the mid 90’s, sponsored by a large whisky company. We had PR minders, and at every interview opportunity had to try to get the company strapline in: “How was it out there, Nick?”, “Well Brian, the waves were 30 foot and it was A measure of character”. Some time ago, a graduate trainee (presumably) at the Department of Health thought it would make everything sound rather splendid if it became "World Class". We aspired to World Class Commissioning, amongst other things. I wondered what happened at National and Regional level, and presumably if you only represented your County at commissioning, you still had a great deal to learn, in every sense. A club-level commissioner might still need to use their fingers to count, but could probably do so without having to poke their tongue out.

While I'm at it, another ghastly addition to the medicopolitical lexicon is "The Offer". Everybody in Health and Social Care is at it. It's used to describe what they think should be done. For instance, in the recently published Urgent and Emergency Care Delivery Plan, there are "offers" listed under NHS 111, GP Access and Urgent treatment Centres. Under GP Access, we find: "The offer • Continued provision of urgent care services by general practice • Additionally by March 2019 the public will have access to pre-bookable evening & weekend appointments with general practice • Delivering this aims to secure: 1. Transformation in general practice.....(blah blah).

No. NO! One hundred times no. An offer is what someone makes for your house, rebuts behind a bike shed, or does at a vicar's tea-party with a plate of sandwiches. Who's offering what to whom? I'm getting fed up with having to work out what words mean, especially those I thought I'd nailed as an infant.

A handpicked group of us are off to Edinburgh next week for the LMCs Conference. We’re scheduled to lead the debate on pensions, although Harry’s perfectly-formed motion has been moulded slightly by the Agenda Committee. One of us grey-haired lags will probably propose that one, but hopefully we’ll all get involved in the action at some point or other. I'll write a full, unexpurgated account of what happens at and around the Conference in due course (available from me by direct email/plain cover) and a sanitised pre-watershed and heavily redacted version will be published on the website.

We're going to need a regular international section in the blog. As Donald might say, we're all bigly concerned about the workforce crisis and recognise we need to look overseas for staff. Last week I interviewed a Greek physiotherapist, although any passers-by, drawn by my screams to the open clinic door and peering in, would have been forgiven for tiptoeing away and contacting Amnesty International on my behalf.

I've recently started easing my battered body back into tennis, and 24 hours earlier had hit the Mother of All Backhands, a searing, dipping cracker of a shot that would have had Federer gawping in wonder, before scurrying back to the practice courts. Half a second later I knew that I was going to pay for the MOAB, having rent asunder the eclectic mix of superannuated muscle and scar-tissue that makes up what remains of my left soleus muscle. I hobbled 100 yards to the bar, where they had lots of ice, at least initially, and tucked into a couple of therapeutic beers. I too had read that paper suggesting it's a better analgesic than paracetamol. I wasn't at that stage going to be too sniffy that it appeared to be a meta-analysis of 18 studies by the University of Greenwich (Yes there is- in London). I wondered whether the vasoconstrictive benefit from the ice would be negated by the alcoholic vasodilatation? I was prepared to take one (or two) for science.

Fast-forward 24 hours, and I'm face down on the physio couch and subjected to the not-so-tender mercies of Nadia. She had powerful fingers and an intriguingly archaic TENS machine, which she connected to my leg by cables that could have doubled as jump-leads. The main unit had the size and subtlety of a tumble dryer, and I suspect that if you'd jemmied off the lid, you'd have found an array of ancient glowing triode valves. Only a small tweak in the giblets and we could have picked up a dinner-jacketed BBC newsreader telling us about some unpleasantness in the Sudetenland. She cranked up the current until I said stop, and then just carried on cranking. She was a talkative soul, and keen to probe me deeply, but had to shout above the noise- whimpered yelps from me and an industrial thrum from the equipment: "WHY YOU ALL VOTED BREXIT? WHY THERESA MAY PRIME MINISTER WHEN SHE WANTED REMAIN? WHY GERMANY HATE GREECE SO MUCH? WHY BORIS JOHNSON? WHY? WHY?" Six perfectly reasonable and pertinent questions, delivered in a rapid Hellenic staccato, whilst I squirmed on the couch, more pre-occupied with my proximity to the Greek national grid, and wondering at what voltage I should start to worry about bursting into flames. This could be an entertaining addition to Andrew Marr's BBC show, and we'd soon see how Strong and Stable these politicians really are. I managed to hold out, though, revealing only my name, age and room number. I learnt from her that physiotherapy was the only medical specialty for which it was possible to get insurance in Greece, and that same afternoon she had to take her mother to see a cardiologist at a cost of 100 Euros. More alarmingly, she said that some doctors demand an "under the table" payment in addition to their published fees. Corruption, she said, was widespread still in all public services. In the event, she proved to be a mighty effective physio, and I managed to leg it away at a reasonable lick, trailing cables behind me, when released.

Meanwhile, the passage of the American Care Act (aka Trumpcare) through the US Congress was little short of an abomination. The text wasn't published until the day it went to a vote, nobody appears to have read it (even the ones who can read), and no Republicans are prepared to be interviewed about it. In addition, it hadn't been assessed for financial value by the Congressional Budget Office, which is pretty extraordinary for something that is estimated to impact on one sixth of the US economy. The last version was anticipated to have resulted in 24 million people losing their healthcare, and this version has been described as a mechanism of shifting tax benefits from the lowest 40 to the top 2 in society. Pre-existing conditions that states can decline to offer coverage for are multiple, and include sexual assault and rape (which are thus less likely to get reported). The quoted premium for someone previously diagnosed with breast cancer was $26,000, rising to $125,000 for patients with metastatic disease. Per annum. It seems unlikely to make it through the Senate, but to even get that far is extraordinary.

Last time I reported an invitation to Musgrove to play "Flowopoly". I got a bit sulky when told that I couldn't be banker, couldn't have the titchy racing car, and nobody was going to jail. It turned out to be me and a load of Chief Operating Officers, A and E consultants and senior nursing staff from the FTs, the CCG and Social Care, invited by the Academic Health Science Network to come up with ideas/theories about the reasons for patients flooding into the A and E departments and clogging up the system. Vocare and NHS 111 were notable absentees, presumably having been invited as late as I was (I only heard about it the day before). We had a wizard time scribbling stuff on fluorescent post-it notes, which then got stuck on the walls all around Boardroom 1, and we're having a follow-up session in a few months. If we're going to start rebranding board games to sort this stuff out, I suggest switching Cluedo to "Flowdo". It's a format familiar to most, with players having to apportion blame by working out the three cards in the central envelope: "It was the risk-averse non-clinician, with the dodgy algorithm, in the 111 call-centre". It's a start.

At an LMC Exec get-together on Monday evening, our Treasurer and Vice-Chair suggested I put something in the blog about tits, but I've run out of space and am slipping slowly and inexorably into Purdah, so that will have to wait.

Nick Bray

(T-64) It's happening.

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