The role of the intestine in type 2 diabetes …

Researchers at the University of Adelaide have discovered that the way the gut ‘tastes’ sweet food may be defective in sufferers of type 2 diabetes, leading to problems with glucose uptake.

This interests me greatly as I have type 2 diabetes. I developed the condition after an operation on an infected Meckel’s Diverticulum necessitated removal of a section of my small intestine. The Meckel’s was undiagnosed for over four years as bleeding from my bowel, noticed by a young hospital doctor prior to an operation on my bladder, was ignored by my then General Practioner. Following the operation, I began to experience unnerving symptoms, most disturbing of which was falling asleep immediately after eating potatoes. Yes, it sounds weird now but at the time it was quite frightening. For some reason, my GP referred me to a hospital clinic that dealt with irritable bowel syndrome. At the clinic my urine was tested; I was told I had glucose in my urine and should report it to my GP. My GP, however, told me I was not nearly fat enough to have diabetes and ignored it. Two years later, the GP retired and another GP was appointed to the practise. I told him about my symptoms, he referred me to a diabetes clinic and type 2 diabetes was diagnosed.

I was told many times that I was not fat enough to have diabetes and I admit that I was quite lean. I certainly did not fit into the classification of a patient who might be considered at risk of diabetes. But if my diabetes was not caused by being overweight what did cause it? This new Australian study may offer an insight. My intestines had been infected for a number of years by the deteriorating condition of the Meckel’s and the operation on the small intestine caused more trauma.

My diabetes has now progressed and I am insulin dependent. It would be interesting to know if my pancreas was affected by the trauma to my intestine or if, once I had the condition, it progressed in a way that would be considered ‘normal’.

Isn’t the human body wonderful – a biological machine that can malfunction in so many ways and needs regular inspections and maintenance by mechanics (doctors and nurses) who actually know what they are doing!


NHS Accident and Emergency Departments

In my experience …

There is nothing wrong with A&E Departments that a full review of incompetent, inefficient and ineffective GP services, particularly focusing on out-of-hours services, could not cure.

Benefits payments and abuse

Benefits payments are not just made to lazy cheats who refuse to work. For some, benefits can mean the difference between barely managing to survive and suicide.

Before the new Pope was inaugurated media headlines seemed full of stories about children who were sexually abused by priests. Of course, priests aren’t the only abusers and sexual abuse isn’t the only way in which children are damaged. Physical and emotional abuse take their toll. And abuse is far more prevalent than we like to admit.

Disability isn’t restricted to physical damage and deformity. One the most depressing aspect of abuse is that abused children often become socially withdrawn adults incapable of living a normal life; abuse can result in apparently normal people being unable to function within society because of their experiences.

Some are so damaged that they find it impossible to trust anyone. They cannot work, they cannot join clubs or societies. They survive by isolating themselves from society, some receiving therapy, some surviving by their own devices because therapy has been unable to help them.

Some can be seen shuffling down the road, unwashed, unkempt. Some manage to keep themselves clean and tidy but as soon as they are faced with having to interact with other people immediately withdraw into their shells.

Of course, some victims can put their abuse behind them and function normally. They can hold down a job, maintain relationships, have families and bring up their own children. Others cannot. For them, benefits aren’t a lifestyle; they are necessary for their very survival.

By lumping everyone on benefits as shirkers, by labelling abuse victims as benefits cheats, politicians like David Cameron and Iain Duncan Smith are causing the suffering of abuse victims to continue, indeed to become far worse. Ans all those who are jumping on the bandwagon and ranting that they shouldn’t have to pay benefits from their taxes are just as culpable, just as guilty as those who committed the original abuse.

Mid Staffordshire Public Inquiry Report Published

Mid Staffordshire Public Inquiry Report Published

I guess everyone must have heard about the report by now. Many patients were left to die in the most horrendous conditions – and this in NHS hospitals.

In some ways this is far worse that the Dr. Harold Shipman affair. Shipman’s patients died because Shipman sought to steal his patients wealth by killing them and altering their wills in his favour. He had a goal in mind and was determined to achieve it. The real fault in the Shipman affair lay with the inspection and regulation of doctors.

The Mid Staffordshire report found that patients died not because they were killed by a criminal who wished to enrich himself. They died because no one cared enough and the system drowned out those who did. Oh, families and friends cared – and they had a right to expect those paid to care while their loved ones were in hospital would ensure they were safe. But too many doctors and too many nurses did not care; managers did not care; health care assistants did not care; those who were expected to monitor and regulate the service did not care.

Of those, the managers, in fact, must come out reasonably well. Managers are not employed to care; managers are employed to look after the figures and to administrate the system. Managers are expected to try to save money and cut the amount of time and expense doctors and nurses require to do their jobs properly. Managers are tyrants with pens and clipboards, computers and slide rules. Managers manage the system; they are not required to manage patients.

Why did doctors not perform their ward rounds properly? Why did nurses not notice the smell of faeces and vomit? Why did health care assistants not notice that meals were being left or that patients were lying in their own excrement? Because they were expected to manage the system. It’s as if everyone wanted to be a chief, no one was prepared to be an Indian.

Will anyone be prosecuted for allowing this dreadful situation? Can’t imagine it myself. Those in authority will attempt to make this disappear as soon as possible. Politicians will promise that systems will change; professional bodies will say that they will ensure training is improved and unions will continue to whine that it wasn’t the fault of their members. In the end the only change will be that bureaucracyĀ will increase and those responsible for the care of patients will be able to hide even further in the woodpile.

My Father’s War

War does incredible damage to individuals, even those who appear on the surface to be unaffected.

I remember standing at a window with my father as we watched a Remembrance Day parade. He was crying. I asked him why he didn’t take part but he just shrugged. For some reason I remember a phrase from around the same time: ā€œSorry to rain on your parade but …ā€. Whether I had seen an advert or a programme on the television I cannot remember. I also remember a young girl and something about the Burma Star Association. Maybe, in retrospect, I am remembering a combination of various images and news items , the origins lost in time. I cannot say.

My father served in India and then in Japan with the occupation forces. In Japan he was based in Kure. He had photos of Hiroshima and seemed to have been involved with the clean-up of the city but he talked little about his service. I also know he was in REME and worked on generators. I remember there were also photographs of him and his mates, seemingly happy and laughing about something or other, at Angel Falls in India. What I wasn’t sure about was why he cried quite so hard during the Remembrance Day parade. Didn’t every soldier who survived fighting the enemy end up occupying a foreign country?

Whether the images were of different programmes or adverts or not I seem to remember that the image of the young girl and the phrase ā€œSorry to rain on your paradeā€ had something to do with the way troops returning from the Far East were treated. My father returned in 1947 sporting a shattered ankle. He mentioned that one of his most vivid memories of the summer of 1947 was that you could recognise returnees from the Far East because they wore greatcoats while everyone else was dressed in very light clothes because the summer that year was so hot.

His most vivid memory, however, was being treated as an embarrassment. Most people in Britain had been through the European war and wanted to forget it. They wanted to enjoy the peace. Life for ordinary people was changing quickly; a new Labour government was talking about introducing a National Health Service and other major developments in social security. No wonder nobody was particularly interested in returning soldiers. It must have been even worse for prisoners of war who suffered under the Japanese. The public had seen the horrors of the Holocaust on their cinema screens and the horrors seemed to have inured them to suffering. Soldiers and prisoners returning from the Far East were a sight too far. But, for so many soldiers like my father, the memory of being ignored was heartbreaking.

For me, there was something else I did not understand. My father was an assistant in a grocery shop in Kent yet hadn’t been called up to serve in the army until the latter half of 1944. Why? I desperately wanted to know. I knew my mother had been in Air Raid Precautions but I knew nothing of my father’s role. Had he been a spiv, making money on the black market? It didn’t seem likely, knowing my father. There was something else, though. Talking to him now and again revealed the odd comment that suggested an incredible knowledge of unarmed combat, killing techniques and explosives training far beyond the training given to soldiers joining REME. Further attempts to pierce his silence, however, apart from those odd mentions during unguarded moments, revealed nothing.

I had to wait until after he had died before I was able to find out more. Among the few items left after his death were a number of diaries, some written during the years 1939 to 1944. Some of them seemed to have been written in a code. It took a long time to decipher. There were references to meeting ARPs and the Fire Service. References I found most strange mentioned regular meetings with the Chief Constable. Why would a grocery assistant need to meet the Chief Constable on a regular basis? Curious. I had no inkling of what the diary entries might mean until I saw a television programme years later. It concerned groups of trained killers known as Churchill’s Auxiliary. The role of Churchill’s Auxiliary was to act as a resistance should the Germans invade. The auxiliary was disbanded in mid 1944, after the D Day invasion.

Suddenly, it all made sense. The unarmed combat, the secrecy, the refusal to take part in parades. I remember him saying something along the lines of: they aren’t interested in saying to people that war is awful and harms people; they were, he said, saying: look at me, I served my country, aren’t I wonderful.

He suffered many health problems in later life. His leg was amputated when his shattered ankle, a constant physical reminder of his army service became gangrenous. I remember hearing that he was referred to a psychiatrist because of mental problems. He left, supposedly for the appointment, but returned so quickly it was obvious he hadn’t kept it. He must have been either afraid what he might reveal or, more likely, afraid of what he might do if his old memories were drawn out of him.

My father’s experiences left me in no doubt that it doesn’t matter how much people suffer, as long as they are part of a large group or population which has suffered the same experiences they can eventually cope with the trauma. The smaller the group or more dispersed the population, the harder it is for them. Maybe, had he just served in Japan, he could have coped. His earlier war experience together with his Far East service, his feelings of rejection and being sworn to secrecy about the Auxiliary left him isolated and prone to mental torture no one should ever have to endure. The smaller the war or the less people affected by it, the more severe the mental trauma. It’s no wonder soldiers returning from wars like those in Iraq and Afghanistan suffer so much post traumatic stress disorder. Wars are instigated by politicians and public opinion. Soldiers, sailors and airmen are not there because they want to be. We should have learned by now to respect and understand returning soldiers whether they appear normal or not. It is a disgrace that they are still too often left to cope alone.

Child Abuse

A new database of children’s hospital visits is to be set up to identify possible child abuse cases. What I would like to know is: will a record be kept of abuse carried out by doctors and nurses?

My concern is not theoretical but based on experience. I had a profoundly brain damaged daughter, Susan. She was the second born of twins. My wife and I were told soon after the birth that she had suffered brain damage cause by the cord being wrapped around her neck. However, our GP at the time wasn’t satisfied with the explanation and we began a judicial review. It turned out that the explanation was a lie; the damage was caused by an injection of a drug to contract my wife’s womb and expel the afterbirth being given by a doctor who did not check her first. Susan was crushed by the sudden contraction. Despite evidence to the contrary, no doctor would agree negligence was a factor. In fact, one ‘expert’ said he had no intention of ruining a young doctor’s career because of an accident. It didn’t matter that a child’s life had been destroyed; for doctors, their careers are more important than a child’s life.

Susan suffered many problems. A recurring theme was severe pain caused by tendons not growing at the same rate as bone growth. She had many operations to cut her tendons. In one instance, at Buckland Hospital, Dover, the surgeon decided an operation was not necessary and instructed a nurse to press down on Susan’s leg. On her return home, Susan wouldn’t stop screaming. We took her back to the hospital where it was found that her femur had been broken by the pressure applied by the nurse. Our complaint resulted in an apology but it was clear the nurse would have been blamed yet she was merely carrying out instructions given to her by a consultant. We took the complaint no further because we didn’t want to see a relatively innocent nurse sacked for a decision caused by an uncaring and pompous consultant. This is the way doctors wriggle out of responsibility. Would a database have recorded the abuse suffered by my daughter? I doubt it.

Susan eventually went into a Home for severely disabled. She died while being fed by a nurse. We later found out that she was the fourth child to die in similar circumstances. The Home was closed and the abuse hushed up. Would those events have been recorded? Again, I somehow doubt it.

How many parents will be blamed for the actions of doctors and nurses? I dread to think.

No planning Permission for New Hospital in Dover?


East Kent Hospitals University NHS Foundation Trust says it is planning to build a new hospital on the site of Dover’s present Buckland Hospital and claims the new hospital will cost Ā£21,000,000. However, according to Dover District Council leader Paul Watkins the Trust has not yet applied for planning permission. What is going on? My attempts to find out raised more questions than they answered.

As well as being leader of Dover District Council, Paul Watkins is a member of the newly-formed Health and Wellbeing Committee, which will be run by, or has close links to, Dover District Council. To further complicate matters, there is also a South Kent Coast Clinical Commissioning Group. Trying to find information on how the roles of these various organisations interlink or overlap, or do not, seems depressingly difficult.

According to the Department of Health, the reorganisation will liberate the NHS leading to increased democratic legitimacy in the NHS. Yet the Health and Wellbeing Committee appears to have no democratic element at all as members are appointed and are not voted into office. This seems to have led to a committee dominated by ruling Conservative group councillors with no representation from representatives of other political parties. More and more interesting.

Now according to the South Kent Coast Clinical Commissioning Group, their role is to:

1. Prevent people from dying prematurely.

2. Enhance quality of life for people with long-term conditions

3. Help people to recover following episodes of ill health or after injury

4. Ensure that people have a positive experience of care

5. Treat and care for people in a safe environment and protect them from avoidable harm

and in addition to these

6. Tackle health inequalities.

OK, so these are the aims of the South Kent Coast Clinical Commissioning Group. What, then, are the aims of the Health and Wellbeing Committee? Not a lot, it appears. In fact, it will be wound up in 2013 and become the Health and Wellbeing Board. Confused? You are not the only one.

So if I do not know the role of the Committee, and it seems to late to matter now, what will be the role of the Board? According to Parliament’s Publications Website the role of the Board will be:

“Health and wellbeing boards will be the forum for local authorities, the NHS, local Healthwatch(?), communities and wider partners, to share system leadership of both health and care services and population health.

The Act mandates the statutory minimum membership for health and wellbeing boards to include at least one local elected member, a CCG representative, the local directors of adult social services, public health and childrenā€™s services, and a representative from the local Healthwatch organisation. The NHS CB must also participate when invited to do so.

They will develop a joint understanding of local needs through Joint Strategic Needs Assessments (JSNAs); a shared set of priorities and a strategy to address these in Joint Health and Wellbeing Strategies (JHWSs). JSNAs and JHWSs will form the basis of NHS and local authoritiesā€™ own commissioning plans, across health, social care, public health and childrenā€™s services. The Government recently concluded a short public consultation on draft statutory guidance on JSNAs and JHWSs. A formal response to this consultation will be published by the end of the year.

Health and wellbeing boards will have duties to encourage integrated working between commissioners of services across health, social care, public health and childrenā€™s services. This complements duties on CCGs and the NHS CB to promote integration. They will consider how the collective resources of the NHS and local government can combine to improve outcomes, for example through Community Budgets.

By involving local councillors and representatives of people using services through local Healthwatch, and through wider engagement with local communities, health and wellbeing boards will strengthen local democratic legitimacy of health services and increase the influence of local people.”

So, to complicate matters further, a NHS Commissioning Board will have statutory responsibilities for theĀ South Kent Coast Clinical Commissioning Group. There will also be a group overseeing NHS provision for the public and its name will be Healthwatch. It will:

“… be the new consumer champion for both health and social care, and Local Healthwatch will feed local peopleā€™s views and concerns about local health and social care services into the system.”

Have you heard of Healthwatch? I hadn’t. Yet it’s supposed to be the service users’ champion.

I took a look at the membership of the respective groups, committees and boards. On the board of theĀ South Kent Coast Clinical Commissioning Group are: Dr. Joe Chaudhuri and Mr Chris MacKenny.

On the Health and Wellbeing Committee are: Dr Joe Chaudhuri and Chris Mackenny. In addition I found Cllr Paul Watkins and Karen Benbow.

Among the Council of Governors of the East Kent Hospitals University NHS Foundation Trust is Karen Benbow.

And as I had confirmed before, the Leader of Dover District Council is Cllr Paul Watkins.

With the same people appearing on the same committees, boards and groups, wouldn’t you think that information regarding the work of one would be relayed to members of the others? Yet Cllr Paul Watkins, as Leader of Dover District Council, announced to the press that the East Kent Hospitals University NHS Foundation Trust had not contacted the Council’s planning officers over the building of the new hospital. Surely he must have known what the East Kent Hospitals University NHS Foundation Trust was planning through his contacts in other groups, committees and boards he serves on. Couldn’t he have had a quiet word with his friends on the other boards, groups and committees rather than appearing to slap down theĀ East Kent Hospitals University NHS Foundation Trust in the press and potentially cause more confusion for the public? Keeps his name in the public domain, I suppose.

Or maybe other members of boards, groups and committees are not friends but potential competitors?

When do roles overlap and when must they be kept separate and private? How can so few individuals have seats on so many boards and groups? I thought this reorganisation was supposed to make the NHS more accountable and democratic? Sorry, but it seems far more complicated, less democratic and open to accusations of corruption and cronyism. Not that I’m accusing present members of being corrupt but the potential is there.

And where in all this bureaucracy and red tape do ordinary people, the users of the services, come? Do people actually matter any more? And, most importantly, how is all this reorganisation supposed to keep our NHS as a public service and keep it from becoming a money-making machine for private companies?

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