Elderly manMany years ago I got into a spat with a director of social work in Scotland about the cut-off age for a council’s older people’s strategy.

She was adamant that it had to be for everyone aged over 50. I demurred. ‘It’s too young,’ I piped up from the sidelines – but to no effect.

Today I saw an older people’s forum advertised in leafy Buckinghamshire, 500 miles and one Act of devolution away from where I live – again for anyone aged over 50.

It seems that the definition of older as 50-plus is near universal, at least in the UK and amongst those who purport to promote the interests of and support older people.

But most people are

  • living longer
  • staying healthier longer
  • retiring later, currently 65 (for men – women are ‘catching up’) and rising.

So how come this obsession with older = 50, fifteen years before most people retire? Can anyone enlighten me?

This is a serious question. Does the cut-off have any standing in law? Is there scientific or medical evidence that this is the age at which people really do become ‘older’? Or is the assumption just a lazy carry-over from the past that is never reviewed?

Answers on a (virtual) post card to the HelpGov blog please.

This post began as a jokey exchange on Twitter. As part of confirmation that he was taking part in Movember, someone I follow tweeted a link to the UK government’s NHS Direct web site and a ‘checker’ there on Male sexual health.

The principle seemed sensible

If you would like confidential advice about a sexual health problem, you’re in the right place. There’s no need to feel embarrassed or shy if you are concerned about a sexual health issue.

I thought I’d give it a try – and to forestall inappropriate comment, no, I don’t have a ‘sexual health issue.’ I’m interested in government web sites – honest, officer.

Click through to the next step on this helpful ‘checker’ and you’re asked

Before continuing with this health and symptom checker you need to make sure that the person is conscious and reacting to you normally, or if they are asleep, that they react to gentle shaking.

What?! I’m about to check my sexual health and I’m unconscious or asleep?

The next pages ask for my age and where I live. Fair enough.

Then, straight down to business in the next page with the first question – those of a delicate disposition turn away now

Have you been bleeding from your genital area in the last 6 hours?

Whoa, steady on, I thought this was about ‘male sexual health.’ This seems like getting down to business just a tad too soon.

For the sake of research I answered ‘No.’ That took me through to a page giving me twelve further options – none of them implying good news.

If you want to see a better – no, a brilliant – government web site check out GOV.UK, the UK government’s new site that’s supposed eventually to incorporate all their other current sites.

The contrast with NHS Direct couldn’t be greater

  • Clear simple layout and graphics – unlike the dense clutter of NHS Direct
  • The things most people want to know about each subject highlighted in clear language – I cannot believe that most men looking for information on sexual health need as their first port of call a  shock-horror question about whether they’ve been bleeding from their ‘genital area,’ and not only bleeding but within the last six hours. If they’re not unconscious before they read that they might be after.

In fact the NHS Direct pages would more honestly be headed ‘Do you have a serious sexual problem?’ They’re all about sickness, not health.

UK health aficionados will know that NHS Direct covers England only. It advises Scots, correctly, to visit their own NHS 24 site for advice. But before the Scottish NHS get too smug about how they’re doing, a search for ‘male sexual health’ there throws up no fewer than 175 links. On the first page of ten, not one is to do with male sexual health. So a big fail there too.

I can now add abhorrence of NHS web sites to my phobia of what I’ve called elsewhere the  NHS’s ‘disease of poster-itis and advanced leaflet syndrome.’

When I worked for our local council I had a lot of contact with NHS colleagues, many of whom referred to our main hospital in the North East of Scotland as ‘the factory.’

The reason was clear.

It’s big, with major investment in recent years going into a new children’s hospital on the site and, currently, new A&E facilities. It’s also partly replaced the traditional lower tier of local community hospitals that most rural areas once had.

As a patient it can seem impersonal – buildings of different ages linked by interminable corridors, at the right time of day what seem like crowds of staff, patients and visitors surging back and forth, navigation by coloured lines painted on floors or walls, a shopping parade at the main entrance, in places a shabby and unkempt look that at best leads you to hope the money’s going into improved medical practice, the proliferation of ‘information’ that on other occasions I’ve called the NHS’s ‘disease of poster-itis and advanced leaflet syndrome.’ And don’t mention the car parking.

The counter to this moan of course is the service it provides, and on three recent occasions – a diagnose of a neurological problem, the emergency admission of a family member with appendicitis, and an A&E visit of another family member with a broken wrist – I’ve had reason to be grateful for the service the hospital provides.

The use by NHS managers of the slightly disparaging term ‘factory’ went along with a drive to get minor surgery and diagnostic procedures devolved to more local facilities – the community hospitals that remained and GP surgeries, where necessary upgraded.

The irony of this otherwise worthwhile aim is that it has actually led at the lowest level to a concentration of facilities, the de-personalisation of services, and the creation of what you might call mini-factories.

The fate of my own local GP surgery, once known to all and sundry as ‘Dr X’s practice’ is a case in point, Dr X being a much-respected middle-aged woman known for both her sympathy and wisdom.

Her surgery and another over a mile away in the city have been combined in a new building into a much larger practice.

The practice doesn’t have its own web site and two of the four links about it on the NHS Grampian web site are broken. The other two take you to an outdated page about the construction of the building (two years ago) and a general page about ‘how to get involved’ in the NHS.

According to other web sites (Aberdeen City Council and Grampian CareData) either seven or eight GPs practice there. I thought I’d seen nine listed a while ago but I could be wrong. It is not clear who is in charge:  my assumption is that all the medics are now NHS employees. There is a ‘practice manager’ who I would guess is an administrator and manages ancillary staff but certainly won’t be telling the doctors what to do.

This is how the average contact works.

  • Phone the practice’s 0845 number
  • Select option from list given by recorded voice
  • Wait an indeterminate time while music plays
  • Make request of person answering – for non-urgent appointments with both a GP and a nurse I have been offered dates a fortnight away, ‘nothing earlier is available although you could try phoning to see if there’s a cancellation.’ The standard appointment is seven minutes long but if you make a case for a specific purpose you may be offered a ’20 minute appointment’
  • On arrival wait at reception area with c. 20 seats, listening perhaps to the local commercial radio station which no one has been asked if they want streamed into the building. If desperate browse the available leaflets (see ‘advanced leaflet syndrome’ above)
  • If you’re lucky the GP/nurse will come to get you for your appointment, otherwise a voice on an intercom will direct you to the appropriate room

Now, I may be naïve about why this has to happen. And I’m not having a go at the people who work in this system or at the quality of medical care (eventually) available. But tell me, has the service got better and is this anything other than another factory?

Great headline in my local paper today, the esteemed Aberdeen Press and Journal:

Study shows risk of dying doubles.

So that would be doubled from 100% would it?

The text of the article compounds the error:

Scientists in the US found that “feeling lonely” almost doubled the risk of dying in a population of 1,600 older individuals.

Of course, what it really means is that at any given age loneliness can almost double the risk of dying.  At the end of the day the grim reaper gets us all.

It reminded me of a diagnosis I once had of a (not actually too serious) medical problem.  The first medic, a rather gloomy registrar volunteered ‘You have an irreversible degenerative disease, Mr White.’  When I retailed this to the head honcho, a neurologist, he added the helpful corrective – ‘Yes. We all have an irreversible degenerative disease.  It’s called life.  And what’s more it’s sexually transmitted.’

A while ago I blogged on Computers may rule but we still need people.

It was a short post responding to a statement by an IT whizz that

We are at a very interesting point in terms of the products we can make…Anything we can imagine we can build, we are no longer really limited by the technology

I listed some of the things that a supposed new computer might do including

strok[ing] the hand of an elderly dying woman in a council care home and assur[ing] her that her absent daughter loves her.

but what I was really saying was that these were some of the fantastic things our public sector staff do and a machine could never replace.

Today the wonderful world of the web brings me news of engineer-artist Dan Chen’s idea for an End Of Life Care Machine –

Watch it with grim horror.  I’m sure Dan’s making an ironic point about the care of the dying in society, but you never know…

Thanks to FastCompany for alerting me to this.

I can write this because D2* was a meat eater until she turned ten then, prompted by a cousin but with a good deal of serious thought, became a vegetarian.  Last year she spent a semester – that’s right, she’s a student – in Canada and returned a vegan.  She will forgive me if I use her as a hook for this Blog Action Day 2011 post (you can also find other contributors’ efforts through the Twitter hashtag #BAD11).

Having a vegetarian and then a vegan in the family has been a challenge that’s expanded my culinary repertoire in ways I didn’t expect and led to some interesting incidents over the years.

Here are the upsides and downsides from this amateur foodie of the three ways of eating (and cooking).

Meat (and fish) eater

Looking good

  • Why not?  Humans are naturally omnivores – this is arguably our most ‘balanced’ diet
  • Widest range of taste sensations – nothing beats the smell and taste of sizzling bacon
  • It doesn’t mean only eat meat and fish – you can tuck into those wonderful veggies and fruit too
  • Least hassle – you can find something to eat wherever you go

Not so hot

  • Watch out for the more processed products – the cured meats, sausages and patés.  Some unhealthy stuff may lurk in there
  • Most likely to plunder the planet for all that protein – whether it’s feeding the domesticated beasts before we eat them or hunting the wild ones almost to extinction
  • Most expensive – in money for us, in cost for the environment


Looking good

  • Animals don’t get bumped off directly to feed you
  • Some wonderful vegetarian recipes and restaurants out there
  • Cheaper – meat and fish are expensive
  • If you’re ethically minded you’ll feel better for that reason alone
  • Less chance of putting on weight from all that animal protein and fat

Not so hot

  • Friends – get used to meat eaters sniping at your diet.  Decide whether it’s something you’re going to debate or not
  • Be aware the concept of food without animal products is barely understood in some countries.  Chances are that in Spain ‘Ensalada mixta, por favour. Pero no carne o pescado’  (‘Mixed salad please.  But no meat or fish in it’) will still arrive with a glob of tinned tuna on top
  • Watch out for the vitamins and other good stuff like iron in meat and fish and make sure you still get them through your choice of vegetables and fruit.  Top up with dietary supplements if necessary


Looking good

  • Arguably the most ethical diet – dairy products may not kill animals directly but there’s a whole industry out there where they get bumped off as a direct result and often live in confined un-natural conditions
  • Some unexpectedly great cake recipes
  • Plus – the other benefits of being a veggie

Not so hot

  • Hard work. Goodbye all animal products.  Goodbye honey.  Goodbye leather belts and shoes
  • Get ready to search for substitutes for things like eggs to make those wonderful cakes rise
  • People – if your carnivorous friends had a go at you because you were veggie, stand by for the mickey taking when you go vegan
  • Eating out – in many countries get ready to negotiate around the one vegetarian dish on the menu to get the cheese taken out.  Resign yourself to more risotto than you’ve ever eaten before
  • If you thought being a vegetarian needed attention to a balanced diet and the possible need for dietary supplements, don’t forget being a vegan is even more challenging.

PS – D2 has just told me that she became vegan exactly a year ago today, Blog Action Day.

* – regular readers will know that D1, D2 and D3 are my three daughters

This post is my response to Blog Action Day 2011 on the subject of Food.  Regular readers wondering what it’s got to do with helping the public sector improve its performance will be disappointed.  But I  did warn them when I started the HelpGov blog that there’d be the occasional random post

I was saddened to discover a new report that needs, more than most, to practice what it preaches, the Scottish Government’s Principles of Inclusive Communication: An information and self-assessment tool for public authorities.

Alas, it doesn’t.

It’s written by

members from the Independent Living in Scotland Programme partnership, Disabled People’s Organisations and other representatives from the public sector and third sector, in co-production with the Improvement Service

That mouthful may be a clue why what should be a winning race horse looks distinctly like a camel.

First, the title, which neither explains what the report is about and is full of jargon like principle, inclusive, self-assessment and tool.  Further unnecessary jargon is scattered throughout the report.

Second, it addresses its audience inconsistently, mostly in the third person (“it”, “they”) and only  occasionally in the much more direct and effective second person (“you”).

Third, it uses too many words.  The statement ‘To ensure you can provide communication accessible services, it is good practice to allow time to arrange different formats or communication support depending on the needs of your audience’ appears in a list of good practice examples.  All the words in my italics are redundant.  There are many other examples.

Fourth, some statements are just plain wrong.  Quality service delivery is not ‘when the service provider and person who uses the service understand each other, and the person who is using the service is able to express their needs and choices effectively’.  Quality service delivery is when a good service is provided.

Fifth, typos have escaped any proof reading that has been done – for example, ‘one system will not meet the needs of the all the people who use services’.

Lastly for the purposes of this post, although there are other comments that could be made, the ten performance indicators appended to the report merit a small essay in themselves.  Suffice it to say here that many only record levels of activity and some are contradictory, for example expecting an improvement every year in a visible and public commitment of support by senior managers.

Lurking at the heart of the report are six excellent albeit poorly-expressed principles and some valuable good practice examples – which should have  more prominence than they do.  Unfortunately all its other limitations are likely to mean the leaders and senior managers it is aimed at will pass it straight to the equalities officer and (in councils) the social work service.

A not untypical report produced by a committee and a missed opportunity.