Focus Group 2

Me What do you think is the biggest health problem facing everyone today?

FG23 I think the waiting lists.

FG22 Retirement.

FG23 Suppose thinking more along the lines of what causes the problems that you need the waiting lists, I’d say it is obesity, in terms of that generally that whole section of the population.

FG21 I would agree with you, the biggest problem with health today is the lack of healthy food, good diet, good education, lack of exercise.

[General agreement]

FG24 And drinking. Those two lead to unhealthy style.

FG23 I agree.

FG25 Lifestyle.

FG21 I think that part of that is the fact that the aging population, elderly care because you can’t, because you can’t do lifestyle without that, that’s going to be a big problem. Two ends isn’t it, the one end is kids and education, getting the right lifestyle early so that you can carry on with it. At the other end, thousands and tens of thousands of people who will definitely hit the health service bigtime. How can we keep them healthy for longer.

FG22 Yes.

FG21 The two ends. The one end is kids and babies getting the right lifestyle early so that you can carry on with this, then there’s the other end tens and thousands of people who will … …Keep them healthy.

FG24 … … Prevention and … …

Okay we’ve got a few ideas about different things which need sorting out probably a long list as to the most important. What do you think the government should do to improve the health?

FG23 Well it’s very difficult because we all know we should eat five portions fruits and vegetables a day and we know we should do exercise when actually a __+ and a bar of chocolate is quite nice, packet of biscuits, might have…

FG25 Do you think the pace of lifestyle.

FG23 ?Maybe not completely?, though the places of life I live, personally, I’ve got __+ and I work full-time and going __+ this year but there’s not a lot of time, and I don’t know that that’s anything to do with government, that’s just my choice of lifestyle. ?Not a lot of money left though?

FG25 Thinking for example at one end the information for young people, you have __ school and more activities, they have school dinners __+

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not that children ?oh if I’ve want – you know that this is ?poor? this is ?poor? they all have more amount of exercise at part of the curriculum and before I left, well we know the issue has been raised about how the schools have these lunch, like __+ came into the schools so these two issues, public can ?influence? the way, of course if you have parents who are uneducated and they just give any junk food they like ?without? vegetables or __. They are raising them in an unhealthy environment but one in ten __+

FG23 Yes but it is a number and that’s the problem with it as far as I’m concerned as soon as they make it an issue of what you should eat and what you shouldn’t eat and compare it with … … I try and give my family vegetables we eat more vegetables but I’m eating … … Vegetables … … I’m bothered about that and I’m trying to eat more vegetables and … and whatever but there’s a whole load of other people who don’t know what they should be given but actually don’t listen to the government advice either so.

FG21 The government has a massive problem in that as far as I can see as soon they issue an edict about what you should eat and what you shouldn’t eat the parents who will listen to it are those persons who try to do that anyway. I try and give my three year old vegetables, my three year old doesn’t want vegetables but I reading all the research, all the __ articles and thinking, give him __ vegetables then. I’m bothered about that and I’m trying to give him vegetables hidden in, cut them up or whatever. But the whole set of other people who don’t know what they should be giving but actually don’t listen to the government advice either.

FG23 Yeah but that’s what I’m saying, I’m the one that listens to it though whereas people who should be listening to it, they don’t

FG21 So it’s how?

FG21 I I think the important thing is governments have very little impact on what we do, the work. The one thing they could do is to unfragment all the systems and link together the fact the ways in which we teach, the way in which view our children now there has a direct impact on the way in which they will present to the sickness service acutely later. Whether that’s because of obesity related things, early onset diabetes, because of obesity and bad diets __+. So it’s about, that isn’t even in the same ministerial department. Lets work with the same budgets and unless you, I could care less, acute hospital administrator. In fact I want the money that you want for school dinners, and I will fight tooth and nail with every pound of that to put in my budget because that’s the way the government works. Departments fight one another, somehow we have to bring together the pathways that ?link? care up. Got to break down the barriers, departments and organisations and get us to care for people and the community wherever they hit the system. And not worry about whether that’s your problem or my problem.

FG22 The long term solution lies in giving the parents help that’s where … … it’s going with parents … … Children so that we know so that at least we could get them healthier … …A lot of the young people now have been brought up on junk food and those parents don’t really know how to eat because they’ve always lived on that food or whatever so you know they’ve always … ... Educate them with … …

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FG23 I think the parents need help as well, I think that is where money should go in to helping them. Helping the parents, because lets face it, they have a busy life, ?as you know? finding time for them to produce decent food for the children so they don’t have to ?feed?. To get them healthier, but they need it, and really, think __ start them very young, the young ones. Because a lot of the generation now have been brought up on junk food and those parents don’t really know how to cook, because they’ve always lived ?on that type of food?, they’ve always been used to it. So until we start to get in and educate them, we’ve no __ really.

FG21 Well it’s not, I’m sitting here and I’m the only man in the focus group you know. We die on average three years earlier than any of you guys sitting round the table and we don’t do anything about it. We are not a priority, if it was the other way round it would be a national scandal. Why is it __ men in the country that are bad at looking after their own health. They pretend, I think because of the macho culture we’ve got, we have to pretend to be well until finally we die. And __ nobody’s well everybody gets ill at some stage. There’s such a huge work to do with the male population and whether or not you start that in schools, obviously ?we don’t?. There’s a lot of fifty something’s out there that were active because we grew in schools when there a football match but we don’t live like that ?day to day? __+

FG22 Oh I think you will once you retire, one you retire it’s another world and you can do this or do that it’s the time, I’m sure of it once, retirement comes round the corner, because people ask you to join, so “why don’t you come to this and come to that” and you’ve got the time.

FG21 The average life expectancy in males is about 68. Something like five or six years longer seventy something so I mean we don’t get through retirement very often.

FG22 No.

FG21 Now the pensions department like that… It’s about recognising that there are great sections we’re about to look at those sections and trying to decide what it is that adversely affects children and women and things in childbirth isolation and whether it’s about middle aged man’s stoop, don’t know how to talk to many people.

FG24 Although that does raise another issue that I’ve come across which is, it seems to me a little bit of, previous things about the previous Labour government, on the whole ?not? expecting it to change but they’ve done these kind of targeting where they really target things like heart disease and whatever, there’s lots of money for that kind of stuff. If you go to the northern general heart disease wing it’s incredible. Fortunately I didn’t have a heart problem but I __+ which is like falling apart at the… and I understand there have to be priorities but then you this whole issue of, kind of averages. Heart disease is one of the major causes of death, a la expectancy. The average life expectancy is going to go up if you target that but then you are excluding other people because of targeted funding. It’s very difficult. The other thing I was going to say about children was that did anyone see “Supersize Me” last night. Well basically this guy eats Macdonald’s for a month, yes, and puts on 2 stone, puts on 10 pounds in five days and one of the things they talked about from that is that the average American child sees ten thousand adverts for sweets,

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crisps, junk food a year. And if you sit down with your child at every meal it ?lessens the chances? you have as parents you have an impact on your child. So there are some issues to do with regulation of advertising perhaps to children because you’re fighting a losing battle I think as a parent, because you just don’t have the same influence as __+

FG25 As well they raised the issue of the lobbies of the government of these companies because here’s all this junk food, they lobbied, they go __+ they want make delicious food __+ that company they would provide big lunch, not just in schools __+. That because they, they are in __ schools, and you ?speak of an improvement, politically?

FG23 The government has brought in the primary schools, not certain how many, __+ Sheffield thing or a nationwide think I don’t know. Fruit, each child gets a little fruit a day.

FG21 Now you’re talking about priorities now you’re right statistically … … Don’t spot the people out there their children are five stone over weight when they’re ten.

FG23 It’s absolutely crucial that schools, that rather than teaching food technology as such, which is what gets taught to them everywhere and a lot of emphasis on packaging and marketing and there’s not necessarily much left for cooking. As the kids don’t come out of schools learning how to cook __ they very much have to eat from package and not go into the processing of that particular packaging but they don’t necessarily come out with the menu that you can easily cook. Some of them do catering, that’s much more hands on, but the vast majority of __+

FG21 Sorry I was going to say I used to be a PE teacher and I watched them destroy my ?traditions? and I refused to have anything to do with it and that’s why I left. I just said this is nonsense. We’re not giving these children any opportunities, any interests, any values that will last them later in on their life and enjoyment and understanding of sport and you just said you were on the bowling green

FG22 This afternoon yeah

FG21 Absolutely wonderful. But you know your kids probably won’t be, they’ll be sitting in front of some game box.

FG23 Mine won’t.

FG21 No yours probably won’t but. But it is a problem.

Me I’m just going to pick up on the points you raised that people aren’t stuck on … … That … … helpful but what can the government do about it or should they?

FG21 Yes in terms of creating policy and frameworks, I think the problem is that governments increase and want to micro-manage what’s going on because civil servants tend to do that because you say if you’re responsible for an increase in longevity by two years I want to measure that and I want to be able to do it ?pro-actively? So suddenly you have to have all these stats __ and before you know it all the work is going into feeding you into the ?know?. So I think the government’s got to do two things from my point of view; one is to let go and let

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local people manage all the resources, target it, appropriately for Crookes or Fulwood or Herries Road or Shire Green. Lets do what’s right __ works there as opposed to trying to invent something, borrowing out of Leeds or London. But then you need the instructions to do that as well so for me it would be letting go. I think they’ve got lots of things in place but they don’t have, as far as I like GP teams, like teachers, like the church and everything else, get them to work as groups in communities instead of in isolation focus on. You keep saying what are the priorities and they’re not waiting times, one of the first things you said, well waiting times would not be a problem if we fixed the sick, if we didn’t let people get sick in the first place, so we’re tackling the stuff from the back end.

FG23 Yes.

FG21 You have to do some of that but that will just get worse and worse if we don’t stop, this aging population, increasing the use of preventative treatment, it’s just going to get more and more likely __+ You’ll never fix the waiting lists unless you fix the front end.

FG24 I do think that sort of funding for __+ where the funding goes, __+ and at the moment, I think it is changing, but I think there is a real focus on lets, kind of __ up the treat the sick, which is important of course, but totally not focussing on prevention. I like this idea, where they’ve got a Health Centre and your GP can give someone, ?or badger? to go swimming, to do and do exercise and I think there are a lot of people who are overweight who are very intimidated from the start and actually they need to have supervision, to start to do that would __+.

FG22 I think in the hospitals and I used to work up at Lodge Moor, it’s the management level when I was there they built a whole new layer of management and that is that is where the money is going, more than onto the wards or maintenance because we used to do a lot of maintenance, how much we were allocated each year but it was getting cut because more had to go to the management, so you couldn’t do the building work, who knows, but a lot of management level could be cut out in these hospitals really.

FG21 You start, yes you’re right, because clubs the hospitals go together, too many hospitals in the wrong places. It’s about saying that one of the things that you can’t do is you can’t take health money and put stairways in there. One of the biggest problems with elderly females, because there aren’t many males left around, well that’s because they are all dead, is fractured neck ?femur? and you get that because if you fall down stairs, you know, so the answer is, not orthopaedic surgeons in hospitals to treat that because they die anyway after about 25 weeks of misery, __+ and all the rest of it, because they’re all sort of late seventies eighties. So what you do is take that amount of money out of the hospitals and you make sure that these people are in single storey dwellings in sheltered accommodation, or if they want to live in their homes you put handrails in, ?of all the things that hospitals can buy, much more responsible to put handrails in?, __ financial __+ You can’t do it because if you spend the money on hospitals, it’s difficult. So it’s about that thing of how would we measure. If the government could do something, it’s to stop putting in surrogate measures that only do this bit at the end. It’s a prevention thing, we should be saying is how many of these people should never be there in the first place. To measure it is very difficult __+ A business does opportunity costs all the time. You don’t run a business

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that’s successful unless you understand the opportunity costs of not spending money there because you’re spending money there and we never do that in the health service.

FG24 Well, that’s interesting because field of interest is AIDS in South Africa and one thing they are finding in Africa is they need this two pronged approach. They need to be dealing with those that are HIV+ and have AIDS. Equally if they are going to have any possibility of __+ they need to putting in prevention measures as well, so they are forced into that because they are in such an extreme health situation and really that’s what we’re saying isn’t it, that these __+ that’s where the government should shift it’s focus, more of a long term ?vision?.

Me Okay those are fairly general questions I’m going to pass round one possible government policy which could be introduced and I want you to.

Banning smoking policy….

FG21 … … Damn lies … …

Me Okay what do you think of this policy?

FG23 I think it’s likely to succeed. I don’t have a problem with banning smoking at all.

FG22 I think it’s a good idea we went to Ireland and it’s wonderful, the pubs in Ireland now, they’ve got a ban on smoking over there and it’s unbelievable, it doesn’t seem to have taken much effect, you know they’ve still got people going into the pubs but it’s unbelievable, everywhere, went in and it was so pleasant to go in these places without cigarette smoke. Yes I’m in agreement with it.

FG23 If no smoking, sorry ?I’m a frequent smoker?. Usually if I’m thinking of going out one of the big reasons I don’t do so often is just because I hate, ?having to experience all the smoking?. If you go to a restaurant or anything like that I used to, even if you have every third one, you always __+ impossible to breathe it so it could be an issue, reducing, not too much for people who if they going to stop then ?they’re going to stop anyway? but for the people who don’t.

FG24 I’m not a regular smoker at all but I do occasionally enjoy a cigar with my whisky and I am it’s not something I do at home it’s something I do as part of my late night pub experience so on one hand. My only problem is this nanny state thing Labour have, that they want to curtail more __, so in that sense but at the same time I’m aware I’m not a smoker. One cigar a month is not probably going to __ my life and the fact is the benefits for people who are on forty/sixty a day might be considerable __ lets give up and so as a member of the population I would bear some small private cost to have this happen, although certainly I like to still be able to do that.… …

FG23 I don’t see it as an attack on civil liberties at all, ?I think it’s an important that people don’t? over 27% of people smoke and 73% don’t. It’s just awful to be in a restaurant, to have to cope with smoke in restaurants. And it’s even quite a small café and they don’t mind smoking in a fairly small café. It’s so obnoxious smoking when people are eating, o.k. if you’re going for a drink perhaps, but I’m not sure.

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FG24 I agree with that.

FG21 But that’s banning smoking in public places it doesn’t allow. The whole point about, or rather it should be, is that you should know that if you are going out to a restaurant that it is non smoking if that is what you want. But if you are a cigar smoker or you like a brandy and cigar after dinner then you shouldn’t be criminalized for that. To be honest I was a serious smoker, one of the hardest things I ever did was to give up, one of the things I’m most proud of, is to stop smoking sixty a day. To get to none took some doing. But the stats and the arguments for this ban, there is absolutely no way that anybody knows that passive smoking increases or decreases health risks. We’ve got a population in this room where everybody smokes and they don’t get lung cancer so the science is rubbish, it’s purely political and if it’s political because you’re right, 70% of the people don’t smoke, because it’s not, one of the things you recognise is that smokers smell beautiful because you don’t smoke enough. Serious smokers you can smell when they go through a doorway and they don’t know but it is horrible but this is political nonsense and not helpful. If we’re really interested in a thousand people we could certainly do something about the 30 000 we kill every year on the roads. And I think we get some horrible tens of thousands die in house fires, ?crappy mattresses?, people don’t realise if they leave the chip pan overnight it’s ?very dangerous?.

FG21 So you know it’s another in terms of public health it’s a non issue. In terms of real impact ban smoking in public places you will not be able to measure the difference and it’s interesting they never mention the costs… …

FG25 So medium term policy would be having places that are smoking places. Because they have the freedom of choosing them.

FG21 I think we’ll ban smoking in public places in the next parliament, it’s almost certain because it’s a popular issue

FG23 I don’t understand that it is a political issue in that case they could target lots of other things but actually targeting that is an easy thing to do.

FG21 It doesn’t cost anything.

FG23 It doesn’t cost anything and actually it’s beneficial, so I don’t see as part of a political issue at all. Okay statistically you’re not … … statistics but it’s clear that smoking is bad for you and even if you’ve only got a 10% increased risk of passive smoking being a problem ... … by reducing smoking so I really don’t think there’s a problem with that. Smoking if people who knew now, most people who smoke now … … If they knew what that was going to do to them when they started if they thought it was seriously going to affect them when they started the kids are smoking today and they don’t see long term they say, ‘I’m sixteen I’m smoking,’ or whatever.

FG21 Smoking is the, was cultural now it’s down … and it’s rebellion so if we ban it everywhere kids will try it.

FG23 They’re trying it anyway.

FG21 Yes I know but you know it’s difficult to argue if they say they’re going

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to ban it in public places fine, but I wonder if it is the government’s job to remove all risks and I’m not sure it is you know. I don’t think it’s the government’s job to stop people climbing without a rope.

FG23 But you have them affecting the next person walking through the streets if they’re smoking then they are being affected aren’t they whether health-wise or just it’s horrible it doesn’t matter? You are being affected by someone else’s smoke you don’t put … … It’s you that has the problem not everybody else so it’s a different issue.

FG22 You’re saying that…

FG21 I do this all the time ……

FG21 It effects everyone who has to pull headless people out of car crashes. Lots of things we do we’re not very sensible about and I sometimes think that one of the things we’ve got wrong is to keep looking to the government to fix what our problems and they have to come up with the horrible big clubs to bash everything up with. So the answer to smoking in public places is it should be market forces and it is market forces in this country. More and more of us do not like smoking because there are more and more customers in the non smokers than in the smokers and that’s how you should get to it. I think there is something about this and you’re are absolutely right is that if it might, your children might inhale it in a public place, then it probably is a health risk for the young, then they shouldn’t be subjected to that. But if an adult wants to smoke then there should be nothing wrong with having clubs that say, ‘This is a smoking club,’ but that’s not what we’re talking about here is it? There aren’t smoking clubs in Ireland are there?

FG22 Oh no … … It’s absolutely wonderful over there and just to be able to walk around … … People that don’t … they won’t smoke will they so they go into pubs and they won’t smoke so therefore … … Give up smoking so that would save money eventually.

FG21 But there on the streets though from the outside of the NGH … the universities and everywhere else it’s just full of fag ends now we don’t have anywhere to stub out cigarettes because you’re not supposed to smoke at all so you can’t encourage it by having something and now they stand, you know the thing I laugh at with people, you see them on the outside of hospitals they’ve just had their leg taken off because of blood circulation problems and there they are with a fag in their wheelchair… You know at the end of the day…

FG22 They won’t be told

FG21 At the end of the day ‘I don’t mind, they’ll take my other leg off’

FG23 Well they should put more baskets. We went all through this at Loxley moor when I was working there as the Matron. How they were going to smoke and where, so in the end we had to put all these waste paper bins and everything for them to put the cigarettes in because otherwise they were just throwing them everywhere like they are when you go round the buildings.

FG21 The other thing I’d wish I’d known, all the films and everything, my hero’s smoked, everyone, cinema screens, cigarettes, __+, all that sort of subliminal message to you, you have to smoke. It was part of

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growing up. I just wonder if we knew now, it’s the reason we had dreadful teeth, had dreadful complexions, __ do you have cancer, everything about you, loss of hair, __+, and yet the only thing they say is you might get lung cancer. And while that’s dreadful most people don’t.

FG23 But they do go into schools. In schools they do the anti-smoking message quite hard. It is about smoke can ?give you cataracts? and your fertility is ?at risk by having a smoke? and actually that could be where the problem is, I mean they are very practical, the kids will be ‘turned off’, I worry about __+ after, this isn’t going to happen to me. But they do go into schools.

FG24 Is it possible that … … They go out and they spend quite a lot of … … In the pub and now they’ll spend more time smoking at home where the kids are. Now they like to go out to the pub after … and that’s it. Yes but I think smoking is part of that spirit … they’re not coming in the business unit they don’t give up … …

FG22 No I don’t think so because they like to go out, to the pub atmosphere __+

FG21 I’ll tell you why this annoys me why we should be able to do it is that we can only do this at the moment because it’s time’s coming, whereas if you really tried to __+ the government can’t even contemplate something like this around __+ for example a 60 year old driver re-testing compulsory eye tests. There are people out there on the roads driving at 70 miles an hour that shouldn’t be there, if you put that as a policy at this moment in time it will cost you votes. The government will not do it. There’s one of the biggest problem, there people on our roads that aren’t fit to drive, either because it’s so long since they had a test or because of their medical conditions. We would never contemplate letting get into an airplane under those circumstances, I am a qualified pilot as well, the hoops I have to jump through, three year medicals, if I was fit as a fiddle, thirty something, and if you do crash one of those things you just make a hole in the field, and you and who’s daft enough to sit next to you. Yet we’ve got people driving, ?people who are killing? 30 000 a year, without any policies in place that would make a difference to that because the motoring lobbies are just so powerful, __+

Folic acid policy….

FG25 But they issue the folic acid when you are pregnant, a tablet, so I don’t see any point of having it. So if you don’t need folic acid for your whole lifetime, anyway as we go by just these statistics it’s just a correlation that we have. I don’t know why ?human race is so __+ can’t ?find out the? truth, of course __+ to say yes, if it has success that is why you’re giving to pregnant women. I don’t think we should be, even though it’s such a small population with __ ?effects arguing?, even if it the possibility for curing __+

FG21 I suppose that’s the question of whether or not this is in addition to what is already added.

Me It wouldn’t be…

FG21 No. No.

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FG24 Just think if you consider the whole population, of what proportion of that population is pregnant at any given time and therefore they are the ones that are going to benefit from it. But, how long do you take it for

FG23 Just three months before conception and three months after conception, ?so it would be? six months.

FG21 That’s what I was saying about whether or not these saved babies are additional to pregnancies of people who don’t know enough to get that dose during pregnancy, presumably it is. Ideally you would mass dose the whole of the population for the whole of everybody’s lifetime. But the types of returns probably bizarre given that there are other ways of tackling the problem.

FG24 Think a lot of them __+ ?take multivitamins? as well so maybe overdose, not aware of __+ that would be one concern for me.

FG21 Actually you will have another paper that comes saying you can’t get vitamins unless they are prescribed, __ permission

FG24 I’d rather see them promote education and bring up standards.

FG23 I agree I mean the cost of putting in, for everybody and whatever must be much greater than the ?pain?, the cost of folic acid __+. I don’t know whether the blanket prescription of prescribing folic acid, I didn’t __+ prescribed through my surgery but a friend of mine who did, they got a prescription or whatever, but even that can’t be that much in, __+ look at how I feel. This for me is much more a civil liberties issue. I would like to know what is being added to my food, __+ research to suggest, too much folic ?turning out to be? detrimental to heath, if it didn’t __+ haven’t got a choice.

FG21 They’re ought to be a way in which, given that this focus group __+ There are some things that you shouldn’t do even though you could, there are ninety babies here. There are some things you shouldn’t do even though you could say what is very emotional, emotive subject, very easy to get that argument and say, do you need to kill __+? And the answer is no but that is not the right way to tackle the problem.

FG24 I mean a 180 babies, ?while it is? too many to die of something, is a very very small percentage of the babies born __+.

FG21 The one thing that is probably a problem is that genetic testing, again in terms of public acceptance, the politicians' willingness to actually get rid of all of 180, but it’s not politically acceptable.

? I think the thing is if they have the folic acid they wouldn’t have the neural tube defects so I don’t think it is genetic.

Me No it isn’t

FG23 It congenital, it’s a created, it’s preventable. But I mean, folic acid in pregnancy, you’re concentrating, you’re ingesting every bit of literature that you could possibly read, if you’re the type of person who reads stuff and wants to know, the difficulty of

FG23 Number of babies who are affected by people drinking and not knowing they are pregnant or taking drugs and not knowing they are

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pregnant or __+ when they are pregnant and what ever, choosing and whatever.

FG21 Sorry just out of curiosity really, are we saying that if you take folic acid it reduce your chances, but doesn’t eliminate it.

Me Sixty six percent reduction.

FG21 Roughly which is what you’ve got here which is what you’re showing here to a certain extent. You do all of the right things and you still…

Me I’ll chip in my statement. These previous numbers, I’ve got some evidence behind them ?which is? quite rock solid so you might be quite sceptical of the smoking but. Sort of condensed from a very large report into four paragraphs here. There’s a few of the things which I’ve raised before and people… one is that obviously unplanned pregnancies, taking folic acid doesn’t help at help at all and those tend to be in the poorer parts does that strike any chords with anybody?

FG25 ?Healthier eating, depending on what you eat? For the population __+ if any, what type of whatever will get you good health and that’s why people have big problems with health. Eat in twenty four hours we don’t eat enough vegetables but the average population in the UK what they eat, is just fried things and __ They don’t know and children don’t know what a vegetable is, they don’t know what __+ so if you __+ vegetables they have never seen it. Because their parents, they don’t want to eat vegetables or anything and they won’t know either and they don’t know how to cook, so it comes back to the issue of education.

FG24 Vary easy to introduce targeted education, you know that first of all __+ health, then you say it’s more common amongst the lower classes. So it’s very easy to target these things.

FG21 It comes back all the time to the fact that the poorest members of our society and I don’t think anybody’s horribly, materially starving to death, there’s all sorts of poverty. They are disproportionately affected by all of these things and I understand why you would come up with that and say therefore actually if we do this all of those people will not get any of that regular treatment, they the very people who will get this because it will be given out. I just think it’s tackling the back end of the problem. I think you should be __+ and I think it would be wonderful if you have, whether or not you have protected sex or whatever, is to, not not to do it, that’s just not going to happen, but to recognise that pregnancy is a dreadful illness, for a thirteen to fourteen year old girl. That the defects in the babies, not just this but lots of other things, and their own health is permanently reduced, and they have disproportionate levels of illness all the way through their lives. We’ve got to try and explain that, again and let them make healthy choices that the rest of the people, that our section of society makes all these sort of choices all the time. It’s back to what’s the important things, it’s this, __ things too late, should be doing something more ?up front?

Me There’s one other thing that which I’ve put in a longer description previously that, wouldn’t interest you, but again this is where the numbers start to get ropey is that actually your likely to cut down with miscarriages as well because a lot of miscarriages something to do

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the body realises that something’s wrong with the foetus so because you’re reducing the number of neural tube defects in the very early stages of pregnancy it could cut down the miscarriages

FG21 But you would have a religious debate about whether you would abort them anyway

Me It becomes very uncertain with those numbers, just again you mentioned the some of the, possibility of adding too much folic acid. In fact the research has shown there are potentially other benefits of folic acid as well, such as coronary heart diseases, __+ just unknown, it’s a number between zero and a million lives.

FG21 If you do that you should be adding fluoride

Me I deliberately didn’t want fluoride because you mentioned fluoride.

FG21 I probably have more problems with that one than this…

Me Always the case, you get the wrong people in the wrong groups.

FG23 I think the whole thing is very difficult because I mean, for example, for the folic acid thing you would get via information via your GP or whatever and also stuff around children’s food and education you’d get through your health visitor. But the problem is there is a sector of society who are very suspicious of involvement by health care professionals so what you see that the health visitor coming to the house would be a threat rather than a help and so therefore there’s a whole kind, it does come down to education I think it’s a kind of I don’t know.Well it’s a cultural thing as well. There are far too many males GP’s and not enough females, you don’t want some guy wandering into your house if you are a Muslim, you don’t speak English anyway, your husband is never going so it’s not just education it’s cultural as well.

FG21 Well it’s a cultural thing as well. There are far too many males GP’s and not enough females, you don’t want some guy wandering into your house if you are a Muslim, you don’t speak English anyway, your husband is never going so it’s not just education it’s cultural as well.

FG23 It is I mean, but you supposed to come up with problems and come up with the difficulties but actually it is about education, it is about trying reduce the differences in society. Was on the radio tonight that the longest living in East Dorset and the shortest living people live in Glasgow, there’s a twelve year difference in lifespan, it’s not just because you live in Dorset. It’s warmer down there, temperatures __+

FG21 Does anybody know, do we mass dose anything to the whole population? __+ even whatever we eat and drink. That is a deliberate __ health. I think, chlorine in all water but that’s just to purify drinking water, it’s not a treatment for us. It’s a prevention of disease by curing bacteria they’re not endangering us with a mass dose. Don’t think anywhere in the world is doing it.

Me Flouride, places do. Some people do put folic acid into flour.

FG21 In this country?

Me No, in the United States

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FG21 But just into flour, this one says food.

Me That’s the conduit

FG21 Oh right, sorry if I was reading myself I would have assumed we’re adding trace amounts to everything.

Me I’m trying to bring those two together because we’ve got two completely different potential policies underlined. When you read those do you see any common themes do you think they’re similar in different ways? What jumps out at you as similar issues?

FG21 Government intervention

FG24 They are legislating things aren’t they?

FG23 Cutting bad things, imposing good things

FG24 I’d say as well it’s not the main issue. Like if you look at the numbers you’ll see __ that __+ although these are obviously ?big? issues. Just like a thousand here, whatever there.

FG21 Well they are doable and that’s one of the things the government likes, whether they are about wanting solutions so therefore you can enforce them. If there are known benefits about doing it, well they’re important. But it doesn’t do anything about the major part of the problem does it? Anymore than anything else we’ve done. So if we have another forty like this we’ll probably save another four thousand people out of the tens of thousands that are dying every week…

Me Difficult to get another 40 I can tell you

FG21 So in terms of the public’s health it’s irrelevant.

FG24 The key thing here is it doesn’t require any of us change our attitudes to doing it. The fact is if I go and smoke my cigar and this is passed I going to be locked up. I’m not going to feel the effects of it and actually this doesn’t take an attitude of changing me, what we talked about right at the start was we need everyone to change their attitude to lifestyle.

FG22 The first one we were more in agreement than the second one. We don’t want this one as much

Me But they’re both compulsory. You said yes to the first one some of you said yes to the first one.

FG22 The majority sad yes to the first one

FG21 Well the arguments are not that they are legislative and therefore we are obliged to do them whether or not you’d rather not, that’s not what we’re, I don’t think that’s what we’re asking, because that’s why we’ve split the two. We’re saying that in actual fact if you did legislate for this one say well there’s probably enough benefit in that (smoking), I think there other ways of doing it. I would like to see exemptions if you had smoking places or not. But this one, as I said the mass dosing of people. This one’s saying you don’t have to suffer

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my smoking you can guarantee that if you and I wind up in this restaurant I’m not going to inflict passive smoking on you. This one we’re saying, we’re about to inflict folic acid on anybody using flour and flour products and I’m not sure that I ?would be happy with that?

FG25 Yes, in the first one, if we can give freedom to everybody banning it from some places but then you will have to special places where you can go and have a smoke and have special clubs and those will be midway, having freedom in both of cases, freedom to choose.

FG23 For me it’s the uncertainty of the benefits of this (folic acid), what are the benefits. Also it says this could lead to some elderly people… how many people is that, is it the same amount as the amount of babies or would there be more elderly people having problems with vitamin B12 deficiency and whatever and although you mentioned there might be other health benefits I feel that there’s a lot of research the juries out on things like that and that it could cause problems we just don’t know. If you knew that categorically folic acid would not be detrimental in any way shape or form and could be beneficial, might not necessarily be but could be. You might have a problem with it being an additive but I’m just concerned twenty years down the line it might be…

FG25 Even the nice things, we don’t know, in twenty five years time we could find out because that they were using these and these and these, so using it and we have more brain cancer, kill more and more people, I ?feel? suspicious about it because you have so many children brain tumours, coming from somewhere

FG22 No the old people have had their time, is that the attitude, so it doesn’t matter about them they’ve had their time supposedly.

FG23 I just think it’s a kind of an unnecessary expense really, so many babies are lost through miscarriage and genetic defects that perhaps money could be put into research, the money that would be spent on putting folic acid into flour, could be spent on research. One in four babies are miscarried and there’s not much research going on as to why that is. I speak from personal experience, I speak from the NHS being actually fantastic as to sorting out why I was having miscarriages, 50% of miscarriages are not known why, can have concurrent miscarriages and you think, once again, need to try help research?.

FG21 I’m quite clear about this, very, very scary when any government should start to choose the relative importance of one section of society over another. If they did that then it’s ?hell of a long war? there would be an awful lot of people to stop. You can tell it’s a bad idea __ all these people and I think we should treat the right people the right way, appropriately and with all our endeavours, regardless of whether they’re male or female, babies or elderly. I think we do have to choose the most effective way to do something, there are times when you have to say there isn’t anymore we can do within our current system, ?because it’s not about one thing or another?. You’ll never treat everybody so you do have to choose, __+ it’s right that you say this is, then we do do it and I think it’s wrong. They do say I can treat __ people under 55, even 30, we will treat you a lot differently.

Me Okay coming on the end I’ve got a question I’m going to go round the

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table. If you had to vote on whether these schemes went ahead, what would be the two main factors to help you make up your mind? The two factors about these that would help you make up your mind?

FG21 Well the same for both in a way, it’s about looking at the benefits and the costs of doing it, whether or not you understand fully the downside of any of these. So I’m quite clear that there are things that we do not know about mass dosing the population (with folic acid) and I think there are other ways of tackling this problem so I can’t weigh up the equation, I can’t balance that because I think there is going to be a downside. You’re quite clear about the upside - it’s a hundred deaths - but I just don’t know what the downside is and that could be ten times that or a hundred times that, you just don’t know. On that one (smoking) the downside is about a bit of, not discomfort that’s the wrong word, it’s a bit awkward for some people who like to smoke, it’s a social issue and it will displease some people, but it certainly won’t hurt them in anyway and may well help some of them ?to give up smoking?. So that’s fine and you can still smoke at home and you can declare a place not a public place by saying it’s a club and all the rest of it there’s plenty of clubs that you have to be member of in Ireland that you can smoke in, not a public place. And I’m fairly certain that everyone’s clear in their minds. So I can see you could ban smoking in public places.

FG25 Guess it’s the same. I’m clear that smoking is bad anyway that you see it, and I’m not clear that folic acid is going to be good or going to be bad so. And then the second one is __+ selfish in way and I don’t like smoking.

Me So one is strength of evidence and one’s pure self interest.

FG25 Yes according to … … It is yes.

FG24 The thing that would help me make up my mind is the belief that government has considered the alternatives and considered them __+. So ideally I’d like us to say this what we’re going to do, like with the top up fees, I know that the ESRC did a report and analysed the effects of graduate taxes and those sort of things and they considered that and to me, if I had pretty certain if they were doing it, if they were doing something right by the population and not just seeking political ?positions?.

FG23 Yes I agree I don’t need anymore evidence on that, lets ban smoking, that’s absolutely fine. So nothing, I don’t need anything to help me make that decision I must confess. That (folic acid) is about evidence and is it the right thing to do, even though in the back of my mind it feels like …. even if it’s beneficial then it’s still right. Shouldn’t I have a choice whether I take that folic acid or not, and I wouldn’t have a choice, so it’s kind of evidence for myself, bit irrational, doesn’t feel right to…

FG22 Yes I agree with the smoking, no problem, but with this one (folic acid) would like to have the choice, to choose whether it’s in food or not rather than just having to go and buy it. Alright if they are going to do that to lots of flour make two lots of flour, one with and one without, so you then have the choice to eat it or not rather, it’s in and you can’t do anything about it really

Me Yes but that’s going to complicate things.

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FG25 Some of them, do have feeling for smoking, foli acid, other policies you have to be convinced, well I don’t have feelings, hope to have to eat food that is like that, there will be other people who have to be more convinced that it’s not because of political issue or it is because you have many connections with any community or whatever or it doesn’t affect you but in any case would __ take any offer and we know because we are informed how these things are made and how __+ really tricky as well when you know where the facts come from in medicine and economics. In a way it’s always a political issue as well, and you can __+ rational, maybe. So you must have some

FG21 We don’t agree with that one because some scientist has just done some research, that’s a lifetime of our personal experience. We know about smoking, the whole world knows that isn’t good for you and it’s damaging in all sorts of ways. __+ scientists can tell you that was exactly wrong because that’s the nature of the scientific community and so it should be, it’s about conflicting between opinions and __ research and then further research to validate that, __+, so there is something about, you can’t just say “yes it’s okay” otherwise BSE is o.k. and then it isn’t __+. It is about finding out about in 2050 what has been killing us along is something that they have been telling us is good for us, sometimes __+

FG23 I think also the government also has a difficulty in the way things are reported so whilst a scientific study may be very valid actually the headlines that gets into the media isn’t necessarily what the research has come up with because it’s only kind of delved into the article, a bit more or you have got access to information that you can make an informed choice. Just for instance there was that thing last week about children who go to nurseries, my children go to nursery so I read these things, they are more likely to be aggressive or whatever, but actually when you read the article it was something like, I mean I’m not making them up but I won’t remember verbatim, but it was something like 7.8% of children who don’t go to nursery get involved in an aggressive incident in their first year of primary school and 8.1% who do go to nursery do. So yeah okay the points of difference but is that significant and yet the headlines say, “Nursery children are more aggressive”, and you think “oh no my children” but actually it’s a really small percentage and you hear this double the rate of breast cancer and whatever but actually the rate of breast cancer or whatever cancer is quite small and doubling the risk isn’t making it that big you know and I think the government has a big problem with statistics and how the media portrays them.

FG21 It’s about stories, that’s the thing, they’ve been trying to do this for years, how do you make that big headline story out of “if you eat better you going to be healthier”. If you do cook at home you know, the fact that you can’t cook if you weren’t taught how to do it, but if you knew how to do Jamie Oliver’s stuff the kids would actually sit round the table you would ?get all this? At some stage in the future you are less likely, whereas what you want is “new drug cures cancer” and you keep saying can’t resist ?that?, no it doesn’t and you know by the time you get to end of it, it’s a __+ it’s just never going to happen. The big problem is the national sickness has become steadily worse and no matter how badly we live they can fix it and I think it’s the biggest problem I’ve had working in the health service and I think we do it, we all do it because we want to do what we want to do and then

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when finally the consequences happen of our lifestyle choice and all the rest of it I want someone to fix it and the doctors have been saying yes I can because I’m God and I will fix you.

FG22 Nine years ago I had a mastectomy so I’m still here to tell the tale.

FG21 I think they do some wonderful things but what we can’t do we can’t do what we put on the packet, which is we can’t fix those you know if you get something like that I think that’s fine but if you are five stone overweight when you’re ten we’re not going to fix that, that’s too late even if you get that child back to __ the damage is already done. But there is an optimism __

FG24 That’s just human nature, human nature wants everything fixed. I don’t want to hear that I’ve failed, I want to hear if I’ve put on a bit of weight that I can ?take it off again?

FG25 __+ displaying statistics, they come, they are level. You are more likely to be better if you can show people in that way as when people are unaware of __ things, that it is good for you’re, You are more likely to be like that but for me __+ so if I want to continue doing bad things __ it’s just going to be a small chance I get sick or whatever, I think it’s a trade off, you need some type of __ in a way but not too much, it’s just to get the right balance.

FG23 It’s interesting that something like the government’s five vegetables a day has been quite successful because you can sort of quantify how big that. But something like the government’s thing about salt is much more difficult to get across because it’s much more difficult to work out how much salt and how much sodium is worth a bit of salt and all that malarkey. It’s just much more difficult so you don’t want it to be too complicated because ?people? just can’t do it.

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