It’s very odd.

Experienced nurses should have the authority to decide if patients should be resuscitated, according to new guidelines to health professionals. BBC

Economics. That is what triggered this. Not patient care, not experience, not patient knowledge, just economics. People are becoming more aware that Do Not Resuscitate orders exist. Gone are the days when all this was hush hush and terms like “No crash” “No 333″ “TLC (tender loving care) only” were used as professional jargon. And when people know of something they will rail against it at some point.

“So your father – who had had 9 heart attacks, had advanced chronic obstructive airways disease, had kidney cancer, cirrhosis of the liver, gangrene in both legs, probably brain damage and warts – had his last heart attack and died, and because he had a DNR you think that’s wrong and are going to sue this hospital?”
“Yes”
“Okay – suspend the nurse who made that order”

Suspending a Dr costs a lot of money. They need full pay, the hospital needs to pay over the odds for a replacement and it could drag on forever. Effect on patient care can be measured.
Suspending a nurse means they still need their wage, but compared to the Dr they are cheap. There are lots of nurses so effect on patient care is zero.
The British Medical Association will have instigated this and there are 2 important factors here:
- Dr’s are supremely protective of their little empires. So giving any territory away is serious.
- The BMA could not care less about their handmaidens.
The BMA know that Drs will get sued, know it will bring their profession into the headlines and know they do not want this to happen. So easiest thing to do is wash their hand of the whole affair and make sure their ties are straight for when they are interviewed .. “Oh no, I would have said he could recover, We can treat gangrene very well these days and 9 heart attacks? Well you have to ask if they were even giving him the medication we prescribed”

This role is a poisoned chalice.

Like millions of others we do not own our own home and given we were working as nurses those salaries couldn’t get close to affording one around here if we were still there. So we rent. Not a problem except Jacq needs a downstairs toilet. We become reliant to a huge degree on what are laughingly called ‘social services’ and ‘councils’ as Jacq has ‘unmet needs’.

So. We ask for a downstairs toilet. The Occupational Therapist says that will not serve J’s needs forever so no, we cannot have one. She says that we need an extension on the back of the house which can have a bedroom, bathroom, toilet etc. Here is what happens:

1. We have to complete detailed financial accounts. This will entail an Accountant’s report as well
2. The council consider this.
3. The council say they will do the work if we contribute £XXX. Last time we enquired about a downstairs toilet they wanted £18000. Up front.
4. We tell them we cannot get a loan (true) but that if they let us pay them back that would not be a problem (also true). Councils don’t do loans. So this stage comes to nothing.
5. Next stage. We have to complete detailed financial accounts. This will entail an Accountant’s report as well
6. Another part of the council consider this.
7. They will again come up with a figure but hopefully less. They also ask up front.
8. IF we can meet that, then they give the go-ahead for plans.
9. Once plans are set, we enter the next stage.
10. We have to complete detailed financial accounts. This will entail an Accountant’s report as well
11. They meet to agree the plans and give the final go-ahead
12. I am told that following this “things might happen”

But:

• if the neighbour disagrees at the end (shared party wall) it all stops dead.
• if a building survey finds a fault, it all stops dead. (note how these happen at the end?)
• if at any time anywhere between a finance report being done and a meeting to consider our financial circumstances change then that stage is reset. (I asked about exchange rates, and yes, that could affect this bizarrely)
• if the landlord has any objections (which he won’t know til he sees the plans) it stops.
• if an estate agent says that the extension could actually harm the house value (which in this case it could) then obviously it would stop.

Also, if this happened then we would be taken off the housing waiting list because J’s needs were being met – even though it’s privately rented and liable at any time. Even if the landlord agrees to terms his life events would take precedence.
The above is not about us not wanting to pay – we would if they would let us. It is strange that councils can play the money markets but not give loans to the people they are meant to serve.
Accountant’s reports are not cheap.
So all that process, which takes time, energy and too many people and far too many rules, has to be gone through because the occupational therapist says we need an extension on the back of the house.
It’s like they put every obstacle in the way because they don’t want to spend any money.
All we asked for was a downstairs toilet. We don’t want the extension. But we can’t have what we would like, we have to have what they say. Of course we don’t ‘have to’ anything but it seems beyond stupid that what would cost less and take 2 days and is wanted is overruled in favour of something way more expensive which is not wanted and subject to many variables.

Councils. Nonsense.

Nicotine should be freely available in products which do not carry cigarettes’ health risks, to help smokers who find it impossible to quit BBC

Wrong. No. Bad move.
It’s not the nicotine. Nicotine addiction is not the problem.
Smoking a cigarette: Find pack, find lighter. Remove cigarette. Put pack away, Light it. Smoke it. Stub it out. Resume whatever you were doing. That’s not just “smoking”, it’s whole set of behaviours that become part of your life, they form a pattern, they become associated with other enviromental factors.

Example: I used to sit down to play console games. Cigarettes on one side of me, beer on the other. I haven’t drank for some 4 years, smoked for a little less and yet I still feel they should be there when I play a game. It was that strong early on I had to stop playing because of the association.
You have people at work who will congregate outside, maybe they go to escape the noise. They have to stop doing that.
If they smoke after eating then the pattern kicks in after that.
If they get stressed, have a beer, go pub they are more patterns.
If they see someone on the TV light up then they might too.
If they are lying or buying time or feeling uncomfortable then the ceremony of smoking is not there to help them.

It’s not quitting the nicotine that’s the issue. It’s the replacement of a wide range of behaviours that matters and it matters hugely. But no amount of patches will fix that because this part really does come down to the person seeing that as the obstacle and actively working though each situation.

There is also the fact that if you give patches away for free then they become of no value. If you are prepared to invest your own money in the solution then surely that is much better?

(If you want an example of a behaviour that is difficult to change – next time you have a shower/bath, wash yourself differently. Start with a different part of the body, change the order you wash around your body. Try and change the whole routine in some way. It’s not easy to do and yet still feel comfortable.)

Guardian: The Darzi report states that the government … doesn’t mention the many ways in which the erosion of tax funding is already occurring to NHS service loss

Times Online: Take a blank canvas. Talk to 1,500 NHS staff. Spend 12 weeks thinking hard. And then come up with the ideas you first thought of. by
Telegraph: “Lord Darzi, a world-renowned consultant”
Daily Mail: Professor Sir Ara Darzi – a pioneer in robot-assisted surgery

Daily Mail snippet:
Nurses will swab anyone admitted to hospital to test for life-threatening infections such as MRSA.
Those with positive results will be placed in isolation and given creams and body washes to clear the bugs.
Really? Smidge of cream and a good wash fixes MRSA? As if.

They are doing to general health what they did to mental health and learning disabilities nursing over the past 20 years. What people should be doing is investigating every management level in every hospital and Trust – backhanders will be happening. They probably always have but the bungs just keep getting bigger.

Work in the Health Service? You must be mad. Get out while you can.

(Read the Guardian article)

This isn’t a broken bone, or an infection, or a question of mental capacity. They don’t know what causes MS, they have no firm treatments for MS, it’s just research and more research. So the treatments they do have – such as Interferon – should be the choice of the patient barring significant medical contra-indications.

We shall see.

Camera is good. Lots of photos today, all crap (clouds / sunsets are so hard to do!) and the images are fine. Don’t have an excuse for a new one.

I have a desire to trawl ebay to find something I don’t yet know I want but I just know will prove indispensible (for at least week anyway).

There was someone who once had a blog and his tagline involved henchmen for himself. Was checking some old links late last night and found the domain has expired and now has the regular ad stuff that squatters use. Which is a shame. It’s all transient …

And J is down right now. Very very down. Badly down. Really not good at all. There’s nothing to say though, nothing to do. Nothing can change what is happening and no amount of talking will make it go away. So there is nothing anyone can do. The Social Worker says see the MS Nurse who says it’s for the SW, The GP and MS Consultant will write letters and say what J needs and yet no-one listens. Silent screaming she called it the other day. So she gets no help, she is deteriorating, she gets stressed because I’m doing everything but she can’t and she sees no light at the end of the tunnel. That last part is very bad.