Mid Staffs and the systematic failure of targets

It was no surprise that our esteemed leaders have tried to pin all the blame for the appalling standards of care at Stafford Hospital on the local NHS managers, this was to be expected, the fact that many hospitals around the country are also compromising standards of care in exactly the same manner as a result of the systematic mismanagement of the NHS is not something that Gordon and his friends in government will mention.

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:

"If there is one lesson to be learnt, I suggest it is that people must always come before numbers."

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:

Dear.............

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.

Yours sincerely...........

Simpy copy and paste and send it to your MP: http://www.theyworkforyou.com/

The 25,000? The thromboembolism lies

Following up on my last piece on the government's spinning of the thromboembolism death statistics, it turns out that less than three thousand people die as a result of venous thromboembolism per year, this is according to the 2008 statistics.

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.

Thromboembolism propaganda from HMG

The government is trying to convince us of the massive threat of venous thrombembolism (VTE), for some reason the threat of deep vein thromboses and pulmonary emboli has been hyped up beyond all proportion in recent years. Sometimes myths get propagated from nowhere as no one has bothered to check the actual facts from scratch, in my opinion this is the case with venous thromboembolism. This is a direct quote from the Department of Health's document on the subject:

"In 2005 the Health Select Committee estimated that there were around 25,000 deaths each year from VTE in hospitals in England and that the cost of treating the long-term disability caused by VTE was around £640 million a year. In 2007 there were 16,670 recorded deaths in England and Wales where pulmonary embolism and deep vein thrombosis (VTE) were mentioned on the death certificate (Office of National Statistics)."

This is disingenuous to say the least. Clots in the leg veins (DVTs) are common, pulmonary emboli (PEs) are much rarer and deaths from PEs are even rarer again. The government is spinning the evidence and facts. There were only 16670 deaths in one year with DVT or PE on the death certificate, so a DVT or PE was only the leading cause or a contributory cause in this number. They then go on to say that there are many more that are not put on the death certificate, in actual fact this is their faulty assumption. In reality DVTs are common and are by far the most common reason that VTE will end up on a death certificate, however equating a death certificate with a DVT as a contributory factor as being a preventable death directly due to VTE is simply preposterous, it is the logic of spin doctors, not scientists, no wonder this 25,00o fugure came from the Health Select Committe and not a proper medical journal.

To then jump to the conclusion that there are 25,000 'preventable deaths' a year from VTE is utterly ludicrous, there are probably way under this figure in terms of deaths, so to assume that 100% of these deaths are preventable is utterly ludicrous, utterly utterly ludicrous.

Medicine and life is a game of risks and balances. The government and NICE have come up with VTE prevention guidelines which mean that virtually everyone in hospital needs to be treated with blood thinners. Basically by making the above faulty assumptions they are forcing blood thinning drugs on a hell of a lot of patients and probably doing a lot more harm than good. For one there is no good evidence that any prophylactic agents can reduce the risk of fatal VTE, also the blood thinning drugs have some very well documented side effects, some of which are rather rare but extremely serious and life threatening.

To illustrate just how ludicrous the government's figure of 25,000 preventable deaths is, I have done a little mathematical calculation. Interestingly this figure of 25,000 was not produced by scientists or in a reputable medical journal, it was made up by the politicians of the Health Select Committee. Anyway if one assumed that every single person in the country had a hip replacement in one year, one would then expect there to be about 40,000 deaths from VTE that year, of note hip replacements are a very high risk procedure for death from VTE. So even if the whole country had a hip replacements then it could still be argued that we would not even get to 25,000 'preventable' deaths.

This whole sorry saga is rather reminiscent of the whole swine flu hype. The weak and corrupt state wants to make itself appear powerful and clever by creating a massive threat and then trying to stamp it out, hence creating the massively exaggerated threat of death from VTE and then try to combat it. As part of the same process a lot of drug companies and their friends on government panels like NICE are making a lot of money from selling a lot of over hyped drugs that thin the blood. At the same time patients are probably worse off as a result of the various side effects of these drugs, while the rate of death from VTE will not really be affected at all. Same old politics, a new topic for abuse and propaganda.

Hinchingbrook disgrace and PFI nonsense

Apparently the struggling District General Hospital in Hinchingbrook is to be taken over and run by a private company, according to the government and politicians this is not 'privatisation', it is about providing high quality services by using a leading provider. Interestingly Hinchingbrook's trouble must have nothing to do with various PFI schemes in which it was involved. It was also nothing to do with the PCT staving the hospital of funds because it was committed to throwing money at various private providers like a new treatment centre, as ordered by central government. These are the real reasons for the debt of poor Hinchingbrook:

· the Trust had lost out under Payment By Results;
· its NHS Treatment Centre had been starved of referrals by its own PCT;
· its caseload had been further squeezed by Foundation Trusts seeking
surpluses and by PCTs seeking economies and redirecting patients away
from hospital care;
· its budget had been further cut, and the cash used to send NHS patients
to private hospitals;
· and the merger of Cambridgeshire’s PCTs lumbered Huntingdonshire’s
health services with new deficits from elsewhere in the county.

The companies in the running include Circle Health, a company that specialises in 'John Lewis-style employee partnerships to boost productivity'. From their website regarding share ownership '50.1% is owned by Circle International plc'. This is the investment vehicle that blue chip City institutional investors have subscribed to for shares by providing the capital for Circle. So the controlling majority are not working 'partners' like John Lewis but sleeping 'partners' like banks. Care UK are also bidding, they are the firm that has been paying Andrew Lansley off for something that he can hopefully do when he steps into office later this year.

The perverse nature of this selling off of NHS contracts is there for all to see. Hospitals only get into debt because they are forced to comply with the top down market based reforms enforced by Whitehall, essentially they are being underfunded for doing the work that they have to do for patients. The market and payment systems are artificial, patients' illnesses are not, so when the system's error results in hospital debts, it is only the patients that will end up suffering.

Ironically these private firms will not give their money to improve the service, they will reduce the quality of the service and asset strip in order to generate profit for shareholders, this is the world of the short termist in business. Even more perverse is the fact that many of the scandalous PFI deals that are forcing numerous NHS trusts into massive debt are run by some of the big banks that were recently bailed out by billions of taxpayer pounds. The government is corrupt, foolish and acting against the interests of the public.

The likes of RBS and Lloyds are making shed loads of easy cash from numerous poorly thought out public service PFI schemes, and having been bailed out by the taxpayer, they are now partly owned by the taxpayer. Yet the government insists that these PFI schemes are good value and will not renegotiate them, meanwhile NHS trusts go into debt and are bought by big private firms that may even be partly owned by the very same banks. The banks cannot lose, the taxpayer and the patient simply cannot win, this game is rigged and it is a complete and utter disgrace.

Hinchingbrook is not an exception or an aberration, it is the inevitability of the destructive market based reforms that this corrupt government has indulged in. The top down market and privatisation agenda makes the like of Hinchingbrook's failure an absolute inevitability, the government knew this when it set about introducing the ghastly NHS Plan in 2000. Hinchingbrook will not be the last, it will be the first of many, the market based reforms have enriched many private firms for providing low quality services for a lot of money, the market is now set to bankrupt a lot of NHS hospitals, these hospitals will now be sold off and be used as yet another money making vehicle for the private sector. It is enough to make one weep.

Managers and the pathetic HSJ

If the public based their opinion of doctors on the picture painted by the media and not on their actual first and second hand experience of doctors then they would hold us all in incredibly low regard. Fortunately the vast majority of the public are much cleverer than the media give them credit for, doctors routinely do pretty well in various surveys of public opinion and levels of trust.

As Dr Grumble remarks, if one reads the Health Service Journal (HSJ) then one would think that doctors are evil blood sucking scum and that managers are lovely good willed angels. In fact the HSJ is not really a journal, it produces nothing of any quality, it is generally a magazine of selected opinion and discussion, one could almost go so far as to say it is a piece of propaganda, in fact I will. Compare the woeful HSJ to the journal of the British Medical Association, the BMJ, the BMJ is never so flagrantly partisan, it is never so overtly biased, it produces some decent balanced articles and some decent research, it might not be the New England Journal but it is reasonable.

The HSJ is an embarrassment, it is a Heat magazine style production, there is rarely anything of any substance in it, one will not find decent researched evidence used in any discussion or opinion pieces, one just gets baseless speculation and ideology. The Jobbing Doctor has exposed this with help of the excellent Clive Peedell. The likes of the HSJ fail to show any kind of objectivity in covering all matters health related, whether it be the government's complete mismanagement of GP Out of Hours care or the Consultant contract, you can be sure that only one warped side of the story will be spun.

In fact the government and the managers are the main two groups of people who routinely ignore the clinical needs of patients, they merely care for their own jobs and livelihoods, therefore spinning about their own success is all that matters, they would rather have a service that looks good on paper which lets patients down than an excellent service that doesn't look quite so perfect on paper. These two groups are strangely quiet when it comes to the selling off of the NHS to Richard Branson, Boots et al, it doesn't take a genius to see who this lot are looking out for and it ain't the patients.

Power corrupts absolutely - Berger, the BMA and the rot

The recent case of a young career politician being dubiously slotted in as the official Labour candidate for Wavetree is demonstrative of the fundamental problems within our corrupt political system. The fact that Berger lived at the house of the person running this 'selection process' obviously had nothing to do with her selection, it was simply down to her remarkable life knowledge and experience. She certainly has some money and connections, her shiny website is strangely closed to any comments. Interestingly it says at the bottom of this website that the very same Peter Dowling promotes the site, he is the partner of the Ms Kennedy who Luciana Berger stayed during the selection process.

People like Luciana Berger are the reason why are political system is going to the dogs. She is typical of a new breed of professional politician that knows nothing of real life but is highly skilled at meaningless gassing hot air. Berger is a close friend of the repulsive Euan Blair, another one of this cohort of young know it alls. The people of Wavetree should stick two fingers up at the likes of Luciana Berger by voting for the candidates with some real world experience.

This new breed are invariably ex-student politicians who spent their student days sliming around debating and greasing each other on committees rather than doing normal human activities. They then typically study vague and useless subjects such as politics and business, it is unusual for them to study something proper like a hard science. Then they will never get a real job which exposes them to the reality of life, they will instead lubricate with other greasy slime balls in an industry such as pubic relations, management consultancy or lobbying. They then become career politicians at a young age, they have no interest in serving the public, they are serving their own career interests. The only thing they are capable of by this stage is talking the dishonest doublespeak of a politician, they are now destined for a life of hypocrisy as self serving liars. They are of no use to anyone but themselves.

The medical equivalent to this contemptible breed is the career medico politician. Liam Donaldson is a great example, a colossal tool who couldn't cut the real world of clinical work, a man who preferred to tell the government what they always wanted to hear than actually serve his profession or the public. Carol Black is another example, a lady who is on more committees than John Terry has had lovers, she is a typical career medico politician, her malignant work in recent years has seen her sell her soul to the government in shafting junior doctors and the whole medical profession.

The process of gaining extra pay as a doctor is intrinsically corrupt, the 'clinical excellence awards' system is a corrupt old boys network that is used by medico politicians to control the workers, anyone who dares go against the politicians and managers will be partly discouraged from doing so by pay cuts that can result from the corrupt nature of this process. The GMC/government's new revalidation process for all will be yet another weapon with which to beat dissenters, the GMC's new local officers will be empowered to intimidate anyone who would dare speak out about malpractice or systemic failures, the conflicts of interest between the Trust/PCT management's interests and the roles of the local officers in protecting the public will be glaring, however this is what the government wants, a corrupt nepotistic system that will cover up problems, not an effective open system that will learn from its mistakes.

The corruption and anti-democratic nature of the way in the medical profession's union, the BMA, works is also another prong of this dysfunctional web of corruption. The talk from the likes of the BMA's Jonathan Fielden always sounds good, but the reality of it is that these Chameleon like creatures will say whatever is required for them to get to the next level of the food chain, they are only serving themselves like two year olds who pretend to be hurt in order to get an extra sweety. Back here Jonathan Fielden pretended to care for what the BMA membership felt in order to force Jim Johnson's resignation, I wonder how long it wil take for Fielden to metamorphose into the new Jim Johnson.

So what's the point of this wandering rant? Well, it is obvious that power corrupts and that those who seek power are the least suitable to wield it. Corrupt systems fade and grow in cycles, but the corruption will only wane if people start making some tough decisions, it is not an inevitability. The people of Wavetree need to make a stand against the shallow career politician that is Luciana Berger, however it is not quite so easy for the NHS and the medical profession. Hopefully every little stand will help, every time a target is ignored to give a patient a better service, every time people speak out against the lack of representation provided by the BMA, every time a consultant tells a manager to stick it when fighting for patients. Maybe with enough small pushes, the big pushes will start to follow.

Campbell cracks, if only the inquiry had some balls

Unfortunately I have been too busy to catch most of the Chilcot 'inquiry', if one can call it that, from the bits I have caught it does appear a completely limp and toothless sham. Most of the interviews I have heard have consisted of vague nothingy questions which allow the skillful liars, the politicians, to side step any awkward areas. The people doing the interviewing are clearly not skilled interrogators, if anything was to come of it then the questions had to be very salient and based on clear facts, Blair and Co will not be caught out when asked 'Hello magazine' style questions as to whether they have any regrets or not.

Dr Grumble alerted me to this moment on the Andrew Marr show when Alastair Campbell pretty much gave the game away, he was completely lost for words, I'd imagine this was because he got to a point in the road at which he could no longer lie to travel onwards. This point in the road that involved Blair misleading parliament, something Campbell tried to deny would ever be the case no matter of other hypothetical facts, this was a big error from Campbell, as if the evidence was not there on the WMD then it would be obvious that Blair had indeed misled parliament.

It is a sad indictment on the Chilcot inquiry that two of the biggest breakthroughs have come thanks to Fern Britton and Andrew Marr on their TV shows. This says more than anything else. In the end Campbell couldn't answer the question and after a few moments of silence, claimed 'Tony Blair is a very honorable man', he then tried to pretend he cared and was upset at events, my heart bleeds. The facts are clear, there was no decent evidence behind the claims that Iraq and Saddam had WMD, Blair had no decent evidence, the weapons inspectors openly stated there was no evidence, yet our government proceeded and spun things the way they wanted. It was never 'beyond doubt' that these WMD were around, it may have been 'beyond doubt' that Tony wanted to believe there were WMD because he wanted war anyway irrelevant of this. Blair, Campbell and all their cronies are liars, cheats and a disgrace to our country.

Polysystems, NICE killing, Mike 'O'Brien et al

There is just so much moronic drivel spewing forth from the government and its cronies that it's hard to know where to start. I shall start by the drive in London to decimate primary care there. The government is trying to make primary care cheaper and privatised, the problem is that all the changes to service delivery along with their new associated bureaucracies end up costing more money than just leaving the old system in place. Then when it is realised that the reforms are very expensive, the service ends up being cut and patients end up suffering as a result.

This is Lord Darzi's legacy in London. The 'polysystem' madness current being rushed through is exactly the politically driven policy disaster that doctors expected. There is simply no logic behind plans to centralise GPs into these poly-shambles centres, it is a massive waste of money and highly inconvenient for patients to have to travel far greater distances. In reality polysystems are just a shallow excuse for dumbing down the standard of primary care even further, more patient consultations will be handled by those without proper medical training (nurses), while the quality specialist led care of district general hospitals will be eroded by shutting these hospitals and dishing out the work to less trained doctors and other quacks. This is all about cheapening medicine and pretending it's in the best interests of patients when it quite clearly is not.

NICE is a another government organisation that is about as useful as a bullet in the head. Their guidelines are not only overly simplistic and frequently wrong, but they are also a hazard to patients. NICE's drive to lower the blood sugar levels of diabetic patients to such low levels that it actually increased their chances of dying was just one example of this. Another great example of this is NICE's drive to give everyone drugs to thin the blood to prevent the incredibly rare and infrequently fatal pulmonary embolus (PE). The danger of thinning every one's blood is obvious, you get more problems like thrombocytopenia and other bleeding complications. In fact there is a lot of evidence emerging that the blood thinners do very little to prevent clots, but they do increase the risk of some very nasty complications. First do no harm should be NICE's motto, alas it is not, many of their guidelines seem to have been written by those with some rather glaring conflicts of interests, as a result the guidelines end up serving pharmaceutical firms and not the patients that they are meant to help.

A fascinating exchange between a rather thick government minister and David Colquhoun has taken place in the BMJ this week:

"Secondly, and far more importantly, he is wrong to say I was mistaken to claim that "you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense." If it were irrelevant that the subject you are trying to regulate was nonsense then why not have statutory regulation of voodoo and astrology? The Pittilo proposals would involve giving honours degrees in nonsense2 if one took the minister’s view that it doesn’t matter whether the subjects are nonsense or not. Surely he isn’t advocating that?"

In my opinion the government minister, Mike O'Brien, comes across as a thick plank of the highest and densest order. His idiocy is well demonstrated in his illogical rambling. The government's policy making invariably ignores the actual scientific evidence, the people making these decisions seem barely able to tie up their own laces, let alone decide how to create new laws that should best serve the public interest. It is perfectly summed up by Gordon Brown's completely ill informed comments on cannabis while his own government completely fail to tackle the most dangerous drug in this country, alcohol.

Liam Donaldson also seems to have forgotten his science and has become rather too political with his swine flu exaggerations. The global warming nonsense is another good example of how what should always have been a scientific debate has become completely wrecked by its politicisation, the way in which this bullying bandwagon has been created on dodgy foundations reminds me a lot of the MMR scandal, hopefully bloggers will continue to dismantle the rubbish that our mainstream media and governments try to feed us.

European Law the problem

The coroner has ruled that a patient's death was unlawful after an incompetent German doctor who couldn't speak English properly gave him a fatal overdose of diamorphine. The case of David Gray has been well known and shows just how lethal the free labour market of the EU is. It is something I have harped on about here many times before.

It is simply beyond belief that the GMC are not allowed to check the English speaking and the medical competence of doctors who are registered with non-UK European countries who then wish to work in the UK. This is thanks to European law and it is a complete farce.

The German killer Daniel Abani is only the tip of the iceberg, every doctor, myself included could tell you numerous stories of various completely incompetent EU doctors who have worked upon these shores in recent years. The GMC's hands are tied by European law.

The government and DoH will try to pin the blame on the PCTs, this is rubbish, there are over one hundred PCTS and it would be ludicrous to expect these organisations or other employers to individually assess the competence of doctors they employ, this should be done by the regulator, the GMC.

The fault here lies squarely with the government for signing us up to these ridiculous and poorly constructed European laws, they have signed away our autonomy and our ability to properly run our own shop, in the process numerous bungling incompetent doctors are now free to work on our shores and there appears very little that can be done about it.

Niall Dickson, the new GMC chief, is in full agreement with me on this, he wants the GMC to be given the powers to regulate doctors properly, after all if it can't do that what can it do? The most shocking thing is that the current European system is a lethal farce, Daniel Abani is still able to work in all EU countries other than the UK, he is only struck off here.