Sunday, 3 August 2014

The Twittering Classes, Unhealthy use of Public Money and One (or two) Last Glasses of Wine

Twitter and tweeting featured for me in many ways last week. I am a late adopter in Twitter terms, meaning I came to the party later than most, and up to now I remain fascinated by this social media platform. Others have moved on to use other social media. This micro-blogging service (each tweet must be no more than 140 characters long) provides the opportunity for lively debate on any subject and with both your friends and family and people you might not be able to normally communicate with, the Prime Minister or the latest soap star.

Many organisations now recognise the value of Twitter in enhancing their customer service, resolving complaints at an earlier stage, and of course advertising their services. Twitter went public last November, and despite only having some 200m users (compared to 1bn people who were logging onto Faceboook), its valuation at that time was £14bn. Its value was based upon the notion that more and more people would buy into the Twitter idea.

Getting others to buy into an idea might well have been in the minds of the Healthier Together team, who, its reported, have spent nearly £4m of public money trying to get the people of Greater Manchester to buy in the idea that health services in the conurbation need to change. Although it has been claimed that there is wide spread support from doctors for the changes being proposed, judging by the cries of outrage and despair from GPs, hospitals, local MPs and watchdogs such a Healthwatch this seems very much in doubt.

Just as Twitter has struggled to deliver its social media potential and gain more users in the numbers it expected, so it seems, this might be the case with Healthier Together. They are currently in the midst of a fairly shambolic public consultation. For example, they are reporting on average only 45 people attending their public meetings. There are 2.7m people living in Greater Manchester. Perhaps this lack lustre response has something to do with people’s suspicions over what it will mean for them. Last week newspaper and social media reports carried the Healthier Together claim that no hospital of A+E Department would close, yet this commitment appears to be left out of the consultation documents.

As the NHS is in the final year of a 4 year challenge to save £20bn, with estimates from NHS England that a further £30bn worth of savings are required by 2020-21, people might be forgiven for thinking that Healthier Together’s long term plans include the closure 1 or 2 hospitals in the Greater Manchester area.

It’s a complicated set of issues. Transforming health care services both hospital based, and out of hospital care, does not lend itself to easy solutions. For example it’s estimated that 20% of hospital beds are currently taken up with end of life care. Of the 500,000 people who die in the UK each year 60% die in hospital. 40% of these people do not have a curable condition and most will have been ill for 6 years before they die.

60% of those that die in hospital would prefer to die at home. Providing integrated health and social care that is community based in order to effectively meet these needs will take resources. However its argued that many new developments could be funded through savings achieved by freeing up hospital beds. For example in 2010 DEMOS (the policy and politics think tank) estimated that end of life care cost the NHS £20bn a year. Setting up a national ‘hospice at home’ scheme capable of supporting 90,000 peoples care at the end of their life would cost £150m. 

I was interested to learn last week (via Twitter) of a new approach in France, to improve the end of life care for the nearly 280,000 people who die in hospital there each year. From next month, patients with a terminal illness at the Clermont-Ferrand University Hospital will be able to enjoy a drink with their friends and family at a wine bar to be opened in the hospitals Palliative Care Centre. Whatever you think about drinking alcohol, and there are challenges for health care professionals in taking this approach, I thought it sounded like a good idea. 

However, not everyone gets the chance to say goodbye. The BBC News service (another Twitter alert) published a very dignified article and image of the 298 victims of the Malaysian aircraft flight MH17 who clearly didn't have the chance to say goodbye to thier loved ones. It was a story that was made all the more poignant for me as last week I also learnt of the death of my former wife, friend and gardening mentor. We had separated and divorced over 20 years ago, and had not maintained contact. Despite Twitter, email, Facebook and old fashioned snail mail, it was the executor of her will who finally got to tell me she had died in March of this year. Rest in peace Inez, I am sure you will have already got your garden sorted in heaven.