Category Archives: Acne

Family doctors working ‘beyond safe levels’, says GPs’ leader

As doctors describe dealing with up to 70 patients a day, college warns of risks to public health

Waiting room of GP practice


Patients face longer waits to see a GP, says the Patients Association. Photograph: Alamy


GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.

Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.

The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.

Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”

One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”

Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.

It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.

“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”

Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”

He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.

Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”

Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”

‘Haemorrhaging nurses’: one in 10 quit NHS England each year

Data showing 33,000 nurses left in 2016-17 triggers warning of ‘dangerous and downward spiral’

Two NHS nurses


More nurses have left the NHS in England in the past three years than have joined. Photograph: Medic Image/Getty Images/Universal Images Group

One in 10 nurses are leaving the NHS in England each year, according to official figures, raising fresh concerns about staffing shortages in hospitals.

Data published by NHS Digital on Wednesday shows that just under 33,500 nurses left the service in 2016-17 – 3,000 more than joined and 20% higher than the number who quit in 2012-13.

The worrying figures come amid an ongoing winter crisis fuelled by rising demand, coupled with staff and bed shortages.

The data shows more nurses have left the NHS in England than have joined for the past three years, with the deficit highest last year. In each of those three years, the number quitting has been 10% of the total.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Janet Davies, head of the Royal College of Nursing, told the BBC, which initially requested the figures, that they were of great concern. “The government must lift the NHS out of this dangerous and downward spiral,” she said.

“We are haemorrhaging nurses at precisely the time when demand has never been higher. The next generation of British nurses aren’t coming through just as the most experienced nurses are becoming demoralised and leaving.”

Although 6,976 (21%) of the nurses who left in the year to September 2017 were 55 or over (the age at which nurses can start retiring on a full pension), just over half (17,207) were under 40.

The figures suggest Brexit may be having an impact, with more nurses from the EU leaving than joining in recent years. Last year, 3,985 EU (excluding the UK) nurses left, compared with 2,791 who joined. By contrast, in the last full year before the 2016 referendum (2014-15), 2,416 nurses quit the NHS, while 5,977 joined.

Hospital bosses have called for the 62,000 EU workers in the NHS, who represent 5.6% of the total workforce, to be given reassurance about their status post-Brexit.

But it is not just EU nurses who are leaving. Davies said low pay and the pressures of the job must be addressed if retention were to be improved.

Last week, senior doctors wrote to Theresa May, the prime minister, warning that patients were dying in hospital corridors during the winter crisis because the NHS was so underfunded and short-staffed that it could not cope.

The percentage of patients being treated within four hours at hospital-based A&E units in England fell to its lowest-ever level (77.3%) last month.

A Department of Health and Social Care spokesperson said there had been a rise of 11,700 nurses on wards since May 2010, and an additional 5,000 training places would be available from this year.

‘I knew I was in labour’ – why are women being turned away from hospital during childbirth?

As a number of women recount how they were mistakenly told to go home and wait, before giving birth on the pavement or in a lift, experts warn that more investment in early-labour care is needed

Some women who have been turned away from maternity units have soon after given birth in the street.


Some women who have been turned away from maternity units have soon after given birth in the street. Photograph: Alamy Stock Photo

Because her first baby had arrived quickly, Lizzie Hines was told at all her antenatal midwife appointments that she should go to hospital as soon as she recognised the first signs of labour. So, a couple of hours after she first felt twinges, cramps and contractions, she and her husband set off for a hospital in central London, but when she arrived, the midwife who examined her told her she wasn’t in labour. “I knew that not to be true,” she says. “I knew I was in labour.”

They were told to go home for a few hours; Hines asked if she could stay, but was told she couldn’t unless she wanted to wait in the corridor. Her husband booked them into a nearby hotel to wait it out, and they walked around the corner, with Hines, wearing pyjamas and a coat, steadying herself against the walls of the building with each contraction. It was 7am.

“We checked in at the hotel and I was probably there all of about 15 to 20 minutes when I said to my husband, ‘I’m having the baby. This is happening.’ I couldn’t really talk to him, but I could feel this was imminent. He said: ‘No, I’m going to get you [to hospital], we can’t do this here.’” He carried her across the road, and as another contraction came, Hines sat down on the street. “Apparently I let out a huge noise, but I don’t remember that at all. People came over, and I do remember ankles starting to appear around me.”

Then, she says, her son Louis “came out, and I remember feeling every limb fly out of my body and on to the floor and into my pyjamas. Someone in the crowd reassured me, saying, ‘Don’t worry, we’re going to get to the hospital, you’re going to be fine’. I said: ‘No, he’s here.’ They opened my pyjamas and saw him red and squirming, attached to me with the umbilical cord. He wasn’t screaming at first. Someone said put him against you so I lifted up my T-shirt and put him against me.”

She doesn’t remember much of what happened next, but last month she pieced her son’s birth together after a post she put on Facebook to search for the strangers who helped the family in December 2016 went viral. People have told her that her waters were running down the street, that someone in the crowd had tried to film her giving birth and a fight broke out to stop them. She didn’t even know when Louis was born – she was told it was 7.30am.

Lizzie Hines, in the street outside a hospital, moments after giving birth to her son Louis.


Lizzie Hines, in the street outside a hospital, moments after giving birth to her son Louis. Photograph: Courtesy of Lizzie Hines

The temperature was zero degrees. Some people in the crowd who helped her worked at the hospital. Hines and her newborn were taken there, using a wheelchair. She had a few stitches but all was well, and they went home that afternoon.

It was, she says, “a wonderful experience. He was healthy, I felt physically and mentally good about it, and I felt really joyful – I think the hormones were a huge part of that.” But, she adds: “There is also the thought that there was a misjudgment there.” It was a straightforward birth. “I feel very fortunate,” she says. “He didn’t have the cord round his neck or any immediate problems.”

Michelle Booth had a similar experience in 2013 with the birth of her son George, her first baby, who arrived in a hotel bathroom across the road from the hospital she had been turned away from a few hours earlier. She had been told she wasn’t dilated at all, and to go home. “The really stressful thing about it was I felt I was really on top of it, and then all of a sudden people were telling me I wasn’t in labour. When you haven’t had a baby before you don’t know. It freaked me out – if this wasn’t labour then what was it going to be like?”

Nearly three hours later, she called the hospital for advice and to ask if she should come in, but they told her to take a paracetamol. Soon afterwards, she gave birth in the hotel room. Like Hines, she says, it was a “really positive experience”, but she puts that down to being very prepared before the birth, having practised hypnobirthing and reading a lot about the birth process. “I think if I hadn’t done that, and had that experience, it would have been really scary.” She did, however, lose a lot of blood, and she and George were taken to hospital by ambulance quickly afterwards.

It was frustrating not to have been listened to, she says. “You’re having an experience and someone is telling you that it isn’t the experience you’re having. If you’ve never had a baby before, you’re reliant on the professionals giving you advice. I suppose what I’ve learned is the whole thing about birth is based on data.”

Being turned away in early labour, only to give birth soon afterwards, is “a symptom of something that affects women in maternity care a lot, which is not being listened to,” says Rebecca Schiller, chief executive of the charity Birthrights. “One of the problems we’re keen to address is changing culture in maternity care, so that women’s perceptions, experiences and information about their own bodies, own pregnancies and own labour is taken seriously. It’s something that’s important from a safety point of view. It’s been shown that some women who have had serious problems like stillbirths have reported worries and concerns, turned up to their maternity unit several times and been ignored, and gone to have tragic consequences.”

It can also be distressing to be told that you are not in labour when you feel you are, she says. “We know that how women feel giving birth can have an impact on their emotional wellbeing for quite a long time. It’s important for safety, and it’s important for women’s entry into motherhood and how they go on to feel about themselves and their experience of birth that they’re listened to.”

Michelle Booth and her son George.
Michelle Booth and her son George. Photograph: Courtesy of Michelle Booth

For Antonia Kennedy, who lives in the north-east, the birth of her fourth child, Oscar, in December 2016, was distressing. “Once you’ve had three other children, you know when you’re in labour,” she says. “[The midwife] said I was 1cm dilated and I should maybe go shopping – there was a shopping centre not far from the hospital – for a couple of hours.” She asked if she could stay at the hospital, but “they were adamant that I couldn’t. I said I really didn’t want to go back home. I felt ‘thank god we’re here’ but they said they wouldn’t let us stay.”

By then, she had been having contractions for a couple of hours, and at the hospital they were so strong, she couldn’t move. Her partner drove them the 15 minutes home, where they stayed for five minutes, before heading back to hospital. She made it through the doors, but gave birth to her son in the hospital lift. Her partner caught him. There were people watching and she says she felt really embarrassed. Since then, she has been plagued by thoughts about what might have happened if her partner had not caught the baby, if he’d hit the floor, and she believes the experience has contributed to the anxiety she has felt since the birth.Labour is unpredictable, acknowledges Schiller. “In my second labour, I went suddenly from not really feeling I was in labour to having a baby 40 minutes later. Sometimes you can’t predict those things and there will be women who give birth very quickly, and won’t be able to make it to a unit in time. But I think if a woman is at a unit and that’s where she feels safe, and she says like she feels like she’s in labour, it’s important that medical professionals don’t just rely on their traditional observations and vaginal examinations. It can be very easy to reduce a woman’s labour to measurements and standards, but we’re individuals and our bodies don’t often play that game.”

Early labour should be a time when women can feel safe, and while many women prefer to be at home, for some women, being in hospital might provide more reassurance, particularly if the hospital is not close to home, or an uncomfortable drive away.

The Royal College of Midwives declined to comment, but some hospitals have invested in early labour care. At Chelsea and Westminster hospital, they have a room called the Nest, which opened in 2012 and can be used by women in the early stages of labour, before going on to the hospital’s midwifery-led unit, or the labour ward if they choose to. There is low lighting, comfortable seating, such as beanbags, and relaxing music. It is staffed by doulas, who support women at this stage, rather than (expensively) trained midwives.

“There isn’t a lot of investment in maternity services at the moment,” says Schiller, but a simple, comfortable room might not be unreasonable to expect. “It’s a vulnerable time,” says Hines. “There is so much care taken by the NHS during pregnancy and after the birth, to such a high level of expertise, but for this splice of time in early labour, for maybe two hours or 10 hours, that doesn’t seem to be considered part of the care.”

Have you had a difficult experience going into labour? Please comment below.

When private meets public sector: the history of a tangled relationship

Interaction between the private and public sectors can be a politically charged process in the UK, not least when the contracts that underpin such a partnership go wrong. Here are some recent examples of cooperation between public bodies and private companies that have caused controversy.

Scottish schools

A private finance contract to build a series of Edinburgh schools became a costly embarrassment after the new buildings were found to be faulty and one partly fell down. A report into the deal found that the contractors had used substandard concrete to build the schools, all of which were considered unsafe and in need of substantial repair. But a review by the council found that the financing behind the Edinburgh Schools Partnership (ESP) was not to blame. ESP is a private finance initiative (PFI), a popular form of funding for projects whereby a company pays the upfront construction cost and is then paid back over time by the government, which effectively pays the constructor to lease the property. However, the review did say there were aspects of the way in which the PFI methodology was implemented that “increased the risk of poor quality design and construction”.

Virgin Health

Private firms scooped almost 70% of the 386 contracts to run clinical health services put out to tender in England during 2016-17. They included the seven highest-value contracts, worth £2.43bn between them, and 13 of the 20 most lucrative tenders. Last year, Virgin Care, owned by Richard Branson sued six clinical trusts after it lost an £82m bid. It secured an out-of-court settlement. It also went on to win £1bn worth of contracts.

London Underground PPI

Bob Kiley, tube boss in the early 2000s


Bob Kiley, tube boss in the early 2000s, described the PPP financing model for transport improvements in London as ‘fatally flawed’. Photograph: Channel 4

A series of public-private partnerships (PPPs) were signed by the last Labour government in 2002 and 2003 to upgrade and carry out maintenance on London’s tube network. Described at the time by then tube boss Bob Kiley as “fatally flawed”, by 2010 the process had unravelled. In exchange for carrying out complex work on an ailing network, the businesses behind the contracts would receive a monthly payment that would increase or decrease depending on whether they hit targets for measures such as train cleanliness and reliability of services. The process became mired in endless rows over costs; the biggest contractor, Metronet, eventually went bust and the other, Tube Lines, was bought out.

East coast rail

For the second time in a decade, the secretary of state for transport has been forced to bail out a private rail company running the vital east coast mainline. In 2009, the then Labour government took the line under public control after its private operator, National Express, couldn’t pay out the £1.4bn promised under the contract. The previous holder of the franchise, GNER, had already been stripped of the route after its US parent firm was struck by financial troubles. Last year, the government waived the majority of payments due under Stagecoach’s £3.3bn contract to run the London to Edinburgh route. Whenever the merits of rail privatisation are debated, the east coast line is a key argument for those in favour of nationalisation.

Everything you’ve ever wanted to know about my colonoscopy (but never dared to ask)

The thing about writers – the thing that makes us hated and occasionally liked – is that very often we have our heads up our asses. There are two ways that people in my profession can address this.

We could develop a deeper sense of humility, looking beyond ourselves and try to use our voices to amplify the experiences of other people in this cruel, cruel world.

Or: we could bring you into our asses with us.

It’s January, a month where we tend to fall short of our ambitions, so I’m going to opt for the more realistic choice here. But before I invite you on a guided tour of my colon, there’s something you should know about it – it is not a happy place. It has not been happy for a very long time.

From the age of about 20, I’ve had inexplicable stomach aches accompanied by a red liquid that would dye a clear bowl of water or a bundle of white tissue. But I ignored it. Even when there was a lot of it. Even when I started to feel faint. The only person that could witness this was me, alone in the toilet stall and after a while, the only witness stopped noticing. For 10 years, I ignored it.

But early last year, something strange happened. My stomach started to hurt more than usual. The next day I had to take painkillers. A week later it hurt to sit down, it hurt to stand up and I had to go home early from work.

When I realized it was affecting my job, I started to see what I had been ignoring.

The first thing I did was research prevalence. About 16% of all adults experience some blood loss from the bum according to a survey of 1,643 adults published in the American Journal of Gastroenterology.

Source: American Journal of Gastroenterology, 2017


Source: American Journal of Gastroenterology, 2017 Illustration: Mona Chalabi

Another study found that that 59% of people who experience rectal bleeding have never sought any medical advice.

The contrarian in me decided to book an appointment with a gastroenterologist. To find one, like any good New Yorker, I turned to Yelp.

People have a lot to say about being sedated and probed. People like Nancy C in Manhattan, who issued a one-star review about her “south of the border colonoscopy” (what other kind is there?). She was infuriated, in part, that when she woke up she was greeted by orange juice rather than a cookie. Nancy seemed like a smart woman. I heeded her advice and booked an appointment elsewhere.

The night before the procedure you have to drink a liquid designed to “clean your system”, which is a gentle way of putting it. The drink makes you shit and shit and shit and shit until you’re shitting water so clear that your bum could be an Evian volcano. By the time you arrive for the procedure, you haven’t eaten anything for 24 hours, you haven’t slept and your stomach aches from the constant fart-clenching.

After getting changed, a nurse wheeled me into a small room with two huge TV screens where a camera inching through my colon would be projected like an episode of Blue Planet. The anesthetist came in and injected me with something. I got halfway through a sentence explaining that the injection wasn’t working and then woke up wondering where the hell my cookies were.

A week later, the doctor called to discuss my results with me.

On her desk lay five pages stapled together with photos of me on them. Specifically, photos of my colon. Using the tip of her pen, she gently pointed to different areas and explained that I had a slight tear to my rectum, but the pain didn’t quite seem to match up to the injury. She suggested eating more fiber and gave me a prescription for a suppository (which is currently tucked behind some sunscreen on a shelf in my bathroom).

On the train home, I took out her report and studied the pictures a little closer to see if she had missed something. I wondered if a string of veins might have been turned from blue to a wine-purple after Donald Trump was sworn in. A little smooth area that glowed white from the camera’s flash suddenly struck me as a chunk of my stomach lining that might have worn away as I watched the news in the days that followed.

The truth is, we really do have “gut-wrenching” experiences because our brains and our stomachs are closely related. In a review of 13 studies, patients who tried a psychological approach saw greater improvements in their digestive issues than those who didn’t.

Maybe the doctor who had inspected my inner workings had missed something important. We use euphemisms even when we’re talking to ourselves. Our bodies are even capable of this linguistic device. My stomach hurt because my brain couldn’t speak my anxiety to me about a new political reality.

Euphemisms make our world more comfortable. We say bathroom even when there’s no bath in sight, and we generally stay away from words like shit and blood though they are the substances of life. These are little gentle sidesteps from the truth. Tiny verbal hugs in a scary world. The scarier the world becomes, the more tempting it is to deal in them. But I think now, more than ever we need to speak the truth as plainly as we can to ourselves and to each other.

This piece was first performed at Chris Duffy’s You Get A Spoon in December 2017

Dentists warn of child tooth decay crisis as extractions hit new high

NHS surgeons are performing record numbers of operations to pull out rotten teeth in children.

Hospitals extracted multiple teeth from children and teenagers in England a total of 42,911 times – 170 a day – in 2016-17, according to statistics obtained by the Local Government Association.

That is almost a fifth (17%) more than the 36,833 of those procedures that surgical teams carried out in 2012-13. Each one involves a child having a general anaesthetic and at least two teeth removed.

“These statistics are a badge of dishonour for health ministers, who have failed to confront a wholly preventable disease,” said Mick Armstrong, the chair of the British Dental Association, which represents most of the UK’s dentists.

He condemned “ministerial indifference [to] … the child tooth decay crisis”. Ministers were being “short-sighted” by not taking children’s oral health more seriously. Under-18s in England were receiving “second-class” services to prevent rotten teeth, in contrast to Scotland and Wales, both of which have a dedicated national programme, Armstrong added.

Tooth decay chart

The cost to the NHS of removing severely decayed teeth in under-18s has also escalated over those four years, from £27.3m to £36.2m.

Health campaigners said the “alarming” trend showed children were eating too many sweet foods and should prompt tough action to cut their sugar intake.

“These figures show that we have an oral health crisis and highlight the damage that excessive sugar intake is doing to young people’s health,” said Izzi Seccombe, a councillor and the chair of the LGA’s community wellbeing board.

Children’s poor dental health can limit their ability to eat, play, socialise and speak normally, she added.

The government’s main policy to prevent tooth decay in children most at risk, called Starting Well, was not given new funding and operates only in parts of just 13 local council areas in England, the BDA said.

“This short-sightedness means just a few thousand children stand to benefit from policies that need to be reaching millions,” Armstrong said.

Dr Nigel Carter, chief executive of the Oral Health Foundation charity, said the rise in childhood teeth extractions was “completely unacceptable” and was causing pain and distress for the under-18s undergoing the procedure.

Dr Sandra White, Public Health England’s director of dental public health, said: “Parents can reduce tooth decay through cutting back on their children’s sugary food and drink, encouraging them to brush their teeth with fluoride toothpaste twice a day, and trips to the dentist as often as advised.”

Prof Russell Viner, officer for health promotion at the Royal College of Paediatrics and Child Health, said ministers should ban television advertisements for foods high in fat, salt or sugar before the 9pm watershed and stop fast food shops opening near schools and colleges.

My cancer operation was cancelled and I can’t sleep at night. Jeremy Hunt, how can you? | Carly O’Neill

Dear Jeremy Hunt,

I didn’t sleep well last night. I was nervous, anxious about what was going to happen the next day. I’m not great with needles, never mind scalpels. But I also knew that I was in the hands of professionals, who would do absolutely everything they could to make me better.

I was diagnosed with skin cancer in early October. It’s been a stressful few months, because a cancer diagnosis, even with an excellent prognosis like mine, is terrifying. It was hard to be at the mercy of the NHS waiting lists for different appointments in different hospitals with different specialists.

But at last, today was the day. I would have surgery, and after that I would be able to focus on recovering and putting all of this behind me. I would be able to get back to my PhD again – I’m due to submit that very soon. I’m getting married later this year, and I look forward to planning the wedding and trying on wedding dresses. Life feels a little like it’s on hold until this cancer is dealt with.

It’s quite a big operation, and it’ll take a few weeks to recover. Last week, four months since my GP first referred me and three months after being diagnosed, I heard that I would be having surgery soon. I was worried, but mostly really relieved that it would all be over soon. I only heard a few days in advance, so it was quite a dash to get everything sorted. My colleagues have been amazing in organising cover for me at such short notice. My fiance had to take time off work, too. So his colleagues have had to be equally wonderful.

This morning I got up very early and made my way to the hospital. I saw nurses, and the surgeon, and the anaesthetist. There were boxes to tick and forms to sign. They drew the markings for surgery on me, and I was put in a gown and given wristbands with my name and allergies on them. The most suitable vein for the IV was found. They went through all the possible risks in detail, which is of course a good thing, but it didn’t help me relax.

Hospitals can be intimidating places and it’s stressful to be at the mercy of others, even when they are the amazing people in the NHS. I can’t emphasise enough how much respect they deserve for working in the circumstances they’re put in, and they remain not only impressively professional, but understanding, calm and kind.

But at last, all the waiting was over, I was all prepared, the only thing left to do was to actually have the surgery. And after all that, Mr Hunt, after all that: I was sent home, because there wasn’t a bed available.

The winter pressures on the health system – including flu, which can exacerbate underlying conditions to the point where urgent care is needed – had brought the hospital to a near standstill. Only life-threatening conditions were being treated in the theatres. Even cancer operations, like mine, had to be shelved.

I’ve been pencilled in for February, but have been warned the same thing could happen again. And I’ve seen the headlines – people with more urgent problems than me are being sent home, sometimes repeatedly. I read yesterday about a young child who had faced five cancellations.

Mr Hunt, I know you didn’t cancel my operation yourself. And I know that hospitals sometimes have to prioritise. But my local hospital didn’t get into this state simply because of the season.

You keep telling us how funding for the NHS has increased. What you don’t mention is that, since 2010, the rate of increase has been far below the long-term average increase in health spending, at a time of massively rising demand. Our health system is like an old building: it’s creaking and shaking in the bad weather because the owners haven’t bothered to keep it in good repair. That is something you are responsible for.

Long term I’ll be OK, because I’m sure that eventually there will be a bed available. I’ll have a few more sleepless nights, though.

Congratulations on keeping your job, Mr Hunt. I’m sure you’ll continue to do it ruthlessly. I hope you sleep well.

Yours,

Carly

Carly O’Neill is working on a PhD

You don’t have to be poor to be hooked on drugs or alcohol but it helps

Dry January ought to be the season to talk about drunks. According to what passes for the public health debate, unfortunately, most of society thinks there’s little to say.

If you drink yourself to death, while taking care along the way to abuse your family, friends and unlucky strangers who cross your path, that’s your fault. You believed Ernest Hemingway when he said “a man does not exist until he is drunk”. No one has the right to be surprised that the drink has finished you – as it finished Hemingway – least of all your own pickled self. Stay too long at the bar, and you must expect to hear last orders called.

We have telethons and sponsored tests of endurance for every conceivable ailment. The charitable raise money to combat poverty in developing nations, cancer and heart disease. But I have yet to hear of a marathon run to save alcoholics from marathon binges or a public appeal on behalf of drying-out clinics. There’s no money in public health. Or votes either.

What applies to drink, applies to drug addiction, sexually transmitted diseases and obesity. In each instance, arguments you hear are filled with a mixture of denial and blame. The discourse is inherently conservative because it affirms that public intervention is pointless. People who cannot get through a week without a drink or a Saturday night without getting plastered are by any reasonable standard addicts. I speak from experience when I say that no heavy drinker agrees with this diagnosis. A line separates wild men on park benches from you and me having a good time. Britain’s tipsy culture won’t say where the line is for fear too many would find themselves on the wrong side. Never doubt that when you have crossed it, you alone will bear the blame.


I have yet to hear of a marathon run to save alcoholics from marathon binges or a public appeal on behalf of drying-out clinics

In this climate of punitive neglect, addiction and obesity are dismissed as diseases of choice, which to use that most class-bound of Tory insults, the “nanny state” cannot cure. It’s true that breaking free from heroin, alcohol or sugar requires an effort of individual will. It is equally true that it is easier to summon the strength to quit when others are on hand to help. These truths ought to be self-evident. But they are not evident in Britain. Virtually everyone who is running to fat has at one time or another denied the results of body-mass index tests that report they are obese. The index would find that Olympic sprinters are overweight, we say, in our defence. So it would. Yet how many of those who say it have the muscles of Usain Bolt?

To be fair, dieting is discussed to excess – unlike alcoholism and drug addiction. But the conversation is dominated by fad diets that always disappoint. When even the BBC, promotes obscurantist delusions about fasting, the favoured weight-loss strategy of medieval mystics, there is an urgent need for the state to foster public health.

The state is failing because the Conservatives have got away with a great, shining lie. Journalists who think themselves speakers of truth to power rarely notice the fabrication. Opposition politicians who bellow about the depth of their hatred of “the Tories” allow ministers to escape without criticism. The lie is that the government has ring-fenced health spending from cuts. The argument about health spending has thus been an argument about the government’s failure to allow the NHS to keep up with the costs of an ageing population and advances in medical technology.

Few spotted that, with a magician’s sleight of hand, the government removed public health from health spending in 2013, and – hey presto! – public health was no longer defined as health. This playing with names, these accounting tricks, have allowed ministers to pretend they are not cutting health spending at the very moment they cut it. The King’s Fund described how the con went down. There were good reasons for giving local authorities control of public health. Councils regulated pubs and fast-food restaurants. Of course they should be responsible for alcoholism and obesity. If Britain is ever to catch up with the rest of Europe and encourage people to walk, run and cycle, the bulk of the work would fall to local authorities. Once again it made sense for them to take the lead on fitness.

For a few years all went well. Then in June 2015, the Treasury clawed back £200m from the public health grant. Local authorities took on responsibility for childhood obesity. The money they received for the extra work hid the scale of the cuts. But not for long. The last spending review announced a reduced income in real terms of £600m a year until 2020-21. Services to help men, women and children stop smoking and to control the spread of sexually transmitted diseases including Aids are already a mess. Meanwhile, I’ve interviewed drug and alcohol workers with scores of clients on their books they cannot begin to help. Their one relief is the sight of rich junkies because they know that all they want is methadone and will get what counselling they need privately.

Speaking of the rich, one cannot overlook the class element in the government’s trickery. You don’t have to be poor to be drink or drug dependent. But it helps. Michael Marmot’s great work on inequality in health shows how it is determined by the wider inequalities of society that deny access to education and decent housing. This is another truth which ought to be self-evident, particularly in Britain where the poor and working class are twice as likely to be obese than their better-born peers.

Obesity costs Britain £20bn in NHS spending and lost working days, and that is before you count the human price of lives shortened by diabetes and heart disease. But as I started with booze let me finish with it. Public health is not separate from the national health. You can’t hide it in a corner and strangle it in the dark. Alcohol contributes to 60 illnesses from mouth cancer to depression. A man who abuses a woman is likely to be driven by drink. A driver who runs you down is likely to be drunk. Alcohol consumption accounts for more than one million hospital admissions a year and over half of all violent crimes.

That the government should lie when it says it has protected the health budget is bad enough. That it can get away with lying is astonishing. Alcoholics Anonymous describes alcohol as “cunning, baffling and powerful”. So it can seem. But it has nothing on the Conservative party.

My charity sees the toll of job losses on mental health – we struggle to meet demand

As chief executive of a small mental health charity in one of the poorest areas of north east England, I don’t sleep well. We deliver frontline recovery services in Redcar & Cleveland and in 2011 our funding was cut by 61% in one fell swoop. We used to get £350,000 from the local authority; now we manage on £135,000.

Meanwhile, mass unemployment and financial pressure have taken their toll on people’s mental health and we’ve seen demand more than double. The steelworks used to be the lifeblood of our community and its closure in 2015 has been catastrophic.

Across the country, suicide is the biggest killer of men under the age of 50 and rates of depression and anxiety in young people are spiralling. We see the human face of those statistics every day, and although I am an eternal optimist, most days are tinged with upset and anger.

I regularly meet staff who work in search and rescue. We offer them resilience training and mental health support through our Blue Light Programme. We know that staff and volunteers working within the emergency services are at increased risk of suicide due to stress.

One instance that particularly stays in my thoughts is when a young volunteer from a local search and rescue team was involved in the harrowing experience of retrieving a body from the foot of Huntcliff, a beautiful and majestic landmark along our coastline. They had just had their first experience of the trauma of suicide and remained in my thoughts all day. It’s volunteers like that who potentially need our services.


Too many people need us, and our resources are limited. Very limited.

Later that day I received a call from my 19-year-old son. The body retrieved from Huntcliff was someone he knew. The sad irony is not lost on me: three young people of a similar age. One is dead, one may not sleep due to what they have witnessed, and the other is touched by sudden bereavement. What words do I choose that can possibly make this better? I am at a loss.

I do what I do today because of my own lived experience. In 2006, out of the blue, I suffered a life-threatening depressive episode. It lasted six months from onset to recovery. During that time struggling to understand my mental illness, I made repeated attempts to take my life. Back then I had no idea that services like Redcar & Cleveland Mind existed. I survived through the support of my wonderful children, a great GP and some very loyal friends. But I know some people aren’t so lucky.

I will do everything within my power to make sure our service continues to be there for anyone who needs it. But therein lies the problem. Too many people need us, and our resources are limited. Very limited.

Our Road to Recovery service is funded to support people with “mild to moderate” mental health problems. We are asked to categorise people depending on how unwell they may be, or how much support they may need. If they are too ill, we’re not funded to help them. But of course we do. We will treat them as real people and help them to realise that their lives matter.

We make a small income on the Well4Work training we offer employers to help them support their staff’s mental health – but this is all reinvested into the work we do. We increasingly rely on donations, often from those bereaved by suicide.

Mental health doesn’t have the appeal of other charitable causes, unless it touches people directly. We will continue to fight for those you may have loved and lost. And in the meantime I remain hopeful that in this new year we will see Huntcliff in its majestic glory rather than as a place where hopelessness claims more lives. As for me, I suspect 2018 will bring many more sleepless nights.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

Talk to us on Twitter via @Guardianpublic and sign up for your free Guardian Public Leaders newsletter with news and analysis sent direct to you every month

My charity sees the toll of job losses on mental health – we struggle to meet demand

As chief executive of a small mental health charity in one of the poorest areas of north east England, I don’t sleep well. We deliver frontline recovery services in Redcar & Cleveland and in 2011 our funding was cut by 61% in one fell swoop. We used to get £350,000 from the local authority; now we manage on £135,000.

Meanwhile, mass unemployment and financial pressure have taken their toll on people’s mental health and we’ve seen demand more than double. The steelworks used to be the lifeblood of our community and its closure in 2015 has been catastrophic.

Across the country, suicide is the biggest killer of men under the age of 50 and rates of depression and anxiety in young people are spiralling. We see the human face of those statistics every day, and although I am an eternal optimist, most days are tinged with upset and anger.

I regularly meet staff who work in search and rescue. We offer them resilience training and mental health support through our Blue Light Programme. We know that staff and volunteers working within the emergency services are at increased risk of suicide due to stress.

One instance that particularly stays in my thoughts is when a young volunteer from a local search and rescue team was involved in the harrowing experience of retrieving a body from the foot of Huntcliff, a beautiful and majestic landmark along our coastline. They had just had their first experience of the trauma of suicide and remained in my thoughts all day. It’s volunteers like that who potentially need our services.


Too many people need us, and our resources are limited. Very limited.

Later that day I received a call from my 19-year-old son. The body retrieved from Huntcliff was someone he knew. The sad irony is not lost on me: three young people of a similar age. One is dead, one may not sleep due to what they have witnessed, and the other is touched by sudden bereavement. What words do I choose that can possibly make this better? I am at a loss.

I do what I do today because of my own lived experience. In 2006, out of the blue, I suffered a life-threatening depressive episode. It lasted six months from onset to recovery. During that time struggling to understand my mental illness, I made repeated attempts to take my life. Back then I had no idea that services like Redcar & Cleveland Mind existed. I survived through the support of my wonderful children, a great GP and some very loyal friends. But I know some people aren’t so lucky.

I will do everything within my power to make sure our service continues to be there for anyone who needs it. But therein lies the problem. Too many people need us, and our resources are limited. Very limited.

Our Road to Recovery service is funded to support people with “mild to moderate” mental health problems. We are asked to categorise people depending on how unwell they may be, or how much support they may need. If they are too ill, we’re not funded to help them. But of course we do. We will treat them as real people and help them to realise that their lives matter.

We make a small income on the Well4Work training we offer employers to help them support their staff’s mental health – but this is all reinvested into the work we do. We increasingly rely on donations, often from those bereaved by suicide.

Mental health doesn’t have the appeal of other charitable causes, unless it touches people directly. We will continue to fight for those you may have loved and lost. And in the meantime I remain hopeful that in this new year we will see Huntcliff in its majestic glory rather than as a place where hopelessness claims more lives. As for me, I suspect 2018 will bring many more sleepless nights.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

Talk to us on Twitter via @Guardianpublic and sign up for your free Guardian Public Leaders newsletter with news and analysis sent direct to you every month