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Author Archives: Shibley Rahman

I trust that the latest episode of “Hancock’s Half Hour” made you laugh a lot. The transcript of his speech, exactly as it was delivered on 20 July 2018, is available here, in case you missed it. It was the same script, more or less, but delivered by a different newsreader. As once said, it was the ‘same meat but different gravy’. One of the lines delivered is this: “Paramedics, doctors, nurses, community health staff, managers, IT workers and support staff all working together to provide the best care possible.” Trish Greenhalgh immediately saw the problem with this.     […]
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“This is about the standards you want to abide by as a country” So uttered Theresa May in defending a ‘carve out’ in a mythical trade agreement with the U.S. We do not know what these standards are. For all I know, the NHS could be about to launch innovations which are the equivalent of ‘chlorinated chicken’.   Donald Trump, POTUS, admitted this week that he didn’t give Theresa May ‘advice’ on negotiating with the European Union, but he did make a ‘suggestion’. It eventually turned out that Trump advised May to ‘sue the EU’ according to May in her […]
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The thing I’ve learnt the most from my experience as a patient is that the world doesn’t actually “do” binaries. My law training gave me training in being able to argue both sides of a case, and to present the case convincingly, so that I almost believed myself. A client pays a lawyer to win the case, and not to sit on the fence – or even worse, argue the opposite side. As a doctor, I am taught to believe that people have diseases or not, and that each disease will have a relatively predictable outcome assuming that all the […]
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  I am not sure it’s feasible just to use “length of stay” and “avoidable admissions” together only as yardsticks. Imagine if the only metric you had of how effective the provision of weekly groceries was was how much time you spent in a supermarket. But that’s actually the level of the argument. Or, in the alternative, imagine for a moment if a lot of effort was put in, by external advisors, into drawing up lists of how to avoid inappropriate trips to the supermarket; or screening for members of the public who might be at high risk for running […]
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  It may not be actually necessary to abolish the term ‘patient activation measure’. It is such an unappealing term anyway, it is hard to feel that patients themselves, despite free tickets as campaigners and leaders to industry-sponsored conferences, wish to be perceived as ‘activated’ like washing machines. The idea that patients are not passive recipients of medical advice is a crucial one, but that is not the issue. When I was asked what I would replace the term ‘patient activation measure’ with, I was of course obligated to look up the accepted definition of “patient activation”. This is helpfully […]
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For a moment – guess who said this, and when? “We will be studying the report carefully to identify learning points.  We are committed to taking any further action necessary in light of information revealed by this report.” Do we need another report? More lessons learned? It seemed like – not that long ago – we were discussing Southern Health or Winterbourne? This saying above was in fact reported to have been the responseof Charlie Massey, CEO of the General Medical Council (GMC), in response to the events at Gosport War Memorial Hospital. Dr Jane Barton, meanwhile, the doctor at […]
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The opening gambit for anyone criticising plans in health and social care was to mention at the first opportunity Stalinist Russia. That is of course a ‘cheap shot’. Would a rose by another name smell as sweet?  The Department of Health published in 2009 a dementia ‘strategy’ which set out important goals, and has published subsequently different documents under different names such as “The Prime Minister Dementia Challenge” or “The 2020 Implementation Plan”. It is perhaps time to face facts. Talk is cheap. It’s much easier to talk about ‘England is the best place to live with dementia’ than to […]
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Oh no. In this world nothing can be said to be certain, except death and taxes. And NHS reorganisations. The next election could be in 2022, unless the current Tory government falls under the sword of Brexit. So, with all of the current government’s efforts being taken up with exiting the European Union, it might seem intuitively odd at Jon Ashworth might want to think the unthinkable – another redisorganisation of the NHS. By 2022, some of the ‘integrated care organisations’ might be up-and-running. Or, possibly, by that stage, accountable care organisations might have been killed off in the law […]
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Whilst the meanings of hashtags can be immediately obviously, such as #EndPJParalysis, some meanings are possibly less obvious. Yesterday, my timeline was littered by pictures of socks celebrating the #socksfordocs campaign. My immediate reaction on Twitter was this. But thankfully somebody sent me a private message to explain the background to the campaign. The background to this particular campaign is pretty amazing, and my reaction was to post a tweet with this picture this morning on my Twitter @dr_shibley. The history is important for me. I have found campaigns about mental health pithy and largely from professionals who’ve had no […]
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As far as bandwagons go, ‘friendly communities’ take some beating. There is a palpable momentum behind big charities politically endorsed to promote a ‘friendly community’, with champions and award ceremonies. The official reason for ‘dementia friendly communities’ is actually unknown. As part of David Cameron’s “Prime Minister’s Dementia Challenge”, the ‘dementia friends’ campaign suddenly emerged from the Alzheimer’s Society and Cabinet Office. A few million pounds were pumped into it, including slick PR and advertising campaigns. The new incoming Coalition government promoted it, just shortly after the 2009 English dementia strategy. The aim, we think, was to ‘raise awareness’ of […]
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Doctors advise that you shouldn’t stop suddenly certain drugs such as antidepressants for fear of severe discontinuation symptoms. Privatisation is a drug on which Government has been dependent in the UK for nearly 40 years, and we need to grit our teeth and come off  the drug. In an era long ago, far predating the trials and tribulations of Brexit, the Coalition government of 2010 wondering what to do decided that they would do a ‘shake up’ of the NHS. Everything was perfect. Andrew Lansley called on his friends in McKinsey’s to take another bite of the cherry following their […]
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What can it be like to lose the life of a loved one to an institution? Clinical care is currently running the risk of burying its head in the sand of less than adequate regulators, and being dehumanised in a swathe of bureaucracy. It struck me recently that the 6Cs of nursing, which arose from NHS England’s “Compassion in practice”, can be, to some extent, applied to patients as well as clinicians.   [graphic source] The 6Cs are: care, compassion, competence, communication, courage, and commitment. One of my issues is that, while the 6Cs are elegantly branded and themselves slickly […]
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