Slimey rotten DoH wriggles in pool of its own wretched filth

The Department of Health has responded to Sir John Tooke's independent inquiry into Modernising Medical Careers. They have taken their time to come up with an indecisive and insulting response. It is a response that many of us have seen coming from many miles off.

Remedy sum up the situation well, pointing out the rather salient fact that the DoH are only accepting just under a quarter of the recommendations of the inquiry unconditionally. Another quarter of the recommendations have been accepted 'in principle', meaning that they will be twisted and abused to meet the DoH's needs and not the needs of doctors and their patients.

While another quarter have been subsumed by the cynical Lord Darzi review which appears to be genuinely consulting no one at all and deliberately set up to privatise the NHS in the interests of only politicians and their friends in the big health care corporations. Importantly the need to set up a new body to oversee training called NHS:MEE is one recommendation that they want to brush under the carpet, as this would genuinely pose a threat to the DoH's deliberate top down destruction of decent standards of medical training and consequently patient care. As one example, here is a snippet of the DoH's response regarding policy making:

'Underlining the importance of an evidence-based approach, the team is being enlarged to
include more educationalists involved in the delivery of medical training.'

That's just what we don't need, more educationalists, and more communication skills at the expense of the core science and basic knowledge. The DoH's idea of evidence based policy making seems to be to manufacture lame flawed pilot schemes to empower the ignorant, as we have seen with nurse prescribing, physician's assistants, nurse practitioners doing the job of a general physician without adequate training et 'Skills for Health' cetera. Fiona Patterson continues to tell us that MTAS had good evidence behind it, and we all know how very wrong she was proven to be. The DoH will just continue to spin its own web of dodgy evidence to back its shambolic corrupt agenda, after all one's evidence is only ever as good as the people one has intrerpreting it.

The problem with the Tooke report is that the the very same people who have negligently mismanaged medical training over recent years are still managing medical training, thus they are going to do everything they can to continue to wreck things, in other words the fat child still has the keys to the pantry. Sarah Thomas, Clare Chapman, Liam Donaldson et al. are all still employed by the Department of Health, say no more.

Medical training reform is being managed by the DoH as part of their overall strategy of dumbing down and privatising health care in this country, the Tooke report runs against this as it stands for professionalism and high standards. Tooke is bigger than just medical training, it shows just how wrong the government is in its general management of the NHS as a whole, the problem is the government itself, thus the government cannot be trusted to fix the problem. So how do we force the government to do these very neccessary things that is really has no desire or intention of doing? The battle begins.

How much to polish a turd?

The scary motives and underhand agenda behind the government's NHS reforms continue to be unpicked. The Skills for Health scheme bears all the hallmarks of a New Labour dog's dinner. It is based upon the logic of a brain dead mango, has been orchestrated by a government stooge and offers to tangible benefits to anyone, other than the government and their close friends in business. The government does not want anyone to know how much it is spending on the ridiculous Skills for Health scheme, it is using the classic economical get out clause:

"Thank you for your email of 2 February requesting, under the Freedom of Information Act, information about the costs of the Skills for Health project. Your email has been passed to me for reply.

I can confirm that initial searches indicate that the Department of Health is likely to hold information which may fall within the description specified in your request. However, it is estimated that that the cost of complying with your request would exceed the appropriate limit of £600. This represents the estimated cost of one person spending three and-a-half working days in determining whether the Department holds the information, and locating, retrieving and extracting it. Under section 12 of the Act, the Department is not obliged to comply with your request and will not be processing your request further."

If the DoH is telling the truth, then it is massively embarrassing that they can't even work out how much the dimwitted Skills for Health scheme has cost. They will be hearing more from my ferreting representatives.

The motives behind the government's reforms are becoming crystal clear. New Labour's ideological framework of poo has been assembled to service themselves and the party's backers, the agenda of all out privatisation in all areas of the public sector continues apace. In the NHS we have seen the damage inflicted by the patient pseudo-choice agenda, as Darzi's private polyclinics are trotted out like a bad case of the runs.

Skills for Health is part of the deprofessionalisation of medicine, it is about dumbing down standards so that more and more health care can be flogged off to the private sector. Service is sacrificed so that medical care is no longer monopolised by those with the proper training and skills, perversely 'Skills for Health' means the very opposite of its name, it is New Labour newspeak yet again. Dumb me down Scotty.

Depressing news for big pharma

A review of all the data concerning new generation antidepressants has concluded that they are no better than placebo. Critically data which big pharmaceutical companies have tried to bury was included in this review, meaning that for the first time ever a full set of trial data was available.

I have long suspected that antidepressants are no better than placebo, the signs have been there for all to see; as even the best evidence that the big pharmaceutical firms could manufacture was hardly very convincing. So when scientists forced them to reveal the buried data, the truth had to out in the end.

This case highlights the dangers that come with health care being privatised. Big business does not care whether its products actually help anyone or not, only selling their produce and consequently generating profit is important to them, hence the rise of things such as bottled water.

The dangers lie not only in the form of useless drugs such as antidepressants being used to create a multi-billion dollar industry, but they also lie in the side effects of these drugs which make them much more dangerous than placebo tablets. For example SSRIs increase the risk of major gastrointestinal bleeding in all patients by a factor of three, and may also increase the risk of patients committing suicide. Hardly a cheap safe placebo are they?

Rewriting history at our expense

It has been revealed that the government is wasting our money trying to rewrite the story surrounding their damaging and antidemocratic NHS reforms, by amending Wikipedia entries:

"Information obtained by Conservative shadow health spokesman Stephen O'Brien shows that between 22 August 2005 and 3 August 2007, there have been close to 1,500 occasions when the department's IP address (the code that identifies which computers are being used on the internet) has been associated with the creation or amendment of entries on the encyclopaedia website. That's more than two per day."

As every day passes more examples of this abhorrent regime's Orwellian behaviour come to light, and it is most definitely not covering them in glory, far from it, it is making them appear to be incompetent propaganda peddling fools of the highest order. Just to make sure that Wikipedia doesn't miss this little affair, it has been included in the Department of Health's wikipedia entry. Mind you I'm sure they'll have edited it out by Monday lunchtime, always best to sneak these things in out of hours, I'm sure the irony of this won't be lost on you GPs out there.

Virginal innocence

"Thank you for your email of 2 February requesting information about healthcare centres and Virgin Healthcare.

Arrangements for the provision of NHS services using local health centres are a matter for local NHS bodies and the Department of Health has no plans to enter into contracts with any private health care provider for the provision of UK health centres.

However, I can confirm that as part of regular discussions with representatives of the independent sector providers, the Department has met Virgin Healthcare to discuss a range of issues around independent sector involvement."

Obtaining information from the government via the Freedom of Information act is a bit like drawing blood from a stone. I wonder what the DoH has told PCTs about the procurement of services and I also wonder what exactly has gone on in discussions between the DoH and Virgin Healthcare. The doors need to be prized open, as it seems that the PCTs are ordered around by the DoH, however when the DoH is asked what it is up to then it just passes the buck to the PCTs. Very shady indeed.

Darzi and the abuse of power

This government just seems to go from one scandal caused by rank incompetence to the next. The reasons for 'renegotiating' the GP contract are being hidden by the Department of Health, as a reply to a Freedom of Information request neatly demonstrates:

"Thank you for your email of 2 February requesting, under the Freedom of Information Act, documents detailing discussions between Ministers and officials regarding the proposed changes to the GMS (GP) contract in 2007/08. Your email has been passed to me for reply.

I am afraid that the information you have requested is exempt under section 35 of the FOI Act, as it concerns the formulation of Government policy."

Why is it acceptable for the government to keep such important information secret when they are repeatedly found to be making decisions against the public interest in an underhand and corrupt manner?

Computer Weekly has done some sterling work in forcing out evidence that shows how the democratic process is cynically manipulated by those in power for short termist political gains, rather than being used as it should in the public interest.

Anyone keeping an eye on the news should be able to start putting this jigsaw together. Standards of care are dumbed down, more and more under trained staff are empowered to meet meaningless targets, targets are spun and care suffers as a direct result. More and more work is shipped put the private sector with win-win contracts, as primary care is privatised and depersonalised via the unconsulted Darzi polyclinic agenda. Are the real reasons for this antidemocratic privatisation too disgraceful for them to be revealed? There is only one way to find out.

The fall out of MMC

Rabid doctors like myself have been predicting the massive service shortfalls that would result from the rushed Modernising Medical Careers reform of medical training. The media have started to take notice.

The Channel 4 news reported on the shortage of frontline doctors yesterday, while the Telegraph quickly followed suit. The crisis has hardly made the news until now, but a lot of people who work on the ground in hospitals will tell you that these staffing shortages are very widespread indeed.

The lethal combination of MMC and MTAS has resulted in the same amount of work being done by fewer staff, with the inevitable knock on effects on patient care. This is more than slightly perverse, given the large number of doctors who have not been able to find work and the number who have emigrated to work elsewhere.

The is already one of the most underdoctored countries in the developed world, so one would think that a government with half a brain would be more than a little worried at developments:

"We know there is some anecdotal evidence of these problems around middle-grade junior doctors. However, while we are keeping a careful eye on it, there is no evidence that such problems are widespread."

This is typical from our leaders at the DoH who are in a state of permanent denial. I just wonder whether this state of denial is linked to the deskilling of those working in the NHS via the skills ladder, is this what the government really wants? Is it a great idea to have a health system where anyone can have a go and where highly skilled doctors are no longer valued, thus becoming demoralised and broken? The black cat and the ferret have their ideas.

Darzi's privatisation hides being FOI act

"Thank you for your email of 2 February requesting, under the Freedom of Information Act (FOIA), information about the decision to set up walk-in centres in every Primary Care Trust. Following publication of Lord Darzi's interim report 'Our NHS, our future', published on 4 October 2007, which makes a number of recommendations for fairer access to GP services, decisions were made at a ministerial level to invest new resources to:

• establish at least 100 new GP practices into the 25% of PCTs with poorest provision, and
• develop 152 GP-led health centres (one in each PCT) in easily accessible locations, offering a range of services - including pre-bookable appointments, walk-in and other services, where registered and non-registered patients can access a GP between 8am-8pm seven days a week.

You also asked for documented records of discussions relating to this decision. I have to advise you that this part of your request would involve searches costing substantially in excess of the £600 cost limit specified in S12 of FOIA, and that for this reason, we will not be taking this part of your request further. You may however wish to make a more specifically defined request relating to this decision. Should you do so, it may be possible for us to comply with such a request within the cost limit, although it remains possible that information falling within your new search criteria could still be held to be exempt under such provisions of FOIA as S35, which covers information relating to the formulation of policy."

If their motives were honourable and honest, then they would be happy to reveal them; the DoH acts behind closed doors and never reveals the truth, therefore I can only assume the worst.

Milking the fat

As most of you are well aware the government is making a bit of a ham fisted attempt to halt the rising obesity epidemic, 372 million squid is being frittered away on gimmicks to pretend that the government gives a shit. After all it's much cheaper to throw away a few million on cheap gimmicks, than adapt all one's policies to fight the battle in an all encompassing holistic manner.

Would selling the school playing fields and replacing them with a healthy snack vending machine be seen as good for 'healthy living' by this government? You see what I'm getting at.

The end result of this shoddy policy making is that PCTs will be wasting yet more cash on schemes with either no or very scanty evidence behind them. 'Paying the obese to lose weight' is part the government's amazingly naive strategy. It is the genius of ideas like this that have to be seen to be believed.

The obese are being taken for a ride and the tax payer is also being ripped of at the same time; various profiteering companies are allowed to freely peddle their useless pap, and it's all ok because it's all in the name of a good cause. It would be stupid to use proper evidence to base anti-obesity strategies upon, this government would much prefer to fritter away millions on gimmicks and empower bureaucrats with no medical knowledge in PCTs to waste a few more million pounds. To effectively tackle obesity the government would have to remove itself from the back pocket of big business, grow some testacles, become honest and act in the interests of the electorate. That won't bloody well happen, will it?

The 'free' market and competition

A lot of people naively think that economics is simple, and that markets are either free or not free, and this is the only thing that affects the overall output of the system. The naive also tend to see competition as only a good thing, while any regulation or protectionism can only be bad.

This kind of noddy economics is deeply flawed and the government is arguably guilty on relying upon this noddy level understanding in building a lot of its useless ideological reforms.

If one looks a bit harder then some rather gaping flaws in this masterplan become rather obvious. Competition can be good and bad, and the same is true of regulation and protectionism; it all depends on the complex context in which these nuts and bolds are assembled.

For example no regulation can lead to anarchy, and if the consumers are also poorly informed then market forces can lead to poorer services and lower quality goods succeeding in a way that is not in the best interests of the general population. Competition in certain contexts is markedly counter productive, for example in areas that are natural monopolies such as the railway and water networks. Protectionism is also rather important as many markets that the naive claim were 'free' were actually rather well protected and managed.

The NHS and this Labour government's privatisation of it is a case in point, as the ideology of free markets and competition have been shown to be rather lacking in their real world application. The competition is so unrealistic and stage-managed that no benefits are gained, while massive inefficiency is caused by the bureaucracy needed to maintain the artificial market. This can be seen in the way in which primary care contracts are being preferentially dished out the private sector. PCTs are also not well informed enough to judge who can deliver the best service for the money put on the table, meaning that the fruits of competition are never harvested. Hence the government has managed to waste money on more bureaucracy while making the service worse, pure genius.

There is some truth in saying that competition could be better exploited to improve the overall standard of health care in this country, however the lack of improvement is really down to bad management and bad regulation, not a lack of competition and a market that is not 'free' enough. Better regulation and better more minimal top down intervention is what is needed to improve the NHS. The US has already shown us that a more 'free market' style system can lead to useless junk being peddled for big money, as the ill informed rich are convinced to needlessly part with their hard earned cash. There is a happier medium out there somewhere I feel.

Targets kill, beware

This excellent Guardian piece succinctly dismantles the government's pathetically stupid target based culture that has been enforced across the whole of the public sector:

"What happens when bad measures drive out good is strikingly described in an article in the current Economic Journal. Investigating the effects of competition in the NHS, Carol Propper and her colleagues made an extraordinary discovery. Under competition, hospitals improved their patient waiting times. At the same time, the death-rate following emergency heart-attack admissions substantially increased. Why? As targets, waiting times were and are measured (and what gets measured gets managed, right?). Emergency heart-attack deaths were not tracked and therefore not managed. Even though no one would argue that the trade-off - shorter waiting times but more deaths - was anything but a travesty of NHS purpose, that's what the choice of measure produced.

As the paper observes: 'It seems unlikely that hospitals deliberately set out to decrease survival rates. What is more likely is that in response to competitive pressures on costs, hospitals cut services that affected [heart-attack] mortality rates, which were unobserved, in order to increase other activities which buyers could better observe.'

In other words, what gets measured, matters. Measures set up incentives that drive people's behaviour. And woe to the organisation when that behaviour is at odds with its purpose. Imagine the cost to NHS morale (one of Deming's unknown and unknowable figures) of the knowledge that managing to the measure resulted in more deaths - the grotesque opposite of its aims. Hospitals are the extreme example of a general case. As such, they allow us a definitive rephrasing of our least favourite management mantra. What gets measured gets managed - so be sure you have the right measures, because the wrong ones kill."

This thinking is based upon this article in the Economic Journal, whose abstract makes the situation rather clear:

"Our results indicate that hospitals in competitive markets reduced unmeasured and unobserved quality in order to improve measured and observed waiting times."

In other words targets are a complete waste of time, not only do they increase the bureaucratic burden but they result in the lowering of standards in anything that is not directly linked to a measured target. The government's answer to this has been to produce more and more targets, but you cannot measure everything, so anything without a target attached is still left to rot, while the system becomes more and more innefficient as the bean counters and bureaucracy proliferates exponentially. Targets need to be decimated.

Doctors are evil scum - news shocker

The media do love a good bit of doctor bashing, there are some great examples of this around in the papers today, and none of the upstanding hacks involved would ever dream of letting the facts get in the way of a good vitriolic story.

It is pathetic what passes for journalism in the Daily Mail, as this doctor bashing story demonstrates very nicely. The facts of the story are that consultants get a small budget of 800 pounds per year for study leave. This budget barely covers the cost of a one or two day course but will be all that a doctor receives for several weeks of study that has to be paid for somehow. Therefore some doctors choose to go somewhere nice, like a skiing resort for example, for their continuing education and shock horror, may actually choose to eat out and have a few alcoholic beverages in the evenings. The Daily Mail hypes this up as doctors having it large at the tax payer's expense, which is a completely dishonest misinterpretation of the facts. For example my study leave budget for this year will pay for about 5-10% of the courses that I am attending during my study leave, this means that I am paying for my over 90% of my own education, the Mail doesn't tell you this story though.

Another woeful piece of anti-doctor spin appears in the Observer; making it out that GPs are solely to blame for people that are addicted to certain drugs including benzodiazepines and painkillers. The fact that mental health care is completely inadequate in the UK is ignored by the Observer, however it may well have something to do with 'prozac' being increasingly dished out like candy. If you combine a broken and failing society, in which community spirit and human support networks are being decimated in favour of short term capitalist gains, with a pharmaceutical industry that dishonestly manipulates statistics to peddle useless drugs, then you will get an end result of patients who demand a pharmacological fix to their unhappiness. In this environment it is also rather dangerous for more and more medicines with potentially serious side effects to be available over the counter without a prescription. If nothing other than economic gains are valued by government, then there will be more and more human misery created for which business will try to peddle a quick fix. One week doctors are not prescribing enough painkillers, the next week doctors are to blame for the side effects of the painkillers they prescribe, is this a no win situation in the eyes of journalists with arts degrees who are too stupid to understand science?

Dr Crippen has it spot on with his incisive commentary on yet another tragic tale of a medical suicide. If you believe what you read then doctors are lazy, greedy, selfish and good for nothing. However who is telling you this? A mixture of politicians and journalists of whom very few have much knowledge of anything medical or the medical topics on which they are so keen to give us their 'well informed' opinion. So what is the government's fix for this problem of a useless self interest medical profession? Well, they want to empower more and more people with far less knowledge and training than proper doctors, they want to restrict the public's access to doctors, and they want to dish out more and more work to big health care corporations. All of this will lead to an increasing tendency towards dishing out drugs when they are not needed, as prescribers will be less aware of the detailed evidence bases upon which decisions are based, and the big corporations will always be keen to flog patients something, as in their eyes creating a needless demand for something useless makes good business sense. The small GP practice in which decisions are made in the best interests of patients will be a thing of the past, and the big health care corporations selling us tests and treatments we don't need will be the brave new way of the future.

Lies, spin, and more lies and spin

The lies and propaganda from the government continue, the Department of Health today claimed that the GPC were backing their proposals regarding GP opening hours and the new GP contract offer:

"We are pleased the GPC are now backing our proposals and urging GPs to support them."

This is a ludicrous line to take. If someone offered you a choice between two deals, and one deal involved your wife being raped and brutally murdered while the other involved your child being molested and deep fried in oil; then would choosing one deal over the other be seen as backing that deal?

The government is taking the michael. It is offering a bullet in the head or a bullet up the arse. The BBC should know better than to report this propaganda as breaking news, the journalists who do this clearly know very little about the topics on which they report. If GPs have any sense then they will defend their territory and tell the government where to stick it, after all if bullying is accepted then one can become a victim for ever.

The naked noctor?

The 'barefoot' doctor was created in the 1960s in communist China, as urban-trained doctors would not settle in rural areas. The 'barefoot' breed of doctor was typically a farmer with only a few months of very minimal training, their creation became institutionalised by Chairman Mao's cultural revolution. When the commune system of agriculture ended in 1981, so did the day of the barefoot doctor. They were told to take exams or be demoted to the position of a lowly health aide. Barefoot doctors were certainly better than no doctor at all.

Chairman Brown has obviously read brother Marx's manifesto, and has come up with some kind of new sick offshoot ideology. This has resulted in Chairman Brown's great leap backwards, however party sources insist it should only be referred to as the great leap forwards, they do have a rather strange sense of humour. The future of family medicine seems gloomy as a result, as Labour's 'naked' doctors have been empowered around the country at a Walk in Centre near you. The naked noctor is an even more extreme version of the barefoot breed; as some have only had a few weeks clinical skills training, even less than the average barefoot. The sense of the great leap backwards is hard to see, as going from fully clothed full trained GPs to these naked noctors is hardly what could be seen as progress. I guess it all depends on whose progress we are looking at, doesn't it?

ps on a completely unrelated matter congratulations to Mr Tony Blair on his latest richly deserved job

The great leap backwards

In the beginning there was a big bang, or Adam and Eve, or something different that you believe in; anyway whatever you believe in, there were certainly no doctors or hospitals.

As human civilisation developed more specialisation became possible, meaning that some people became full time physicians while others ploughed the fields and scattered.

The Sinhalese might have been the first to introduce hospitals en masse in the 4th century BC, soon the Romans got involved, but it was arguably Muslim physicians who developed hospitals as we mean in the modern sense of the word in the 8th century.

Throughout modern history medicine has become more advanced and more subspecialised, resulting in standards of care that would never have been evisaged in days of old.

Then came New Labour and Darzi. Their motives are unknown but their plan is obvious.

They want to reverse progress, they want regression.

Rather than provide high quality care in hospitals that is proven to be efficacious and safe, they are keen to shift more and more work into the community even though it is clearly a dangerous step backwards.

The mechanism for regression involves an extensive innefficient bureacracy controlled from the top down by self interested cronies of the party. This bureaucracy then stretches its greasy tenatacles far and wide and orders everyone else around.

Even the most highly skilled professionals are now controlled by nonsensical protocol-driven idiocy from the likes of NICE, everyone must obey their master or else. Training and education are no longer important, professionals are no longer respected, everyone is made to be equal in this socialist nightmare.

Money is now spent on avoiding doing work rather than doing the work that needs to be done. This costly manager-led rationing of treatments against the clinical interests of patients has become the depressing norm.

The perverted logic that sees excellent specialist services deliberately ship wrecked while private treatment centres profit for from shoddy care has to be seen first hand to be believed. PCTs have no incentive to provide a good service, instead they are encouraged to privatise and avoid paying for neccessary treatment.

Medicine in the UK is regressing. The government's desire for excessive amounts of control will only continue to erode standards if allowed to continue unchecked. I just hope Darzi and Brown are proud of their place in history.

Monkey see monkey do - Lord Leitch's brainwave

Competency based training when used in isolation can encourage low standards and a relentless dumbing down, this article by Martin Talbot is an excellent critique of the competency based collapse in standards. John Tooke's excellent report also highlights this problem and seeks to address it by defining the role of a doctor, by this Tooke is attempting to prevent the less skilled taking over various roles which they are clearly not adequately prepared.

Skills for Health epitomised all that is stupid and wasteful in the NHS. This scheme attempts to transform the health workforce thanks to ideas from Lord Leitch, Lord Leitch of Labour that is. Lord Leitch seems to have a rather interesting history of being very closely allied to Tony Blair and the Labour party. He has also been a major financial backer of Gordon Brown. Strangely though he has only experience of the insurance industry, so how on earth he is qualified to do a generic review on the huge topic of 'skills' is a little beyond me.

The review of all 'skills' by Lord Leitch can be read here, the report is entitled 'Prosperity for all in the global economy - world class skills'. The report is meaningless rubbish in its entirety and starts off with some good old Labour propaganda:

"How is the UK placed to respond to this challenge? We have many important strengths – an excellent higher education system where more people then ever are studying for degrees; many good initiatives on vocational training; an increasingly effective school system; and a strong record of improvement over the past decade."

More people are studying at universities for sure, however by doing this the value of a university education has been reduced and a lot of money has been wasted in dumbing down university degrees. Crucial subjects such as science, both at schools and universities, are in crisis regarding funding and numbers of pupils. While there has been a proliferation in useless subjects studies at school and at university, and the railroading through of new diplomas that universities have no confidence in. There's no doubt we need an alternative for non academic pupils, however to do this one doesn't have to decimate high level academic study. The corporatisation of education is something to be very concerned about indeed. This all comes as a direct response to the government being obsessed with only short termist direct economic gains, as Lord Leitch's review made clear 'Economically valuable skills’ is our mantra.'

The danger of this corruption of education is there for all to see. The pharmaceutical industry has shown us how scientific and human progress is held back in the name of short term profit, as trials are hidden, manipulated and suppressed; while anything that is not economically profitable to them is ignored, even if it would benefit the human race significantly. Dr Grumble highlighted this when talking about the way that a needless has demand for bottled water has been manufactured to make money. The reason for this is that politicians are backed by a few wealthy businessmen, hence they keep them happy by keeping their businesses happy, and in this way everything is becoming commercialised; everything is seen in economic terms and nothing else matters.

Medical education and education in general should be there to achieve excellence, not to satisfy the economic needs of a few wealthy businessmen. The skillification as described by Lord Leitch is as bizarre as it is stupid, it is a kind of competency based training for all workers in the country. It ignores the fact that different people have very different abilities, different levels of education and different qualifications; there are many better ways of gaining skills which do not involve his competency based methods. As with all stooge-led government reviews we have someone poorly qualified conducting a review of something huge that cannot possibly be reviewed by one person and one review; the area of all 'skills' is so enormous that all comment becomes such a generalisation that all conclusions are completely meaningless.

The end result of this government megalomania is yet more money wasted on QUANGOs and thousands of bureaucrats with no real skills of their own, and these fools are ordering around the highly trained and catalysing the deprofessionalisation across the board. Everything is top down and centralised, the state and business are fusing into one horrendous ugly beast that sees only short term economically valuable skills as important. There is a massive contradiction here, because this pursuit of short termist economic success will lead to catastrophic economic failure in the long term, the competency based approach leads to stagnation and failure; only the pursuit of excellence when the motivation of individuals is harnessed will lead to long term success for our country. Lord Leitch's vision is a fascist nightmare, standards are dumbed down and everyone is made equal by the state; there is no room for harnessing the flair and drive of individuals as everyone is controlled by the state, the able will become demoralised and progress will grind to a halt. In Lord Leitch's world anyone is capable of anything, even Lord Leitch is seen as capable of reviewing generic 'skills', what depressing irony.

BMA and Remedy session with the BMJ

An interesting interview with Ram Moorthy of the BMA and Matt Jameson-Evans of Remedy UK can be heard here on the BMJ website. There was nothing overtly wrong with anything Ram Moorthy said, however Matt Jameson-Evans just seemed a little more convincing with his answers.

Initially Matt Jameson-Evans purposefully stated that Remedy would have made a proper stand against MMC and MTAS if they had existed earlier, in reponse to this Ram Moorthy claimed that the JDC had made a stand, a slightly twisted interpretation of events in anyone's opinion. The lack of consultation was highlighted, as was the slightly malignant influence of educationalists upon the MMC process. The need for flexibility was also emphasised, something I feel the majority of doctors would agree with very strongly.

Tooke deserves a new paragraph, Tooke must be kept in the headlines and implemented in full, the government must not be allowed to weasle out of this: Remedy were committed to this, the BMA not quite as strongly so. NHS:MEE was seen as being vital by the BMA and Remedy. The controversial subject of the sub consultant grade was brought up, as was the government's dishonest failure to live up to promises of expanding the consultant grade.

Whatever happened to the consultant led service? We're currently heading towards a noctor led service. The short termist strategy of the government was discussed regarding poor workforce planning, while the looming disaster of an expanding bulge of post-CCT doctors who may well not have jobs to move into upon completion of their training was also discussed; I have to say that Ram Moorthy was let off the hook as the debate was moved on, the post CCT problem must not be forgotten.

Matt Jameson-Evans was far more voiciferously against the evils of EWTD and had the guts to mention how training was being wrecked by the short termist idiocy of using certain HCPs instead of junior doctors. Ram Moorthy was also excellent on the issue of HCPs and how ineffective they are cost wise. Jameson-Evans said the biggest issue facing them was 'deprofessionalisation' and I have to agree with him on this, this must be at the centre of the battle ground.

Then the issue of representation was touched upon. Matt Jameson-Evans explained how Remedy had come to exist, precisely because the BMA's structure did not allow for quick meaningful action. Ram Moorthy talke of the complimentary nature of Remedy and the BMA, and again reiterated how the government's desire to morph all HCPs into one block would not be good for the standard of care or patients.

The chat was generally good, the goal of high quality patient care and the fight for professionalism in medicine were high on the agendas of both organisations. It was clear to me at the end of this that Remedy have become key, as they have given the politicians something to fear, and they will keep the BMA on their toes, thus making the BMA more effective. Personally I hope that Remedy never becomes like the BMA, as when the committees and the illusion of democracy becomes more important than getting things done, then institutional impotence results. For Tooke to be implemented in full, we must fight the bastards to the death, complacency could be our undoing.

Darzi the stooge gets both barrels

Taken from the Telegraph letters section, a rather learned legend of surgery puts the young stooge Darzi in his place:

"Sir - Lord Darzi's assertion that our hospitals can only separate the sexes by converting or building all hospitals with separate rooms is absurd (report, January 28). Hospitals have had no difficulty in providing separate wards for men, women and children for hundreds of years.

The pressure to mix the sexes in the wards began in the 1970s when politicians mistakenly began to believe that most surgical, and many medical, illnesses could be treated with outpatient or short-stay procedures and so demanded that, in theirview "unnecessary" hospital beds, be closed to reduce costs. At the same time administrators, having been told to achieve a 100 per cent bed occupancy to become more efficient, also enforced the closure of wards. The result was a shortage of beds so that those needing admission were put into any bed available regardless of theirsex or wishes.

If hospitals ran with the ideal average bed occupancy of 85 per cent, it would not only be possible to have single-sex wards, but also be able to cope with the periods of heavy demand and have the opportunity to clean and refurbish. All of which would reduce hospital-acquired infection.

Lord Darzi should stop listening to the Treasury and direct his efforts to ensuring that patients are placed in an environment that will aid their recovery not impede it. He should tell his Secretary of State to reopen the multitude of beds that his and previous governments have closed and so give space and time for all the staff of the NHS to do their job properly.

Prof Sir Norman Browse, Past President, Royal College of Surgeons, Alderney, Channel Islands"

Quite, and coming from an ex-President of the Royal College of Surgeons who is arguably one the most respected people around. Many of the problems in the NHS are as a direct result of this kind of political interference when it is not needed. Bed occupancy levels are far too high and this results in many knock on problems such as high rates of hospital acquired infection and other dangers such as patients being scatterd on inappropriate wards. Darzi is being used by the politicians to justify their stupid policy, and Darzi is happy to go along with this. He is beneath contempt.