This blog is mainly about the governance and future of policing and crime services. (Police & Crime Commissioners feature quite a lot.) But there are also posts about the wider justice system. And because I am town councillor and political activist, local & national issues are covered a little, as well.

Tuesday, January 29, 2013

The Secret Diary of a PCC (Day 68): The (secret) plan!

Time is running out for me. The Chief Exec and Acting Chief Constable keep badgering me to write the blasted introduction to the police and crime plan. They keep saying, “this is your plan, you have to write some of it!” So I have been digging deep into my repertoire of handy phrases and waiting for the muse to grab me by the unmentionables. And then an old pal from college days turns up with his draft introduction to his clinical commissioning group plan. Dr Tim Slim sent me his draft for me to comment on. Not wishing to pass up such an opportunity, I am considering basing my own intro on his words. With a couple of tweaks, I reckon I could get away with it! Top shop what! Anyway, here is the original text before all the ‘policifying’ that I will need to do:

General Practitioners reduce ill health primarily by treating those who are unwell. However the requirement to reduce sickness is only part a doctor’s job. Parents, schools, the police, the magnificent pharmaceutical industry and wondrous private health care suppliers, community nit nurses and the overall Health Care System (HCS) all have a major role in the reduction of illness. Without their pro-active support, nasty bugs and really pesky bacteria cannot be reduced by general practitioners alone. We are all in this together, as it were, in a way, sort of, just about, maybe.

The majority of ill health that directly affects the public is caused by the excessive consumption of food. Too much of a good thing is always bad for you in my book. There are also hypochondriacs who are addicted seeing doctors. They too cause ill health by stopping properly ill people see their GPs. Food is the primary causes of ill health and general lack of well-being. Indeed domestic cooking also causes injuries sometimes.

Being overweight is also an indicator of class and deprivation as we all know. Much of this kind of ill health happens within the late night economy when people are having late night snacks and visiting the fridge too many times. 24/7 opening hours for supermarket establishments only make matters worse. Opening hours are within the remit of the Government. They have the responsibility to see that these establishments are properly run and are not the cause of ill health and anti-social obesity. GPs have the responsibility for preventing obese behaviour descending into really obese behaviour but our ability to do this is a last resort. Afterall the essential problem has been created by the people themselves. The amount of sugar and fat pumped into everything sold by supermarkets has nothing to do with the problem whatsoever, I will have you know. I believe in self-control. As GPs, we will be working closely with the Government to encourage them to use the powers open to them to control the late night eating economy and reduce ill health caused by excessive consumption of food. Fridges with time locks for particular over eaters is something I wish to explore.

Prolific and persistent over eaters cause the majority of ill health in Northfordwestshire area. Local doctors cannot really comprehend people who eat and drink so much because we only consume food and alcohol in moderation. We can do what we can to stop people eating but as soon as they leave our surgeries, they start doing it again. Making over eating illegal is probably not the way ahead. Although a limited experiment somewhere up North, perhaps in Scotland, might be worth a trial. It would have to be a randomised controlled trial of course so that we could prove whether making over eating illegal worked or not.

The rehabilitation of over eaters, whether in bed or outside on the streets is the key to reducing ill health. Nothing is more conducive to ill health than allowing persistent over eaters the chance to spend ‘their money’ on junk food. However, the prevention of large scale importation of transfatty acid thingummies into the UK lies to a great extent within the powers of UK Waistline Agency. Financial cuts in these areas merely cause much greater extra cost and increased ill health within the community.

The self-abuse by vulnerable overweight people can only be tackled effectively if Social Services and the public bring the abuse to the attention of doctors. Self-abuse is usually carefully hidden, and its reduction requires Social Services and the public to be aware of the problems and, when they occur, bring it to the attention of their GPs. It must not be hidden. Usually, by the time it has become apparent to doctors it has already caused considerable distress and major over eating has been committed.

Rural ill health amongst isolated overweight people is endemic. In the past the serious effects of this have been underestimated. It will now be tackled with the seriousness that the cost, both in financial and in personal terms, warrants. It is unacceptable to have overweight people living on rustic farms. The workers and contractors who support these vital communities need to be shown how to eat less.

An efficient GP service can only be effective in reducing ill health by the partnership of all, from the public to lots and lots of other people. As the local GP commissioner, I am committed to ensuring that all partners play their role in reducing in ill health. I will make this clear very publicly. Furthermore, where I believe partners are not playing their part, at whatever level of responsibility, I will take whatever action is open to me, including taking away their funding, making them do little embarrassing dances or writing 5000 lines “I must work harder to help GPs tackle over eating”. I believe in partnership working, even when it hurts.

Besides local ill health, I and the Chief Nurse of Northwestfordshire also have a responsibility for ensuring that sufficient capabilities are in place to respond to serious and cross-boundary over eating. We will support the work of national agencies such as the new National Agency for Getting Action on Large Overweight Tribes (NAGALOT). The national threats that doctors must address are over eating on a national scale, organised parties where there are too many tasty but ultimately far too calorific foods, public engorgement and cyber threats (such as websites dedicated to cooking with oil). They require a response that is rooted in local action by GPs, with local commissioning groups playing their part on the local, regional and national stage.

No matter how efficient and effective doctors and their partners are in reducing ill health, there will always be a few people who eat one too many packet of crisps. Therefore, there will be victims of overeating (such as people who have sit on buses next to overweight people) . We will be proactive in seeking out the views of the victims of overeating in the area so that I and my partners can respond appropriately. A policy on segregated bus seats for thin and overweight people is an option I am considering.

Lastly the good will and support of the public is essential to all aspects of healthcare. This requires doctors to be scrupulously clean, uncorrupted and to use their power with good jokes, grace, and skill.

This plan for reducing ill health in Northwestfordshire aims, with our many partners, to continue to reduce ill health and the causes of ill health (over eating) within our area, and to do so with the most efficient and effective use of the public money that is made available to us by our gracious and beneficent government.

The Diary until now:

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