Wednesday, 13 June 2007

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.

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