Wednesday, 21 February 2007

Point by point - then off on a tangent

I wish to address points one by one and I will directly quote from "Learning from tragedy, keeping patients safe" the government's recent report. (

1. Why are doctors being singled out in this when there are ample examples of nurses murdering patients? There has also been the extension of full prescribing rights to nurse practitioners and pharmacists, and this must have implications for the regulation of these professions; however I see no white papers singling them out?

Remarkably nursing personnel made up 86% of the healthcare providers prosecuted here, and doctors only 12%! Even if nurses make up eight times the number of doctors then both are equally likely to serially murder, meaning that the question still begs an answer.;jsessionid=2mn3l8cfms0uj.alice

2. "the statutory protection for whistleblowers should be strengthened." I will be looking our with interest to see if this is just hot air. See Dr Rant for a good piece on this:

3. "the adoption of the civil standard of proof (“on the balance of probabilities”) rather than the
criminal standard (“beyond reasonable doubt”) in fitness to practise cases;"

Lovely! I'm glad to see the media have not picked up on this rather significant point. The government's argument is that our healthcare system must be centred around the patient. The government will now be able to manipulate the process to their own ends more easily; as they get to appoint some members of the panel and the burden of proof is significantly less. Is it fair that one could be struck off and have one's life wrecked at less than a criminal standard of proof?

No, this is not fair. This part made me fume.

Especially when you consider that the politicians who rule us get to regulate themselves and their record makes the GMC look like a utopian organisation. Anyone waiting for Blair to launch an inquiry into the Iraq war? precisely (Shipman eat your heart out). And we all know that politicians appoint their own cronies to investigate any areas of controversy....Hutton. Then think for one minute what politicians have to gain from their lack of proper regulation ($). The medical profession does not stand to gain in anything like the same way by self-regulating, yet this power is being stripped from us by these corrupt morons.

4. "-to assess the quality of the care they provide, using a combination of clinical outcomes and
measures of patients’ experience;
-to reflect on this experience, including both successes and failures; and
-to apply the lessons learnt in order to improve the quality of services."

These three principles of clinical governance seem to contradict all government health policy. There is no evidence behind any of their policies (PFIs/ISTCs/CATs and on). They do not monitor the impact or performance of their privatised schemes. They carry on reforming despite massive amounts of hard evidence proving that the reforms are failing.

5. "At the level of the individual clinician or clinical team this process includes participation in
clinical audit. But healthcare organisations as a whole – and PCTs in relation to the primary care
services which they commission on behalf of their populations – need to carry out a similar process
of assessment in order to identify poor-quality services and to encourage and reward the good.
Identifying poor performance, and taking whatever steps are needed to protect patients from its
results, is therefore an integral part of clinical governance."

Again, convenient banter than runs against the grain of government health policy. The same comments relevant to 4 apply.

6. "supporting people who want to make complaints or raise concerns, so that they know where to go and can be assured that their story will be listened to and acted on;"

It's all very well to claim that we should listen to complaints and concerns. However they are many instances when patients' complaints are completely unfounded. Something the government consistently ignores is that it is important to weed out well-founded complaints from baseless accusations. The current complaints procedure encourages baseless accusations to be taken higher and higher, and if they carry on pandering to patient power we will soon have a situation where doctors cannot even give patients lifestyle advice without fear of a complaint.

The doctor-patient relationship is a key part of a functional NHS. However at the moment we have patients who swear at staff, who are threatening physically to staff and who physically attack staff. In my last week at work I have been sworn at my drunk patients and the nurses I work with have been called the c-word on several occasions. I can tell you this is becoming more and more routine. There is also a distinct lack of respect shown towards medical staff at times; for example patients chatting on mobile phones during consultations and then getting upset when they are asked to switch their phone off. I must emphasise that the majority of patients are very respectful and well behaved. The government's measures will undoubtedly give more power to patients who make baseless accusations and more doctors will be disciplined for things that they did not do.

I'm off on a ranting tangent now, but what's wrong with going with the flow on occasion? I've damn well had enough of radio phone-ins hosted by morons where patients are are encouraged to slag off the medical profession. The media is allowed to openly call doctors 'arrogant' and 'overpaid'. This is not a debate about medical regulation, it is gutter journalism of the lowest kind. Most patients trust their doctors more than any other profession and most patients are very happy with the service they receive. I think the journalists should stop pointing out the small grain of dust in the eye of the medical profession, when there is a rather large rowing boat in their own; public trust in journalists is not exactly impressive.

There is a serious point here. Thousands of doctors are in the process of emigrating or switching careers. There is already a significant problem with suicide, mental health and drug abuse in the medical profession. Will a more punitive culture run by political stooges be good for the health of doctors and good for the care of patients? Quite clearly the answer to both is no.

Finally look at what is really happening here. Power is being taken from a trusted and respected profession and this power is now subject to a greater political influence. Will this power shift make it easier for the government to crank up the speed at which the NHS is dismantled and privatised?

For a second ponder how many politicians and managers have been made accountable for decisions that have had disastrous impacts on patient care? By this I mean how many have been sacked or struck off their professional register for these errors? None, they are simply moved sideways and they have no professional register as they are not regulated. As Dr Rant points out above their is a growing trend of management trying to influence clinical decisions. Who carries the can when this goes wrong? The doctor carries the can. The white paper will make it easier for doctors to be blamed and castigated for the errors of their controllers.

The lowering of the burden of proof the the politicisation of medical regulation must be debated in this context. When the government is so keen to chat of clinical governance, is it not a tad hypocritical to pick on the medical profession in this way, while the politicians and managers are completely unaccountable for decisions that can sometimes result in the death of hundreds of patients?

It's more central credit and local blame from those in power. It's rather ironic that medical regulation is passing from the GMC, once labelled a 'totalitarian' organisation, to the Department of Health! Once could never accuse the Department of Health of resembling a totalitarian organisation, they'd have you struck off.

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