Cuts and More Cuts – a Disaster for our Population’s Health and Wellbeing

It amazes me, in this 24-hour news world that we live in, that a further £1 BILLION of cuts to our county councils doesn’t remain on the BBC front page until much past lunchtime! It feels a bit more important than some of the stories being picked by the editorial team instead!

 

https://www.bbc.co.uk/news/education-45573921

 

Anyhow….these cuts will be utterly devastating for our population’s health and wellbeing and the “extra funding” for the NHS is simply not going to be enough to undo the damage. Local government will have lost 60% of it’s budget by 2020, with devastating consequences and no amount of local taxation will replace the difference, especially in poorer areas of the country. And just look at what will be cut:

 

  • 58% of councils said highways and transport (including road improvements, streetlights, pothole filling)
  • 47% said libraries
  • 45% said early years and youth clubs.
  • 44% ear-marked public health services like smoking cessation, sexual health, substance misuse
  • 36% said children’s services.

 

 

So:

  1.  We will have far higher risk of road traffic accidents, especially for cyclists/motorcyclists (I’ve seen the effect of people hitting potholes and fracturing their spine).
  2. there will be less access to shops and leisure facilities for our poorest communities, meaning a worsening of the obesity epidemic.
  3. We will have increased social isolation and reduced learning opportunities for our elderly (therefore increasing risk of dementia and depression).
  4. We will have decreased social support for our young people, leaving them far more vulnerable to gangs and substance misuse.
  5. We will have less support for young families, struggling to cope and so less opportunity for parental support and an increase in Adverse Childhood Experiences – with devastating long term consequences for physical and mental health.
  6. Smoking continues to affect 1 in 5 people in a hospital bed, and is still the biggest cause of death in many parts of the country – yep good idea to cut that.
  7. Our drug crisis is rising exponentially, and we’re seeing an increase in STIs and yet councils will not be able to provide services to help.
  8. Children’s services, those vital safety nets that work to prevent serious safeguarding incidents will have to be reduced also!

 

WHAT?!

 

There isn’t a council in the country that wants to make these cuts and the lack of foresight by the government to drive these further cuts through when the ones we’ve had already have been so deep, is utterly ludicrous. I’ve sat with council officers in tears over the choices they are having to make – these are people who love the communities they serve and are trying to do as much damage limitation as possible, whilst being left to take the blame.

 

What does it tell us? It tells us a few things. Firstly, there is a serious lack of joined up thinking about the long term consequences of these cuts. Save money now, but pay for it 5-fold in the future. Secondly, there is a genuine lack of concern for the poorer communities in our country. Thirdly, our current political model is broken and more than ever we need a politics of love/compassion. Fourthly, our current economic model is caput and cannot give us the regenerative and distributive future we need for humanity and the planet. I feel so despairing, sad and am grieving what this is going to mean for so many of our communities. We need to feel this pain and face up to this and find hope in reimagining how we might do things radically but necessarily differently.  This piece in the Guardian is worthy of serious reflection:

 

https://amp.theguardian.com/politics/2018/sep/16/the-eu-needs-a-stability-and-wellbeing-pact-not-more-growth?__twitter_impression=true

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Death – Allowing it to Happen Naturally

Twice a week I do a ward round at our local nursing home. All of my patients there have profound dementia, and none of them recognise me from one visit to the next. Most of them are doubly incontinent and many of them are unable to communicate and are bed bound. And in that place I find the very best of human compassion and care; real, genuine dignity. I completely understand why families feel unable to care for their loved ones when they reach this stage of life and these kind of care facilities, although imperfect, are of huge value.

But, I believe we need to have an emotive conversation about advanced care planning, living wills and how to allow people to die in a compassionate way without needing to kill them. Most of my patients in this particular home have had at least one urinary tract infection and a chest infection in the last year. Our current default position as medics is to treat the infection and keep the person alive. And I want to ask some tough questions: – For what? For how long? Why? Isn’t there a difference between living and being kept alive?

Now, please hear me. I am not saying that people with dementia are worthless and we should just let them die. Indeed my lovely Nanna has vascular dementia, but she is truly happy and doing very well. I recently went to see her for a weekend. On the first night I took her out to dinner with my family. The very next day she had forgotten all about it, though she still knew who I was! I’m not suggesting that next time she gets a chest infection, we shouldn’t bother treating her. I am saying that every human life is precious, and each person should be honoured and loved. But there comes a point when we have to ask if our ability to sustain life becomes more inhumane than genuinely loving.

Although most of our patients in nursing homes have a ‘Do Not Attempt CPR’ order (because not one of them would survive such an attempt and it would be an horrific ordeal to put them, their family or staff through it), we actively keep them alive when they have an infection. It has caused me to personally reflect that I will make a living will that if I develop dementia one day, and become doubly incontinent, bed bound  and unaware who my family are, I will not want to be treated with antibiotics. I would like to be kept comfortable and let the natural consequences of an infection overwhelm my immune system and allow me to die in peace.

 

I understand that this either takes a living will or should involve team decisions with doctors, nursing staff and where possible the family of the person or next of kin.

We are keeping literally thousands of people alive in this country every year who would be able to die peacefully, without the need for euthanasia if we took our ‘healing hands’ out of the way and allowed compassionate hands to nurse them into the grave. We have every drug we need to keep people comfortable. We have the most amazingly caring staff to treat them with dignity. Are we afraid of letting go? Are we scared of what is on the other side of death? Whatever our reasons, we have to ask if our current management of our elderly citizens with end-stage dementia is kind or compassionate or indeed sustainable.

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