Introduction

You can't avoid health news. Is the NHS failing or the best thing since sliced bread? And how much salt is in sliced bread anyway? And shouldn't we be off carbs altogether?  Is this latest wonder drug all its cracked up to be? You might not care if you're well, you might focus on the issues that are currently affecting you or you might obsess over every substance that might heal or harm you. Either way, you might find a story a little extreme in its viewpoint and appreciate a second opinion. You might wonder if an experiment in a petri-dish has any relevance whatsoever to you and your family. You might just want more and more health news. If so...

Welcome to the inaugural MediCave health blog. It's not going to make you well, but hopefully it will help you make sense of the barrage of health news we receive every day. I understand your frustration. On the same day a food or similar might reduce your risk of heart disease, increase your risk of cancer, be good for some people but bad for others. We might worry about ebola but hear nothing about hip fractures in the elderly. Your local hospital might hit its waiting time targets but have poor cancer diagnosis rates. Is it a good place to go? Do you have any choice anyway?

All of this is inseparable from politics. Each news outlet has its own agenda. Should adults be free to make their own choices (and mistakes) or is it up to the government to intervene and protect the people? Is the NHS a sacred institution or can the private system do better?

I should declare my position on this now. Everything I write will be a blend of my own opinion, prejudices and interpretation of the evidence. I would be described by many as more left-wing in my thinking. Although I grew up in a Tory stronghold, I've become increasingly aware of health and social inequalities as I've progressed in my training and career and feel it is the duty of all those in power to work to reduce these. Other news outlets may not be so honest in their motivations but know now that this will colour almost everything that I put out on this, my own personal blog.

I've been a doctor for over six years, including 14 months working in medicine and critical care in New Zealand, a year and a half training in anaesthesia and the rest in various medical specialities in England. I'm currently working as a locum doctor in various hospitals around the north west of England whilst undertaking research in public health policy. I write this whilst "working" at a motor racing circuit as a track doctor (my environmental credentials may leave a bit to be desired at times...). I hope to pursue a career in public health and work at altering local and national policy to improve the health and well-being of everyone in Britain and beyond. I am not an authority on any particular medical subject, but do have broad hospital experience and this has fuelled an interest in these issues.

So what can you expect from this blog? Well don't set your watch by it. I'll be posting as and when I have the time and I find something interesting to talk about. Don't expect it to be as serious as this post. I hope you'll find it amusing and entertaining, as well as informative. I hope it will be interactive - feel free to ask any questions by email and twitter. I'll talk about documentaries, books, radio and TV shows, news stories and twitter feeds, basically anything that interests me and might interest you.

More excitingly, it will be aural. Coming soon will be Matt and Dave's MediCave podcast with me and some of my colleagues and friends. This will include a light-hearted look at the week's health news, our own take on other relevant issues and some stuff that has nothing to do with health at all but interests us. This podcast will happen once I sell some Xbox games and buy a microphone. That's the level we're at people.

Please check back, subscribe, read, listen to the podcasts, contact us. Please don't follow our advice too literally or be offended if we disagree with something your paper has printed. Please don't sue us, we're still paying off our student loans.

Many thanks,

Dr Matthew Atkinson MBChB, BSc (hons),

From now on, just Matt.

Hospital Parking

There's been a bit about hospital parking for visitors and patients. I agree that some of the fees are extortionate and should be reviewed. I'm not sure it should be free though.
http://www.bbc.co.uk/news/uk-28905695

I want to talk about hospital parking for staff though. Anyone who works in a hospital will know that this can be a major headache. It either takes weeks to get a staff permit, or you get turned down, or it's crazy expensive. Or it's fine, maybe.

Despite my love of motorsport and fast cars (ones I would like to own, rather than ones I do own), I am a supporter of sustainable transport. There are proven health problems associated with air pollution and benefits to exercise so I think we should all make an effort if we can. Global warming is going to affect the health and wellbeing of the world's people.  Not to come over all pius but I do commute by public transport when I can, either by bus or train and cycle. The hospitals I work at are making efforts in helping cyclists get to work, in the form of safe cycle storage, showers and changing facilities. They are all serviced by buses in some way or other.

There was a study in last week's BMJ (now called thebmj in a reverse the facebook to just facebook branding exercise), which showed that those that commute by walking and cycling or using public transport  had a lower body mass index and percentage body fat than those that use their cars. So maybe hospitals should get rid of staff car parking for those who live nearby or can get public transport.
http://www.bmj.com/content/349/bmj.g4887

Sometimes, however, you just need your car. Shift workers may not feel safe arriving and leaving in the dark by public transport. Sometimes the weather's awful or you've got a load of paperwork to bring in and sometimes you just can't be arsed. On those days, you need somewhere to park.

Generally, this means a staff parking permit. This tends to be a fixed monthly amount taken from your wages and proportional to your salary. So far, so fair.

But what if you only need your car twice a month? Your per-visit price would then be quite high. You've paid that set amount, you might as well get your money's worth. So you drive more often and we all miss out on the benefits of public transport.

I've heard this argument before in relation to other one-off fees such as car tax. Once you've paid it, then your cost per additional journey (or car park use) is zero, so fill your boots.

So what's the alternative? The single day parking price at my most recent hospital is £8. Two night shifts and you might as well pay monthly.

I would say is that the alternative is a reduced per-visit rate for staff. This would encourage other forms of transport without excessive punishment of those who use their car from time to time. You could retain a monthly price for those who need to use their car every day.

Is this viable for trusts? Many now farm out their parking to external companies and rely on the income that this brings in to subsidise some of their loss making activities, like providing emergency care to sick patients. But surely there's a way of structuring the pay as you go payments so they don't lose too much money, whilst making public transport a more attractive option to staff.

We already have staff smoking cessation programmes and other initiatives, such as subsidized gyms. We owe it to the staff who give so much to the hospital to make sure they stay healthy. The health system's biggest asset is those working within it.