More Big Problems

Rather than a reply in the comments section of the Big Problems post, it seemed easier and probably more effective to write a continuation. I know I'm not very good at replying to comments, something at which I intend to improve, but just so you know, I read and appreciate them all! Well, except the spam ones wanting to sell me watches, bank accounts in the Far East and prescription drugs...

It's a difficult issue to tackle, because I genuinely believe that there's no one simple solution, much like a large number of issues within health care. Luckily, I'm not big, brave, clever or well paid enough to make these decisions, but as they do impact me directly, I see no reason why I shouldn't have my say.

Paying for health care has always been, and will continue to be a contentious issue in these shores. In North America this argument, to a certain extent, is incongruous with reality, as the vast majority pay into an insurance scheme and receive their health care dependant on if and what they've paid. However, on both sides of the Atlantic - times, they are a changin'...

As far as taxing foods that are bad for us, and those taxes going directly to health care, well, in truth, that already happens. There's no VAT (purchase tax) on food that isn't considered a luxury. Fruit and vegetables are tax free. Chocolate isn't. Simple. Putting up tax in a way that would make these luxuries only affordable to the upper echelons, will only mean that we have very fat rich people. Well, maybe not. But the question remains of how much of a nanny state do we want to live in? Do we want a government scheme by which you must clock in the exact number of calories you've consumed every day? The idea is impossible to manage, and is the antithesis of living in a land where we are free to make our own choices. And as Fee said, taxing cigarettes and alcohol more and more every year, seems to have done nothing to reduce the overall number of smokers and drunks.

Girliebob made a fantastic point. We can't judge whether a person's worthy of an ambulance just because they're overweight. She's paid umpteen years worth of income tax and national insurance into the system with no obvious return from health care, and should be no less entitled than the young mum next door who's feeding three kids on state benefits, despite having paid in nothing. Irrefutable logic.

A private message I received also questioned the charging of patients who self-harm. More often than not, self harm is caused by mental health issues, whether short-term, temporary issues, acute moments of madness if you will, or some who are chronically ill, clinically depressed, and on a downwards spiral that society struggles to understand and accept. Do these people, those who take blades to their arms, those who genuinely attempt suicide, deliberately overdose on drugs, also deserve to be charged when using the health care system? I'd find it very difficult to justify that these people should be charged, despite the fact that these injuries are self inflicted.

Charging for medical services does occur,  even in the UK. We have to pay for prescriptions (certainly in England and Scotland, although the Welsh get them, errr, scot free), we pay at least part for dental care, even under the NHS, and I suspect that more charges are coming. Minty mentioned frequent callers and also questioned at what point on the overweight scale would we start charging. They're good points, and I wish I had the answers. But then, I'd be a politician and have to make them up, so I think I'll stick to what I hope I'm good at.

I've said it before. The NHS is the victim of its own success, and we're all going to have to get used to the idea that the free ride is well and truly over, at least to some extent. I still don't have the answers, but the questions are fascinating, and the discussions you all prompt are even more so.

I'll leave you with yet another point to ponder.

What about the smoker who improves their life by giving up the cigarettes, but then puts on the weight because of it?

Big Problems

Remember this post about drunkenness, and the discussion it generated? I still don't have the answers, but I'm always coming up with more questions!

So, here's another one. Go read the following article and watch the video, then come back.

http://www.bbc.co.uk/news/health-12287880

How do we deal with another one of society's big problems? And yes, the pun was intended. These ambulance and hospital adaptations are not for the almost run-of-the-mill 100+ Kilo (220+ pound) patients. A two-person crew will regularly need to carry these sorts of patients down a flight of stairs. 

These specialised beds, equipment and ambulances are for patients double that, sometimes, as the report suggests, even triple and more. I sat listening to an overnight radio presenter talking about it, and listeners calling in adding their suggestions, frustrations and solutions. As usual, there were the calls for these patients to pay for their specialised care, or be refused it. Passions ran high between those who have clearly never experienced the problem, and those who face it on a daily basis. People were claiming that as morbidly obese patients bring their condition upon themselves, they don't deserve free NHS treatment, whilst the obese themselves (by their own admissions, this was radio after all), claimed that life-style choices are not the benchmark by which the NHS allocates treatment.

So I ask again.

What about smokers who suffer lung cancer as a direct result of their habit?

What about extreme sportspeople who get injured in their pursuit of adventure?

What about drunks who fall and crack their heads open due to their intoxication, be it acute or chronic?

Do we bar all of them from free treatment, as these are all self-inflicted?

The NHS is still, for the most part, a free service, and proudly calls itself the envy of the world. Its staff, for all their grumbles, are proud of what they do and are dedicated to it.

But everything comes at a cost.

For every bariatric ambulance, somebody, somewhere, will be denied some other treatment.

And whilst the ambulance in this report seems to have all the equipment, there's still one glaringly obvious omission.

What happens when there's a flight of stairs to contend with?

What about the physical cost to the crews?

I only have the questions, and an undecided mind.

Answers are another thing all together.  Education is clearly one of them, as with everything else, but over and above that, I really don't know.

Do you?

Head for Heights

The message comes down the MDT from the police. "Please approach with caution - no lights or sirens. Patient threatening to jump".

Out of area as usual, we don't really know the names of the buildings, but this one has its name on a sign that can, for a change, be seen from a couple of blocks away. As requested, we make a silent approach, as much as is possible in an almost 5-ton truck with a large diesel engine, and await further instructions from the police officers on scene.

In front of us, still about 100 metres away, looms a large apartment block, and I count at least 12 storeys. If she jumps from there, our presence will be superfluous. In contrast to our orders, the police seem to be turning up in force, blue lights bouncing off the surrounding buildings, giving the street a look of a club on a Saturday night, the staccato lighting beating in time to the music. The street is cordoned off at both ends preventing traffic from approaching, and any pedestrians, though very few at this time of the day, are shepherded away from the scene on a long detour. A chorus of complaints comes from one group of bystanders who want to see the action, as they are firmly removed and asked not to return. A police Inspector approaches us, his two-pipped shoulders confirming his command, and explains the situation.

"At the moment, we're talking to her on the phone. She says she's in flat 55, and threatening to jump from the balcony. It sounds like she's had a lot to drink too, so anything could happen. There are, we believe, six flats on each floor, so she's probably on the 10th. We're just trying to see exactly where she is and what she's doing, and then we'll decide what we're going to do about it. You two just hang back and wait." He ends abruptly and walks off, retaking his position in control of the out-of-control situation.

Only once before have I been involved in something similar. Back then, when I was still only in my probationary year, we sat waiting for four hours. We drank tea, read books, snoozed and generally sat still as nothing continued to happen. At the end of it all, despite negotiations and attempts to get into the building, he jumped, and there was still nothing that we could do.

So once again, we sat. I don't tend to take a book with me to work any more - there's never really any time to read it - this time, my phone would have to suffice for entertainment. A police officer was sent over to us and informed us that she was our liaison. As soon as it was safe for us to approach, she'd get the message on her radio, and advise us to advance. We made ourselves comfortable for what could be a long stay.

The message arrived after less than fifteen minutes.

"Suspect detained indoors, advise ambulance safe to attend."

We drive the short distance to the block, and find that it's split into three separate entrances. Several more officers walk out of the middle of the three. Some are smiling, some are laughing, some just walk by silently. We take out our equipment, and advance on the entrance.

"I hope there's a lift. Don't fancy a walk up 10 flights of stairs."

"Wouldn't worry about that", chimes in an officer, a mischievous grin on his face. "The lift's working, tells you which floor you need just outside the door".

We look at the sign stuck on the wall by the lift. Graffiti is sprayed and scrawled all over it, some of it legible and unrepeatable, some of it just looks like streaks of dirt. Through it all, a list of floors and it's corresponding flat numbers is just about distinguishable. All the while, officers are streaming down the stairs next to us. You've had a long walk down.

Eventually, we actually pay attention to the sign.

Ground floor - Entrance

First floor - 53 - 56

Second floor - 57 - 60

Third floor - 61 - 64...

And so it goes on. Up to the twelfth floor, and flat number 96, four flats per floor, not six.

"What number did we want?" I ask my partner.

"55".

"Are you telling me that all this was for someone who was going to jump from the first floor?"

"Apparently so..."

We don't bother with the lift, and walk the dozen or so steps up onto the first floor and into flat number 55. The room is littered with empty bottles of vodka and ashtrays filled to the brim. The patient looks up at us and before we even get the chance to say a word, starts yelling.

"I would have jumped you know! If it wasn't for these coppers I'd have done it! There wouldn't be nothing left of me except bits of brains on the floor, and it'd all be your fault!" She points randomly at one particular officer, who'd only just entered the room, and was forced to respond as the patient was being clasped in handcuffs.

"You might, if you were really unlucky, have broken your leg. There'd be no brains anywhere!" "Especially in your head", he adds, just loud enough for us to hear.

"Well I'd have jumped from the top floor", she bites back, "but I might've hurt myself. And anyway", she rasps, years of smoke having damaged her vocal cords, "I've got no head for heights".

Knowledge

There are certain things in this world that I know I do not, can not, or will not understand.

1) Women. But I think that's the same for any man.

2) Children. But I think that's the same for any parent.

3) Smokers. But I think that's the same for any non-smoker.

Category 3 has a sub-category. Smokers, who are still smoking, despite the fact that it is close to killing them. And they know it.

I know that it was your stressful job that started off the habit in the first place.

I know you can't turn the clock back, and not start smoking.

We both know that that's no excuse.

You know that the inhalers are less effective than they were.

You know that your breathing is getting worse by the day.

We both know that it's killing you.

Your daughter knows that you've called an ambulance, again.

Your daughter knows that she has to spend hours with you in hospital, again.

We all know that each time could be the last time.

Your daughter knows that you should stop.

You know that you could stop.

I know that you won't.

Do you think that your daughter understands?

Who knows...