The CMO's report

Last year Sir Liam Donaldson produced his review of medical regulation (http://www.dh.gov.uk/assetRoot/04/13/72/78/04137278.pdf). To say that there are several flaws in his report would be an understatement and there there has been a significant backlash of opinion from many experts, since the report was released.

An article was written in the BMJ which had several rapid responses published here: http://www.bmj.com/cgi/eletters/333/7560/161 and http://www.bmj.com/cgi/content/full/333/7575/0-f. In particular Dr Pringle's response merits a careful read due to its eloquence and popularity among the medical profession.

The report is based on the fundamentally flawed assumption that it is possible to measure exactly what makes 'a good doctor'. Even though the CMO admits this flaw, he then goes on to suggest a range of reforms that aim to measure the unmeasurable! The resultant cost and bureaucracy do not bear thinking about, let alone the numerous inevitable impracticalities that would soon become apparent upon trying to implement such reforms.

It short the CMO's report set about politicising medical regulation, giving responsibility to a body (PMETB) that couldn't organise a piss up in a brewery, reducing the burden of proof that doctors are tried against and pushing for the grossly impracticable revalidation of the medical profession. The Walton of Detchant's comments are very fair in my view (http://www.bmj.com/cgi/eletters/333/7560/161).

Not wishing to go into too much detail, I will bore you terribly otherwise; the problems appears to be that these reforms are being driven through in a manner a la nuclear. By this I mean that the consultation process appears to have been a typical New Labour exercise of charade. In my humble opinion these reforms should not be put into practice until a proper consultation process has been seen. I am sure the reason for this is that, with a proper consultation process, the CMO's report would be planted firmly in the dustbin. The decision is coming up on February 21st.

For an example of the expert opinion disagreeing with Sir Liam, take the scottish CMO and the BMA (http://www.bma.org.uk/ap.nsf/Content/CMOresponse1106).

Then again nothing surprises me with this administration. My favourite man, our Tony chuck, has come up with a great idea! http://news.bbc.co.uk/1/hi/health/6374093.stm

Nevermind that this suggestion is an old one that was abandoned several years ago due to a massive problem with increased surgical complications. Not forgetting the fact that there are few other 'slight' hitches with this idea: who does the operating? surgeons already work hard with long hours, the back up services are not around at night, who pays for this surgery? (remember elective surgery for routine stuff like hernias, varicose veins etc has been postponed indefinitely in numerous parts of the country!) and what of emergency cases at night- how do they fit in with this?

Even an NHS manager, who had had their brain substituted by half a peanut, would have realised that this idea is the stuff of Dime bar adverts.

Another way of solving the waiting list problem would be much simpler. It would involve taking the market based approach out of the NHS, paying for and doing the work that is medically indicated, scrapping all expensive schemes like PFIs/ISTCs/CATs and letting the NHS provide a service again.

That seems very much like a pipe dream, as opposed to the nightmare Tony has imposed upon us.

An email may inadvertently have been sent to the Department of Health on the topic. You shall be kept posted.

"Dear DOH,
I am writing as regards a FOI request about the CMO's report from July 2006. I have some specific questions.
1. Before the report was published, with who did the CMO discuss the possible content or suggestionsto be included in the report?
2. Did the CMO receive any advice advice before embarking upon his work on his report? If so who was the advice from and what records do you have of this advice?
3. Was the possible content of the report discussed by the CMO with the prime minister, any ministers or politicians, government advisers, senior DOH officials, or corporate representatives?
4. 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.
5. What evidence do you have that the consultation process for the CMO's suggested reforms has been adequate?
6. Do you have any records or documentation of any possible discussions of this consultation process between the CMO, DOH officials, ministers and advisers?
7. If you think the consultation has been adequate then how would you reassure members of the public and medical profession who are concerned with certain areas of the CMO's report,
many thanks for your service,
yours, "