Why we need to understand loss when we talk about war

War of the Arrows is a 2011 Korean period action movie, an emotion-fuelled ride of terror from the very first scene. The smooth and sensitive direction drags you into the story from the first few shots and is immediately devastating. It doesn’t really let up, and leads to a climax and end as desperate as its start. The character set ups were well designed, fitting seamlessly into the story which provided surprise after shock throughout its 122 minutes.

I won’t spoil it – please go watch the film. Here’s my takeaway from it, and how I feel it relates to the state of our world right now.

What I learned from watching War of the Arrows by director Kim Han-Min

Tonight, I learned about loss and its link with our culture’s loss of humanity. Instead of connecting war to loss, we have connected it to violence. We understand the act (war is violent) but not the emotional pain. This film was brutal to my western eyes, because of the emotional terror, but I was hooked from the very first shot.

Japanese films and games – and comics – are often castigated for being very violent, but I can think of two examples from East Asia (War of the Arrows and Barefoot Gen) – and there are probably plenty more – that are devastating because they show you the emotional losses on all sides. In contrast, western media focuses on the violent acts, but rarely aims to express the emotional pain of people we see on the TV, especially those who are in an ‘other’ group, people we see as ‘the other’ because we label them as different from us.

Showing a woman from an ‘other’ group crying and renting her clothes and hair in the aftermath of a bombing attack doesn’t make people cry and feel her pain. Showing her child’s body, covered in blood and dust might get a little nearer to the emotional centre. But it’s only after we get to know her that we will be personally affected (in a small way maybe) by her loss. To emotionally connect with her, we need to have known her and her child before the bomb happened. A lot of news programmes do try this type of work, but they don’t always hit the nerve centre of the emotional content – how ordinary and ‘just like us’ everyone is. Remember 7-year-old Bana in Syria? Hers was a story they ran with for a while.

The use of this emotional connection in fiction is what I call ‘the Casualty effect’. Casualty is a long-running British TV drama about a hospital. Every story is structured the same. You meet a character. You get to know them and like them. Then BANG! The struggling single-dad window cleaner slips on some water on his high-rise scaffold and is impaled on the railings below. You’re immediately flipped from the emotional high of liking and understanding that character, to the possible loss and fear they may not make it through their ordeal.

(Spoiler, sorry). In War of the Arrows, a teenage boy and a tiny girl of 5 or 6 run for their lives, away from men with attack dogs and swords. He holds her hand tightly until she slips and they both fall. A dog is almost upon them, but is killed by an arrow in the nick of time. It is their father. He gives his bow to Nam-yi, tells him he must be Ja-in’s father from now on, and packs them off to his friend’s home for refuge. Ja-in won’t leave her father, so Nam-yi goes back and witnesses his father’s death by soldiers. He kills them and, bitten by dogs but alive, he and Ja-in escape.

This tiny girl clinging to her brother’s hand, screaming for him to go back for her father, her pain was palpable. So brave and crazy she would have gone herself, so her brother had to tie her to a tree while he crept back.

The story whips you up and tosses you in. You immediately see so much depth in the characters, you can’t fail to respect their choices, so there’s no getting away from all the losses they endure. The overarching tale is about the Second Manchu invasion in Korea in 1636, and you witness the reactions of both the heroes and their enemies to their respective losses. The way they lay their dead out with their weapons if they have time. How they care about and respect other people, though they don’t behave with great shows of affection. The desperation as ordinary life is unexpectedly disrupted by war, and the concern of a commander when he sees a soldier in shock at what he has seen.

Why is this important?

Loss is the true cost of war. In western media we see only the violence – and much of that is censored. We don’t feel the loss, the pain, the heartache. Not fully.  If we don’t acknowledge and experience the other side of violence – the other side of war – the losses – we cannot understand the devastation of character and soul (the spiritual damage) that is war. If we cannot feel compassion and respect for our enemies, we lose our humanity during war. They are people too. They have loved ones who have lost them too. They are ordinary too.

We cannot comprehend the devastation of war unless we emotionally access and process its losses.  This is why so many westerners are so blind to their own callous behaviour. We can go on holiday and laugh as a desperate man drowns. We can send our sons and daughters to war on the back of a vote cast only by rich men, and not truly understand the significance of such a  move until our children come home in boxes. We are not there to see them die. We do not witness their bravery. We are eternally separated from their experiences of our choices. We choose to allow those rich men to vote on our behalf.

It is only really (unless you are incredibly sensitive) when someone you personally love comes home from war changed or dead, that we can start to understand a  little of the devastation of war. And even then it is one-sided. We are restricted from fully experiencing and learning from the experience because we don’t see the consequences on the other side.

War has consequences. And they go much deeper than just being life or death.

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Is the Success Regime ‘getting away with breaking the law’? (Clue: they’re not!)

They’re not breaking the law … yet.

Yesterday I posted:

Now, I’m not even close to an expert in the law, but I would have thought just as a builder might become liable if someone’s house fell down, the Success Regime’s work will have a long lasting impact on Cumbria’s people, and surely should maintain some accountability for the model design.

They should at least be compelled to carry out ‘suitable and sufficient’ risk assessments of their proposals, in the same way building design has to satisfy safety standards.

They have no intention of risk assessing the options until after the decision has been made. Why?

Because they are only going to use one-in-three of the options. Out of all 12 suggestions, only 4 will be chosen. They’re not breaking the law at all. They only have to assess the risk of the options they decide upon.

Why would they risk assess all the options now when they can wait and risk assess just the four they’ll use?

Here’s why:

The success of the Success Regime hangs on patient safety

Most of the objections by the campaign as a whole and by individual people are concerns about patient safety. They are worried about the roads and the weather, about the time it will take to transfer from one hospital to another, about how much extra pain they and their loved ones may suffer as a result.

They are scared their babies will be born still or with special needs, or on the side of the road in a howling gale and sideways rain. They’re afraid to send their old folks across the county to hospital, because they know patient outcomes are reduced as a result of seeing fewer family and friends in hospital.

And patient outcomes is where it’s at from a health care professional point of view. How well the patient is at the end of the journey is the most important factor to consider throughout the redesign of the health care system. This Royal College of Nursing best practice guide states that clearly. The success of the SR’s redesign will be at least partly measured in healthy, surviving patients.

geograph-5002780-by-graham-robson

You’ve got all kinds of road users all the time on Cumbria’s twisty roads. This is part of the A595 north of Cockermouth, the road that will be used most by ambulances and hospital traffic including patients. Image credit to: Graham Robson

So we should all agree that patient safety is the most important thing.

What the Success Regime apparently haven’t realised is that most people will only choose options they perceive as safe. That’s why the campaign has fully rejected all of the options.  None of them are safe, according to local people who live in the area.

So you’d think the Success Regime would clearly show us which option will result in the best patient outcomes and safety. In a full comparison of risks.

If the Success Regime decided to assess ALL the options for risk

a) Their ‘vision’ of Cumbria and how it works would be clearer and easier to understand (and refute misconceptions!)

b) The public could assist with ensuring the right information was in the risk assessment and risk register – a real and meaningful form of consultation and engagement. Revolutionary!

c) It would be much harder for them to argue this model is suitable for rural areas with dispersed populations.

d) The disadvantages caused to poor people, women, children, and older people, would be clearer and more proportionate.

So yet again, the Success Regime miss a trick. They might not be breaking the law, but in refusing to do risk assessments on each of the proposals, they waste an opportunity for real, meaningful consultation. They could have listened to our safety concerns, but instead have boxed off risk as someone else’s job. As if it isn’t integral to the design.

So what can you do about the Success Regime’s awful options?

You might think, okay, we’ll wait till they’ve made the decision and done the risk assessment and as much mitigation as possible, and we’ll cautiously use their services, and then we’ll see if it’s a better experience than before.

But if something really does happen, to you or one of your loved ones, it will probably feel like the health care provider’s fault. You will be urged to make complaints to the provider. In fact, if you take a look at the CQC’s website, they tell you they can’t take your complaints at all; you have to go to the provider, and if you don’t get a result you’re happy with, you can take it afterwards to the Parliamentary and Health Ombudsman.

No-one will be able to say it was the Success Regime’s redesign of the service that caused your loss. Not until lots of people have died or been harmed in a similar way in similar circumstances. After that, a pattern emerges, and it’s easier to see there’s a problem.

Before it can be seen as a design problem, your loss could be put down to individual negligence, under-staffing, under-funding, misconduct, or capability. It could be said to be due to malfunction of equipment. None of which would be the Success Regime’s fault, or the fault of their redesign.

So here’s the thing:

It’s only in testing a design or an experiment that you find its flaws. If you get repeatable results or patterns you didn’t plan, it’s flawed.  But you can’t do that with health care, otherwise you have a lot of dead people and the threat of a public inquiry.

I think, in lieu of being able to test it, the Success Regime should risk assess all its options and make that documentation open to meaningful public consultation.

What do you think?

Comment below and let me know!

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Is the Success Regime breaking health and safety law?

Keswick

Keswick area looking all sunny

I have a question: How can the Success Regime continue with their sham consultation, when they appear to be breaking the law?

At a public consultation meeting in Carlisle this week, members of the public asked if there will be a risk assessment of the proposed options. A panel member mentioned ‘risk management’ but another ‘mumbled’ that risk assessments ‘would come after the Decision has been made’.

Hold on there a moment. No risk assessments until afterwards?

This is the law

The Management of Health and Safety Regulations 1999 Regulation 3 part 2 states:

2) Every self-employed person shall make a suitable and sufficient assessment of—

(a)the risks to his own health and safety to which he is exposed whilst he is at work; and

(b)the risks to the health and safety of persons not in his employment arising out of or in connection with the conduct by him of his undertaking,

for the purpose of identifying the measures he needs to take to comply with the requirements and prohibitions imposed upon him by or under the relevant statutory provisions.

We’re looking at Part (b) there. Obviously, the Success Regime are not employers as such. But if they are consultants, they are contractors; if they are contractors, they are self-employed. No? Then please comment below and tell me what they are, and how they slip out of their responsibilities.

Now, I’m not even close to an expert in the law, but I would have thought just as a builder might become liable if someone’s house fell down, the Success Regime’s work will have a long lasting impact on Cumbria’s people, and surely should maintain some accountability for the model design.

They should at least be compelled to carry out ‘suitable and sufficient’ risk assessments of their proposals, in the same way building design has to satisfy safety standards.

Unsafe Success Regime proposals

Health and Safety law is really quite straightforward: you or your employer or your work should never endanger or harm another person, if it is at all possible to avoid, and you must take measures to ensure this.

Yet the excellent viability and impact report by Nina Wilson explains in no uncertain terms that any one of the so-called ‘options’ offered by the Success Regime consultation is unsafe, nonviable, impossible, or will have a detrimental impact on the emotional and physical well-being of patients, their families and their carers.

Her figures and other research back up her claims: all the plans for reforming NHS services in North, West, and East Cumbria will lead to patient suffering and unexpected deaths. Go ahead and read it if you want. See for yourself, it’s right here in black and white, with numbers and analysis to back it.

So what gives, folks? How can the Success Regime sweep into Cumbria and dictate a new design/model of health care services that are clearly unsafe for patients without even completing a single risk assessment? Don’t forget it’s coming soon across the rest of England – 44 new STPs and Success Regimes to come in 2017.

Risk assessment isn’t part of the Success Regime plan – how do they do that?

So at one of the final public consultation meetings, as I already said, the incandescent public called for risk assessments to be carried out on the proposals, but panel members ‘mumbled’ things about ‘risk management’, and that ‘risk assessments would come after the Decision has been made’.

Let’s consider that again from a different angle: they intend to manage the risks after the Decision has been taken. I.e. whatever risks present themselves in the implementation of the Success Regime’s dangerous proposals for Cumbria, will probably be down to the health care providers to deal with.

The NHS providers are Cumberland Infirmary Carlisle (CIC) and West Cumberland Hospital (WCH), and what remain of the cottage hospitals. They are the community health teams such as district nurses, physiotherapists, occupational therapists. These organisations all have clear lines of accountability and responsibility as they are required to by law. They are used to shouldering these things. Accountability and responsibility are integral to health care practice.

The Success Regime not so much. No lines of accountability and responsibility here. The moment everything’s signed off, it’s my guess those people will be out of sight.

In that event, the responsibility for risk assessment and risk management of these dangerous, unsafe service designs will surely divert to the hospitals and community services – and let’s not forget social care, through local authorities.

How is this legal? Really! How?

Do Success Regime members have something in their contracts that state they are not liable for health and safety related to their new model/design?

Unpleasant Decisions are being made about the functional design of our health and social care services without input from those services or the public.

Once the Decisions are taken, the individuals who make up the Success Regime will most likely melt into the background, contracted to do so. Sir Neil McKay is very good at slipping off with a nice big golden thank you, too.

The Success Regime’s puff of smoke may be worth £thousands/millions in their bank accounts, but the best thing of all (from their point of view) it seems they cannot be found accountable for the chaos they leave behind as services try to work with increased numbers of patients and fewer resources and staff.

So please, tell me, comment below, tweet @Soulsubsistence, however you like, but please put me out of my misery and explain to me HOW the Success Panel are NOT breaking the law?

How are they getting away with it?

Is it in their contracts? Is it some unofficial remit that they are to kill people off as they go? Population too old? A loophole? Please tell me, because all I have is my own personal theory, and I’d like to think the world is a better place than that.

This is a scandal and it’s happening to us! What can Cumbria do to stop it?

Whitehaven is nicer than Sir Neil McKay

Whitehaven looking very nice there.

Image credit to: www.westcumbriatri.co.uk

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References:

  1. The Management of Health and Safety Regulations 1999
  2. The Viability and Impact of Success Regime Proposals for the Reorganisation of Hospital Based Healthcare in North, East, and West Cumbria by Nina Wilson B.Sc.
  3. The Telegraph on Sir Neil McKay: NHS manager in line for £1 million pay out
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Can Cumbria County Council close down The Success Regime?

The three lucky (read: reluctant) participants of the Government takeover, The Success Regime, are Essex, North Devon, and West, North, and East Cumbria. Although Essex may be falling into place, it seems things aren’t so happy on the Devon front. They certainly aren’t in Cumbria.

Image credit to Gilda

North Devon looks very nice. Image credit to
Gilda

An angry county councillor, Frank Biederman, in Devon has today put forward a motion to Devon County Council that The Success Regime in North Devon should be halted. Here’s what he said, according to the North Devon Journal:

“The proposals that are likely to come out of the Sustainability and Transformation Plan (STP) are simply unacceptable.

“The document states stroke, paediatrics, and maternity are not clinically or financially sustainable.

“We live in a vast rural area, it does cost more to run services in a rural county like ours.

“Ten thousand people are supporting the SOHS campaign in Northern Devon alone via their FB page.

“If this goes ahead I am sure it will cost lives, it will put the remaining services under so much pressure it will break. This must be our red line too. No cuts to vital services.”

Spot the similarities with Cumbria! All and any of those comments apply also to Cumbria, though we have more than 16,000 supporters on our FB page. We’re probably a bigger county.

His fellow councillor, Brian Greenslade, called for The Success Regime to be cancelled altogether. He pointed out:

“There is also a conflict of interest in the process. I do not see how Ruth Carnall, the leader of the success regime, can be both a consultant and an independent chairman in the process. We as county councillors would be hung drawn and quartered if we allowed ourselves to get in such a situation and rightly so. This should be stopped.”

Dame Ruth Carnall owns the healthcare consulting company that has been awarded the contract for North Devon Success Regime. This lady is paid to be independent. But she isn’t independent. It’s a stitch-up, and the only people suffering are the Devon public, as she oversees strangulating cuts that render the health service ineffective. Just like their ‘options’ in Cumbria.

Why are we even in the Success Regime?

Let’s be clear. For as long as we endure a Tory government, our necessities are commodities, to be sold off as quickly as possible for as much money as can be made. All you have to do is look at the language used in the discussions around the consultations.

NW&E Cumbria, N Devon and Essex are described as ‘failing Local Health Economies (LHEs)’.  How can they be ‘economies’? Public healthcare is a loss leader. It’s impossible to make a profit from it. The NHS deficit in its very first year was £69 million. That’s £2.6 billion in today’s money. It only increased from there.

Like Devon, North, West, and East Cumbria is one of the lowest-funded, poorest-served health service areas in the UK. On paper, we can’t fight back. We can’t seem to stop them from forging ahead, paying nothing more than lip service to the consultation and infantilising the community.

Our Sir Neil McKay may not be in the luxuriously corrupt position of Dame Carnall, but he’s already received a nice big wadge of NHS money. Look at all the figures being thrown around in THIS articleis it any wonder the NHS has no money when it pays individuals literally £millions?

How stupid do they think we are? Sir Neil McKay was one of the co-founders of an organisation (Strategic Projects Team) designed to move public healthcare into private hands.

Read the article, it’s long, but it tells you what their plan is:

All the counties and health service areas targeted by The Success Regime have been singled out for wholesale privatisation. This isn’t just ‘all maternity services’, or ‘all older people’s services’, it’s all the services. Wholesale.

success-regime-2

The only good news (in a bleak sense) is, if you read the link about Sir Neil McKay, many of the Strategic Projects Team’s administered projects have failed, and private companies have walked out early from contracts. This leaves local people with no immediate health services at all in some cases. I see this as good news only in the sense that at least we can probably get our hospitals and services back in the long run, but bled dry by the privatisers and desperate for public money. Our taxes, or our donations.

So, why do we have to go through this?

We don’t. If Devon County Council can call a motion to halt The Success Regime, and perhaps mount a proper inquiry, that means Cumbria County Council can do the same.

Just as the snow blankets the ground in one of the areas most hit by the health cuts in Cumbria, maybe the County Council can save themselves (and the people) and put a stop to this healthcare privatisation by stealth.

Apparently Alston Moor earlier today / yesterday.

We should petition local councillors to put forward a similar motion and put some pressure on the people who are behind this. A health service plan like the one put forward by the N, W, E Cumbria Success Regime will put an incredible amount of pressure on County Council services. Like Social Services and Children’s Services, for example. It’s in the Council’s best interests to get fully involved in the mess, and it may also be their public duty.

Privatising the health service doesn’t work.  It is a myth, perpetuated by individuals like Dame Carnall and Neil McKay, for those individuals and their respective organisations to line their pockets with public money in the very short term, and then get the hell out. Some private companies have dumped their 10-year contracts after only 3 years! Many diseases last longer than that!

success-regime-3

There is no health care reform. This is government-sponsored daylight robbery, and it’s putting people’s lives at risk.

Sources and additional reading links:

  1. North Devon Journal
  2. NHSHistory.net
  3. Sir Neil McKay: NHS manager in line for £1 million pay out. (The Telegraph)
  4. The ninja NHS privatisers you’ve never heard of (OpenDemocracy.net) You have heard of one. It’s Sir Neil again.
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The Success Regime in Cumbria has made a MASSIVE mistake

A clear theme runs across everything being said by Cumbrian people as part of this Success Regime consultation period. wharrelshillfromallonby-jf

Give us health services that fit our rural circumstances

Young or older, the diversity of their requirements means they want a proper general hospital in both of the key sites, Whitehaven (West Cumberland Hospital, WCH) and Carlisle (Cumberland Infirmary  Carlisle, CIC), and older people’s services to be near to their homes.

Two examples of requirements mentioned by stakeholders (in no way official, just my take on what was said and reported):

  1. Women want consultant-led maternity to remain at both sites.
  2. Older people want beds in cottage hospitals to remain open, because they know they’ll probably need them.

41% of people whose official wishes are to die at home, die in hospital instead, as there are often unscheduled emergencies on the way to dusty death. Better to be closer to home.

Why we can’t have what we want

Those two particular services are linked, though you might not realise it. Both WCH and Alston Cottage hospital are struck by a lack of staffing. There is a staggering number of vacancies across the NHS in Cumbria, in quite specialist positions, and this results in either dangerously low levels of staffing, or locums being employed – at great expense.

For some reason doctors, consultants, nurses, and auxilliary staff, don’t want to risk their happiness by living out here permanently in the bleak north, or whatever it is others believe this beautiful place to be.

[EDIT: Maternity consultants at WCH emphatically disagree:

“We are also disappointed that our recent successes in recruitment have been denied publicity. The trust and Success Regime have not engaged with our new working models and new recruitment strategy, nor considered it as a way of improving recruitment within other departments.”]

3-day-lake-district-and-hadrian-s-wall-small-group-tour-from-edinburgh-in-edinburgh-40886

Because they say they can’t get the staff for more remote areas, or the more grim places, the Success Regime wants the people to be able to receive care at home instead of hospital.

So you’d have thought they would have included health and social care services in the consultation and the proposed strategy.

Nope.

Debbie Freake, an important member of Cumbria Clinical Commissioning Group, more or less admitted at the Kirkby Stephen consultation meeting that although the plans did lean more on health and social care, they hadn’t been included in the plans as there was a very wide scope just with health services.

And there’s the problem, right there. It’s a poorly thought-out plan that misses the obvious. It’s almost as though they intended to pass the buck to social care. If it was meant to work, they would have included all the services across health and social care, to create a joined up approach.

The consultation document contains 3 different ‘options’ for each of the areas under reform – maternity, hyper-acute stroke, children’s, and emergency and acute services. But those options are a joke!

The weird, laughable (scary) ‘options’

In each set of options they provide one they support, one that is similar to the first, but without some key service for some reason, and one option that is more or less unworkable.

For example:

consultation-doc-1  consultation-doc-3

consultation-doc-2

 

 

 

(Images taken from the easy read’ consultation document).

Take the Emergency and acute options (pictured): the third option is ludicrous, just considering Carlisle’s roads and access to hospitals for A&E. But if anyone’s been to CIC’s A&E in recent years, it’s not exactly a tip-top service, with a bottleneck that starts with ambulances having to wait outside the unit, and ends with patients abandoned for hours on A&E until a bed can be made available … somewhere – anywhere. The real blockage is in the number of beds available. (Often none). So unless CIC increases its beds, an enlarged A&E service will go nowhere. And they said elsewhere that they hope to decrease CIC’s beds in years to come. The mind boggles.

So that leaves two.

Option 2 involves kicking out patients at 5pm from WCH if they aren’t ill enough to go to CIC – which could mean key workers or nurses having to ensure those patients will be adequately  looked after at home … how many hours would that system run before it all came crashing down?  In addition, and for extra incredulity, intensive care patients would have to travel the 50+ miles, presumably in an ambulance or helicopter. Are we sure that experience will improve their conditions?

Option 1, of course, is the most reasonable option, since that’s apparently the service they currently provide. Maybe it looks even more reasonable next to those other ideas.

All the others are like that, including maternity services:

consultation-doc-4 consultation-doc-5 consultation-doc-6 Option 3, again, has just been popped into the document for a laugh. The idea of trailing up the motorway for some lubricant and an epidural seems pretty extreme, but are home births really that popular?! Are there going to be a lot of ladies having their babies on the side of the A595? The ridiculousness of the imagery is testament to how dumb that option sounds. In that circumstance, WCH could house nothing more than a social club for new mums and health visitors. Another part of what used to be a hospital becomes the dead white elephant everyone said it was.

[EDIT: New research shows that travelling in a car seat for more than 30 minutes can harm a baby under 4 weeks old. Whitehaven is a minimum of 40 minutes drive from Carlisle. More, if there’s an accident and a road closure. That means all but Maternity option 1 are risky to mothers in West Cumbria, even if the births went smoothly. Surely the plan is already dropping to bits?]

Why the Success Regime model doesn’t work for Cumbria

These options aren’t a proper choice. They’re weighted. There’s only one doable option in each set. Except this model doesn’t work for our dispersed rural communities. It doesn’t work for the fact that by 2020 25% of our Cumbrian population will be older adults. (People move here to retire, for heaven’s sake!)

Of course, it can’t address the loss of our public transport, our libraries, our post offices and ‘church spirit’. Of our essential communities made up of all ages. It’s not the health service’s fault how high property prices are under the spectre of the second home brigade, taking house opportunities from people who might have lived and worked in the area.

But most importantly of all, it’s an incomplete model. It doesn’t address the fact that the CQC thinks health and social care is at a ‘tipping point’ in the UK.

Also not covered:

  • The problems already experienced by community health staff, even at the current levels.
  • The problems in quality already experienced by residential homes and home care companies across the country.
  • The fact that some care companies pass back contracts, calling them ‘undeliverable’. So some older folk get passed from company to company, and all the while they’re not being cared for. And that’s at current levels of care.

Yet they didn’t think they needed to involve Health and Social Care within the consultation?

This consultation is a disgrace.

Sources and additional reading links:

  1. Easy Read consultation document
  2. Bristol University: research on the effects of car travel on infants. Includes link to paper.
  3. CQC reports Health & Social Care in the UK is at a ‘tipping point’.
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My latest baby: a handy guide for anyone who wants to sell crafts online.

The last 3 months has been spent writing, designing, and twiddling with my newest book idea. The result? 4 STEPS TO SOCIAL MEDIA MARKETING FOR CRAFTERS. I have to write it in capital letters to make it stand out. Let me know if that gets annoying.

Take a little look for yourself if you please:

4stepstosakinafrontfinalBack cover of 4 STEPS TO SOCIAL MEDIA MARKETING FOR CRAFTERS

Cover courtesy of the talented  Monique Snyman, of Muti-Nation fame.

The writing

Once I’d planned the structure, the words just tripped out of my fingers. Because I’ve sold – and still sell – crafting products online myself, it was easy to remember the things I thought were most important when I did them.

I listened to what other people said about using social media for marketing. One woman said Facebook promotions had cost her a huge and unexpected amount of money. In response to that, I included step-by-step details with screenshots, and throughout that section of the book I urge readers to check and double check dates and money and to be sure they are happy with what they’ve chosen. Experience has taught me to stop and look and check, and I wanted to share all the things I’ve learned in a really useful way.

I figured my audience might be used to step-by-step project books, so thought the best way forward would be to produce a print book with an ebook option and go from there.

The design

Now, I’m no designer, that’s for sure. I have a more ‘splattergun’ approach to creativity. So I’m extremely proud of the results of my understated design!

Inside, it’s laid out mainly in two columns with plenty of white space and few distractions, other than the odd callout box. This is to make it easier to read. The text line distance is more or less what is known as the Golden Ratio for type.

sneak-peek3

sneak-peeksneak-peek2

You know how sometimes you read a book and you get to the end of a line and accidentally re-read the same line? Apparently, that happens when the gap between the lines (the line distance) is too small for the length of the line. The Golden Ratio sorts that right out.

The callout boxes are to emphasise important points to remember, and the splash motif (with occasional lovely multicoloured-but-muted giant splashboxes) is because my creativity is wedged firmly in the AK47 PAINTBALL ARENA. Muted, tasteful, and unobtrusive is not normally my style!

Think I did okay?

The publishing

Self-publishing has to be one of the most self-satisfying things a writer can do. Whether you do it through a local press and buy 150 copies to sell, or you take on the contracts of an online monster like CreateSpace (Amazon, of course), taking a project from idea through writing and design, through to seeing and holding a print proof …

I’m proud and pleased and frankly, glad it’s over. I’ve never worked so hard outside my comfort zone.

Except that it’s not over. See, this is a book about marketing. So I better take my own advice and go tell people about it!

Pre-order the ebook right now, or wait for 1st November 2016 to get your copy of the paperback.

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Renationalise the NHS! Here’s why:

Alston Hospital campaigners pictured before the start of the Success Regime Health meeting,

Alston Hospital campaigners pictured before the start of the Success Regime Health meeting,

The privatisation of the NHS has already happened – more or less since the introduction of market forces 2001-07. But it is a process, not an event. So it’s taking time for the public to realise, and meanwhile, they may be missing an opportunity to take it back.

But the renationalisation of the NHS will be a long, arduous process, even with an immense budget, as it will be fought through the courts as each private health provider bellyflops on the beach to the bitter end. And it’s a long way from happening. Mrs May is determined to take the ‘public’ out of public health care, and Labour isn’t paying attention.

So step by step, the privatisation strategy continues, bringing the NHS to its knees reducing budgets as if the world is running out of money, and replacing it with ‘fair’ tender contracts.

The Success Regime

One of the new arms of the strategy is the overarching governance, The Success Regime. The very use of the word ‘regime’, beautifully teamed with ‘success’ makes the phrase a perfect metaphor for ‘corporate fascism’. It has a cheerfully threatening tone. The language around all the documentation is scary, and it appears to be some kind of government takeover since each organisation that administrates it is a public body that reports to the Department of Health.

One of the first three ‘challenged local health economies selected to enter the Success Regime’ (see how creepy it is?! Sounds like the Hunger Games!) is North Cumbria. Now, Cumbria has its problems. But this new governance gives them ever more KPIs with patient targets of better-funded institutions, coupled with the stranglehold of endlessly rearranged budgets and the constant threat of collapse (to be replaced with private health care, of course). Not to mention restructures, where fewer staff work larger loads for the same money as before. Frozen wages in some cases. (Article is from 2013).

The Chair for the Success Regime, Sir Neil McKay, seems a very charming chap. He spoke to a small demonstration outside one of the consultation meetings, and reassured them their voices would be listened to. I heard somewhere he is being paid what I’d call an exorbitant amount of money to do the job, so I daresay he can afford to be nice to the people who are losing the beds at Alston Moor Cottage Hospital.

(At least Cumbria isn’t in the same situation as Devon, where it happens the ‘healthcare consultation company’, Carnall Farrar, ‘selected to provide consultancy support following a competitive tender’ is the baby of Dame Ruth Carnall, the appointed chair of the Success Regime (that followed as a result of Carnall Farrar’s consultancy, presumably). Nice).

So public healthcare as we think of it is on its way out in Cumbria, a long, painful, drawn-out death, not a quick one.

What will happen to our health care system?

The effect of a fully privatised American-style health care system on the British public most likely can’t be quantified or measured ahead of time. Americans say they still have to pay hundreds of dollars even when they are insured, so if you’re too poor to pay, you’re in trouble. Imagine not going to the hospital with a broken bone because you know you won’t be able to afford the hundreds of pounds it will cost to set it. That limp and the aching bone will last you forever. It’s why Dickensian characters are deformed (some of ’em, anyway).

What will happen to us?

Capitalism is destined to destroy itself by destroying its workers unless it is mitigated with a strong welfare state and health service. By turning public services into businesses, the NHS privatisation removes the need to deal with everyone. They only deal with those who can afford to visit. Bed numbers reduce, money is made, and everyone calms down and falls into place. To give it context, that was more or less Enoch Powell’s suggestion in 1961, and even he knew that couldn’t be called a health service.

The result is that even though ‘the weakling, the old and the subnormal would be left to die’, the workers also become less healthy, more sick, less likely to live as long …

But there is, if you can imagine it, a potentially deeper cost.

A cost that is, in a sense, greater than the lives of the people living today.

It started out as an unforeseen beneficial effect of the National Health Service, and now the entity is being slowly turned over to full-on market forces, this benefit has been forgotten again.

The miscalculations

One of the things William Beveridge explained in his nation-changing report on the Welfare State (1942) was that the introduction of a National Health Service would make the workforce more well and fit. It would make the nation healthier.

He was wrong. Instead of being more well, the people seemed to become more ill.

What’s more, the whole thing got really expensive.

In 1946 when the NHS Bill went

to Parliament the estimate of the total net cost annually was £110 million. At the end of 1947 it was £179 million. At the beginning of 1949 a supplementary estimate of £79 million was added and the figures turned out to be £248 million. The actual cost in 1949/50 was £305 million. The following year it was £384 million. The government became alarmed. 

NHSHistory.Net

There was one major cost they hadn’t accounted for, and they’re forgetting it again.

First of all, they underestimated the need. They’d based their figures on the people already using health care. Hadn’t accounted for those who were too poor to even contemplate it until it became free.

However, the most unforeseen result of the NHS creation was an explosion of medical research. With all the people coming to the doctor for the first time ever, doctors did more research and shared new information. University hospitals were renowned. Common diseases were eradicated within ten years of the inception of the NHS and new ones discovered, all because of research. Research cost money and it was worth it, because it was cheaper in the long run to cure and mitigate diseases.

So the people weren’t more ill in 1952; they didn’t go to the doctor before the NHS was formed, and the doctor was likely not to know what they had anyway.

Medicine and public health care is doomed without renationalisation

The medical profession is the epitome of respectability, but it’s only made a difference since free universal healthcare was made available. The research, the breadth of patients, the new information and wider experiences benefited staff and in turn made things better for patients. The NHS was a glory across the whole world for a long time. But all that new knowledge only occurred because the organisation came about.

Scientific research sponsored by drugs companies are not a replacement for truly unbiased research. It’s impossible to truly trust the research. Even charities who produce good and useful work may have their biases due to the way they’re funded.

We’ve only had this opportunity provided by the existence of the NHS to improve medicine for 70 years, and now we’re losing it to privatisation.

In some ways, this is worse than people suffering now as a direct result of these austerity-based plans.

This is all future British research and breakthroughs relying on large charities, contaminated by private interests, or lost altogether.  Patients are just pawns in the money flow.

That’s why I would like proper, fully-funded renationalisation of the NHS. Research matters. Medicine needs to improve.

Check out Jeremy Corbyn’s plan for mental health care.

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