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VIEWS NO HOLDS BARRED Margaret McCartney The BMJ readers can buy Margaret’s new book, Living Why I love Parkrun with Dying, Long ago, at a riverside hotel, my betrothed Social interaction is associated with for £7.99 (RRP and I went for a walk. We were joined by the £11.99) from www. longer life, and exercise is associated pinterandmartin.com hotel’s dogs, yelping their delight. We had with reduced mortality with code BMJ799 found ourselves a couple of companions who recognised the gleeful combination of social And shorter runs for under 14 year olds are have something to aim for (including coveted interaction and exercise. beginning on Sundays in many areas. T shirts for people who complete 50, 100, or This is the winning combination that we Running in a park involves none of the vile 250 runs). And what delights me most is that find in Parkrun (www.parkrun.org.uk). Every mirrors that haunt me in gyms; instead, you are a quarter of people taking part don’t describe Saturday at 9 am, or 9.30 am in the darker surrounded by trees and grass and encouraged themselves as runners; overweight and northern climes of Scotland, people gather by marshals to keep going. Because runners middle aged people are well represented, as together in parks to run 5 km around them. are asked to do a little volunteering if possible, are people with limiting disabilities.1 It’s entirely free. If you want to know your it’s easy to get to know the regulars, and the I have a bias: I love Parkrun. You might, too. time, register online and print out a barcode. resulting atmosphere is cheery. Social interaction is associated with longer That’s all you need to bring. The events are I take great pleasure in seeing Lycra clad, life,2 and exercise is associated with reduced run by volunteers, who usually run on other sub-20 minute runners at the front later mortality.3 The Olympics were never going weeks themselves. In other words, the events clapping the folk at the back as they cross the to get the nation doing a decent amount of are self sustaining. finish line, and anyone is welcome to walk for exercise.4 But community running—inclusive, There are commercial sponsors, but some or all of the course or to take part in a interactive, and regular runs for ordinary the organisation is not run for profit and wheelchair. Parkrun includes old and young people—is something that might actually is supported by only a handful of paid runners. make a difference. employees. The number of runs in the United Personal statistics are available for even the Margaret McCartney is a general practitioner, Glasgow Kingdom has grown from one in 2004 to slowest runner to analyse on the website— [email protected] about 300, and now more than 50 000 total runs, volunteering, age grading, fastest Cite this as: BMJ 2015;350:h230 runners are out “parkrunning” each Saturday. time this year—meaning that runners always • Twitter @mgtmccartney IF I RULED THE NHS Mayur Lakhani Promote a massive cultural shift in attitudes to dying In a 2008 poll BMJ readers voted “palliative care Although Britain’s p olypharmacy. End of life care planning would in conditions other than cancer” as the interven- palliative care be integrated into management of long term tion that would make the “greatest difference to services are conditions. I would combine community nursing healthcare.” If I ruled the NHS I would make this among the best in with general practice to make one unified team. a reality. All people with advanced progressive At the heart of this new holistic model of care incurable illnesses would receive palliative care the world, we are would be federations of general practices. The regardless of diagnosis or postcode. only scratching federation, on a hub and spoke model, would By doing this, we would make good care for the surface be people’s “medical home.” I would ensure all at the end of life the norm. People in the last that federations were “stamped” on the NHS years of their life or with life limiting diagnoses home to a hospital needs to be a thing of the map of England. There should be a national would be encouraged to think ahead and make past. The situation is pressing, the numbers of building programme of health and care cam- advance care plans. Quality and value would deaths are expected to rise. puses so that they became centres of excellence improve dramatically. Moreover, it could tackle I would promote a massive cultural shift linked to universities. I would ensure that men- the problem of “overinvestigation” and futile in professional and public attitudes to death toring and support were of the highest stand- treatments by shared decision making, which and dying. Transformational plans would be ard for all staff and that an incentivised and is the central tenet of care planning. demanded from commissioners. Specifically progressive career structure was in place for all The case for change is strong. Although I would co-locate palliative care doctors with GPs, including sessional GPs. B ritain’s palliative care services are among relevant secondary care physicians such as If I ruled the NHS specialists and generalists the best in the world, we are only scratching oncologists and geriatricians. would work together in “teams without walls” to the surface. Most deaths still occur in hospital. This model would require a robust infrastruc- promote the highest possible clinical standards. Wards are full of people who do not need to be ture with strengthened and accessible services Mayur Lakhani is chairman, National Council for there, simply because no one has discussed outside hospitals, 24 hours a day, seven days a Palliative Care, UK [email protected] their choices with them for what lies ahead. At week. I would build this around general practice Cite this as: BMJ 2015;350:h605 least 92 000 people at the end of life do not get and its registered list. Advanced general practice thebmj.com the care they need. The default of an ambulance with lower list sizes would provide continuity ̻ Read previous articles in this series at taking a patient at the end of life from a care of care for patients with multimorbidity and http://www.bmj.com/specialties/if-i-ruled-nhs the bmj | 7 Febuary 2015 23 PERSONAL VIEW Saatchi is right to promote medical innovation but his bill is wrong way to do it Medical innovation in the UK is thriving already, writes Michael Baum. A commission to consider obstacles to progress would be more useful and safer for patients than the Medical Innovation Bill ZEPHYR/SPL he peer Maurice I can provide examples from my We already innovate in breast cancer treatment Saatchi’s Medical own career regarding innovation Innovation Bill in the treatment of breast cancer. “suck it and see”? Well, firstly, itself prolong life.7 In addition has just passed its Along with groups in the United we will learn nothing from such to medical and palliative care, third reading in the States and Italy, clinical scientists anecdotal reports. Secondly, they many patients should be offered THouse of Lords and will shortly in the UK lead the revolution in could mislead us. spiritual support as their time be debated in the Commons.1 I breast cancer treatment, from The expectation of life in runs out. So called “holistic oppose the bill and believe that radical mastectomy to breast “terminal” cases is unpredictable. medicine” is but a poor alternative it is based on a false premise conserving surgery, improving It is nothing but urban myth to the appropriate rite of passage that innovation in medical patients’ quality of life.2 Of equal to claim that “the patient was of most of humankind’s tribes and practice is inhibited through importance was our pioneering given only six months to live.” If faith groups. fear of litigation, but whatever work on adjuvant endocrine through “innovation” at Hogwarts the outcome for the bill some therapy with anti-oestrogens School of Medicine she lives We need no-fault compensation things must change so that (tamoxifen) and aromatase for nine months, this will be I must congratulate Saatchi for real impediments to medical inhibitors.3 4 These approaches trumpeted as proof of success opening up this debate, which innovation are recognised and have contributed to a 37% fall of the bill. If she dies at three in its own way has provoked dealt with. in breast cancer mortality in the months, it will be written off as a period of reflection among The law is a blunt instrument, UK in the past 40 years (from 40 the patient’s fault for not having lawyers and clinical academics and we risk serious unintended deaths per 100 000 women to sought treatment earlier. such as myself. Nevertheless, I consequences in changing the about 25 per 100 000), the best “Unproved” treatments already beseech members of the House of status quo. A “bill to cure cancer,” outcome in Europe.5 blight the lives of many; bizarre Commons to reject this bill. however well meaning, would Never once have oncologists in diets often take time to prepare, The problem of excess remove current safeguards and the UK encountered interference and they deny patients the litigation in healthcare be likely to add another layer of or obstruction because of fear pleasure of self indulgence in might be tackled by no-fault bureaucracy that would inhibit of litigation.6 There are, though, choice of food and drinks.

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