An NHS Independent Board

Our health service has been founded on the principle that healthcare should be freely available to all from cradle to grave, and that provision should be based on need rather than ability to pay. These noble aims and ideals have been translated within the NHS to create what is frequently described as a ‘beacon to the rest of the world’.

This weekend Gordon Brown released his plan for the NHS: to devolve power away from politicians and create an NHS independent board. Basically, repeating his trick with the Bank of England by taking decisions away from ministers. This seems to be in tune with a recent YouGov poll carried out following the book ‘The Future of the NHS’ which found a two-to-one majority favouring the government withdrawing from day-to-day running of the NHS.

To give any possible future NHS independence board some idea of the mammoth task ahead, it’s worth noting that the NHS is the fifth largest employer in the world with 1.33 million people, behind only the Chinese army, the Indian Railways, Wal-Mart and the US department of defence. At any one time the total NHS population equals around the size of a small African country, such as Botswana. Thinking of the NHS as a country, and of this magnitude, really brings home some of the difficulties faced in how to manage an organisation with a vast number of patients, an unstable economy, an ageing infrastructure and an organisation that does not produce saleable goods.

On the face of it, an independent NHS board may look like a welcome reform, removing the temptation of politicians to meddle for short-term political gain. So why has the British Medical Association warned that the new proposals do not help address NHS problems? Perhaps, the reality is that by creating an independent board, it hands over an important part of our political system to an unelected group, and takes the decision-making process yet one step further away from the people it directly affects. After all, we already live in a society with 882 such quango bodies costing a total of £124 billion.

Next year sees the end of the increased level of spending pledged to the NHS and what will remains are some extremely difficult policy decisions to be made. The question then seems to become, is this new level of bureaucracy a method of passing the buck on political decisions?

Stick-thin obsession must end

This was published in The London Paper, 18/9/06

To celebrate London Fashion Week, try the following exercise. Count the number of times your brain registers an image of a thin woman between getting up and going to work.

Check your cereal box, your newspaper, your morning TV, posters on the Tube. When I did this recently, I was staggered to count 63 models who appeared underweight in less than an hour. Almost every minute, my brain was being subjected to an unhealthy image. Society now seems to accept that junk food is an unhealthy input into our mouths, yet it still seems unconcerned that junk information is unhealthy food for the brain. We get a choice of different foods on offer, so why don’t we have a choice of what stimuli our brains are bombarded with?

Eating disorders including anorexia nervosa, bulimia nervosa and binge-eating disorder, affect a staggering 12 per cent of the population with milder forms being more prevalent. The common factor among all eating disorders is dissatisfaction with body shape and consequent dietary restrictions. Although these disorders are multifactorial, few would dispute the social pressure to be thin, especially for women.

The sad fact for anorexia nervosa sufferers is that as many as 20 per cent may die – some during their quest to imitate underweight role models. What must be done?

Few people would argue with the general proposition that weight in itself is a matter of personal choice. Further, that press freedom is crucial to a democratic society. However, with freedom comes responsibility and this is where the problem lies. By turning a blind eye to the effects it is having on society, the media is simply abusing its freedom at the expense of us all.

One solution may be to add provisions into the constitutions of the media’s regulatory bodies, such as the Press Complaints Commission, to try to avoid portraying the symptoms of eating disorders as glamorous. Or, as we celebrate the start of London Fashion Week, a lead might be taken from a recent show in Madrid to ban models with a Body Mass Index below 18 and urge them to go see a doctor rather than go down a catwalk.

Why Society is Part of a Big Family

Tory leader David Cameron said his party must do more to keep families together, after a report suggested that parental splits are creating an underclass.

Indeed, it is known that behaviour is learnt after spending years imitating parents, siblings, friends and society. Many people like to blame their parents for their maladaptive coping strategies, and this may, in part, be true. However, this also leads onto the good news – if behaviour is plastic then it can also be modelled, so new behaviours can be learnt changed and modified. After accepting that behaviours can be learnt from others at any age, the door is opened to breaking the cycle of maladaptive coping mechanisms, by modelling new behaviour on different adaptive coping mechanisms.

Whilst the report highlights the role of parents, we forget at our peril, the societal social responsibilty.

The Master

“the metaphor is perhaps one of man’s most fruitful potentialities. Its efficacy verges on magic, and it seems a tool for creation which God forgot inside one of His creatures when He made him.”
Jose Ortega y gasset

The master of metaphor Winston Churchill understood that to make something understandable, the message had to be given to the receivers’ brain in a way the brain can create a picture with it; after all, a picture can incorporate a thousand words. Nearly everyone finds it easier to understand in terms of metaphors. For example, “struggling to keep my head above water”, is a cry many people howl when they have taken on too much work.

It is interesting to consider the power of metaphors within our own internal questioning. Can internal stress be increased by saying you're “struggling to keep your head above water” rather than “climbing the ladder of success”? If working is seen in a similar light as “pulling teeth”, will it make the task much more arduous than if it was seen as “playing a game”? When a metaphor is given, it’s important to remember the framework it’s sending your internal mind. It is far easier supporting the mind, than informing it about the possibility of drowning or having teeth removed.

The power of metaphors is dicussed futher in the new book (due start 2007) 'Why Lawyers Should Surf' by myself and Mr Tim Kevan

Psychiatry and Surfing at the Beach

Next time you are at the beach, spare some time to observe the waves. Many will have heard life advice ‘go with the flow’, but is this really the answer? If you take the journey of life to be analogous to surfing the sea waves then there are several things to consider.

Just as in life, ground work must be undertaken. The way the sea, wind, shore, tides, and moon interact must be learnt about. Knowledge must be attained about the equipment, boards and the safety procedures. Dangers and consequences must be considered with reference to respecting what's around you and the environment's possible limitations. Inevitably there will be obstacles along the way and some waves will throw the surfer off the wave resulting in the full weight of the water above, crashing down upon them. Each situation has to be dealt with individually; but the important thing is never to loose the love for trying, otherwise that would be paramount to lacking the zest for life. Instead the surfer must get straight back on the surf board and rise up to the next challenge. Surfers can expect to get thrown off some waves, but rather than seeing these ‘wipe outs’ as failures and giving up, surfers seize them as learning opportunities. Mistakes and ‘wipe outs’ are experiences to learn from and it’s never too late to learn from failures and share knowledge with others. Buckminster Fuller once wrote “Whatever humans have learned had to be learned as a consequence of trial and error experience. Humans have learned through mistakes.”

Surfers need to carefully consider which wave to catch and which direction they must point their board in order to gain the most awesome ride. Surfers quickly learn to consider their direction of travel, as not only do they have to be able to avoid dangerous sea bed rocks but also their wave position makes the difference between riding a wave and falling off it. This is analogous to planning life’s journey, as forgetting to consider the direction of travel would be like trying to fit together a jigsaw puzzle without having seen the bigger picture. Life does not and can not stand still, deciding upon the wave to follow, prevents just ‘going with the flow’ of water and being washed up somewhere you had not anticipated to be. Instead, surfers learn to steer their own course and ultimately their own destiny.

These thoughts will be included in a new self-help book entitled 'Why Lawyers Should Surf' (xpl publishing), which will be available in bookshops from 2007.

Anchors away

Anchors
Anchors are used as a method of anchoring an experience, and giving it permanence. Adverts try to use this method, so that every time their logo is viewed it is anchored with an experience. The anchor they use is the product of repeating a media experience message with visual images and sound. If adverts could reach out and touch consumers every time they were exposed to the product, they would do so.

Ideally an anchor is similar to pressing a button to create a physiological state that's acquired without having to think about it. Similar to the famous Pavlovian dogs, salivating each time they heard the sound of a bell. Unfortunately, most of us have developed anchors haphazardly; however, we have the ability to create our own personal positive anchors.

Exercise to create your anchor
For an anchor you need two things:
1) You need to remember a special time when you felt good, positive, strong and successful and remember the way your body physiology felt during this time. The more intense the physiological state the easier it is to anchor. The mind and physiology need to be congruent, as the body and mind must be working together in harmony.
2) You need to choose a unique stimulus, so that each time this stimulus is activated, it will produce the physiological response of that special moment without you having to think about it. A frequently chosen stimulus is to squeeze the thumb and the middle finger together on the left hand.

Now you have the tools the next step is to anchor the two together. You will need to practice this repeatedly for the brain associations to develop the anchor. So, in a quiet room with no distractions think of your special experience when you were feeling ‘on top of the world’, remember it in minute detail. Get your mind to replay that memory and make that memory bright. If there is light and colour, turn up the brightness, if there is sound, turn up the volume. As you remember the memory in detail, your physiology and emotions should be repeating the way you felt during that good experience. At the peak of the ‘feel good factor’ you should press your thumb and middle finger together, or the action you have chosen to be your stimulus.

This will take practice and repetition to get your mind to associate the unique action stimulus with the fantastic memory you chose. But once you have put in the hard work to anchor, then you can use it for your advantage. Many people use their anchors before interviews, giving presentations or giving speeches and find that using their confident physiology induced by activating their anchor point dramatically improves their performance.

For more practical tips then await the book 'Why Lawyers Should Surf' - to be published at the start of 2007.

More sleep needed?

‘For all the advances of modern society, we cannot afford to ignore the rhythms of the animal brain within us, any more than we can neglect our need to breathe or eat. Without the biological clocks in our brains, our lives would be chaotic, our actions disorganised. The brain has internalised the rhythms of Nature, but can tick on for months without sight of the sun…….’
Blakemore 1988

Most animals have a circadian rhythm, a cycle of various physiological and behavioural functions, synchronised to just under a 25 hour cycle. Even the body’s immune system changes during waking and sleeping, with more natural killer cells present during the day yet more T cells active at night. Disruptions of this pattern can explain why infections tend to plague shift-workers. The body’s internal clock is about as reliable and regular as most manufactured clocks and it is thought that the body clock is located in a tiny cluster of neurons called the suprachiasmatic nucleus (SCN).

How much sleep is needed?
According to Maas (1998) the prehistoric genetic blueprint for sleep has not evolved fast enough to keep up with the fast pace of twentieth-century living. Humans are more likely to need an average of ten hours sleep a night rather than the four hours Margaret Thatcher was famously able to get by on. Maas also claims that each of us maintains a personal sleep bank account, and as a rule of thumb for every two waking hours incurs a sleep debt of around one hour. Maas and others argue that modern society is a sleep-deprived society and notes that over the past 20 years an extra month of working hours has been added to the annual working and commuting time. In fact the British work longer hours than any other nation in Europe, and sleep one-and-a-half hours less per night than two generations ago.

Does Sleep Deprivation Affect Health?
In short the answer is ‘yes’. Dement (2000) believes that most of us carry a large ‘sleep debt’ and has linked this to high blood pressure, heart attacks and strokes. Sleep debt is dangerous and potentially be lethal. For example, the Challenger space shuttle disaster was attributed to human error caused by extreme sleep deprivation.

So, sleep is perhaps more important than realised. This was taken from a book being published entitled 'Why Lawyers Should Surf' written by myself and Mr Tim Kevan

The brain is full of logos

Advertising is a multi-billion pound industry paid to frame and reframe our perception of different products. Companies tussle for position in our brains wanting to associate their logo with something desirable. It is an intriguing point of reference to consider how the marketing industry tries to manipulate the psychology of a population. Their success and failure stories can teach us a great deal, not just about advertising, but about how brains receive and processes information.

In 1909 Scott wrote the first British textbook published about advertising. In it the most fundamental principle identified was ‘association’. Adverts aim to associate themselves well beyond the memory of a logo into the association of the brand meaning a lifestyle. When trying to sell a fast car, the message on television or billboards is always the same, suggesting to the buyer that to purchase that particular car would buy the lifestyle of 'Bond girls' and adoration, avoiding the tricky questions about the impact on the savings account. The car is branded with a particular message and the mind is framed to think of an exciting sexy fast car driving along country lanes, not sat in traffic jams guzzling fuel.

Perhaps a more recent example is by looking to how political parties try and sell their brand. Framing the mind of the voting public is the new political centre ground. Labour rebranded itself ‘new labour’. Since David Cameron has been at the helm of the conservative party, there has been a big push to reframe the old Tory brand starting with a new logo.

By far the most controversial aspect of advertising is subliminal advertising. It originated in America when Jim Vicary (a market researcher) after he arranged for the owner of a cinema to portray during a movie showing, messages so quickly, or printed so faintly, that they couldn’t be consciously perceived other than via ‘subliminal perception’. ‘Hungry? Eat Popcorn’ and ‘Drink coca-cola’. It was found that sales of popcorn rose by about 50% and soft drinks by 18%. Despite subliminal messages being made illegal in the 1950’s, they have recently been making a comeback. In an American department store music was mixed with a barely audible and rapidly repeated whispering (‘I am honest. I will not steal’) and there was a reported a dramatic decrease on shoplifting. However, ‘so far none of the more fabulous claims for subliminal marketing have been borne out by well-controlled and replicable studies.’ (Zimbardo and Leippe 1991)

The Future of the NHS

It is an absolute pleasure to be able to tell you about a brand new book entitled ‘The Future of the NHS’. Much hard work has gone into the development of this book and the outpouring of goodwill from all those involved has managed the initially almost unthinkable task of producing a single volume book discussing such a mammoth topic.

To give this a bit of perspective, the NHS is the fifth largest employer in the world, employing 1.33 million people. The only larger employers are the Chinese army, the Indian Railways, Wal-Mart and the US Department of Defense. When you consider this number of employees in global terms, it equals around three times the population of Malta or Barbados. After adding in the number of patients being treated at any one time, it brings the total NHS population to be around the size of an African country, such as Botswana or The Gambia. Thinking of the NHS as a country of this magnitude brings home the difficulties involved in how to manage an organisation with a vast number of patients, an unstable economy, an ageing infrastructure and an organisation that does not produce saleable goods. However, this is offset by the fact that unlike any other country on earth, the NHS has one single and extraordinary asset – its population is driven and united by hard working, dedicated employees who are the cornerstone to the service. These are the people who need to be consulted when problems arise. These are the people who need to be consulted when reforms are proposed and these are the people who need to be consulted when legislation is being implemented.

This year 2006, marks the historic 60th anniversary of the passing of the original NHS legislation, so it seems to be the perfect time to start talking about the future of the NHS; to be making long-term plans and ensuring that the NHS does not itself go into retirement. This book brings eminent experts together from centrally relevant disciplines with a wide range of perspectives, to set out views clearly and readably; to enable the general reader (whether professional or lay person) to better understand the cardinal questions involved in this NHS debate. Early chapters express views from main political parties, Labour, Conservative and Liberal Democrats and continue with chapters from top NHS professionals in leading authorities across a broad range of specialties. The discussion continues about how the NHS is managed, trained, regulated and funded and considers alternative and innovative methods of tackling complex financial issues.

The NHS was founded upon the principles that healthcare must be freely available to all, from cradle to grave, and that provision must be based on need rather than ability to pay. So radical was the idea that its architect, the then Health Minister Aneurin Bevan, described it as “the biggest single experiment in social service the world has ever seen undertaken.” Whilst many may see it as clichéd or old-fashioned to be harking back to those early days, it is nevertheless important to realise, that the circumstances of its formation have left a very important legacy. Those noble aims and ideals were translated within the NHS to create what is frequently described as a beacon to the rest of the world.

It is with all this in mind that this book brings together centuries of experience and expertise and I know that everyone involved wants it to be the start of a positive and open-minded great debate about the NHS, rather than the destructive culture of blame and short-termism which so often holds sway.

This book is available from xpl publishing, most bookshops, BMA hammicks or amazon and the book supports charities, such as, Mind and The Patients Association.. For more information or to join in the great NHS debate, then simply log onto The Future of the NHS

Jean Jacques Rousseau (1712-1778) - The Rights of Man

Liberty, freedom, equality and democracy - today we hear those words so often we cannot image a time when they were a new and challenging idea, which shook civilisation to its foundations. It was Jean Rousseau who was an influential founder of this concept and gave it both shape and power.

Rousseau was the son of a watchmaker in Geneva, Switzerland. His mother died nine days after his birth due to complications from childbirth; his father, a watchmaker, abandoned him to avoid imprisonment for fighting a duel. During his childhood, Rousseau often read in the tranquility of a garden, which he would later describe as the most serene part of growing up.

Rousseau saw a fundamental divide between society and human nature, and contended that humankind was good by nature, but corrupted by society. Perhaps his most influential work was 'The Social Contract'. It gave the world ideas about the natural rights of everyman, and analysed the whole question of government including who should benefit from it. His answer was the common man. Some claim that his influences instigated the French Revolution.

His writings made startling changes as he put his beliefs about liberty, equality, and democracy into words. As a result he was heard like a trumpet call, and people all round the world rallied to this brave new standard.

Quotations from Rousseau:

“Liberty, Equality and Fraternity.”

“It is the common people who make up the human race. What is not the common people is hardly worth considering.”