I thought a brief explanation about survival rates might be helpful.
Before I started working in the health service, I had no idea what the concept meant. I figured it meant you either lived for ever or you died. But on joining the health service, I learned pretty quickly.
An 80% survival rate doesn't mean that eight of ten people will live for ever and a day after being diagnosed with X illness or disease. It refers to a five-year period. Not that you will necessarily live out your so-called normal life until 70 or 80 or 90 or whatever. Just that you have a good chance of being alive five years after diagnosis. And that doesn't even get into the issues of reoccurrence or metastatic cancer for example.
I must say as with a lot of communication, the NHS (UK health service) has improved its presentation of statistics. You can actually look up five year survival rates for cancer. - Here for anyone interested. If you look at that cursory weblink, you will note that breast cancer survival rates are above 80% which is a good thing. Similarly the rate for testicular cancer is 97% and prostate cancer is 80%. Malignant melanoma is between 80 and 90%.
Why then are people jumping on bandwagons to promote our awareness of any of those cancers?? Pancreatic cancer has a survival rate of less than 4%. Liver cancer is similar - the graphs I looked at didn't mention the rate and also used one year survival rates because they look better. Lung cancer is around 8%. As is oesophageal cancer. Stomach cancer - 15%. Ovarian cancer is one of the baddies too but that is a whopping 40 odd %. Colorectal is one of the three 'common cancers' along with lung and breast. The survival rate for colorectal is just over 50% - that is really poor. When do we hear about any of those cancers??
Pause for a quick anecdote. We sold one of our houses to a medic. An eye surgeon. He had a Land Rover so mostly Partner and he talked Landies. But at some point they flipped onto a clinical discussion and Partner pointed out that survival rates were based over a five year period. Eye surgeon/Landy friend was bemused and asked how Partner knew that. Pretty obvious really given the fact I was responsible for cancer services. Then 'Well yes but not many people know that." Maybe not, but they should. Telling people they have a survival rate of 80% or 20% or whatever - without telling them it is over five years is downright misleading. The Mayo clinic - as ever - has a good and clear article here.
Now, while I am on about survival rates, I need to mention lead time bias. I was rather up on this at one point and could quote every relevant piece of research under the sun. Put very simply - lead time bias is about the difference between the start of your illness and when it is diagnosed or discovered, and the perceived impact earlier detection has on survival rates. Actually for once, Wiki puts it incredibly well. Check it out here.
Basically for example, if you are diagnosed with breast cancer from the screening programme, you may well find out that you have cancer sooner than you would if the cancer was diagnosed when symptoms appeared (normally small lumps in the breast/axilla areas). When the cancer is diagnosed doesn't affect the overall life expectancy (and therein lies a whole issue about waiting times) but it can skew survival rate figures if it is detected early. If you are diagnosed earlier - you may well 'appear' to live longer. But life expectancy isn't or shouldn't be dated from diagnosis, it is from when the disease starts. There is a huge difference there. Anyway, check out the Wiki link because the diagram on there explains it very simply. Wiki also points out the additional impact of mental anxiety of earlier diagnosis.
Let's go back to survival rates and lead time bias. For women diagnosed with breast cancer in 2001-2006, five-year relative survival rates have reached 82% (England only) compared with only 52% thirty years earlier in 1971-75. Ten year survival rates for women diagnosed with cervical cancer have improved from around 46% in the 1970s to 64% for the latest period.
Lead time bias anyone given the screening programmes??
Saturday, 6 August 2011
Thursday, 4 August 2011
Cancer - and that time of year
Oh dear. It is that time of year where women start posting crass comments on facebook about the colour (of their bra), the state (of their hair), where they like it (left their handbag) and now the latest one, which I can't possibly reveal - or remember - what it is.
If anyone is interested mine were white, long and messy, and hidden under piles of clothes.
All to raise awareness of breast cancer.
Do you know anyone who hasn't had breast cancer? Unlikely.
UK stats for 2008 say that of all cancers in women, 31% are for breast cancer. Or a different statistic says that the risk of developing breast cancer is i in 8, ie 12%. You can do anything with statistics.
I have met some great patients with breast cancer, have some lovely friends who have had breast cancer, and I can't begin to know how they manage to smile and keep going every day after their crap treatment, and everything that really goes with a cancer diagnosis.
But what gripes me about this facebook trivialisation is that I don't see how it helps anyone.
Why does making a sexually suggestive comment raise awareness of breast cancer? Why do we need to raise awareness of breast - or any other - cancer?
What we need to do is generate a little more knowledge and empathy.
There is nothing funny or light-hearted about being diagnosed with a potentially life-threatening disease.
Openness, honesty, and supporting friends seems to me to be a far better way to go.
Three friends come to mind immediately - one who has set up a facebook support group for cancer survivors and caregivers, another, who has posed for photographs bald and naked. Another has used her talented skills to help other women with chemo problems find the right wigs while they are going through hair loss.
To me, that is what raising awareness of cancer is about.
Wednesday, 3 August 2011
Health service rationing
Everyone knows health care is rationed. Don't they?
Whether it is funded, or not funded, by government or insurance companies - or you pay for it privately - it is still rationed because money is finite. It is just not possible to fund every medical treatment under the sun, and people who complain about that are amazingly naive. The difficulty comes when deciding exactly what to ration and how to do it.
Here are a few random tales, all of which were publicised for whatever reason at some point so I'm not breaking any confidences. Let's start with breast implants. I was happily sitting at my desk when the 'phone rang. It never stopped all day. When I put it down it rang again, and my secretary was in and out all day with messages from newspapers, radio and tv stations all wanting me to call them back.
Why? Because one of our local GPs had referred a patient for breast enlargement so that she would be more successful as a topless model. Some background. Well, naturally the NHS isn't - or wasn't - some sort of support agency to the Job Centre. It's prime function is not one that offers surgery to anyone and everyone who feels they might do better in life if they were 'better' looking. Or perhaps, looked different would be a more appropriate description.
And indeed, being referred for surgery to help her topless modelling career wasn't how the doctor got the referral through. His patient was suffering from low self-esteem due to her small breasts. If she didn't have depression then, no doubt it would set in later. The operation cost slightly over two grand. Not huge in the scheme of things.
Working in public sector press and media I found it useful to not have a view on things. It made it much easier to churn out my party line, and not get involved in any discussions and - say the wrong thing. This GP wasn't a fundholder so it fell to the health authority to fork out the £2K+ - and that's why I spent all day politely telling every media caller that a) we couldn't go into detail about individual patients and b) it was up to every doctor to exercise their clinical judgement appropriately when referring patients for surgery etc etc etc. I was quite happy with this line and it was dutifully repeated by everyone who called me when they published or broadcast it.
Some years later on, I can allow myself an opinion. In no particular order:
1) I still think it is up to each and every doctor to decide what is the right treatment for their patient. Up to the patient then to decide whether to take it up.
2) Suffering from lack of self-esteem and/or depression is not good. Just because mental illness isn't obviously visible doesn't negate from the seriousness of the illness and the trauma that people suffer. People who are mentally ill and fall in and out of big black holes do not have a good time - and like other chronic illnesses - it is always with them.
3) I have probably also had low self-esteem from having small breasts, although becoming a topless model wasn't high on my list of career choices. It is not nice to pass people in the street and hear them saying they can't decide whether you are a girl or a boy. Not helped by the fact I was tall and had shortish hair. Then there are the ones who quite bluntly tell you that you have small breasts, that you are flat-chested, that you look like a boy, and that you don't look remotely sexy. And this last point is the issue.
What on earth is it about our (male) society that imposes such conditioning on women they feel they need to have surgery to get bigger breasts? Or that the aspirations of a young woman are to become a topless model? I know that appearances are important and that we are all judged on them. But women are judged in a different fashion.
We all know the ideal woman. She has a slim but curvaceous body. Long well formed pins, reaching right up to her cute and firm arse. Oh, I should add that those pins are immaculately smooth and shaved every day so that a chiffon scarf will drop straight down them. She has long sexy hair, big eyes, and a beautiful Colgate pearly white smile. And naturally her breasts are NOT small, but just the perfect size, firm with a suitable amount of cleavage for men to peer down.
Who creates this ideal woman? Men. She's not a woman. She's a sex object. And anyone who wants breast enlarging surgery is sadly conditioned to believe all this. They are buying into the male fantasy of the perfectwoman sex object. And they aren't doing any favours to women who don't want to be judged on the size of their breasts. A few years ago I met someone who had undergone breast enlargement and had her eyes tucked. She looked top heavy and the skin around her eyes was so tight. I think she could have spent her partner's money more wisely.
So these days, I would be sadly disappointed to hear about any GP referring their patient for breast enlargement. For whatever reason. It seems to me to be treating the symptom and not the cause, but maybe that's what medics do. Some helpful counselling and assertiveness skills would be a lot more helpful - IMO.
Some of the longest waiting lists in my NHS days were for plastic surgery - and the two critical areas were for burns, and for reconstructive surgery following breast cancer mastectomies. Technically I suppose one could argue that reconstructive surgery is similar to breast enlargement and could well involve self-esteem issues - but at the end of the day, I don't think there is any comparison between a woman who has gone through surgery and chemotherapy, that was not something of their choosing and a young woman wanting bigger tits so she can appear on page 3. Incidentally, I read later that her modelling career didn't last long. So, in terms of rationing - I would not want to see the NHS spending money on breast enlargement for women, whether for self-esteem issues or not. There are other ways to gain self-esteem.
Onto another controversial area. Fertility treatment. We decided that we needed to introduce criteria for this service. Which is another way of saying rationing the service. We put a paper to the board with extremely tight criteria. The chief executive had primed the chair about it. She was expected to approve the paper.
But she had been lobbied by some of the local fertility action groups. And - she told me in confidence, and quite a few others as well - that she had been unable to have children back in the days when fertility treatment didn't happen on the NHS. So when it got to the critical moment at the board meeting - she deferred the decision for consultation with our local groups. Great, another two months of indecision.
The proposal got watered down of course. The age limit went up to nearly 40 (conception is less likely as you get older so treatment for older women was less effective), we had a clause requiring residency in the area for a couple of years, something about a stable relationship, and there was probably something about only three goes at it, or something similar.
Out of those of us who originally discussed it, there was me - the only woman, and some 40 or 50 year-old men, who had children. Not exactly the most empathetic group for infertile women. Yes, we heard about the angst. The emotional trauma for women who couldn't fulfil their lives by not having a baby. The sheer mental distress of it all and how it affected their relationships. And how wonderful it was for those who did eventually conceive. That's great. Because in a world of limited resources - you stand up and tell someone who is being deprived a few months of life for an expensive cancer drug that your need for an IVF baby comes first. I couldn't.
Next up came screening for Down's Syndrome. But by then I think we had lost the will to ration, and this really was just a long-winded exercise to write down some firm criteria about when and whether pregnant women should have blood tests, ultrasound tests or amniocentesis.
But a few years later, with a change of directors - rationing picked up its lively head again and we decided to hold a public meeting and discuss how to spend our so-called development monies. These were peanuts in the scheme of things as virtually 90% of the budget is already spoken for as soon as it is allocated. Those of us responsible for some of the key services - maternity and child health, elderly services, mental health services, cardiothoracic medicine, and cancer - were asked to present our 'case' for investing in our service.
I have to say it was rather a tabloid exercise. Asking people to decide how to spend money based on a few presentations over a couple of hours? I didn't present my case. I asked a clinical director for cancer services and a breast cancer patient to make the case. I figured they could do a lot better than I could have done. They did. We 'won' the debate. Always choose the right people to give the message. And there ends my mixed post on rationing.
In theory it should be based on clinical effectiveness - ie don't provide services that don't work. Secondly, don't provide expensive services that either don't work or when there is a cheaper and as effective service available.
Most people don't want to accept, or don't like the fact that rationing exists. They also don't want to make the decisions themselves but they sure as hell want to blame those of us who can't make a health service budget into the bottomless pot of gold at the end of the rainbow.
Whether it is funded, or not funded, by government or insurance companies - or you pay for it privately - it is still rationed because money is finite. It is just not possible to fund every medical treatment under the sun, and people who complain about that are amazingly naive. The difficulty comes when deciding exactly what to ration and how to do it.
Here are a few random tales, all of which were publicised for whatever reason at some point so I'm not breaking any confidences. Let's start with breast implants. I was happily sitting at my desk when the 'phone rang. It never stopped all day. When I put it down it rang again, and my secretary was in and out all day with messages from newspapers, radio and tv stations all wanting me to call them back.
Why? Because one of our local GPs had referred a patient for breast enlargement so that she would be more successful as a topless model. Some background. Well, naturally the NHS isn't - or wasn't - some sort of support agency to the Job Centre. It's prime function is not one that offers surgery to anyone and everyone who feels they might do better in life if they were 'better' looking. Or perhaps, looked different would be a more appropriate description.
And indeed, being referred for surgery to help her topless modelling career wasn't how the doctor got the referral through. His patient was suffering from low self-esteem due to her small breasts. If she didn't have depression then, no doubt it would set in later. The operation cost slightly over two grand. Not huge in the scheme of things.
Working in public sector press and media I found it useful to not have a view on things. It made it much easier to churn out my party line, and not get involved in any discussions and - say the wrong thing. This GP wasn't a fundholder so it fell to the health authority to fork out the £2K+ - and that's why I spent all day politely telling every media caller that a) we couldn't go into detail about individual patients and b) it was up to every doctor to exercise their clinical judgement appropriately when referring patients for surgery etc etc etc. I was quite happy with this line and it was dutifully repeated by everyone who called me when they published or broadcast it.
Some years later on, I can allow myself an opinion. In no particular order:
1) I still think it is up to each and every doctor to decide what is the right treatment for their patient. Up to the patient then to decide whether to take it up.
2) Suffering from lack of self-esteem and/or depression is not good. Just because mental illness isn't obviously visible doesn't negate from the seriousness of the illness and the trauma that people suffer. People who are mentally ill and fall in and out of big black holes do not have a good time - and like other chronic illnesses - it is always with them.
3) I have probably also had low self-esteem from having small breasts, although becoming a topless model wasn't high on my list of career choices. It is not nice to pass people in the street and hear them saying they can't decide whether you are a girl or a boy. Not helped by the fact I was tall and had shortish hair. Then there are the ones who quite bluntly tell you that you have small breasts, that you are flat-chested, that you look like a boy, and that you don't look remotely sexy. And this last point is the issue.
What on earth is it about our (male) society that imposes such conditioning on women they feel they need to have surgery to get bigger breasts? Or that the aspirations of a young woman are to become a topless model? I know that appearances are important and that we are all judged on them. But women are judged in a different fashion.
We all know the ideal woman. She has a slim but curvaceous body. Long well formed pins, reaching right up to her cute and firm arse. Oh, I should add that those pins are immaculately smooth and shaved every day so that a chiffon scarf will drop straight down them. She has long sexy hair, big eyes, and a beautiful Colgate pearly white smile. And naturally her breasts are NOT small, but just the perfect size, firm with a suitable amount of cleavage for men to peer down.
Who creates this ideal woman? Men. She's not a woman. She's a sex object. And anyone who wants breast enlarging surgery is sadly conditioned to believe all this. They are buying into the male fantasy of the perfect
So these days, I would be sadly disappointed to hear about any GP referring their patient for breast enlargement. For whatever reason. It seems to me to be treating the symptom and not the cause, but maybe that's what medics do. Some helpful counselling and assertiveness skills would be a lot more helpful - IMO.
Some of the longest waiting lists in my NHS days were for plastic surgery - and the two critical areas were for burns, and for reconstructive surgery following breast cancer mastectomies. Technically I suppose one could argue that reconstructive surgery is similar to breast enlargement and could well involve self-esteem issues - but at the end of the day, I don't think there is any comparison between a woman who has gone through surgery and chemotherapy, that was not something of their choosing and a young woman wanting bigger tits so she can appear on page 3. Incidentally, I read later that her modelling career didn't last long. So, in terms of rationing - I would not want to see the NHS spending money on breast enlargement for women, whether for self-esteem issues or not. There are other ways to gain self-esteem.
Onto another controversial area. Fertility treatment. We decided that we needed to introduce criteria for this service. Which is another way of saying rationing the service. We put a paper to the board with extremely tight criteria. The chief executive had primed the chair about it. She was expected to approve the paper.
But she had been lobbied by some of the local fertility action groups. And - she told me in confidence, and quite a few others as well - that she had been unable to have children back in the days when fertility treatment didn't happen on the NHS. So when it got to the critical moment at the board meeting - she deferred the decision for consultation with our local groups. Great, another two months of indecision.
The proposal got watered down of course. The age limit went up to nearly 40 (conception is less likely as you get older so treatment for older women was less effective), we had a clause requiring residency in the area for a couple of years, something about a stable relationship, and there was probably something about only three goes at it, or something similar.
Out of those of us who originally discussed it, there was me - the only woman, and some 40 or 50 year-old men, who had children. Not exactly the most empathetic group for infertile women. Yes, we heard about the angst. The emotional trauma for women who couldn't fulfil their lives by not having a baby. The sheer mental distress of it all and how it affected their relationships. And how wonderful it was for those who did eventually conceive. That's great. Because in a world of limited resources - you stand up and tell someone who is being deprived a few months of life for an expensive cancer drug that your need for an IVF baby comes first. I couldn't.
Next up came screening for Down's Syndrome. But by then I think we had lost the will to ration, and this really was just a long-winded exercise to write down some firm criteria about when and whether pregnant women should have blood tests, ultrasound tests or amniocentesis.
But a few years later, with a change of directors - rationing picked up its lively head again and we decided to hold a public meeting and discuss how to spend our so-called development monies. These were peanuts in the scheme of things as virtually 90% of the budget is already spoken for as soon as it is allocated. Those of us responsible for some of the key services - maternity and child health, elderly services, mental health services, cardiothoracic medicine, and cancer - were asked to present our 'case' for investing in our service.
I have to say it was rather a tabloid exercise. Asking people to decide how to spend money based on a few presentations over a couple of hours? I didn't present my case. I asked a clinical director for cancer services and a breast cancer patient to make the case. I figured they could do a lot better than I could have done. They did. We 'won' the debate. Always choose the right people to give the message. And there ends my mixed post on rationing.
In theory it should be based on clinical effectiveness - ie don't provide services that don't work. Secondly, don't provide expensive services that either don't work or when there is a cheaper and as effective service available.
Most people don't want to accept, or don't like the fact that rationing exists. They also don't want to make the decisions themselves but they sure as hell want to blame those of us who can't make a health service budget into the bottomless pot of gold at the end of the rainbow.
Saturday, 30 July 2011
Generic prescribing
I spent the vast part of my life knowing nothing at all about - prescription - drugs.
The nearest I got to anything remotely druggy was when I had appendicitis, or maybe it was when I had yet another fractured ankle. But I got this wonderful painkiller when I was lying post-operatively in my hospital bed. it was an injection and it transported me heavenwards. Seriously.
I floated above the boring old hospital bed and felt as though I was in another world. It was so good I asked for another painkilling shot. Sadly the staff must have wised up to teenage druggies. I got a painful shot in the arse and no ethereal levitation. That was my only brief dalliance with the wonderful world of opiates - or whatever it was.
Period pains, headaches, anything else - I never bothered with painkillers. Figured they would all eventually go off anyway. And they did. So when I started working in the health service and drugs became part of my job, it was a whole new world. I learned about generic prescribing.
This is an easy one. For anyone who doesn't know - as I didn't before I joined the NHS - generic drugs are just drugs without a brand name. So to give an example: Zovirax is a brand name cream for cold sores made by GlaxoSmithKline UK. The active ingredient in this is aciclovir. Aciclovir is what makes the difference. It doesn't matter what the drug is called or who makes it - the active ingredient is what counts.
A few months ago I skipped off to Morrisons and, as I was stressed out of my head for no reason in particular, I had a cold sore looming. I asked at the pharmacy counter how much the Zovirax was. Seven pounds something for a tiny tube. Er, I don't think so.
Facebook pals will know that I invariably recommend Smirnoff Blue Vodka for all oral problems - and at around eight pounds something it is far better vfm. I don't recommend drinking the vodka though, however nice it may taste. Far too strong. Best to use as an antiseptic or mouth wash or whatever.
But back to the pharmacy counter. I pulled a face, wrung my hands, and said how expensive that was. The pharmacist said, 'We have our own brand' and gave me the box to look at. I compared it with the Zovirax. Exactly the same. The pharmacist watched me and helpfully told me they were the same. I parted with three quid for Morrisons' own brand aciclovir. Not sure if it is any more effective than Smirnoff but that's another matter.
This post is about generic prescribing and how you need to check out active ingredients. Incidentally, I have noticed that my American friends are far more clued up on generic names - whether for dog drugs or people drugs - and I wonder if that is for health insurance issues?
The nearest I got to anything remotely druggy was when I had appendicitis, or maybe it was when I had yet another fractured ankle. But I got this wonderful painkiller when I was lying post-operatively in my hospital bed. it was an injection and it transported me heavenwards. Seriously.
I floated above the boring old hospital bed and felt as though I was in another world. It was so good I asked for another painkilling shot. Sadly the staff must have wised up to teenage druggies. I got a painful shot in the arse and no ethereal levitation. That was my only brief dalliance with the wonderful world of opiates - or whatever it was.
Period pains, headaches, anything else - I never bothered with painkillers. Figured they would all eventually go off anyway. And they did. So when I started working in the health service and drugs became part of my job, it was a whole new world. I learned about generic prescribing.
This is an easy one. For anyone who doesn't know - as I didn't before I joined the NHS - generic drugs are just drugs without a brand name. So to give an example: Zovirax is a brand name cream for cold sores made by GlaxoSmithKline UK. The active ingredient in this is aciclovir. Aciclovir is what makes the difference. It doesn't matter what the drug is called or who makes it - the active ingredient is what counts.
A few months ago I skipped off to Morrisons and, as I was stressed out of my head for no reason in particular, I had a cold sore looming. I asked at the pharmacy counter how much the Zovirax was. Seven pounds something for a tiny tube. Er, I don't think so.
Facebook pals will know that I invariably recommend Smirnoff Blue Vodka for all oral problems - and at around eight pounds something it is far better vfm. I don't recommend drinking the vodka though, however nice it may taste. Far too strong. Best to use as an antiseptic or mouth wash or whatever.
But back to the pharmacy counter. I pulled a face, wrung my hands, and said how expensive that was. The pharmacist said, 'We have our own brand' and gave me the box to look at. I compared it with the Zovirax. Exactly the same. The pharmacist watched me and helpfully told me they were the same. I parted with three quid for Morrisons' own brand aciclovir. Not sure if it is any more effective than Smirnoff but that's another matter.
This post is about generic prescribing and how you need to check out active ingredients. Incidentally, I have noticed that my American friends are far more clued up on generic names - whether for dog drugs or people drugs - and I wonder if that is for health insurance issues?
Thursday, 7 July 2011
Spoilt brats
I don't like or dislike children. I just have no particular interest in them.
The concept of having my own never occurred to me. It always strikes me as bizarre when people call adults selfish because they have chosen not to have family. I am not aware that I have a duty to reproduce.
Anyway, what I do not like are spoilt brats. And selfish mothers. Getting on the bus yesterday with three bags of shopping in the heat of the day - who occupied the first four seats on the bus? Yes, three children and their mother, who, was approximately half my age. Did any of said three children get up and offer a 52-year-old woman their seat? Of course not. I wasn't the only middle-aged or older person standing either. They weren't toddlers. They were children of say, junior school age. They didn't have any bags or baggage. They could quite easily have taken seats at the back of the bus, which is what a woman with her two children did yesterday. Another seven-year-old boy (I know how old he was because he started chatting to the others) also sat next to them - he was travelling on his own.
So I could see no reason for these three and their mother to take up the first seats on the bus. They were looking sulky and bored. One of them stared at me. I glared back at it. The middle one stared too. I glared again. I suppose it could have been worse. They could have been screaming. Grumpy old people like me grew up in the days when we stood up on the bus to let older people have our seats.
What is so special about today's children that they NEED to sit? Why do they lack basic manners and courtesy? The only people I ever seem to see giving up their seats for older people (and I mean older than me here) are adults of varying ages, as I would still do too. But children? They never give up their seats. Precious little gits, presumably with rude and badly educated parents.
If you are a parent and your children are ever unprivileged enough to get the bus on the rare occasion you are not ferrying them around in your SUV, perhaps you could suggest they may wish to offer their seat to an older person. And not take up all the front seats when there are plenty at the back. Thank you.
The concept of having my own never occurred to me. It always strikes me as bizarre when people call adults selfish because they have chosen not to have family. I am not aware that I have a duty to reproduce.
Anyway, what I do not like are spoilt brats. And selfish mothers. Getting on the bus yesterday with three bags of shopping in the heat of the day - who occupied the first four seats on the bus? Yes, three children and their mother, who, was approximately half my age. Did any of said three children get up and offer a 52-year-old woman their seat? Of course not. I wasn't the only middle-aged or older person standing either. They weren't toddlers. They were children of say, junior school age. They didn't have any bags or baggage. They could quite easily have taken seats at the back of the bus, which is what a woman with her two children did yesterday. Another seven-year-old boy (I know how old he was because he started chatting to the others) also sat next to them - he was travelling on his own.
So I could see no reason for these three and their mother to take up the first seats on the bus. They were looking sulky and bored. One of them stared at me. I glared back at it. The middle one stared too. I glared again. I suppose it could have been worse. They could have been screaming. Grumpy old people like me grew up in the days when we stood up on the bus to let older people have our seats.
What is so special about today's children that they NEED to sit? Why do they lack basic manners and courtesy? The only people I ever seem to see giving up their seats for older people (and I mean older than me here) are adults of varying ages, as I would still do too. But children? They never give up their seats. Precious little gits, presumably with rude and badly educated parents.
If you are a parent and your children are ever unprivileged enough to get the bus on the rare occasion you are not ferrying them around in your SUV, perhaps you could suggest they may wish to offer their seat to an older person. And not take up all the front seats when there are plenty at the back. Thank you.
Wednesday, 6 July 2011
Trial by jury? or by media?
Please people, don't indulge in convicting someone through trial by media.
A few points about trials. If someone pleads not guilty, then to all intents and purposes they are not guilty until proved otherwise, ie beyond all reasonable doubt and all that.
It is difficult for most people to avoid seeing or reading media reports on deaths, and suspected murders. (Not so much for me as I don't have a television). But because there has been a death, and there are suspects, does not automatically make someone a murderer. Emotive reports and hard facts are not the same.
Jurors concentrate on what they are told in court not the crap that has been churned out on television or in newpapers. Being a jury member is an incredible responsibility - especially when you could be condemning someone to death. You aren't there to say - I read about it/saw it on television so therefore this person is guilty. You are there to listen to two sides of an argument and objectively decide which one is stronger, based on the evidence presented.
Casting aspersions on someone's character, ie proclaiming that a woman is a slut/whore/lives a promiscuous lifestyle however you wish to call it, is not evidence of anything. Unless a woman is being prosecuted for having lots of sex of course.
I wasn't a juror in the Casey Anthony trial so quite frankly it is not up to me to say whether she was guilty or not. She was found not guilty of murder (and two other charges, although guilty of misleading police) so that should be an end to speculation. Don't jump in and condemn the people who were chosen to do the job, and came to a unanimous not guilty verdict.
What I will do though, is criticise our society that even makes it acceptable to portray a woman as a pleasure-seeking slut who is therefore, a bad mother. This isn't to advocate the idea of bad parenting. I am not doing that for a minute.
But I am criticising the stereotypical view that a woman needs to be a chaste - almost virginal - stay-at-home mum. I mean, she has to be bad right, because she is a single mum in the first place? Unpackage the imagery of what women 'ought' to be according to society.
Don't judge women because of their sexual mores and perceived bad parenting. It certainly isn't relevant in a murder trial based on circumstantial evidence. As others have said, she wasn't on trial for being a slut and a bad mother. But that was what she was judged for in the media. And when someone has been proved innocent stop saying they are guilty and that you know better.
I remember a discussion about the Guildford Four once in a newspaper office. Or maybe it was the Birmingham Six. Either way, I rashly pointed out that we all knew they were guilty. I got a blasting from a colleague and rightly so. They had been proved innocent in a court of law and that's what matters.
I wouldn't want to take my chances of trial by media. For all the flaws in our legal system, a jury trial strives for impartiality and objectivity and we should all be grateful for that. Two interesting links: The first one says what I was trying to say except better. The second is written by a psychiatrist and considers the issue of bi-polarity. One Two
A few points about trials. If someone pleads not guilty, then to all intents and purposes they are not guilty until proved otherwise, ie beyond all reasonable doubt and all that.
It is difficult for most people to avoid seeing or reading media reports on deaths, and suspected murders. (Not so much for me as I don't have a television). But because there has been a death, and there are suspects, does not automatically make someone a murderer. Emotive reports and hard facts are not the same.
Jurors concentrate on what they are told in court not the crap that has been churned out on television or in newpapers. Being a jury member is an incredible responsibility - especially when you could be condemning someone to death. You aren't there to say - I read about it/saw it on television so therefore this person is guilty. You are there to listen to two sides of an argument and objectively decide which one is stronger, based on the evidence presented.
Casting aspersions on someone's character, ie proclaiming that a woman is a slut/whore/lives a promiscuous lifestyle however you wish to call it, is not evidence of anything. Unless a woman is being prosecuted for having lots of sex of course.
I wasn't a juror in the Casey Anthony trial so quite frankly it is not up to me to say whether she was guilty or not. She was found not guilty of murder (and two other charges, although guilty of misleading police) so that should be an end to speculation. Don't jump in and condemn the people who were chosen to do the job, and came to a unanimous not guilty verdict.
What I will do though, is criticise our society that even makes it acceptable to portray a woman as a pleasure-seeking slut who is therefore, a bad mother. This isn't to advocate the idea of bad parenting. I am not doing that for a minute.
But I am criticising the stereotypical view that a woman needs to be a chaste - almost virginal - stay-at-home mum. I mean, she has to be bad right, because she is a single mum in the first place? Unpackage the imagery of what women 'ought' to be according to society.
Don't judge women because of their sexual mores and perceived bad parenting. It certainly isn't relevant in a murder trial based on circumstantial evidence. As others have said, she wasn't on trial for being a slut and a bad mother. But that was what she was judged for in the media. And when someone has been proved innocent stop saying they are guilty and that you know better.
I remember a discussion about the Guildford Four once in a newspaper office. Or maybe it was the Birmingham Six. Either way, I rashly pointed out that we all knew they were guilty. I got a blasting from a colleague and rightly so. They had been proved innocent in a court of law and that's what matters.
I wouldn't want to take my chances of trial by media. For all the flaws in our legal system, a jury trial strives for impartiality and objectivity and we should all be grateful for that. Two interesting links: The first one says what I was trying to say except better. The second is written by a psychiatrist and considers the issue of bi-polarity. One Two
Sunday, 26 June 2011
Birthdays - and friends ... again
Another year older. Sadder? Wiser? Sadder - in some respects. Wiser - not a chance!!
First up, thanks to all my Facebook friends for the lovely greetings, wherever you come from, either geographically, or from various networks. You may be dog friends, land rover friends, feminists, part of the Scottish network, or from Farmville. Think I've covered everything there, but whatever, it was lovely to get those messages. I've been off-line for a couple of weeks and it was gorgeous to come back to lots of happy birthdays. Today has been my first chance to say thanks.
Now for the rest of the post, if you have haven't read the earlier stuff - here is some context. Birthdays and Party, party
The quick precis for anyone who can't be arsed to read those, is that I think it is nice when people remember your birthday and acknowledge it, and, that this year, I was invited to a party in the UK the day after mine - and was deliberating whether or not to go. These posts are both relevant - read on.
To start with the last post first, no, in the end I didn't visit the UK and go to the party. I received some very generous offers from internet friends to meet up, offers of accommodation, and some good advice too.
So, why didn't I go? Sounded good. Posh party and meet new people before and/or after. How about cash-strapped? That's probably the basic one. I can't justify spending hundreds - verging on a thousand pounds - for a few days jolly. Simple as that. Plus, for whatever reason, because my partner and I have birthdays on consecutive days, we have always tried to make our two days special. Did I want to spend our birthdays apart? No. Haven't done that for years.
Next. Over the last few years, one of my basic questions has started to become - what would someone else do if the situation was reversed? ie would they traipse a few thousand miles for a party? When my partner's niece died Sarah and he planned to fly back to the UK for the funeral, we started to question if anyone would ever fly out for one of our deaths. Unlikely. Again if you can't be arsed to read the post, he wasn't even offered transport or accommodation.
Back to party party. This is (was?) to be fair, my dearest friend from university. In our lovely long university hols, I visited her and other friends at their parents' homes. And some came back to stay with me. On leaving university, most of my friends ended up in London, away from their family homes. We were all growing up. Arrangements between all of us became much looser - 'always welcome, come when you want'. Luckily, as my remaining close friends were all in London, I had a decent choice of accommodation there. If there was a work conference or meeting needing an overnight stay, it was a good opportunity to catch up with friends. And if I ever got a rejection, it was because someone was away, so I just rang one of the others.
Not many people passed where I lived, Up North, although ironically Dearest Friend did. And that's exactly what she did. Although we lived a couple of miles from the motorway, did she ever stop off? Of course not. One day, we were somewhat put out to discover that on one of her annual holidays, she had taken the time to drive down from their second home to a local castle ten or fifteen miles away. Hmmmm.
It wasn't as though we weren't welcome at her holiday home though. It was about sixty miles drive away, but we were frequently summonsed when they were in residence. We camped outside as there wasn't room inside. At New Year, we stayed at a crap hotel so we could dine together on New Year's Eve. One year, I had picked up some ghastly virus and couldn't face the annual winter summons. She sounded rather put out. I should have realised then that she was not to be disobeyed.
When I moved to Spain, it took her five years to condescend to spend less than 24 hours with us, en route from a dressage course teaching horses how to dance. I had discovered by then that she had visited Spain on numerous occasions, some relatives of her husband had a place up the coast, they had a quick trip to Madrid one week, a friend in Majorca held a party, etc etc - how far down the list had I sunk?
The last time I visited her, we had to go to the post office. 'Do you think the card will get there for her birthday tomorrow?' she said anxiously. To Majorca? To the Spanish friend who seemed to merit more visits and cards than me? I doubt it would have got to her on the other side of London the next day, let alone Majorca. 'No.'
So this is the woman who wants me to drop everything, forego mine and my partners' birthdays and attend her summer luncheon housewarming party. The party was today. My birthday was yesterday. I sent my reply a month ago saying I wouldn't be attending. And did I receive any birthday greeting from her? I don't think I need to answer that. I think you can all work that one out yourselves.
So, yes, it hurt that she didn't acknowledge my birthday. Maybe Vicky was right (see previous party party post) with her comment. Maybe our paths have become so wide apart that we are strangers. Sadly. Which brings me specifically onto birthdays.
There are some internet friendships you make that are closer than others. You remember their birthday, they don't remember yours. Or vice versa. I know, because I have been guilty of that - knew when it was roughly, but something came into your mind and - whoosh - you miss it, for which I am truly sorry. Not helped by being offline half the time (excuses excuses). So when someone doesn't remember mine, hasn't made a note, doesn't think it is an important thing to say Happy Birthday, you realise you aren't that important in their life. Even if you are in contact every day. There comes a point when you stop telling people it is your birthday just for them to dish out a trite and meaningless greeting. As I said, sadder - and - wiser ?
And all the more reason for appreciating the birthday wishes I did receive when I returned on-line today. Thanks especially to those of you who sent e-cards as well as a greeting. Sometimes FB helps because it makes remembering birthdays easy - just look up at the right-hand corner. Maybe I'll make more effort after yesterday, even if I don't know people too well.
Almost forgot. What did I do? Woke up at some disgustingly early hour, and decided to get rid of superfluous clothes. Some went in the charity bank, the others are marked up for poss car boot sale/Friday Ads - or the charity bank. Walked round the beach. Went into town to buy a bottle of cava and a couple of beers. Wandered around town checking out all the changes. Came back home, cooked lunch (asparagus and potato salad for the foodies out there) - and decided against cleaning. It was a good day.
First up, thanks to all my Facebook friends for the lovely greetings, wherever you come from, either geographically, or from various networks. You may be dog friends, land rover friends, feminists, part of the Scottish network, or from Farmville. Think I've covered everything there, but whatever, it was lovely to get those messages. I've been off-line for a couple of weeks and it was gorgeous to come back to lots of happy birthdays. Today has been my first chance to say thanks.
Now for the rest of the post, if you have haven't read the earlier stuff - here is some context. Birthdays and Party, party
The quick precis for anyone who can't be arsed to read those, is that I think it is nice when people remember your birthday and acknowledge it, and, that this year, I was invited to a party in the UK the day after mine - and was deliberating whether or not to go. These posts are both relevant - read on.
To start with the last post first, no, in the end I didn't visit the UK and go to the party. I received some very generous offers from internet friends to meet up, offers of accommodation, and some good advice too.
So, why didn't I go? Sounded good. Posh party and meet new people before and/or after. How about cash-strapped? That's probably the basic one. I can't justify spending hundreds - verging on a thousand pounds - for a few days jolly. Simple as that. Plus, for whatever reason, because my partner and I have birthdays on consecutive days, we have always tried to make our two days special. Did I want to spend our birthdays apart? No. Haven't done that for years.
Next. Over the last few years, one of my basic questions has started to become - what would someone else do if the situation was reversed? ie would they traipse a few thousand miles for a party? When my partner's niece died Sarah and he planned to fly back to the UK for the funeral, we started to question if anyone would ever fly out for one of our deaths. Unlikely. Again if you can't be arsed to read the post, he wasn't even offered transport or accommodation.
Back to party party. This is (was?) to be fair, my dearest friend from university. In our lovely long university hols, I visited her and other friends at their parents' homes. And some came back to stay with me. On leaving university, most of my friends ended up in London, away from their family homes. We were all growing up. Arrangements between all of us became much looser - 'always welcome, come when you want'. Luckily, as my remaining close friends were all in London, I had a decent choice of accommodation there. If there was a work conference or meeting needing an overnight stay, it was a good opportunity to catch up with friends. And if I ever got a rejection, it was because someone was away, so I just rang one of the others.
Not many people passed where I lived, Up North, although ironically Dearest Friend did. And that's exactly what she did. Although we lived a couple of miles from the motorway, did she ever stop off? Of course not. One day, we were somewhat put out to discover that on one of her annual holidays, she had taken the time to drive down from their second home to a local castle ten or fifteen miles away. Hmmmm.
It wasn't as though we weren't welcome at her holiday home though. It was about sixty miles drive away, but we were frequently summonsed when they were in residence. We camped outside as there wasn't room inside. At New Year, we stayed at a crap hotel so we could dine together on New Year's Eve. One year, I had picked up some ghastly virus and couldn't face the annual winter summons. She sounded rather put out. I should have realised then that she was not to be disobeyed.
When I moved to Spain, it took her five years to condescend to spend less than 24 hours with us, en route from a dressage course teaching horses how to dance. I had discovered by then that she had visited Spain on numerous occasions, some relatives of her husband had a place up the coast, they had a quick trip to Madrid one week, a friend in Majorca held a party, etc etc - how far down the list had I sunk?
The last time I visited her, we had to go to the post office. 'Do you think the card will get there for her birthday tomorrow?' she said anxiously. To Majorca? To the Spanish friend who seemed to merit more visits and cards than me? I doubt it would have got to her on the other side of London the next day, let alone Majorca. 'No.'
So this is the woman who wants me to drop everything, forego mine and my partners' birthdays and attend her summer luncheon housewarming party. The party was today. My birthday was yesterday. I sent my reply a month ago saying I wouldn't be attending. And did I receive any birthday greeting from her? I don't think I need to answer that. I think you can all work that one out yourselves.
So, yes, it hurt that she didn't acknowledge my birthday. Maybe Vicky was right (see previous party party post) with her comment. Maybe our paths have become so wide apart that we are strangers. Sadly. Which brings me specifically onto birthdays.
There are some internet friendships you make that are closer than others. You remember their birthday, they don't remember yours. Or vice versa. I know, because I have been guilty of that - knew when it was roughly, but something came into your mind and - whoosh - you miss it, for which I am truly sorry. Not helped by being offline half the time (excuses excuses). So when someone doesn't remember mine, hasn't made a note, doesn't think it is an important thing to say Happy Birthday, you realise you aren't that important in their life. Even if you are in contact every day. There comes a point when you stop telling people it is your birthday just for them to dish out a trite and meaningless greeting. As I said, sadder - and - wiser ?
And all the more reason for appreciating the birthday wishes I did receive when I returned on-line today. Thanks especially to those of you who sent e-cards as well as a greeting. Sometimes FB helps because it makes remembering birthdays easy - just look up at the right-hand corner. Maybe I'll make more effort after yesterday, even if I don't know people too well.
Almost forgot. What did I do? Woke up at some disgustingly early hour, and decided to get rid of superfluous clothes. Some went in the charity bank, the others are marked up for poss car boot sale/Friday Ads - or the charity bank. Walked round the beach. Went into town to buy a bottle of cava and a couple of beers. Wandered around town checking out all the changes. Came back home, cooked lunch (asparagus and potato salad for the foodies out there) - and decided against cleaning. It was a good day.
Friday, 10 June 2011
Death and bereavement
Remember the Funerals post here?
Here is its companion. I ended that post having attended three funerals in my life, between the ages of approx 30 and 40. It seems from comments received on that post, that I wasn't alone in being excluded from family funerals as a child.
The next funeral I went to was my father's. I wrote about my last visit to see him here. There is something about death that takes you totally unawares and knocks your legs from under you.
As a kid I often worried what would happen to me if I became orphaned. My mum and dad, and Good Dog Tarquin of course, were my world. I couldn't envisage one without that security bubble. But with age, and so-called independence, work, and a relationship of your own with someone, that fear recedes.
As an adult you know, or at least expect, that one day you will have to cope with the death of your parents. Sensibly you tell yourself that day will happen, and once they are in their 70s, you think it isn't that far away. Although not imminent. But you know you will be able to cope with it as a grown-up.
So when my father did die, even though I knew it was going to happen, I was stunned. In fact, I probably didn't feel anything straightaway as it fell to me to sort out everything. My mother was nominally the executor, but she hadn't a clue what to do, and why should she? I was around and was happy to handle all the paperwork - all she had to do was sign the forms and letters.
I went to the Registrar with the letter from the GP to get the death certificate to start moving the paperwork. I opened the letter to see what the GP had written. It didn't make any sense to me, and I asked the Registrar what it meant. It was some vague woffly term that implied he had died from cancer all over his body. Well that isn't what kills you. It may be what leads to the death, but I wanted to know what had happened. The Registar said it was probably heart, lungs, liver, kidneys - whatever - that had failed, and that GPs in the community weren't as precise as hospital doctors.
There was a slight admonition that I shouldn't have opened the letter as it was addressed to her. Well hell!! Who cares? It was my father and I WANTED to see the cause of death. What a load of crappy bureaucracy. I should add that there had been no post-mortem examination as he had been seen in the local hospital by a doctor in the previous week. So there we were, from suspected colorectal cancer (Stage 3 by my guessing from the minimal info from the geriatrician over the 'phone) to death a few weeks later.
The funeral came and went. Although my mother was technically the starring player, I was Best Supporting Role, and dressed up accordingly. Black Cerruti suit, jet necklace, nice black (Wolford) tights and smart black shoes. Black lace gloves too. As, 'Gloves and no hat, but never hat and no gloves,' for those churchgoers out there.
When I returned to Spain, I felt, well, flat. Very flat. I didn't really know what to do with myself apart from speak to my mother every day on the 'phone when she rang up worried about one thing or another. My partner started spending increasing time on 'planes visiting my mother to sort things out. 'Siempre esta volando en el aire,' as my Spanish neighbour said - he's always flying in the air. And he was.
Then one night I started to have a panic attack. Thinking about my past, my parents, realising my dad had died, and just wondering where life was going and I was suddenly lying there breathing horribly quickly and too fast. For anyone who doesn't know - panic attacks don't kill. But they aren't too good when they are happening and they can be frightening for the person lying next to you. And they continued. Every now and again, or maybe, quite often, I would start one. But when they were over, there was actually a feeling of relief. I guess they are a way of relieving stress.
When my mother died - I couldn't face going back to do the honours. Practically, we couldn't both go because of the animals. I really couldn't handle going back to their home, to the same church, and - one parent less. Exactly the same scenario except the mother who had stood next to me at my father's funeral would be in that wooden box up front. So while I made the arrangements over the 'phone, Partner agreed to go and be the Star. Meet rellies he'd not met before.
It was after her death though that the desolation kicked in. If I had felt that some of my past had been wiped out when my father died - it felt like it had all gone when my mother joined him. It was as though the first part of your life, your early and formative years, no longer existed. With them gone, so had those first precious and childish years. And while it wasn't the idyllic childhood they had told me it was, it was the only one I had. All contact with that had gone. Just memories. No more.
Thinking of my mother was split between two views, her later cranky years in life - and those lovely early ones when she soothed my brow and fed me beef tea, picked me up from school on Wednesday lunchtimes (half day) to go for lunch at the Strafford Arms and eat egg mayonnaise and grissini, bought me Famous Five books - the list is endless. I read quotes on the internet about 'you'll never know how much you miss your mother until she isn't there' - and realised they were true. Gah! I hate sloppy stuff like that!!
And, although I had a partner, I felt so alone. Isolated. Where was my support now? There wasn't any? It was silly really, because I had been financially and emotionally independent for years. I had been the one trying to help them in their later years. But old habits die hard, and I felt frightened. They weren't there for me to go back to when something was wrong (and feed me beef tea and soothe my brow). They just weren't there. And half my life had died with them. I still miss my mum. And I still feel alone. Perhaps it comes of being an only child.
Here is its companion. I ended that post having attended three funerals in my life, between the ages of approx 30 and 40. It seems from comments received on that post, that I wasn't alone in being excluded from family funerals as a child.
The next funeral I went to was my father's. I wrote about my last visit to see him here. There is something about death that takes you totally unawares and knocks your legs from under you.
As a kid I often worried what would happen to me if I became orphaned. My mum and dad, and Good Dog Tarquin of course, were my world. I couldn't envisage one without that security bubble. But with age, and so-called independence, work, and a relationship of your own with someone, that fear recedes.
As an adult you know, or at least expect, that one day you will have to cope with the death of your parents. Sensibly you tell yourself that day will happen, and once they are in their 70s, you think it isn't that far away. Although not imminent. But you know you will be able to cope with it as a grown-up.
So when my father did die, even though I knew it was going to happen, I was stunned. In fact, I probably didn't feel anything straightaway as it fell to me to sort out everything. My mother was nominally the executor, but she hadn't a clue what to do, and why should she? I was around and was happy to handle all the paperwork - all she had to do was sign the forms and letters.
I went to the Registrar with the letter from the GP to get the death certificate to start moving the paperwork. I opened the letter to see what the GP had written. It didn't make any sense to me, and I asked the Registrar what it meant. It was some vague woffly term that implied he had died from cancer all over his body. Well that isn't what kills you. It may be what leads to the death, but I wanted to know what had happened. The Registar said it was probably heart, lungs, liver, kidneys - whatever - that had failed, and that GPs in the community weren't as precise as hospital doctors.
There was a slight admonition that I shouldn't have opened the letter as it was addressed to her. Well hell!! Who cares? It was my father and I WANTED to see the cause of death. What a load of crappy bureaucracy. I should add that there had been no post-mortem examination as he had been seen in the local hospital by a doctor in the previous week. So there we were, from suspected colorectal cancer (Stage 3 by my guessing from the minimal info from the geriatrician over the 'phone) to death a few weeks later.
The funeral came and went. Although my mother was technically the starring player, I was Best Supporting Role, and dressed up accordingly. Black Cerruti suit, jet necklace, nice black (Wolford) tights and smart black shoes. Black lace gloves too. As, 'Gloves and no hat, but never hat and no gloves,' for those churchgoers out there.
When I returned to Spain, I felt, well, flat. Very flat. I didn't really know what to do with myself apart from speak to my mother every day on the 'phone when she rang up worried about one thing or another. My partner started spending increasing time on 'planes visiting my mother to sort things out. 'Siempre esta volando en el aire,' as my Spanish neighbour said - he's always flying in the air. And he was.
Then one night I started to have a panic attack. Thinking about my past, my parents, realising my dad had died, and just wondering where life was going and I was suddenly lying there breathing horribly quickly and too fast. For anyone who doesn't know - panic attacks don't kill. But they aren't too good when they are happening and they can be frightening for the person lying next to you. And they continued. Every now and again, or maybe, quite often, I would start one. But when they were over, there was actually a feeling of relief. I guess they are a way of relieving stress.
When my mother died - I couldn't face going back to do the honours. Practically, we couldn't both go because of the animals. I really couldn't handle going back to their home, to the same church, and - one parent less. Exactly the same scenario except the mother who had stood next to me at my father's funeral would be in that wooden box up front. So while I made the arrangements over the 'phone, Partner agreed to go and be the Star. Meet rellies he'd not met before.
It was after her death though that the desolation kicked in. If I had felt that some of my past had been wiped out when my father died - it felt like it had all gone when my mother joined him. It was as though the first part of your life, your early and formative years, no longer existed. With them gone, so had those first precious and childish years. And while it wasn't the idyllic childhood they had told me it was, it was the only one I had. All contact with that had gone. Just memories. No more.
Thinking of my mother was split between two views, her later cranky years in life - and those lovely early ones when she soothed my brow and fed me beef tea, picked me up from school on Wednesday lunchtimes (half day) to go for lunch at the Strafford Arms and eat egg mayonnaise and grissini, bought me Famous Five books - the list is endless. I read quotes on the internet about 'you'll never know how much you miss your mother until she isn't there' - and realised they were true. Gah! I hate sloppy stuff like that!!
And, although I had a partner, I felt so alone. Isolated. Where was my support now? There wasn't any? It was silly really, because I had been financially and emotionally independent for years. I had been the one trying to help them in their later years. But old habits die hard, and I felt frightened. They weren't there for me to go back to when something was wrong (and feed me beef tea and soothe my brow). They just weren't there. And half my life had died with them. I still miss my mum. And I still feel alone. Perhaps it comes of being an only child.
Wednesday, 8 June 2011
Public relations - in the NHS
Stress seemed like a good topic for the day - but in thinking about it, I thought I should precede it with one about public relations to give a little insight.
As everyone probably doesn't know, the average PR person is not that well paid. When I first went into PR from journalism, the salaries were better than I was getting as a journalist, but Max Clifford super-earners we were not.
Invariably people graft away in relatively lowly jobs either in the public sector - local government, civil service, health service - or in the private sector, where the salaries can be good, and, they can also be even worse than the public sector.
As everyone probably also doesn't know, every one in the world without the slightest relevant qualification, thinks they are a PR expert - to the extent of even applying for PR jobs. When I advertised for PR managers, specifically requiring journalism and/or PR skills and experience, I got every person under the sun applying. 'I like talking to people, so I can do this job,' sort of application.
And every non-PR manager KNOWS, just KNOWS, that they are far more of an expert about PR than someone specifically appointed to the job. They may have even listened to a lecture for an hour about it. Who knows? Just gotta love the civil servant telling me how to write and where to place the commas. What my intro should be. What boring verbose language to use. Hell! Why not write the press release yourself? Actually some of them did 'helpfully' send down drafts. They were crap.
And the medic, the nurse, the manager, everyone, but everyone, telling me what to do and what we need. And would they actually pull their tiny little finger out to do anything themselves? Only if and when it meant personal glory for them at my expense. So the realities of life in PR, are not a social whirl of booze and buffets. About the only decent one I ever managed was a launch in Scotland where we had chablis and smoked salmon. But otherwise food and drink was pretty mediocre on that wonderful circuit of networking, chatting, and no hard work. The civil service was slightly better than the health service. At least we had a budget for smoked salmon and chablis. Once.
PR involves being on-call at weekends and nights during the week. In some cases, there are formal rotas - invariably when you have a nice large department and you take it in turns to be on-call. This does mean that you get an on-call allowance, ie extra cash. In very olden days you had to stay in all over the weekend - because there were no office mobile 'phones. (When the mobile 'phone did arrive your arm nearly dropped off lugging it across London to go home). The only time you could escape was to go and buy every single newspaper on Saturday and Sunday mornings and then spend the rest of the morning ploughing through them looking for relevant cuttings. Even Sunday Sport!!
When the 'phone rang, you answered it. Didn't matter what time it was, you answered it. Our 'phone was downstairs which was just as well, as I had sort of woken up when it rang after midnight and I had finally staggered down the uncarpeted stairs, carefully avoiding the ladders that were permanently stored on our staircase. It was usually a nuclear query of course. Gah! Which nuclear expert to wake up at some unearthly hour to ask about nuclear probs? And try and absorb the answer. An escaped canister somewhere? An unacceptable leak of radiation? Exactly what you wanted to deal with when you were half asleep. Still, choose job, get paid, do job.
But when you have attained the lofty rank of a senior manager - there is no on-call allowance. Your salary is deemed to be sufficient and this is when you start to be owned by the company, whether it is public sector or not. Especially when it is the health service. Then you have to find one of your colleagues who specialises in the subject to speak to the press (unlike the civil service where normally you are the spokesperson). Invariably your colleagues don't want to speak to the press. They don't consider they are paid to do so, they may have the knowledge, and you don't, but it is your job to speak to the press even when you have no idea of the topic being asked about. They sure as hell aren't going to tell you something they know about in order to make you look good.
At the time we had a boss who considered that PR was everyone's business. Sadly all his staff did not. My colleagues considered weekends and holidays to be off-limits. I received a call one New Year's Day, and rang the relevant manager. 'I don't want to speak to the press on New Year's Day, can't you deal with it?' Er no. My New Year's Day has also been interrupted thank you very much. I was gardening at the time, it was beautiful weather. Really, how do people think I can possibly speak to the press without being told about the issues? I wasn't telepathic. Nor am I now.
When we held our big public consultation, I usually arrived in the office around 8am. If I was lucky I went to a public meeting in the evening and finished sometime after 9pm, or 10pm or whenever. If I was unlucky, I stayed at work until after midnight working on the fifty millionth version of the crap draft document, accompanied by my superb admin assistant who would rapidly make all the amendments and endlessly keep printing it out. I would take her home, and then drop off the latest versions of our draft documents to all our board members through their letterboxes. I should say there was no extra cash for either of us for this dedicated duty. We had a job. At a time of cutbacks it was enough.
We had board meetings virtually every week. One day, one of the intelligent non-executive board members had a bright idea. 'Why don't we get a journalist to write this document for us?' Bang head on table? One of the exec directors who knew my CV helpfully pointed out that we did have a journalist around that very table. NED looked at me from under his microscope (he was a medic of sorts) wondering what sort of species I was. If I was a journalist, why was I working for the health authority? I couldn't possibly be a proper journalist could I? Because if I was, I would be working for a newspaper.
And how many battles had I already had with the arrogant self-opinionated managers who considered that they could write a public consultation document far better than me? Public sector life? Easy? Money for old rope? No. In the end, I committed to re-writing the - so far - crap document over a few days and getting rid of all the ghastly managerial speak. I demanded input from a couple of knowledgeable people, but given that, I could do it. We did do it of course.
Me, and a couple of directors spent a couple of days locked away, even including getting a couple of pizzas in the office to keep us going. (We paid for them before anyone starts to worry about a couple of pizzas coming out of the public purse). We left the office only to go to the toilet. We went home when it was finished. Or rather they went, I finished the document off - and yes, delivered the latest version to the picky board members into their letterboxes. After midnight. As usual. Was it a good document? Yeah, I reckon it was. Within the constraints of what people wanted to include, but at least it was readable and didn't come on like an MBA thesis.
And - therein lies another PR lesson. Always, but always say how good your work is. Doesn't matter if it is rubbish because, that is what everyone else does. Gotta promote yourself. Tell everyone you are fantastic. Completed an insignificant piece of work - gosh! I did great stuff didn't I? You don't need to be good. Just say you are. To the right people.
Now, onto the next PR lesson. When people tell you they want a PR strategy and lots of really good communications, that means they are telling you how to do your job. In fact they want nothing more than to tell you how to do it, without doing anything else. Will they provide contacts, information, write anything, provide interviews, move their arses to help? Quite honestly - will they fuck.
Newsletters? Don't even go there. The nightmare of every PR manager.
What your super colleagues will do, is endlessly moan and wail about the need for great PR - and tell you to do something. Like PR is one person's business? Because no, it definitely is not. I got sick of it in the end. Ha! I told my dear colleagues exactly what was needed from them to run a decent PR strategy. Everyone lost interest. See, it's easy to say 'What we need are good communications, a newsletter, a PR strategy...' and all the rest of it. Anyone can say that. Hardly takes Brain of the Year. It griped me to hell that my health service colleagues on more money had crap PR skills, expected me to deal with the press for them on their behalf - without giving me the relevant info - and I was treated like some mediocre person, without a skill, who could just chat to the press and write a few press releases, but who didn't understand proper health service stuff. So that my dears, is why I left PR. And learned about cancer services.
As everyone probably doesn't know, the average PR person is not that well paid. When I first went into PR from journalism, the salaries were better than I was getting as a journalist, but Max Clifford super-earners we were not.
Invariably people graft away in relatively lowly jobs either in the public sector - local government, civil service, health service - or in the private sector, where the salaries can be good, and, they can also be even worse than the public sector.
As everyone probably also doesn't know, every one in the world without the slightest relevant qualification, thinks they are a PR expert - to the extent of even applying for PR jobs. When I advertised for PR managers, specifically requiring journalism and/or PR skills and experience, I got every person under the sun applying. 'I like talking to people, so I can do this job,' sort of application.
And every non-PR manager KNOWS, just KNOWS, that they are far more of an expert about PR than someone specifically appointed to the job. They may have even listened to a lecture for an hour about it. Who knows? Just gotta love the civil servant telling me how to write and where to place the commas. What my intro should be. What boring verbose language to use. Hell! Why not write the press release yourself? Actually some of them did 'helpfully' send down drafts. They were crap.
And the medic, the nurse, the manager, everyone, but everyone, telling me what to do and what we need. And would they actually pull their tiny little finger out to do anything themselves? Only if and when it meant personal glory for them at my expense. So the realities of life in PR, are not a social whirl of booze and buffets. About the only decent one I ever managed was a launch in Scotland where we had chablis and smoked salmon. But otherwise food and drink was pretty mediocre on that wonderful circuit of networking, chatting, and no hard work. The civil service was slightly better than the health service. At least we had a budget for smoked salmon and chablis. Once.
PR involves being on-call at weekends and nights during the week. In some cases, there are formal rotas - invariably when you have a nice large department and you take it in turns to be on-call. This does mean that you get an on-call allowance, ie extra cash. In very olden days you had to stay in all over the weekend - because there were no office mobile 'phones. (When the mobile 'phone did arrive your arm nearly dropped off lugging it across London to go home). The only time you could escape was to go and buy every single newspaper on Saturday and Sunday mornings and then spend the rest of the morning ploughing through them looking for relevant cuttings. Even Sunday Sport!!
When the 'phone rang, you answered it. Didn't matter what time it was, you answered it. Our 'phone was downstairs which was just as well, as I had sort of woken up when it rang after midnight and I had finally staggered down the uncarpeted stairs, carefully avoiding the ladders that were permanently stored on our staircase. It was usually a nuclear query of course. Gah! Which nuclear expert to wake up at some unearthly hour to ask about nuclear probs? And try and absorb the answer. An escaped canister somewhere? An unacceptable leak of radiation? Exactly what you wanted to deal with when you were half asleep. Still, choose job, get paid, do job.
But when you have attained the lofty rank of a senior manager - there is no on-call allowance. Your salary is deemed to be sufficient and this is when you start to be owned by the company, whether it is public sector or not. Especially when it is the health service. Then you have to find one of your colleagues who specialises in the subject to speak to the press (unlike the civil service where normally you are the spokesperson). Invariably your colleagues don't want to speak to the press. They don't consider they are paid to do so, they may have the knowledge, and you don't, but it is your job to speak to the press even when you have no idea of the topic being asked about. They sure as hell aren't going to tell you something they know about in order to make you look good.
At the time we had a boss who considered that PR was everyone's business. Sadly all his staff did not. My colleagues considered weekends and holidays to be off-limits. I received a call one New Year's Day, and rang the relevant manager. 'I don't want to speak to the press on New Year's Day, can't you deal with it?' Er no. My New Year's Day has also been interrupted thank you very much. I was gardening at the time, it was beautiful weather. Really, how do people think I can possibly speak to the press without being told about the issues? I wasn't telepathic. Nor am I now.
When we held our big public consultation, I usually arrived in the office around 8am. If I was lucky I went to a public meeting in the evening and finished sometime after 9pm, or 10pm or whenever. If I was unlucky, I stayed at work until after midnight working on the fifty millionth version of the crap draft document, accompanied by my superb admin assistant who would rapidly make all the amendments and endlessly keep printing it out. I would take her home, and then drop off the latest versions of our draft documents to all our board members through their letterboxes. I should say there was no extra cash for either of us for this dedicated duty. We had a job. At a time of cutbacks it was enough.
We had board meetings virtually every week. One day, one of the intelligent non-executive board members had a bright idea. 'Why don't we get a journalist to write this document for us?' Bang head on table? One of the exec directors who knew my CV helpfully pointed out that we did have a journalist around that very table. NED looked at me from under his microscope (he was a medic of sorts) wondering what sort of species I was. If I was a journalist, why was I working for the health authority? I couldn't possibly be a proper journalist could I? Because if I was, I would be working for a newspaper.
And how many battles had I already had with the arrogant self-opinionated managers who considered that they could write a public consultation document far better than me? Public sector life? Easy? Money for old rope? No. In the end, I committed to re-writing the - so far - crap document over a few days and getting rid of all the ghastly managerial speak. I demanded input from a couple of knowledgeable people, but given that, I could do it. We did do it of course.
Me, and a couple of directors spent a couple of days locked away, even including getting a couple of pizzas in the office to keep us going. (We paid for them before anyone starts to worry about a couple of pizzas coming out of the public purse). We left the office only to go to the toilet. We went home when it was finished. Or rather they went, I finished the document off - and yes, delivered the latest version to the picky board members into their letterboxes. After midnight. As usual. Was it a good document? Yeah, I reckon it was. Within the constraints of what people wanted to include, but at least it was readable and didn't come on like an MBA thesis.
And - therein lies another PR lesson. Always, but always say how good your work is. Doesn't matter if it is rubbish because, that is what everyone else does. Gotta promote yourself. Tell everyone you are fantastic. Completed an insignificant piece of work - gosh! I did great stuff didn't I? You don't need to be good. Just say you are. To the right people.
Now, onto the next PR lesson. When people tell you they want a PR strategy and lots of really good communications, that means they are telling you how to do your job. In fact they want nothing more than to tell you how to do it, without doing anything else. Will they provide contacts, information, write anything, provide interviews, move their arses to help? Quite honestly - will they fuck.
Newsletters? Don't even go there. The nightmare of every PR manager.
What your super colleagues will do, is endlessly moan and wail about the need for great PR - and tell you to do something. Like PR is one person's business? Because no, it definitely is not. I got sick of it in the end. Ha! I told my dear colleagues exactly what was needed from them to run a decent PR strategy. Everyone lost interest. See, it's easy to say 'What we need are good communications, a newsletter, a PR strategy...' and all the rest of it. Anyone can say that. Hardly takes Brain of the Year. It griped me to hell that my health service colleagues on more money had crap PR skills, expected me to deal with the press for them on their behalf - without giving me the relevant info - and I was treated like some mediocre person, without a skill, who could just chat to the press and write a few press releases, but who didn't understand proper health service stuff. So that my dears, is why I left PR. And learned about cancer services.
Wednesday, 1 June 2011
Health issues - more smears ......
OK, a few stories about screening.
The biggest story to hit the UK was when screening errors at Kent and Canterbury Hospital led to the deaths of eight women and 90,000 women were recalled for further tests. BBC News link about results
Not surprisingly, after that, screening procedures were tightened up somewhat. 'Quality' crept into screening bigtime. Actually it didn't creep, it jumped in and screamed across the stage. When I first took over responsibility for cancer services, I was told screening was included. Big difference in health authority terms, none to the public. But basically, screening is regarded as a public health function, ie something to keep people healthy. Cancer services are about treating people who are sick.
'You'll be chair of the quality assurance group,' said one colleague. Knowingly, and sniggered. I didn't even get to the first meeting of 'MY' group. I was busy writing the Millennium Plan for Year 2000 and couldn't spare the time. I had, however, recently acquired a seconded assistant - a medic gaining public health experience - so I cheerfully sent him to cover for me. It was only afterwards that he told me what an interesting experience it had been for him because he had never chaired a meeting before in his life.
I finally made the next meeting. I guess the group wasn't too happy that I had skipped the first one. They also weren't too happy that for more than 12 months my authority had been promising them a newsletter that had never materialised. Ah! a gift horse. Newsletter? Get that one whacked out in no time. Even if one director, a secretary and a public health consultant had failed to do it. See, journalists do have some advantages.
At the end of that first meeting, one of the consultant surgeons said to me, and I still remember his words to this day: 'I am right, aren't I? You aren't a clinician.' Well, so what. Two clinicans hadn't produced the frigging newsletter that they were all clamouring for so they weren't much use. And secondly, there were so many clinicians around the table that there were more points of view than you could poke a speculum into.
I think I gave the polite and restrained (for me) response of: 'No, I'm not. We are lucky to have plenty of intelligent clinicians around the table with a lot of knowledge and experience. It's my job as a manager to pull that together and use it in the interests of improving the service.' Or some such similar crap.
This guy was no walkover. He had more than one of my female colleagues in tears and was rude and insulting to them. He was well known for being sexist and arrogant, and old-fashioned. He didn't try it on with me any more. In fact, when he moaned about the preponderance of vegetarian food available for our lunches - which people had said they preferred - I arranged a carnivorous banquet for him but he didn't turn up. I received grovelling apologies however and no further complaints about the food.
I should say that I also represented our organisation at his leaving do. He wasn't a bad guy, in fact I would say he was good if you stood up to him. He also took the time to show me around his clinic one afternoon so that I had a better understanding of the work he did. I liked him.
Bit of background. My district included two hospitals with laboratories where the smears were tested, and the same hospitals also had colposcopy clinics where women went for an even nastier procedure than a smear. We had a totally separate admin department that organised the invitations and result letters. Then there were all the hundreds of GPs, and community clinics, the GUM clinic, blah blah. Oh, and health promotion, I always forget that one. All this lot were on my cheerful little group.
To add spice to the mix, one lab was also used by another authority, and that authority had different procedures to ours. Gah!! The minor first disaster was learning that in spite of all our new quality assurance procedures, the shared lab had discovered some poor reporting of smears and hadn't bothered to tell either me, or my colleague in the other authority about this.
Whose neck is on the block? Theirs - and - OURS, as guardians of the screening programme. So much for joint working together. But when the other lab had a problem - they did tell me. I probably wished they hadn't. I had to call a serious incident procedure. The lab had totally missed a smear that wasn't just borderline, or abnormal. It showed cancerous cells on the slide.
This is probably the point at which to say, that screening slides of cervical smears was a hellish boring job that was badly paid. Invariably as local technicians qualified, they were poached for a few more quid by a local lab. I would never dream of blaming the technician for missing something. Or even the cytopathologist that double checked it. It was just not an easy job.
For me though, the very worst experience was one that didn't happen - hopefully. A colleague was in charge of registering local homes, some of which included people who had disabilities. There was a problem in a home with someone who didn't want a smear. Did my colleague come and ask me what the local policy was? Of course not. ( A few personal power political games possibly in play here).
She went happily off to ask a MALE public health doctor who knew jack shit nada about the work of our group. 'Sedate her,' he said authoritatively and arrogantly. 'She needs a smear.' Well, Mr Arrogant Public Health Consultant, it is basically not your decision. Simple as that. It wasn't then and it isn't now. Do not force a woman with disabilities to undergo an invasive test that she clearly doesn't want. Sedating her? Hey date rape doctors here we go.
Finally I'll finish with a comment dear to my heart. It's hardly surprising that patient information has always been one of my priorities. I could never understand why medics, nurses (usually left to nurses of course) and every other clinican in the health service, always thought they could write well, because they couldn't, it wasn't their job to write - theirs to diagnose and treat.
When I discovered that GPs were sending out info and letters, as well as our computerised admin centre sending out similar-but-not-quite-the-same info to our resident female population, I asked a colleague to conduct an audit. By which I mean, asking all the local surgeries to send in their patient info stuff so that we could share best practice, aka tell the ones who are writing rubbish to STOP DOING THAT. Because that was what I wanted at the end of the day.
And what was worrying about the results? GPs were writing out to the women on their list and telling them, basically, that if they didn't attend for a smear they would get cancer. Now that was not only misleading, it was a downright lie, and only served to perpetuate disinformation. I wonder why women are ill-informed about cervical smears? What next? Patient consent perhaps?
The biggest story to hit the UK was when screening errors at Kent and Canterbury Hospital led to the deaths of eight women and 90,000 women were recalled for further tests. BBC News link about results
Not surprisingly, after that, screening procedures were tightened up somewhat. 'Quality' crept into screening bigtime. Actually it didn't creep, it jumped in and screamed across the stage. When I first took over responsibility for cancer services, I was told screening was included. Big difference in health authority terms, none to the public. But basically, screening is regarded as a public health function, ie something to keep people healthy. Cancer services are about treating people who are sick.
'You'll be chair of the quality assurance group,' said one colleague. Knowingly, and sniggered. I didn't even get to the first meeting of 'MY' group. I was busy writing the Millennium Plan for Year 2000 and couldn't spare the time. I had, however, recently acquired a seconded assistant - a medic gaining public health experience - so I cheerfully sent him to cover for me. It was only afterwards that he told me what an interesting experience it had been for him because he had never chaired a meeting before in his life.
I finally made the next meeting. I guess the group wasn't too happy that I had skipped the first one. They also weren't too happy that for more than 12 months my authority had been promising them a newsletter that had never materialised. Ah! a gift horse. Newsletter? Get that one whacked out in no time. Even if one director, a secretary and a public health consultant had failed to do it. See, journalists do have some advantages.
At the end of that first meeting, one of the consultant surgeons said to me, and I still remember his words to this day: 'I am right, aren't I? You aren't a clinician.' Well, so what. Two clinicans hadn't produced the frigging newsletter that they were all clamouring for so they weren't much use. And secondly, there were so many clinicians around the table that there were more points of view than you could poke a speculum into.
I think I gave the polite and restrained (for me) response of: 'No, I'm not. We are lucky to have plenty of intelligent clinicians around the table with a lot of knowledge and experience. It's my job as a manager to pull that together and use it in the interests of improving the service.' Or some such similar crap.
This guy was no walkover. He had more than one of my female colleagues in tears and was rude and insulting to them. He was well known for being sexist and arrogant, and old-fashioned. He didn't try it on with me any more. In fact, when he moaned about the preponderance of vegetarian food available for our lunches - which people had said they preferred - I arranged a carnivorous banquet for him but he didn't turn up. I received grovelling apologies however and no further complaints about the food.
I should say that I also represented our organisation at his leaving do. He wasn't a bad guy, in fact I would say he was good if you stood up to him. He also took the time to show me around his clinic one afternoon so that I had a better understanding of the work he did. I liked him.
Bit of background. My district included two hospitals with laboratories where the smears were tested, and the same hospitals also had colposcopy clinics where women went for an even nastier procedure than a smear. We had a totally separate admin department that organised the invitations and result letters. Then there were all the hundreds of GPs, and community clinics, the GUM clinic, blah blah. Oh, and health promotion, I always forget that one. All this lot were on my cheerful little group.
To add spice to the mix, one lab was also used by another authority, and that authority had different procedures to ours. Gah!! The minor first disaster was learning that in spite of all our new quality assurance procedures, the shared lab had discovered some poor reporting of smears and hadn't bothered to tell either me, or my colleague in the other authority about this.
Whose neck is on the block? Theirs - and - OURS, as guardians of the screening programme. So much for joint working together. But when the other lab had a problem - they did tell me. I probably wished they hadn't. I had to call a serious incident procedure. The lab had totally missed a smear that wasn't just borderline, or abnormal. It showed cancerous cells on the slide.
This is probably the point at which to say, that screening slides of cervical smears was a hellish boring job that was badly paid. Invariably as local technicians qualified, they were poached for a few more quid by a local lab. I would never dream of blaming the technician for missing something. Or even the cytopathologist that double checked it. It was just not an easy job.
For me though, the very worst experience was one that didn't happen - hopefully. A colleague was in charge of registering local homes, some of which included people who had disabilities. There was a problem in a home with someone who didn't want a smear. Did my colleague come and ask me what the local policy was? Of course not. ( A few personal power political games possibly in play here).
She went happily off to ask a MALE public health doctor who knew jack shit nada about the work of our group. 'Sedate her,' he said authoritatively and arrogantly. 'She needs a smear.' Well, Mr Arrogant Public Health Consultant, it is basically not your decision. Simple as that. It wasn't then and it isn't now. Do not force a woman with disabilities to undergo an invasive test that she clearly doesn't want. Sedating her? Hey date rape doctors here we go.
Finally I'll finish with a comment dear to my heart. It's hardly surprising that patient information has always been one of my priorities. I could never understand why medics, nurses (usually left to nurses of course) and every other clinican in the health service, always thought they could write well, because they couldn't, it wasn't their job to write - theirs to diagnose and treat.
When I discovered that GPs were sending out info and letters, as well as our computerised admin centre sending out similar-but-not-quite-the-same info to our resident female population, I asked a colleague to conduct an audit. By which I mean, asking all the local surgeries to send in their patient info stuff so that we could share best practice, aka tell the ones who are writing rubbish to STOP DOING THAT. Because that was what I wanted at the end of the day.
And what was worrying about the results? GPs were writing out to the women on their list and telling them, basically, that if they didn't attend for a smear they would get cancer. Now that was not only misleading, it was a downright lie, and only served to perpetuate disinformation. I wonder why women are ill-informed about cervical smears? What next? Patient consent perhaps?
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