The slippery slope

The government's drive to empower less trained professionals continues, as prescribing powers are being handed out to more and more non medically trained workers. Optometrists are the latest to be handed extended powers, strangely it seems that the government thinks this is a good move for patients. I fail to see how handing prescribing powers to people without proper medical training in diagnosis, basic science and pharmacology can be safe.

More worryingly the government is also intent on handed extended prescribing powers to nurses, another dangerous move given that these 'specialist' nurses only have a ridiculous 26 days training which then magically turns them into safe prescribers. The government's reasoning seems to be that this move will free up doctor time, however the evidence points the other way with it arguably being more likely that more time will be spent mopping up after the nurse's mistakes.

This incredibly dangerous dumbing down sees a nurse handed extended prescribing powers after a brief 26 day course. The safety mechanisms in place to monitor the carnage are surprisingly non-existent, as seems always the way when the government tries to convert nurses into budget doctors. It will simply be left for the nurses to assess and police their own competence, a bit like allowing an air hostess to fly the plane and only call for help when he/she sees fit. The nursing regulatory authorities seem to have no concern for patient safety, as they allow the under trained and undereducated to have a crack at things that they are not adequately prepared for.

There seems to be a recurring theme here, the government sees it as progress to continue to empower workers with lower and lower levels of education a and training. This is allegedly all being done for patients. It is rather obvious to anyone with more than a small cluster of grey cells that this is a very disingenuous line to take. More power and responsibility being handed down to those who are not as adequately prepared for it is not progress, it is a regression that shows only a contempt for the high standards in medical care that we should be aspiring too. Poly-clinics, walk in centres and all these gimmicky new schemes are all part of this dumbing down of standards; it is simply shoddy health care on the cheap.

Unsavoury characters

The Daily Telegraph reported on a very unpleasant, misinformed and threatening letter sent by a certain shady agent of the state:

"The letter, sent by DoH Commissioning Director-General Mark Britnell, informs primary care trusts to come up with plans to persuade doctors to "respond to the needs and expectations of their patients, for instance by opening practices for longer periods". "

Dr Rant explains things succinctly here, there does appear to be no logic in Mark Britnell's stance; after all it was the government that has made several bad decisions in reforming and managing out of hours care in this country. It is at best misguided that Mark Britnell is writing such an aggressive letter ordering things to be done as he wants.

At worst it could be argued that Mark Britnell is a despicable scum bag who is keen to further his own medico-political career by helping the government privatise primary care. Unsurprisingly the apolitical Britnell was a Labour activist as a student. It seems Mark Britnell could also be accused of telling porkies on occasion:

"He had originally planned to become a lawyer but turned to the NHS after realising that the law was "more paper than people based."

Working in the public services also chimed with his aspirations: "I was attracted to running a big public sector organisation. It was about producing social value, about making a contribution."

His actions seem to contradict his statements above. It appears that Mark Britnell has one thing on his mind and it isn't 'the social value' of his work. He seems to be a rather menacing agent of the state, a man who values party loyalty above the public good and a man who will try to force through government reform at any cost.

It may come as breaking new to Mark Britnell but the government's very own survey revealed that the vast majority of patients were very content with their GP's service and opening hours. His bullying tactics are frankly beneath contempt, however they are something we have come to expect from a rather nasty bunch of authoritarians at the Department of Health. Shut it Britnell.

The NHS Confederation

The world has indeed has gone stark raving bonkers, maybe that's a slight exaggeration of events; it is however certainly fair to say that the NHS Confederation is a complete waste of space. If you don't believe me then simply have a look at this collection of suggestions from the 2007 NHS Confederation annual conference, it really isn't hard to work out why the NHS is in trouble when the people managing it are a bunch prize idiots. To quote Dr Rant these people really are a fine example of the 'twatterati'. Some of these suggestions really are rather unintentionally funny, however one's laughter can soon turn to tears when one realises that they were unfortunately not intended to be humorous:

"A quality improvement project for junior doctors, Jenny Rusby

Suggest to PMETB that a quality improvement project with rapid cycle and small changes would be more valuable in junior doctor "competency" assessment than "audit". Offer a prize for a completed project with most impact. Junior doctors could be an army of improvers!"

"Create improvement in the system, Carol Culshaw

I think it's very effective (as with the Engaging with Quality initiative to start with a Royal College) and (as with the Safer Patients Initiative to start with an organisation) to create improvement in the system."

"Develop a failure of the year award, Dave Dawes, European Nursing Leadership Foundation

Develop a "failure of the year" award, which celebrates and learns from innovation that doesn't work."

"Governance training in medical schools, Rob Keogh, Guy's Hospital

Implementation of comprehensive governance training in medical schools at our undergraduate level."

"Let the patients speak, Mike Evans, Atherton Evans Association

Let the patients speak. Let the clinicians listen!"

"Patients can make a difference, , Claire Allen, Royal College of Nursing

Making patients believe they can make a difference; acting on their enthusiasm and encouraging participation. Its all about belief and self-belief."

"Value clinicians at the coal face, Anne Howers, Sutton & Merton PCT

Valuing the role of clinicians at the coal face and coordinating their insights into national professional initiatives for young people. "Children are the future - we will not see" - Aynsley Green

We need to ensure investment in young people to improve the availability of future health in our country."

"More engagement with clinicians, Caroline Bollard, East Riding and Yorkshire PCT

To quote David Cameron for the next few years in NHS structure and policy, "Evolution not revolution".

More engagement with clinicians 'bottom up' and patient-centred policies.

The Health Foundation sum up exactly where things are going terribly wrong in the NHS, an organisation that waffles on about improvement and somehow manages to spend 20 million pounds a year on producing nothing more than offensive hot air. It is depressing that this settlement of gas manufacturers are simply too dim to see the great irony that their toothless organisation represents.

It is hard to find the words to describe the sheer lunacy of their extreme and nonsensical approach to health care 'improvement'. Their fundamentalist stance as regards care being completely centred on the patient defies belief and common sense; the doctor-patient relationship is a very complex entity but it is clear that, for it to be functional, the doctor must have more power than merely being a convenient listening device for the patient. If this lot had their way then doctors would never have time to learn basic sciences and subjects like anatomy that are fundamental to becoming a good doctor, they would be forced to endure years of communication skills and clinical governance teaching sessions instead, amazingly this is the way medical education is going; soon medical degrees will contain more teaching in waffling management speak than in areas which actually prepare you for practical doctoring.

Their offensive patronising chatter is rather symptomatic of the general malaise present in the overall management of the NHS today. The banter is of 'patient safety' and 'improvement' but practically they are pouring pound notes onto a bonfire, while creating yet another layer of useless bureaucrats who are happy to work against and stifle genuine progress. If they genuinely engaged with clinicians and believed in bottom-up management, then they would rapidly find that their organisation no longer existed. However as the NHS is run in an inefficient centralised fashion, it is no wonder that these kind of organisations keep springing up from unpleasant state orifices.

My failure of the year would go to the NHS Confederation and the utter hogwash that it represents. However I would not be celebrating this failure as I am not a moron. Doctors should be trained to do their job as doctors and once trained they should be trusted a bit more to get on with it, not forced to endure the incessant meaningless ramblings of these politically correct glossy-pamplet-loving quangopoops. Judging from these 'managers' comments they have about as much idea about working at the coalface as Paris Hilton, but perhaps the NHS confederation is simply a clever trick to massage the unemployment statistics?

My suggestion for the NHS Confederation 2007: cease to exist if you really want 'improvement'.

Healthspeak, a form of news speak?

"Has healthcare become infected with the wrong words?

Are health managers mired in management-speak? How good are clinicians at using language that patients can understand? The reform programme has introduced the language of the market, but for many it still sticks in the craw.

Nuffield Hospitals is initiating a debate about the vocabulary which has grown up around the delivery and management of healthcare.

Are there words and phrases you would like to see expunged from healthcare altogether?

Join the debate by clicking on ‘comments’ below. You don’t need a TypeKey or TypePad account to post a comment. The contributions will be reflected in a report to be published in November."

The government continues its drive to erode what it actually means to have done some training and been educated as a professional. It's strange that these days the word doctor is rarely mentioned, almost as if a medical degree doesn't really matter anymore. In an attempt to dumb down and cheapen standards everyone is being amalgamated into a 'practitioner' grade, training doesn't matter anymore, medicine is seen as something like baking a cake and everyone can have a crack.

The nurse 'consultant' has been created, whatever that is supposed to mean, personally I have no idea. The public are being tricked as the new breed of incompetent introduce themselves as doctors despite having the most inadequate of educations. In this brave new NHS with no proper standards we are all 'health care practitioners', everyone has been dumped in the same crate of faeces.

Privatisation without stealth

The government are pretty shameless in their auctioning of the crown NHS jewels, they don't even feel the need to hide their continued privatisation of the NHS from the general public. Personally I'm not even sure anymore if the government are cynical or just plain stupid, perhaps they are a mixture of the two.

As the good old NHS struggles to pay off deficits and staff are laid off as a direct result of this belt fastening procedure, one can rest assured that luxury juicy cherries are still being served up to the private sector. For example Capio seem eternally guaranteed to be dished up tax payer's cash, even when they don't bother doing the work that they were contracted to undertake. This is not an isolated example, there are private firms driving the NHS out of business in many other regions thanks to this central mismanagement which results in a rather uneven playing surface being forced upon us.

Capio and their ilk are like a pack of hungry lions drooling with anticipation as the government prepares them yet another course of expensive tax-payer-funded morsels, while the NHS is served up an empty plate of hot air. The NHS is simply the 'biggest privatisation opportunity' in Europe, in Capio's own words the NHS is merely a lump of profitable meat. Behind the hollow chatter about markets and capitalisation, this malignant monster is waiting to profit at the expense of all of us poor tax payers. Scandalously our own government is assisting the generation of private monopolies of health care provision that will see millions wasted in lining shareholders pockets; while democratic change will be impossible as the power will no longer lie with our own government, it will lie with a few very wealth businessmen who will have no obligation to respect the values of equality and justice that the NHS stands for.

Bile Broadcasting Corporation

More weight has been added to the rumour that the BBC is being used as a mouthpiece for the government press office by yet another misleading article regarding GPs and OOH care.

The headline "GP out-of-hours complaints soar" is not an overt lie but it is deeply misleading to the public. Thanks to the government/DoH's gross incompetence in handling health service reform the responsibility of out of hours care is now held by PCTs, yet somehow the blame for the government's errors is always handed to the GPs who try hard on the ground.

"It is a fact that patients are annoyed when they cannot see their normal doctor and I think this is more likely to make them complain about the care they receive."

This statement is pretty much right on the mark. Thanks to the government and the PCTs mismanagement of OOH care they have scrapped a good system where patients got an excellent service for great value, and replaced it with a poorer service that costs more with no continuity of care. The government sees this as progress.

More complaints and more mistakes are inevitable if patients are seen by doctors who firstly do not know them, and secondly do not have access to their proper medical records. More problems are also inevitable as OOH cover is made more skeletal with fewer doctors covering fewer patients, and thanks to non-doctors being handed more responsibility in taking clinical decisions for which they are not adequately trained or accountable.

The rise of phone advice by so called 'health care professionals' will have its undoubted cost in terms of patient mortality and morbidity. Even the most skilled and trained medically qualified struggle to assess clinical problems over the phone for unfamiliar patients, especially when the patient has not been assessed by a competent clinician. Hence the government's drive to shift more work that should be done in person to being conducted by phone is not in the best interests of patients.

Parallels can certainly be drawn to the government's mismanagement of front line hospital care. Doctors are thinner on the ground out of normal working hours, meaning that more work is being done by the non-medically qualified in a rather unsafe and dangerous manner. Clinical decisions are being handed down to many new forms of 'health care professional' despite the fact that they have not been adequately trained for the job, they are also not accountable in the same way as doctors are for their decisions. 'Hospital at Night' is a case in point, a cost cutting scheme that pretends it will make things better, when in reality it has been a metaphorical gun to many a patient head.

The BBC seems to think that all these problems are the fault of GPs and doctors; this is strange given that these people are the ones actually trying to fight what sometimes appears to be a losing battle against the Department of Health's drive to privatise and cheapen the service. It is also even more strange as GPs and doctors have not been the ones making these negligent errors in reducing the quality of the service, ironically they are frequently the ones fighting against this cost cutting dumbing down in the interests of their patients.

I suggest that you think long and hard about these issues before you blame the convenient medical scapegoat that the government has created in a quite blatant attempt to shift blame away for its own gross incompetence. The government and Department of Health like to pretend that things are always getting better and that they listen to concerns raised, however nothing could be further from the truth. In actual fact the government routinely ignores concerns from the medical profession about their malignant health reform program; they do not care if they kill patients with their cost cutting short termism, it is all about how they are perceived, hence more money is invested in spin and propaganda at the expense of patient care.

I am amazed that the BBC chooses to trust the government so much when they have been caught lying with their pants around their ankles on such a regular basis. The government's rhetoric never changes, the chorus of 'patients safety' and 'better care for all' is repeated ad infinitum; I suggest that you judge them by their actions and not their hollow words, their gross practical incompetence should speak for itself.

The NHS manager

There are many types of manager in today's NHS and judging from their end product it seems that something has gone terribly wrong in the land of the NHS manager. The logic of the NHS manager means that due to their inherent incompetence when they try to make things better, they inevitably make things worse; a more intelligent manager would then realise that a change of approach was required, but unfortunately the NHS manager tends to carry on digging their pit deeper and deeper by obstinately refusing to change tack. This assumes that their intentions are always benign, undoubtedly this is not the case for the cynical politically driven manager; their kind knowingly do harm in a rather amoral way. In their own eyes the NHS manager is never wrong. The NHS manager is also not helped by the fact that the NHS super managers in the Department of Health nerve centre have no intention of making the service better, they are simply the automaton enforcers of the government's will for us all, ie a cheaper shoddy health service for us all.

The NHS manager can be sub divided into a few broad categories, obviously there are no generalisations at all in this evidence based piece of research, however there is a small grain of truth in the ferret fancier's guide to NHS managers.

The common malingerers

The 'NHS University manager'- this is the born and bred NHS manager, trained in pure management with no knowledge of anything other than pure meaningless waffle; this results in a complete inability to understand what goes on in the real world, meaning that any attempts they make to affect change will be based on groundless management banter and will therefore only result in stifling the attempts of people who do the practical work on the NHS shop floor. They are named after the NHS University as this fine educational institution was an example of millions of pounds spent with precisely nothing to show for it.

The 'Impinging Nurse manager'- this is the extremely common sub type that plays a rather prominent role in stifling any possible progress that clinicians try to make on the ground. Invariably the weight of several packets of chips on their shoulders results in a complete inability to engage with anyone other than their fellow impingers, with whom they spend many hours snacking on lardy treats in expansive committee rooms that are only just large enough to permit the wobbling of their highly obstructive derrieres. Typically this nursing breed comes from a background of being rather useless at the real job of nursing, and from a enjoyment of bullying ones fellow employees; this lack of ability combined with a nasty vindictive streak results in a uniquely regressive style of management that many of us have the misfortune of experiencing first hand on many occasions. In their eyes the protocol can do no wrong, even when written in pigs faeces by a dyslexic crack-fuelled monkey.

The 'Donaldson'- this type of malodorous turncoat manager is named after our beloved CMO, Liam Donaldson. This type is medically trained but is very happy to sell out their own profession absolutely for the guarantee of honours, a nice office with a padded leather chair and a very occasional embarrassing appearance in public when the sh*t has really hit the fan thanks to some rather pitiful policy making. Personally I find this type to be particularly unpleasant, not only on the eye but also from an ethical viewpoint, as frankly this lot should know better. Unfortunately they are greedy egotists who have no care for anyone other than themselves, and this means that their management style always results in them enforcing the will of their master, the government. They care not for patients, the service or the staff on the ground; they are looking out for number one.

The 'Management Consultant'- this lot of smooth talking city slickers are particularly adept at being paid a small fortune for doing very little indeed, a quite remarkable talent. Despite invariably having no knowledge of medicine, healthcare and the NHS; the government seems to be rather fond of consulting these chaps using large wads of tax payer's cash. Despite the fact that many clinicians on the ground have been suggesting practical solutions to problems for years while going blue in the face, the government ignores this highly talented wealth of specialised knowledge and chooses to consult an overpriced source that doesn't really know that much about anything if we're honest. It's amazing how business seems to go ones way when one happens to donate a few pence to the political party in charge.

The 'Total Numpty'- this sub type of manager is the completely untrained breed of manager that can be found with remarkable ease in the NHS today. This type has very little knowledge of anything at all, they don't even have that precious managerial skill of being able to send you to sleep with a magic cloud of superwaffle. The NHS does have room for many types of incompetent who would not be able top find a job anywhere else, after all it is cheaper to pay them a low managerial wage than to fund their benefit claims. Strangely they do less damage than the more highly trained 'NHS university manager', as due to their complete ineffectiveness they can do no good, but also no harm.

Rarer manager types

Good manager - this exceptionally rare breed is trained in management but actually engages with staff on the ground, listens to constructive criticism and is able to learn from mistakes. Unfortunately these managers are often sacked for refusing to go along with destructive orders from above, while some of them become corrupted into the 'NHS university manager' sub type.

Ex doctor or nurse manager with no chip on shoulder and good intentions- this type is spotted in the NHS only very occasionally, a bit like the lesser spotted welsh warbler; these managers actually have the vision and insight to be able to save the NHS. It is therefore very sad to say that they frequently spontaneously combust thanks to the sheer frustration despair of having to engage with the more common forms of NHS manager. These noble managers have also been subjected to vicious smearing campaigns with little basis, and some have also been removed from office for not doing as they were told.

Overall this rather unique blend of the incompetent, the even more incompetent and the plain unpleasant results in one of the most dysfunctional management structures ever seen. The top down authoritarian lead of the Department of Health, under pressure from our corrupt politicians, has crafted this disastrously ineffective manure heap through many years of bullying and wrecking. The Department of Health has slowly amassed a team of incompetent bullies sculpted in its own malignant image. It results in those staff on the ground who are actually trained to care for and treat patients being obstructed by a complicated network of utter cretins. The staff on the ground cannot make sensible decisions in the interests of their patients anymore, they have become mere pawns taking part in a meaningless game of chess played by their idiotic managers, and the patient has been forgotten. We now routinely have untrained idiots making clinical decisions about patients in an overtly dangerous manner, as money is shuffled between different NHS bodies in a way that prevents patients from getting the care that they deserve; and this is all in the name of modernisation and progress. Brave new NHS indeed.

The 'ambitious innovative' MTAS

This is the picture that the BBC attempted to portray this evening on Newsnight, a report fronted by an Economics editor that woefully failed to get to grips with the real issues regarding MTAS and MMC. Junior doctors were unfairly portrayed as spoilt brats who had no right to expect to be treated humanely by their masterful employer, the NHS.

The illogical statements of Jim Johnson 'vascular surgeon', which claimed that crushing the hopes of thousands by forcing them into demoralising service grade posts would improve the service, beggared belief. While the spiteful Alan Maynard again showed his utter failure to understand anything about how to provide a good quality health service by hinting that doctors were simply too expensive now; I wonder if the patients would be happy to hear that the government thinks it is now too expensive to provide a high quality service run by doctors?

The program was a shoddy attempt at journalism concocted by a broadcaster which has consistently failed to get its head around these complex issues. How Channel 4 have shown them how it should be done over recent weeks. The patronising and insulting tone adopted by the aristocratic BBC journalists did appear more than a little hypocritical given their own secure careers, careers which they have forged by attacking easy targets such as junior doctors. It made me laugh that they portrayed us as a 'powerful' group, while our union the BMA were painted as a militant band; events this year have shown that we are far from 'powerful' and that the BMA are more of a damp squib than a militant mob.

The worst thing was that this BBC report failed to capture any of the human element of this disaster, by trying to portray the oppressed as spoilt and and powerful, they had only succeeded in making themselves appear as callous agents of the state. It is very sad that we have almost become so numb that all the upsetting stories do not have the impact that they should anymore. I sit and think that I should be sadder, or angrier, but the emotional tap has run pretty much dry. I have been left resentful and bitter, not a pleasant combination I know.

I find it hard to take in just how many people's hopes, dreams, lives, careers have been left in tatters thanks to this year's shambles. I think of close friends who I know have been let down and then I start to feel less numb, I can still empathise after all. But when it comes to trying to add up just how many doctors have been let down so very badly, I hit a brick wall, I cannot imagine so much neglectful destruction in one go.

So many have been left unemployed and shattered, so many have been moved miles from their homes, so many have had offers withdrawn, so many have been treated with disdain and scorn by various agents of the state, so many have been left in a state of depressed apathy that they so do not deserve to have to experience.

It is too much to imagine, would we be able to cope if we could imagine so much human suffering on such a scale? We must not forget this betrayal, if any of us make it higher up the chain of command we should always remember how this felt, there should be no excuse for treating people with so little respect.

The BBC thinks things have been 'overdone'. I am embarrassed for them that they are so happy to belittle the betrayal of a generation of hard working caring professionals in such a way. The government's admission that a high quality NHS run by properly trained doctors is just too costly is not newsworthy in the eyes of the BBC. But then I just a spolit junior doctor who happens to want to be trained to a high level so that I can do my job well in the future, what's so wrong with that?