Sunday, 31 August 2008

The rise of the incompetent jobsworth

I obviously do not claim to speak for anyone other than myself, but for me Labour's reign has seem an utterly ridiculous empowerment of the ignorant and a continual belittlement of genuine talent and achievement. A lot of this has been undertaken in the name of 'equality' in a rather politically correct manner. It seems that knocking down the motivated while empowering lazy jobsworths is Labour's idea of great management. I'd argue that this approach is both inefficient and stupid.

The attitude demonstrated by this PCSO is typical for that of Labour's empowered ignorant, they tend to possess a very in-your-face aggressive streak that those with genuine intelligence and knowledge would never dream of revealing. They are completely unaware of their rank lack of training and expertise, they think that their title or position entitles them to treat other humans without any respect of dignity. They demonstrate quite succinctly just how power has the potential to corrupt so absolutely.

This agenda of dumbing down is not cheap, a PCSO is paid a very handsome wage, especially considering the lack of qualifications, training and competition for places. The same is true in other sectors, for example the health and legal sectors have also seen the properly professionals undermined at the expense of fulfilling a corrupt government reform agenda. The driving force behind this is not the unfortunate individuals who have been inappropriately empowered on the front line, it has been the unaccountable ever proliferating network of managers that have presided over this tremendously poorly planned waste.

Despite numerous management failings and programs of dangerous wasteful reform, those who have run the show in government and in the Department of Health continue to force their dross upon us and there seems to be very little we can do to stop it, short of organising a full blown military coup. The catastrophic waste is so beautifully encapsulated by the wasted millions of the NHS University, bear in mind that this is only the tip of the iceberg.

In the NHS those who prevent the show from going under have been those who have been routinely castigated and bullied by the management regime. It is the consultants, the GPs and the nurses on the front line who have had to take all the blame for various problems that should really be dumped at the door of their managers. The managers want all the power but will take none of the responsibility. The government is afraid of those with expertise who the public trust, so no wonder they hate the front line staff who do their best to care for patients when their hands are tied.

Some NHS managers do do a good job, however I am struck by the routine nature of bullying and similar jobsworth type behaviour that is shown by these managers to many of their fellow NHS staff. Good management should involve listening, accepting constructive criticism and working together with people in a cooperative manner to make improvements. NHS management involves ordering people around despite not knowing anything about the implications of one's orders, not listening to any criticism, bullying those who constructively criticise and then carrying on regardless of one's crass incompetence.

The point I'm trying to make is that it's not the fault of the under trained PCSO if he or she fails to do their job competently, it's the fault of the regime that has created a system that empowers the ignorant. Those who have changed the way the system works are completely unaccountable for their work. For example as regards HAIs (hospital acquired infections), the recent government decision to make certain potentially toxic antibiotics available over the counter flies in the face of the government's pretend attempts to combat C.Diff et al.

The medical profession has it's own malignant branch of this empowered jobsworth, and it seems that they frequently hide away from clinical duties, preferring to bully those on the front line by exploiting their many handy crony-based connections. I know I've significantly digressed from my original point, it's partly because I could rant on inanely for hours on this particular pet hate of mine.

I carry on because I love my clinical work, but it's incredibly frustrating to see progress stifled by such an incredibly backwards culture of top down bullying and incompetence from uneducated jobsworths. There's almost too much to criticise, so much so that the criticism is dissipated over a wider area, there are so many leaks in the NHS roof that it feels as if we're in the shower. The re branding of PCTs is the latest example of this foolish campaign of regression.

So if any of you jobsworths happen to be reading then I hope you realise just how much top talent you are forcing out of out public services such as the NHS. I recently encountered a very experienced and talented ex-nurse who had quit her job as a senior AE sister because she was so fed up with seeing the damage inflicted by the 4hr AE target. She loved her clinical work, however she was sick of seeing doctors bullied by jobsworth bed managers, she had had enough of fighting against this tide of empowered small minded incompetence. I just hope enough of us keep fighting, otherwise the outlook for out patients is not good.

Sunday, 17 August 2008

The NHS Stasi

There has been a lot of recent talk about a junior doctor who was suspended from work for comments made on a private Internet forum. On one hand it seems that our medical leaders cannot take a bit of banter on closed Internet fora, while on the other hand they are happy to nonchalantly wreck thousands of lives without expecting any punishment at all.

It is rumoured that the doctor's ridiculous suspension has been lifted, apparently some big media cheeses were sniffing around the story and this prompted some action from our esteemed medical leaders.

Dr Rant also remarks at just how unlikely it is that the likes of Liz Paice and her buddies will be investigated by the GMC for their cowardly acts which could be seen as a gross abuse of power by some.

Amazingly doctors such as myself have no choice but to pay almost 400 pounds every year to the General Medical Council. Some would say that the GMC selectively punishes various enemies of the state, so in this context is seems very strange that doctors have to fund yet another outpost of government?

It all makes Remedy UK's campaign to hold those behind MMC to account all the more important in my opinion, 1430 signatures so far, surely those behind this negligent reform should be punished? Or maybe swearing on a private Internet forum is more important in the grand scheme of things.

I'd better stop there, as I'm sure the Department of Health will be monitoring my words and telephone conversations using RIPA. Better keep quiet and sing Carol Black's praises then.

The GMC is great, they would never ever selectively punish doctors at the request of people that they are close to. MMC is great, modernisation for the sake of it is progress, even if it results in a terrible dumbing down of standards and the butchering of thousands of hard work professionals' careers. We do not live in a country in which the government continues to empower itself in a rather Stalinist manner, in a way that threatens the liberty of its citizens.

We live in a parliamentary democracy, we should be grateful, our politicians would never ever slip dodgy legislation through that spits in the face of freedom. Or would they?

Thursday, 14 August 2008

Walk in Centre comedy

I do not normally steal stories, however for this little Pulse gem I shall make an exception. Steve Nowottny tells us just how his trip to the Walk in Centre turned out:

"Pulse's senior reporter Steve Nowottny was impressed by the local walk-in centre. Luxurious, accessible, friendly. All the things you want the NHS to be. There was only one thing wrong. No-one could help him with his problem.

Pulse team blog
At Pulse I spend a lot of time writing about primary care. But as a young, fit and – touch wood – generally healthy journalist, it’s not every day I get to see it at the sharp end.

For the past three weeks though, I’ve been suffering from a low-level cough, and yesterday I finally caved in and decided to seek help.

The thing was, I didn’t want to go to my GP. After two years of covering extended hours, polyclinics and the rise of the commuter patient, I probably should have known better.

But I didn’t want to have to make an appointment, I didn’t want to wait and I didn’t want to have to stay at home.

So I went to the walk-in centre.

It turns out there’s an NHS walk-in centre just a ten minute bus ride from Pulse Towers in central London.

It’s a little hard to find, tucked away in a shopping arcade behind a railway station. But the sign in the window promised they could deal with coughs, and once inside it was a thing of a beauty.

Luxurious padded brown leather seats. Friendly receptionists. And best of all, just two patients ahead of me in the queue.

I sat and waited my turn. It took about ten minutes, and a nurse came to get me. She was very professional. She took my blood pressure. She took a detailed history. She listened to my chest.

But she was also very candid. I didn’t appear to have anything serious, but she couldn’t be sure, and wasn’t qualified to say.

My cough shouldn’t have lasted as long as it had (this I knew already). There was a small, a very small, chance it could be something serious.

TB was even mentioned. I could try some over-the-counter treatments, she said, and reeled off a couple of names.

But my best bet, she told me - and this was before we even started - was to go and see my GP.

I rather enjoyed my trip to the walk-in centre.

As one of those young professional patients Gordon Brown wants so badly to help and private companies are advised to target, I couldn’t help thinking it was everything the NHS should be.

I was able to turn up and be seen straight away. It was easily accessible and centrally located. It was beautifully decorated. I left feeling decidedly warm and fuzzy about walk-in centres, Lord Darzi, and the health service in general.

There's was just one niggling thing. The only thing it couldn’t do was help me with my cough. Or tell me for sure it was not something to worry about.

Tomorrow, I'm calling my GP."

This amusing little tale sums up just how unproductive this government's fiddling with the public sector has been. A lot of money has been wasted creating shiny and entirely useless gimmicks. At first glance, things look great, however the government has merely created a stage upon which it acts out this pathetic game. There is no end product for all the gloss. We have numerous empowered ignorami, but alas they can do nothing of use. The NP, the PCO et al, what a great waste of our money.

Saturday, 9 August 2008

Prof Paice - what a leading light

News has been circulating that a junior doctor has been suspended for comments made on a private internet forum. The exact ins and outs of this story have yet to emerge and I do not wish to comment more until more facts are known.

Moving on I thought I would share some golden nuggets with you, these nuggets are some of Prof Elisabeth Paice's finest comments in recent years. She obviously has a very high profile position and a lot of power in medical circles, these quotes show you just why MMC and MTAS have been such glowing successes:

"…one might have feared a tidal wave of applications, but that has not happened.
Obviously, people are targeting the post they want…they are spreading their
applications so that across the country people are getting applications in the
thousands, though not tens of thousands. Therefore, so far so good"

So Prof Paice thought MTAS was running smoothly in 2007, she also thinks medical education should be lumped in with everything else:

"Professor Elisabeth Paice of the London Deanery argued that creating an organisation dedicated specifically to medical education would make it more difficult to integrate planning and would isolate decisions about the medical workforce from their wider context: I would hate to see medical isolationism as the outcome of this and a step backwards from the integration of service strategy and financial planning, using medical education, if you like, as an enabler for service change and reform."

Hmmmm. MMC and 2007 were 'good for patients' apparently:

"Obviously, those people turned up elsewhere and are doing extremely well. It is good for patients that good people are all over the country, but it is very sad for individual doctors who perhaps have set their heart on particular placements. One of the outcomes is that people have applied for jobs and have got them but feel very distressed at the outcome."

Prof Paice is also a big fan of PMETB's standards and thinks that these are able to magically cope with EWTD's reduced training hours:

"With the European working time directive and so many changes in the health service the way we deliver training has to change; and we have to change the way in which we assess people so be more reliable and robust. A lot of this change is being driven,
rightly, by PMETB and the standards set by it."

She also squirmed when asked as to whether COPMED and the deaneries had been speaking with one voice:

"I think we have been speaking absolutely with one voice through what has been an extremely difficult time. It is correct that the experience has been different. If one asked whether this had been smooth one would get two answers, yes and no, but that is not the same as not being together in what we are trying to achieve."

MMC and MTAS are good for patients then. I stand corrected. The raft of unaccountable bureaucracies and organisations are all speaking with one united and representative voice. With the likes of Prof Paice in charge I find it very hard to understand anyone can dare to question the noble motives of our esteemed medical leaders. We are lucky to have experienced the glowing success of recent years, we should feel privileged to have been stroked by the hand of medico political genius that has been guided us to such fresh fertile pastures. It is just terribly unlucky that we all landed in a big cow pat and not on the lovely lush green grass than our medical leaders inhabit.

Saturday, 2 August 2008

Silence is no sign of success

MTAS and MMC are still not seen as failures by a small minority of arrogant and self serving fools in the medico political establishment. Some of these people would not be able to recognise failure even if it punched them square in the chops, they are in denial, while the others are just plain psychopaths.

There has not been the mass outcry this year, but this has not been due to a system that has been run slickly and the fact that doctors are content, far from it. Many people have battle fatigue and are so disillusioned that they do not have the energy to cry out as they are beaten, after all no one seems to be listening. This apathy has been learnt as those in positions of responsibility continue to refuse to listen, they also remain unaccountable for massive errors that have had massive impacts upon patient care. Sir Liam, Carol Black et al drive onwards and upwards, oblivious to their gross failings and inability to work for the long term interests of our patients.

I will not deny that the application process has been improved since last year, however speak to anyone who took part and you will quickly discover that the system was riddled with major faults which once again resulted in a lot of very preventable heartache for doctors in training. A barbaric process that only allowed a short window of 48 hours in which to accept an offer meant that many were left with impossible decisions due to a rigid and inflexible application process. The lack of a decent coordination in job advertisements made it very tricky for doctors to juggle long hours with completing long winded application forms, while the short listing and interview processes were hard pressed to be fair given the time pressures associated with having all jobs having fo be filled at the same time every year.

The wheel has been reinvented, by trying to stamp out a problem that never existed, Sir Liam has created many new problems of much greater significance and potential to do harm. Currently numerous junior doctor posts remain unfilled, meaning that many people are being forced into working illegal numbers of hours and the large gaps in rotas are also reducing the quality of training for large numbers of trainees. Add to this the demoralisation of so many doctors and the great difficulty in obtaining elective locum cover, then you have a veritable disaster in the making. Obviously I wouldn't want to forget the massive numbers of doctors who have quit the NHS, or will do in the next few years as a result of these poorly planned reforms.

Well done Sir Liam et al. There is no doubt that you have left your marks, it's just a great shame that none of these marks represent anything remotely positive.