Rate your doctor

I have recently been ranting about the dangers of a one way doctor patient relationship, and since then I have been alerted to the rather interesting website RateMDs.com which allows patients to rate their doctors online.

It could almost seem like a good idea if one had left one's brain in the car park, however there are many reasons why this kind of website are a complete waste of time. For one it is completely insecure, meaning that anyone can submit a doctor and anyone can rate the doctor. There is absolutely no check at all of anyone's identity, it really does beggar belief.

In fact there a few famous UK doctors have already been rated, Sir Darzi, Sir Liam Donaldson and Dame Carol Black amongst the elite few. If you fancy rating them or anyone else, then go for it, the site is completely insecure!

I am sure this kind of hair brained scheme will be coming to the NHS very soon, despite the fact that using 'patient satisfaction' as a surrogate marker of care quality is about as reliable as a Roulette wheel, our political masters just want sticks to beat and bully us with.

The people running these schemes are invariably the politically climbing of the medical profession, people who have sold their souls in order to chase money and honours. Organisations like the GMC are now run by selfish politicos who are keen to sell out their colleagues in producing yet more layers of needless and useless regulatory bureaucracy. It is also strange that nurses and other HCPs are not subject to the same mechanisms of command and control.

Dr Crippen has also recently written on how Primary Care is being wrecked by these traitors. Ironically as the quangos and these new gimmicky schemes proliferate, the patients will be the ones to suffer as good local services will be destroyed and doctors will find their job of caring for patients increasingly obstructed by the hair brained new ideas.

The world has gone mad

When I was a youngster at medical school I remember being taught the importance of the doctor patient relationship, it was interesting stuff at the time, and even then it was emphasised how the relationship could be varied to get the best outcome out of it for the patient. Many factors affect this complex relationship, the personalities of the doctor and the patient, the issues being dealt with, the time available et cetera. Sometimes the patient wants a more paternalistic approach, and sometimes the patient wants to be involved more in the decisions making process.

Frequently what the patient wants is not best for the patient though. Whether it be the overweight smoker who does not want to listen to a doctor politely explaining the implications of their lifestyle, or the women with breast cancer who wants to be told that herbal medicine can be used to treat her cancer instead of the effective modern approach. These patients would be happy to be badly managed by their doctors, demonstrating the serious problems with assessing doctors by relying solely on patient satisfaction surveys. Ironically Harold Shipman was very popular amongst his patients, likewise I have seen countless examples of patients who have been negligently managed who have also been very happy with their care.

Teachers are being plagued by the same politically correct nonsense, I'm sure many of us can recognise that our best teachers were frequently not our favourite teachers at the time. I wonder how long it will be before all parents are forced to respond to all the unjustified complaints from their offspring, it may well result in TV all day with ice cream for breakfast, lunch and tea. Some of the new breed of Health Care Practitioner such as the nurse specialist love this new method of assessment, as they simply defer tricky problems that might make them unpopular to the doctors, while they have so few patients to see in so much time that they can afford to indulge the patient with plenty of ego massaging attention and a few cups of tea.

The world is going mad. Junior doctors already have things hard, they are easy targets for bullying from other staff due to the short nature of their placements;they are now an easy target for other HCPs thanks to the wonders of the 360 degree assessment which allows the assessors to criticise in a completely unaccountable fashion. What next, all doctors being forced to enlist themselves with websites that allow patients to rate their care in a similarly unaccountable one way fashion?

The doctor patient relationship should be a two way street, not the one way street that our nonsensical politically correct culture is trying to force upon us. While it is important that patients have sufficient power to comment and complain, it is equally important that doctors are not subject to unfair abuse and bullied by manipulative aggressive patients. I wonder what the reason for the deteriorating discipline in patients, pupils and children is these days? It couldn't be anything to do with out politically correct culture empowering them way beyond the limits of common sense?

Doctors do not have an easy job, they frequently have to choose the lesser of two evils and it is not uncommon for some people to be offended in the process, even when the best option is chosen in the most polite way humanly possible. Opening yet another avenue in which patients can unaccountably vent their spleens promises to benefit no one, except the politicians who want to enslave our profession. I wonder, will this new set of chains enable us to feedback on the management prowess of Sir Darzi, Sir Liam and Dame Carol? I very much doubt it.

Pharmacy and the 'clinical practitioner'

It seems to have been smuggled in by the back door, but now even pharmacists are allowed to have a crack at history taking, examination, differential diagnosis and the management of medical disease. Pharmacists, albeit being quite handy at pharmacology, have bugger all training in anything else but for some reason the government thinks it's safe to let them loose as yet another prong in the ever expanding army of pseudo doctors as 'clinical practitioners'.

One wonders what the government's precise motives are, just why would they be dangerously empowering those who tend to work for large pharmaceutical corporations while trying to undermine self employed doctors? Labour is struggling for funding these days, and Boots et al have been known to be rather cuddly with el Gordo and his greasy pals.

Pharmacists up and down the country are opening up their small cupboards and acting doctor in these pseudo doctor's rooms, some of them are quite happy to get their stethoscopes out and start playing doctor. Whether it be managing the complex medical complications of Diabetes or the brittle Asthmatic, the new 'clinical practitioners' will feel quite at home playing around in waters well out of their depth.

This dangerous empowerment won't even save money as GPs are already paid to do the same job for less, so the government is wasting money and dumbing down standards at the same time, how very priceless. When this is combined with legislation that acts in the interests of big pharmaceutical firms and not patients by restricting GP dispensing, here we have a government that is frittering away our cash in order to keep big business happy. It seems this government will do anything to get their dirty mitts on more cash, it's just lucky for us that money can't buy them trust anymore.

World class idiocy

Type the words 'world class commissioning' into google and you'll unearth a goldmine of utter tosh, starting from the DoH's page on the subject. Apparently there are four key parts to this large hunk of management turd:

"a vision for world class commissioning, a set of world class commissioning competencies, an assurance system and a support and development framework."

Have a read and if you can honestly make any sense of the undecipherable management speak then please get in touch, because I can't. The document is littered with meaningless guff like 'adding life to years and years to life', it is utterly cringe worthy. Essentially all they're saying is that they intend to make health care better with world class commissioning, in the most long winded and nonsensical manner humanly possible.

The meat of this reform is hidden in the FESC section, that's Framework for procuring External Support for Commissioners in long. This is essentially privatisation by the back door again. PCTs will be enabled to directly commission work from independent providers, private providers in other words.

FESC is designed to privatise the NHS further, the PCTs will undermine the local NHS services by starving them of funds by commissioning their work to private firms instead. PCTs are turning into the biggest joke in the NHS, their bureaucracies never stop expanding and instead of actually paying those who know what their doing to do their jobs, ie the hospitals and local NHS services, they would rather burn our money in commissioning their own hair brained schemes.

It would be far too simple to fund our hospitals and local services properly, our PCTs want to starve these services of cash while lining the private sector's pockets. In this manner PCTs spend lots of money trying to avoid paying GPs and hospitals for the work that they actually do, increasing the bureaucratic inefficiency of the system.

The way in which DoH stooges try to dress up this agenda of privatisation as some kind of revolutionary breakthrough in the science of commissioning has to be seen to be believed, have a read of the incomprehensible Helen Bevan's explanation:

"The biggest risk is that the transformational aspirations of tomorrow get hijacked by the thinking of today."

No Helen, the biggest danger is that people will see through your camouflage of management mumbo jumbo and see world class commissioning for what it really is, yet another dishonest attempt to privatise the NHS that will have a devastating effect on local NHS services and standards of care. Mark Britnell's limp words sum up the Kafkaesque nature of this government campaign.

It may have passed the the moronic DoH apparatchiks who read the Health Service Journal by, but their ilk have been wrecking the NHS for the last eleven years, therefore why on earth should anyone believe the faeculent management speak that is spewed forth from their treacherous behinds. These apparatchiks are very good at producing meaningless waffle that claims they will make things better, but if these hollow words are not backed up by meaningful action then surely these failures should be shown the door? Unfortunately for us this government rewards lying and failure with promotion, so we have an NHS run by a proliferating network of dishonest cretins who have only just mastered shoe lace tying.

So as 'world class commissioning' grows, expect to see your local GP and local hospital starved of cash resulting in essential services closing, then watch and weep as the private sector is paid large sums to do the same work less well. This is world class idiocy.

Utterfraud in the Times

I don't believe I am on my own in stating that Thomas Stuttaford doesn't half love to pretend to be a master of everything. His latest offering concerns Deep Vein Thromboses (DVTs) and their sometimes fatal complication, the clot in the lungs called the Pulmonary Embolus (PE).

Dr Thomas comes out with some rather dubious statistics that the Department of Health has recently plucked from it's arse:

"DVTs and pulmonary embolisms are estimated, according to a recently published Department of Health report, to account for 25,000 deaths a year in British hospitals."

I would love to know how the DoH 'estimated' this figure, it may have involved the arse plucking that I suggested earlier. Dr Thomas doesn't stop there though:

"The figure of 25,000 fatalities may well be an underestimate because many patients thought to have died from a post-operative chest infection may in reality have initially suffered from small pulmonary emboli."

It may well be a massive overestimate too, as this figure is a complete guesstimate, this doesn't appear to have occurred to Dr Thomas though. His final paragraph then claims that many of these deaths are preventable and that a new drug called 'Pradaxa' will help in this regard:

"If adequate precautions were taken before someone undergoes surgery associated with a high risk of DVT, many of these deaths could be prevented."

Actually Dr Thomas you are completely wrong in this regard, there is absolutely no evidence to back up this statement that you make. DVT prevention (aka prophylaxis) in the form of various drugs has been shown to have no effect at all on mortality and symptomatic DVT rates.

Large cohorts of high risk patients who have received no prophylactic treatment have been shown to be at no increased risk of death compared with their counterparts who have been treated with expensive blood thinning drugs. Dr Thomas doesn't mention this, he seems very keen to blow the trumpet of expensive new drugs, is there a conflict of interest here that he is not revealing?

Hot air from Darzi

"Education, training leadership and the NHS review" was the topic for debate held at the Royal College of Physicians on workforce, education and training led by Lord Ara Darzi with Professor John Tooke, Professor David Sowden of MMC and Clare Chapman, Director General of the NHS Workforce.

Darzi talked of improvements needing to be made and a framework of accountability, but never touched upon how this would actually be done, while he also ignored calls for ring fencing training budgets. There was also a lot of banter about 'learning agreements' that were seen as some kind of magical fix by some, however how on earth they would force Trusts to take training seriously was not explained adequately.

Sir John Tooke saliently pointed out that there was no one in charge of training, that there was no one to blame if things went wrong. An excellent question was posed by Richard Marks of Remedy UK as regards the workforce planning as regards junior doctor numbers. Do we appoint trainees in a number proportional to the consultant posts that will be available in the future or related to the service needs? Clearly the government wants to flood the market with 'training posts' in order to force down wages by creating a sub-consultant non-training grade, this must be opposed.

Clare Chapman farcically talked of 'openness and honesty', I don't think she intended this as a joke but this is how it came across to me. Given that her malignant Department is behind the dumbing down of training and the deliberate creation of a surplus of demoralised doctors, I doubt her comments would pass a lie detector test. An excellent workforce point was made by Sir John and one Oncology trainee, who both pointed out that demands for particular specialists may change massively over short times; meaning that it would be sensible to ensure that all trainees receive several years of more generalised training before sub specialising, so that they are more prepared to adapt to future workforce needs.

Some superb comments were made about the naivety of educationalists who think that more training content can be easily achieved by fiddling with the bureaucratic elements of training. Darzi was then thoroughly unconvincing when he tried to explain the massive cynicism that the audience felt towards politicians, Darzi claimed that this cynicism was all part of 'democracy', he should have added in the word 'corrupt' before the democracy I feel.

The general dumbing down of undergraduate education was mentioned, as was the massive step backwards that competency based training assessment methods have been. Trainees have gone from being closely monitored by one senior clinician to being grossly unsupervised in their training. The excellent point was also made that doctors are being downgraded in the context of the MDT, doctors in training have to take a lot of the clinical responsibility but are treated with a lack of respect and sometimes disdain by other members of the MDT. If this kind of lack of respect and disdain was shown by doctors to other members of the team, then the doctors would be in great trouble; unfortunately with the current ethos of all Health Care Professionals being equal doctors are being downgraded and routinely bullied to satisfy the government's need to enslave the profession. Clare Chapman was quite pathetic in her comments on this topic.

Overall Darzi appeared all talk, there was a lot of hot air expressed as regards how genuine his role was and how things were so different at the top, with clinicians being engaged. This battle is only just starting, but it was clear from the overall opinion expressed that doctors are not happy with being treated undervalued and bullied by their employers; medical training needs to be completely depoliticised so that patients can be better cared for in the long term. Doctors genuinely want better training because they want to be good at what they do, hence they are fighting the government's desire to dumb down training in order to catalyse the privatisation of the NHS. I'd love to get Darzi on a lie detector.

PMETB - wrecking medicine

As entry standards for medicine at University are dumbed down in a rather politically correct fashion, PMETB continues to oversee the wanton destruction of decent medical training, with years of knowledge and expertise being thrown in the bin because the political stooges at PMETB would prefer to implement the unwieldy psychobabble that spews forth from the recta of educationalists.

Educationalists have a lot of waffle that they used to justify their half witted rubbish, they believe that they can pull the wool over our eyes by repeating words like 'reliability' and 'validity' until the cows come home. In fact A Levels and GCSEs have been dumbed down in the same manner as the Royal College membership exams, the MRCP and MRCS, by making everything so objective that is ceases to be a useful measure of anything at all.

Educationalists do not allow experienced clinicians to use years of their expertise and knowledge to judge candidates, they insist upon replacing tried and tested exams with tick box exercises that allow no room for subjective manoeuvre. In denying the value of subjectivity PMETB regulations have forced the Colleges to comply with their vacuous plans that enforce the dumbing down of training standards, in this way the surgical vivas and clinical exams that are assessed by top consultants are being replaced by OSCEs that can be manned by non-medically trained technicians. This is happening across the board.

PMETB has also dumbed down what 'training' actually means. The poorly worked Foundation program and MMC have resulted in thousands of posts that were previously non-training posts magically becoming 'training posts' overnight, despite the fact that these jobs still have no proper training content. This means that thousands of doctors in training are struggling to get the necessary experience because their job simply does not give them adequate exposure to the core of what they need to learn.

Competency based assessment is then used to pretend that the overtly woeful training is actually thorough and comprehensive. In the old days one had to do decent chunks of a wide variety of specialties to progress, meaning that one needed a broad base of skill and experience to progress to the next level. Now all one needs is a few bits of paper signed that prove one has done a few things once, and one is magically transformed into a super-competent doctor. The wonders of competency based training never cease.

In reality the great irony is that competency is not encouraged by competency based training. Competency is a very grey entity and one cannot prove one's competency by doing something once, and then getting a piece of paper signed. PMETB produces more turd burgers than the biggest dairy farms in the land, it is an organisation that has been found wanting in recent inquiries and investigations into it's complete failure throughout the implementation of MMC. So why on earth is PMETB still being listened to? Why are PMETB's educationalists still allowed to carry through the implementation of the dumbing down of medical training? Why are the competency based fundamentalists being allowed to triumph? PMETB should be wiped out of existence and we should only listen to the sound of it's explosion.

Who needs beds?

The imminent loss of 5,000 Oncology beds has been hitting the news this weekend. Apparently in order to improve our radiotherapy and chemotherapy services, these beds will need to be cut to fund the investment. It's all part of the great Darzi review that pledges to force reform upon the whole country in its uniquely undemocratic manner.

As has been pointed out to me by the ever aware A&E charge nurse "the UK population has grown by 17% since 1951 while the number of NHS beds has fallen by 40% since 1959 - we have one of the lowest bed per 1000 patients in Western Europe: 3.3 compared to 6 beds in Germany, to cite just one example."

Certainly keeping some people out of hospital is a good thing, however many of the DoH's reforms have wasted money in ineffectively trying to keep people out of hospital and in forcing patients out of hospital when it is clearly the most appropriate place for them to be. I also heard in the news that the budget for elderly care is to be trimmed by several billion over the forthcoming years, another example of the lack of joined up thinking in government, as with an ageing population and an increasing demand for care for the elderly, these short sighted cuts will only result in yet more inefficiency with old people blocking acute hospital beds as there is nowhere else for them to go.

The cut in Oncology beds is bizarre, as anecdotally I have heard of cases of there being such a shortage of beds locally that sick Oncology patients are having to be treated as in patients in waiting rooms and day rooms. Oncology patients get sick quick, radiotherapy and chemotherapy have some pretty serious side effects such as neutropenic sepsis, and these cannot be adequately managed in 'cottage hospitals' as the government seems to think. The Darzi philosophy seems to be all about cutting services and beds, while shifting sick patients into the community to save cash, I personally don't recognise this a progress.

The national bed shortage and near 100% bed occupancy rates have so many negative knock on effects in terms of patient care and efficiency that I could bore you with them all day . Around the country numerous operations are needlessly being cancelled because there are no beds in which to admit patients for their stay, meaning that surgeons, anaesthetists and theatre staff are often left to twiddle their thumbs in empty theatres because of this knock on inefficiency. Patients are frequently not cared for in an appropriate ward to suit their particular illness, as bed shortages mean that any bed sometimes has to do; this can sometimes be deeply inappropriate with adults being cared for on paediatric wards, and it can also result in significant morbidity and mortality as patients may be significant distances from their medical staff, while their specialist nursing staff may well not be familiar with the particulars of dealing with another specialities' patients, surgical nurses looking after oncology patients for example. The link between high bed occupancy rates and hospital acquired infection is for another day.

Overall the beds are cut and the inefficiency increases, economies of scale are ignored as the short sighted penny pinching results in the flushing of bank notes down the toilet on a rather regular basis. It makes me weep to see stooges like Darzi pretending that these reforms are in the best interests of patients up and down the country. If my mother was lumped on an orthopaedic ward with her neutropenic sepsis I would not see this as progress, I just wonder why Ara Darzi is so happy with this dismal state of affairs.

Health Committee bottle it - first thoughts

The Health Select Committee released their report on the mess that is also know as Modernising Medical Careers (MMC) today. A bunch of politicians with only a little understanding of medical training were never going to produce anything as insightful or intelligent as Sir John Tooke. Overall the report talks the talk, pointing out a lot of glaring errors that occurred along the way, but fails to walk the walk, as it does not call anyone to account or propose any sensible changes that would help prevent similar mistakes being made in the future.

The report states the obvious failings that occurred time and time again throughout the botched MMC process. The DoH rushed the reform through negligently without listening, where have we heard this before? The leaders of numerous quangos and the so called 'leaders' of the medical profession let us all down time and time again. PMETB and the GMC are muppets. The CMO won't even take responsibility for his own nappy.

Tooke's report was infinitely superior to the Health Committee's inelegant and cumbersome blunderbuss of an effort. They seem to have been sucked in by certain porkies concerning the glorious success of Foundation training according to the DoH and Deaneries, what neutrals these people are in describing their own lovechilds. They were not sucked in as regards to completely useless process that was the infamous MTAS 2007. While the Committee's comments on the consultant grade appear ominous to say the least.

Overall though the Health Committee have just produced a lot of paper and hot air, there is not much at the end of all this that will prevent such disasters happening again in the near future. No one is being forced to account, meaning that many of chief MMC culprits are being left in control to 'fix' their own mess, the useless MMC programme board carries on regardless. NHS:MEE and Tooke have been neatly sidestepped, it is simply not good enough to say that the DoH must listen in the future, they have been told this time and time again, but they never listen because no one is ever responsible or accountable for their wreckless decisions and reforms. The problems of EWTD and the sub-consultant grade will not magically dissappear, likewise the evil of competency based fundamentalism is also ignored. What is the role of the doctor? One hopes that bending over to be regularly shafted by the government is not part of the job description.

One thing I have learned from this disatrous MMC and MTAS experience is that unless we all unite and force the hands of the so called 'leaders' then we will continue to be led down the garden path towards the dung heap. The DoH, the GMC, PMETB, Ara Darzi, the Colleges, our so called 'leaders' and the BMA will not suddenly grow testacles and brains in order to save medical training from the MMC blender, we will have to do that for ourselves somehow.

I don't know if I can do this anymore

This DNUK extract is well worth a read, the doctor who wrote the original piece has kindly given me permission to reproduce his words here. It sums up the way in which the front line doctors of the NHS are frustrated beyond belief at a system that continually obstructs the thing that they want to do to the best of their ability, namely care for their patients:

"I love medicine. I think I wanted to be a doctor from about the age of eight. Although I'm sure this sounds like a cliche, it's true; I wanted to be a doctor since I was a kid.

A hospital chaplain once said to me that one person only has so much patience, compassion and energy. I think he is right.

I have just finished a long set of nights in a moderately busy emergency department. It is a relatively good department, in a relatively good hospital.

A lovely gentleman presented with very severe chest pain and back pain. His family were even more lovely. I did a heart scan that showed his aorta, the largest blood vessel in the body was tearing. This is called aortic dissection and is to understate things, a surgical emergency.A CT scan of his chest and abdomen showed that the dissection extended from his heart all the way into his abdomen.

I contacted the local cardiothoracic surgical centre and spoke to the surgeon who would be able to fix this probably fatal condition. In a rather embarrassed tone he told me that there were no available beds on his unit.

Meanwhile the patient sits opposite me. I advised his wife that they should try to get all his available relatives to see him, as he might die suddenly. Each one arrives, and comes to thank me for "all that I am doing".

After two hours I had spoken to four other surgical units. None of them had any beds.

Another family member arrives, walks over to his relatives. They point at me, the relative walks over touches my arm and smiling thanks me for all I am doing.

What am I doing? Am I colluding with a system that is letting this man and so many others like him down. I am trying to tread water in a what sometimes seems a third world system. A system crippled by short sighted targets and budgets. A system where a waiting list is more important than an intensive care bed. A system where the four hour target means that patients are rushed through the hospital, not getting the correct diagnosis, waiting in corridors, in pain and critically ill.

I don't know if I can do this for another 20 years."

I think the nation's professionals all feel this incredible frustration, and the blame lies firmly at the door of an increasingly centralised and controlling state. The state has steadily made it harder for all professionals to do the jobs that they love to the best of their ability, professionals work better when they are treated with respect and trusted to do their jobs by their employers. The current top down micro managed state of affairs is not helping anyone, and certainly not our patients.

ME mincing

Logic has been cast aside as some geneticists have got more than a little carried away in trying to subdivide ME/CFS into genetic subtypes. Firstly I would like to state that I am not of the opinion that everyone with the ME/CFS label has nothing medically wrong with them.

However I think it is completely stupid to claim that all people with a ME/CFS label have the same 'disease', as the 'disease' has no specific symptoms, no specific signs, and no decent diagnostic tests. I think the medicalisation of these kind of so called 'diseases' as discrete entities when one cannot even define what the 'disease' is creates far more problems than it solves. That is not to say that many of these people do not have very real pathologies, however to lump them all together under the ME umbrella is nothing but foolish and short sighted as we are no way near understanding this condition as yet.

There are other conditions that are very poorly defined and hence come into the same trouble as ME/CFS, many of them rather vague and sometimes bogus psychiatric diagnoses, and one can't help but feel that the diagnosis of Irritable Bowel Syndrome is another steaming pile of poorly understood conditions that have been lazily dumped together in an attempt to feign a pretence for understanding things that are simply not yet understood.

Back to the case in hand, how on earth can geneticists claim to be able to subdivide up a condition into genetic subtypes when they cannot even define or diagnose this condition in the first place? I would argue that they cannot. More importantly pretending to understand things that are not understood is dangerous, as it prevents people from openly and honestly trying to understand these conditions better, as anyone who questions the existence of ME/CFS as a discrete pathological entity is written off in a rather annoying politically correct fashion.

There are also many cases of people who have had clear diagnoses missed and then been inappropriately labelled with ME or IBS, meaning that their real diagnosis went untreated. Also the more we medicalise the poorly understood then the more normal people with no problems will become medically labelled, and then start acting up to their label; I don't think this is a good thing either. The worried well will be happy though, the ever growing band of fashion conscious Gluten avoiding bored housewives will have a new act to follow.

Brace yourselves

"The Health Committee will publish its Third Report of Session 2007-08 on Modernising Medical Careers (HC 25-I) on 8 May 2008 at 00.01 am. A Press Conference will be held at 10 am on Wednesday 7 May in Committee Room 5, Palace of Westminster. Please note: that all comments made at this press conference will be strictly embargoed until publication of the report at 00.01 am on Thursday 8 May 2008. Embargoed copies of the report will be available from Committee Room 5 on Wednesday 7 May at 9.30 am."

I wait with interest to see what the Health Committee will have to offer when it passes judgement on MMC. I expect this type of political committees to swallow a fair amount of the DoH's propaganda, however there are limits and surely they must be able to see what a dismal failure MMC has been thanks to some rather corrupt political agendas lurking beneath the surface that have been pushed through by some rather compliant 'leaders' of the medical profession.

Medical training should be sculpted with the interests of patients at its heart, unfortunately MMC has been crafted with the aim of deprofessionalisation the medical profession and privatising the health service, and this has worked directly against the short and long term interests of patients in this country.

The deprofessionalistion has gone hand in hand with a national initiative of devaluing proper education and training via the Skillification advocated by Labour crony Lord Leitch. In the NHS this has seen the dangerous empowerment of a wide variety of undertrained and undereducated workers, justified by the logic of people with no experience of medicine and health care provision.

The aim is the opening up of the market, as this is seen as the holy grail in the naive free market fundamentalists' warped master plan. In their pea sized brains there is no danger in empowering the ignorant to do things way beyond their means, as the market will magically prevent any harm being done. In reality harm does result, as consumers are not perfectly educated and perfectly informed to make sensible rational decisions. In reality a lot of useless and/or dangerous rubbish can be peddled successfully in the 'perfect' free market, as the brainwashing of consumers with manipulative advertising and the exploitation of the consumer's uneducated ignorance can combine to devastating effect.

One only has to take a small glimpse around to see the garbage that is peddled dishonestly in the name of improving one's health; back street surgery by untrained surgeons, multivitamins, Chinese medicine, homeopathy, osteopathy, reflexology et al. I wonder what the free marketeers would say to this, the consumer does not appear to behave at all rationally or cleverly with these stupid decisions.

Anyway I digress, but the point I'm trying to make is that MMC is part of a perverse and stupid vision for health care provision that has been plopped out of the back passages of idiots who have no concept of what it takes to provide a sustainable high quality service for patients. The Modernisation of MMC stands for dumbing down and crushing high standards of medical training and working towards a useless competency based system that will allow anyone to have a crack at anything, I just hope the Health Committee have the honesty to describe MMC for the steaming turd that it is.