Monday, 31 March 2008
Sunday, 30 March 2008
Firstly diabetes and MS are chronic conditions which may present acutely, so the BBC has got this completely wrong in the first paragraph. The pursuit of choice in the health care system is beginning to appear rather religious in its nature:
The government took us to war in Iraq because of a flawed belief that violent regime change would be the means to an end, the end being the Utopian style of government that is western democratic capitalism. Their naive ideological pursuit is failing dismally there.
There are parallels between Iraq and the NHS. In both situations the government is trying to apply a one size fits all ideology to a situation that is eminently more complicated and intricate than they realise. In both cases they have a misguided and almost 'religious' belief in an ideology that is a means to an end, the end in both cases is seen by them as an achievable utopia. They are stupid and deeply misguided.
As is excellently point out here, anyone who sees that there is an end point in the provision of the perfect health care system is most likely an imbecile, a politician or both. All systems have their flaws and there unfortunately is no utopia. The government's ideological pursuit of a market in health care, when finite resources are available to manage an exponential demand, is deeply flawed. This reform is leading to more and more money being wasted on creating the market, managing the market, rigging the market and fiddling with the market.
The end result is an NHS in which more and more money is diverted away from patient care and towards a burgeoning bureaucracy. Just like Marxism, fundimentalist free market capitalism exhibits all the hallmarks of deluded religious thinking; their ideology is a means to a perfect end, the end justifies any means and they cannot be wrong. To hell with reason.
Thursday, 27 March 2008
Apparently it's not only important to be clean and smart for infection control reasons, but because the public use appearance as a 'proxy measure of competence'. So anything that makes the patients happy, right? Also if one has strange religious beliefs then you can probably blag some kind of exemption from this authoritarian code by liaising with the 'Equality Steering Group', probably another group of dried up nurse managers who spend most of their time snacking on ethnic goodies.
This new code will also be enforced by the managers, as long as they have time to stray away from the cookie jars, as they will be carrying out 'Spot checks of dress and uniform compliance' and 'Questioning samples of staff regarding their knowledge of the policy'. They are very particular about footwear
I despair, why on earth must the colour of my shoes be dictated to me by these mincers? Also it seems that those of us who develop stubble rapidly may have to shave midway through a long shift:
While they are keen to point out the precise nature of any make-up, what constitutes an offensive tattoo and the need for no strong smells; it certainly will be hard to find that balance between body odour and deodorant use, if i stray too far in one direction will the strong odour police come sniffing?
No 'necklaces, chains, bracelets and ankle chains, rings with stones or ridges' are allowed. They are also rather particular about :'The wearing of earrings is limited to one pair of stud sized earrings no larger than half a centimetre in diameter' , I am sure this will make a difference to that proxy measure of competence. Apparently shoes should also be of 'low noise', I must remember to leave my talking Bob the Builder shoes at home.
These words of wisdom came from the CMO, Sir Liam Donaldson, a man who loves to compare the airline industry to the NHS. There are certainly many similarities such as the low quality food, the cancellations, the dirty toilets, the long queues, the lack of local services et al.
"Rather than looking at harm and deaths that occur to patients as one off events, we should look at connections and similarities, the common causes, and use them as a source for learning and action just as the airline industry has done"
However I wonder what Sir Liam will try to learn from the pandemonium at Heathrow terminal 5. Is a new initiative of putting the possessions of patients onto conveyor belts and watching them drift into oblivion about to come into place?
The only thing that one can learn from the airline industry is that monopolies, whether run by the state or private corporations, can become rather inefficient and useless at providing the service that they are meant to. We all need a kick up the backside from time to time, and that's why it's so important that the government has the balls to do this to both state-run services and those run by private firms. It's a great shame the government has no balls, as they seem to be firmly in the grip of the CBI and big business.
Wednesday, 26 March 2008
Sam is right, this silence needs to be broken; Remedy are doing their best but the money is drying up, and it is becoming harder and harder to motivate an increasingly apathetic cohort of doctors. Doctors need to unite, those who have done well from the MTAS and MMC debacles need to get behind those who have been shafted, we all need to work together for the long term good of the profession. Anyone who thinks that they need not act because they themselves are doing OK should be ashamed of their deeply selfish attitude, it is precisely this kind of attitude that has got us in this mess in the first place. Bruno Ribiero has been one man that has spoken out as regards the devastating impact of MMC's implementation, he should not be an exception to the rule.
If you believe the DoH then its the best year ever for patients as they will benefit from the intense competition for jobs. What utter rot. The long term impact of driving thousands of highly motivated and talented doctors from the NHS will be devastating for patients. Ironically this is happening while the government continues to empower the ignorant and under trained to do the jobs that should only be done by proper doctors.
The battle must be fought on several fronts. Firstly we need more training posts to prevent an unprecedented loss of talent from the NHS. Secondly we need to fight to maintain high standards of medical training, we must take on the competency based fundamentalism that is threatening to destroy training, and we must fight to preserve the royal college exams. Thirdly we must come up with a practical solution to the loss in training hours that is being forced upon us by the EWTD, the Barbados plan by Remedy is a preliminary step in the right direction. Fourthly we must oppose the sub consultant grade and fight for enough decent jobs for doctors who have completed their specialist training. There is no time for apathy or inaction, it is time to unite against the common enemy, as if we don't then we will all be in trouble in a few years time, even if we are not already.
Similar things are happening elsewhere, as PCTs build up surpluses of unspent cash while the frontline service providers are starved of their fuel. This means that an overall NHS surplus is developing while more and more standard treatments are withheld by PCTs. The inguinal hernia repair is just one example of an effective treatment that is being rationed in my PCT. The end result is that patients suffer while PCTs wallow in their bath tubs full of smug notes.
How about the NHS stopped treating any patients at all, this would then mean that it could make a 75 billion pound surplus, or profit, every year; that's what I call a great idea. It couldn't be that the best type of NHS would spend all of its money effectively providing patients with a valuable service, rather than wasting lots of money on various complicated layers of Kafkaesque bureaucracy that would rather hoard money than treat patients? No, that would be far too sensible and efficient.
Sunday, 23 March 2008
While Chief Executive of the NHS David Nicholson said:
"This report shows that we've made really solid progress against delivering an integrated IT system for the NHS, which is not only making us more efficient, but is helping our clinicians and staff deliver better, safer services for patients."
Scratching beneath the surface, it becomes rather obvious that the NPfIT has cost a hell of a lot of money, and that this multi-billion pound figure will only continue to rise above the current 12 billion estimate:
The DoH reckons that this scheme that will cost over 12 billion may save us just over a billion pounds by 2014:
How on earth can this be seen to be good value for money? Twelve minus one is eleven, meaning that the NPfIT will have cost the tax payer eleven billion pounds by 2014, it will not have saved the tax payer a penny. Computer Weekly have already revealed that Tony Blair recklessly rushed the NHS IT scheme against the interests of the general public, simply so that he could profit politically in the short term from this grandiose delusional scheme.
The DoH is dishonestly abusing the english language in covering up its own crass incompetence, and this incompetence extends upwards all the way to our corrupt dictators in Labour HQ. It is more than a little worrying that these idiots who are running our country cannot own up to their mistakes when they make them, as they would prefer to pretend that their mistakes represent brilliance; this means that lessons are not learnt and that the incompetence is allowed to proliferate. The billions will continue to smoulder.
This case could have rather grave implications for the likes of Simon Fradd, and the government, as they seem very keen to empower the ever growing army of health care practitioners well beyond their means.
The standard response to nurses being empowered beyond their means from some nurses continues to be that the NMC will step in and make nurses accountable for their actions when they step outside their 'sphere of competence'.
This does not happen. The NMC have been complicit in empowering the nursing profession beyond their means, hence they are all too keen to overlook these incidents, incidents that are becoming ever more frequent in my opinion.
The point is that this stupid attitude to medicine and competency is exactly where things are going wrong. If one has not been educated and trained to a sufficient level, then one will never know when one is acting dangerously outside of ones 'sphere of competency'; this is the position that many health care workers find themselves in these days, whether it be as WIC nurse practitioner, or as a physician's assistant.
The worker drones are not the ones to be blamed in cases like Dr Gray's, it is those who empower them beyond their means that need to be held accountable. As happened when the Royal College of Veterinary Surgeons dished out punishment to an experienced vet, those who knowingly empower the ignorant should take the rap.
The main players in this dangerous empowerment have been the government, the Department of Health, the Royal Colleges and a group of senior politically climbing medics. These are the people that need to be punished, otherwise the dumbing down will continue and standards of care will continue to slip.
Sunday, 16 March 2008
Alas, Modernising Medical Careers came along not long after Calman, so before things could settle down, training had to be rehashed again. The European Working Time Directive (EWTD) had also reared it's ugly head, starting to have a massive impact upon the hours worked by doctors in training from the late nineties. This meant that the new consultants produced by Calman's system with their shiny CCSTs would never be the equivalent of their consultants of old, they simply wouldn't have the experience that was obtained in days of old.
The gimmicky and cynical MMC was a dishonest con from the start, based on Sir Liam Donaldson's 'Unfinished Business', it set out to solve problems that were not present, while creating many more problems that have still not yet be addressed. Tooke's analysis of MMC was spot on, pointing out the vague meaningless principles and poor implementation that have plagued this politically motivated fudge from the start.
We have now come full circle. The current post-CCST fellows are the exact equivalent of the old SR grade, they have finished their formal training but there is no organised and fair route by which they can continue their training to become an independently practising autonomous consultant. The post-CCT fellow and the old SR grade are the exploited underclass of the future and the past respectively. The new system sees doctors struggling to get adequate amounts of experience throughout their training, and then potentially stuck at a miserable sub consultant grade, in which the forced terms and conditions of service may be rather poor, and the chances of career progression may be extremely limited.
Unhappy demoralised doctors who are treated shabbily by their employer, while having their hope for the future crushed, do not make productive and enthusiastic employees. It is good common sense to treat your employees well and fairly to keep them happy, and consequently get the best out of them. This government is treating doctors like shit and this is not a good thing for patients, but then the government cares not for patients, it cares only for its own self preservation and this is a great shame for the vast majority of us.
Wednesday, 12 March 2008
Polyclinics will have only one properly trained General Practitioner, and the remainder of the doctors will be made up of 'career grades' who have not had the proper training in general practice to be let loose to work unsupervised. Undoubtedly these will be the doctors who are unfortunate enough not to have got proper GP training jobs or hospital training jobs, who have been forced into this unenviable position of working without being properly prepared by a government that is obsessed by bullying staff, rather than working with people in cooperation.
As Dr C points out, this is something that should not be brushed under the carpet, we should not be forced to keep quiet about the clear fact that many staff are being dangerously empowered way beyond their limited means. The great irony of all this is that Darzi's polyclinics are just another prong of the government's dumbing down fork, and this is while the DoH is claiming that they will revolutionise primary care. Darzi's dumbed down polyclinics will also be manipulated by various large corporations so that patients can be sold a load of useless alternative pap in the form of herbal medicines, homeopathic treatments et other bull. Even the right leaning Economist has come out strongly against Darzi's agenda for change, while the Witch doctor has noticed an excellent piece that decontructs the real motives behind these government reforms. So all in all, the DoH see progress as less access to properly trained staff and more access to useless alternative medicine, fantastic isn't it?
Monday, 10 March 2008
These words are ignorant at best and dishonest at worst. In simple non-scientific terms there is no decent evidence behind giving various drugs prophylactically to try to prevent clots in the legs and lungs. Operations on the lower limbs and pelvis put one at high risk of clots, but no treatment has been shown to reduce the incidence of fatal clots or symptomatic clots.
Drug companies are keen to flog their overpriced injections of LMWH (heparin of a sort) but they do not prevent deaths or symptomatic clots, but they do have a negative effect on wound healing and bleeding from various orifices, as well as costing a hell of a lot of cash. It is also likely that the dangerous side effects of prophylactic heparin are much more common in pratcice than in the trials, as very different patient groups are involved. Aspirin does reduce peri-operative mortality due to its cardioprotective effects, but won't do anything to the clots. In certain patients warfarin has a role, but only in the very high risk, as if used in lower risk patients its side effects would outweigh its positive effects.
Thus overall the evidence for the use of heparin injections is sketchy when viewed with the eye of faith, and utterly crap when viewed objectively. Sir Liam is therefore talking out of his spotty ginger arse when he says that this problem should be dealt with systematically, how can one deal with something systematically when nothing has been shown to be of systematic benefit? Maybe he knows something we don't, or maybe he's an utter twat. I certainly feel that there are some rather malignant clots residing alongside Sir Liam in the Department of Health headquarters that should be dealt with before he turns his attention to this highly controversial area.
Sunday, 9 March 2008
"Sounds like they need their immune systems boosting," she said. "Bring them to me. I'll show you what you need to do." Reflexology, the practice of massaging specific zones on the feet to relieve tension, ailments or "imbalances" in other parts of the body, has a bit of a flaky reputation, but in the right hands, it can be a powerful tool."
The author goes on to describe how giving her children massages helped them become closer and it also gave her children pleasure, hardly the revelation of the century is it? I just cannot stand the way in which that this kind of shoddy journalism dresses up having a massage as being something on the cutting edge of science. Humans like to feel good and have social contact with others, thus anything that encourages these things is likely to improve our health, it's hardly bloody rocket science.
However dressing up a massage as a pseudo medicine in the form of 'reflexology' is just a clever way that a few bullshitters have come up with to make stupid people part with excessive amounts of their hard earned cash. The author also advises vitamins and fruit juices for staving off viral infections at the end her lame piece, yet another piece of advice that has no evidence behind it and that will also see numerous idiots wasting more money on overpriced pap.
You won't improve the function of your bodily organs by having the sole of your foot prodded by hippy con artists wearing flower power t-shirts. If you want to feel good and stay healthy, then sleep plenty, eat a balanced diet and exercise regularly, also stay off the crack cocaine and don't smoke toxic chemicals. It's hardly rocket science, it's simple bloody common sense and you can get it here for free, I won't try to peddle you overpriced gimmicky merchandise and dress up my simple advice as pseudo intellectual drivel in an attempt to charge you lots of money for something that is simple common sense advice. Next time your walking down the street, just be careful that you don't tread on your colonic area, it could have devastating consequences.
Wednesday, 5 March 2008
The average hospital stay for a person with diabetes is normally 11 days, according to the study, which is being presented at the Diabetes UK Annual Professional Conference in Glasgow.
With an average daily bed stay at the trust costing £215 in 2007, 47 fewer admissions equates to a saving of £111,155 for the hospital a year.
Translated across the NHS, this could be up to £100 million a year, researchers said."How many dubious assumptions do they want to make? They assume that all the discharges were as a direct result of the nurse specialist's input, I wonder if they have any evidence for this assumption at all. They also assume, extremely naively in my opinion, that these patients that were discharged within 24 hours would have stayed another ten to eleven days if it were not for the nurse specialist! The so called research has now fallen apart right in front of our eyes.
At best even if we assume that the diabetic nurse specialists prevent 47 admissions a year in this hospital, and that these patients stay a day less in hospital, then they are only saving the hospital ten grand a year. I bet you the cost of employing a specialist nurse for this amount of time would cost well over ten thousand pounds, plus it's not as if they use no equipment and incur no other extra costs to the hospital. At worst the diabetes nurse specialists prevent no admissions and wast money, one cannot just assume that because 42% were discharged quickly within 24hrs that this would not have happened anyway. This research is a turd burger that relies on stupid assumptions. I am just amazed at how uncritically it is being analysed in the media.
It is therefore rather ironic that average NHS waiting times have actually gone up under labour, a story that has hit the news this week. Most importantly clinical imperatives are now overridden by political ones. Urgent cases are now delayed because non urgent ones must be carried out, in order to meet the holy targets and it results in more patient suffering than strictly necessary. In health care one has to be very careful what one measures, as once something becomes measured it changes its nature entirely. In health care measures can also be rather meaningless and deceptive, for example as regards productivity; if productivity is simply seen as completed patient contacts then one could increase productivity by replacing all doctors with monkeys, however logically this is clearly a daft idea, it's a great shame that the likes of Simon Fradd and the government like the monkey thesis. Targets continue to appear a bad idea on many levels, and this situation will not be helped by the government introducing more targets to cover the previously un-targetted areas. I wonder, would this government fix a leak in the roof by taking the roof off? I sincerely suspect they would.
Monday, 3 March 2008
Ben Bradshaw, the slimy Labour grease ball that he is, tried to defend the fact that staff and patients in the English NHS still have to pay fairly hefty fees to park at hospitals around the country. He claimed that if parking were free, then it would be subsidised at the expense of patient care. I think the thick Bradshaw might like to know that parking has been free for many many years before his sick government introduced this stealth tax as a way of subsidising patient care, people are in effect paying twice, as they pay for the NHS and they now have to pay to park at their local NHS hospital. Bradshaw's logic is the stuff of a decapitated limpet, so fairly standard for the Department of Health then.
It is Labour that forced NHS trusts into a corner, from which they were forced to start introducing parking fees, it was Labour's top down centralised control freakery that forced trusts to balance their books in this short termist and foolish manner. In Labour's mind a hospital that sold off all its assets and land but made a profit would be seen as a success story, even if it could treat no patients.
What next? Will Ben Bradshaw be defending NHS charges for the air we breath whilst on NHS premises? Surely they will then have to continue charging for the air we breath, otherwise patient services will be affected. Great logic Ben, you putrid Department of Health fistula to the outside world.