Big Gordon is our new Big Brother

August is fast approaching and there are more than just a few gaps in hospital rotas that have yet to be filled. In fact with only a month to go there are some people already starting to panic at the prospect of a major shortage of junior doctors on the wards.

Remedy have revealed some rather worrying statistics that have come to light as a result of a leaked DoH document. You can have a look at the statistics for yourself, there are thousands of empty posts that have yet to be filled. What is going to happen in August is anyone's guess really.

The scandal continues over plans to shut Worthing and Chichester hospitals, several leading consultants are speaking out about the completely antidemocratic nature of the so called 'reconfigurations' that would leave a population of 300,000 without a proper hospital. The complete lack of an attempt to properly consult has been obvious all the way along this road of railroaded reform. The government is lying and lying in trying to cut costs by centralising services and shutting good specialist units, it makes me fume and the consultants seem pretty convinced that it is not in the interests of their patients.

Alan Johnson has been appointed as the new Secretary of State for Health, and I have absolutely no faith that he will do anything differently to the acursed Hewitt. I am suprised that some people believe that a change from one incompetent idiot to another will have an effect on Labour's antidemocratic reform program. Their e-petition scheme sums up their pathetic attempts to listen, their response to a petition calling for the responsibility for medical training to the Royal Colleges was typically ignorant. What is the point in asking for feedback if you ignore the mass of opinion to come out with exactly the same stupid party line?

I certainly have no faith in the new 'Stalinist big tent' that has been assembled by Gordon 'Stalin' Brown. It is naive to think that the hollow banter coming for Gordon's gaping cakehole is anything but a dishonest sham. Gordon Brown has been instrumental in many of New Labour's woefully thought out top down reforms of the last ten years, I have seen no evidence at all to suggest that there will be any tangible change in direction under his command. We should ignore their chatter and judge these politicians by their actions.

Certainly as regards the NHS, Brown promises to continue the usless reform that has already left the NHS on the verge of a cardiac arrest. More schemes that reduce 'choice' will be used to railroad through more closures and reconfigurations, as good local services are swapped for inefficient low quality private portacabins. Big Gordon is our new Big Brother, the doublespeak of 'choice' will unfortunately continue.

Trust me I'm not a doctor

Given that I am subjected to so much vitriolic abuse when I try to argue that being adequately trained for ones job is very important, I will keep my opinion to myself and provide you with two recent clinical cases kindly provided by clinicians working in the coalface:

"I was working a weekend out of hours shift recently, a call came through from an ambulance crew. They had a woman who had central chest pain but her ECG was normal. Could they bring her in for me to review? (The nearest acute hospital to the OOH centre is over an hour away by road and the ambulance crew bring people in to the centre all the time for review much to my chagrin). I reluctantly agree but make them wait while I check her over. Before we can repeat a 12 lead they pop their head around the door saying they have to go back to base. I say no they have to stay until after ECG. They say tough their ECG was normal so not MI so no need for hospital and leave. Two minutes later 12 lead done by myself shows ST elevation in several chest leads. Call 999. They crew arrive back and don't believe me til I show ECG. But how can that be our ECG (done about 30 minutes before) was normal!? Little lady gets a blue light ride in the ambulance after all."

"Demented granny in a residential home has a fall. Refuses to weight bear afterwards. Ambulance called.

Friendly helpful reassuring paramedics come out and check her over. Leg is not shortened or externally rotated so obviously can't be broken. Matron feels she needs an x-ray as she has seen old people hobble round on fractures in the past. But paramedics patiently and condescendingly explain to her that if it was broken, the leg would be shortened and externally rotated, wouldn't it? Matron made to feel an idiot. Paramedics leave, saying she should call the GP to visit to assess pain control.

I visit. Patient is too demented to say whether or where she has pain, but all movements of her R hip cause her to scream out. Leg is not shortened or externally rotated.

This is happening time and time again. It has become an almost daily occurrence in our large practice that we are called back to an address following a paramedics attendance.

When will they start taking responsibility for their decisions? Is anyone auditing the outcomes of patients left at home following a call to the emergency services?

Once again, the wrong outcome is being measured. Number of patients "successfully" managed at home by paramedics counts for nothing if they are later sent in with a more serious condition after a delay."

I do need to point out that just because there are no ECG changes it does not mean that a patient does not require hospital admission with their chest pain. Any orthopods amongst us will also know that just because a leg is not shortened and externally rotated, it does not mean that there is not a fracture that requires surgical intervention; the inability to weight bear is it itself a fairly significant finding to the skilled clinician.

I will leave the rest up to you.

The crux of the matter

This 'dumbing down' debate is an interesting one, and it certainly has the potential to get pretty emotional and messy. I felt the need to clarify my position as some people feel the strange desire to distort things in a way that stifles a proper discussion.

The multi-disciplinary team is invariably a good thing, different members of the so called 'team' are trained for their differing roles and if all runs smoothly, then the patient is the one to benefit from the mixture of skills and expertise on offer.

I have an enormous amount of respect for the vast majority of staff I have worked with in the NHS whether they be nurses, doctors, physiotherapists, paramedics, OTs, phlebotomists, radiographers et al. We are all trained for different jobs and it is essential that we all respect one another's roles, while appreciating the particular expertise of one another. I realise that paramedics are far better at managing a trauma patient at the scene than I am, however there will be a few things in which I am more highly trained and proficient.

Modern health care is undoubtedly different to the old fashioned system, and some aspects of change have been essential. However the 'dumbing down' of which I speak is a change that I fear has the potential to have a detrimental effect on patient care. Why do I think this, I hear you ask?

Different health care staff have different roles, meaning that they are trained in very different ways to take this into account. Nursing training does not prepare one to be a doctor, and vice versa. I therefore have grave concerns when one form of worker is given jobs that were previously done by another differently trained form of worker, without having as adequate and thorough a training as the worker who previously did those jobs.

As a doctor I appreciate that I have not been trained to be a paramedic or nurse with my training, hence if I wanted to switch careers I would expect to do the same training that paramedics and nurses have had to do. The converse applies, if non-medically qualified workers want to have the significant responsibility of practising medicine in unsupervised roles then they should have to undergo the proper medical training that a doctor has to.

Some new roles provide a valuable and excellent service, for example when nurse specialists are used in their nursing area of expertise. There are many roles in the NHS that have recently appeared, in which less thoroughly trained workers are doing jobs that were previously done by more highly trained workers. One example is in ambulances where paramedic technicians are being used in roles which were previously manned by paramedics, despite a reduced level of training. There are some that would argue that this has its inevitable consequences. There are clearly some staff who agree that paramedic technicians are being used in roles in which they may find themselves out of their depth:

"it needs a paramedic on every truck. I've said it before and I'll say it again; techs are adequately trained to do their role as first aiders but it needs a paramedic to be able to provide the necessary advanced skills to ensure the highest chance of rescue.I'm afraid a tech with or without his lma is just not up to speed for most pre hospital work. "

The debate needs to be had in my opinion. It is important that proper standards of training are not eroded in a way that endangers patients. I do not think it arrogant to think that staff who do similar jobs should be trained to similar levels, as if one group is not trained to as high a level then it is unfair on patients. No group of workers is perfect, we all make mistakes and we are all fallible humans. However it runs against reason to suggest that a group of more highly trained workers will not do the job they have been trained for better than a group of less highly trained workers. I am sure some of you will be keen to say otherwise though.

The illusion of choice, the reality of death

As an arrogant medically trained doctor I must first apologise in advance for daring to have an opinion that may not be agreed with by all multi-disciplinary team members. It has to be accepted that a small percentage of health care professionals are boneheaded enough to think the all the government does is in the best interests of patients, while some are corrupt as opposed to boneheaded.

The government seems only too happy to keep pretending that it cares for the interests of patients, the pretence goes on with the NHS centre for 'involvement'; what utter codswallop. It is another in a long line of expensive glossy schemes that are designed to pretend that the government is listening, when in actual fact there is no listening going on at all.

In reality the government's ideological program of reform is putting patients lives at risk. There have been efforts to enforce the privatisation of the NHS via the internal market and centrally imposed deficits. Have a read about the government's attempts to downgrade Worthing and Southlands hospitals, it's pretty dismal stuff. It comes from the same team that has brought us numerous similar schemes of reconfiguration and downgrading up and down the country, all of it against the wishes and interests of local people.

There is a nonsensical push to move emergency and obstetric care into the community, while the resources for this switch are not provided; and even if they were it would still be a step back to the dark ages, some things are still best cared for in a hospital unless you have a deathwish. Many senior consultants are in agreement the the cuts will put patients at risk. There was very little consultation, and it is extremely worrying that the services that will remain after this downgrading bonanza could well not be able to cope with the new increased demand. Is this ringing any bells? Have New Labour done this in a region near you?

It has happened near me. One specialty service was downgraded at a local hospital and shifted to a private treatment centre. Unfortunately this new treatment centre did no more work than the old hospital's specialty unit did, and it cost as much to run as all the other specialty services at the local hospital put together! This is where ideological reform gets you, to where you were before for around ten times the price.

Be sure before you drop your pants

This description of a GP's consultation with a patient is reproduced below, many thanks to the original author for his permission:

"Had an interesting consultation this morning. Paraphrased version:

"Hi, Doc. You got the fax from Urology? Can I ask who signed it?"

"Errrr... Mr Illegible Scrawl. Why?"

"When you referred me urgently to Urology, did you think I'd be seen by a Consultant? I thought I would be - especially as you thought I'd got prostate cancer."

"I got a bit suspicious about the doctor in clinic. He introduced himself as 'Fred', knew something about my cancer but really didn't seem to know anything when I mentioned being treated for mt blood dyscrasia and wasn't remotely interested in that. And he did what you did in the way of examining my prostate, looked at a blood test, then said he'd send you a fax and I should see you tomorrow for treatment"

"When I pressed him a bit and asked whether I should call him 'Doctor' or 'Mister', he replied I should just call him 'Fred'. Then he said he couldn't prescribe any treatment for me, I'd have to see my GP for that."

"When he eventually dismissed me, I made some enquiries from the clinic staff and found out he's something called a nurse specialist. So I've not even seen a junior urologist, let alone the consultant, and they've told me to come and get some treatment for my cancer from you. It was a bit of a waste of time sending me down there if you can't get a proper specialist opinion anymore. I wonder how many less enquiring patients think they have seen a consultant when they come out of there?"

This is not a rare problem either. Patients are being tricked by non-medically qualified staff who pose as proper doctors, in this case the nurse specialist strangely forgot to mention his actual title and this was certainly misleading the patient. When does 'misleading' result in the patent's consent to be treated becoming null and void? There is also the small issue of these nurse specialists managing patients without discussing cases with the medically trained specialists, resulting in the nurse specialist ordering GPs to start their requested treatment. What happens when this is the wrong treatment, does the GP carry the can as the one who is signing the prescription? A worrying situation to find oneself in really for any doctor. Who is going to carry the can when these nurse 'specialists' mismanage a patient's cancer?

Patients are being conned around the country. There are so many stories of this kind of deception that I cannot repeat them all here; but there are nurse consultants (whatever that's meant to mean) in A/E who call themselves 'consultants' only and there are podiatrists who pose as properly trained surgeons. The Witch doctor has already written expertly on this nonsensical drive to call everyone by a vague meaningless name; is this the government's way of pretending that this shoddy dangerous service is good enough for patients?

There are the protocol adoring outreach nurses who prescribe rapid IV fluids for everyone with low urine output, irrelevant of their rip roaring heart or liver failure. There are the acute pain nurses who perform simple arithmetic to convert one painkiller to another, while anything more complicated than this is left to the Consultant Anaesthetist. There are the A/E ENPs who spend hours seeing uncomplicated patients, while the doctors crack on through the majority of the workload. There are the specialist nurses in Dermatology who take hours to see patients with simple problems, only for the Consultant to come and do the job in two minutes. There are the community matrons who spend most of their time with a select bunch of patients, trying to prevent their hospitalisation; however evidence shows that their patients come into hospital just as often as they used to. There are the psychiatric specialist nurses who spend hours seeing each patient in order to produce their life history typed out on A4; it's just a shame they are seemingly incapable of producing a proper psychiatric history and mental state examination, their scribing often resembles an OK magazine feature and not a trained professionals work. There are more examples of this wasteful empowerment program, but I think I have made the point.

This is not a safe or cost effective way in which to reform the NHS. There is definitely a place for experienced nurses to become specialists in particular areas of their nursing expertise, however empowering inadequately trained nurses so that they can have a crack at being doctors is unfair on patients and a big waste of money. I am sure I will hear all the same old arguments coming out in defence of these quacks, but the tiredness of these defences is becoming more and more obvious.

There are going to be thousands of unemployed highly skilled junior doctors this August, while thousands of inefficient nurse practitioners are swanning around seeing patients at their leisure. Junior doctors have medical degrees and are trained to a much higher level, meaning that they have the potential to become independently practising consultants at the end of their training. Nurse practitioners may become nurse 'consultants' but what does this really mean, is it really safe to assume that the unknowledgeable can be continually promoted to positions of increasing responsibility without any rigorous tests of their knowledge and skills? As a result the sustainable consultant led service is being put in jeopardy and a generation of talent is going to be wasted as medical standards plummet into an abyss of incompetence.

In this New Labour fantasy land, proper examinations and standards are cast aside in favour of a system that allows the untrained to pick and choose what they fancy having a stab at. New Labour's logic allows the individual 'quacktitioner' to be so magically gifted that they can instinctively stay within their 'competence' zone at all times. It's a shame that the ignorami in control don't realise that it takes years of proper training and experience to be able to safely practicise medicine independently, and even then it's a very tricky business indeed.

I am sure there will soon be a day when the advanced nurse practitioner in primary care can refer a patient to their nurse practitioner colleague in the cancer clinic, who can then refer the patient to the surgical nurse practitioner for the operation. The doctor will probably be the one changing the patient's sheets and scrubbing the ward floor by then, the doctor will probably also get struck off when the surgical nurse practitioner stumbles blindly into the patient's aorta with a scalpel, because they never studied anatomy beyond 'Jack and Gill' level. This will be called progress.

Dumb me down porridge

The following email has been sent to GPs by an Out Of Hours service:

"Dear Doctor

Further to a recent feedback meeting with our ECPs I am writing to advise you that at this early stage we would normally expect an ECP to be asked to accompany you on a visit to the prisons, rather than them being sent on their own.

This is because they need some further supervision and experience within the setting of the prison before they will be confident to deal with calls on their own. Unfortunately due to sickness absence it has not been possible to implement our planned training sessions for ECPs and doctors yet but we will rectify that as soon as possible. In the meantime, until more confidence is attained by the ECPs we would be grateful if you would undertake visits to the prisons and ask the ECPs to come along with you. In due course when they have gained further experience and we have provided them with some extra training, we can of course review this.

On analysing the figures I can confirm that over the last three months there have been twenty six visits to the four prisons we cover, so we would not anticipate a significant impact on workload.

I appreciate that you may have concerns over the time prison visits will take but I would like to reiterate that this is a temporary situation to enable us to develop the confidence and expertise of our ECP workforce."

This is a strange email to send. If ECPs are working unsupervised already then I do not see why they should need supervision in this particular instance from the GPs, this assume the premise that ECPs are safe to work unsupervised in the first place, a dubious assumption in my opinion.

More worryingly an alternative perspective on this could be that the ECPs realise that they are well out of their depth working in an unsupervised manner, hence they are not ready to work unsupervised in prisons. This then begs the question, if the ECPS do not feel happy to work unsupervised here, then should they really ever be let loose on patients in an supervised way?

It is also dodgy that the OOH service thinks that a small amount of supervised work will suddenly transform the ECPs into safe independent 'practitioners', the OOH service can then re-review the situation and deem that the ECPs no longer require any supervision. This is without any examination or testing of the ECPs' skills or knowledge.

It appears this kind of dumbed down second rate method of training up independent 'practitioners' or 'quacktitioners' is symptomatic of the general dumbing down of medical standards. It used to be the case that one needed to have studied medicine at a high level to be able to practice independently, now anyone can have a crack after going on a few courses and watching a real professional for a few weeks; there are no standards being upheld for this new breed of quack.

Is it fair that prisoners will be left with this second rate standard of care? Is it safe that the OOH service can make decisions about what roles certain non-medically trained staff are able to safely perform? It seems that the answer to both these questions is 'no', and the patients are the ones will yet again suffer as a result of this cost cutting short-termism.

And who carries the can when it all goes horribly wrong and a serious mistake is made by one of these independent practitioners? It would not surprise me if the GPs were handed some of the blame for their role in the 'training' of the ECPs, while the OOH service washed its hands of any responsibility altogether.

Are they taking the michael?

There has been a significant amount of controversy surrounding MMC and MTAS this year, to say the least. The government has already organised an independent review panel to look into the disaster of MTAS, however the 'independence' of this panel was shown to be seriously lacking. After significant pressure from opposition parties and from junior doctors, the government had its hand forced and had to order an inquiry into the issues concerning MMC and MTAS.

The real motives behind MMC have not yet been revealed to the public or to the medical profession, so it is hard to see how one can really analyse the issue if the government are not revealing their real reasons behind the scheme. Some naughty dissident has been pestering the Department of Health with Freedom of Information requests:

"1. Who made the decision that John Tooke would chair the review?

The Secretary of State for Health, Patricia Hewitt approved John Tooke’s appointment as chair of the review.

2. Who contributed to this decision? did any senior Ministers, PM, special advisers, interested parties have any input into John Tooke's appointment as chair?

Many officials contributed to this decision.

3. I would like to see the documents detailing the discussions as regards John Tooke's appointment.

The Department considers that this information is exempt from the duty to disclose pursuant to section 36 of the FOI Act.

Section 36(2)(b)(i) provides that information is exempt from disclosure if to do so would, or would be likely to inhibit the free and frank provision of advice.

Section 36 is a 'qualified' exemption and we are therefore required to consider whether the public interest in disclosing the information outweighs the public interest in applying the exemption.

Section 36(2)(b)(i) recognises the critical role in effective government of free and frank discussion. Premature disclosure of information protected under section 36 could inhibit officials’ willingness to offer advice in the future and prejudice the quality of any advice given. There is a recognised public interest in protecting the ability of senior officials to offer candid advice to ministers, and in protecting the processes by which senior public appointments are made.

For these reasons, the Department believes that the public interest strongly favours the application of the exemption at section 36 of the FOI Act."

The Department of Health also ignored the question which asked whether Sir John Tooke had been made aware of the information, that was being withheld by the DOH under the FOI act, concerning discussions regarding the motives behind MMC. Another FOI request concerning MTAS is being delayed, delayed and delayed; probably until after August when the storm had died down I would imagine.

It is rather revealing that the Department of Health will not release information that would shed light on the discussions that led to John Tooke's appointment by Patricia Hewitt. It makes one wonder whether they have something to hide?

After all, it would not be the first time and the Department of Health is still stonewalling attempts that would force them to reveal the real reasons for pushing MMC through so quickly. I will probably only find out the truth when I am grey and old, but it will be worth the wait to expose these people for what they are.

Take a moment

I am no longer shocked by news of this year's job application saga, many juniors have been beaten so brutally that they are no longer registering the pain. The farce does continue and indeed it gets worse.

Job offers have been made erroneously and retracted, candidates were not informed of their interviews, the faulty buddy scheme has led to couples being split up, the MTAS short listing scores have been used to discriminate between candidates and the rules have been changing on a daily basis. Meanwhile Round 2 jobs are now being opened up to application, strangely some deaneries are using exactly the same flawed questions that were used in the MTAS round 1 application forms. Those who have been lucky enough to have been offered the so called 'golden ticket' have not felt like celebrating, as it is not satisfying to have succeeded via such an unjust lottery-like process. It is also not appropriate to gloat or even feel joy when so many thousands are staring down the barrel of a double barreled shotgun.

The Department of Health seems to have finally registered that things have gone slightly awry, and they are running scared trying to minimise the damage. It is too little too late from these government incompetents, they should be hanging their heads in shame. Remedy have even been informed that the DoH is still planning to increase medical student numbers by 2000 a year, even when it is overtly clear that there is no room for them to continue their training in the UK. The DoH are proving to be a very dangerous mixture between the cynical and the utterly incompetent, a surefire recipe for disaster. Incidentally the DoH have still not made a decision as to whether they will force Remedy to pay costs.

It seems rather obvious that there are some rather cynical forces at work here, I can see no other explanation for the deliberate flooding of the medical workforce. PMETB have remained rather silent on the matter of MTAS and it seems they have withdrawn the records of their board meetings from March to May from the website, this appears to be more than a little suspicious. At least some forces of good appear to have formed in response to the havoc wreaked by our dastardly overlords; there is Remedy and the newly formed Fidelio, two organisations that I hope can prove to be pivotal over the next few years in stubbornly fighting our corner.

I would like to finish by asking everyone to take just a few moments to think of those juniors who are suffering at the moment, it is vital that all of us do our bit to support our colleagues throughout the remainder of this sorry affair. Medicine is a pretty stressful career at the best of times, but this year's events has resulted in unparalleled strain being placed on junior doctors. It is a time to consider all those who have been treated so heartlessly and inhumanely; in the future it is important that those of us who have been lucky enough to emerge from this unscathed never forget the lost tribe of 2007. We must use this terrible experience to become stronger as a profession so that we can fight against the injustice inflicted upon us and our patients by this so very cynical government.

Fisher Price Monkeys

There has been talk in the press regarding New Labour's new invention in schools, the classroom assistant. There have even been stories of classroom assistants teaching classes on their own for many weeks in a row, and teaching subjects in which they have had no formal education. There have been complaints from both properly trained teachers and parents, as they fell that many children are being seriously short changed by this cost cutting dumbing down. One teacher was quoted as saying:

"Frankly I am appalled by this shoddy dumbing down that the government has instituted. Classroom assistants are simply not adequately trained for the tasks that they carry out in schools. Anyone teaching in schools should have to have a certain level of education and training that ensures they are capable of teaching at a sufficiently high standard."

Some proponents of the government's reform agenda argued that teacher's are arrogant to show such a superiority complex and that they should show more respect to these educational professionals. While some members of the union for educational professionals argued that no teachers are perfect and that classroom assistants can provide a valuable service.

It is lucky for the general public that New Labour has the Midas touch as far as policy making is concerned. Their policy is simply blessed in such a way that things like education, training and experience can be ignored; new 'professionals' can simply be trotted off the HMG production line with only a few weeks of inadequate training. These new 'professionals' can then miraculously do the jobs that were previously done by genuine professionals who had much more extensive amounts of education and training. New Labour really are to policy making what Paul Daniels is to magic.

It's fortunate that they have also had time to save the NHS, as well as increasing illiteracy and innumeracy to new record levels. The British public are lucky enough to have health care assistants instead of nurses, paramedic technicians instead of paramedics, emergency care practitioners and nurse practitioners or physicians assistants instead of doctors, and surgical nurse practitioners instead of surgeons. It would simply be arrogant to claim that less education, less training and less rigorous assessment makes these health care professionals any less safe or skilled than their predecessors.

It is rumoured that New Labour have a new health care professional waiting in the pipeline, it is called the 'fisher price monkey'. Department of Health representatives have set up a monkey training camp in darkest north east Africa, and it is believed that these monkeys will be let loose to diagnose and manage patients in the NHS after around 4 weeks of intensive competency based training with their fisher price stethoscopes. The DoH is keen to install the monkeys with electric shock devices that will be used to force the monkey to work for fewer bananas per hour.

The DoH has published the extensive list of competencies that these monkeys will have to fulfil, the monkeys will also magically be able to know when they are practising outside their field of competence; they have been trained to howl loudly for a doctor when their sphere of competency has been breached. Critics of the scheme claim the monkeys will be unsafe in their roles, however the DoH has comprehensively refuted this claim by surveying the monkeys for their opinion on this matter; the regulating bodies are also not concerned with the monkeys' command of the english language, as this will be left for the local employers to sort out.

New Labour: it's our best year ever, professional standards have never been set higher; get your private health insurance now, before it's too late.

Dumb and dumber

It turns out that, as expected, MMC is leading to a rather worrying dumbing down in training standards; the transitional MRCS examination is looking set to contain no clinical examination:

"1. The present proposals for the new MRCS do not represent an adequate level of knowledge or clinical skill to merit the award of the Diploma. The Court feels strongly that the MRCS Diploma should not be awarded without assessment by written, oral and clinical examination.

2. There will be a disparity between what is required for the award of the MRCS Diploma for candidates in the UK and overseas. This will introduce a two-tier system.

3. The introduction of the need for a surgical tutor to give clinical approval based on workplace-based assessment is unsatisfactory, and workplace clinical assessments have yet to be adequately validated.

4. The Court feels strongly that the level of knowledge and skill required to achieve the Diploma of MRCS should be defended and not compromised by the drive for intercollegiate cooperation and to meet specialty demands.

5. The Court feels that the difficulties arising in delivering the proposed changes to training and assessment exist because we are failing to take into account the need to set and maintain standards. If changes are to be introduced, we feel strongly that they need to be piloted in a way that demonstrates their superiority to existing systems."

Is anyone else surprised to see untried, untested and unvalidated tests being introduced over tried and tested ones thanks to the magnificent MMC? It appears to be out of the same lame duck box as the Foundation year workplace assessments; the competency based fundamentalists are turning their hand to dumbing down specialist training.

Does anyone actually genuinely believe that Modernising Medical Careers is about improving medical training? To me it seems to be doing the precise opposite, the government's cynical vehicle for catalysing the privatisation of the NHS is a dangerous menace. Introducing the sub consultant grade is a step back to the dark ages, a step away from excellence towards mediocrity which must be militantly resisted.

The death rattle

There seems to be no end to the dumbing down of medicine in the NHS, a great example of this is the empowerment of ambulance staff in a way that both defies logic and threatens to result in many unnecessary deaths. I use the term 'ambulance staff' as there are so many new varieties of Health Care Practitioners who ply their trade in ambulances these days, many of these workers are endowed with less training than ever before.

One of New Labour's great gifts to the grim reaper's flourishing business has been the unprecedented handing of clinical responsibility to medical staff who are simply not adequately trained for it. Any punter can have a crack at medical diagnosis these days, in the eyes of our clip board wielding protocol obsessed managers anyone with the appropriate numpty diploma, short training course and fisher price stethoscope should be able to have a crack. This frankly lethal empowerment process is often justified by pointing out that doctors make mistakes and are not perfect, of course this is true; however one could claim that fighter pilots make mistakes, hence why not let anyone loose as a pilot after watching Top Gun a couple of times. This logic can obviously be used to justify the overtly unjustifiable.

There are many tales of ambulance staff being empowered to try to prevent patients coming to hospital in a way that can only be described as completely reckless. Do not make the mistake of assuming that these are isolated examples, it is worryingly becoming standard practice in our brave New Labour NHS. I personally have seen several examples of extremely sick patients being refused transport to hospital by ambulance staff, even when their GPs had seen them and quite rightly recognised the critical nature of their conditions. I have heard of cases concerning ruptured ectopic pregnancies, diabetic ketoacidosis, unstable angina, and serious head injury. All these patients had obvious symptoms and signs that would not have been missed by anyone half decent medic.

I do not solely blame the ambulance staff for the inappropriate dirty work they have been handed by the state. The culture of trying to force patients away from hospital comes straight from Whitehall, in trying to save cash the politicians in control are knowingly supervising this wanton slaughter; the money wasted on ineffective schemes that try to prevent unavoidable hospital admissions would be better spent ensuring A & E departments had the capacity to safely manage the workload. As it is the government is living in a state of dangerous denial that forces the sick to stay at home, and the ambulance staff are used as the government's agents of enforcement.

Medicine cannot be practised by protocol. It takes several years at medical school, lots of tough exams, several years of supervised practice and even then after years of experience of practice medicine is still bloody hard. So imagine the potential for disaster when less educated, less trained, less skilled and less experienced staff are suddenly handed roles far beyond their station. Some of these staff have enough insight to realise that they are not sufficiently trained to overrule the decision of an experienced GP, however others lack this insight and become an arrogant disaster waiting to happen. When this dumbing down is combined with management forces that push the under trained to act beyond their station, and an unaccountable NHS management system that leaves managers free to kill tin order to satisfy the political needs of their psychopathic masters; you have a real recipe for disaster.

This dumbing down is not confined to the ambulance service, it seems to be infiltrating every sinew of the NHS. It may indeed by safer to call a Taxi to get into hospital, but unfortunately even having got to A&E you still have to somehow be seen by a good medically trained doctor. This proves difficult at times in the NHS, as the 4hour target means that the patient with the stubbed toe who is about to breach will often be prioritised ahead of a genuinely sick patient; while there is a proliferating array of non medically trained practitioners who are keen to dust off their fisher price diagnostic equipment. Add to this the fact that many of the best UK trained doctors are quitting medicine or emigrating thanks to New Labour's incompetence; while the GMC allows these well trained UK grads to be replaced by any old EU medical graduate, no matter how suspect their medical training or command of the English language.

On second thoughts you'd probably be better off having a go at repairing your own aortic aneurysm on the kitchen table with a big sharp knife, a pair of scissors, some garden twine and a bit of plastic. After all patients just want to stay at home, don't they? Who needs doctors.

post scriptum:

due to several tasteless and offensive comments I have withdrawn comments on this post, if people wish to debate in the future I suggest they at least remain civil, it seems however that this is beyond some people

Blair on the media

Tony Blair delivered a lecture the other day criticising the media, likening the media to ' a feral beast' that was 'obsessed with impact'. Tony's insightful words of wisdom can be read in full here, if we trust Mr Blair it is just an honest 'argument' and nothing to do with him trying to get the last word in before he bows down at long last. He does admit some undeniable home truths though:

'We paid inordinate attention in the early days of New Labour to courting, assuaging, and persuading the media.'

Even Mr Blair could not try to deny that New Labour have used the media in a more dishonest and cynical manner that any previous British government. His 'argument' is full of little attempts to pretend that he is trying to engage in debate, when in fact he is doing nothing of the sort:

"But it was an example of being held to account, not avoiding it. But leave that to one side."

Here Mr Blair pretends that he doesn't even need to tell us all how accountable and honest he is, as if. He has consistently avoided being accountable for several of his dishonest and deceitful actions, the only inquiries he has ordered have been run by his own personal cronies such as Lord Hutton.

Mr Blair then proceeded to detail some rather obvious facts about the way that technology has been changing the media, hardly cutting edge stuff really Mr Blair. He then tries to do precisely what he promised us he wouldn't; that is blaming everyone but himself and his party for today's cynical state of affairs:

"We devote reams of space to debating why there is so much cynicism about politics and public life. In this, the politicians are obliged to go into self flagellation, admitting it is all our fault. Actually not to have a proper press operation nowadays is like asking a batsman to face bodyline bowling without pads or headgear. And, believe it or not, most politicians come into public life with a desire to serve and by and large, try to do the right thing not the wrong thing.

My view is that the real reason for the cynicism is precisely the way politics and the media today interact. We, in the world of politics, because we are worried about saying this, play along with the notion it is all our fault. So I introduced: first, lobby briefings on the record; then published the minutes; then gave monthly press conferences; then Freedom of Information; then became the first Prime Minister to go to the Select Committee's Chairman's session; and so on. None of it to any avail, not because these things aren't right, but because they don't deal with the central issue: how politics is reported."

The lies are spun. The cynicism is nothing to do with the cynical policy making behind closed doors that has become the norm these days. It has nothing to do with reform agendas that are pushed through without proper consultations against the will of the public, it is nothing do with a top down authoritarian power structure that rides roughshod over the democratic process. Tony 'the great' has given us the wonderful Freedom of Information act, which is yet another pretence at openness by a regime that is anything but open. In Tony's eyes it's all down to the way it is reported, and nothing to do with the way which politics is conducted.

The speech continues along the same illogical lines; Mr Blair even has the audacity to accuse the media of seeing things in black and white, just remember that this is the man who sees the world in terms of 'an axis of evil' and 'a war on terror'. Mr Blair accuses the media of seeking impact and sensationalising stories, of course this is true; however Mr Blair's has certainly played his part in this unhealthy dumbing down of the press. Politicians such as Mr Blair are always keen to talk of engaging with the public, however he must be judged on his actions over the last ten years which have shown zero genuine signs of engagement in 'debate' as he likes to call it.

No one will be taken in by this deeply hypocritical diatribe of Mr Blair's. The media response has already pointed out several glaring flaws in Mr Blair's argument of sorts. The slightly worrying element to Blair's comments is the hint at yet more over controlling regulation by a cynical regime that wants to try to control everything. It is amusing that a man who has cynically used the media to further his own interests via a certain Mr Murdoch has so suddenly changed his tune. There is a lot to comment on, as this issue links in with everything that has become so detestable about New Labour. The talk is of more accountability, more local control, more freedom and more open debate; however the reality consists of an increasingly authoritarian dictatorship that seeks to be completely unaccountable for the damage it does via corrupt policy concocted behind closed doors.

'I've made this speech after much hesitation. I know it will be rubbished in certain quarters. But I also know this has needed to be said.'

This is true Tony, your hypocritical words will be rubbished as they are so demonstrably hollow and dishonest. It is precisely because of new kinds of new media source such as the blog that your deceitful nature has been exposed for all to see. Your policy has helped one man increase his media ownership in such a way that an unhealthy monopoly has been approached, it is this kind of unhealthy state that encourages the sensationalist dumbing down of the media. If you live by the sword, then I am afraid that you must die by it; you cannot simply change your tune when things don't go your way and pretend to be an honest champion of democracy.

It is strange that the fault is never your own, there is always someone else to blame for your mess. This is precisely why your rule has been such a dismal failure, you are never willing to admit fault and learn from it; your way is to lie, pin blame elsewhere and carry on regardless. Your words are hollow Mr Blair, have you no depths that you are not willing to plumb?

The Heckler speaks out

Philip Smith, the junior doctor who infamously heckled Patricia Hewitt on questiontime, has kindly allowed me to publish his summary of the disillusionment felt by many junior doctors this year. This piece is his summary of events and has been copied with his permission from Doctors.net:

"A few weeks ago I heckled Patricia Hewitt on BBC’s Question Time over the junior doctor job application fiasco. This was not an easy thing for me to do, as heckling is seen as such a ‘un-doctor-like’ thing to do, in fact I was publicly criticised by a journalist in a national newspaper for being rude. Someone who had absolutely no insight into me, firstly as a doctor (‘Frankly doctor, your bedside manner stinks’) or the disaster befalling the medical profession and the NHS as a whole. Doctors are supposed to be apathetic and detached – ‘stiff upper lip’, ‘shut up and put up’ – aren’t they? They can’t care too much about their jobs, their patients, and their livelihood? I am not a politician or a public speaker, just an ordinary doctor. My passionate and emotional heckle that night, was prompted by anger and despair – but also by fear – that things would get worse. They have.

I am utterly heartbroken – and I got my first choice job. I do not use these emotive words lightly, but I am distressed to the point of distraction by the agony I have seen my loved ones, friends and colleagues go through. The jobs for the first round came out last week, and as I feared, thousands of junior doctors were not allocated a job with just over 6 weeks until the new jobs are supposed to start. In a nutshell, there are going to be thousands of unemployed doctors, thousands unhappy with no training posts, and thousands leaving the country. Very few members of the public realise that this is even happening!

In the past, doctors left medical school, completed their first year as a doctor and then could apply to whatever field of medicine and surgery they wanted to, in whatever area of the country, applying directly to advertised jobs in hospital trusts. Doctors would then have to complete postgraduate exams through the different Royal Colleges (e.g. Royal College of Surgeons) to progress, to ultimately become a consultant. This process takes many years in some specialities as experience counts, particularly in the surgical specialities! This didn’t fit with the Labour Government plan - more consultants are needed. Therefore, Modernising Medical Careers (MMC) was born, training for doctors would be streamlined so that the time to consultant would be clearly defined with scheduled training all along. ‘Time to consultant’ level would be less. The tool to implement this was also conceived, Medical Training Application Service (MTAS), all junior doctors would apply for jobs at the same time of the year via this online computer system and would be matched to jobs using it. Simple.

As with anything, behind the superficial façade lies the truth, which I will explain. Training budgets were cut this year, so millions of pounds dedicated to training junior of doctors, helped amass a surplus in the overall NHS budget. The European Working Time directive was being implemented – so the hours that doctors can work legally (and be covered with medical protection insurance) was slashed – so trainee junior doctors are getting less training! The idea behind MMC was already being exposed as being fundamentally flawed, less training funds, less training time, less training years doesn’t produce the same quality doctor – end of story. MMC is a tool for government to say ‘we have more consultants.’ Actually they will have ‘more very junior, inexperienced consultants,’ a very scary thought for patients, and for doctors.

Then came the implementation of the ‘master plan,’ ignoring the calls of the BMA and the newly formed junior doctor pressure group Remedy UK. In February of this year, MTAS was launched, despite never being tried or tested. This was the way junior doctors had to reapply for jobs, all contracts and jobs were cancelled from the 1st August 2007 as this system would allocate doctors to the most appropriate jobs. As a result of the implementation, junior doctors from the before mentioned ‘old training system’ would be directly competing with even more junior doctors who had already started on the MMC pathway. A ‘bottleneck’ situation was obvious. Doctors had to fill out all their personal details on the internet website (including sexual orientation), also completing multiple statements on the online form which would be scored on a mark scheme. Questions would include: ‘Tell me about a situation where your communication skills fundamentally impacted on a patients care,’ the doctor would have to explain in 150 words or less, this scenario. These answers were given more weighting in scoring than the more traditional tests (on a CV) of how good a doctor was e.g. such as previous research experience, prizes, degrees etc. They were designed to identify the best doctors. Doctors could only apply to four deaneries each within the UK. For example, to work in London you would not apply to a particular hospital within London, you would have to apply via the website to the deanery called London/KSS, meaning you could be allocated to any job in the whole of London, Kent, Surrey and Sussex. Large areas of the country! The website kept crashing, the consultants marking the forms were overwhelmed with work (on top of their duties to their patients), then the fun really started. The job interviews came out and it became apparent that thousands of doctors were not even getting interviews – thousands not getting interviews for jobs they were currently doing!

Very quickly, it was clear that MTAS had failed in many different ways and doctors were angry, they had only one chance to apply for a job per year, with only one monopoly employer for junior doctors (the NHS!). No interview meant no chance of any job, unemployment beckoned for thousands. Doctors marched thanks to the Remedy UK organisation (a superb group of ordinary doctors, standing up to the government), MPs up and down the country had despairing letters from doctors and their relatives. The government panicked, the goal posts changed, and changed again, the website crashed, Patricia got heckled, morale fell, then fell further and further. Patricia and Lord Hunt span facts about the NHS, ignored the anger of junior doctors, then apologised for incompetence, and again, and again, but things never really got better. Then everyone got interviews, thousands of further interviews, thousands of doctors hours lost. Consultants had to cancel lists, clinics, daily duties. Then, nearly 4 months down the line, MTAS was axed and the gallant Remedy UK were defeated in a court battle by the devious government (who forced Remedy UK to pay thousands of court expenses), and the first round of jobs were allocated.

This is where we are today. No happy ending though. No happy doctors. Just lots of tears and lots of despair. Thousands of doctors without job offers, with a second round that offers little more promise. Those that have jobs are not even happy, they have no idea what part of the region they will be in, what hospital, what speciality, what consultant etc. – can you see the trend? Furthermore, hospitals don’t know who they are getting or whether they want to work in that hospital, a classic case of ‘bums on seats,’ except with people’s lives to add to the mix. Many have been offered jobs with no training potential (no chance of being a consultant if they stay in that post), but worse still, many have been cruelly separated from loved ones in the MTAS lottery. I have been separated from my long term girlfriend because of this when even a spell on intensive care for me, has never separated us. She didn’t get a London job and I did, despite her being on a ‘gold circuit’ rotation already in London. If she doesn’t accept a job offer elsewhere, she will be unemployed and with our mortgage and £30000 each in tuition fees to pay, we can’t afford to do that. We’ll have to live separately for potentially many years, as the MMC master plan doesn’t allow you to move regions! One of my closest friends, a brilliant doctor, with all of the qualities you could ever want in a physician has been shafted by this incredible system. Not one job offer. I’m devastated for her and will never forget or forgive the government for the suffering she has been through.

The shocking thing is, is that so many are in the same boat as this, a situation that sickens me to the core. Anyone that is a doctor, or knows a doctor will know the sacrifices a doctor makes and continues to make to be one. Of course, sacrifice is not exclusive to doctors, and no one would say that, but, the incredible number of exams, stress, financial costs and years studying to name a few things, not just at medical school, but after qualification, is practically unmatched. You don’t become a doctor to be rich, I get paid £7.50 per hour with all the extra hours doctors do to care for their patients properly. You do it because it’s a vocation, and you love your patients. You look into their eyes and you know that you can help them; you want to help them in their most vulnerable hours often, a thought that inspires me even in my lowest moments. You are with patients at happy times but also at times of great distress – you can make a real difference. Competition is fierce even before entering medical school, and is nothing new for doctors. We are certainly not zealots adverse to change, it is part of every day practice. Being a doctor is not just a job, it is your life, many of us live and breathe it, worried about our patients when we go home at night. There is nothing wrong in being passionate and fighting for our jobs, I would want a passionate doctor fighting my corner if I was a patient, rather than an apathetic one. This crisis has devastated many junior doctors’ lives, devastated many of my friend’s lives, which is unbearable to think about. People are leaving the country, leaving the profession – good doctors - because this crazy system has pushed them to the brink. I don’t blame them, but it is a travesty of the highest degree and should not be allowed to happen.

Now, Patricia will spin out facts about the NHS that will make you think you’ve got vertigo. But let’s face facts, the reality if far away from the verbal diarrhoea she oozes. The NHS is in surplus financially – nonsense! The vast majority of trusts are crippled by debts (from Private Finance interest payments which they will pay off for many years) so that wards have closed, thousands have lost jobs, all ‘non essential services’ cut, wards understaffed because of locum cuts, the list goes on and on. Waiting lists cut – nonsense - ‘cherry picked’ procedures take priority over other patients – taking resources from one patient group, to give to another. In no way am I demeaning the patients awaiting these symptoms at all (they need their procedures), but by taking it out of the control of the doctors and nurses, reasonable decision making cannot be made on who needs the treatment immediately in a fair manner. In my cardiac unit, patients not on a government target list regularly have their procedures cancelled multiple times while the ‘waiting list patients’ skip past them. ‘The best year for the NHS’ – give me a break! Speak to the doctors, nurses, physiotherapists and other support staff whose morale has been destroyed.

So why should the general public be bothered? Apart from the obvious vast amounts of taxpayer’s money to train unemployed doctors being wasted (£250,000) and money wasted on the failed computer system being a monetary incentive. You should be upset that the government seeks to develop a generation of younger consultants with much less experience and training to meet targets (whose training budgets have been taken by government), think about that if you’re needing an operation in the next few years. You should be upset that YOUR doctors are being treated like this, we are here for you if you are having a heart attack, here for you if your baby needs delivering. The junior doctors are the frontline with the nurses and support workers. From a human point of view, you must see that this is wrong. There are no other employers for junior doctors, the NHS is it. Granted, many will say ‘no job is for life’, but if I was a journalist who did not get a job at one newspaper, I would apply to another. There is no such facility for junior doctors. Do you want doctors allocated to specialist jobs on the back of an unfair system? Do you want to be treated by a doctor so bemused and despairing, treated so poorly, that he can’t bear to be in work? Hopefully even the most cynical observer will see that all of these factors are ultimately not good for patients.

The really ridiculous thing is that I voted Labour in power in 1997, my first ever vote. I’m from a working class background, my parents never attended university, I went to a comprehensive school, fought for my life in intensive care twice in the last ten years because of my Crohn’s disease and even wrote a book encouraging people like me to go the medical school. The Labour government betrayed me and my generation of doctors over tuition fees, now for many unemployment beckons. All I ever wanted to be was a doctor. I’m sure there are thousands of doctors just like me that feel the same but whose lives have been ruined by this fiasco. This is a national disgrace and something that should not be allowed to be hidden under other bad news. Shame on you Patricia – ‘this is your legacy, this is Tony Blair’s legacy – leave now!’"

Thick as two short planks

I have been inspired by Patrica Hewitt's latest ramblings to point out some rather glaring errors in her infantile argument:

"The NHS is four times the size of the Cuban economy and more centralised."

She is correct in saying that the NHS is far too centralised, it is also managed in a far too over controlling and top down manner. Unfortunately for Patricia and her moronic cronies this top down centralised structure has been their trademark, they are the main reason for this increasing centralisation.

She also added that services needed to be more 'patient led', a meaningless statement if there ever was one. Under New Labour and Hewitt services have been less and less related to what patients want; they have ignored the wishes of patients time and time again in pushing through their useless ideological reform. They have left us within an inefficient expensive dumbed down internal market where many patients simply have no choice but to suffer inadequate care from non medically qualified staff. She then added that that competitive pressure could create "startling results for patients", she is right if 'startling' is translated to mean rubbish, dumbed down and shoddy.

There was however a more fundamental flaw running through her illogical purulent splurge, this was her undying belief in the internal market and all types of 'competition'. If analysed in more detail she seems to equate anything 'nationalised' to being antiquated and useless and anything with any kind of market as dynamic and brilliant, this logic belongs at below primary school level. The kind of top down centralised stage managed internal market present in the NHS today can only be bad for the service provided, it simply doesn't matter whether this is done publicly or privately; any system that is so badly managed in a top down fashion will be doomed to failure. Likewise simply because something is state owned does not mean that this thing has to be centralised and top down in nature, there are many examples of great nationalised schemes that have been very bottom up in their approach and they have consequently been extremely successful. It is important that people are genuinely listened to and that services are allowed to spontaneously evolve to adapt to the changing demands of the nation, this can only happen if there is the correct balance between a 'catalytic' style of central management and locally responsive services.

Fundamentally the issue is not whether a service is public or private, the important thing must be whether the service is responsive to the needs of individuals. New Labour have plumbed new depths as far as forcing through policies that are antidemocratic and against the majority's wishes, hence their policies have failed on the whole as they do not have any way of adapting and reacting to the demand of individuals. It is incredibly rich and naive of Hewitt to simplify and dumb down the argument to a childlike level of internal market versus nationalised industry; after all it is ironic that New Labour's 'competitive' internal market has come to represent the most Stalinist failure of them all.

Bog standard

It seems almost as if nothing has happened this year, as the government continues to push its reform agenda on. The wheels of this antidemocratic band wagon are seemingly indestructible.

The government's gimmicky drive to reduce waiting times is appearing more misguided by the day. The centralised target based approach has many flaws, high up this list must be the way that clinical need is now overridden by the desire to gather political propaganda. This means that urgent clinical issues are lumped in the same basket as trivial non urgent things, in this way the system adapts to the government's demands. Unfortunately the government doesn't care for outcomes or the quality of the service provided, this is again demonstrated in other stupid schemes like Payment by Results which allow cheap shoddy surgery to profit over the quality provision of trickier work. No wonder senior surgeons are fed up with the lack of progress in the NHS, the familiar story of not listening to those on the ground is not the exception to the rule.

The useless NHS direct is another superficial glossy HMG creation that has no end product, in fact it actually creates extra work due to its amazing uselessness. Even the government's own figures regarding the 18 week target are deeply embarrassing, they reveal that no way near even half of patients are being treated within this particular target. The statistics are pretty useless as different trusts have gathered them over massively different time frames, meaning that comparisons between areas are remarkably meaningless. The government doesn't seem to care that the numbers mean nothing anyway, they will carry on trying to fiddle the targets even if it is completely pointless to do so. If they actually gave a bit more power to those with brains strapped to their shoulders, then it would be possible for clinicians to drive improvements to the service; rather than this bizarre situation where propaganda is valued over human life.

The MTAS/MMC roadshow rumbles along, medical trainees around the country are probably starting to wonder what on earth is going to happen when this useless reform actually has to be put into practice. I'm not sure that the 'gold standard' will be helped by these never ending reams of waffle. The government seems to be running scared to a degree, but it hasn't stopped their dumbing down of medicine in the NHS by trying to replace doctors with under trained quacks. I am not sure why the media seems so desperate to plead for more and more midwives while not mentioning the fact that more specialist doctors are needed in this area? Maybe it's because killing more babies than ever before at home will reduce the workload of these particular hospital docs?

Either way, it is utterly disgraceful that so many junior doctors face being unemployed or left in non training grade jobs, when the government is burning money in employing more and more non medically trained quacks. The public don't seem to realise that junior doctors are paid a relative pittance compared to these specialist nurses. It makes no sense from a financial or a safety point of view. I ask you who delivered Gordon Brown's baby, and who dealt with Tony Blair's heart? An inferior dumbed down two tier system is evolving before our very eyes.

The worst thing about MMC is its potential to absolutely wreck good medical standards in the UK, it's evil is brilliantly mused upon here by Dr Rant. It is hard to explain the precise nature of this malignant evil to people who are not working in the NHS, it can be summarised nicely by equating MMC to an aggressive malignant tumour; and if it is not radically excised, then the consequences will be felt for many years to come. The NHS has been held together for years by some rather high quality medical staff, MMC threatens to dismantle this by producing a lower standard of generic sub consultant who will unhappily provide a lower quality service to whoever darkens their door. The government's agenda of enforcing the internal market will see tow cohorts of patients emerge, one will be wealthy enough to afford properly trained doctors while the other will have no choice but to see one of a range of pseudo competent service providing monkeys. In reality there will be no choice for the patient, those without the cash will simply have to lump a cheaper second rate service.

Once the trust has gone from a system, disintegration does not take long to follow.

No time for celebration

The fancier has been lucky enough to secure employment for August this year, however there are many who have not yet been so lucky. Remedy Uk is running a list which contains all the junior doctors who are staring unemployment in the face at the moment.

It's hard to sum up just how traumatic this year has been for everyone involved, and this trauma is not yet over for the majority of candidates, it must seem that it will never end. It has been five months of uncertainty so far, and this will stretch towards eight months for many. And this stress has been all added on top of working in some pretty demanding roles as it is. I am quite sure that this has been too much for some people to take, the emotional and physical drain has taken its inevitable toll.

All of us know people who have quit medicine or are quitting, or who have decided to end their days with the NHS and flee for greener grass overseas. At my lowest ebb I have had thoughts of quitting medicine, even though it is the only thing I ever really wanted to do, but we do all have out limits of endurance. I don't know how much longer I could have lasted before breaking.

I have now got lucky. I will not lie, I do feel very relieved but there is no sense of satisfaction for me; a feeling of hollow emptyness has taken hold as a result of the grave injustice inflicted upon so many of us this year. The Department of Health may be running scared now, but nothing they do now can make up for the terrible damage that has already been done.

It is not just about a job, it is about so much more that that. A generation has been treated inhumanely and with a complete lack of respect, as if they were nothing more that cattle being forcefully bullied into a pen. Our generation has been abused and violated, and this betrayal will live long in our memories. Those behind this should be deeply ashamed of what they have done, and events should never be forgotten, they must be remembered so that future generations never have to suffer like this again.

It is no time for celebration, it is a time for thinking of those who are still having to endure this nightmare process. Whether being forced to uproot and move miles from home, or having to worrying about unemployment when having to support a young family; it is hard to ignore the devastating human cost.

The long term damage done by this years events cannot be underestimated, the last remaining islands of goodwill and trust have been all but decimated. The risk of creating a whole generation of demoralised staff who see no incentive in investing that little bit extra threatens to become a very worrying reality. Those in control have always failed to appreciate how the service is held together by some very hard working well meaning doctors; this years events threaten to be yet another nail in the NHS' coffin.