Better Than Joe Wicks

On my mum's birthday, three days after Christmas, my gallbladder finally had enough of DEALING with my SHIT. Dealing with CHEESE, and MILK, and CHOCOLATE. In fact, it had probably had enough several days before since I'd been feeling sick and off food since Christmas Eve. I remember saying to Tom that I hoped I wasn't coming down with a sick bug because I would hate to not be able to eat at Christmas. OH. OH THE NAIVETE.

I spent that night in screaming, doubled up agony, with absolutely no idea what was wrong. At first, I thought I had trapped wind. Ha. No. I developed rigors, which is a Bad Sign, but didn't even recognise them. I couldn't wake Tom up. I had to keep putting Alex back to bed when he followed me to the toilet when I was being sick, and at one point felt something rip in my back. At no point did it occur to me to ring an ambulance, because it turns out I am only good at diagnosing other people. I googled. I worked out it was my gallbladder. I figured it probably wouldn't kill me (turns out I was wrong, it can kill you quite easily). At about 6am, I woke Tom up enough to get me some ibuprofen and then managed to sleep for a bit. I managed to sort myself out enough to ring the doctors and then rang 111 to see if I wouldn't be better off just going to hospital. They sent a paramedic out. The paramedic decided I didn't need admitting because I was in far less pain than before. The doctor put me on antibiotics. Another doctor put me on more antibiotics a week later. A week after that, I went to A+E and finally had a blood test to check there were no stones in my liver since I was still jaundiced. This showed the infection had cleared. I went for a scan a few days later, more than three weeks since I first got ill, which showed my gallbladder was absolutely fucking RAMMED with stones. So much so that the sono was surprised my gallbladder was still intact. So, at least I knew what was wrong. It also showed I have a fatty liver, which is not great in someone my age. I managed to get a surgical referral four weeks and three days after my initial diagnosis. 

Just a note here. The NICE guideline for acute cholecystitis, which is the proper name for a gallbladder infection, is bloods, scan, admission, IV antibiotics and a cholecystectomy within a week. This is because of the risk of chronic infection, sepsis and death (woo). I am still kinda fucking salty that this did not happen for me, because my temperature was 0.4 degrees under admission criteria when the paramedic came out. 

My first hospital appointment got cancelled because a water main burst under the hospital and they had to close the hospital down, so I didn't see a surgeon until eleven weeks after diagnosis. His happy news was that my surgery will be in the next twelve weeks. He gave me a diet sheet to force my liver to burn up its fat store before surgery. It reads like a diet of kings... two eggs for dinner? In what universe?

Now, some people get gallstones and they get the odd twinge if they eat the wrong thing. My dad is one of these lucky bastards - he's had a couple of biliary colic episodes ever (biliary colic is all the pain, no infection). Other people get gallstones and suddenly find they have zero tolerance for fat. Your gallbladder is a little organ that hangs out by your liver, injecting bile and helping digest fat. It spasms to release bile when you eat fatty food. Stones aren't always a problem, but if they get caught in the opening of the gallbladder, these spasms are CHRONIC FUCKING AWFUL AGONY. I mean it. I have had three huge-headed sons without painkillers, and gallbladder pain is worse than that. You can't get away from it, it's like a massive belt around the bottom of your ribs, squeezing and making you feel sick and wrong and breathless. I most commonly get pain on the opposite side of my rib cage and diaphragm, and in my back, because it rebounds all round your ribcage. My diaphragm always hurts and is distended. Breathing is a real issue when it's bad, as is the accompanying nausea.

via http://theawkwardyeti.com/

Unusually, I had no pain from my gallbladder until it got infected. Since then, constant fucking pain. I can't tolerate saturated fat at all. At. All. The first week or so was terrible, I thought I would die of hunger. It was the first time since childhood where I can honestly say I was properly hungry. I went ketotic for ages, and I know that's some sort of bizarre holy grail for dieting, but fuck me it's horrible. Your pee reeks of sugar, your mouth tastes constantly sweet, you feel achey and wrong and tired and sort of gluey in the limbs. But it passed, and now I'm used to it, and it's OK. Boring as fuck, but OK. 

I cry when I have to do the shopping because I can't eat what the kids have. Cooking for the kids is an endless nightmare - a few days back, they had jacket potatoes so I picked at the grated cheese. It hurt for hours. And I can't watch food programmes because I start to imagine the joys of food and then my gallbladder hurts because FOOD IS A THOUGHT CRIME. In terms of funsies, I've missed Christmas food, New Year booze, pancake day, Mother's Day, Jim's birthday cake (which I've just sobbingly made, without licking the bowl), and I will miss Easter and my birthday as well. 

I'm listed for surgery now. I can't wait. I cannot wait. I literally cannot wait. If I could spare six grand, I would have had it out privately weeks ago, but...lol, no. This is the most miserable illness I've ever had, and doubly cruel to take my cheese away. I know the recovery can be a bit rough, but I really don't care. 

But I have lost 20kg in less than three months. So there is a tiny silver lining. If you would like to experience this weightloss for yourself, but inconveniently lack gallstones, here's how*:

- Eat twice a day - muesli and Skyr for lunch with some jam for calories, and then something fatless and dense in lentils and other veg for tea. Shellfish are good. So is rice. Plain chicken is your only real meaty option. Jelly and fruit pastilles are allowed, Haribo isn't. If you haven't been in pain all day, you  might risk a stick of kikat as a snack in the evening. Otherwise, fast for eighteen hours out of twenty four.

- Should you eat eggs, chocolate, cake, pastry, pie, red meat, cheese, oily fish, butter, yoghurt or full fat milk by accident, don't panic. Fetch a metal kebab skewer and stick it in, nice and deep, under your ribs. Oh sure, it'll bleed and hurt, and you might end up with an infection or rupture, but it will remind you why you don't eat these things anymore.

- Drink plenty because you will be dehydrated as hell, and it's a useful way of getting calories in. Enjoy your single cup of tea a day (unless you can drink black tea), and remember, no alcohol. If you forget and have a glass of wine, ask someone to punch you in the upper abdomen or mid-back. You won't do it again.

- Take supplements. No, really, you will die otherwise.

- Now and then, regardless of how obedient you've been with your diet, stab yourself again with that skewer. Just in case you get complacent.

- Carry this diet on for a minimum of three months, and then wonder at your weight loss, strawlike hair, fragile skin, reduced concentration, poor mood, exhaustion and decimated social life!


*NB: Don't do any of this. I mean it. 

Cancer

Cancer is a fight. A battle. A conflict between the brave victim and the merciless disease. Cancer is a war to be won, or lost.

Cancer is often depicted as some insidious evil, worming its way inside, unseen. Like a horror film, the monster that crawls inside in the dead of night to burst out when least expected for shock value. Cancer, however, comes from within.

So what is cancer? Cancer is a vast collection of diseases that get put under the same umbrella because they all stem from the same root cause - some cells in the body go wrong.
You have a multitude of different cells in your body, and the majority multiply by splitting into two perfect copies of the original. The scope for this simple, taken for granted act to go wrong is enormous - one wrong protein in your nucleus and you've got something your body didn't plan for. Most of the time you, immune system will spot the error and kill the imposter. These irregular splits happen thousands of times a day and you're none the wiser.
Unless. Unless. Unless.
Mutations, for that is what they are called, build up over time. A slightly irregular cell doesn't get blasted by your immune system, it splits into two more slightly irregular cells, and so on and so on. This is why cancer becomes far more common with age - mutations have been building one on top of the other for years and years, and one day, something shifts and it goes from unusual cell patterns to a tumour.
Some substances make these mutations more likely. Smoking, drinking a lot, eating too much red meat, eating insufficent fibre, asbestos, etc etc. You've heard of everything causing cancer, I'm sure, and in some cases they're justified.
Some people have a genetic susceptibility to cancer. They have a gene fault that makes either the irregular cells as standard or that makes the irregular cells multiply far faster than normal. This is why people who have never smoked get lung cancer, and why people who have always smoked don't. This is why young people suddenly get cancer for no apparent reason. Genetic mutations in your DNA can be inherited (like the BRCA gene for breast and ovarian cancer) or you can develop them in utero. Perhaps cancer is simply stamped on our genetic template long before we are people.

There are only three treatments for cancer, and they're both simple and terribly complicated. You can cut a cancer out, provided it hasn't spread. You can burn a cancerous tumour away. You can poison your body, to kill the cancerous cells. A tumour removal can be a ten minute minor operation for a skin cancer, or it can be an intricate hours-long operation on your brain. There are as many types of chemotherapy as there are cancers, and some are designed to cure and some merely to buy time, and chemotherapy in itself is dangerous and often difficult. Radiotherapy is most useful in tumours that are difficult to get to, to burn away what couldn't be cut away. There are other treatments, particularly in reproductive cancers that are heavily influenced by hormones, but these are the big three.
We speak of curing cancer. We talk of wanting a day where nobody dies of cancer, where everyone can be treated and live forever. Cancer has existed as long as life has. It is the paradox, that what gives us life, this constant replication of cells, can kill us. The longer lifespan our species has, the more likely cancer becomes. We speak of hope, of treatment, of cure.

But we don't speak of what happens when there is no cure. We speak of those who have died, but not those who are dying. It hurts too much. It is difficult to admit there is nothing to be done. Cancer is always framed as this eternal battle between the darkness and the light, and when no cure or treatment is available, it is concealed, somehow wrong. Failing. Losing. Giving up. There must be SOMETHING that can be done? Surely, in this day and age, there is SOMETHING?

The nature of medical intervention changes. There are no treatment plans made, only plans for comfort. Suddenly home is a hospital - a hospital bed in the dining room, Class A drugs through the arm, syringe drivers under the stairs, medication that would fell an ox when previously she wouldn't take paracetamol for a headache.

My mum hasn't given up, even though we have known there would be very limited scope for treatment from the very start. She is doing everything she can to stay well, to recover from setbacks and to live properly through this. Our family cluster around. Those who can't ask for updates, but there are no updates people want to hear. It becomes harder to talk about, because we can't put the discourse in terms of What's Next treatment-wise. Sometimes, I wish she could have chemo just so I had something to tell people when they ask how she is. She's planned her funeral to the last detail, but what happens after that is the Mordor in the distance. We, her children, are attacked by grief at unpredictable times. Grief and rage and unfocused pain, but love and laughter, black humour and togetherness. Dying isn't the same as death. We can't imagine her absence while she is still so alive. We live in stasis, a bizarre limbo where there is no hope, only now. Only today.

I write these blogs partly as release, but also to inform. We are collecting for Macmillan, but if you are in Lincolnshire, please also consider donating to St Barnabas Hospice whose nurses are currently looking after Mum at home.

The £10 GP Charge

In an act of either smug self-importance, or epic trolling, Dr David Jones, a junior endocrinologist at  Worthing, has written to the BMJ stating that GPs should charge £10 a visit to prevent people wasting appointments. You'll note Dr Jones is not a GP, because any GP who has been practicing more than twenty minutes knows this would be disastrous.

First, how many patients do you think don't get their prescriptions filled because they can't really spare the £8.20? Loads. Way more than you'd imagine, because why else go to the doctor if you're not planning to use the medication you're obviously seeking? Many people don't go to the doctor for a cure, but for answers. If the answer is a medication they can't afford, well at least they know the answer. So, the country already has all these demonstrably unwell people not getting their medicine because of the cost. What's going to happen to all these demonstrably unwell people who cannot afford to go to the doctor's in the first place?

Then you have the people who can afford £10 to visit the GP, and therefore will assume it entitles them to special treatment. You see it all the time. People ask for a referral to the hospital clinic, find out the waiting time, and then decide they would like to go private because they envisage a system where they can be seen on the same day. Their optimism turns to rage when this mythical same-day-service turns out to be a two week wait. Bringing in a GP charge is unlikely to change patient turnover much at all in some areas, so instead there will be a crowd of furious people who have TEN WHOLE POUNDS AND EXPECT TO BE SEEN IMMEDIATELY! You already get this entitlement in the NHS. I cannot tell you how many times someone has huffed "I pay your wages" down the phone because I couldn't give them an appointment for three weeks, like that meant they owned the appointment system. Bring actual money changing hands instead of the invisibility of national insurance contributions and you have a recipe for a lot of upset patients, and stressed, threatened staff.
There would be people who, having paid their £10, would be furious because their three week cold is still a three week cold, and not pneumonia, demanding their money back on the basis of incompetence. And if the GP did get the diagnosis or treatment wrong, what then? Refunds?

Dr Jones seems to think the entire population of Britain has his medical knowledge and thus know when they should or should not seek a GP's advice. They don't. How many people can tell the difference between a viral infection and a bacterial infection when it is happening to them? Even people who are aware of the clinical differences between the two in presentation sometimes need it confirmed by a doctor. When you phone NHS Direct for PRETTY MUCH ANYTHING, they tell you to see your GP immediately or go straight to A+E, which does nothing to help patient anxiety. We have collectively lost our medical common sense in this country, partly as a result of being dependent on the NHS. We are told not to take painkillers for more than 3 days without seeing a GP. We are told to consult our GP before starting an exercise regime. We have to see a GP to be referred to hospital or for a blood test, even for longstanding complaints the GP is well aware of. Pregnant? See the GP, even though s/he will have absolutely nothing to do with your pregnancy care unless you're unwell.

What about when the doctor tells you to come back in a week? Do you have to pay another £10 just to be told you're better? Or when you have to see the GP for medication reviews on a regular basis? Chronic illness, already depressing and financially shite, could become very expensive. I had to have five injections in one week once - that would have been £50 just to stop me dying.

I strongly suspect that if the NHS introduced a £10 GP charge, the only change GPs would see would be a lot more people going to A+E (this already happens in massive numbers when people just can't get an appointment, like A+E give a shit about earache) and a lot more post-mortem reports coming through. Those who can afford to pay £10 for reassurance every time their elbow twangs will continue to waste GP time. Those who cannot afford to pay £10 when they're genuinely very ill will get worse and either overcrowd hospitals or die.

The whole point of general practice is that it's a gateway to medical help. Yes, if your arm is hanging off, you really do need to attend A+E, but what if your arm is just very swollen and painful at the elbow? And then it's your finger joints, your wrist, and then all your joints? And you have to pay £10 to be seen the first time, to have tests ordered, and then £10 to see the doctor again to be told the tests showed up rheumatoid arthritis, and then £10 again to see if the drugs (that you didn't get because you'd just spent your last tenner on the GP) prescribed last time actually worked, and then £10 a few weeks later to see if the drugs that you actually got last time have worked, and then another £10 because the GP forgot to refer you to rheumatology and just needs to check something again...and so on and so on.

GPs are massively oversubscribed, we all know that. If you don't believe me, ring up and find out how long you have to wait for a routine appointment. But GPs don't just deal with ill people and timewasters. It's not a dichotomy of the sick and the well.
They deal with people who are very sick indeed, but seem well. They deal with people who are physically fine, but full of psychosomatic illness because of anxiety or depression. They deal with people who are just lonely, who are slowly dying, who are actually dying right there in the waiting room. They deal with those who are absolutely fine but won't believe it, who seem absolutely fine but are definitely not. They deal with chronic illness, with acute illness, with tiny babies, and with centenarians.
So how to relieve the pressure? How about better patient education and empowerment in dealing with minor ailments? How about NHS Direct not telling absolutely everyone to go to the GP or A+E (down with NHS Direct!)? How about giving pharmacists and nurses more power?

The NHS needs to remain free at the point of access.

Love Your NHS

I am not afraid of hospitals. In fact, they are almost a second home. The NHS has saved my life twice, mended me in various small ways since then, and also seen my three boys safely into the world. I worked for the NHS for eight years, in various administrative and minor healthcare roles. My degree's mainly focused on healthcare delivery. The NHS has been my lifeline, employer, coworker, chief educator, and friend.
I get exasperated by the NHS. Sometimes, I get thoroughly pissed off with it. But mainly, I adore it and think it's the greatest thing our country does.

My eldest boy, Jim, had his second ever surgery yesterday; a reasonably routine hernia repair. The hospital were completely amazing. Once admitted, the play therapist was on hand to run through the preop procedures with him, and then went off to find him colouring to do to distract him from his raging hunger and anxiety. His nurse then found him a portable TV to watch The Lego Movie on as his surgery was delayed for several hours, and a starving autistic kid does not a happy patient make. We were left alone to watch it, and as it finished, the orderly came to warn us it was almost time. The same orderly made going to the theatres fun, and held an ipad with Angry Birds up to Jim's face while he was cannulated and put under, so he would keep still. He then explained where to go, how long it would be, and gave me a pager to summon me at the end. The recovery nurses explained why he was in so much distress, answered my slightly-too-clinical-for-a-parent questions, and calmly gave him extra pain relief. One of the students made him four rounds of toast, which he declared the greatest thing he'd ever eaten. The handover to the main ward was smooth, and everyone was happy to wait long enough for Tom to come back with some food for me, and to let him stay with us until we were all ready for sleep. They turned a blind eye to me keeping Alex on the ward with us on account of breastfeeding. A HCA took Jim's cannula out this morning and he didn't even wince. Everyone asked us constantly if we were ok, if we needed anything, if everything was OK. And it was immensely, enormously reassuring in the circumstances.
And that's 'just' the nursing and support staff. The surgeon, anaesthetist and various registrars and house officers we saw were equally amazing. They took the time to ask if we had questions, to listen to those questions, and answer them. They had god-knows-how-many patients to cover, but they didn't seem rushed.
Doing anything out of the ordinary with Jimmy can be difficult and stressful, but this was astonishingly easy. Exhausting, and emotional for me, but not harder than it needed to be, mainly because the staff were so wonderful. The day was fairly standard, a child admission, a routine procedure, their daily bread, nothing unusual or exciting here. They could have been blasé about it. They could have been dismissive of our fears. They weren't, not once. We felt safe. We felt reassured. We felt OK about something parents generally find very difficult to be OK about.

I support the junior doctors strike absolutely. I would support a strike if every single clinician in the NHS was involved, because the NHS is the greatest thing we have, and the government seems absolutely intent on destroying it, through a carefully considered strategy of underfunding care and undermining clinicians.
Fight it. Support your healthcare network. Love your NHS.

Image via telegraph.co.uk

Anxiety

If I start to think, then I will die.
That's how it starts, how it always starts. I think about what's to come, whether it is a party, an appointment or just seeing a friend. And I become convinced that way lies death. Or illness. Or disaster. That nothing can ever go right again in this world, because doom.
It is not rational. If it was rational, I would not be unwell. I would be normal.

It started when the baby was born. It started when I found out I was pregnant. It started when we decided to get pregnant. It started when I got knocked out. It started when Jimmy was diagnosed. It started with the divorce. It started when Jack was born. It started when he left. It started when Jimmy was born. It started when I bought the old house. It started when I lost a baby. It started when I left school. It started when I started grammar school. It started when I was at primary school.
I can't put a date on it. It's only recently that I've realised fear has haunted me since I was a child. But there is a chasm of difference between a child's fear of monsters, of bullies, of loss, and an adult's all consuming terror of the vagaries in life.

I am frightened of tiny things, like the buttons you use to call a lift, and the postman's knock. I am frightened of massive things, like cot death, and accidents, and horrible life changing illness. I have daily intrusive thoughts about bizarre things; whole hideous scenarios play out in my head and I live them in a little side room of my brain.I haven't had a panic attack in over a month, and this is a major achievement. I feel like I am getting better, although sometimes I have a blip. I am currently having a blip.

I decided a while ago, that talking about anxiety and fear was BOUND to make the things I feared most come true. I kept it all inside. I thought, believed, knew that if I told anyone what I was afraid of, or discussed things I was looking forward to, everything terrible would happen. And I made myself ill. My anxiety manifested as burning joint pains, as terrible headaches, as weakness and exhaustion, because I wouldn't let myself express it. Being pregnant changed that, because my terror of losing my baby was a real fear I could talk about, and channel all the extraneous fear into. It was a rational thing to worry about, although the fear paralysed me at the end, making me angry, agoraphobic and terrified.

I felt like I was destined to have postnatal depression after Alex was born because of the all consuming terror of his pregnancy, but instead I have postnatal anxiety. And that is a very different beast. I had PND after Jimmy was born, and all I wanted to do was die. Or run away. Mostly die. I didn't feel anything towards my baby, myself, or anyone. I didn't have the energy to do anything about it, and eventually it lifted. Postnatal anxiety is much easier in some respects, because I love my baby. I interact with him. I take immeasurable pleasure from what he does, and cuddles, and feeding. I am able to function reasonably well, to get work and chores done and to look after the big boys as well. But it taints everything. It is like a sad gauze I have draped gently over everything. My mind runs at a thousand miles an hour, trying to sort the rational from the irrational. I try to talk it out when it's particularly bad, because other people can tell me the difference between legitimate fear and crazy fear.

This blip has been triggered by incoming essay deadlines, a surgery date for Jimmy, an appointment for my eye, socialising, Christmas, breaking my laptop-that-isn't-technically-mine, Jimmy's DLA form, parents' evening, the dentist, and a hormone shift, which are all legitimate worries that mount into one giant elephant in the brain, sitting on the sensible bit, squashing it flat.

And it feels like horror. A tight chest, breathlessness, getting too hot, visualising everything awful, wanting to stop everything, paralysing fear, no concentration, feeling snappy, guilty, angry and hopeless.

And it sucks. But it's getting better.

NHS Bureaucrazy

I am cross.
Last year, I had a head injury that led to concussion and whiplash. I had all sorts of terrifying symptoms at the time like slurring, amnesia, dizziness, nausea, night blindness, peripheral vision loss and anomic aphasia. I couldn't stand up for a week, but I was back to normal within a few weeks.
Except that I still have a small blind spot in my peripheral vision. At first, I thought I was imagining it, and ignored it. Then I went for an eye test a month ago, mentioned it, had all the tests done and was referred because I wasn't imagining it.
Normally, if you have a dodgy eye test, the optician refers you directly to the hospital, but (presumably because of the head injury) I had to go and visit my GP first and talk about it to decide whether to send me to ophthalmology or neurology. The GP thought it was either caused by damage to my retina, optic nerve or visual cortex. The initial injury was on the right side, but it's my left eye that's affected. She referred me to ophthalmology. This was early last week, because GP appointments are gold dust.

Now, the bit that's made me cross.
Today, I got a letter that looked suspiciously like junk mail. I get a lot of junk mail at the moment, thanks to foolishly letting the Bounty woman have my details in the hospital after Alex was born. So, I opened it, expecting yet another life insurance offer because PARENTS DIE, and instead found a letter from some random fucking 'care innovations' company who the LGC apparently employ to triage ophthalmology referrals. Obviously, GPs cannot be trusted to refer to the right people, so this company in Henley-on-Thames does it for them.
The letter told me I needed to be triaged by an optometrist, and gave me a list of four clinics to go to for triage. In order to select one, I had to either ring up and tell them who I wanted to be referred to, or go online and do it. WHY NOT JUST SEND ME TO THE NEAREST? WHY THE FUCK WOULD I WANT TO GO TO A CLINIC 30 MILES AWAY?
Ahem.
So, I did this, only to be told that my 'chosen provider' will send me an appointment in the post.
*jumps up and down in a rage*

In ye olden days of eye referrals pre-NHS-sell-off, you saw your optician, they sent a referral to your GP who passed it on to ophthalmology, who trusted their secretaries to triage it and send you a suitable appointment. The process took perhaps a couple of weeks. This has already taken a month.
Now, I don't talk about it much because it's evil, but I am suffering quite severe postnatal anxiety at the moment. The very IDEA of going blind, never exactly appealing in the first place, has been preying on my mind like a giant wasp that will not stop hovering by my face. All I really want is an appointment to be told what the hell is up with my eye, so I can work my flailing anxiety into something like a sensible approach to the whole thing. And now I have to go and see an optometrist, who will then probably send me to ophthalmology anyway, lengthening the whole process into one of months rather than weeks.

Not to mention how confusing this must be to people who are perhaps less computer savvy or presume the crappy junk-maily scam-ish letter is junk mail, particularly if their sight is poor. I mean, it doesn't even have anything visual to suggest it represents the NHS:

SEEMS LEGIT!

It's almost like they're trying to get people to ignore the letters so they can cancel the referral (she said, cynically).

Prescriptions

So, Jeremy Hunt, who will best be remembered as the man who attempted to demolish the NHS (and will probably succeed) has a new idea. He has decreed that the wholesale cost of drugs costing more than £20 should be printed on the prescription label, to tell the person taking those drugs that they are funded by taxpayers.

I used to work in a rural dispensing practice. I absolutely loathed working in the dispensary, and only did during very busy periods, but sometimes I helped unpack the drug order upon which the wholesale cost of drugs is printed. This is the cost your CCG actually pay for the drugs, which you then pay £8.20 per item for, if you pay at all.

Now, in some cases, the price of the drug is less than the prescription cost, so you can bet Jeremy Hunt isn't going to put THAT on your drug box. It would not do for people to know they are paying £8.20 for a drug which has cost less than a quid. They might lose their faith in the prescription charge altogether, and then there would be issues.
However, many drugs cost an absolute fucking fortune. I used to use an asthma drug called Seretide, through an accuhaler (which is a type of inhaler where you don't have to co-ordinate breathing and squeezing). They cost £75 each, wholesale. I often used two a month when my asthma was severe, because I was on double dose. I paid standard prescription cost for it (£6-something back then). My GP recently changed it to the much cheaper Qvar, which is nowhere near as effective, but considering I'm "poorly compliant", it's cheaper for them.
One of my least-favourite jobs when working for the NHS was changing people's drugs, in batches, to something cheaper (usually statins and contraceptives) because the CCG had decided X drug was exactly the same and 5p cheaper, so upsetting hundreds of people's medication routines was worth it. And I could see their point, because that 5p multiplied by a few thousand people per month was a large saving. I hated the impersonality of it.

Now, Jeremy Hunt claims that this new measure will reduce drug wastage. Drug wastage is a HUGE problem for the NHS. If you take your drugs out of the chemist, change your mind and pop back in, those drugs have to be thrown away. They cannot be recycled. They cannot be put back on the shelf. Once they've been signed over to you, they're gone whether you take them or not. Sometimes, an elderly patient would die and their relatives would bring in binbags full of unused medication, hoping we could recycle it. Medication collected month on month, for which they'd paid nothing, never used because they hadn't told the GP they'd stopped taking X four years ago, or they didn't trust the new packaging and weren't sure it was the same drug, or they didn't NEED a fresh bottle of psoriasis shampoo every month, or they weren't sure if they were supposed to take the red tablets with the little white ones. Regular medication reviews may be a pain in the arse if you're on repeat prescriptions, but they're designed to stop this sort of thing happening. I daresay it still does, particularly with older people who live alone and struggle with transport.
But I doubt Jeremy Hunt's measure will make any difference. In fact, if I know elderly, often anxious patients on numerous medications, it's more likely to make them scared to get their medication at all. They don't want to make a fuss. They don't want to cost anyone £80 a month. They don't want any trouble. They'll just leave it. If they only take the pills every other day, that'll help save the NHS money. And that calcium tablet, they only take that once a week anyway, so maybe they don't need it at all?
And you can imagine the damage.

Well, if you can't, increased falls, increased stroke, increased heart attacks, increased extremely expensive operations and intensive care therapies, increased inpatients, increased A+E attendance, increased premature death. None of which will particularly save the NHS money. Except the deaths, I suppose.

There is another issue here. If there is one thing I could not loathe more about this toxic fucking government, it's the buzzwords of taxpayer and hardworking families. As a former taxpayer, married to a current taxpayer, in a hardworking family (I assume we're hardworking, I haven't ACTUALLY sent the kids to work down the mine yet, but it's only a matter of time) with fuck all money, I can honestly say that if I get ill, paying for a prescription vs waiting to see if I get better is often a genuine ethical conundrum. I frequently don't bother ordering asthma medication because it costs me almost £17 a month in prescription fees that I don't feel able to justify. It's not a problem at the moment because I have a maternity exemption certificate, but in another year, that'll be gone and I'll be back to poorly managed asthma and recurrent chest infections. Woop. If I was on multiple therapies, the problem would be multiplied. SOME people with life-threatening conditions get their medication free, but not all. And most people who have to pay for their prescriptions ARE taxpayers. This is the sheer bloody idiocy of it.
Taxpayers aren't IMMUNE from illness. Indeed, in the current economic climate, taxpayers are more likely to need antidepressants, anxiolytics and painkillers than usual. Wealth directly correlates to good health, less disability affected years, and longer life expectancy. The poorer you are, the sicker and more disabled you are likely to be (see The Black Report, The Marmot Review for more info) regardless of whether you work enough to pay tax or not.
Not to mention that the elderly, who probably cost the NHS the most in free prescription charges, have been taxpayers. Just as the government like to put pensions in the 'benefits' bracket of government spending, they also put them in the 'workshy' bracket of usefulness. Bloody old people, living too long and costing us money. Let's have a cull.

The money raised by prescription charges helps pay for everyone's medication cost. You might pay £8.20 for your one pound pack of painkillers, but the old lady behind you in the queue has paid nothing for her monthly bag worth £80 or so. And there is a massive deficit, because people live longer thanks to a regime of drugs aimed to hold chronic illness at bay. One day, you will probably need one of those chronic disease drugs, be it aspirin, insulin, a statin, a betablocker, or inhaled steroids. Maybe you're already on them, but begrudge having to pay for it because you'll die without it. Or you begrudge having to pay when you already pay your tax. But National Insurance doesn't just cover medication.
As a five year old, I cut my arm in half, lengthways. The NHS sent an ambulance, X-rayed my arm, cleaned all the glass out, fetched a plastic surgeon in on call to repair tendons and stitch a ligament back together, sewed it back up, gave me two days of inpatient care and then sent me home to recover, with painkillers. The staff, equipment, anaesthetic drugs, bedspace and care were not cheap. Without it, I was unlikely to have died from my injury, (unless it got infected) but I would have lost the use of my right hand, effectively disabling me for life. The NHS has emergencies like that every single SECOND across the country.

Chronic disease causes heart attacks (for which you need intensive care, heart surgery, specialist care, rehabilitation and sometimes intensive care transport), strokes (see previous, but with brain surgery instead of heart), progressive lung disease (home oxygen therapy, home care), and of course, death. The medications used to tackle chronic disease attempts to reduce the need for these expensive interventions. They are ultimately cheaper than inpatient care.Which is also funded by the taxpayer. Perhaps if this measure is a success, we will have balloons at the end of each inpatient bed telling us how much our stay has cost the taxpayer. I mean, I'm due to have a baby any day now, and that'll cost the NHS between £800 and £1000. Perhaps I should go and thank my husband for his taxpaying contributions that will allow a (hopefully) safe birth.

Personally, I think the prescription charge should be reduced, and means tested. If more people paid it, it would be both more profitable even if it were cheaper for individuals. I don't think it's fair that (lifelong taxpayers or not) some very rich people get their medication for free while people scraping the barrel have to choose between food or drugs.

But I don't actually think Jeremy Hunt's new scheme is anything to do with reducing wastage, and the cost of medication to the NHS. If he was that bothered, he'd aim his ire at pharmaceutical companies, who never shy from making money out of the sick. I think this is an early attempt to frighten us into accepting the eventual demise of the NHS, and the use of health insurance.

The NHS Is Doomed

No election should be fought on a single issue. No party should stand on a single issue - one of my main problems with UKIP outside the rampant fascism is their focus on immigration at the cost of everything else. However, the NHS is a massive issue that should have totally dominated this election, far more than taxes, immigrants or the EU.

The NHS is a socialist ideal - free healthcare for all. It's a very simple, very expensive ideal. It was introduced as a post-war reform, to centralise, regulate and democratise healthcare. Prior to this, healthcare was paid for either as it was necessary, or by insurance. My granny and her sister were in hospital for weeks with diphtheria in the 1930s, and that was paid for by their father's work 'stamp'. There was a lot of self-medication then as well - this being in the days before antibiotics - mostly with unregulated supplies of opiate based medicine. Colicky baby? Opiates! It was to be paid for through work-related National Insurance, which was not dissimilar to what most people were used to paying anyway. It was an ideal system.
The NHS, since those days, has mutated into an enormous, bureaucratic beast. In attempts to save money, managers were brought in to regulate practice. They have ended up sucking more money out of the NHS in wages than they save in administration. I was an NHS administrator, I know we are very necessary people, but I was on minimum wage to begin with and some are on hundreds of thousands of pounds a year.
Labour had some interesting ideas on how to make the NHS more profitable - mainly by getting private firms to build hospitals on a sort of hire-purchase agreement. Then they started selling off the buildings and responsibility for hospitals and GP surgeries to private companies. That worked fine, until the private companies decided they couldn't afford to run them anymore, and withdrew. You see, that's the real problem with privatising aspects of healthcare, as it has been with privatising other public services. When it ceases to be profitable, the private sector simply run away. Free healthcare is not a very lucrative business, so this is likely to happen a lot more in future.

The coalition government also made a lot of cuts to the services offered on the NHS, as well as raising prescription costs enormously (£7.20 per item in 2010 to £8.20 in 2015). In a startling deviation from my usual lefty saucepan-banging, I believe prescription costs should be around £0.50 per item, but applicable to all but the critically ill and the extremely poor. I know how much medication costs wholesale: it shouldn't be free to as many people as it is, but neither should it be prohibitively expensive. The coalition government also cut staffing, particularly in nursing where I suppose they think people won't notice, and in A+E departments, where people certainly do. 

The problem with the new Conservative government and the NHS is that the Conservatives are ideologically opposed to the NHS. This isn't me being a bleeding-heart liberal: they believe in telling us what to do to keep healthy, and that is as far as it goes. The Conservative viewpoint on health is that it is your responsibility, your fault and your problem if you're ill.
Thatcherism took this even further into the realms of market liberalism. Don't be fooled by the name, the liberalism refers to the freedom of the markets, not you. Market liberalism holds that the market should be free to set costs without government interference. So not only are you ill (which is your fault), your treatment price is inflated. Hurrah for Thatcher (said nobody, ever).

And the thing is, that would be FINE if health was merely down to a matter of personal responsibility. But we all know it's not, even if we try and convince ourselves ideologically that people give themselves cancer, or depression, or chronic disease. We all know someone healthy cut down in their prime by some apparent fluke illness or accident. We all know someone who's done every single recklessly unhealthy thing you can imagine and lived to a ripe old age.

One of the biggest factors in your lifespan and your years of freedom from disability is your wealth. The more money you have, the healthier you are likelier to be, and the longer your life. There is a nine year gap in average lifespan between the richest and poorest areas of the UK. NINE YEARS. Not only is there that lifespan gap, there's also a huge gap in experience of disability.

Now, there are loads of reasons poor people experience poor health, and very few of them are down to personal factors. One of the main reasons is infrastructure. When you live in a poor area, your access to doctors, hospitals, transport, nutrition, good housing, employment, and exercise is limited. Your exposure to pollution, cigarette smoke, accidents, antisocial behaviour, stress and housing-related issues like mould is increased. Education also has an important, if unexplained, effect on health - more educated people tend to be healthier, and schools in poor areas tend to have lower qualification rates.
All of this is exacerbated by work. If you are fairly well off and work in the private sector, it's likely that you have a sick pay scheme. You may even have health insurance. Even so, suddenly being unable to work for a long period of time can be a disconcerting, depressing and stressful experience. However, when you work in lower class employment, or in the lower sectors of the public sector, you are dependent on statutory sick pay. SSP is currently £88.45 a week. You cannot claim SSP if you are on a zero-hours contract, or a very low wage. It's eligible for six months, after which you either continue on nothing, be sacked for continual absence and thus ineligible for jobseekers allowance, or leave work and switch to a disability benefit. I know a lady who was sacked because she'd had too many periods of sickness in the last few years, and then had a bad chest infection. Her previous absences were due to having chemotherapy. This was perfectly legal. Naturally, switching to a disability benefit is universally considered a bad thing by the Conservatives. Far better to keep the working masses in work, surely?

Yet it is the working mass, the seething, swarming low-paid mass, that needs the NHS most, potentially costs the benefit system most, and is capable of paying back into the economy. These are the people the Conservative government would prefer did not exist. The people they wish would be as wealthy as they are, so they didn't have to worry about society. The people they continually push down the ladder through social and economic inequality, and then seem surprised when it costs the state money to do so.  I'm sure there are plenty of individual Conservative MPs and voters that staunchly believe in the NHS, but that's not the party line, so they may as well piss in the wind.
Thatcher said there is no such thing as society. Unfortunately for her acolytes, there is, but don't expect the gentle dismantling of the NHS infrastructure to stop now the coalition has ended.

Expect it to get worse. Expect it to become more overt. Expect to become anaesthetised to the idea that the NHS is a salvageable , workable entity. Expect to be unsurprised when it's rebranded, or you are asked to put down a deposit when making a GP appointment 'to ensure your attendance'. Expect GPs to be blamed. Expect A+Es to be blamed. Expect managers to be blamed. Expect ill people to be blamed. Expect immigrants to be blamed. In fact, expect everyone else to be blamed for the sad, but necessary dissolution of the NHS except the government.

I love the NHS - I love it as staff, I love it as a patient, I even love it as a parent of a disabled child, where it's failed us most.
I hope I'm wrong about this. Ask me in five years. 

The reality of living in a deprived area

Wealth and health correlate - the more money you have, the better health you are likely to experience.
I happen to live in a deprived area, in the red on this handy deprivation index map. So, what's it actually like? How does it impact on our ability to make healthy choices?

First up, diet. Everyone knows poor diet is linked to numerous long term health conditions and obesity. There is a lot in the media about choosing to be fat, but how much choice do you actually get in deprived areas? All distances are courtesy of Walkit.com, and are fastest route, so mostly along dual carriageways.

CLOSEST SHOP: Cornershop and Nisa. 0.2km
CLOSEST SUPERMARKET: Morrisons, 1.1km
ALSO AVAILABLE: Marks and Spencer 1.1km, Farmfoods 1.1km, small Tesco 1.7km.

The food choices are varied. The cornershop sells mostly sweets and newspapers, with a small amount of essential daily purchases, like milk.
The Nisa sells a very poor selection of 'fresh' fruit and vegetables, at slightly increased prices. I have never had an unmouldy onion from there, but it will suffice at a push. There is no fresh meat, just sausages, bacon and ham, and no fresh fish at all. There are four whole aisles dedicated to sweets, crisps and cake. There's also a large frozen food section. One whole side of the shop is full of alcohol. There is also a large variety of cigarettes. The deals offered by Nisa are usually focused on cheap multibuys of packs of sweets, alcohol and fizzy drinks.
I'm sure you're acquainted with the produce sold by Tesco, Morrisons, M+S and Farmfoods.
Cost wise, it is cheapest to get a full shop, including fresh produce, from Morrisons or Tesco However, this requires transport, on which more later. The nearest greengrocer is approximately 4km away. There are food banks all over the city, with supermarkets regularly collecting for them. The nearest one is about 2km away and open once a week, accessible by voucher.

Now, exercise. The opportunities for exercise here are limited to walking/jogging, children's karate and gym membership.
BANNATYNES: Costs more than £600 a year, 2km away
COUNCIL FUNDED GYM: £8 a session, 1.7km away
PERSONAL TRAINER: £25 an hour

There are three parks within walking distance. One has lots of broken equipment, countless enormous rabbit holes, and is a popular haunt for drunks. One is much bigger, with better equipment, but is sited right next to the nastiest pub in the area. The last one is a proper landscaped town park, but last time we visited the park, it was full of dust and fumes from the housing estate being built behind it. The general area is well provided with pavements and trees, at least on the main thoroughfares. Once you get into the residential areas, it's less of a concern.

Education is a key determinant for health. The better your education, the better your job prospects, the better your later income, the better your health. The schools here are not great. There is only one primary school here, which received a good rating at its last Ofsted inspection. There are two secondary schools with catchment here. The closest is inadequate according to Ofsted. The other requires improvement, and is 1.7km away. Thankfully, the nearest preschool has an outstanding rating, but is oversubscribed by the entire city, as it has excellent special needs provision.

Transport is not amazing. In fact, my city is apparently the worst in the country for public transport, a particularly damning statistic for a 'new town'. There is a bus service every ten minutes into the city centre, which costs around £4 for a dayrider. Theoretically, this allows travel across the services in the city all day, but it's usually cheaper to get a dayrider than a straightforward return (it's £2.10 for a single to town). A taxi is between £5 and £7 each way, depending on where you're going - it's £5 to go the almost 5km into the city from my house, and £5 to go to the next suburb along. The bus is a five minute walk from my house. My husband is out of the house working from 10 to 12 hours a day. We can only afford one car, and all the families round here are the same. This means doing the grocery shopping has to be done either on foot, or at the weekend. Thankfully, we do the majority of our shopping online, as we can both afford both the technology, and the delivery charge. Access to the internet cannot be taken for granted.
It also means going to the doctors (which is 4km away) relies on public transport or friends. This is great fun when you've got a sick child on the bus.
One nice thing for the city in general is that it does have comprehensive cycle lanes and footpaths. The only problem, as a lone female, is that some of them seem designed to make you fear attack. There is one underpass here that goes under one road and over another. It terrifies me every time I go through it, even when it's the middle of the day, because it is totally invisible from the roads and surrounded pathways. Subways and leafy, murder-alley type paths are de rigeur. Good lighting, and CCTV are less popular.

Employment opportunities are slim to none here. You have to travel either into the city, or to the outskirts where the factories are. Unless you want to work in retail, but retail never paid anyone's living costs by itself. Or you could be a dinnerlady, or a cleaner. Which...same. If you work outside the area, you better hope you earn enough to run a car, or face the awful buses, or be healthy enough to cycle.

Housing conditions are poor. My house, which is a little older than average, is a terraced Edwardian villa. It features original windows in the kitchen and bathroom, which means no double glazing. All three exterior doors are originally, and not weatherproof. They also let in an unseemly number of slugs. The heating is inadequate for the size of the house, and the gas costs approx £1 an hour to run. The walls are lime plaster and keep falling down when you put nails in them, and there's no cavity wall to insulate. The damp gets really bad in the bathroom. My landlord's attitude is that it's an old house, it's not worth the work. Many landlords and rental agencies will not countenance your application if you are on benefits, because as ANY FULE KNO, people on benefits are going to ruin their house, and never pay their rent. I do not know how this is legal. How does it MATTER how you pay your rent, as long as it is paid? We claim minimal benefits now, but would still have trouble getting a new rent because of this ridiculous ruling by most agencies.

There aren't many opportunities for socialising. The primary school have craft mornings for parents (which aren't advertised, so how you're supposed to know it exists is beyond me). There's a large immigrant population here, which has no apparent provision from anyone. There are no language classes in the area, and no advertised groups for those who have recently arrived. The nearest Surestart centre was closed as part of budget cuts (to make way for the £120 million city centre redevelopment, which has so far pissed off everyone who lives here, and attracted very new visitors) but the preschool who occupy half the site has managed to open a few groups for families, as so far the plans to turn it into a disability outreach centre have not been implemented. The nearest fully operational Surestart centre is a little over 2km away, and includes a KS4 pupil referral centre that may put off some parents from attending. There are two pubs locally, and plenty of outdoor drinking spaces, as well as a Costa, but as far as making friends go, opportunities are somewhat limited if you don't already know people here. You can travel out to other areas, if you can bear to navigate the awful bus system. But that's a big if. Being part of strong social networks is one of the best ways to protect your health.

Health services need to be easy to access. I speak as someone who feels rubbish at the moment, but cannot face the bus journey, and then half mile walk to the doctors' when struggling with sickness and pelvic pain. The nearest doctor's surgery is actually in the next suburb along, and would take me 25 minutes to walk, or I could get off the bus in front of it. The reason I joined my actual doctor's surgery is because they have a branch surgery at the top of my road. Alas, this has been out of use for six months, although they claimed it would reopen after Christmas. I have personally never had a problem with getting appointments because I have inside knowledge on how the system works, and thus don't object to detailing my health woes in great detail to a receptionist. Dentists are also a problem. I have a very good dentist, who I love, who is only about 2km away, but who will only see me as long as I have a prescription exemption certificate. Thankfully, I've had one almost constantly for the last five years. However, when I lose my exemption, as I will around a year after my baby's born, I will either have to pay astronomical private dentist fees, or re-register with an NHS dentist miles away. Bad teeth is an image of poverty, because many people either cannot reach, or cannot afford, a decent dentist.
The local hospital is an originally PFI funded, highly modern, highly in debt, new build about 10 minutes away by car. I have to say, I've used them regularly since it opened, and I have never been less than impressed with their care and service. However, to try and get there by bus is a nightmare. You have to catch the local bus into town, going PAST the hospital as you do so, then transfer to a DIFFERENT bus which will eventually drop you off right outside. The local link community bus service that linked up directly from the north of the city to the hospital was dropped as part of the council cuts over a year ago.
My son is autistic, and is still waiting for his assessment, one year after initial referral. Thankfully, the council-run educational psychology team is a lot more efficient than the NHS-run neurodevelopment team. I imagine other disabilities and services are similarly hit and miss, though thankfully we don't need to access them.
On a slightly different note, midwifery services are also taxed, and I have been warned that if I have a homebirth (this is the plan, I'm sure I'll blog about it at some point), the midwife on call may be coming from up to 64km away. However, homebirths are being encouraged to reduce the load on the maternity unit.

Now, a lot of these problems are things that could be (in fact, can ONLY be) solved by a forward-thinking government, or some well informed local councillors. The local councillors here are mostly concerned about things like parking on grass verges, and tree trimming. I know this because they send me the most unintentionally hilarious newsletter every now and then. They do nothing about improving the general local services, aside from repeatedly shutting down attempts to open YET MORE takeaways on the main drag into town. I imagine actually fixing the structure of the area takes considerably more red tape than people in a four year term of government can be arsed to go through.
And some of these problems are circumvented by moving away (if you can afford it), owning a car (ditto), or taking on the 'Big Society' initiative and trying to set things up yourself. Again, this is not easy.

In a few months, I've got to propose an improvement to my community as part of my dissertation. And just writing this has given me so much to think about how much this community COULD be improved. But where do you START?

Chickenpox - a study of frontline care in action

The NHS relies on patients being able to self-diagnose. If every patient went to their GP, or a walk in centre or A+E with a sniffle (and some do), the service would be swamped. So, the NHS expects individuals to be able to decide when they are ill enough to need a professional opinion.

My eldest son has chickenpox. Chickenpox is the last remaining widespread childhood disease. In the USA and other countries, a vaccination is offered, but the NHS does not offer it as it's largely harmless and short lived. Some parents, in an effort to expose their child to the disease young, hold chickenpox parties to spread infection. Varicella infection is dangerous in non-immune pregnant women as unborn babies can die from it, so I think a chickenpox party is a bit daft. However, most children will have it before they leave primary school.
Parents expect it, they recognise it and they treat it largely without professional help.

So, I phoned my doctor's surgery to ask them to record it on his notes. After all, doctors aren't psychic. The receptionist was astonished that I'd done this and told me only a doctor could record a diagnosis. So, I sighed a deep and heavy sigh, pointed out that I didn't want to infect her waiting room or waste an appointment, and my son isn't particularly unwell, just incredibly spotty and grumpy. Eventually, she agreed to put it on his notes.
Then I wandered up to my local chemist. There is a service called Pharmacy First that allows your chemist to diagnose and prescribe medications for children in the chemist. It's only really for over-the-counter medications, so parents can have them for free without using a GP appointment. They prescribe for conjunctivitis, hayfever and mild analgesia. I asked for piriton, if it was available, after asking for calamine. I didn't take my son with me, because he's INCREDIBLY spotty and likely INCREDIBLY contagious. After some argument about whether or not chickenpox is contagious after the spots come out (they said no, I said yes), they ummed and ahhed over whether to give me the medication without seeing the child. Eventually they agreed to - I use the chemist on a very regular basis, for all kinds of minor illness, so they're well acquainted with me and my kids.
But what else would I want free piriton for? I could buy it easily. I'm not going to sell it on the black market, or use it to drug my poor defenceless children. Their argument was that they had to be sure, and it wasn't a 'remote' service.

And you know, I understand that. It seems that the more the NHS tries to give patients additional autonomy, the more bureaucracy needs to be fulfilled, the more patients are put off. Why bother going through rigmarole and form filling at your pharmacy when you can go direct to your GP? I have eight years experience in general practice, as a receptionist, administrator and nursing assistant, I'm pretty confident I know how the system works and how to diagnose chickenpox, and everything I've done this morning has been aimed at saving GP time. My motives for doing so have been scrutinised. Is it that impossible to imagine a patient might genuinely want to avoid wasting resources? Is it impossible for a person to diagnose the most easily recognised rash without formal medical training?

The NHS relies on self-care and self-diagnosis. However, there seems to be another force at work trying to keep diagnostics firmly in the hands of professionals. Front line care is flooded by people who are anxious about minor symptoms, who need reassurance and OTC medication. The NHS needs to give people confidence in their autonomy.

Immunisation

Immunisation and cancer screening are the two of the leading forms of healthcare prevention practiced by the NHS. Most women will have smear tests regularly during their pre-menopausal years, and then breast screening when they are older. Men are increasingly offered prostate checks, and both genders are being offered bowel cancer screening. These screening tests are designed to catch early neoplasms, and in doing so, save lives.
Immunisation is routinely practised on children, from 8 weeks old until approximately 16 years. Immunisations carried out after that point are either for holiday/employment means or immunologically compromised patients.
In cancer screening, patients have the right to refuse. They might be exhorted to attend, for QOF measures and for their personal health, but they're under no obligation to go.
However, families who choose not to immunise their children are denounced.

 Childhood immunisation has been part of the NHS since it's inception, and was part of public health schemes long before that. The Diphtheria/tetanus/polio vaccine was administered regularly from the early 1960s, and as more vaccines have been developed, more have been offered. My children are immune to diphtheria, tetanus, polio, meningitis C, haemophilius influenzae type B, whooping cough, pneumonia, measles, mumps and rubella.
Pre-immunisation, these diseases killed millions. My grandmother suffered diphtheria in the days before the NHS, immunisation and penicillin. She was in an isolation hospital for months, forced to lie down constantly and kept away from her family (except her sister who was in with her). She watched other children on the ward die. This was not uncommon. Families who couldn't afford to send their children to hospital, if their child was suffering from a notifiable disease, were legally culpable. The child would usually die without good nursing. In my days working for the NHS, we had several patients suffering from ongoing disabilities from polio infections in their childhood, some dating from as late as the 1950s. For these families, a simple immunisation would have been a lifesaver.When I summarised patient notes, it was rare to find a patient growing up pre-1965 who didn't suffer from one of the childhood diseases that we now consider rare.
The MMR jab was not developed until the 80s. I suffered from mumps in 1988, and my brother suffered measles around the same time - neither of us were immunised, as we were too old when the vaccine became available. Cases of measles are now on the rise, as the herd immunity offered by mass vaccination wanes. This is largely due to the Wakefield Report, which linked autism to MMR vaccination, a report that has since been deemed false, and fraudulent.

There are many reasons that parents do not vaccinate their children. There are worries of autism/neurological illness, or a distrust of vaccination ingredients. Others do not believe the theory of vaccination. The common thread, from what I've seen on the internet, is fear inspired by ignorance. In one story I read, a woman refused to vaccinate because the immunisation contained ingredients she didn't know. This reminds me of the time my dad went through his PC and deleted every file he didn't recognise, and then wondered why his computer didn't work.

However, more common is the reluctance to introduce drugs to a newborn's baby. From conception, pregnant women are told not to smoke, not to drink, not to take medication unless it's necessary, not to eat raw fish, to cook meat properly, to avoid cheeses, with the clear message being "If you do, and something happens to your baby, it is YOUR FAULT."
Then, almost as soon as the baby is born, women are enjoined to take their precious newborn to a clinic to have an enormous needle stuck in it's leg, full of chemicals.

And if parents refuse to vaccinate their child, through fear, or ignorance, or cultural belief, or just because they don't want to, society vilifies them. They are called child abusers. Their friends are reluctant to let them play with their children, schools and nurseries are reluctant to take them on. The child and it's parents are punished for failing to conform to the biomedical patriachy. "The NHS has these lovely vaccinations, that could save your child's life, and you don't want it? You ungrateful swine, we hope you get diphtheria, just to prove how amazing we are!"

I remember telling a nurse, who I was friends with, that I wanted my eldest to have his first MMR and HIB/Men C booster separately. She looked at me askance and immediately started having a go about there being no proven link to autism. She could see no other reason why I didn't want my son exposed to two lots of vaccine at once. Nonetheless, after ranting at me like I was an idiot for a few minutes, she accepted my request. My reasons had nothing to do with fear of vaccination - I think vaccination is a wonderful thing - but because my son (like me) reacts badly to immunisation. He gets poorly, and has a localised reaction every time. I didn't want him to have to suffer a double lot of ouch if he didn't need to, and if he was allergic to the MMR, I wanted a clear cause. As it was, he had classic measles-type rash ten days after immunisation and was poorly for a day or so. I knew what had caused it, and didn't worry or panic. My younger son has the constitution of a horse, so there was no need to space out his immunisations. He also had the post-MMR rash.

There is definitely a feeling within the NHS that immunisation is not a parental choice, but a duty. Although a parent needs to give signed consent for administration, it is assumed that they will give this, and any questions are construed as dissent.

There are now a generation of parents and grandparents who do not remember life pre-vaccination. They do not remember fearing that an URTI would mutate into diphtheria. They do not remember worrying that a viral rash would be early measles.Parents are now able to look after their children without worrying about deadly childhood disease, meningitis excepted. There is very little education available on the components and benefits of immunisation, to the average first parent, because consent is assumed - some cursory leaflets and a bit of information in the 0-5 year book. Infectious childhood diseases, which are still rife in certain parts of the world, are assumed eradicated, the need to immunise questionable.

It does nobody any good to call anti-vaccination parents stupid, to act as though they are single handedly ruining the NHS and all it has striven for. Instead, the NHS needs encourage questions on how vaccines work, their ingredients and their necessity, with practitioners able to give answers there and then. An informed choice is better than blind conformity.