Ups and downs in 2013 - Health care reforms go on

I've just made a start on my new year resolutions. They aren't all fully formed yet, but at least this one has begun.
I've been on my last football tournament, I think. It was in Zagreb and resulted in the usual outcome. But I never really went for the outcome anyway. I went for the journey, and the taking part. In recent years the taking part has become less and less interesting as it seems fewer and fewer have the necessary personality to keep me amused. The other reason, of course, is that I need to spend my holiday times with my grandson, Lucas.
Lucas is here right now, with Emily, spending Christmas in manchester and the New Year in London. As I write she is entertaining her friends downstairs, each with their own one to five year olds. The house will be a mess of course, but then who cares. Yesterday we gathered for the annual meeting of the Benetts. This year in Huddersfield at Woodsome Hall golf club. It's an old stately home converted into a club house. It's good all round and everyone can catch up without being overwhelmed. There are always a few new faces and I'm never sure if they'll be there next year. Christmas itself was the usual joyful occasion with food and drink and merriment, and everyone loved seeing Em and Lucas. Lucas is big boy now and can clearly make himself understood - 'my turn now' and 'more'.

In my work 2013 has been quite remarkable. I am now officially Clinical Director for the commissioning group and also one of the Primary Care Champions for the Greater Manchester health reform programme. Although this involves a wide breadth of change, my involvement is in the GP side of it. This has involved speaking at great meetings, appearing on TV and radio, and incurring the displeasure of many of my colleagues. I have spoken briefly of meeting the Prime Minister. I also spoke at a National congress on 7 day working. I met there and was chatting to the chief executive of the NHS and the Chief Medical Officer. The main issue is to extend GP opening hours to make Primary Care easier for people to access and see their GP, rather than go to the accident department. Many of my colleagues think this is pandering to consumerism. Well it may be, but it is them who pay for the service. Some even accuse me of being 'politically driven'. They have so far failed to explain how that can be, but they seem very exercised by the proposition. The 'anonymous' comments in Pulse magazine reflecting the more extreme of the views put to me and about me. Still, I'm proud that in Central Manchester we're leading the way and are amongst the first to offer appointment up until 8pm during the week and also appointments at weekends.

At a more specialist level, I had a running and public debate with local cardiologists about whether cholesterol was important in preventing heart disease, or whether it is the treatment with statins that is the important factors. Without going into technical detail, the American Heart Association and American College of Cardiology, no less, have come out on my side! I've also recently finished off the new NICE update on post-myocardial infarction management. Since then I've been asked to write several articles for various journals. Loving it.
On a routine basis, I am thoroughly enjoying the new distribution of work time, and the 'new' practice at the Range is proving to be brilliant. It's good to be valued and appreciated. I don't have the burden of practice menagement and can get on with writing and service reform. Many of my old patient still remain faithful, although I'm able to see them less often myself.

My own time outside work is spent thinking about family issues, and planning when I can see Lucas. A major development has been to help Rachel buy a house in Crystal Palace. It's small but it has a garden and it's a start. Jonny is doing great stuff in his teach first course. I gather he's doing particularly well in class control and always gets good reports. What a star.
Lizzie went over to America to be a nanny. When I was last in America a few weeks ago, I went over with Emily to see her. She was staying with a family in Cleveland Ohio. When we got there it turns out she wasn't very happy there. The family were treating her little better than a servant, undermining her, and speaking badly about her to baby sitters and others.

So we brought her home - yeah!

What of the New Year resolution. Well one of them is to start running again. Sure enough earlier today I went for a run. It's not a long run but I nearly died! At least its a start. I hope I can do this at least once a week. We'll see

Meeting the Prime Minister of Britain

'It'll be all over in a flash', I thought, as we waited to hear when they would arrive. The whole meeting had been thought of, set up and actioned within the previous 24 hours. Ian had said 'We are going to be visited by a "very senior" politician', and winker so I knew he meant The very senior politician, the first amongst equals. 'He wants to visit a practice'. 'Ok I'll ask Colin' I replied, and it all snowballed after that...and if you're reading this now, you'll have to wait to see what happened when I finish this later today

The Old Man of Coniston

'We'll get up early and go to the Lakes'. That's what we said to ourselves on Friday night anyway. Of course we didn't get up early, but we did go to the Lakes. To Coniston and for a walk around 'the Old Man'. The was a slight delay when we got there, a slight diversion to take in a huge 'mountaineer' breakfast. 'It's five hours up and down' the lady in the tourist centre said

I haven't written about recent developments have I? I was on the BBC evening news a couple of weeks ago, broadcast all over the country and the world. In recent months, building up over recent years, people have been going to A&E more and more. It started in 2004, coinciding with GPs opting our of 24 hour care. The correlation is quite startling, but GPs wont accept it. Anyway, there was a piece about people queueing up in A&E. My 15 seconds of fame was about what response we could give, as commissioning groups, to the apparently ever rising demand on acute services. So there you are, a new media career beckons. I'm meeting the ITV journalists next week, and also filming a piece about 'the Healthier Together' programme of modernising the health service in Greater Manchester.

'The Old Man is the highest point in historical Lancashire, though following the 1974 revision of county boundaries in England it now lies, for administrative purposes, within Cumbria. This assertion rests upon it being higher than its near northern neighbour, Swirl How. There appears to be some doubt in the current literature over whether the height of Swirl How is 802 or 804 m, following resurveying. If modern measurement has not added 2 m to its rival then The Old Man of Coniston is the highest point in the Furness Fells, and the twelfth most prominent mountain in England'

Lizzie went to America to be an aupair a few weeks ago. For some reason I'm more worried about her than I was of Emily. Skype is a great thing, and the few exchanges I've had with her have been very reassuring. Also her facebook pictures tell a good story. She says the family are great and the two children seem really lovely. The woman is a urologist, and he owns restuarants, I think. They live in Cleveland Ohio and they have a house in Miami...must go and visit.

Emily sent a short video of Lucas hoovering the front room. Hilarious. I'm going to see them all in November for a couple of weeks and take in Thanksgiving in America.

'At the summit of the fell there is a unique combination of a slate platform and cairn. The extensive view from the summit on a clear day includes much of the southern Lake District, Morecambe Bay, Blackpool Tower, Winter Hill, the Lancashire coast and the Isle of Man.'

Getting to the top is hard enough but getting down is worse. Going up was steep and windy, but at least the wind blew you up hill. Coming down is slippery on the loose shale, and puts a real pressure on ones already painful knees. We did smile, exchanging banter with climbers going the other way. 'Hope you get up before sundown' and 'what a funny place to have a pub'. Oh how we chuckled.

Talking of which I have officially hung up my boots. No more touring for me. The personalities and characters no longer go and I can't be bothered with their weak banter. This most recent tour was to Zagreb. We lost every game again, but that's not the point. There was also a massive falling out. Besides my knees are so painful in the mornings after that I really think my footballing days are over. Besides I have my media career to consider now. Quit while you're at the top, they say. My top was sometime ago I think. Probably our Portland trip, about ten years ago, was when I was at my best. Ah, happy days.

We did get down from the Old Man eventually, but had to be rescued by car, after taking a wrong turn. There have been several turns recently but I think all of them good. It's also been just over a year since I changed practice. It's good to be somewhere where I'm valued and respected. I can't wait for my next Turn on TV.

Newport, Rhode Island gets 5 stars

I'm going to give Newport RI the full 5 stars. We decided to spend the night in Newport after going for a wonderful lunch overlooking the harbour. If ever a town epitomised East Coast opulence it is here. The buildings are perfectly formed in typical New England style and everywhere is clean. The town itself is like a picture book model town only full size. Everywhere is immaculate. Further into Rhode Island are the Newport Mansions. I think the only place I have visited where people lived on a grander scale is Versailles. We visited the Breakers. If ever a place represented the aspirations of the American Capitalists to emulate and become part of European aristocracy, this is it. The house was conceived funded and built by Cornelius Vanderbilt, who had made his wealth from the railways.

The Breakers is the architectural and social archetype of the "Gilded Age," a period when members of the Vanderbilt family were among the major industrialists of America. Indeed, "if the Gilded Age were to be summed up by a single house, that house would have to be The Breakers." In 1895, the year of its completion, The Breakers was the largest, most opulent house in the Newport area. It represents the taste of an American upper class—socially ambitious but lacking a noble pedigree—whose determination to imitate and surpass the European aristocracy in lifestyle; a taste and ambition which was cynically noted by many members of the European upper-classes. However, this cynicism, coupled with assumptions of vulgarity, was not so deeply rooted that it prevented the daughters of these lavish houses and their associated dollars marrying into the European aristocracy. Gladys, the youngest daughter married a Hungarian Count and with it added the title to the Vanderbilt family.
Cornelius himself only lived in the house a few months. He died from a cerebral hemorrhage caused by a second stroke in 1899 at the age of 55. The Breakers was left to his wife Alice, who outlived her husband by 35 years and died at the age of 89 in 1934. She, in turn, left the building to her youngest daughter, Countess Gladys Széchenyi. None of Alice's other children were interested in the property while Gladys had always loved the estate.
In 1948, Gladys leased the high-maintenance property to the non-profit Preservation Society of Newport County for $1 a year. The Society bought the Breakers in 1972 for $365,000 from Countess Sylvia Szapary, the daughter of Gladys. However, the agreement with the Society allows the family to continue to live on the third floor, which is not open to the public. Countess Sylvia lived there part-time until her death on March 1, 1998. Gladys and Paul Szapary, Sylvia's children, continue to spend summers at the house. Although the mansion is owned by the Society, the original furnishings displayed throughout the house are still owned by the family. It is now the most-visited attraction in Rhode Island with approximately 300,000 visitors annually and is open year-round for tours. The sumptuous decoration and attention to detail is well worth seeing. It seems that no expense was spared. The electric chandeliers had back up gas lighting in case of electrical failure.

This place is just of a different age, and politacally and socially anachronistic. But for me it is nevertheless, beautiful.

Four go to Mystic

Yesterday we drove along the coast the Mystic. It's the weekend and I've been with Emily, Sean and Lucas since Wednesday. I'm staying with them in Stamford and mainly just spending time. It almost seems unnecessary to say that I am having a wonderful time, just doing ordinary things. One day we went to the Mall, another day Lucas had a friend come round for a couple of hours. On Friday night a baby sitter came round and we went out for a meal. 'Mystic is a village in New London County, Connecticut, in the United States. The population was 4,205 at the 2010 census. A historic locality, Mystic has no independent government because it is not a legally recognised municipality. Rather, Mystic is located within the towns of Groton (west of the Mystic River, and also known as West Mystic) and Stonington (east of the Mystic River).' The weather hasn't helped. Emily and I looked out of the window on Friday morning. 'Looks just like Manchester' we thought. 'Perhaps we'll brave the rain and wind and go to a park'. It was just a bit too cold for that. Later that evening on the TV the news was of terrible weather affecting the Eastern sea board, with flash backs to hurricane Sandra or Sarah or something, which had caused so much damage recently. Still the forecast for the weekend is good. Goodish. Emily has started this baby sitter exchange, where like minded mothers, four at present, have seven cloths pegs. The idea is that you barter them against baby sitting exchanges. Very 'Chorlton', but then Emily is a Chorlton girl. It's only just started. Emily is down to five clothes pegs. She wants to start up a business where pre-school children come to her to look after and be taught on the 'British curriculum'. The Yanks love that sort of thing, especially here in New England. Everywhere seems to have some sort of connection to England. So yesterday, Saturday, we set off to Mystic. It was a two hour drive up the coast, well east along the coast really. There was still a nip in the air, but the sun was peaking through. I optimistically put my shorts  and flip-flops on and took Lucas for a walk. 3 degrees outside. I came back in a put a jumper on, confident that it would warm up. It did. Just a bit. Just enough for me to keep them on. Sean too felt confident about the weekend weather and both of us wore shorts, T-shirt and flip-flops. Emily was a bit more cautious. Luckily. Connecticut is called the 'constitution state' because it was the first of the American colonies to have a constitution in writing. It played a key part in the 'Declaration of Independence'. 'Historically a leading seaport of the area, the story of Mystic's nautical connection is told at Mystic Seaport, the nation's largest maritime museum, which has preserved a number of sailing ships (most notably the whale ship Charles W. Morgan) and seaport buildings. The village is located on the Mystic River, which flows into Long Island Sound.' We're staying at the Mystic Marriott, of course. Sean emphasises the 'ot' of Marriott, whereas we tend to let it stop abruptly. Apart from the 'Historic Seaport' there's not a lot to do in Mystic. We got into the seaport for free as Emily is a teacher. She has a certificate and everything. The reason is not that they particularly like teachers, but that they will make notes and plan for a day trip to the place with their class. The place is quite enchanting and the volunteers try to bring it to life. There was an exchange of signs between boats. One of them had had a 'man over board' and was asking for help. Fortunately they weren't dressed in period clothes. The houses are mainly colonial style and wooden. we gave the planetarium a miss. No-one else was wearing shorts and flip-flops 'Before the 17th century, the Pequot people had established an empire across southeastern Connecticut. For many years, historians believed that they migrated in the 16th century from eastern New York. Archaeological evidence showing the presence of a people who lived in an area called Gungywump, somewhat northwest of the Mystic River, now suggests that the Pequot were indigenous to southeastern Connecticut. The Pequot built their first village overlooking the western bank of the Mystic River, called Siccanemos, in 1665. By that time, the Pequot were in control of a considerable amount of territory, extending toward the Pawcatuck River to the east and the Connecticut River to the west, providing them with full access to the waters. They also had supremacy over some of the most strategically located terrain. To the northwest, the Five Nations of the Iroquois dominated the land linked by the Great Lakes and the Hudson River, allowing for trading to occur between the Iroquois Nations and the Dutch. The Pequot were settled just distant enough to be secure from any danger that the Iroquois posed.' Back at the hotel we decided to try out the pool and spa. I put on my speedos. Proper speedos aren't allowed in America. At least they cause extreme embarrassment to those accompanying people wearing speedos. My speedos are actually swimming shorts. Lucas is now 18 months, but hasn't yet had much exposure to water. He wasn't keen, but we managed to persuade him in so long as he grabbed his mum tightly. At one point, as I decided to show him how much fun it is in water, I pretended that I had been thrown underwater. He burst into tears and scolded his father for splashing me. He'll need to get back into the water soon or he'll develop a phobia. The Mystic massacre - You wont be surprised to hear the the history of this place is includes much blood shed, as English, Dutch and Native tribes strove for supremacy. In May 1637, captains John Underhill and John Mason led a mission through Narragansett land along with their allies. The Narragansett and Mohegan joined them, along with the Uncas and Wequash. They struck the Pequot settlement in Mystic. The settlement, mostly of women and children, was decimated. Mason set fire to eighty homes, killing 600–700 Pequot in an hour.   Captain John Underhill, one of the English commanders, later recalled 'Down fell men, women, and children. Those that 'scaped us, fell into the hands of the Indians that were in the rear of us. Not above five of them 'scaped out of our hands. Our Indians came us and greatly admired the manner of Englishmen's fight, but cried "Mach it, mach it!"—that is, "It is naught, it is naught, because it is too furious, and slays too many men." Great and doleful was the bloody sight to the view of young soldiers that never had been in war, to see so many souls lie gasping on the ground, so thick, in some places, that you could hardly pass along.'  Mystic is such a beatiful name, and in such a beautiful land, yet has such a brutal past. It was, of course made famous by the film starring Julia Roberts. Although there's not a lot to do, it is one of the most beautiful towns I've been to. Clean, bright, and quiet. No town centre drunks here. I think the ugly people get sent somewhere else. Wherever I go I like to get a mug. It helps me recall my visit there when I have tea or coffee. There is a chain in New England called 'Black Dog' named after the founders dog, who was black. It sells an odd range of things including doggy things, sounvenirs of the area, and even a cook book. How odd. So I bought a black dog mug with Mystic on the side. It may not be heaven itself, but I think heaven might look a bit like Mystic. I wonder why it's called 'Mystic'?

What I said to the Secretary of State for Health

I stepped up to take my place on the panel. He extended his hand and said 'Hello'.

I had been asked to take part in an 'Any Qustions' discussion at the launch of Dementia Awareness in the North West. The SoS was up and due to attend the meeting at the Manchester Royal Infirmary. The hospital seems to have several names now including the Central Manchester Foundation Trust, or Central Manchester University Hospitals. To me they'll always be the MRI, St Mary's, Royal Eye hospital and Dental Hospital.

My new career as Clinical Director and working at my new practice is turning out to be great. I couldn't have planned the change to have a better outcome. They really appreciate me, which is great. I'm just sorry it had to come about in such a way. Anyway, I'm not allowed to go into details on public media about the break up from my practice.

A week or so earlier I'd been invited to a CMFT governors meeting where I was to present the Clinical Commissioning Group work plan, and how we we're all beginning to work together better for the benefit of our patients. It is actually true. I think we are. We've all realised we're on the same side. They're success is our success, and our failure is their failure. This includes the local authority.

So before the governors meeting there was a bit of food and networking. I gravitated to people I knew, of course. One of them was Lawrence, my cardiology mentor. Talking to him was one of my favourite, now retired, consultants and former Medical Director. He was always the sweetest of consultants even though he was also one of the most pioneering in the hospital. I talked about being a student on his unit and then later a junior doctor. He vaguely remembered me but wasn't sure, and definitely wouldn't have put a name to me. As I edged towards someone else to talk to, he said 'so was I alright then, as a teacher?'. 'You were [pause] alright' I replied. They both laughed. 'You asked for that' Lawrence chuckled, but we all knew that I joked out of huge respect.

The talk to the governors went well I think. I told how we had reduced urgent care activity and that referrals were being managed much better. We all want to reduce secondary care activity by investing in community and primary care services, so that we can afford the specialist services CMFT offers. Our CCG  is uniquely placed to be able to do this as CMFT don't have a stake in filling up their beds with secondary care activity, and we all have a stake in keeping these people well and at home. Our incentives are aligned, as they say. Sadly I fear other hospitals are not in as good a position.

So one of the joint projects we have with them and the city council is to focus on integrated working. In particular integrating care for frail older people, many of whom have dementia. In other words their brains are starting to function less well, often at the same time as other organs are wearing out too. So that's why I was at the Dementia Awareness Launch day.

We'd all gathered in the Jefferson library. The minister was running late. Eventually a murmuring announced that he had arrived and was downstairs meeting the important people. We took our places in the lecture hall. I sat near the front so as to access the panel when called upon.

The SoS was taller than I expected and very 'public school'. He was also brighter than I expected and gave a short but well researched speech. This had not been crafted by a speech maker, he was reading off notes he'd obviously written himself. Then he and the other speakers took their place on the panel. I stepped forward, having not been introduced to him before and not given a talk. This was my chance.

'Hello' he said and shook my hand. 'Hello' I replied once he'd been told who I was, and took my place next to him at the table. I took a few questions and answered them rather well, I thought. Then he was whisked away. We shared no more words. I wonder if he'll remember our brief exchange.