Hewitt plans £4bn shift out of hospitals to new clinics

Monday January 30, 2006
The Guardian

A big switch of NHS resources out of hospitals into GP health centres and German-style polyclinics will be proposed today in a white paper from the health secretary, Patricia Hewitt. Over the next decade, medical work worth £4bn a year could be diverted from hospital outpatient departments in England into NHS and private units closer to people's homes.

Ms Hewitt has been struck by the NHS's heavy reliance on hospitals in dealing with the 45m or so outpatient appointments each year. She wants to switch a substantial slice of this work to 50 new community hospitals, modelled on the "polyclinics" successfully pioneered in Germany. The hospitals would be state-of-the-art, with the latest diagnostic facilities, specialising in a range of common medical conditions but without the A&E departments that generate emergency pressures on district general hospitals.

The decision may provide a reprieve for dozens of community and cottage hospitals threatened with closure, which could instead supplement the polyclinics. NHS trusts will be urged to look again at using satellite hospitals for the new approach to patient care.[snip]

The proposed re-routing of resources may call into question the government's plans for big PFI investment in building hospitals. [snip]

Ms Hewitt has backtracked on proposals to offer all patients a "health MoT" from the family doctor, the most popular idea to emerge from citizens' juries in the autumn. The scheme was dismissed in Whitehall as costly. Instead there will be a trial NHS Life Check, offering patients, initially people in their 50s, an online health questionnaire.

I like the bit about how cottage hospitals can 'supplement' these 'polyclinics'. Cottage hospitals always have been 'polyclinics'. At last it would appear that the government has realised that what really eats into budgets is huge hospitals, miles away from where most people live, with ludicrously small car parks. So many local hospitals have been closed down: excellent little units where people could be treated near their own homes. Even now the government can't climb down and admit it was wrong.

PFI has only ever been good news for the private companies involved. It would have been better if the government had just handed over a load of money to their mates in the private sector - oh, but that's what they did, isn't it? Imagine you go to a builder and say, 'I'll give you money to build me a house, and then I'll pay you rent to live in it.' That's PFI.

At least they've got rid of the stupid 'Health MOT' thing, if this report is correct. Just another way to hand over NHS money to private firms. The NHS already spends far too much money on 'preventative medicine'.

I am currently involved in a spat with my GP practice because I refuse to go for routine smears and asthma checks. The asthma check thing is embarrassing for the practice nurses - I know all about asthma, I only have it in a mild form, and I refuse to do a peak flow anyway because it induces bronchospasm. Many people with asthma have had it all their lives and know more about it than your average practice nurse. What's the point in dragging us all down to the surgery? Oh yes, of course, there's a box which must be ticked.

When I was 22 I lived in a flat on my own and all was fine, until I met that boyfriend: you know the type - you love them even though they are so desperately wrong for you, and in the end you have to dump them because of it, and there never is any closure, because your heart was never any part of the decision. For me, that boyfriend was Dai. He was ten years older than me, was just back from Thailand, and was the most glamorous thing I'd seen in Wales ever. He dressed like Don Johnson and looked like Mel Gibson (this was, believe it or not, a desirable thing in 1987). He was also a heroin addict. When we met, he told me he was clean: but then, they always do. It was the longest day of the year, and we kissed as we watched the sun rise over Abercynon pit. It was more romantic than it sounds!

He did all the things that heroin addicts do: lied, stole, cheated, disappeared for days at a time. And all the while the weirdest things were happening in the flat.

Doors would open then bag shut for no reason. Things would fall off walls and shelves. Clothes would disappear then reappear exactly where I'd known they should be all along. There would be banging on the walls. Once my mother could hear the banging over the phone. Then the fire escape door in my bedroom kept opening. It was one of those ones you push down a bar to open. One time when I found it open, I pushed it shut, then as I walked away, it sprang open again. So I very carefully shut it and made sure it was properly shut. I turned, and it sprang open again. This time as I shut it, I heard a little girl's giggle.

It really started to escalate after that. I had a small shelf with spices lined up on it, and one evening they moved forwards and dropped off the shelf one at a time. A few nights later I woke to feel myself falling back to the bed. The fire escape door was open and wind was blowing madly around the room. I was too scared to stay in there, I ran into the living room and in desperation phoned the Smaritans. 'I'm not suicidal, but a poltergeist has opened my fire-escape door, and I need you to wait while I go and close it...... OK, I'm fine now' Poor woman obviously thought I had completely lost the plot.

One night Dai turned up at gone midnight wanting to come in. I told him it was over, to go away and never come back. The strange happenings totally stopped.

Hewitt plans flexible NHS services

Extract:

"Patricia Hewitt has pledged "faster, more convenient NHS services" in locations that meet the needs of the public.

The health secretary's pledge came as she officially launched the first two 'commuter walk-in centres', which will be located in London Liverpool Street and Manchester Piccadilly stations. [snip]

Patients will not need to make an appointment to attend the centres, which will be open from 7.00am to 7.00pm during the week.

General Medical Clinics PLC will run the London centre while Atos Origin will run the Manchester clinic.

The services, to be provided under the NHS banner, will remain free to patients.

Treatments will be available for minor injuries and illnesses, in addition to prescriptions and healthcare advice.

"The public has told us that they want faster, more convenient NHS services," said Hewitt.

"Many banks and supermarkets are now open round the clock - the NHS needs to move to match people's expectations for extended opening hours.

"We will be exploring further possibilities, such as extending opening hours of existing GP surgeries, as part of the forthcoming white paper."[snip]

And Michael Summers, chairman of the Patients Association, said that being able to see a doctor or nurse without an appointment "makes life so much easier for patients and will have the added advantage of taking pressure of GPs and A&E departments".

So let's take a look at that. These centres will basically be dealing with the minor injuries and illnesses of people on their way to work or elsewhere. Things that under normal circumstances they wouldn't bother to see a GP about. And the NHS is paying private companies to do this. GREAT. What a really good use of scarce resources: create a need and then give private companies tax-payers' money to fill it.

Yes, patients may want extended GP opening hours. Personally I want to be tended to by semi-naked GPs who all look like Geroge Clooney, but I recognise that this isn't going to happen. If patients really wanted something, they'd want to pay the extra taxes for it, and it would appear that this country's electorate feels quite differently.

The NHS cannot afford to cater to people's wants. It can only afford their needs. GPs don't need to open all hours, because if a person is genuinely sick or worried about their health, they'll be willing to take time off work to see their GP.

Which patients are being catered to here anyway? If you visit a GP surgery you will find it full of the elderly and the severely disabled. These are the people whose needs should be being considered, not the 'working well'.

Instead of passing all these meaningless 'rights' onto patients, government should be addressing a few of the responsibilities people have for their own health. Make sure everyone knows how often they should be having a check-up for eyes, teeth and body; how and when to contact NHS Direct; when it is necessary to call for an ambulance; what kinds of conditions are suitable for accident and emergency; what kinds of conditions warrant an emergency GP appointment. Then it is up to patients to take care of themselves.

As an aside, I see Hewitt ('NHS? She's out to screw it') was trumpetting six-month waiting times on 'Today' this morning, and now they plan to cut them to 18 weeks. The reality of the situation is that if your health trust overspends, a nice way for it to avoid failing the targets is for them to decide your surgery 'isn't necessary', thus scrapping the waiting list altogether. So whereas in the 'bad old days' you would wait two years or more for your hernia repair, nowadays you just won't get it at all. Forwards not back, eh Mr Blair?

I often have dreams where famous people come to speak to me and tell me things. David Beckham told me his marriage was a sham, and soon after there was the Loos woman incident. On the other hand, Tony Blair told me he would resign or his health would suffer, and he's still clinging on in there.

So last night Davina McCall said she wasn't pregnant, and asked me to put my hand on her tummy to prove it. I felt the baby kick, but thought she was hiding it for a reason, so I winked at her and agreed she wasn't pregnant. 'Did you feel that?' she said. She hadn't known she was pregnant until I'd touched her.

So time will tell......

Example of the full story:

The Guardian, Jan 23rd

In brief the story is that Patricia Hewitt, the health secretary, is issuing a “Business Arrangements” rulebook for NHS managers, which will explain that financial management must have a higher priority than clinical objectives during the coming year.

She believes that a "handout culture” has been responsible for a quarter of trusts veering into the red in 2005/6. Their half-year accounts forecast overspending totalling £948m by the end of March. The Health Service Journal surveyed Trust Chief Executives and found that 63% of acute hospital trusts had closed wards to reduce outgoings, 75% had frozen recruitment and 26% are planning to withhold tax payments until the new financial year. 37% still expect to be in deficit.

Until this year hospitals agreed contracts with local Primary Care Trusts, and thus they would know how many patients they would be treating, and would provide services at a price which would cover their outgoings. Now that patients can choose where to be treated, hospitals can lose income if they don’t attract enough patients.

Hewitt is also setting set a national tariff for every hospital activity, except critical care, and creating incentives to keep patients out of hospital if they can be cared for better, or more economically, in the community.

But let’s be clear about this – all it is is yet more tinkering around by an incompetent Blair yes-woman. She knows nothing about how to provide healthcare, nothing about what is involved and why some operations/treatments cost more than others. She cares not a jot how she is demotivating staff. At least it is the turn of management this time.

Here’s an example of why productivity in the NHS is decreasing rather than increasing with every stupid reform. [Let’s ignore the fact that just as staff get used to collecting the latest piece of data/using the latest useless computer programme/recording the latest meaningless statistic the government changes it all again and you have to start from scratch with a new system]. When I began in the NHS in 1986, physiotherapists worked a 36 hour week – in theory, because in practice you’d take paperwork home with you, work over if the patients needed you, work through lunch, do courses in your own time and at your own expense etc. Then along comes ‘Agenda For Change’. Physios get a pay-rise, but in return their holidays are cut and their hours increased to 37.5. So what do the pissed-off physios do? They work the 37.5 hours and no more. They do fewer patients so they can get the paperwork done in work time. They only do courses that are funded and where time is refunded. When they work overtime, they take the time back or claim for it. They take their full lunch break.

Well done, Patricia Hewitt et al: you’re now paying more for less. And all because you didn’t value the people on the ground and were greedily trying to claw back a few measly pounds.

Some people are incapable of learning lessons.

The Sunday Times January 22, 2006

“INFANTS could soon be given the flu jab up to the age of two. Government health advisers say vaccinating babies could cut health costs by preventing flu epidemics and the expense of treating them.

The plan has been proposed by the joint committee on vaccination and immunisation which considers medical evidence on new vaccination programmes and advises the Department of Health. [snip]

Flu is responsible for about 800,000 GP visits, 19,000 hospital stays and 10,000 respiratory deaths in England and Wales each year.
Doctors believe that children aged from one to four years would benefit significantly from flu jabs with a wide age range of those vaccinated producing the greatest effect.

The committee’s proposal envisages all children receiving two doses in the first year.

Experts believe that flu in infants drives the disease in all age groups. American research suggests that if four out of five children aged six months to 18 years took up the flu vaccine the incidence of the disease within the general population would fall by 91%.

The elderly could be the group that is most helped by vaccinating infants because of their relative susceptibility to infection. However, parents have been reluctant to expose children to more jabs since the MMR controversy three years ago.” [snip]

So once again babies are going to be vaccinated to protect other people. How can it be right to vaccinate the vulnerable infants because the adults can’t be arsed to get themselves vaccinated? Flu vaccine is available freely to the elderly if they want it.

All the current research on the safety of vaccines is seriously flawed for one huge reason – it only ever compares children given one type of vaccine to those given another type of vaccine. No research ever compares vaccinated children with non-vaccinated children.

In addition, as with all side-effects, adverse incidents following vaccination are mostly unreported. In one year alone, two of my friends’ children were admitted to hospital with convulsions following MMR. Both were told it was due to a high temperature, and not to do with the MMR – but how do the doctors know that?

Everyone seems to have got hooked on the idea of herd immunity, as though that is the answer to all health ills – and it’s a fool’s gold, because no vaccine is 100 per cent effective and immunity from vaccination isn’t permanent (immunity acquired from having a disease is permanent). This madness has led us to pump our children full of pathogens and poisons (preservatives etc) without any consideration being given to the possible consequences – for instance, could vaccines have anything to do with the rising incidence of hayfever, asthma and other auto-immune diseases that afflict us nowadays?

Strangely, the minute a vaccine is developed, a previously relatively innocuous childhood disease suddenly becomes a killer – this is now happening with chicken pox.

Vaccination alters diagnosis too. I long ago got used to seeing children who patently had whooping cough being diagnosed with ‘bronchiolitis’ since ‘it can’t be whooping cough because they’ve been vaccinated.’

I am all for vaccination in places where diseases are endemic, sanitation is poor, nutrition is poor, and overcrowding is the norm. If I go to India, I want my vaccinations. But in the UK, where we are relatively healthy (I’m excluding mucousy shopworkers, obviously), well fed, well housed and have excellent sanitation?

If there were to be an outbreak of measles, then fine, have vaccines ready if people want them. But vaccination also makes us disregard other far more effective means of preventing the spread of disease such as quarantine (the real reason smallpox has been wiped off the face of the earth) and good hygiene practice.

I know this is hugely controversial, and I know that there are children and adults out there who have been badly damaged by diseases that they could have been vaccinated against. I respect everyone’s right to choose what is best for their family. Yet it seems to me that the pendulum has now swung too far in the other direction – parents are encouraged to buy into the myth of herd immunity rather than think about relative risk – a more difficult concept, but a truer one, I think.

Most of all, something seems very wrong about vaccinating children for the sake of adults.

I've been meaning to write about ghosts since reading about PurpleDragon's lodger.

Dad is convinced that I am nuts because I am always seeing ghosts. Me and Little Sis once saw a ghost in a caravan (a little curly-haired girl), which he thought was hysterical. Little Sis has seen the same girl in the spare bedroom at the Parents' house - and I once had a horrible experience when I was off school sick and Mum was taking her to school. The dog was on my bed, and suddenly got up, stared at the door, cowered down and put his ears back, hackles up, growling and baring his teeth as though he was shit-scared of something. This was a labrador cross, so not a highly-strung animal. It took me ages to get him to calm down, and I couldn't see anything.

Another time my Senior and I were going up to a ward to see a very sick lady, when we saw her coming down the stairs towards us. These were the 'back' stairs, which only the staff used as they weren't heated or carpetted. We stopped her and suggested she go back to the ward. Did Sister know she was off the ward? 'Oh, it's alright, they all know about it, I'm just going down,' she said. She was messing in her bag, and we assumed she was off to the hospital shop. When we got the the ward, we asked Sister if she did know that Mrs So-an-so was off the ward. 'I can tell you for certain she's not.' 'Yes she is, we've just seen her on the back stairs.' 'No you haven't, 'cause she's behind that curtain, dead.'

Birmingham Accident Hospital had loads of ghosts, some well-known, but I only ever saw one. I came off the Burns Unit one Saturday morning, and noticed an old man leaning on some old beds which were stored against a disused door. I carried on to the stairs, as I thought he was a visitor getting a breath. Then he moaned, so I hopped back up the stair and walked towards him saying, 'are you ok?' But he disappeared in front of my eyes.

I'll wrote about my poltergeist experience next time - that is the only time a ghost has bothered me.

Someone has tagged me 'pretty girl', and I feel obliged to point out that this is no longer the case, I have aged badly, and please see the 'Fern Britton' pic way below!

The picture I use, is, of course, how I still look on the *inside*.

The Observer
Sunday January 15, 2006
Jo Revill, health editor
Poor diet link to rising cases of depression

Extract:
"Increasing rates of anxiety, depression and irritability could be due to a poor diet that lacks the essential chemicals to keep the brain healthy, according to a leading mental health charity.
A report out tomorrow describes the links between the less severe forms of mental disorder, such as anxiety, and the nation's increasing reliance on ready meals and processed food, which are heavy in pesticides, additives and harmful trans fats. Eating a diet without fresh fruit and vegetables, fish, pulses or nuts deprives the brain of the essential vitamins and nutrients needed to regulate it.

The report, 'Feeding Minds', was produced by the Mental Health Foundation and Sustain, two charities which are launching a campaign that argues that dietary changes could hold the key to combating problems such as depression and ADHD (attention deficit hyperactivity disorder) in children."

Ages ago I read a book about how you could treat even severe mental illnesses such as schizophrenia with diet - "Nutrition and Mental Illness" by Carl Pfiffer.

Of course, this is the sort of thing makes no sense to your average psychiatrist and his beloved medical model. Yet how can it not? As I used ot say to the lovely Dr Craig, either you believe that drugs work, or you don't. If you believe they do, then you accept that chemicals affect the brain. And what is food? Chemicals. What does exercise do? Changes chemicals. Therefore, why not treat people with food and exercise? [With thanks to Mick Skelly for giving me the words]

But physiotherapists don't have the persuasive powers of drug companies; or the funds for the research to back up our hypotheses.

I am my own guinea pig. I had depression for years: from when I was 14 to the time I walked out of work the day after a night contemplating suicide because I couldn't cope any more. Three weeks of seroxat had me feeling better - but then, so would three weeks of alcohol or speed.

It's really nice and comforting to be told that you have a problem with brain chemistry, and it's not really your fault, there's nothing you can do except take a pill and hope it makes it better. Nice, comforting, but, as I soon realised, ultimately unhelpful.

I've never met a depressed person with a happy life. My life was unhappy, and I had to change it. That meant I had to learn to say 'no': a thing I really hated doing. I said 'no' to too much work, and I said 'no' to antidepressants. I turned it around, and I am so grateful that I was blessed with depression because I'm a better physio for it. I've been to the dark places my patients have been. I've taken medication, I've come off medication, I've been told that withdrawal symptoms were my depression coming back. I did my own thing and got well through eating well, exercising, and learning to think differently [changing the way we think changes brain chemistry too]. It's not that I deny the chemical aspect to depression, but I prefer to tackle it in a different way to taking medication.

That's not to say depression has gone forever. I feel it approach at times; I see the edges of the world dimming, or find my emotions flattening. There's always something wrong when that happens - with my life or the way I'm thinking. There are those like Lewis Wolpert who insist that their depression is nothing to do with their lives, and that only drugs can keep them free of it. I think they are kidding themselves. Life isn't only the stuff everyone sees: the more real things are going on in our heads.

Depression isn't the enemy: it is the friend who sometimes has to make me see where I'm going wrong.

A minor achievement

Today I was able to do a set of full sit-ups for the first time in over four years!

Full sit-ups must be done correctly, otherwise you risk damaging your back, encourage a pot belly and only exercise your hip flexors. I put on four stone when I was pregnant, and had a split rectus. It's now much better: still slightly split but not to the extent that I can still do my party trick - letting people feel my 'intestines'. So it has taken ages to build up my muscles.

I feel quite sad for people who believe it when programmes like 'Ten Years Younger' say that their stretched skin will 'never' go back. It takes ages, and my tummy still has saggy skin, but it is much improved over the four-odd years. I'm nearly 41, and my life isn't about being a supermodel. I have no wish to wear a bikini on the beach, and in clothes I look fine. My saggy tum is my badge of honour, and today I am SO proud of myself for achieving something I'd thought was forever beyond me. Surgery can't give you that.

Keep Fit Videos
I am one of those physiotherapists who believes that physios should be physically fit. Otherwise, when you are prescribing exercise, how can people take you seriously, and how can you demonstrate correctly if you aren't fit yourself? So I excercise regularly and do loads of different things - running, weights, yoga, Pilates, dance, all sorts. I use lots of videos too as if I have to miss a class due to work or whatever, then I can still work out.

So I watched that channel 5 programme about celeb exercise videos. What a pile of pants! They slagged off Cindy Crawford and Jane Fonda: Jane Fonda goes for the burn and has had a hip replacement so hers are all rubbish; Cindy's look like porn videos so hers are rubbish too.

In fact, for regular exercisers, Jane Fonda and Cindy Crawford are the only celeb videos that hit the spot. They *do* both have their faults in that they are not suitable for beginner exercisers, but by the time you are capable of doing them properly, you will know how to modify the exercises that are a bit dodgy in Jane Fonda - and Cindy's 'Next Challenge' is faultless for form. Most importantly, they get a sweat up. I hate things like the praised Lorraine Kelly video - BORING. I like to sweat and I like to go for the burn! Crawford and Fonda are TOPS!

Oh, and Jane Fonda's hip replacement probably has a lot more to do with her eating disorders than her exercises.

A pretendy achievement
I bought a size 12 skirt today. I was always a size 12 until my late 20s. In those days my vital stats were 36-26-33 (I was obviously the model for Lara Croft). Today they are 41-34-38. Somewhere someone has decided to trade on women's vanity.

If Vanessa Feltz would still like to be a size 12, she should head for Primark.

Once again bird flu was high on the BBC news agenda this morning. Second story - and the birds must be really pissed off that Charles Clarke's resignation and the LibDems kept them off the top spot they've become accustomed to.

So why does this story merit such attention?

The H5N1 strain has only infected 144 people since 2004. 76 of those have died, which admittedly is a high mortality rate, but compared to heart disease, diabetes, or even smoking, I would have thought that avian flu has a long way to go before it is worthy of even a moment's worry. In the winter of 2003/04, 'ordinary' flu killed 153 children in the US alone - yet somehow this wasn't as newsworthy as avian flu.

The media are constantly forcing it down our throats. We are incessantly told that it is just a matter of time before the virus mutates and becomes transmissable between humans (with no mention of how such a mutation may affect its lethality). There are endless parades of 'experts' filing through TV and radio studios, all regurgitating the scare-mongering of the presenters: if any of them dares to deviate from the script, the likes of Richard Madeley will quickly butt in to reassure the viewer that, "in the end, what you're saying is, WE'RE ALL GOING TO DIE!"

When information emerges that cases previously thought to be avian flu in humans actually weren't, it is buried at the bottom of a pile of other news (in a similar way to the news that the 'schizophrenia gene' discovery was a mistake). Maybe in the hope that we won't notice: good news, after all, is no news.

Chances are that one day there will be a serious flu epidemic. We have no way of knowing if it will be a descendent of H5N1, or if it will mutate from any one of the multitude of flu viruses kicking around. Luckily, in the West, we are better fed, better warmed, better cared for than we ever have been before - so we stand a better chance of recovery than any other population in history. Yet we still worry.

We also abdicate all responsibility for our own health. Rather than concentrating on our nutrition and following good hygiene practice (frequent hand-washing, avoiding touching faces with hands, use of tissues when coughing, sneezing etc) we go rushing to the doctor demanding a vaccine or an anti-viral. And of course, when we *are* unwell, we struggle valiantly into work to spread our germs to our colleagues - a practice encouraged by short-sighted employers implementing punitive measures which discourage sickness absence. It would appear that the likes of Tesco is convinced that its employees are a bunch of malingerers. Personally I am sick of being sneezed over at the checkout and fed up of being given snotty receipts.

So please can the BBC stop telling me about bird flu and concentrate upon the real health issue facing the UK - mucous-ridden shop workers.

I've seen lots of dead people, and I've been with people when they died, so it wasn't a surprise that the body in the coffin looked nothing like Steven. My parents didn't want to look, but I wanted to, because then it was sure and definite. Once you've seen the empty shell, then you know he's gone.

Before we went over to Steven's Partner's for the funeral, I'd kind of felt that I had no right to be upset like other people were. We hadn't been close for many years before he died - along with the rest of the family I'd only seen him at Christmas for the last ten years or so. At SP's house she'd put out loads of letters and pictures of him, from ages back right up to the present. Then I realised that I was mourning the person he'd been when we were close.

When Little Sis and me were little and he'd babysit for us, and he looked after us when Mum was in hospital. He was possibly the most cool brother on the planet, the person I wanted to be when I grew up. When I grew up and was like him, I used to go and stay with him in Minehead for debauched weekends and holidays. Even then, when we were doing frankly recklessly dangerous stuff, I always felt safe just because he was there. When he was on a ventilator, I still felt safe, and there was a part of me that thought he wouldn't die - then or ever - because that's not what Steven does. He tries to commit suicide in the most gruesome way and lives. He overdoses on heroin and lives. He gets pneumonia and lives.

So what really got me was when the sealed coffin in the hearse arrived at the house. Because that's it: that's Steven in a box, gone, and the world isn't safe anymore.

Mum was in pieces during the service, which I wasn't expecting. Mum and Dad disapproved of him so much, I wasn't sure if they thought he deserved what had happened. Of course, she's a mum, and mums never stop loving their children, or expect to outlive them. He'll always be her little boy.

After the service, SP gave us some jewellery he'd bought for us, and our Christmas presents. Now, Steven doesn't do Christmas presents. He turns up on Christmas eve, goes down the market and buys whatever's left going cheap, then randomly allocates stuff to people. The only time in his life Steve did any forward planning was for his death. The only time he's bought me something I love (medieval cloister games), I don't get to thank him.

Little 'Un said, 'I'm sad because Uncle Steven is dead. But he's in heaven with Fluffy and Ginger and Richard Whitely.' Looks like he'll be winning 'Celestial Countdown' for the foreseeable future.

So what is mad is that for the first time since I cleaned up my act (thus of necessity removing myself from his company), I miss him.

for me is that I hate making people pay. I haven't increased my fees since 1995, when I first started doing some private work, even though now I travel to see people rather than seeing them at home (saves on public liability insurance for my house).

At the moment my fees are £40 for a first session, and £30 thereafter, which sounds a lot, but the first session is at least two hours and the others a minimum of an hour or I cut the price. I give discounts to half price for people in financial difficulties. I give discounts for treatments bought in a block. And though I say it myself, I am damned good at what I do (chronic fatigue, chronic pain, backs, necks, anxiety, panic etc are my specialities). If I don't think I can help (sports injuries and stuff) I'll send the patient to someone who can.

The big problem comes when I know I can help a patient and I also think they can't afford to pay even £15 a session. So I end up doing free sessions, because there's not another craniosacral therapist for miles, and the nearest one hasn't got mental health expertise, and countless other reasons I use to justify my Princess Diana complex.

So I decided I'm hiking the fees to £50 and £40. But I've already told the patients I already see that they can keep the same fees for their current treatment episodes. Really, I'd like to employ someone to collect payments so that I don't have to be involved in it at all. But I can't afford to, because I hate making people pay......

The government's latest way of tinkering with the NHS until it is irreparably broken is to bring in patient 'choice':

http://news.independent.co.uk/uk/health_medical/article336091.ece

"From today, patients will be able to choose among at least four hospitals, clinics or treatment centres in their area, including private units in some cases, marking what ministers described as the end of the "take it or leave it" NHS.

Hospitals are preparing to launch advertising campaigns to compete for patients, which critics say is a waste of precious NHS resources and will undermine the communal culture of the NHS. Less popular hospitals may be forced to close while successful ones may be overwhelmed in the NHS market.

By 2008, ministers plan to offer patients a choice of any hospital, NHS or private, anywhere in the country that can provide treatment at the NHS tariff."

This is like offering someone two wrapped boxes and asking them to choose between them. Or even worse, it is like offering them wrapped boxes with descriptions attached - descriptions which may or may not be true. This is what patients will be basing their choices on, since the government's league tables bear no relationship to how good a hospital really is. What they measure is how well hospital managers can bully their staff into achieving meaningless targets. For instance, the maximum four hour Accident and Emergency waiting time target: does it matter if a time-waster sits drunk in casualty with a cut finger for four hours and ten minutes? Or is it fine for someone with 40 per cent burns to sit waiting for half an hour even? Yes, those are extremes, but they are indications of how useless these 'targets' are. I don't care how long I wait in casualty so long as I am sure that patients are being prioritised according to need, and this waiting times target gets in the way of that.

So patients have no idea of how hospitals are performing, unless they know someone who works in the NHS in the area: staff always know which hospitals are good and which are bad, and which surgeons are good and which aren't. That your average patient is clueless in this area is proven by the big stink kicked up in Birmingham when the General Hospital (bog-standard) was due for closure. Meanwhile, Birmingham Accident Hospital, a centre of excellence and the best hospital I have ever had the priviledge of working in, was quietly broken up and shut with nary a whisper of complaint.

NHS Trusts have, however, been wasting money on advertising for years, ever since the beginning of the internal market. This will only make it more obvious. Do we really want taxes spent on advertising budgets?

Thatcher must be very proud.