Monday, 31 December 2007

Happy new year one and all

I would like to wish all my readers, both the accidental and the deliberate ones, a very happy new year and all the best for 2008.

I am working at the moment, as I would not be on the Internet if I were not, I would probably be dribbling by now.

My zeroes for 2007 go to Patricia Hewitt, Liam Donaldson and Martin Marshall.

Anyways happy new year.

BBC spinning for HMG

This story headlined this morning's news on the BBC. The crux of it comes down to some guidelines on cancer referral by the government's rationing agency NICE that can be seen here and here.

Hardly the straightforward story that the beeb portrays. The NICE guidelines are hardly free of confusion themselves and as the BMA say, the capacity is not there to deal with all these referrals anyway.

Really the issue of capacity should be addressed before laying into GPs who have to do a tricky job. Interestingly capacity is barely mentioned by the BBC, one just wonders how much of a push from government they got to run this story?

In the old days referrals were screened by specialists who would prioritise the referrals as they saw fit, using their years of training and experience to benefit patients. Now referrals are sorted by managers who have no medical knowledge at all, meaning that cases are not prioritised as effectively as before.

The 2 week wait has been shown in the scientific literature to be a complete waste of time as the capacity is not there to see all the urgent cases within two weeks, and the system ends up prioritised the anxious patients over the ones who are more likely to have cancer. For example it has been shown that with breast cancer, the 2 week wait has lengthened the time to diagnosis and has increased the numbers of cancers referred as 'routine' non-urgent cases.

If the BBC actually researched it's stories properly then it would realise that the problem we have is a lack of capacity and the stupidity of the 2 week referral system. We need to increase capacity to deal with referrals and go back to the old system of letting the expert clinicians screen the referrals, thus prioritising the most urgent cases. Experts will also tell you there is currently a crippling shortage of breast radiologists, meaning that it would be impossible to increase the capacity for the quick triple assessment of breast lumps anyway.

Thursday, 27 December 2007

The antidemocratic decimation begins

It's not been the most clever, subtle or brilliant plan of the Department of Health's; however their resident incompetents have shown yet again that they care not for quality of service or for what people really want. Large surveys costing millions have shown time and time again that people just want good local services, and that the majority of people are very happy with their GP services. There is undoubtedly a problem in poorer areas, a problem that has been made worse by the new GP contract which makes it impossible for GPs working in poorer areas to earn as much as those in richer areas, thus further disincentivising GPs moving to these poorer areas. The DoH's tick box QOF medicine has done the exact opposite of what was intended, it has catalysed more inequality and wasted a lot of money on paperwork.

The Department of Health is now railroading through plans to privatise primary care, this is despite a groundswell of public opinion against such moves, and a rather lack of a transparent consultation process:

"Doctors have
accused the government of trying to privatise general practice after it
published guidance about setting up new practices in England.

Ministers have ordered health chiefs to create 100 GP
surgeries and 150 super-surgeries known as polyclinics.

The British Medical Association said the guidance works
against existing GPs from bidding for the contracts, leaving the field open for
private firms. "

The polyclinic is an appalling idea. It will mean those in deprived areas having to travel much much further to reach their local services, and one must remember that it is not easy for the sickest and frailest in society to travel the extra miles. So much for 'local' services, the polyclinic represents the worst of both worlds; not big enough to safely do what a hospital can do, but centralised enough to be a massive inconvenience to patients.

The Department of Health has no idea of business or medicine, thus when it tries to combine its thinking on the two, the end result resembles horse manure. The private sector is given a massively unfair advantage whenever it is involved, thus meaning that any gains of competition are lost immediately. Service will be sacrificed at the expense of profit, while the Department of Health conveniently forgets to audit or regulate the new private providers. We have seen in the past how negligently the DoH has been in helping the private sector to our money, whether it be in the form of the pitiful Walk in Centres or the ludicrously expensive ISTCs.

It is indeed a new year, however we still have the same bunch of corrupt incompetents in charge of the Department of Health. If these idiots worked for a business then they would have driven it bankrupt long ago, but alas they work for the state and this government seems to reward their incompetence with special favours. Their record of mismanagement spoke for itself in 2007, and I'm sure they will plumb new depths in 2008. Well done DoH, you truly are an example of how badly wrong top down state controlled ventures can go.

Monday, 24 December 2007

Merry Christmas to one and all

The year is finishing as it started, with more incompetence from the Department of Health, as yet more personal data has been lost by NHS Trusts around the country. The Department of Health cannot have it both ways as usual, they must shoulder some of the responsibility for the mess that they have created beneath them.

The new MMC website has been launched, for some reason they think that putting shit in neat packages magically turns the shit into good policy, it's a great shame for trainee doctors that this isn't the case; rather the reverse seems to be true, as the more money that is wasted on pretty packages the less money is left over the actually spend on the nuts and bolts of training. Read this and vomit:

"Modernising Medical Careers (MMC) is making radical changes to postgraduate medical education with the aim of bringing more structure into the career path for doctors and better training towards the very best care for patients."

One wonders how completely demoralising a generation by rushing through training reform far too quickly is going to be good for patients in either the short or the long term. MMC is a classic example of the DoH's complete lack of skill in making good policy, in fact the evidence from the Health Committee of late has shown how the DoH has a bunch of idiotic cretins making the policy who are completely out of touch with the clinicians on the ground. The MMC group had no one with a background in clinical medicine in the end, no wonder it was completely detached from reality.

The DoH has been found to have breached the Data Protection Act by the ICO, after last year's leakage of applicants' information during MTAS 2007. It's a shame that the pathetic punishment by the ICO consists of just a written warning and the DoH having to respect the law in the future, surely they should be punished properly for ignoring the law last year? That would be too much like accountability for the DoH though, and if they were accountable for their mistakes they would probably have no employees left by now.

Anyways a Merry Christmas to one and all, and a happy new year while I'm at it. Seasons greetings to Dr Grumble who does not quite see why so much money is being spent on computers, to Dr Rant who does not see the point in extending GP's opening hours, to the Angry Medic who details the impotence and malignant nature of 'Dr P' who has sunk lower than most with some rather vindictive lies (it seems some people have to resort to rather desperate tactics when logical argument has failed them), to Dr Ray who seems rather happy for a pleasant change, to Front Point who has been consistently impressing some excellent commentary as always, to Nursing Student wishing her all the best in her job search, to Random Acts of Reality who is as enjoyable to read as ever, to Barry Monk who has been campaigning as effectively as ever, and lastly to the Witch Doctor who is hopefully correct in saying that a daffodil may be about to bloom. Regards one and all.

Thursday, 20 December 2007

Bureaucratic nightmare

There has been plenty of talk in the media of late on the subject of the EU's attempt for a free market in health. Obviously there would be some advantages to such a scheme, for example it may well lead to the dismantling of the ineffective internal market; however how on earth could such a scheme be practical?

"Under the draft plans - which are now expected to be announced in the New
Year - a patient would have to be referred by a medical professional and
demonstrate they faced an "undue" delay for treatment in their own country.

They would have to pay for the cost of their treatment up front, and
then claim it back from the NHS. The patient would also have to meet travel
costs themselves."

Is it just me, or would the potential costs in the form of the bureaucratic burden of this new scheme far outweigh any benefits that it may bring? Just imagine the potential for a proliferation in the costs of running and managing the market, let alone regulating it. At the end of the day people just want good local services, they do not want to travel to other countries for their operations. Also a lot of medical work is done as an emergency and cannot be done electively; the elective work is needed to keep a hospital ticking over so that it can provide its emergency care. Thus if hospitals lose their elective work then their emergency services will suffer, and who will pay the price for this? It will be those unfortunate enough to get ill in these areas.

Friday, 14 December 2007

Health Committee update

Some rather revealing information came out this week, I shall attempt to summarise it for you. Crockard and Heard pointed out that they were the only two with a medical background on the MMC specialist board, and when they had left there were no people with medical backgrounds left in the MMC specialist training committee. This is an amazing admission and a sad indictment on the way that medical training is being run by idiots with no understanding of what they are managing.

What about the 'drift' towards run through training? Well it seems here that the four CMOs made a policy statement which set the direction for run through training, and this appears to have never been properly consulted as the wording of the earlier 'Unfinished Business' left things quite open and flexible as regards run through training. The policy seems to have been rather ahead of the consultation process, and then for some reason run through training became a straight jacket that it never had to be.

It came out that Crockard and Heard were both rather in favour of run through training, and therefore rather unable to see the massive downsides to its rigid nature. They didn't touch upon junior doctors who change their mind about which specialty to pursue, they also ignored the fact that many people do several years of other specialties which adds to their all round skills. Crockard and Heard's naive love of Foundation training showed how detached from reality they are, they must have been living on another planet for the last few years to believe that Foundation training gives junior doctors a better all round grounding than the PRHO year. Thanks to Foundation training juniors can waste months in useless posts without getting enough exposure to the bread and butter.

Amazingly MTAS was set up in 2005 without any attempt to engage the MMC team in the process, from the sound of it the DoH railroaded through DoH ideas in a completely uncompromising fashion. Shelley Heard made it clear that in her opinion the use of the electronic modality was very badly thought out indeed, and stated that scoring of applicants should have been based on 'harder' information, surely a dig at the white space questions? It was clear that the DoH tried to 'go it alone' in limiting applications from HSMPs, the DoH ignored the Home Office in its great wisdom. It shows an astonishing arrogance and incompetence exhibited by the DoH. Even Alan Crockard had great difficulty in getting through to the CMO's ivory tower, he spoke the deputy CMO about his concerns but I wonder what actually happened between the CMO and his deputy?

Next came the BMA and BAPIO, including Jo Hillbourne. The BMA bizarrely hinted that the profession should take the blame to a degree, whatever that means, surely the BMA's job was not done properly as they are meant to be representing the profession. The BMA was asked whether Remedy and Fidelio were more representative of the profession and their answer was pretty limp. Remedy was described as a single issue pressure group, what patronising rubbish, and the BMA claimed that when it raised concerns of policy it was excluded! Does this mean our union should never raise its concerns because it may be excluded? This is pathetic.

Jo Hillbourne thinks the JDC did everything it could have done, but was not supported by the higher BMA. Jo Hillbourne still thinks that it was a good idea not to have withdrawn from the MTAS review process, she thinks that engagement was more productive than open withdrawal; interestingly she said that the Royal Colleges did not want the JDC on the Douglas review group. It was very clear the the BMA and BAPIO felt that workforce planning had been completely mismanaged by the DoH.

I am still only1 hour 40 mins through! I will try to find time to listen to the remainder and vent my fury.

DoH sees anyone who disagrees as just 'noise'

The first interviews by the Health Committee involved hearing some rather pathetic comments from the deputy CMO Martin Marshall; as he had to explain the reasons for railroading through MTAS 2007 against a massive majority of the medical profession:

Martin Marshall "On balance the benefits of continuing far outweighed the benefits of stopping the process"

( the benefits for the DoH that is)

When he was asked what the profession was saying at the time:

"There were a lot of letters, emails, blogs on websites that said that the process should be stopped, but I felt that the voice of those that felt it should continue was muted, particularly in the spring in the heat of the problems, their voice were expressed very strongly, by a lot of the candidates who had had interviews who wanted them to stand, by the service who didn't want a vacuum on August 1st, and by a lot educationalists as well"

Then when asked if there was an equal balance of people who wanted it scrapped and people who wanted it to continue?

"Not on volume, not on noise, certainly not, the people who wanted it stopped were making a much louder noise"

So then what was the justification for not listening to this noisy majority?

"It had to be a rational one, not one based on noise"

This sums up the contempt that the Department of Health routinely shows for the medical profession in trying to railroad through its unpopular and failing policy. It is hardly surprising that everything the DoH touches turns into manure, when they write us off as just 'noise'. If the majority of the medical profession are 'noise' then I would equate the efforts of Liam Donaldson and Martin Marshall to a gnawing 'sqeak' emitted from a dying rat. The recent Health Committee interviews with Crockard and Heard unveiled the fact that the MMC specialist training group contained zero, yes zero, people with a medical background.

We are being managed by buffoons. The health service cannot be adequately managed and run by people who have no understanding of medicine, the DoH are proof of this. Would it be acceptable if the Bank of England was run by people with no knowledge of economics and no background in finance? The DoH is even so foolish as to empower people with no medical degrees to diagnose and treat disease, this could only have come from people with no background in medicine. Negotiation with these fools is not productive, as they cannot detect sensible reasoned argument when it slaps them in the face. The police service has been treated with a similiar contempt by this government, and they have now realised that agitation and beyond is the only way ahead. How much longer must this go on before we do the same?

Thursday, 13 December 2007

BMA drop an absolute clanger

One would have thought that following the BMA's negligent role in the MTAS affair of 2007, that they may have learnt something from the episode; unfortunately for junior doctors is Scotland it appears not. It turns out that the BMA's Scottish Junior Doctors Committee is backing run through training, despite it being against the wishes of the majority of its members.

In medicine for example, posts at the level of ST1 will be run through posts, as in MTAS 2007. This means that only Foundation doctors and non medical trainees will be able to apply for these run through posts, all other medical trainees will be deemed 'too experienced' to apply. The 'lost tribe' are being frozen out as these run through posts are not available for open competition.

The uncoupling of posts as suggested by the Tooke review is not something that the Scottish JDC appears to agree with. However around 66% of people disagree with the JDC on this, with only 22% agreeing; that's a ratio of 3:1 in favour of uncoupling. This majority of people must be delighted with the BMA's representative role here.

Another great achievement for the BMA, they really must be proud of themselves.

Tuesday, 11 December 2007

An obvious lack of skills for health

The Department of Health has been contacted as regards the scary 'Skills for Health' ladder, another seemingly idiotic reform that must have been spouted by someone who knows very little about providing a good standard of health care. This is the response received:

"Thank you for your email of 6 November requesting, under the Freedom of Information (FOI) Act, information about the Skills for Health Career Framework. Your email has been passed to me for reply.

I can confirm that the Department of Health does not hold the information you have requested.

The Career Framework for the NHS originated from the former NHS Modernisation Agency. A stakeholder steering group was established in 2004, chaired by Andrew Foster, former Director of Human Resources for the Department of Health. The aims of this Group were to determine priorities and timelines for the development of the framework, determine its aims and objectives, and to provide leadership.

The Career Framework was officially launched through the publication of a discussion document for open distribution in June 2004. Over 30,000 copies of this document were distributed. The document included an invitation to share comments, a number of which were received from healthcare professionals, education providers and professional bodies.

The Department of Health asked Skills for Health to take over further development and population of the Framework in summer 2005. The remit was to further develop and embed a competence-based career framework for health, where possible ensuring that the framework is capable of being applied on a UK basis. Initial priorities were given for population of the framework.

Since that time, work has been ongoing to test and refine the framework methodology and to develop integrated tools to enable the sector to use the Career Framework consistently as part of their approach to workforce development."

Sounds like a load of hot air to me, just like the "Skills for Health" framework. With this kind of useless government scheme it is standard that the very opposite of what is being claimed is actually true, ie "Skills for Health" would be better termed "Lack of Skills for Health".

This kind of pathetic numpty level thinking is responsible for the dumbing down of medical standards in this country. The rise of the Noctor is a worrying phenomenon whereby those without proper training are empowered to do jobs that they are simply not adequately prepared for.

Proper education, proper training, proper examinations, proper experience all mean nothing these days. All one needs is a short training course with minimal assessment, and one if free to have a crack at jobs that previously would only have been done by a registered professional. The rule for the gold standard of any system that many doctors apply is to think, would I be happy if my family member was to be treated by this new professional/system/process?

I can safely say that I would not want anyone I even knew, let alone a member of my close family, being medically managed by one of this new breed of health care professional who do not possess medical degrees. Yet again the government is dumbing down, and yet again it is a false economy. Money will be wasted as standards continue to fall, what fantastic progress, who needs skills for health?

Saturday, 8 December 2007

MTAS 2008 - salvage of the wreck

The details of the application of system for junior doctor jobs for next year have been released and can be read in full on the Remedy Uk website here. It is undoubtedly true that some lessons have been learnt, however it does appear that some significant problems remain. The message for all applicants from the MMC team can be read here on the mmc website.

Applicants should do a few things which include getting an up to date CV written, subscribing to the mmc site for updates, working out where they want to apply and getting registered at NHS jobs on line. Worryingly it seems that there will be a very draconian deadline system for applications, with a narrow 2 day window present, outside of which applications will be rejected.

Lessons have been learnt to a degree, however the damage was most definitely done last year. I say this because there will be so few posts available at ST3 level because all the run through jobs given out last year will have to be honoured.

This is a huge problem because many hundreds of trainees will be frozen out because of last year's MTAS farce, a process that was acknowledged by all to be significantly flawed. Therefore hundreds of trainees have run through posts that have been gained via a deeply flawed system, and this is clearly very unfair on those who have been frozen out. There are hundreds of excellent ST3 LATs and hundreds of FTSTA2s who have only a very small chance of not being frozen out this year.

Many of these FTSTA2s and ST3 LATs are excellent trainees who are committed to one particular specialty. There will also be a significant number of run through ST2s who get ST3 posts in specialities which they are not particularly keen on. Personally I find this completely unacceptable. An ST3 lat may be 100% committed to Orthopaedics, but may find that a Plastics committed trainee has got the Orthopaedic run through post that they wanted, almost by default.

The government must take a large amount of the blame for this state of affairs for rushing through this badly thought through reform. However the Douglas group and the BMA must take a significant chunk of the blame for pushing for all run through posts to be honoured. The BMA sided with the DoH in the courts and this was arguably a key action that has led to this very preventable situation. The fall out of this mess will be around for years and years to come.

Tuesday, 4 December 2007

Yet more misinformation

Some journalists have been covering the exceedingly worrying trend of rising maternal mortality rather well, this excellent piece in the Independent draws quite a few strands together rather eloquently:

"The report reveals that the mortality rate among mothers giving birth is up to almost 14 per 100,000 people – an increase of more than 50 per cent since 1985-87."

This is a very scary statistic and these comments by Dr Gibb are a terrifying indictment on this government's management of this issue:

"The rise in deaths is no surprise to Dr Donald Gibb, a consultant obstetrician formerly based at King's College London who now runs his own clinic in Harley Street. "There's a lack of consultant input, not through lack of will, but through lack of numbers and time, as well as the ongoing shortage of midwives," he said. "I think we need to look at systematic failures of the organisation of care. There is a lack of availability of specialist expertise. The standard of 40 hours of consultant cover per week for every obstetrics unit, set eight years ago, has still not been met.

"The Government has not acted on repeated warnings, he added. "What really annoys me and other consultants, many of whom work in the NHS, is that in spite of repeated recommendations to increase the consultant cover in labour wards, nobody seems to have done much about this. A lot of consultants are disillusioned and burnt out.

"It seems as if the Department of Health doesn't listen to what doctors tell them. There's a political imperative to run units as cost-effectively as possible. But when things go wrong, for the small number of women that run into trouble, we're talking about life and death. The stakes could not be higher." "

The truth of the matter is that the government's drive for more deliveries in an environment with less back up is downright dangerous. There is also a serious problem with inadequate staffing levels of specialist doctors and nurses resulting in poor care.

The BBC chooses to take a rather disingenuous stance on this issue, strangely seeming to bury the fact that maternal mortality is rising so fast and concentrate instead on the role of obesity:

"Obesity is the fastest growing cause of women
dying in pregnancy or childbirth in the UK, a report shows."

This is a bizarre piece of misinformation in my eyes as:

"Substandard care accounted for 40 per cent of maternal deaths in the last
report and I am fairly sure the same will be true here"

So I wonder why the BBC chooses to highlight the obesity link, when such a staggering percentage of the deaths are so very preventable? The BBC also choose to buy into yet more cynical misinformation spreading concerning GPs by the Healthcare Commission, that 'independent' body:
"The watchdog found family doctors had measured the body mass index - used to
identify obesity - of 12.5m patients - but this was over 2m less than planned. "
This is yet another example of dishonest anti-GP propaganda. In fact the idea of measuring the BMI of millions of people is completely pointless, just another of the government's poorly though out exercises in gathering useless information for the sake of it. A tactic employed by the government to undermine GPs is to blame GPs for the obesity problem, when in fact GPs can do very little to stem the tide; primary care can only really pick up the pieces when it comes to obesity, the problem is a result of many decades of short termist policy making from central government in areas outside of health. The Healthcare Commission claims:

"The watchdog said these were essential in helping to prevent people with conditions such as heart disease, diabetes and asthma ending up in hospital."

I wonder how much evidence they have for this baseless statement. Putting people on registers for the sake of it doesn't keep people out of hospital, however good medical management of their chronic diseases does; I think it is rather more that good GPs help keep people out of hospitals, not the government's registers. The Healthcare commission appears to be yet another branch of HMG's health dictatorship that seems intent on bullying GPs, rather than adopting a more productive cooperative strategy.

The rising maternal mortality rate needs addressing, and this will involve dealing with staffing levels and the incompetent top down management of the health service by the DoH. Health inequalities need tackling too, and the best way to do this is by cooperating and engaging the medical profession, not by dishonestly bullying and intimidating doctors. The BBC should better represent the real issues and not swallow government propaganda piecemeal. It should be remembered that centralised registers do very little positive for people's health, and that GPs are capable of doing a lot more good work if encouraged so to do. As currently GPs are stifled by brainless top down diktats.

Time to resign

The following letter beckoning Sir Liam Donaldson's resignation has been signed and delivered to their MPs by ten programme directors:

"Dear Member of Parliament,

We are writing to you as we believe that the time has come for the current Chief Medical Officer, Sir Liam Donaldson, to resign or be sacked from his position. His opinion no longer carries any weight in the medical profession given how appallingly he has helped to design and implement Modernising Medical Careers.

We don't mean to be uncharitable, there are some things that Sir Liam Donaldson can be genuinely proud of in his tenure- his work to bring a ban on smoking in public spaces and on patient safety are to be commended.

However, it is his work on the training of doctors which has so outraged colleagues, specifically the controversial scheme Modernising Medical Careers.

Sir Liam should take the advice of the Daily Telegraph (19th July 2007)- "Well, he's clearly not listening to the doctors or he'd know that, in this conflict, it is the public who have the most to lose. Perhaps he should ask himself how he'd like to be remembered: as a government stooge or as a doctor who really did uphold the best interests of patients."

Some quotes from him over the last year show just how out of touch he has been with reality. In an interview with the British Medical Journal(BMJ) (21/10/2006) about the training of junior doctors he said:"So there were big problems with the old system. We think there are going to be many fewer problems with the new system, it won't be perfect but it is attempting to iron out very longstanding difficulties with what was becoming a very outmoded way of training and education."

In April 2007, he stated in the BMJ, "Sir George Godber, one of my predecessors. A giant of his time. He mastered the three qualities needed by a good CMO; the ability to command the confidence of ministers, the skill to negotiate the complexities of Whitehall, and the gift of communication. Finally, he was a man of great integrity. If people do not trust you, you are lost."

In May 2006, Sir Liam told the House of Commons Health Select Committee that "My own view is that I do not really accept the assessment that there is an oversupply of doctors." On 15th November, again at the Health Select Committee, he denied that there was a problem of doctor supply, yet admitted that the Department of Health had not yet worked through the implications of the Court of Appeal action ruling that the DoH's action over overseas doctors with HSMP visa status were illegal even though we are less than 2 months away from the next round of applications.

Yet, Prof Alan Crockard, former national lead for MMC, in his resignation letter earlier this year stated "From my point of view, this project has lacked clear leadership from the top for a very long time".

In April of this year 99% of 400 UK neurologists polled voted against the principles of MMC in a debate at the Association of British Neurologists meeting.

All doctors we have spoken to appear to back a full implementation of Sir John Tooke's review into MMC, but we remain doubtful that such a full implementation will take place when one of the main architect's of MMC remains in charge. Although implementation of the Tooke review will not solve the problems of significant doctor over-supply (which Sir Liam remains in denial over), it will be a good start to restore confidence.

To recite Sir Liam himself "If people do not trust you, you are lost."We do not trust him, he is lost, it is time for him to go."

It is indeed time to go Liam, the profession has seen your true colours and it is now time for you to acknowledge this by resigning. Patients and doctors would benefit from a Chief Medical Officer who represented their interests, and not the interests of politicians. We sorely need a change of leadership before it is too late.

Monday, 3 December 2007

BMA shoots itself in the foot

The BMA's rather strange decision not to allow the publication of an advert for Remedy Uk appears to have backfired somewhat. It does call into question the editorial 'independence' of the BMJ, if the BMA has the power to ban such items. The Remedy advert can be read in full here. As Remedy right point out, the BMA is making some rather unsubstantiated claims at the moment:

Dr Ram Moorthy, Chair of the BMA JDC, quoted in Hospital Doctor today, says:- “If you look at what both organisations want, there's actually not muchdifference

I judge people and organisations by their actions, and given the contrasting actions of the BMA and Remedy on issues such as MTAS, I fail to see how anyone can claim that both organisations want the same things. In fact the BMJ appears to be ignoring its own words, as in the BMJPG's policy is the following:

"The BMJPG believes in competition and is against protectionism, and it will accept advertisements from competitors even if they refuse ours."

It doesn't look like it - BMJ, BMA or whatever you choose to call yourselves. The BMA appear to be a little bit scared because they may actually be forced to represent the views of their members for once, not the just views of their committee dwelling politicos. Whatever the reasons for their decisions, it seems that the BMA is running scared, when instead it really should be looking at itself very hard in the mirror. The BMA should listen to its members and try to represent them, rather than trying to obstruct others who are trying to make a bit of progress for the doctors they represent.

Saturday, 24 November 2007

Forging ahead

The government continues to rapidly change the way in which health care is to be delivered, and yet another reform is being steam rollered through in front of our very eyes. Do we trust the 'Commercial Directorate' to do this job properly? Does rapid rushed reform result in the best long term results? I'll leave that for you to answer.

Dr Grumble reiterates the worrying lack of consultation that has taken place regarding the lowering of the burden of proof in doctors' fitness to practice cases. It turns out that this highly controversial change is included in the government's legislative programme, this can be read here:

"13. Health and Social Care Bill
The purpose of the bill is to:

create a new integrated regulator for health and adult social care, Ofcare, bringing together existing health and social care regulators into one regulatory body;

reform professional regulation to enhance public and professional confidence and strengthen clinical governance as part of the Government’s response to the Shipman Inquiry; and

• include provisions to make a one off payment to all expectant mothers from the 29th week of pregnancy.

The main benefits of the bill are:

• to assure patient safety and apply a consistent approach to regulation for all types of provider through a new registration regime, requiring providers of health services and adult social care to be registered;

• to implement the 2006 Budget commitment to bring together existing health and social care regulators into one body (‘Ofcare’). This will operate with a significantly lower budget than the existing bodies and be established in 2008; and

• to implement, following the inquiry into the case of Harold Shipman, the manifesto commitment to strengthen clinical governance; and to ensure professional activity is more accountable to the public.

The main elements of the bill are:

To establish a new, integrated health and adult social care regulator Ofcare,from existing regulators; to define the functions of the new regulator in the areas of safety and quality assurance, information and performance assessment and safeguarding the rights of detained mental health patients; and to update the system of registration that applies to providers of health and adult social care services and extend this to include NHS providers.
To introduce legislation to use the civil, rather than criminal, standard of proof for all healthcare professional regulatory bodies; to create an independent adjudicator to undertake independent and objective formal adjudication for the professional regulatory bodies; and to ensure that all healthcare organisations employing or contracting with doctors appoint a ‘responsible officer’ with personal responsibility to work with the GMC to identify and handle cases of poor professional performance by doctors."

This government is not one to do things by halves. This government seems to think that legislation and reorganisation will automatically result in improvement to services, we have seen time and time again how the exact opposite is true. Endless reorganisations in the civil service has led to numerous scandals that could have easily been avoided, such as the missing data on the 25 million for example. Reorganisation without thought and with far too much speed is not necessarily a good thing. The token useless gimmicky policy is present with the one off payment for pregnant mothers, something else to encourage single mums to procreate, but what a great soundbite for our politicos to use in their regular propaganda delivery sessions.

DK and Dr Rant have been covering the slightly underhand efforts of a certain PCT in trying to force work in the direction of an ISTC. Choice (TM) as Dr Rant calls it seems to be the very opposite of genuine choice. Dr Ray covers the complete failure of yet another botched DoH attempt to improve efficiency by involving the private sector.

I particularly enjoyed this piece by Dr Rant that neatly describes the reality of MTAS, it puts the words of Donaldson et al into context; Donaldson's pride in the DoH's salvage job is a bit like George W Bush being proud of the mess that Iraq has been left in.

The recent rank incompetence exhibited by HMG is neatly summarised by Barry Monk, it really is hard to understand how these idiots think ID cards are such a good idea, when they repeatedly fail to deliver with much smaller schemes. This old piece by SJ Howard amazingly tells the story of how the government chooses to reward failure and rank incompetence with juicy new contracts; the makers of MTAS, Methods Consulting, appear to be profiting from their lack of skill. While on the subject of incompetence, Dr Grumble talks of a scandal that shows how the government will privatise anything, seemingly oblivious to the dangerous long term consequences of this; nothing new there then, short term gain and more long term pain.

The Witch Doctor is obviously more than a little sceptical of HMG's deep clean, I have to say I agree with him and when one sees that there has been another Clostridium Difficile outbreak in Maidstone right after their 'deep clean'; it certainly adds evidence to our argument. Another piece of misinformation present in the media is the constant lies about doctors' salaries. Chez Sam's points out that junior doctor's are relatively rather feebly rewarded given their training and expenses. Some rather salient facts are listed that make the financial rewards of nursing look relatively generous in comparison.

The rather grim reality of nursing in the NHS is spelt out by militant medical nurse, I can see why frontline nurses such as herself are considering fleeing to lands afar. Nurses are frequently left with far too much on their plates, as our many frontline doctors; and when the shit hits the fan, it's never the manager who gets the blame, even though they had been warned about the dangerously low staffing levels. It will be the doctors and the nurses who take the hit. This topic was touched upon fairly recently by Advanced Practitioner here.

Something that is sure to be in the news a lot in future weeks, is the rather worrying shortage of acute beds in the NHS. It's amazing that after so many billions invested in reform and reconfiguration bed numbers are falling year on year. Couple this with increasing immigration and an increasingly elderly population, and you have a recipe for disaster. Anyone working in the NHS will tell you that many problems such as MRSA are propagated by this shortage of beds and the need to run at almost 100% bed occupancy levels all the year round, most places I've worked at are full to bursting at even the most quiet times of year.

Wednesday, 21 November 2007

DoH hides motives behind CMO report


Thank you for your email in which you asked for an internal review of the Department’s decision to withhold information requested by you under the Freedom of Information (FOI) Act. Your original request was in seven parts and information was given in response to six parts except for part 4 which was withheld under s36. Part 4 of your request stated:

“If the content of the CMO's report was discussed with any of the above people, I would like to see records of precisely what was discussed and who was present.”

I apologise for the delay in responding to your internal review request which has been subject to extensive discussions within the Department.

The review is now complete. The Department is satisfied that section 36 of the FOI Act was correctly applied to that part of your original request and that the public interest in withholding the information did and continues to outweigh the public interest in disclosing the information you requested.

Our public interest arguments were fully explained in our original response. I can also confirm that the opinion of a “qualified person”, in this case a Minister of the Crown, was sought as to the use of the section 36 exemption.

By way of further explanation of the decisions taken, the principle issue in this case concerned the fact that Ministers and Government officials need to be able to engage in free and frank discussion of all the policy options, to expose their merits and demerits and their possible implications as appropriate. Their candour in doing so could be affected by their assessment of whether the content of such discussion would be disclosed in the future. Additionally, papers need not be released if release would inhibit the provision of advice for the purposes of deliberation, or would otherwise prejudice the effective conduct of public affairs.

If you are not content with the outcome of the internal review, you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner can be contacted at:"

There we have it, democracy is dead, the fact that the CMO's report was discussed with ministers and civil servants is no surprise; however it is another thing that the motives and reasons behind this report can be hidden in this way.

How can the CMO's report be claimed to have been genuinely consulted, if the real reasons for it and the motives behind it are not revealed to those consulted? So much for consultation.

Remember the CMO's report includes the controversial downgrading to a civil standard of proof in fitness-to-practise cases, which has been included in the Government's Health and Social Care Bill. So much for this being properly consulted then.

I fail to see how the CMO's position remains tenable when it appears that so much of his work is so politically motivated. Above all this lack of transparency is not something one expects in a western democracy, I am amazed how our government is coming to resemble a banana republic. Metaphorically speaking, Sir Liam has certainly had his fair share of the bananas.

Monday, 19 November 2007

Blogging pick'n'mix

Frontpoint Systems has been in typically fine analytical form of late. The waste of public cash on procurement, the grave problems with ISTCs, talk of actually basing policies on evidence (not free market ideology) and dangerous plans to franchise primary care are just a few of the recent topics covered comprehensively.

Dr Rant has been ranting away furiously, with some good mocking of the government's needless drive for more 'access'; while a certain mole has thrown some light on a rather topical issue, casting doubt on the so called 'independence' of yet another of HMG's arms length bodies. While the idiocy of practice based commissioning is excellently described.

Dr Grumble tells a sad tale of someone whose career has been mangled by the MMC juggernaut; while I particularly enjoyed the provocative piece on targets and waiting times, something that anyone who works on health policy would do very well to read.

Anyone who wants to know what real story is as regards homeopathy need look to further than Ben Goldacre's damning piece, he really doesn't mince his words and why should he? The homeopathy brigade need to be attacked for their pathetic tactics which threaten to undermine proper scientific progress:

"But when they’re suing people instead of arguing with them, telling people not to take their medical treatments, killing patients, running conferences on HIV fantasies, undermining the public’s understanding of evidence and, crucially, showing absolutely no sign of ever being able to engage in a sensible conversation about the perfectly simple ethical and cultural problems that their practice faces, I think: these people are just morons. I can’t help that: I’m human. The facts are sacred, but my view on them changes from day to day."

Dr Ray has reproduced a brilliant, albeit lengthy, assassination of the Darzi NHS review. Darzi's sham review is deconstructed to reveal the cynical plot that lies beneath the superficial facade.

The courageous Barry Monk, consultant dermatologist, tells a shocking tale of just what tactics those in control of the NHS use to intimidate those who oppose their destructive reform. Any organisation that treats its most valuable and experienced assets like this needs its head testing, it gives an insight into the kind of attitude that is shown towards those who want to fight for the interests of their patients and the general public.

A lot of people are wondering where exactly Dr Crippen has gone? Has the Witch doctor's black cat caught up with him stateside? Watch this space for updates.

I would like to finish by highlighting the disgraceful performance of several DoH employees last week when they presented their 'evidence' (propaganda) to the Commons Health Committee. Sir Liam Donaldson led the way, closely followed by his profligate stooge Martin Marshall in trying to deny any responsibility for the mess of MTAS and MMC. Their explanations defied belief, as they arrogantly referred to the majority of medical opinion as 'noise', while the Douglas review group was portrayed as a voice of pure objective reason. However even they didn't try to argue with Sir John Tooke's review, but Liam Donaldson might need to read it again, as Sir John didn't paint the policy behind MMC is a particularly favourable light. In my humble opinion the incompetent buffoons who designed MMC and MTAS must be held to account for their actions, and they must resign. There is simply no argument that can save their low quality bacon, especially Donaldson's fatty rasher.

Sunday, 18 November 2007

What do health correspondents know?

I thought that it would be rather interesting to survey the health correspondents, who work for the major media outlets in this country, to examine just how well educated they are in the field of science. The reasoning behind this was that in my opinion it is rather hard to do a decent job as a health correspondent without a reasonably scientific education, given how so many health related issues are so very scientific in nature. Unsurprisingly only a minority of those surveyed responded.

Credit must go to those who did respond. Nigel Hawkes of the Times who writes some excellent pieces, unsurprisingly has a very scientific background with a scientific degree and A Levels in Maths and the sciences. Jeremy Laurance of the Independent has A Levels in Maths and science with a philosophy degree. While Sarah Boseley of the Guardian has no science beyond GCSE level with an arts degree, she also felt the need to comment as below, she obviously knew the line which I was probing:

"I would add that I think the job of reporting is not necessarily to bring any previously-acquired knowledge to a story but to find out and understand it well enough to interpret for a reader who usually knows even less than we do. Some scientists have difficulty with that."

I think Sarah Boseley's argument shows exactly why a scientific education is needed to report to a high standard on scientific issues. I think scientists have difficulty with this argument because of the flagrant lack of logic it demonstrates. A good scientific education is invaluable in analysing scientific evidence and scientific stories; it is essential for weeding out the good science from the dross, for spotting the dishonest lies that some people peddle as indisputable science. It seems to be no coincidence that the mainstream media gives so much time to medical treatments with no evidence behind them such as homeopathy and natural remedies, while so called experts in nutrition and psychology are trusted just because they have paid a few hundred dollars for a cheap masters degree in their field of expertise. I would argue that a proper scientific education is essential so that our health journalists can weed out the likes of Gillian McKeith, rather than naively believing anyone who can talk the talk.

I am still waiting for replies from several journalists, including the BBC's health correspondent. I am sure that journalists will have very wide ranging views on this topic, but surely this debate should be heard; as there is a real concern that if the dumbing down of science continues in the media as it is, then more and more con artists will continue to rip off the general public in a variety if ways with their dishonest pseudoscience. Sometimes it may only mean that someone wastes a few quid on a potion that doesn't work, but on other occasions it may mean that someone dies because they seek the attention of quacks instead of the real doctors who may be able to cure their health problem. I have seen early stage and eminently treatable breast cancer kill needlessly, because a patient was convinced that 'natural remedies' would cure her without the need for surgery. If any journalists wish to join the debate then please feel free to add your name and the details of your education below. Science is the foundation upon which so much modern progress has been built, so if we let these foundations wash away the consequences could be rather disastrous.

Thursday, 15 November 2007

Donaldson and his cronies dissappoint

MMC and MTAS is being investigated by the Commons Health Committee today, all the written evidence can be seen here. It can be viewed via this link if you did not have time to see it live. Remedy Uk is holding a virtual vigil as we speak.

For me watching a few minutes in my lunch break between clinics, I am infuriated by the complete dishonestly and spin shown by Sir Liam Donaldson and his pack of cronies at the Department of Health.

Sir Liam tried to spin the disaster as evidence of how well his team has responded to a crisis, failing to mention that the crisis was largely his fault in the first place. The deputy CMO also tried to spin MTAS as something that a large number of people were happy to see continue without any change, as if it was a noisy minority that wanted things to be stopped.

The amount of times that the DoH cronies had to say "I don't know, I'll have to check that" began to beggar belief, what precisely do these idiots actually do all day at work? Sir Liam agrees with the Tooke report apparently, I hope he agrees with the bits that point out the complete incompetence and lack of leadership shown at the DoH throughout all this.

If I had had time to watch for much longer I would have been tempted to aim my fist at Sir Liam's rotund patronising cheeks staring at me via my computer screen. Heads must roll.

Sunday, 11 November 2007

Darzi's democratic bypass

The government's sham consultation process for Darzi's NHS reform was first exposed by Dr Ray, other bloggers quickly followed his fine example to highlight this worrying issue. The Department of Health have been forced to admit that there is a rather worrying lack of transparency as regards this 'consultation' process, I quote the DoH commenting in response to a FOI request:

"In the weeks leading up to the events, people were approached on the street by Opinion Leader Research (OLR- the company that carried out the deliberative events on the Department’s behalf) and asked whether they would be willing to participate."

"OLR oversaw this process to representative specifications agreed with the Department of Health."

So the government gave this important job to a private firm, so one would therefore hope that this process was transparent given that it relates to matters of a very strong public interest:

"There are no records of the meetings held between Department and the contractor."

There we have it. The Department of Health is privatising the democratic process. They have outsourced an important public consultation to a company that prides itself on spinning and manipulating public opinion. The Department of Health strangely then has no records at all of meetings it has held between itself and Opinion Leader. This is even stranger when one considers that Opinion Leader were chosen ahead of other firms even though their tender was over ten times the cost. Opinion Leader are also involved in the government's nuclear power consultation, another open and honest process if ever there was one.

Meanwhile the DoH claims that no 'social influencers' were used by Opinion Leader at their NHS events:

"I can confirm that no social influencers have been used at any NHS Review event."

This seems to directly contradict the use of Opinion Leader staff as described by people who attended the event. I smell a bit fat porkie. It is yet more astonishing evidence that shows the lengths to which this government will go to manipulate the democratic process; it is also very scary indeed that this kind of important public work can be outsourced and then conducted in secrecy behind closed doors. New Labour is again spitting upon the grave of democracy.

Bankrupt Wanless is the Skills Escalator man

Christmas has come early if you previously thought that you had to go to medical school to become a consultant, because thanks to the NHS Skills Escalator anyone can have a crack without any proper qualifications. Their bizarre nonsensical plan has to be seen to be believed. Also have a look at how you can climb the NHS jobs ladder in the easiest possible way without gaining the proper training or qualifications, apparently the fact that a medical degree may be important for the career of physician or surgeon is seemingly brushed under the carpet by these idiots.

'Competence' can be simply self assessed and there appears to be very little restriction on what those with no decent training can have a stab at. Pharmacists and nurses are the most recent staff who have been given jobs well beyond their means, I wonder how long it will be before porters and receptionists are let loose to diagnose and treat minor illness. Where I work the unaccountable management are sometimes keen to give patients wound care advice. Who are the idiots responsible for this handing of power to the ignorant:

"With redesigned roles and competences and greater participation from other non-medical members of the team we will be better equipped to meet the demands of the future." "Skills for Health (SfH) works with employers and other stakeholder to ensure that those working in the health sector are equipped with the right skills to support the development and delivery of healthcare services. SfH are leading on the development of frameworks and standards to define and develop competence and a programme to support workforce and career development. As part of the modernising agenda and New Ways of Working a 9 level Career Framework was developed, describing England’s healthcare workforce by skills and competencies rather than traditional professional boundaries."

Debbie Mellor, Rob Webster and Becca Spavin are the clueless stooges behind this negligent dumbing down agenda. This is the same Debbie Mellor that was largely responsible for the MTAS disaster. And as the Witch Doctor points out, Derek Wanless is the Skills Escalator man:
"The Government –commissioned report into health sector workforce led by Wanless contends that the only way we can plug potential gaps in the system in future will be to work from the bottom up, starting with the patient, then working through Healthcare Assistants through nursing therapists to medical professionals."

Derek Wanless, Debbie Mellor, Rob Webster and Becca Spavin have no understanding of working on the ground in the NHS, their hard brained schemes to empower the untrained are demonstrative of their complete ignorance of what it takes to provide a good standard of clinical care to patients.

This is the same Derek Wanless who has presided over the recent catastrophe as regards Northern Rock, and in the opinion of many experts was significantly to blame for the problems that arose, problems that were eminently foreseeable and preventable if the likes of Derek Wanless did their jobs properly. He is allegedly an expert on finance, so if he can be shown to be so useless in his field of expertise, I really fear for his idiotic plans as regards the NHS Skills Escalator.

It may well be true that someone with no education could do as good a job reviewing the NHS as Sir Derek, however he should not lump us all together in his boat of rank incompetence. Professional boundaries were there for a reason, they were not just there for fun; they were crucial in maintaining high standards of clinical care and in protecting patient safety. The erosion of proper professional boundaries as catalysed by the idiotic Skills Escalator works against the very essence of professionalism, they represent an incoherent amateur approach that threatens to endanger the safety of patients everywhere, as proper education and training are cast aside because they are just too expensive and too much hassle. Wanless and his incoherent plan must be opposed at all costs, otherwise the lunatics will have truly taken over the asylum.