What value a medical degree?

It seems that the Australians have more balls than the British, down under the Australian government is trying to force through various destructive dumbing down reforms that empower those without medical degrees to jobs that previously required much higher levels of education and training. The Chairman of the Australian Doctor's Fund is clear with his message:

"Who would subject themselves to the rigours of a medical degree when it is so much easier to obtain a nursing degree and be jumped into a medical role?

In other words Ms Roxon has to decide whether she wants doctors or nurses to be the ultimate decision maker on the care of patients. Sadly our leaders seem to be unaware of the problem or seem to think that simply by announcing it, their job is done. Sadly those driven by ideology rarely succumb to reasoned argument; backed by million dollar budgets and armies of public servants they play with their half-baked ideas and impose them on those who know better.

It is our duty and our intent to prevent these destroyers of the culture of medicine from achieving their goals. It is our duty to assert and intervene in all possible ways to make sure that a medical degree, and all the discipline required to achieve it, is given its rightful place, namely signifying leadership in medical care.

This is the model that has delivered Australians world-class medical treatment. There is no reason or compelling case to dismantle it.

When I worked in England many years ago I was appalled that there seemed no one who took personal responsibility for a patient. Let us not go down the same road here."

Ms Roxon is the Health Minister who is coming up with the half-baked ideas, the parallels to the UK are obvious, and these half-baked ideas are very much a threat to world-class medical treatment, once the dumbing down starts it is hard to stop. The Australian Government is also trying to replace GPs as the cornerstone of Australian medical practice, in a way that draws striking parallels to what the Labour government has done here in order to usher through the privatisation of the NHS. A former Australian Medical Association chief has this to say:

" If nurses want to be doctors, trained to take a history, examine, investigate, diagnose and
formulate a management plan with the depth of knowledge required for the possibility of
differential diagnoses, then they should apply to medical school…."

This quote from another big cheese shows how the Australians are trying to push through exactly the same dumbing down agenda as has been done in the UK, it matters not what education, skill or training anyone has, you can all be 'doctors'! But then what will the word doctor come to mean?

"And, interestingly, there is a push for another change – namely, that all practitioners
working in primary care, irrespective of their qualifications and expertise, be now called
“doctor”. Such a collaborative model readily brings to mind the sovietisation of health
care."

There is a problem with bananas, this half-baked philosophy of cutting the number of properly trained staff won't even save money; it is expensive, bad for patient care but it does allow the government to push through it's privatisation schemes more easily. The NHS Skills Escalator looks like it were drawn up by a braindead slug on crack, but sadly this is a creation of our retarded overlords in government and it is being pushed through regardless of its utter stupidity.

Good luck to the Australians in resisting this destruction of their excellent health care system, it will be hard as the government have buddied up with the Australian Nursing Federation and seem determined to repeat the damage that has been done in the UK. They have established a 'National Health Workforce Agency' which may well be another prong in their attack on medical professionalism and standards.

It is sad that there are so many people out there who are too stupid to see the wood for the trees. It matters not whether people are called doctors, nurses, paramedics or monkeys. The labels to things do not matter, relabelling a useless product does not make it better. It is as simple an argument as less education and training makes for a lower quality of care. After all if the government announced plans to train doctors in about three months then I am sure everyone would be up in arms, so why do some idiots find it acceptable to convert nurses into doctors with an even shorter period of training? There isn't even any decent evidence to show that it is safe. In life you get what you pay for, less investment in training people properly will get you a poorer service, it won't magically save you money and provide as good a service.

"The Cochrane Collaboration summary on the equivalence of GP-led and nurse-led care has more disclaimers than a set of K-Tel steak knives. Most damning is the statement that these findings “should be viewed with caution given that only one study was powered to assess equivalence of care, and many studies had methodological limitations”. So, Australian policy-makers, reformers and governments beware – 50 years of general practice hard slog has resulted in international benchmarking for key health outcomes, and unsurpassed general practice patient satisfaction."
(Prof Claire Jackson, The ‘little sick/big sick’ myth of general practice, Australian Doctor, 19/10/09)

Junior doctors deserve no rights

According to this 'consultation' document from the Department of Business, Innovation and Skills the rights of junior doctors are to be completely ignored yet again; apparently medical deaneries, the bodies that are responsible for the recruitment and training programme of junior doctors to NHS Employers, should be 'exempt' from employment agency legislation.

It begs the question, why should deaneries be exempt from employment agency legislation when they are effectively acting as employment agencies? It is a bit like saying that one particular murderer doesn't have to be prosecuted because the law doesn't apply to him like everyone else. The pathetic justification for this is:

"This is based on evidence that the potential consequences could be to seriously hinder the recruitment and training arrangements of junior doctors with a subsequent impact upon both cost and staffing for the NHS"

This is a disgrace to put it mildly. The government are effectively saying that they want to treat junior doctors as subumans because this way it is cheaper and easier to fill the jobs up. If sticking within the law is so hard for deaneries and the government then they should take a long hard look at the shabby and substandard way in which they treat junior doctors, shepherding them around like cattle and not giving a minute's thought that they may be entitled to lives and rights like other human beings.

At least the BMA will stand up for the junior doctors, right? No, wrong, the BMA have met with the Department of Health to discuss treating junior doctors like slaves and they are to draw up a completely toothless code of conduct that deaneries will just ignore because it's not the law. Interestingly Remedy were not invited to this 'discussion forum', strange that. So much for all humans being equal, it seems in the eyes of the government junior doctors do not deserve the necessary protection of the law when seeking employment, it is just too costly to treat them as humans.

Who will do the nursing?

Much talk has taken place in recent days on plans for all nurses to be trained to degree level from 2013. I think a lot of the chatter and debate has missed the point. 'Degree level' is just a label, it doesn't mean a great deal on its own, I think the problems with nursing training are similar to the problems with medical training that have become apparent in recent years.

Good old fashioned basic nursing has become devalued as an entity in recent years, it seems that an apprenticeship in one's trade is simply no way to learn the ropes in our current politically correct times. Basic things such as feeding patients, washing patients and attending to bedpans are beneath some modern nurses. A little knowledge can be a dangerous thing, a quick superficial glance at the science behind medicine seems to have inspired quite a few nurses to bit off a bit more than they were able to chew.

I do not wish to single out nurses, the same types of problems exist with the training of doctors. The basic science has been dumbed down, the apprenticeship has been lost and the ward hours are just not there anymore. The same is the case for nursing training, the ward hours and apprenticeship has been lost at the expense of satisfying politically correct mumbo jumbo spewed forth by educationalists. The subspecialisation of educationalism is to blame for a lot, invariably idiots who were not very good at the job end up doing all the teaching despite the fact that they haven't been on the front line for years.

This loss of the apprenticeship and the reduction of basic standards is a direct result of one thing, money, the government does not want broadly trained competent workers who have learnt the ropes adequately, they want to isolate individual competencies and shift work down to people who have had way less training than in years gone by. To see this in action all one has to do is see who does most of the basic nursing on wards, it is done by 'health care assistants' who have had very minimal levels of training, they are the modern day nurses.

Nursing is no longer good enough for modern day nurses, a lot of them now go into nursing as an easy route to becoming a quasi-doctor or 'noctor'. In life you get what you pay for and less training and knowledge inevitably results in a lower quality of service for patients. Many nurse specialists who specialise in areas which are suited to their skills and training, for example stoma care nurses, district nurses or various sub speciality liaison nurses, are a great asset.

The problem comes when nurses are promoted into jobs that demand a broad based understanding of medical diagnosis and management, for example the nurse in the Walk in Centre who practises independently or the scarily 1984-esque nurse 'consultant'. Some experienced nurses can just about get away with it, some of the time, however when inexperienced nurses are given these roles the consequences can be rather disastrous as well as expensive. One example is the massive failure of nurse-run Walk in Centres to reduce referrals to other health services.

The government cares not for quality of care, all is interested in is privatising the NHS and selling it off to private corporations. Breaking the medical profession's monopoly on doctoring has been part of this corrupt privatisation process. A side effect of this has been the devaluing of proper nursing which is sad to see. There is a real need for patients to be properly nursed and in the future we'd be better off having nurses doing nursing, rather than letting anyone with a couple of weeks training take their place and moving trained nurses into jobs that are outside of their expertise and training.

Who will do the caring?

The BBC has reported on a government report which claims that around 2,000 people's deaths each year are contributed to by the innappropriate prescription of anti-psychotic drugs for patients with dementia. The report claims that:

"But the expert review - commissioned by ministers - said the treatment was unnecessary in nearly 150,000 cases and was linked to 1,800 deaths."

This is all well and good, but when one sees the prescription of anti-psychotic drugs in the context of a care system that has been almost entirely privatised and ground down to the very bare bones, then the government's sticky plaster of a response is nothing but pissing in the wind.

The government wants better access to other kinds of therapy, more training for care workers, more monitoring and a new national director. I wonder where all the money for this will magically appear from given the NHS' budget crisis?

Also it is strange that the government has done so very little to regulate the care industry in the UK in recent years. It used to be largely publicly owned, but after the last twenty years or so of destructive reforms, it is largely privately run for profit. This also means that the government cannot force changes upon the system anymore, as the private firms hold all the card in terms of ownership and lobbying power, they have been very resistant to proper regulation in recent years.

This has meant that many care homes are dangerously short staffed and the staff present are invariably not sufficiently trained for the jobs they do, the government watered down regulation changes a few years back that would have forced a maximum number of patients per staff member. No wonder anti-psychotics are being dished out like smarties, there simply has not been the right number of properly trained staff to adequately manage the most tricky patients with dementia.

The privatisation of a service that should be accountable to the public has led to it being run down in the name of profit. This government and previous governments have caused the care of our elderly to be so woefully neglected, they simply don't want to pay for people to be cared for properly to the grave. This report is yet another dishonest piece of spin designed to take attention away from their own failings.

PCT deprives NHS of cash to to council's job

I read this story in the newspaper that demonstrates how completely stupid those in charge of alot of the NHS' cash are, the Mail covered this story of Durham and Darlington Primary Care Trust (PCT)'s decision's to spend 1 million pounds of NHS money on gritting the county's roads.

"This money will be spent in a variety of ways but, in particular, on gritting extra paths and pavements which will result in improving the quality of life for the elderly who often fall and fracture bones in icy weather. It will also go towards additional road gritting as road traffic accidents have a major health impact and often cause death or lifelong disability for the individuals involved."

This is the logic of a fool. By this logic PCTs could spend money on filling in pot holes, repairing roads, checking vehicle safety, renovating old buildings, improving playgrounds, arresting dangerous criminals, policing the roads, collecting rubbish et aliter. Many other areas of policy can affect health, but this does not mean they should be funded directly with NHS money. This is plain barking mad.

As hospitals are being starved of cash by PCTs, because the uneducated morons in charge of the PCT's funds decide to fritter away money on non-health related issues and on health related schemes that have sod all good evidence to back them up, we see the banks continue to be propped up by the government because they cannot be seen to fail. Why can hospitals be seen to fail because PCTs are wasting all the money they need to provide decent local services for local people?

It has been many years in the making, but the way in which the most educated and knowledgeable are not involved in deciding where NHS funds should be allocated is a national scandal. Epidemiologists and Public Health specialists are now routinely uninvolved, while empowered general managers with no understanding of medicine in tandem with a sprinkling of uneducated idiots are literally pouring petrol on this bonfire of tax payer's cash.

Johnson and Brown: two idiots of the highest order

The Prof Nutt saga is not going away unfortunately for the incompetent duo of Gordon Brown and Alan Johnson. The disgraceful sacking of the eminent Professor is turning into quite s sh*t storm, and quite rightly so. The more information that comes to light, the more corrupt and stupid the politicians appear. Dr Grumble has pointed out yet more flaws in the government's weak line of logic.

Alan Johnson accused Professor Nutt of becoming political with his statements, in fact what he said prior to his sacking was simply a well rehearsed and well researched scientific argument that was backed up by solid evidence. All of Brown and Johnson's comments on drugs have merely shown an immense lack of understanding of the evidence and a pathetic tendency to appeal to the lowest scaremongering sections of the tabloid press.

Skunk is not 'lethal' as fat Gordo stated, in fact by Johnson's logic Brown should resign as he is clearly straying into the scientific domain with this political statement. Johnson is just as bad as Brown with his illogical statements that he has released in order to justify the unjustifiable.

This is a simple issue and it comes down to the government having no balls. Brown is a weak incompetent leader who will do anything, no matter how wrong or dishonest, to win a few votes. Brown has routinely ignored experts on issues of which he and his fellow morons in power have no clue, he is too stupid to have any insight into his own lack of knowledge, he is a first class buffoon. This affair is not going away, it is about important principles, the resignations continue and I sincerely hope that it has done some good in exposing the rank stupidity and arrogance of those leading our country.

Ex-postman sacks Prof Nutt: government shows contempt for independent advice

Professor Nutt has been told to resign as chairman of the Advisory Council on the Misuse Drugs (ACMD) after a series of controversial outbursts including accusing ministers of ignoring scientific evidence to distort the drugs debate.

This is a disgrace. It makes an utter mockery of the government bothering to have any so called 'independent' advisers. Prof Nutt had the audacity to tell the politicians how it was, i.e. that the politicians were pandering for votes by spreading propaganda and scaremongering, and in the process they were ignoring the scientific evidence.

Policy should be based on evidence as best it can, it should not be made up in order to satisfy the tabloids and it should not be drawn up by people with no detailed knowledge of the particular policy area. Just imagine what this kind of pathetic bullying does to all the government's independent advisers, they are hardly going to be inspired to giving their honest opinion in the future are they?

This government is an utter disgrace.

The BNP sideshow - corrupt politics fuels the rise of the far right

The news headlines will be dominated by talk of Nick Griffin of the BNP appearing on the BBC's Question Time program tonight. Whatever one thinks of the BNP, they are a political party and they have a right to their views as long as they are within the law of the land, therefore the logic of various 'anti-fascist' groups appears sadly lacking to me. It has always been apparent that the far right and the far left often end up resembling each other, the BNP and the anti-fascist groups could both do with a good long hard look at themselves in the mirror.

Anyway I digress, the point I intended to make was that the BNP have become more successful in recent years for one reason and one reason only, and in my opinion it is nothing to do with the BNP's policies or approach. The reason for their rise is the complete and utter failure of all our major political parties to represent the interests of the general public. The majority of people in this country have become completely disillusioned with politics and this means that a small number of idiots have shown their disillusionment and frustration by voting for the BNP.

Only just over 60% of people voted at the last General Election. There is just so little choice for voters. There is nothing to choose between the major parties is virtually all the key policy areas. For example as regards health, all the major parties want to continue privatising the NHS, they all want to continue to waste billions in continuing the same deeply flawed market based reforms. There is no democracy, the vote that previous generations fought so hard for has come to mean nothing, our political system is corrupt and the far right will continue to prosper until the mainstream politicians start to mend their ways.

There is very little sign that our political masters will remedy this situation anytime soon though. Gordon Brown has signed us up for the Lisbon treaty despite promising in the Labour manifesto that there would definitely be a referendum on this issue. More and more power is being surrendered to the corrupt and unaccountable bureaucracies of Brussels, this is yet more fuel to the fire of resentment and frustration that is felt by a large percentage of the electorate. The spotlight should be on the way in which our current political parties are representing their own vested interests and not the interests of the electorate, not the bigoted BNP.

Numpetry in the NHS; the Walk in Centre Quacks

"Am on call this weekend as a ENT reg and received a call from a "Senior Nurse Practitioner"(her words) in a local walk in centre. She had seen a chap in his seventies with hearing loss for the last week.She had examined both his ears and had found nothing abnormal.

Upto this point, no problems with the conversation. She then proceeded to tell me that she wanted me to admit him and arrange an urgent scan.

She did not have any idea of what type of hearing loss he had. She had never heard of Rinne's or Weber's and got very annoyed when I proceeded to question her further. According to her, she had been taught that sudden hearing loss required a scan as this could be an acoustic neuroma.

Before the usual Noctor supporters on DNUK jump up and say that I should have just accepted to see the patient, I did tell her that she could send the chap to the hospital and he would be assessed by my SHO and me.

But she insisted that he needed to be admitted and scanned. Oh and proceeded to ask for my GMC number.

I am normally a patient person when it comes to dealing with stupid fools but this really annoyed me. However I managed to stop myself from swearing at her down the phone and spoke to one of the doctors in the same centre. He was a locum chap who saw the patient and examined him properly and called me back.

The patient had actually had a cold and developed a conductive hearing loss over the last week.And he is going to come to the ENT clinic next week for an audio and review.What I can't understand is how these poorly trained idiots are allowed to work without supervision? What are the assessment criteria for them to be certified to work in a independent/semi-independent environment?And if they cause such trouble for small specialities like ENT, how much of a hassle do they cause other, busier specialities. "

The above tale is one of many that happen on a regular basis in the NHS. Before the same old trot is rambled out in defence of empowering the ignorant, I am not insulting anyone without a medical degree. I am talking of any worker who is empowered way beyond their means. This includes GPs who try to do the job of consultants after hardly any extra training, they then call themselves GPSIs and try to work as specialists. This includes several varieties of nurse specialist who are employed in roles in which they have to work as general physicians, they simply do not have the knowledge or training for these roles. Walk in Centres sum up the inefficiency of the new privatised NHS, there is no continuity for patients, there is precious little training for staff and these centres cost a hell of a lot of money for the appalling quality work they do.

At the same time as the ignorant are empowered and overpaid, we have people with a lot of training who are wasting their time carrying out menial tasks when they could be doing other more productive things. It certainly appears that a lot of proper nurses are rather appalled by what is going on, it seems that these days proper nursing is being completely neglected and basic standards are not being maintained on the wards:

"All of the above may be true for a minority of senior nurses but unfortunately the vast majority of band 5/6 nurses seem to have lost the plot. They can no longer prioritise work effectively, they cannot safely administer medications, they cannot measure and record patient observations correctly or add up simple MEWS scores correctly and they cannot recognise the signs of a deteriorating patient. Lets get the basics right before we disappear up our own backsides."

Quite right.

Hospitals will go bust, the cultural revolution goes on

The way the NHS works is never simple, in fact in gets more and more complicated every year as the layers of bureaucracy and management exponentially proliferate. The current financial crisis means that NHS funding is being cut. PCTs are therefore having to cut budgets.

As a result of being forced to comply with various expensive and wasteful top down initiatives such as PBC, Choose and Book, ISCTs and other forms of privatisation, the PCTs have less money for all our local hospitals. PCTs have also massively expanded their own staff which has further reduced the amount of money that trickles through to the frontline providers of NHS care.

So funding cuts, useless stupid reforms and bureaucratic inefficiencies are all resulting in massive funding cuts to hospitals. Unfortunately demand increases as medicine advances and our elderly population expands. This means that all around the UK PCTs are starting to refuse to pay hospitals to treat patients, they have no more money, the market has completely failed.

This market failure demonstrates just how stupid the government's market based approach has been. The patients who need treatment will not go away, there will be two potential outcomes to this disaster. Either hospitals will simply have to cancel all elective non emergency work as they are not being paid for it, or hospitals will have to go under financially. This is happening as I write up and down the UK.

It is a no win situation for the hospitals, the aim from the government has been to force hospitals under in order to ship yet more work out to overpaid private providers; the government will claim it is down to the hospital's inefficiency, this is a lie, if you stop paying anyone fairly they will go bust. Just to think we are paying more in tax in order to subsidise this 'cultural revolution' of change that is destroying our NHS. Thanks Gordon, it's just sad that big Dave will continue the mayhem while the Liberal Democrats don't seem to mind either.

ISTCs kill

I have said it before and I'll say it again, ISTCs are expensive and dangerous. This recent BBC Panorama program says a lot of things that I have said on this blog time and time again.

The comments from the Health Minister and the regulator are beneath contempt, they are either being dishonest or they are completely ignorant of what they speak. The dangerous lack of safety at ISTCs cannot be put down to 'human error', they were down to negligence and a complete rank lack of decent procedure being in place.

ISTCs have been brought in without adequate mechanisms in place to ensure that the care they provide is of a decent and safe standard. This is the fault of the government and the regulator. The only outcomes these shoddy centres have measured are extremely soft and meaningless.

The same lack of transparency is present for many of the government's recent health reforms. No one has looked at outcomes for GP out of hour's services that have been farmed out to dodgy private firms, no one has looked at the dangerous Walk in Centres that often have some rather dodgy staff running them, no one has looked at many new health care projects that this government has forced through in a reckless manner. This government quite literally has blood on its hands, this privatisation has not only wasted our money but has also killed people.

Monkeys for management, the NHS rot

As we all know money is in short supply, the government has frittered away billions on brainless ideological schemes in many policy areas, this is especially relevant to health and the NHS. Who can forget the billions that have gone on management restructuring every two years (SHAs/PCTs), PFI schemes of appalling value, C&B/PBC (the market), Darzification and Darzi's privatisation of general practice et cetera.

The lack of understanding of medicine and health care in general is excellently shown by this chunk the article in the Telegraph:

"Sixty per cent of activity which now takes place in A&E departments should happen in community clinics within five years, the document says, along with 55 per cent of outpatient treatment. Thirty per cent of outpatient appointments will be stopped altogether. Managers say not all appointments are necessary, though many doctors argue it is impossible to know in advance which patients do not need to be seen. The number of diagnostic tests carried out will be cut by 15 per cent, while the amount of surgery will be reduced by seven per cent."

This statement exhibits a rank lack of intelligence and a rank lack of understanding of medicine. Shifting work out to lame little community clinics does not work, not only do the under trained staff at these units have no idea what they're doing but they often end up referring most stuff onto other services anyway, they do not have enough knowledge and skill to actually properly sort patients out.

Just because nothing is done at an out patient appointment it does not make this appointment unnecessary, a lot of appointments involve patients being reassured and adequately diagnosed by a specialist. Not all flood defenses are necessary, does this mean that those manage our flood defenses will go about deciding which ones to remove before the next floods hit us? Of course not, this is the logic of morons. With medicine becoming every more sub specialised it is inevitable that referrals will increase as it becomes harder and harder for generalists to adequately manage in subspecialities which are becoming ever more complex with new treatments becoming available of which they know very little. In modern medicine patients are also becoming more empowered and knowledgeable, this will also drive up referrals to specialist services.

The idea of reducing diagnostic tests and surgery in this context is also completely nonsensical. In the modern day drives to cut diagnostic tests will probably lead to more litigation and hence increase costs, while as medicine becomes more complex and subspecialised, it is inevitable that diagnostic tests and surgery will need to increase. As imaging develops we are constantly finding new indications for surgery which are proven to be effective, you simply cannot aim to reduce diagnostic tests and surgery in this context, it is utter lunacy.

The layers of bureaucracy are now proliferating. Various uneducated ignorami at the DoH, SHAs and PCTs are wasting a massive amount of money in trying to increase efficiency with stupid policies that try to directly reduce referrals in a top down manner. This is done by creating more administration to regulate clinicians in an Orwellian manner, telling clinicians not to refer is plain stupid, clinicians do not refer for fun, they refer when they think the patient will benefit from a referral, so top down interventions to reduce referrals are actually in conflict with good medical practice, it encourages bad and arguably dangerous medicine.

So millions and billions are now being wasted on various crack pot schemes that aim to save money by effectively stop proper medicine being done. In this way money is wasted enforcing bad practice and bullying clinicians. This is a blatantly Stalinist system at work, it is a disgrace. Many of us have now seen first hand examples of this kind of logic at work in the workplace, PCTs are now refusing to pay for certain hospital services that patients need, the demand doesn't just go away if you refuse to pay for something, fiddling the hospital out of money doesn't make certain ailments disappear.

The current system sees various bureaucracies fighting each other, there is no cooperation which would result in efficiency savings, PCTs are fighting hospitals for money, the DH is clawing back money from PCTs, and then finally the government will cut the money off at the source. In the meantime patients will not magically get better, their illness will not just go away. Fiddling the books helps no one in the long term.

The government and our administrators would do better to look reality in the face, in an NHS in which administration costs have almost tripled in a few years thanks to their endless tinkering they would do better to stop the rot, stop the top down artificial market, get rid of the PFI deals, stop wasting money on management consultants that tell them to sack clinicians and hire more management consultants, stop the reforms that are increasing the waste and inefficiency. Start thinking about the needs of patients, start trying to meet their needs as best you can and stop hiring more administrators to increase the efficiency of the system, this is akin to pouring petrol onto a fire in order to put it out.

ISTCs and the disgraceful wasteful marketplace of doom

As with many recent government health reforms that have revolved around ideological nonsense and the enrichment of various groups with close political links, there has been no effort from the start to monitor the safety or performance of ISTCs from the very start. It is only thanks to some excellent local units that we are starting to discover just how much damage has been caused by these devastating reforms. This is without doubt only a small iceberg tip.

It is worth reading the full article and observing just how poor the record of these ISTCs is. The ISTCs have shown to be doing joint replacements that are failed at a rate of around 20% at three years, this is about twenty times the national NHS average rate, this is blatantly negligent and it doesn't need a statistician to tell one this. It is worth noting that this bodged surgery is costing the NHS a fortune to put right, add this to the fact that the ISTCs are often getting paid way more than the NHS for the same work. They are dangerous and bad value for money, the market is a clear failure in this context. The DoH is as always in complete denial as it is just pushing through ideological rubbish at the expense of patient care:

"Patient safety is top priority with all contracts with the independent sector. The Department of Health requires all Independent Sector Treatment Centres to have robust policies and procedures in place. All ISTCs operate under standards monitored by the Care Quality Commission, the independent health watchdog. The CQC... have not raised concerns with the Department about the safety of ISTCs."

What a lie and what a cop out. Like many new government reforms such as Walk in Centres and the contracting out of OOH (out of hours) work to private firms the effects in terms of patient care have not been monitored at all, it is a national disgrace. For example at ISTCs they are employing ' consultant' colleagues from other EEA states and many of these consultants have never worked in the UK before. They will, therefore, be working outside their comfort zone. They are often appointed with nothing like the formalities of an NHS Advisory Appointments Committee and sometimes appointments have even been agreed over the 'phone without any interview or meeting. This is dangerous practice and should be a risk management ' red flag '. Many of these consultants are not members of the respective UK academic college and are working in isolation from UK colleagues.

Millions of pounds of cash are still being dished out to ISTCs and there are simply not the systems in place to monitor just what they are doing in terms of harming patients. This is unacceptable, when those at the top of the political tree keep going on about standards and governance, why are these expensive unregulated disasters still being rolled out? Any changes to care delivery should be rigorously piloted and monitored to ensure that standards are not being compromised, this simply has not happened for the plethora of awful reforms we have seen in the NHS in recent years.

Whether it be your paramedic refusing genuinely sick people trips to hospital having been empowered by a short dumbed down course in being a doctor, your EEA GP with a limited command of English being flown in to do GP OOH work for a cost cutting private firm, your walk in centre quack pretending to be a GP and mobilising their Fisher Price (TM) stethoscope after a two week course in medical diagnosis or your EEA Orthopaedic specialist having a go at joint replacements in an ISTC with techniques which they have never done before, there is no excuse for this erosion of standards. The damage done is very hard to quantify as there has been no attempt to monitor the impact of any of these changes to practice, some things like Orthopaedic outcomes can be more easily eye balled retrospectively as has happened with the Cardiff ISTC but the vast majority of outcomes are almost impossible to measure without well though out prospective analysis, something it appears the government has avoided at all costs because it knows that this marketisation is doing harm to patients. The dumbing down continues.

Supermarket medicine

I apologise for my recent lack of activity, unfortunately life has dealt me a busy hand of late and far too much time has been spent working and in my car. Currently a porcine sore throat means I am feeling rather pathetic and tired, my energy levels are flagging.

It's hard to keep up with the news, there is just so much utter rubbish spouted from various media orifices that it is very hard to know where to start one's dismantling from. Certainly Andy Burnham's recent disingenuous ideas are as good a place as any to start, Dr Crippen has hit the nail on the head yet again:

"The demand is insatiable, and the only way the government can cater for it is by dumbing-down the service and moving towards a 24/7 "medical supermarket"."

The sheer nonsensical nature of the continued NHS reform beggars belief, the same failed ideas continue to be tried out again and again and again. It is no surprise that they continue to fail miserably. With the recession rolling on and debt levels high, cuts will inevitably be made in the places in which they will be felt the most. The real motives are hinted at here by Dr G.

The weak reporting of the the poorly explained entitity of 'misdiagnosis' really got my goat this week. The 'BBC investigation' was dramatic and breathtaking in the BBC's minds, in reality they showed nothing new but were rehashing and sensationalising the work of others. Strange that the beeb didn't mention how anyone can have a crack at diagnosis these days, just a few weeks with a toy stethoscope can give you the power these days.

I bet the useless NHS empire of bureaucracy that is made up by the DoH/SHAs/PCTs will not be trimmed, the front line services will be the ones to suffer as the aforementioned lame duck organisations waste money hiring management consultants and employing more idiots in trying to increase efficiency. Idiots will always try to improve efficiency by hiring efficiency officers to oversee efficiency reforms, a better management strategy would be to cut the ineffective rot out of the system. The problem is that the inefficient rot is running the show and as a result the NHS is doomed.

No waiting lists? Oh dear Burnham as swine flu misdiagnosis kills

Andy Burnham may be a nice bloke in his private life, he may enjoy football, but at the end of the day he is still an incompetent fool who has been caught with his pants down time and time again. Not only has Mr Burnham been caught telling untruths in Parliament on medical issues, he is now peddling utter bullshit as fact in many areas of health policy.

To be fair to Burnham he may not be being deliberately dishonest here, he appears more like a stupid schoolboy who is way out of his depth. The problems with Tamiflu are blatant, it's benefits are mild at best, while its negatives may well outweigh them. The whole Swine flu business smells very much of a useless government pretending to be doing something when it would be better off doing nothing and reassuring people.

The useless and completely dangerous swine flu hotline is not something new for this government, empowering the uneducated is a real hallmark of this government. As many of us predicted deaths are resulting from lethal septic episodes that have been assumed to be swine flu by the undertrained diagnosticians that have been empowered by our cretinous politicians.

The truth is that swine flu is a pretty benign disease, we would be much better off without any stupid NHS call centres manned by numpties, everyone should just go about things as normal unless they become unwell. The unwell then need to be assessed by those with appropriate training, ie medical degrees and experience in medicine. This lame duck of a government had a massive stockpile of useless tablets and wanted to become popular by being seen to be doing something, unfortunately it is doing more harm than good in its misguided attempts to interfere when no interference would be the less harmful option.

Burnham also seems to think waiting lists are a thing of the past. I would like to remind him that this is a complete lie. Waiting lists are alive and well, in fact the 18 weeks target for surgery is resulting in clinical need being thrown out of the window. Because of the blanket targets the most minor and non urgent of surgery is given a disproportionate amount of influence, this results in the more urgent clinical need of others being ignored in favour of elective surgery. This government doesn't seem to realise that rearranging the deckchairs doesn't magically create more deckchairs. So frankly Mr Burnham I don't care if you're a nice bloke when stoking the barbie on your sundays off, your work as health minister stinks and you are blatantly out of your depth.

Morons, swines, cretins and fools

These are the people that run the NHS and that waste ridiculous amounts of money on various useless harebrained schemes that are usually aimed at pretending to do something rather than actually doing anything of any use. The swine flu drama has encapsulated just how utterly pathetic the people are who run and managed the health service from the very top.

Swine flu is a a disease which differs little from severity from several winter viruses, but the English NHS is behaving as if we are in the middle of an Ebloa epidemic. Call centre operatives are making diagnoses on the basis of no training at all, indeed one can even dispense with the call centre and simply diagnose oneself on-line - they are then dispensing a drug of uncertain benefit, but with known side effects and with a documented ability to produce resistance, 'prescribed' by either a computer or a call centre operative with no discernible medical training or skill.

As I have read elsewhere it is rather obvious that many people will have died and will die due to various untrained and uneducated people assuming that every febrile illness is swine flu, thus people who are unfortunate enough to get a severe case of meningitis, urosepsis, cholangitis, endocarditis, and on and on will just be left at home to die because it's 'probably swine flu'. Stories of various patients being refused hospital admission by those without medical degrees with febrile illnesses which were clearly not swine flu are already coming to light. Various numpties have been empowered to diagnose swine flu, who needs doctors? Well, no one does if you would rather die.

This little story also captured my imagination, the DOH is commissioning management consultants KPMG to report on a vision for a digital strategy for the NHS. Well, whoopeedoo, why not waste more money on reviewing just how many completely useless schemes you can come up with to compliment NHS Direct and NHS Choices while diverting more money away from the frontline services that actually make a difference to patients.

I will review NHS Direct and NHS Choices for free, the former is a dangerous waste of money while the latter is more of a plain waste of money. The sad thing is that both the Tories and Labour want to continue to develop this market of madness which simply involves around paying off various big companies to generate more useless NHS bureaucracy that does sod all of any good for patients. What hope is there for the NHS, there is no choice for voters, we are doomed either way.

Remedy 1 GMC 0

RemedyUK has won the first stage of its legal challenge against the GMC’s refusal to investigate the managerial deficiencies leading to the MTAS recruitment fiasco. Mr Justice Hickinbottom found in favour of Remedy in their Permission hearing.

The case can now go on to a substantive hearing which is likely to take place before the end of the year. The case concerns the jurisdiction of the GMC over complaints against senior doctors who were responsible for MTAS.

MTAS was the new process for the selection and recruitment of junior doctors and was an integral part of the "Modernising Medical Careers" initiative. It proved to be a disaster. Remedy argued that the doctors responsible should be referred to the Fitness to Practice committee of the GMC for deficient professional performance and/or serious professional misconduct, and over 1600 supporters joined them in this. The GMC declined to hold an enquiry.

"We’re heading into the biggest public health crisis in recent memory and it’s particularly important that the conduct of doctors in senior managerial positions is not impervious to scrutiny" said Matt Jameson Evans, Chair of RemedyUK. "Accountability lies at the heart of modern professional medical practice, and there should be no double standards for those sitting at senior levels."

The judge acknowledged that MTAS has been a disaster which had brought the profession into disrepute. He recognised the precedent of the case of Roylance, which established the jurisdiction of the GMC over doctors in management, and he recognised that there was a link with the present case. He therefore granted permission for the substantive hearing, on two grounds, and he also awarded a Protective Costs Order in Remedy's favour. He declined the GMCs request for a reciprocal cost-capping.

"This isn’t solely about the events of 2007" said Richard Marks, Head of Policy "but it is also about the jurisdiction of the GMC over doctors in management roles." This is a great day for Remedy. We survive only on our paid supporters - if you value what we do then please join us today.

ps Remedy Uk and others have also had some rather sensible things to say on the topic of the European Working Time Directive reducing junior doctor hours to 48 per week this August at the very same time that the country may be in the midst of a flu pandemic, great work as always from the government and Department of Health, maybe it's time for another deckchair rearrangement Mr Burnham?

Head in sand doesn't make everything all right

Modernising Medical Careers (MMC) was allegedly the reform of medical training for the better, as many of us have since learnt the government lied about the real motives that lay behind this Trojan Horse of festering garbage. When everything when so spectacularly tits up back in 2007, the government had to pretend to act because things had got so bad that the media had started to take notice. In actual fact MMC had been doing damage to training for several years before 2007, the creation of the lame 'competency based model' of Foundation training and the useless application process for these jobs had already been about for several years by 2007.

After some excellent Freedom of Information ferreting I have managed to get hold of documents which detail correspondence between the Secretary of State for Health and the deputy CMO Martin Marshall on the topic of the MMC inquiry. I have highlighted some interested snippets for you to have a look at, taken from Martin Marshall's letter to the SofS:

"PROPOSALS FOR AN INDEPENDENT REVIEW OF MMC DEVELOPMENT PROCESS

....Whilst there have been successes as well as problems...

I understand the NAO are coming increasing pressure to undertake a review, either of the immediate issues with MTAS, or of the wider MMC program. I would hope that the announcement of an independent review would influence this decision, or at least its timing.

The purpose of the independent review would be to examine the framework and processes underlying the design and delivery of the whole MMC process and to make recommendations to ensure improvements for 2008 and beyond. This is likely to involve revisiting some significant issues but not to review the principles underlying MMC. These principles, to develop a competency based training program for doctors based on defined national standards, have widespread support amongst professional leaders.

The leading candidate is John Tooke... He is a committed educationalist, extremely well respected by the profession and more widely, and informal soundings suggest that he might be willing to accept the role if asked."

The above snippets are quite revealing. Not only do they show that the Department of Health has a remarkable habit of being completely unable to realise when it has made a mistake, but they only act when they are forced to by outside forces. The DoH appears to live in a permanent state of denial, completely unable to see just how incompetent their own actions are at times; they only ordered an Inquiry into MMC as they were afraid the NAO were about to nail them with a much more damaging review at a later date.

It is very revealing that the 'principles underlying MMC' were not to be called into question by this review, these were untouchable and allegedly already widely supported by our professional leaders, this all smells of fish to me. Interesting that the 'principles of MMC' seem to change every few days, according to the MMC website they are:

"One of the intended benefits of Modernising Medical Careers (MMC) was to ensure a transparent and efficient career path for doctors."

So much for that efficient transparency, MMC has reminded me far more of corrupt cock ups than anything else. The real motive of MMC was this:

"MMC aims to provide consistent national standards for training through better-structured and managed programmes with competency-based curricula approved by the independent Postgraduate and Medical Education and Training Board (PMETB)."

In reality MMC has resulted in a less flexible top down system which has done nothing but paper over the catastrophic effects of EWTD on medical training. Tons of extra paperwork and curricula will not help train specialists in less years with less hours per year, training cannot be purely competency based tick box numpetry, training must be common sense based and time based to a degree.

This government has dishonestly tried to force through the subconsultant grade with MMC, they lied to us and pretended that MMC was about better training and better patient care when it was about nothing of the sort. MMC was much worse than simply doing nothing as if nothing had been done we would have had to address the evils of the EWTD, as things stand the DoH and the government have stuck their empty heads in the sand and pretended that MMC would fix all our training problems including the EWTD. At the same time many new problems have been created by MMC including a lot of competency based damage to training and rain forests, an erratic and under performing Foundation training system, as well as numerous problems with various job application systems including an invariably useless Foundation scheme application system.

I've rambled on, mainly because it makes me very angry when people stick their heads in the sand and pretend everything is OK when it obviously is not. A lot needs to happen to fix this mess, the failings of competency based training and Foundation training need to be addressed fast before it is too late, maybe an NAO review of MMC would be a good thing to push for as well, while the EWTD monster needs to be taken on at some point. I don't have all the answers by any means, but the first step is to own up to the massive problems that exist, not living in arrogant denial like some choose to do on a rather regular basis.

Shambolic and unclear: Kafka's NHS

It's not hard to find diagrams like the ones above, the Internet is littered with examples of just how overly complicated the NHS' management structure and bureaucracy has become. It shouldn't take several textbooks and a few years of intense study to understand the way in which a health care system works (or does not as the case may be), the fact that the NHS is so hard to understand implies that it is a disorganised shambles with no clear chain of command. It should be so much easier to comprehend, but the government keep reforming, making things more complicated and shambolic.

The market argument is a complicated one, even a bottom up market would probably be more inefficient and bureaucratic than a well run state run system. However one can guarantee that a top down state run market system will be ridiculously inefficient and cumbersome. The diagrams above the the government 'newspeak' sum up the stupidity of the current process. Even people at the top are starting to see the light, and about bloody time too, it's just a shame that our moronic leaders like Tony Blair cared more for their own wallets than the nation's health. The lack of a clear chain of command means that the system is also incredibly dangerous as no one ever takes any responsibility when things go wrong.

The sad thing is that there appears little that we can do as cogs in our great 'democracy' to affect change in this regard. Labour copied all the flawed ideas of the Conservatives and then put them into practice from 1997 to this day, the Conservative would carry a lot of them on if reelected, while the Lib Dems never seem to oppose anything much with any vigour. The current economic situation and the future NHS spending cuts mean that we can expect to see front line services hit hard, while I am sure that the spending on bureaucracy, managers, PCT numpties, new incomprehensible reform strategies, management consultants, quangos et aliter would not be affected much.

It makes my blood boil. So much corrupt and cynical politics dressed up in nothing more than glossy bullshit. In the current financial climate it is a disgrace that money should be wasted in such a wanton manner. If I want to buy a load of bread the most efficient way to buy it is not to pass the money to the shopkeeper via four organisations and decide upon which loaf to buy by employing a cohort of idiots who then hire a group of management consultants to make the expensive decision for them, I haven't even started talking about how this NHS-style system would go about getting my loaf home; if I need a loaf of bread I'd go to the shop and buy it myself.

Power without responsibility

It's a deadly combination, power without responsibility, as we've seen with MPs' expenses if people are allowed to do what they want with little fear for the consequences then they will behave quite appallingly and unethically. One of the best ways of ensuring high standards in any system is to ensure that those people who are making important decisions are made accountable for them, after all if something goes wrong and no one is at all accountable, then the same errors will continue to made time and time again. What relevance has this for the NHS, quite a lot I would argue.

I had the misfortune of encountering a rather arrogant and obnoxious radiographer the other day. Radiographers are the technicians who take XRAYs, CT scans et cetera. I have to say that most of the standard radiographers I come into contact with are very pleasant people. The problem is that as with all things in the NHS, radiology has started to be dumbed down, some radiographers have now been empowered to actually report XRAYs as 'reporting radiographers'.

Don't get me wrong, radiographers see a hell of a lot of XRAYs and are very good at spotting fractures, better than a lot of doctors in fact. Unfortunately they are not medically trained, they are not radiologists, meaning that they do not have the broad base of knowledge and training that enables them to think outside the box and think of rare pathologies. For this reason 'reporting radiographers' are only allowed to report a very small percentage of the XRAYs that are done. There is still a problem as what happens when a 'reporting radiographer' misses that rare abnormality that a radiologist would most likely have picked up, I get the distinct feeling that they would not be held to account as a radiologist would be.

Radiologists are notoriously cautious because they know how tricky interpreting XRAYs and other tests is, most of the time one can see the obvious answer straight away, however if one just jumps straight in without thinking one would never diagnose the subtle, rare and potentially career-ending-if-missed pathologies. Radiology is like a minefield littered with the occassional career ending mine, most of the time one will be OK skipping through nonchalantly, however if one skips for long enough one is sure to get blown to smithereens.

I have digressed. The point I was trying to make was that the rather obnoxious 'reporting radiologist' was so overly confident because they lacked the knowledge and insight to be aware of their own limitations, they were skipping through the minefield assuming that their luck would hold. The particular one I met chose to take a quick glance at the XRAY, then claim that it was completely normal and should never have been done. I kept quiet and didn't mention that a rather esteemed Consultant surgeon had a very good clinical grounds for performing the XRAY. This is power without responsibility in the NHS, it generates this rank arrogance in the ignorant, it creates a potentially lethal over confidence in those who do not have enough knowledge to realise their own limitations. I could move onto the tale of the osteopath who reports XRAYs and misses bone tumours the size of footballs, but I would want to get sued for insulting a quack would I?