Tony Copperfield’s podcast is always excellent, but last week’s (If patients can make it all up, so can I) was particularly so. He was riled by patients lying to him, and so decided he would give them a taste of their own medicine.

You can listen here:

Everybody’s favourite giant-flower wearing government jester, Heath Secretary ‘Mad’ Patricia Hewitt, has pronounced that

some parts of the NHS in England have taken on too many doctors and nurses

That seems a bit of a sweeping statement to me. I think it’s important she’s more specific – exactly which hospitals have too many doctors and nurses? Presumably not the one in Wales, which has had to close its minor injuries unit due to a lack of staff. Presumably not Scotland, where current government estimates say there will soon be 500 too few GPs – a number the BMA beleives to be much higher. And presumably not England, where ambulances have been turned away from understaffed A&Es.

But they’re out there somewhere. And it’s important we find them. After all, we can’t go spending all the NHS money on silly extravagances like doctors and nurses when there’s marketing to be paid for.

So where are these wasteful hospitals? Dr Crippen’s looking for them. I want to know where they are. And I’m sure the electorate surrounding the identified hospitals will be interested.

So come on, Pat, tell us: Which hospitals have too many healthcare staff?

From the Press Association:

A cash-strapped hospital could open its doors to dogs and cats in a bid to raise extra funds, it has emerged.

Ipswich Hospital is proposing to use its state-of-the-art radiotherapy equipment, which lies dormant at weekends, to treat family pets with cancer at special Saturday morning clinics.

It’s like something from The Thick of It. When the NHS is so cash-strapped that hospitals are thinking of treating animals, things aren’t going well. Why do I suspect the hand of Mad Pat in this? Just to remind you, other proposals she’s come up with include closing unpopular hospital departments, making those who spread MRSA face criminal charges, announcing that the doubling of NHS debt means the financial crisis is “stabilising”, and, perhaps most famously, announcing that this year was the NHS’s “best year ever”. Compared to those gaffes, suggesting that NHS hospitals start treating pets seems relatively sane.

How is this woman still in her job?

A cure for hiccups has won one of this year’s Ig Nobel prizes. It involves fingers and bottoms – and probably funny looks if undertaken on public transport. Read more here.

I have written a lot in the past about the NHS, but rarely have I touched upon the subject of dentistry – mainly because it’s not an area in which I think I have particularly special knowledge. This missive from a reader of Dr Crippen needs no specialist knowledge:

Several years ago I had an NHS dentist. I saw him regularly albeit reluctantly, he used to do his ‘stuff’ and I’d leave, sometimes sore and sometimes not.

Then I moved house.

The area I moved to has few NHS dentists and none of them has vacancies for new NHS patients. I’ve been on four different waiting lists for several years during which I’ve received no dental treatment.

It started with a single filling falling out, shortly followed by another and then within six months nearly every filling in my head ended up in the bin. I rang all the NHS Dentists in the area but I was turned away. I was not registered and, in any case, they had no vacancies. Some of the dental practices didn’t even bother to talk to me. As soon as I mentioned ‘NHS’ and ‘Not Registered’ they just put the phone down on me.

The full story (well worth reading) wants to remind everybody that the Labour government has done little to improve the health service in any meaningful way – an assessment with which the Health Secretary “Mad” Pat agrees.

Let me remind you, for a moment, of Tony Blair’s conference speech of 1999:

…everyone within the next two years will be able once again to see an NHS dentist just by phoning NHS Direct

Seven years later, and NHS dentistry is in a worse state than when Tony Blair made his pledge.

Another broken promise. Another absent apology.

The day before my fourth year begins, here’s some less than inspirational, but still highly recommended reading from GP blogger, Dr John Crippen: Should Sammy go to medical school?  The comments are well worth flicking through, too.

The Observer reports today that a leaked report shows that the NHS is ‘failing our children’ through a lack of Child and Adolescent Mental Health Services (CAHMS). And how.

One quarter of the country does not have crisis teams for Child and Adolescent Mental Health Services. That is beyond belief. If the report was that we didn’t have ambulances to pick up children in 25% of the country, nobody would accept it, because we know children would die. Newsflash: The lack of crisis teams means children are dying.

Imagine for a second that, god forbid, your child is standing on your roof and threatening to jump and kill himself. Who do you call? In 25% of the country, there’s no-one to help. Imagine your teenager suddenly has horrific hallucinations of millions of spiders coming to kill him. In 25% of the country, there’s no-one to help. Both of these children might kill themselves, because in 25% of the country, there’s no-one to help – and all because we’re pulling funding from such services to serve the less common but more palatable diseases like cancer.

We’re awful at providing mental health services in general, because we don’t like to talk about them. We like to imagine that the ‘crazy’ people are locked up, and brand every criminal going as having some mental health problem – usually schizophrenia – because we can’t accept that some people are just evil. Poor mental health and criminality become inextricably linked, and who wants to spend money helping criminals?

This is an utterly ludicrous situation. 9 million people in this country – one in six – has a mental health disorder right now. More than 1 in 3 of us will have a mental health disorder at some point – more than will experience cancer. Yet we’re cutting the amount spent on mental health services. Where’s the logic?

The situation is worse for children, because as repulsive as society finds the idea of an adult with mental illness, the idea of a child with it is far worse. When was the last time some do-good charity collecter asked you for money for children with cancer? And when the last time they asked you for money for children with serious mental health problems requiring treatment? The latter is 56 times more common. Yet in some parts of the country, there are no Child and Adolescent Mental Health Services at all.

We need to get over ourselves and face these issues, otherwise our own children will continue to suffer. And there’s a pretty huge chance it will be yours next.

HIV and AIDS are terrible. They’re particularly terrible if you’re living in a country where anti-retrovirals are not available, and I don’t want to appear to trivialise that. But worldwide, the bigger estimates state that only 38 million people have HIV. That’s less than two-thirds of the UK population. Given that we have a very limited pot of money to tackle health problems in the developing world, is HIV the best thing to tackle?

Many people like to try and wage war with HIV on the basis that it’s easy to prevent. It’s said that consulting your sexually transmitted disease doctor, practicing safe sex, or abstinence, prevents HIV infection. That’s true. But that doesn’t make it easy to tackle. Even in the most developed and scientific of nations, we can’t get the safe sex message across. The UK has an appallingly high rate of teenage pregnancy, sexually transmitted infections, and sexually-transmitted HIV. Over 50,000 people in the UK are HIV positive, and that number is growing by almost 7,000 per year. We’re much better placed to tackle HIV than are aid workers with limited resources in Africa, not least because this country has a much lesser objection to the use of barrier contraception. Tackling HIV is not easy.

Treating HIV is vastly expensive. Conservative estimates say that anti-retroviral treatments cost a minimum of US$3,600 per year. Providing anti-retrovirals does not cure HIV, it merely slows its progress. And looking at things in a cruelly scientific way, the longer an HIV positive person is alive, the greater the risk of infecting a greater number of people. I’m not condoning murder of all HIV positive people in Sub-Saharan Africa, and it’s not an entirely sensible way of looking at things, but it’s an opinion held by many.

On the other hand, malaria affects 500 million people per year, and is easily and cheaply preventable. Yet 20% of child deaths in Sub-Saharan Africa are due to malaria. A child dies every of malaria every thirty seconds. 95.2% of malaria infections can be prevented with a US$5 mosquito net impregnated with insecticide, which is effective for 5 years. In many test villages, malaria was eradicated by these nets. For the same cost as treating one person with HIV for one year, 720 nets can be bought. For the cost of the cheapest anti-retroviral treatment for every HIV suffer for a year, over 14 billion of these nets could be bought – malaria could be virtually eradicated.

Malaria is, by no means, a death sentence. Treatment is cheap – US$0.90 for a child, US$2.40 for an adult. But with so many infections, the cost soon adds up. So to claim that malaria is not worth preventing because it’s cheaply treatable is inaccurate, and really makes little sense.

Malaria isn’t as perversely marketable as HIV. It’s not a taboo subject, and it gets little press because it affects the poorest of the poor, not the richer parts of African society. Think: When was the last time you heard the phrase “Millions dying of HIV in Africa”? When was the last time you heard of “Millions dying of malaria in Africa”? Fewer die of malaria than HIV; but we could feasibly eradicate malaria right here, right now. Why don’t we?

People with HIV and the scores of other infections which kill Africans should not be left to die. We have to do something, and we have to start somewhere. Why not with malaria?

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