Saturday, 18 December 2010
Some rather interesting information and recent scientific research points to the obvious fact that the less training you give to autonomous practitioners, whether doctors or nurses or monkeys, the lower quality of service patients will receive. Some interesting research from Holland points to primary care perinatal mortality being higher than that in secondary care, something a midwife would never even dream of considering, it runs against their fundamentalist doctrine of medieval home births. Some interesting recent news on the danger in giving nurses power beyond their means has hit the headlines. I see this regularly at first hand, numerous under trained staff are given responsibility and autonomy way beyond the limits of their knowledge and training, the side effects in terms of patient harm are inevitable and regular. This does not just apply to nurses in dangerous extended roles, it applies to certain paramedics, other quasipractitioners and technicians, including health care assistants and other staff with minimal training.
Onto the topic of health care rationing, something I have no problem with as a general principle, we do not have infinite funds. However when this rationing is done in a way in which the non-medically trained are empowered to make clinical decisions that are both reckless and dangerous, then I am completely against it. Numerous PCTs have sod all cash and as a result are stopping all elective surgery that they deem to be of 'low value'. The problem is that a lot of these low value procedures are often rather essential and need to be done as almost an emergency, if not then the knock on costs in terms of patient morbidity and long term disability are far greater than the money saved it not doing a simple effective procedure. This is stupid short term NHS thinking at its best, so a new government, but the same old stupid top down rubbish spewing forth. I see more of the same for 2011.
Tuesday, 2 November 2010
One can watch his words here on the BBC, I am sure most of you will be infuriated by the pathetic interviewing from the BBC 'journalists', they clearly lack the brains or knowledge to adequately dismantle this topic for their viewers, typically woeful coverage of a scientific issue I'm afraid. I noticed this thanks to Dr Grumble's blog.
The BBC and the media in general are pretty damn rubbish when it comes to covering scientific matters for several reasons. Firstly their journalists lack the understanding of the issues and secondly their bosses want ratings, not decent accurate journalism. One only had to watch their recent Panorama program on the use of antipsychotics in dementia patients to see a complex issue poorly broken down and distorted by some shoddy journalism.
Anyway onto alcohol, it is a national disgrace that the government continues to do effectively sod all to take on the drinks industry. The most effective strategy for improving our dangerous boozing culture is to raise the minimum price of a unit of alcohol, the government continues to resist doing anything in this regard. A&E departments are routinely overrun with drunk patients, the long term health issues associated with alcohol are plentiful. I suspect the drink industry and the big supermarkets' power is part of the reason that the government is doing sod all of use again.
Wednesday, 27 October 2010
Those who read this blog regularly will understand it well. The ideology behind it is so deeply flawed. The white paper just continues the same old flawed policy which the previous Labour government inflicted upon the unsuspecting public.
The introduction of pseudo-competition and the market has been shown to fail before, private firms invariably only do the easy work for a nice tidy profit, the left over work which is much less profitable and a lot trickier is left to the public sector, a public sector which I may add is being dismantled, it is so much harder for hospitals to work effectively when they lose essential working chunks of their arms and legs, as they are sold off to private firms. Commissioning is at the centre of this wasteful reform, a process which oversees the pseudo market and results in a hell of a lot of expensive and inefficient bureaucracy.
Critics of the article's authors, Leys and Player, love to simply claim that their writing is ideologically driven nonsense. The great irony in this is that the actual reform, the white paper itself, is ideologically driven nonsense. There is no decent evidence that any aspect of these reforms will spend tax payer's money more effectively in delivering health care, thus to criticise the white paper's critics for being ideologically driven is nonsensical, the white paper is evidence free, it is hot air, actually there is a lot of decent evidence which shows that various white paper policies have failed time and time again in the past. ISTCs, PBC, PFI, Choose and Book et cetera have been shown to be an ideological bonfire of tax payer's cash, there is no decent argument or evidence which says that the new white paper will be anything but more of the same needless incineration of tax payer's cash.
Tuesday, 26 October 2010
Numerous NHS Trusts around the country are now paying for the government's errors, they are having to service these PFI contracts and a disproportionate amount of money has to be fenced off to do this. These costs cannot be trimmed, the contracts were set in stone years ago, it is as if the government sold its soul and we are now paying the price, there is no going back.
So while essential services are cut, while patients suffer as PCTs restrict access to essential operations and medicines, it is ridiculous that there is no risk to the income of the private firms who have their hands in the NHS' till. These private firms and guaranteed their profit, they will get their money come what may. The system is all wrong, how can this be right when the blind old man with cataracts is not guaranteed a fix, or the limping old lady with a painful hip is not guaranteed a reasonably speedy operation?
Cuts to local government budgets for social care are going to compound this problem. We are already massively short of beds as it is, so with winter coming and money short, as well as our increasingly aged population, there are some very stormy times ahead.
Saturday, 23 October 2010
I was having a quiet pint last night in a very pleasant pub and there was a certain book by 'Dr' Gilliam McKeith on a shelf there. A few of us began to browse through the aforesaid Dr's book and became rather obvious that it was full of complete and utter bullsh*t. It was very well produced from a publishing point of view, very shiny and well presented, enough to convince the ignorant reader that there may be some 'science' and 'truth' within. However when one skated beneath the surface it was clear that there was very little in there that was not based on the meanderings of a stupid fool.
So why am I rambling on about Gillian McKeith you ask? Well, it has motivated me to start making the effort to do a bit of writing again, I am fed up with the low quality rubbish that gets fed to us in the media a lot of the time, especially concerning science, medicine and politics. There are just so many uneducated quacks out there in so many different forms peddling useless rubbish to unsuspecting members of the public, and this culture is propagated by a lot of rather low quality journalism covering all matters scientific.
Anyway that's about it from me for today, I will try hard to cover a few health related matters with a decent amount of cynicism in the forthcoming weeks, there have just been so many health related issues in the news of late that it's been hard to know where to start. The government's ridiculously stupid white paper has been a big story, while the mismanagement of medical training and the EWTD has been another big one, the failure of 'minor injuries units' is also a story that I intend to cover in the not too distant future.
One massive contradiction in recent days has been the massive cuts that are taking place in the NHS throughout the UK in recent weeks, but at the same time the government is ring fencing the NHS' budget. Something quite clearly does not add up. Is this because various NHS Trusts have been saddled with massive bills for PFI deals and they also know that the new crackpot government reforms are going to see more and more money kept away from secondary care, then poured into the coffers of various government friendly private health care corporations? That would be my cynical explanation, billions are being ring fenced to pay for the stupid new rearrangement of the bureaucrats' deckchairs, while more cash will be squeezed away from the front line. New government, same old reforms taking us backwards, no change really.
Wednesday, 11 August 2010
For those of you who haven't had time grasp the catastrophic implications of the government's white paper, have a look at the excellent video above and be afraid, be very afraid. The end result of the white paper is a system that will be privately owned and not publicly accountable. It will also be more bureaucratic and management heavy. Oh dear oh dear.
Saturday, 7 August 2010
As is stated at the beginning of the report McKinsey "were instructed by the Department of Health to provide advice on how commissioners might achieve world class NHS productivity to inform the second year of the world class commissioning assurance system and future commissioner development." They then produced this report, I have only just got around to reading it. In summary the report just comes up with the obvious such as reducing funding to save money (what genius), efficiency savings and moving care out of hospitals. However when one looks into the details of the report the logic behind these 'savings' is sadly lacking.
The report is full of stupid and naive statements like "Acute providers – Potential savings of £1.9–3.0b if all providers below the median productivity achieve 50–80% of the potential improvement of stepping up to the median." and "Acute providers – £1.5–2.4bn savings if all providers below the median of clinical staff productivity achieve 50–80% of the potential improvement of stepping up to the median". Well obviously if we could improve everything below the median then you will get efficiency savings, however saying it is much easier than doing, often trying to improve efficiency can result in the very opposite.
"Acute providers – In addition, £0.4–0.6bn savings if all providers below the median of non clinical staff productivity achieve 50–80% of reaching the median", "Community services – Potential to deliver same level of activity with 11–15% less staff, if district nurses achieved median productivity or 10% above", "Mental health – Potential to reduce beddays by 8–12% if providers achieve 50-80% of the potential improvement of stepping down to median ALOS", "Potential GP productivity improvement could be worth of £0.2–0.4bn, if weak performers achieve standard performance": These are just a few more of the examples of McKinsey suggesting that everyone below the median just magically gets better and then money will be saved. There is very very little on how this is actually going to be done in practice, it is like saying if we magically get much better then we will do better, it is pure baseless and meaningless speculation.
"Mental health – Crisis resolution teams can reduce the need for admissions by 40–50% based on controlled trials": Here is an example where McKinsey do quote the evidence, in this case a BMJ paper, however the BMJ paper itself quotes the results as being 'equivocal', hardly solid backing for more McKinsey savings.
"Acute providers – nurses spend only 41% of their time on patient care", "Study across FTs found only 55% of community midwives time is spent on patient facing activities", "A low-performing GP can spend less than 30% of their contracted hours actually seeing patients": there seems to be a bit of a recurring theme here, a lot of clinical staff are spending a lot of time not seeing patients. A large reason for this is the bureaucracy that has been assembled around the target and tariff driven market based system we have now, strangely McKinsey just want clinical staff to find more time for patients, as if by magic again. This doesn't address the root cause of the problem, only scrapping the market, tariffs and targets would.
The McKinsey talk of 'non-effective interventions' as if numerous things we do are completely ineffective and could be scrapped at no cost at all to patients. Apparently 'spinal injections and fusions for back pain', 'trigger finger surgery' and 'knee washouts' are all relatively ineffective. Apparently "Inguinal, Umbilical and Femoral Hernias, Incisional and Ventral Hernias" are all potentially cosmetic procedures. Hernias don't give significant pain to patients and have a serious risk of strangulation do they? And now a huge list of procedures that are not that beneficial in mild cases "Knee joint surgery, Primary hip replacement, Hip and knee joint revisions, Cataract surgery, Female genital prolapse/stress incontinence (surgical), Dupuytren’s contracture, Cochlear implants (inner ear surgery), Other joint prosthetics/ replacements": McKinsey may be surprised to know that clinicans do not throw around major operations without considering the risk benefit of that procedure, no doubt it would be a manager with no clinical training who would decided what consituted a mild case of hip arthritis or a mild prolapse? Apparently these conditions should not be treated surgically in the first instance "Carpal tunnel surgery, Elective cardiac ablation, Anal procedures, Bilateral hip surgery"; McKinsey obviously don't know much about a severe rapidly progressive carpal tunnel syndrome being left too long.
"Reducing variance of GP referrals for new outpatient appointments could lead to savings of £0.2-0.4bn.", "Potential savings of £0.2-0.3b, if PCTs achieve the median follow-ups to new OP ratio or 80% of the potential of stepping down to bottom quartile", "Variability in performance between SHA indicates opportunity of £60-100m1 if median or 80% of top quartile achieved", "Assuming similar potential savings for all other PCTS, potential savings from shifting acute care to primary care of £0.2-0.5bn": it goes on and on like this, McKinsey wants everyone out of the bottom quartile, everything up to the median, but the details of doing this in practice are extremely thin on the ground.
It is obvious that the report has been written by people with intelligence as it is well written and glossy, however it is also abundantly clear that it has been written by people who understand very very little about medicine. Most of the 'savings' suggested by McKinsey are as a result of the magical transformation of under performers into good performers, somehow McKinsey will get rid of anything below a median, it is truly cloud cuckoo stuff of the highest order.
A massive problem with everything in this report is that the 'savings' suggested are invariably only 'pseudosavings', by this I mean that the work will still be being done it is just that no one will pay for it, this is a great trick of the useless market based system we have now. The inefficiencies in the system today are largely as a result of the ridiculous market based system with all the tariffs and targets that comes with it, McKinsey's approach does nothing to address these problems, in fact a lot of their suggestions would worsen the situation.
Overall I am dismayed that so much taxpayer's cash has gone towards funding McKinsey to produce this evidence-lite report. Fundamentally the market based approach is failing the public and resulting in an extremely inefficient and overly bureaucratic system. We would be a lot better off if secondary care were to be centrally funded directly from the state purse, then hospitals could spend their money as efficiently as possible and a lot of the waste from the excessive bureaucracy would disappear.
The proposed White Paper is a disaster in the making, it will result more and more money being frittered away on the process and less and less going on the patients. The one person who has been forgotten in all this mess is the patient, as power is transferred from the clinically astute to the clinically unaware, the one to suffer will be the patient and that is what the market does, it results in the clinical being forgotten, protocols and guidelines become enforced by the clinically unaware managers, money is saved and the patient is left to rot as the medicine is forgotten.
Friday, 23 July 2010
We have an expanding population which is increasingly elderly, therefore reducing bed numbers safely is not possible. If bed occupancy rates are too high then you increase problems like hospital acquired infection and various operational inefficiencies.
If you speak to anyone actually working on the ground then you would know that hospitals are increasingly stretched already, there are not enough beds to deal with the current workload. This is leading to patients backing up in A&E and managers putting pressure on doctors to discharge patients in a clinically dangerous manner. The system is on the verge of collapsing up and down the country.
Now McKinsey, the management consultants who are paid vast amounts of money for their alleged wisdom are claiming that it is safe to cut bed numbers further, this is obviously not the case if one has actually observed the reality of hospital medicine on the ground in recent months. This 'debt' is also an artificial entity imposed by the market, if the market was destroyed then all the money wasted on its bureaucracy could be directed towards clinical care and not the market fiddling monkeys who will do very nicely from the latest pro-market white paper.
It is certainly possible to save money by treating patients very badly and providing a low quality service that forces sick patients to be inappropriately managed out of hospital. However this is dangerous and unsafe. So as money is frittered away on consulting the morons from McKinsey, patients will be left to die in the community, there will be no beds for them, this is the reality of the new NHS and the failed market based approach that this government persists with.
Thursday, 22 July 2010
As bottled water, useless products that are a complete waste of money will proliferate, this will lead to more inefficiency and patients struggling to get proper treatments that do have solid evidence behind them. The market for health care is no Utopia, it is just a way in which a lot of private firms will get very rich by providing easy treatments for the worried well while proper treatments for the sick are not appropriately prioritised.
A perfect example of the market leading to completely useless rubbish being sold is the APOS treatment from BUPA, it is complete and utter nonsense. Read all about it and be very afraid. You had also better get used to these kind of junk evidence-lite treatments, these bottled waters of the medical industry will proliferate in the next few years, this is what the market promises for your cash. What a sad and terrible waste, but the marketing is very shiny, one can't forget that.
Sunday, 18 July 2010
The market remains, and until the market is destroyed then any hope of an efficient public system is dead. Commissioning is doomed to failure, whoever does it, it is a definite poisoned chalice that GPs would do well to avoid it at all possible.
The logic behind this reform is sadly lacking. GPs are the providers of primary care and are not trained/suited to hold the purse strings for secondary care. Handing the vast majority of NHS funds to GPs is barking mad, it is something that could only have come from a stupid politician with no grasp of how healthcare is delivered.
Billions and billions are being wasted yet again in moving around a set of failing market based deckchairs. All that will be proven by this latest white paper is the fact that our politicians have no clue as to how to run a health system. Lansley is clueless, but so is Burnham, the NHS has been tampered with by successive groups of morons and it will not get better until be have a sensible moderate centrally funded system run by the clinically and medically aware.
Thursday, 10 June 2010
Lansley's chatter is nonsensical, just as Burnham's was, just as Hewitt's was, just as Johnson's was, the list goes on and on. The fundamental problem with these cretins is that the internal market is a moronic idea. The fact that primary and secondary care are not set up to cooperate in the best interests of the patient is plain foolish and until that problem is addressed, the politicians talk is just hollow garbage.
Primary and secondary care need to work together, currently they do not and the stupid payment systems serve to decrease the amount of cooperation between the two, thus worsening patient care. There is a massive needless bureaucracy in place in which both primary and secondary care are fighting over a few scraps, while the interests of patients are forgotten. If Lansley thinks these new ideas will reduce the bureaucracy and squabbling then he is quite wrong, the opposite is true.
The internal market is the enemy and our politicians continue to side with the enemy because their corrupt ideologies are deeply flawed. The Tories are no different to New Labour, both are groups of muppets who refuse to address the systematic problems with the internal market. Top down control of the market won't work, we need a system in which patients are prioritised and the movement of money does not trump clinical need. We need cooperation, not competition, until that is done money will continue to be frittered away on these stupid top down market based initiatives.
Sunday, 9 May 2010
Remedy are taking the General Medical Council to court this week on behalfof 1600 doctors. The GMC have been accused of blocking a Fitness to Practice enquiry into Sir Liam Donaldson, days before he is due to step down as Chief Medical Officer. The case has been branded as ‘The Double Standards Challenge”.
The litigation arises over Donaldson’s management of MTAS – thecomputerised recruitment system for junior doctors. The Health Select Committee concluded that “Candidates and assessors alike were justifiably outraged by the sheer inadequacy of MTAS. The period between February and August 2007 was characterised by unrelenting chaos and severe anxiety for thousands of junior doctors. …
The reputation of both the Department of Health and the leaders of the profession were severely diminished”. The GMC was asked to consider whether those responsible should face a disciplinary hearing. But they declined to refer the matter to their Case Examiners. In a letter to Remedy they stated that Donaldson’s involvement could not render him unfit to practice “whatever the conduct’. This conflicts with the GMC’s own published guidance for Doctors in Management,which states ” You remain accountable to the GMC for your decisions”.
It is unheard of for thousands of doctors to take their own ruling body to court. But Remedy believes that we have been completely let down. There should be one rule for all medics, without exceptions. We are drawing aline in the sand over cronyism and lack of accountability in the upper echelons of the medical profession. This is the first time a case of deficient professional performance has been made against a doctor in management.
Monday, 3 May 2010
Numerous pseudo-doctors have been deployed into roles that were only previously done by doctors. This has led to a lot of patients getting a rather raw deal. Whether this be diverting Orthopaedic referrals to physiotherapists and away from the consultants, or seeing the nurse practitioner at the WIC with your chest pain, the costs in terms of patient care are obvious. This dumbing down may save money in the short term, however in the long term in may well cost a lot more to pay for the consequences of the substandard care that a lot of patients are getting these days.
Sunday, 2 May 2010
Labour have presided over a massive over expansion of medical student places at Universities. I call this an 'over' expansion because they have not maintained standards, they have stuffed medical schools too full, they have dumbed down the quality of the undergraduate medical training system in the process, much the same has been done to all University degrees under Labour.
The expansion in numbers has led to the typical boring propaganda from Labour such as 'more doctors', 'more nurses' and 'more degrees'. This may be true, but it has come at some cost and that is the standards of education, and also the fact that many of these people will have no long term career prospects in their area of training.
Modernising Medical Careers (MMC) and MTAS are two of the government's biggest cock ups, the former being the flawed dumbed down reform of medical training and the latter being a hopeless application process that wrecked many a junior doctor's career. The threat of culling training posts now could be devastating to the service with many rotas being massively short staffed as things stand.
This government simply cannot be trusted. They promised us so much and have delivered so little. The referendum on Europe never happened despite being promised in the Labour manifesto, many other promises have been broken in recent years since Labour came to power.
Medical training is in crisis despite all the money that Labour has wasted on the NHS. This government promises to protect front line services, this is a very dubious promise given these secret plans to scrap training jobs for doctors. The bottom line is that Gordon and chums cannot be trusted, they have lied time and time again. Do not give them your vote next week, they simply do not deserve it. Labour need to be removed at all costs.
Saturday, 1 May 2010
We have billions being thrown away on the pursuit of the internal market when it clearly doesn't work. We have numerous layers of administrators who are not needed such as the PCTs and the SHAs, these bureaucratic layers actually spend a lot of money trying to avoid doing work rather than actually funding the front line services. We have numerous QUANGOs doing sod all of use and we have billions being wasted paying for ridiculous PFI schemes that are often run by the banks owned by the tax payer, this is beyond farcical.
There has been no open honest debate about this waste and this inefficiency, the politicians are too afraid to talk of the NHS, it is a political hot potato. The market needs to be dismantled, the way health care is funded needs to be radically simplified and transformed from the current overcomplicated shambles it is.
Gordon Brown's comments have been beneath contempt. Not only have Labour been sending out misleading leaflets to cancer patients in the most abhorrent of circumstances, but they pretend that scrapping their stupid top down targets would be the end of the world for patients, this is clearly not the case. Gordon Brown has been pretending that targets are the key for patients, actually a lot of the scientific research shows that targets are probably doing a lot more harm than good.
Targets are a waste of time. It is the capacity of front line services that is key, not the centralised targets imposed by the ignorant and uneducated bureaucrats. The 2-week cancer target is a great example of this, without extra capacity the 2-week target will arguably worsen outcomes as it will allow cunning patients a way of jumping the queue in a way that overrides clinical priority.
The old system in which referrals were overseen by the expert clinicians was far better, clinical priority was far better served. The same is true for the ridiculous 18 week surgery targets, a blanket rule such as this helps no one, it leads to ridiculous tactics in fiddling the paperwork to make money, while if capacity is not increased then no one is better off. Some people need their operations urgently, others are happy to wait for a year, lumping everyone in the same box is just plain stupid.
Targets are just one of the ways in which this corrupt abhorrent regime have tried to control the NHS from the top in a way that has not helped the majority of patients. The government's paranoid desire for complete control helps no one, it results in a system in which cooperation is dead, fear and intimidation rule. Clinical priority is now decided by medically ignorant managers and not the highly trained doctors, taking the expertise out of the prioritisation of treatment has been a massive backwards step. This government has empowered idiots because they are easier to control and rule. Gordon Brown is a liar or he does not understand the NHS, the targets need to be scrapped, we need power to be handed back to the clinicians and we need a massive cull in the layers of managers who do nothing more than obstructing patient care. And after all if those in charge think everything is so much better, why are they trying to hide the public from reality?
Tuesday, 27 April 2010
Thanks Gordon and thanks Tony, thanks New Labour. When you hear Gordon talk of how they value the NHS and its staff, I suggest you read the above and remind yourself of the reality of the situation. Gordon and his cronies pretend they care for the NHS, they clearly do not. Maybe the next lot will be no better, one thing is sure though, it is hard to see how they could treat the medical profession with any more disrespect.
Monday, 19 April 2010
The vote should mean something, many people have fought and died for the right to vote, politicians even claim to this day that not voting is an insult to those who fought for the right, I disagree with these politicians. The vote has come to mean very little and this is one great shame.
There is no genuine choice, despite the endless shiny waffle and propaganda in the mainstream media, if one quickly scratches beneath the surface then one soon sees that all the major political parties have pretty much identical policies on the key issues. The vote is practically meaningless, it is a token gesture, party politics is corrupt and has run out of democratic steam.
Take the health service for example, there is simply no choice for voters on policy, all the major parties are not questioning the market ideology, the PFI schemes that are wasting billions, the privatisation agenda, the dumbing down and dis empowerment of the educated professionals. The mainstream media are silent on this scandal, bloggers are the only genuine voice against this disgrace and the election propaganda goes on and on.
Politics is broke, meaningless superficial Television debates will not fix this problem, unless someone in a position of power does something about this disillusionment of the general population, then the time bomb will keep on ticking and eventually it will go off.
Monday, 5 April 2010
The Court's judgement can be read in full here, and this really is a victory for common sense and for scientific progress. Quacks should not be allowed to make unfounded claims about their dodgy treatments, whether this be companies peddling nutritional supplements, practitioners of alternative therapies such as acupuncture, herbal medicine, chinese medicine, homeopathy and on and on, there are just so many quacks out there.
The way in which the British libel law was used to intimidate by the BCA is rather scary and it makes the case strongly for a proper overhaul of our antiquated and repressive libel laws:
"The ruling, by England's two senior judges, Lord Judge and Lord Neuberger, together with Lord Justice Smedley, was scathing of the way the BCA began libel proceedings rather than taking up the Guardian's offer of a right to reply. It acknowledged that the action had a "chilling effect on public debate". The BCA's actions had created the "unhappy impression" that it was "an endeavour by the BCA to silence one of its critics" "
I would urge anyone reading to sign the petition here are the libel reform site and have a look at the senseaboutscience site here. The likes of the BCA need to be shown up for the dishonest rip off merchants that they are.
Saturday, 3 April 2010
The same is true on health, policy is not based on the evidence or on the best expert advice, it is created by politicians and government cronies who have no proper education or knowledge of that particular area, and it is created to satisfy the short term needs of politicians and the Daily Mail, not the best long term interests of our country. Anyway the letter is an excellent insight into the disastrous way in which our stupid politicians create useless policy:
Sunday, 28 March 2010
David Fisher had a history of heart trouble, he collapsed at home, but thanks to the bizarre system of targets and payments he was not greeted with an immediate ambulance, his call was downgraded in urgency and he was fobbed off with a telephone helpline. Untrained idiots on a phone line won't cure cardiogenic shock, so Mr Fisher was left to die at home. The dangerous way in which non medically trained people are now being empowered by protocol is beyond belief, it really is.
The market that we have is a disgrace, we now have an epidemic of managers to oversee this barbaric rationing of care, we are spending more and more money to avoid actually treating patients, this money would be better spent actually dealing with medical problems, not hiding from them via payment systems and tonnes of meaningless paperwork. The number of managers in the NHS is now 84% greater than in 1999, that is one hell of a statistic. Even Kafka would have trouble writing a book on the bureaucratic nightmare that is today's NHS and its dysfunctional network of SHAs, PCTs and Whitehall monkeys. No wonder private firms are using think tanks as a dishonest way of bribing politicians so that they can get greasy hands on this easy money as the NHS is sold off bit by bit. Cooperation is being replaced by dysfunctional competition, doctors like myself are fuming and patients like David Fisher are needlessly being left to die thanks to the substandard services on offer. The managers and politicians presiding over this shambles should be shot.
Sunday, 21 March 2010
Monday, 15 March 2010
This ridiculous market based system is much more expensive, as competition results in the efficiency of cooperative networks being lost. It is also leading to a tremendous dumbing down of medical decision making because with the privatisation of services comes the cost cutting that results in the inevitable reduction of service quality. There are now numerous layers that obstruct a patient getting from a GP to a proper medically trained consultant doctor or surgeon. Virtually all of these 'reforms' result in the empowerment of less trained workers, whether in be the nurse who can now act as an approved mental health 'clinician' , the HCA being given the unsupervised job of a nurse on the wards or the paramedic who thinks it is their job to reduce A&E attendances by diagnosing chest pain as being anxiety related and not related to serious pathology.
Patient 1 came to see me a year ago after he’d crocked his knee playing football. I thought he’d damaged his anterior cruciate ligament and I referred him to an orthopaedic surgeon. I saw him again this week, and he was apologising for wasting my time. ‘I saw a physio nine months ago. She agreed with you I needed surgery, and she said she’d sort it out, but I haven’t heard anything. I phoned her but she’d left. I don’t know what to do.’ A call confirmed the physio had indeed high-tailed it out of the NHS, but had done nothing for my patient, other than discharge him.
Saturday, 13 March 2010
It is hard to disagree with much that Niall Dickson says on this issue. It is just strange that it has taken the GMC so very long to say something about this, it has been a massive problem for many years, one can't blame Dickson for this as he has only been around for five minutes.
Essentially European law means that the GMC cannot test EU doctors competence or ability to speak English, despite the fact that many have a rather limited command of English and that some of their medical degrees are not the most rigorous of qualificiations.
Medical degrees in different countries are very variable. The US and Canada have a pretty robust training system in place, they invest a lot of money in making sure that their medical students are exposed to a lot of clinical work and clinical training. The UK's system is decent but less clinically based, the more clinical a training system the greater the cost. The EU is a completely mixed basket going from some excellent systems to some awful cheap ones in which there is very little clinical teaching at all.
The GMC is right on this issue. It is dangerous that the UK is forced to register any EU trained doctor without testing their English language skills or medical competence. This cannot be left to local PCTs, this should be done by the GMC and if the law prevents this, the law must be repealed or changed.
Tuesday, 9 March 2010
This comes on the back of news that massive cuts in the London NHS could well result in the loss of 5,600 beds, this is almost a third of the total number of beds available in the capital.
Bed numbers go down and down thanks to PFI schemes and the internal market's forced cuts, targets forced patients to be shunted out of AE quicker and quicker, it's really no wonder that patients are spilling over into TV rooms and storage areas.
It's all so predictable and it was all so very preventable. The internal market and the government's program of enforced privatisation has left us with this disastrous legacy of patients dying in corridors, at least the private providers are making their healthy profits come what may.
Sunday, 7 March 2010
The shambles that is the coverage of health and health policy in the media is exposed by this excellent lecture that Dr Grumble pointed me towards. It is a topic I have spoken about many times in the past, the fact that that so many of the journalists that cover health and health policy have no education or training in this area is an utter shambles. The lack of decent educated journalists for health has combined with the problems with the mainstream media (that has been dumbed down as a result of reducing revenues that have led to much cheaper, lazier and more poorly researched stories) to quite devastating effect.
This has led to the current shambles. All one reads in the mainstream media on health is the cheap and easy reproduction of press releases by short cut taking hacks, these press releases from lobby groups and government direct the direction and news follows. There is no sensible analysis of the drivel that is fed to them in the form of press releases, the journalists just churn out manufactured partisan dross. The point made in the above lecture is a good one, this key point is that the public are now so unaware and uneducated on these serious issues in health that the government is able to get away with wasting billions of taxpayer's money on the current corrupt and grossly inefficient privatisation agenda. The government has done this quite deliberately, if the public were aware of what was going on thanks to an open and well informed media then they would not stand for it, as things are when people wake up to it, it will all be too late to do anything about it and turn back the clock.
Saturday, 6 March 2010
The Nursing Times covers the story here. This fits with what I heard of the NMC and the fact that it comes out of this as by far the worst of all the health regulators is not a surprise.
The NMC has supervised and condoned the empowerment of nurses in doing whatever they see as within their 'zones of competence'. If the GMC did the same all hell would break loose, the NMC seems to think that training and qualifications don't matter, that nurses can just be let loose to do as they see fit, then when the sh*t hits the fan they just brush it all under the carpet. Interestingly for all the rather ignorantly pro-quackery commentators the GMC seems to be doing a lot more right than the NMC, they wouldn't tell you that though. I'm not fan of the GMC but at least they are fairly thorough in investigating claims, the same can certainly not be said for the NMC:
Saturday, 27 February 2010
The gross failure of the top down centralised control of the NHS via a depraved culture of targets, bullying and intimidation is the real reason for the shocking standards of care in certain hospitals such as Stafford. This is touched upon by some of these letters to the Guardian on the topic, obviously the cowardly morons at the top like Gordon Brown will always try to pin blame locally, this is despite the clear fact that local managers have their hands completely tied, they have no choice but to obey the top down diktats from Whitehall or else. Dr Grumble hits the nail on the head with his analysis of events in Stafford:
This above statement is Staffordshire inquiry. The problem is that everything the government has done in terms of NHS reforms from targets to the privatisation of services has resulted in numbers always being prioritised instead of people. This talk is hollow, so so hollow. There are so many examples of the top down nature of the NHS and how this harms patients, the way in which the Baby P whistleblower has been treated sums this up perfectly, sadly there are just so many other examples. The Witch Doctor's excellent summary of the coverage of the Staffordshire scandal is well worth a prolonged read.
The latest example of this corrupt top down agenda of reform is the bullying used to force through a program of 'polysystems', basically a way of trying to shut down yet more local hospitals and shunting their work to various private firms. The 'polysystems' reform will lead to less cash for hospitals, this will then result in hospitals being forced to squeeze standards to stay afloat, meanwhile patients will get a much poorer standard of care in attending various new substandard services delivered by primary care providers. The aim of this is to save money and privatise, no wonder standards of care will suffer, again the top down orders will be forced through, local managers will lose their jobs if they refuse, the numbers are prioritised again ahead of the people. Some things never change, centralised power and local blame, numbers before patients.
The BMA explain exactly how corrupt and ineffective the government's reforms have been with their 'Look after our NHS' campaign. Diane Abbott has tabled this excellent early day motion the same topic, if you have time to copy and paste this short letter and send it to your MP then please do, it only takes a minute and the more MPs than sign up to it the better:
As one of your constituents I am writing to ask you to support and sign up to Dianne Abbott’s EDM 889.
COMMERCIALISATION OF HEALTHCARE PROVISION (EDM 889)“That this House believes that for the NHS to provide high-quality, comprehensive healthcare for all, free at the point of use, it must be publicly-funded through central taxation, publicly provided and publicly accountable; is concerned about the damaging effects that commercialisation of the NHS is having through market reforms including the use of independent sector treatment centres, imposed GP-led health centres and polyclinics, the transforming community services initiative and expensive private finance initiative projects; further believes that public money should be used for quality healthcare and not profits for shareholders; further believes that the NHS should care for patients through co-operation and not competition; supports the British Medical Association's call to abandon the market in the NHS in England; and urges Government to restore the NHS as a public service working co-operatively for patients, not a market of commercial businesses competing with each other for financial gain.”The founding principles of the NHS are under serious threat and it is therefore imperative that Parliament holds a debate on this very important matter. I am grateful for your consideration of this request and would appreciate a reply if possible.
Simpy copy and paste and send it to your MP: http://www.theyworkforyou.com/
Tuesday, 23 February 2010
The Department of Health and NICE both reference the Health Select Committee on this 25,000 figure. Strangely the Health Select Committee was presented evidence back in 2004/5 by a surgeon by the name of Linda de Cossart.
Linda De Cossart’s evidence talked of an incidence of pulmonary embolism (PE) of approximately 23 per 100,000 per year with an associated mortality of 12%. If one assumes that our population characteristics are similar to the US’ then this would make the number of fatal PEs in the UK only approximately 1600 per year. Apparently the US have the best data, so this would be a reasonable ball park figure.
Either way it seems that the evidence has been misinterpreted or spun by politicians. It appears that a la David Nutt saga the politicians are ignoring the science in determining policy. The real number of deaths secondary to venous thromboembolism appear to be around three thousand per year in the UK, so the talk of 25,000 is hogwash, the talk of 25,000 being 'preventable' is beneath hogwash.