Credible or incredible: experience is evidence

A senior Scottish figure once gave me advice that it is very important to be perceived as “credible”.

I was thinking about this advice recently when the convener of the Parliamentary Committee considering polypropylene Mesh implants concluded:

It is not surprising, therefore, that those who have experienced harm from healthcare may feel that they are not being listened to.

In the same week another example featured in a week long series of articles in the Herald: “A Bitter Pill”. On a background of ever increasing prescribing of antidepressants it appears that my profession is still struggling to accept the value of people’s experience (which may not always be positive) and can respond defensively:

One responder has already articulated my feeling about this:

My understanding is that this series in the Herald arose, at least partly, because of a petition to the Scottish Parliament which seeks consideration of prescribed drug dependence and withdrawal.

One of the explanations for the rising prescribing of antidepressants is that people are often taking them for many years. Another way of looking at this is that people are not stopping these drugs. It is still the case that we really do not understand why this may be and we are not going to understand this until we listen to the experience of those taking these medications.

Experience is evidence and I find it incredible that we do not listen carefully enough to it.

 

 

 

 

I am a worrier and I worry for Scotland’s Minister for Health

If this headline represents the approach of the Scottish Government, well I worry.

It is doctors, not pharmacists, that are licensed to prescribe and to withdraw any prescription.

The scientific community shares the conclusion that it easier to start medications than to stop them.

Scotland’s Minister for Health would seem to be asking pharmacists (unregulated by the General Medical Council) to provide:

“stricter checks on medication involving addictive medications”.

Meantime, my profession and our regulators would seem to avoid issues such as:

  • the continuing “education” of NHS doctors (those who are licensed to prescribe) by financially vested interests
  • that withdrawal from psychotropic medications may precipitate (for some) a “relapse” with symptoms worse than those for which medication was first prescribed.
  • that long-term exposure to psychotropic medication may have unforeseen consequences.

I am a worrier and I worry.

 

Janet B Wood

“What is in a name? That which we call a rose. By any other word would smell as sweet”
(Romeo & Juliet Act II, Scene II).

If a rose was not called a rose would it still be a rose?

Many years ago an old lady let me take cuttings of a rambling rose that I had admired growing up her garden wall. This old lady told me that this Jacobean rose had been ‘rediscovered’ by her grandmother, Janet B Wood.

The cuttings took. Janet B Wood climbed the mature sycamore tree with equal vigour but greater beauty. That tree is no more and now rose Janet B Wood is growing up our arched pergola.

I was reminded of this rose, its name, and the story when I recently read the diaries of the poet William Soutar who was confined to bed for decades due to progressive ankylosing spondylitis:

 

The only absolute non-stops

This film is about the road over the Capel o’ Mount in Scotland and a ruined Inn called Knowegreens.

The Only Absolute Non-Stops from omphalos

Music credits:
(1) ‘Beyond the Strath’ – by James Ross
(2) ‘For one night only’ – by King Creosote

Radio clip: from BBC Radio Scotland “Thought for the Day” late 2106.

And I drive by

This is a short film about Edzell Memorial Arch to the Earl and Countess of Dalhousie who died within 24 hours of each other leaving behind 5 orphaned sons:

And I drive by from omphalos

Raised by the people of Scotland

Crowd-funding is nothing new. The Martyrs’ monument was funded by public subscriptions to redress the events of 50 years previously when five Scots were transported for sedition. Their speaking up for the common people was judged by those in authority to be “wicked and felonious”.

The Foundation stone for the Martyrs’ Monument was laid on the 21st August 1844:

400 people attended the laying of the foundation stone. 183 years to the day later it happened to be five of us who gathered for a peaceful protest recognising the ongoing imbalance in power between those in high office and those in the general population.

Walter Humes, writing in Scottish Review, 21st September 2015:

President Obama put this in a slightly different way:

Our protest also happened to coincide with a solar eclipse. My particular experience with high office has related to my petition for a Sunshine Act for Scotland:

Surely one of the reasons that we commemorate the past is so that we can learn from it. The voices of the people really do matter.

The end of something

In this film I attempt to tell a bit of the story of the beginning of the end of Usan.

Behind the Keith Mausoleum on the rock of Skae I noticed a Celtic cross that commemorated a doctor: Dr W A Mackintosh who died in 1911 just before the war. I wondered who he was?

Back home I discovered that he was the last Laird of Usan and had died suddenly in his bath. This was the beginning of the end for the Fishertoon of Usan.

In this film I find a connection between an enamel bath (vessel) and the Trawlers (vessels) that did an end to the laird and hand-line fishing respectively. Usan then went into decline.

At the time of this Angus adventure I was reading Ernest Hemingway’s short stories “in our time”. They were written not long after WWI and reflect his terrible experiences. They are somewhat brutal.

The music in this film all comes from the BBC Proms: Scott Walker Revisited. I have been rather moved by this performance of words and music of yesteryear (words and music that were barely noticed for decades)

The end of something from omphalos.

NHS Scotland – it should not take courage to care

On the 17th July 2017, the Scottish Government announced an “Enhanced service for NHS Scotland staff”

The Scottish Government began this announcement stating that:

“Staff in Scotland’s health service will continue to benefit from external support should they have any concerns about patient safety or malpractice”

From 1 August, the NHS Scotland Confidential Alert Line will be re-branded as the Whistleblowing Alert and Advice Services for NHS Scotland (AALS).

This was reported in the Scotsman of the 17th July 2017:

The Scottish Government confirm the enhancements that have been made:

Some personal thoughts:

I have never been a “whistleblower”. I have however raised concerns relating to patient wellbeing and safety in NHS Scotland, and in particular for our older generation. I share the view of Sir Robert Francis that “freedom to speak up” is a better and more encompassing term.

My experience of trying my best to put patients first in NHS Scotland has left me with an interest in this matter and I have followed developments over several years now.

My concern is that this “enhanced service” has taken little account of the evidence presented to the Scottish Parliament from a wide range of individuals and professional bodies, including Sir Robert Francis.

Lifeboat NHS from omphalos on Vimeo.

The “enhanced” service will still not be able to independently deal with any concerns raised and so can offer only to “pass concerns on to the appropriate Health Board or scrutiny body for further investigation”. In practice this will be either to the NHS Board the employee works with or to Healthcare Improvement Scotland which is neither independent of Government nor of any of Scotland’s 23 other NHS Boards.

It worries me that senior Scottish Government officials continue to use words such as “grievance” or “pursuers” when talking about those who are trying to put patients first in NHS Scotland. It seems that the Scottish Government are as quick as any of us may be to label individuals.  This “expanded service” has been re-labelled in a positive way when the opposite has happened to many of us who have raised concerns about patient care.

In summary:

I feel that this is a disappointing outcome given the determination of the Scottish Parliament, and the Health and Sport Committee in particular, to ensure that there is freedom in NHS Scotland to speak up and put patients first.

I would suggest that despite this “enhanced service” that it is still going to take a great deal of courage to care in NHS Scotland:

Courage to care from omphalos on Vimeo.

Lifeboat NHS

A film about freedom to speak up in NHS Scotland based on an edit of the evidence session of the Health and Sport Committee, Scottish Parliament, held on 13th June 2017.

This is just an edit. A subjective view. Nothing more and nothing less.

Improvement science and consent: a failure of NHS Governance

I am an employee of NHS Lothian and have been ‘sign posted’ to the “New Capacity and Consent intranet page: important information for all staff.”

This is a screenshot taken on Friday 2nd June 2017:

The Capacity and Consent intranet page begins by reminding all NHS Lothian staff of the ‘Obtaining Consent’ Policy (2014):

The NHS Lothian ‘Obtaining Consent’ Policy (2014) informs staff that “failure to secure consent may constitute assault under common law in Scotland”.

All NHS Lothian staff are also reminded that “acquiescence when a patient does not know what the intervention entails, or is unaware that he or she can refuse, is not consent”.

Two years ago I wrote about national improvement work undertaken by Healthcare Improvement Scotland for older people in hospital in NHS Scotland and my concern that “compliance” had replaced consent.

Given my experience that the guidance from my employers (NHS Lothian) on consent and the explicit requirements of “compliance” mandated by Healthcare Improvement Scotland seem to go in opposite directions, I wrote seeking further guidance. I have had this reply from Healthcare Improvement Scotland.

In conclusion: I would suggest that a failure of NHS Governance in Scotland has led to a confusion about the rights of older people to give consent.