Hospitals, Hotels and Health

The front page of yesterday's Daily Telegraph featured a young female medical student who had tragically died as a result of taking a banned weight loss drug. DNP (2,4-Dinitrophenol) is used to make herbicides and has also been employed as a wood preservative. The student in question was known to suffer from Bulimia nervosa. Like me, the student in question was a fourth year medical student so I vouch that she must have been a highly committed and intelligent person. No rational person would order a drug off the internet whose use is currently warned against by the food standards agency. But that is the point. With long standing Bulimia, this poor girl would have been consumed with controlling the effects of her regular hunger. As sad as this death is, I wonder if we need to re-address the way in which weight is portrayed in our media. Of course, our media has changed so much in such a short space of time with the internet now the at the forefront. I feel desperately sad for her family and support their call for such drugs to be formally banned. The problem though is that banning something often has the opposite effect. Indeed, the internet seems to able to sell us anything with little real accountability to anyone. Freedom of choice is great but regulation also has its place. It is a tricky balance but one which the policy makers need to address as a matter of urgency.

It is difficult to read anything today without stumbling upon yet another debate about how to solve the problems which currently face the NHS. In all honesty, the NHS has now become so large and so over-subscribed, it is becoming more and more difficult to know where to start. The Prime Minister announced today a plan to open "Hospital Hotels" for nearly 30,000 patients in an attempt to address the current national crisis of "bed blocking". This seeks to replicate a system already well established in Sweden. Surprise, surprise. The plan is not without opposition though. In each "hotel", a threadbare staff of three nurses will be on hand to deal with elderly patients. An emergency requires a doctor to be called and the main caring of the patients is expected to be undertaken by their relatives. Of greatest concern, patients without relatives will be expected to treat themselves under a "self service" system overseen by non-medical staff. It is claimed that many of these patients will have dementia or a known history of falls. It must be stressed though that should the patients require urgent treatment, they will be immediately transferred back to the main hospital.

As our society gets older, care of the elderly is going to become an increasingly divisive issue. Of that there is no doubt. Put simply, the longer we keep people alive, the more things go wrong with them. This is simply the ageing process. Between, stroke, heart disease, cancer, dementia, Parkinson's disease and the million and one other morbidities, illness is sadly an inevitability of old age. That said, we still need to at least be humane in the way we address it.

I live in Denbigh and growing up was often at pains to explain that I was born in the hospital at the bottom of the hill as opposed to one at the top. The one at the top closed its doors for the last time in 1995 and, at its peak, housed in excess of 1700 patients. The "Denbigh Mental" as it was known locally, was originally opened as a Lunatic Asylum in 1848. By the time of its peak in the 1960s, it had become a major reservoir for elderly care with many patients suffering from dementia. While the elderly were cared for there, the local hospital at Bodelwyddan was presumably freed up to concentrate on non-elderly care. I have written extensively elsewhere about the old Denbigh Hospital but would like to say that while it represented an old model of healthcare, something similar might not be too far removed from what we need today. It had extensive gardens and no shortage of wide open spaces set in beautiful countryside. The ration of staff to patients was also a lot better then with 1700 patients and about 1000 staff! Just imagine that today. From the many people I have spoken to who used to work there, it is clear that the Denbigh Hospital was far more than a hospital - it was a community to which the staff and patients alike felt a real sense of belonging. I don't see that as being a bad thing because I see so little evidence of it today - and more is the pity.

The fact is that we will never again see staff ratios like that due to market forces and increasing longevity. We therefore need to adapt and seek new ways. I'm not sure all of the proposals being made today would bear scrutiny, but do have sympathy for some of them. When I was really ill in 2005, my stay in hospital was enhanced beyond all measure by the support of my family when I was in hospital. Far from minding, the hospital welcomed the fact that people were prepared to come in and keep the room clean and attend to my basic needs. I appreciate that not everybody will be as lucky as I was with regard to family but do feel it is an area worthy of consideration. The one problem I have with it is the question of money. I have written many times before about the scandalous way in which successive governments have failed to recognise the worth of the army of carers who already relieve the NHS so admirably. I say it again here. By all means encourage family members to care for their loved ones but for heavens sake pay them something. It may not even be at the level of the minimum wage, but it at least needs to cover their basic expenses.

To expect a patient recovering from a stroke to care for themselves is patent nonsense and although cost cutting is at the forefront of political thought, common sense must also be accomodated. The current litigations outstanding against the NHS continue to rise exponentially with an estimated £1.2 billion being paid out last year alone. Granted, better standards of care within the hospitals will hopefully reduce these figures but perhaps the time has come to just accept that the staff can no longer cope with the sheer numbers confronting them on a daily basis. There are tough decisions to be made and, as with all such decisions, they will not be universally accepted in the first instance.

When it was operational, the Denbigh Hospital didn't have vending machines with sweets, crisps and chocolate. In what would be deemed rather quaint in the modern NHS, it had a working farm from which it took its meat, milk and vegetables. I would argue that rather than being quaint, such a model would be highly progressive today and would send out all the right messages in terms of diet. If the only choice of food was a square meal, I assume that is what people would eat.

Cuts do have to be made and polls suggest that most people understand why. Most people. The announcement yesterday that government borrowing had fallen by a fraction was met with derision by the Labour Party. If anyone wanted to know the intentions of Labour if re-elected, we were given a much clearer vision yesterday. They responded to the borrowing figures by saying that at this rate it would take over four hundred years to get rid of government borrowing. Apart from it being a political statement of schoolboy proportion, it showed clearly that Labour would do what they have historically always done. Spend. Spend. Spend. The shadow chancellor is under the illusion that all we have to do restore growth is to borrow more money (which we don't actually have and probably won't even get) to build more houses (when people can't even afford the ones already out there) and create more jobs (with about as much long term security as a Mars bar in Dawn French's house). We had an ostrich chancellor from 1997 until 2007 and I'm not sure if anyone I speak to is feeling strong enough to risk another just yet. They say that a politician usually says precisely what he doesn't mean and Mr. Brown's watchword of prudence was a case in point.

News last week that up to half of children would gladly cheat to garner an advantage on the sportsfield came as little surprise to me. Ever since Jimmy Hill fought for Johnny Haynes to receive £100 per week, the maximum wage for a football player became a thing of the past. Seeing Luis Suarez bite an opponent at the week-end was just the latest low point of a sport whose morality seems to know no depths. Until our children once more get to see true amateur sport being played the proper way, I fear this trend is likely to continue. Children are great at so many skills and not least for copying. We can hardly be surprised. I shudder to think what the sportsmen of the amateur era must think when they see the way sport is played today. I would imagine they would have the foresight to turn off the television. It is only the switching on of the television which will feed this descent in on-field behaviour.