This could be Ellesmere, or anywhere.

I've been working in Ellesmere Port this week. If you've never been, it's a northern industrial town on the banks of the Manchester Ship Canal and has kept itself busy producing chemicals, refining oil and building Vauxhall Astras. But its high street, Whitby Road, looks like many other roads in less affluent parts of the UK. When walking to work from the train station, I was struck by a feeling that this was not a street designed to improve your wellbeing. There are other streets, of course, as well as out-of-town arcades, shopping centres and supermarkets, but I wasn't there, I was here.

An air quality display in front of a pawnbroker and takeaways.

Due to train scheduling, I had 45 minutes to do a 20 minute walk this morning. I decided, as I'm sure many of you would, to categorize every building along the main, built-up section of the street and then turn this into a pie-chart. I've never really made a 3D pie-chart with pulled out segments as if I was giving a key-note speech so this seemed particularly appealing.

The results are below. It's not very (at all) scientific. I didn't document or publish my aims and methods before setting off, though I did come up with the categories on the train in advance. There were some tricky businesses selling multiple classes of goods and services (there was a company that would do you a loan, book you a taxi or a sell you a refurbished washing machine that I struggled to place...). I'm not sure that I could reproduce my findings, never mind anyone else. Some of the vacant buildings did have people working on them or 'coming soon' signs but I kept them as vacant. There was a Blockbuster that I may have put as retail, when it could have been a service but then I remembered that it has actually gone into administration so I'm pretty sure it went to the vacant category.

Anyhow, minor errors aside, you'll see that there a quite a few businesses here that do not have the health of Ellesmere Port's people as their first concern. There are quite a few pawn shops and short term loan companies, which might be profiting from people's financial difficulties. Once you've got your loan, you can promptly lose it at a range of bookmakers, amusement arcades and bingo halls. It is much easier to spend your money on cigarettes, alcohol or fast-food than anything healthy. I tried to find an apple on my way to the station yesterday evening. I had to settle for an Apple Tango.

The food shops include an Iceland supermarket. This does offer some vegetables and I'm sure you could craft some healthier meals from its wares but looking at this site - http://www.iceland.co.uk/amazing-iceland-value/ - I suspect that it would be easier not to. The other is a Polish shop called Baltic Store. I had to give this place the benefit of the doubt as it wasn't open when I went past. The Apple Tango came from an off-license with a few groceries but the only fresh veg was some green potatoes.

The takeaways ranged from fried chicken to pizzas, to kebabs and burgers and fish & chips. You could dine in at an Indian takeaway or Subway as far as I could see (you can get some salad there, but you'll be offered a meal deal with a large sugary drink) or at the pub. I'm not against all pubs and agree that they can be an important part of the community, but this one was part of a large chain and offered discounts and drink offers.  

There are streets that are worse - I didn't see any sunbed salons for instance - but it is still easy to see how people walking down streets such as these with a limited amount of money in their pockets, end up making unhealthy choices. Surely one of the vacant shops could sell some fruit and veg?

Thankfully, it's not all doom and gloom. I came across the Montague Cafe, which is part of a council-led scheme and offers employment to young people and sells alcohol-free drinks and healthier food options.

http://www.yourwestcheshire.co.uk/NewsArticle/%7BCD92E884-A493-4E1E-ADC2-F5443B30EFD8%7D

The council are offering grants to landlords of long-term vacant properties to enable refurbishment and occupation by community groups and projects and this is starting to improve a few buildings along the street.

http://www.talkingwestcheshire.org/talking_ellesmere_port/my_news_-_ellesmere_port/news_for_2012/october_2012/empty_shop_grant_scheme.aspx

I found an arts and photography project called the Paperboat Gallery

http://www.cheshirelife.co.uk/out-about/the_new_paper_boat_art_gallery_hopes_to_become_a_creative_hub_for_the_community_of_ellesmere_port_1_2182086

and another project called the Fablab, where schools and community groups can fabricate, err, all sorts of things

http://www.fab-lab-ellesmereport.org/

It's this sort of action by councils and community groups that can really make a difference to where we live and work. Well done to them and the local MP Andrew Miller ( http://www.theyworkforyou.com/mp/10435/andrew_miller/ellesmere_port_and_neston ). They are limited in what they can do though. If it's more profitable to sell booze, fags and takeaways than fruit and veg, then that's what businesses will offer. If they are cheaper to buy and it's hard to even find, never mind afford healthy alternatives, then that's what people will buy. Only legislation at national and international level can really change this.

I brought my own apple today, I needn't have bothered. On the way home I called into the Polish food store and its selection of fruit and veg was fantastic. I'd recommend it.

Scottish Independence Referendum

I'm not Scottish, I've never lived in Scotland and I've only been a couple of times. You may choose to ignore my opinion on the impending Scottish Independence referendum. I do have one though. And you've got this far. Wait for it...

I feel like I'd be tempted to vote yes if I were eligible. It's hard to make an informed choice given the quality of the information on offer though. Left-leaning parties tend to do well in Scotland and this may be an opportunity to re-structure the society in a more fair and equitable fashion. I think whether or not I'd be an iPad richer or poorer under that system is secondary to the overall distribution of resources within it.

What would happen to healthcare provision in an independent Scotland?

Scottish doctors seem to think it would get worse. A recent poll in the BMJ (with only a 14% response rate - 311 doctors) suggested that 60% of them plan on voting no. 91% of those no-voters cited a predicted worsening of the Scottish economy.

http://www.bmj.com/content/349/bmj.g5072?sso=

What I can't see is whether the pollers were allowed to give non-healthcare related reasons for their preferences. Doctors are also people and it may be that some of them feel like their personal circumstances might be better in the UK than in an independent Scotland and so be swayed towards a no vote. Some English doctors might plan on voting Conservative (or even UKIP!) at the next UK general election for a lower predicted personal tax burden rather than a belief that the health of our nation would be improved.

Those polling 'yes' gave greater autonomy in healthcare and research decision making as big factors.

As for other considerations, there's talk that the tax takings would decrease and there would be the cost of creating a new governance structure. But the NHS in the UK has to bare this cost every few years/parliaments anyway. It does seem that the Scottish would be keen to defend a system that is free at the point of use and that public will cannot be undervalued. Couple that with a keenness to take tough public health decisions to prevent disease (I'm thinking of tobacco control primarily with other policies following such as minimum alcohol unit pricing) and free prescriptions, you might find a lower disease burden to deal with. Could this mean an independent Scotland was healthier for all?

Either way, I'd be keen to see how an independent Scotland would work out. Would a more liberal and fair society be created with decisions taken to benefit the local population and with support by international legislation created in Europe? This might be be an improvement on the current distant government setup.

I listened to a good debate on Radio 4 the other week (I deemed this too pretentious to open the post with) and this and other media coverage gives the impression that people are actually talking about this referendum and are interested in the outcome. I contrast this with my own experience of trying to spread the word re: the recent council and European elections where my efforts were met with either 'I don't care about / follow politics', 'is there an election on?' or worse 'ok, how do I register to vote?' leading me to lament scientists' current failures in reliable time travel.

A no vote may have its own benefits to Scotland and the other nations of the union. One of the main ones I can see is that a generation of newly engaged and often liberal Scottish voters would be involved in the UK's next general election.

It would be sad to see them go but I'd wish them the best of luck.

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.