PMETB- beyond a joke

PMETB (Postgraduate Medical Education and Training Board) have the unique position of being able to question junior doctors in training on a yearly basis. This is an opportunity that should not be missed, it should be a time when the views of trainees can be taken on board to work out where things are going wrong, problems could then be addressed and training could then be improved. Unfortunately PMETB wastes this opportunity on a yearly basis by ignoring many of the key issues behind training and subjecting junior doctors to completely useless questions that would be better left in 'psychobabbler's monthly'. Listed below are some of the questions that trainees were asked this year:

Have you had formal teaching since leaving medical school in any of the following?
Patient safety Appraisal skills Teaching skills Leadership Team working Communication Time Management Medical ethics None of the above

The political creation 'patient safety' is slipped in here. Everything that a junior doctor learns is aimed at making them a better doctor, and is linked up with patient safety, so what the hell would a 'patient safety' teaching session comprise of? Words fail me.

In this post how often do you have the opportunity to learn together with other healthcare professionals (e.g. nurses, physios etc)?

Why are they asking this? Doctors should not be taught with nurses and physios, as they are being trained to be doctors, not nurses and physios. Again this question shows how PMETB are trying to hint towards the 'skills escalator' with their survey, their politically driven questions are designed to give them ammunition for yet another politically driven agenda.

In the last month, have you made a serious medical error?

Is anyone really going to say yes to this one? The PMETB survey is meant to be anonymous, but in reality it would be easy to work out who filled each form in from the basic questions at the beginning which include speciality, year and university of graduation and more give away details.

I'm always willing to admit it when I make a mistake.

No matter who I'm talking to, I'm always a good listener.

I sometimes feel resentful when I don't get my way.

(Describes me-very wellfairly wellfairly poorlyvery badly)

Now the questions are nothing other than a joke. It is turning into a psychological questionnaire, one wonders what the relevance of this is to medical training?

How often do you feel:

Inspired?

Afraid?

Enthusiastic?

Nervous?

Determined?

Scared?

(Very slightly or not at all A littleModerately Quite a bit Extremely)

The psychobabbling rubbish continues, I find it amazing that so many questions are wasted on such vague nonsense. It is more amazing when seen in context of what has not been asked my PMETB.

They ask nothing about competency based training, nothing about the excessive paperwork that trainees have been bombarded with. There is also no mention of the European Working Time Directive (EWTD) and its impact on training, as arguably EWTD is massively reducing exposure and hence experience levels, how can this be continually ignored? Maybe it's because they want to replace experience and an apprenticeship with black and white competency based assessments, a disingenuous tactic in my eyes.

Even though PMETB are fishing to find out whether junior doctors are being taught with other HCPs, there are no questions as to whether trainees feel that their training is being damaged by the introduction of more and more HCPs doing jobs that used to be a valuable part of a junior doctor's training. There was also no mention of study budgets and whether trainees were still having to fund their own training with minimal help from the government?

There is no mention of MTAS or MMC, and what trainees think of these failed policies. There are strangely no questions about the role of PMETB and how well trainees think PMETB is doing its job. There is also an ominous lack of questions asking about the quality of Foundation training, I suppose any questions on this topic may well scupper the politicians' claims that Foundation training is such a great success, they think by saying it over and over enough times it will magically become a reality, I think not.

I could go on, there were many other rather important issues that PMETB whitewashed over with its 'unique' set of questions. One question that does not need to be answered is what trainees think of the Tooke review's seventh reccommendation:

"PMETB should be merged within GMC to facilitate economies of scale, a common approach, linkage of accreditation with registration and the sharing of quality enhancement expertise."

The haphazard and disorganised regulation of medical training should not be allowed to continue. Organisations like PMETB are happy to tell people what to do, but are never happy to take any responsibility for their actions or roles. PMETB's state of denial during MTAS 2007 summed up this rather glaring lack of accountability.

If anyone from PMETB is listening then I would like to express the state of my emotions regarding PMETB's handling of medical training. I am not at all inspired by PMETB's actions, very scared that PMETB are given such responsibility, afraid of how badly things are going wrong at the moment and very determined that trainees should have much more of a role in leading medical training out of its current crisis. Listen up PMETB, trainees are frustrated with your incompetence and we want to be listened to.

The state nationalises our organs

The Telegraph leads today with a story concerning the government's latest plans to change the way in which organs are 'donated' in the UK. Gordon Brown wants to move towards a system of 'presumed consent' which would mean that anyone who did not wish to donate their organs would have to opt out.

The system of presumed consent is apparently already working well in Spain, where they have the highest proportion of organ donors in the world. Undoubtedly there is a problem with the current state of affairs, as there are too many people dying while waiting for an organ.

However surely it would be more ethical to simply put a bit more effort in getting people to opt in to organ donation in the first place? I, for one, have barely noticed the government trying to encourage people to carry donor cards over the last few years. There would also be many other ways in which to increase the number of people who were willing to donate, for example why not get GPs to ask this question when a patient registers for the first time, just a simple idea. For once I agree with some of the patients' groups:

"We don't think a private decision, which is a matter of individual conscience, should be taken by the state. If people want to give the gift of life, that is their right, but it must be something that is a voluntary matter. "

Ethically and morally I have a problem with the idea of presumed consent. It comes down to whether one thinks that the ends can justify the means, and there are also many less controversial ways of increasing the numbers of organ donors. Personally I think the government should put more effort into gaining people's consent before presuming it.

An open honest culture

The following story shows just what happens to whistle blowers in the NHS, in the open honest NHS culture of ours:

"A junior doctor who was excluded from work for five years after she objected to the inclusion of patients’ medical records, including her own, on research databases without consent has received an unreserved apology from her employers in the High Court.

Named only as Dr Z to preserve her anonymity, she is subject to a gagging order and cannot discuss her case. However, the BMJ understands that she will not return to her job but has accepted compensation for the false allegations made against her and for the blight on her career.

Acting without a lawyer, she brought a libel action against her employers, Cambridgeshire Primary Care Trust, and the East of England Strategic Health Authority, which hosted her training scheme.

Damian Brown, for the trust and the authority, said in a statement in open court that Dr Z, whom he described as "a talented young doctor," had at an early age had a serious life threatening condition that attracted much research interest. She wanted the details kept private.

However, her medical details were disseminated for research purposes to Addenbrooke’s Hospital, Cambridge, and from there to personnel involved in her employment. Despite withholding her consent she was subjected to "uninvited, intrusive, and upsetting" phone calls from unknown researchers. She was also concerned that during her employment she and colleagues were expected to take part in research that used patients’ data without the patients’ consent.

In August 2002 she was referred to an occupational health consultant. As a result of communications arising from that referral she was put on special leave from her employment.

In September 2006 her employment contract came to an end and was not extended. She applied to the High Court and won a temporary injunction stopping the primary care trust from terminating her employment.

Mr Brown said that the trust and the health authority wished to make it clear that their suggestion that her fitness to practise was an issue was "groundless and unfounded." They unreservedly withdrew any suggestion that she was a candidate for referral to the General Medical Council.

They also accepted that accusations that she had given a false name and address to her doctor and had falsified sick notes were untrue. Despite a previous statement by the trust that it was "not possible" that her records were held in the research database, the trust acknowledged that her records were held there.

The trust and the authority admitted that they were misled by a third party, who had now apologised, and should not have placed Dr Z on special leave. They acknowledged that she had had "a long and distressing battle to preserve her medical privacy" and said that future employers should not regard the time she spent on special leave as "in any way a stain on [her] character or professionalism."

Dr Z said in a statement: "I raised concerns relating to unethical research practices which threatened patient confidentiality and were being conducted in breach of the law. I was then excluded from work for a period of five years, on the basis of allegations which the trust now concedes were groundless.

"After six years of medical training and several years working long hours as a junior doctor and dedicating myself to the health service, medicine was my life. Being excluded from work for five years has curtailed my promising career and caused absolute devastation to both my professional and personal life and to my family."

Peter Wilmshurst, a consultant cardiologist who advises whistle blowers, said, "The experience of this doctor shows that promises to protect NHS whistle blowers are hollow. Those who express concerns about ethical matters can still expect to have false allegations levelled against them, to be excluded from work, and to have little or no support from defence organisations or trade unions.

"We need answers to questions. Are the bodies involved now complying with the Data Protection Act? How many millions of pounds were spent in legal costs unsuccessfully defending the actions brought by this junior doctor and in complying with the instructions of the courts to delete computer records and destroy documents? Are the senior managers and senior doctors who failed to resolve this matter at an early stage being asked to account for their actions?"

A spokesman for the SHA said: "NHS East of England follows the national framework concerning the use of patient records for research purposes"."

An open honest culture catalyses improvements to the system, as errors and mistakes are fedback and acted upon.

A dishonest closed top down culture catalyses failure, as errors and mistakes are buried, they are not acted upon, they continue and perpetuate over time. This is the way of the DoH's top down NHS.

Tooke final report now out

The final Tooke report is out, and it can be read in full here at the MMC Inquiry website. It's not the shortest document in the world, and who would expect it to be. However there are certainly some rather interesting chunks in there at first glance. The Witch Doctor found this bit to be particularly relevant to today's NHS:

“In formulating the necessary corrective action the Panel believes that a
presumption of an aspiration to excellence is crucially important if the health
and wealth of our society is to be maximised in coming decades. Both health and
higher education are now global commodities. It can no longer be assumed that
the enviable position that postgraduate medical education (and related
biomedical research) historically enjoyed in the UK will be sustained unless
such issues are addressed.”

I agree with the Witch Doctor and the black cat on this one. It must be seen in context of the way in which education is being seen as a commodity in a rather short sighted and frankly stupid manner by our dumb political masters. Read the excellent Ecologics for more on this here, here and here. In my opinion it shows how unfettered capitalism is a great danger, as if money is seen as the be all and end all to everything then everything else is ignored. In this way excellence and seeking the ultimate truths, for example in scientific study, are not important if they can't be used to make money as commodities. As humans we have many complex needs which do not always revolve around commodities and cash, if we ignore them it will be at our peril, we will become very unhappy individuals indeed.

Medicine is a case in point, it should not be turned into a commodity in this manner, otherwise excellence will be ignored at the expense of easy profits. I will be back to finish off this piece later, but duty calls......

2008 bloggies awards

http://2008.bloggies.com/

The bloggies 2008 want your nominations for 2008, and there are certainly enough categories available for nominating your favourite blogs including best new weblog, best kept secret weblog and best weblog of all.

Among my favourites are Dr Rant, Dr Grumble and Dr Crippen; it's a great shame that Dr C has been out of action for so long but you cannot question his amazing output, I really miss it and hope to see him back soonish.

Please nominate your favourite bloggers and try to put some medical ones on the map at the Bloggies this year. Medical blogging has come on leaps and bounds in my opinion in the last couple of years, and it would be good if this progress continue to be built upon.

Sian Thomas - hang your head

The rushed and incompetently managed medical training reforms will cause untold damage over years to come, MTAS 2007 was merely the tip of the iceberg. The way in which the DoH has presided over this disaster is typical of the way in which the DoH manages things to do with health and the NHS. They have shown their arrogance, incompetence and stubbornness time and time again. Those in positions of power in the DoH seem to be selected on their ability to patronise and negligently mismanage anything that they delight in touching.

The government is privatising and dumbing down the NHS, the UK is one of the most under doctored country in the developed world. Yet the DoH and government are happy to waste millions training up non-doctors to do the job of doctors, while making thousands of properly trained doctors unemployed at the same time. This typifies the way in which the government detests professionals with a decent education, probably because many politicians are just failures who couldn't cut the real world.

For example this year there are over 20,000 applicants competing for under 10,000 jobs and Sian Thomas, another beacon of intellectual genius to emerge from the NHS' management hierarchy, has the ignorance to state:

"It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live."

Sian Thomas is either very very dim or is about as trustworthy as Tony Blair. Competition of this level is not good for anyone. It is lunacy to have so many thousands of highly trained doctors out of the training loop, especially when we are so desperately short of doctors in many many areas. It must be remembered that these junior doctors cannot train anywhere else in the UK, they can only train with the NHS, or they must emigrate for good, something I may add which many are in fact doing. Sam comments on the same issue here.

The mismanagement of medical training will have two main effects. One will be that thousands will quite medicine or emigrate, and this is a shocking waste, especially given the need for doctors given our expanding population and increasing proportion of elderly. Secondly many junior doctors will not be trained, they will be left to rot in career grade posts; and this is most definitely bad news for patient safety. Sian Thomas and her embarrassing colleagues should educate themselves a little before opening their ugly gobs, as their actions are resulting in things that can only be for patients and standards in health care. Sian Thomas are her ilk are motivated by their own career progression and satisfying their political masters at any cost; they are catalysing the dubbing down and privatisation of our health service to save money, and patients will pay the ultimate price for their treachery and dishonesty.

ps Anyone unlucky enough to get caught up in this disaster please keep an eye on Remedy's Job update site which is free for anyone to use.

Scum of the lowest form

The government are nothing other than filth. They have revealed their pathetic offer to GPs today, and it is nothing other than an offensive insult. GPs have been subjected to a campaign of nonstop government propaganda for the last few months, and now we can see why, the government wanted to bully them into accepting this insulting offer.

Essentially if a GP practice does not open for extra hours for free, it's actually for less than free as they will have to fund all the practice's staff for the extra hours for no extra money, then the practice will lose thousands of pounds per year- the figure is around 36,000 pounds for a 6000 patient practice. If the GPC does not accept this pitiful offer then the government will enforce a massive pay cut on GPs on top of this.

I am not a GP but am able to appreciate that primary care in the UK is a pretty damn good service, and the reason for this is that GPs have been empowered over the years to run their own practices. The government, as well as being scum, are thick because they are forcing things backwards towards GPs being salaried in a way that will undo all the good work that GPs have done over the years. This letter from a senior GP sums it all up rather well, it gets across the contemptible way in which the government behaves as it tries to destroy a profession:

"If we ignore the content of the letter where Dr Buckman says that the profession are prepared to work some extra hours on top of our present 52.5 hours a week (albeit for extra funding), the GPC reaction to the government over the last year or so has been so weak that the government now believe they can get away with anything.

We have had all the propaganda in every newspaper, radio and television news programmes relaying the DoH false information on GP pay and how little GPs do to earn that pay. Then we have the government attitude to places like Creswell in Derbyshire, where the PCT have been pushed into accepting anyone rather than conventional GPs to run a vacant practice.

We have Birmingham which is going to run a scheme where the present GPs have to join the PCTs franchised scheme or lose their practices, meaning that the have to apply for their own jobs on less favourable terms. Add rural Northumberland , where practices are being told they will lose a few tens of thousands to some losing well over a hundred thousand pounds, not because their job is going to be easier, but because the PCT is short of cash.

Move on to the GMC which has become a government quango which, for some reason, we pay for the privilege of stopping us working as doctors. Against the wishes of the profession they now run kangaroo courts with a large majority of lay people and just a token medical attendance. It has changed the admissible evidence to "balance of probability" rather than "Beyond reasonable doubt" (and even before that, in Dr Southall"s case, they preferred a mother's account of a vital meeting rather than the doctors, corroborated by a social worker who was taking contemporaneous notes. How long will it be before the GMCNHS rules on saving money, meaning that if GPsGMC (the local GMC rules, not on medical standards but on the standards of the present continue to be the patients' advocates, they will be up before the officers will see to that)

Go on to pensions where, ignoring ones like me who have unilaterally had their pensions devalued, the GPs have to pay a whole lot more of their pay to get the same or even less good pensions. Add to this no pay increase for three years despite additional work, another new tier of regulation on top of the GMC disciplinary body, and I wonder what it will take for the GPC to decide that some action needs to be taken.

We can do simple things. The GPC can use their PR Dept to produce a poster campaign for us to put up in our surgeries with a different subject every month on a rolling campaign so that our patients learn what is in store for them in the GP-light primary care of the near future. We could each of us slightly reduce our index of suspicion, do less of our "watch and see" policies and refer to secondary acre straight away. We could choose to prescribe better drugs for our patients rather than the generic muck we are exhorted to prescribe, we could withdraw all GP input into the running of PCTs and all government bodies, and WE COULD COLLECT RESIGNATIONS FROM THE NHS because in five years our jobs in the NHS will not be worth having.

Why I, a GP who will be completely retired in a few years is so angry about what is happening to my beloved profession, when those who have many years in front of them, is completely beyond me. Do they not mind the loss of professional standards, the loss of a reasonable standard of living with less and less time with their families, or do they just believe that the government will do what it will do in the end. Do they not believe the profession is worth fighting for, and do they not believe that with concerted action we could actually bring any government down?

For God's sake, please let us have a serious campaign against this government plans which will produce an NHS like the russian health system of the 60s."
I couldn't agree more, the government is taking us towards a system that will resemble Russia in the 1960s. Hospital medicine has suffered for many years because of the government's over controlling and toxic influence, and now the government wants to wreck primary care as well. These few years will be looked back on as the classic 'I told you so' moment, when the government well and truly wrecked a perfectly good system thanks to their cowardly contempt anyone other than themselves. They are pure and utter scum.

Honour and a lack of it

It seems that one of the men behind the MMC scenes was honoured by the government, no change there then, rewarding failure as usual. Happy new year Dr Grumble.

Meanwhile Dr Rant predicts a riot, and has copyrighted several prophetic prophecies for the new year. I suspect that Dr Rant's prediction number 4 will be wrong, the conservatives are showing precious little sign of producing any decent health policy: in fact they seem remarkably intent on deliberately not steering too far away from Labour's ideas, as any gap leads them open to attack. The Tories seem to prefer to keep away from disussing real policy changes that might actually do some good, as they would rather score points by criticising Labour for their indisputable incompetence. It's a real shame because it wouldn't take much to improve Labour's management of the NHS.

The Devil's Kitchen talks a lot of sense in dismantling Labour's pathetic record on hospital acquired infections:

"Virtually all of these factors have been contributed too and massively worsened by the government's incessant interference and meddling with the NHS. A chronic underinvestment has left buildings and infrastructure outdated and unable to cope with modern infection control needs. Top down targets have led to the excessive movement of patients and the catalysis of infection spread. Falling acute bed numbers over the last ten years have led to bed occupancy levels rising to too high a level on average, a known factor in increasing hospital acquired infection. Centrally imposed deficits gave led to the financial pressures that result in key front line staff being laid off, while wards are left dangerously short staffed. While endless political interference in the structure of the NHS has resulted in reorganisation after reorganisation, a situation where no one knows their role, and consequently a system of no responsibility and
accountability.

The government has let hospital acquired infection multiply out of control in recent years because it has simply not addressed the root causes aggressively enough. These ideas of fining failing trusts are completely misconceived and would make a bad situation worse. In fact several causal factors are still being worsened by direct action from central government, so the idea of central government fining people for things that it is directly contributing towards is nothing short of idiotic, while the fines would only accentuate the problems by worsening the causative financial pressures on the trust concerned. We currently have a situation where there is no accountability or responsibility, and if there was I have a distinct feeling that several of the people being held to account for this mess would be of the political variety. The politicians should be fining themselves."

Indeed, the government should be fining themselves and they most certainly should not be getting an above inflation pay rise. In fact it would be much better for democracy in general if politicians were paid much less, as this would attract many less career politicians into politics. I would much rather be ruled by wealthy individuals who were involved in politics, who did not depend on their political income at all. They would be far less corruptible than the current bunch. Just think of one Tony Blair, his financial situation meant that he had to keep certain people happy while in office so that once he had left office, he could earn enough cash to pay for his luxurious lifestyle and multiple houses. Cut down MP pay I say and end the era of the corrupt career politician. MPs should be men with experience of life outside politics and they certainly should not be so easily corruptible.

Happy new year one and all

I would like to wish all my readers, both the accidental and the deliberate ones, a very happy new year and all the best for 2008.

I am working at the moment, as I would not be on the Internet if I were not, I would probably be dribbling by now.

My zeroes for 2007 go to Patricia Hewitt, Liam Donaldson and Martin Marshall.

Anyways happy new year.

BBC spinning for HMG

This story headlined this morning's news on the BBC. The crux of it comes down to some guidelines on cancer referral by the government's rationing agency NICE that can be seen here and here.

Hardly the straightforward story that the beeb portrays. The NICE guidelines are hardly free of confusion themselves and as the BMA say, the capacity is not there to deal with all these referrals anyway.

Really the issue of capacity should be addressed before laying into GPs who have to do a tricky job. Interestingly capacity is barely mentioned by the BBC, one just wonders how much of a push from government they got to run this story?

In the old days referrals were screened by specialists who would prioritise the referrals as they saw fit, using their years of training and experience to benefit patients. Now referrals are sorted by managers who have no medical knowledge at all, meaning that cases are not prioritised as effectively as before.

The 2 week wait has been shown in the scientific literature to be a complete waste of time as the capacity is not there to see all the urgent cases within two weeks, and the system ends up prioritised the anxious patients over the ones who are more likely to have cancer. For example it has been shown that with breast cancer, the 2 week wait has lengthened the time to diagnosis and has increased the numbers of cancers referred as 'routine' non-urgent cases.

If the BBC actually researched it's stories properly then it would realise that the problem we have is a lack of capacity and the stupidity of the 2 week referral system. We need to increase capacity to deal with referrals and go back to the old system of letting the expert clinicians screen the referrals, thus prioritising the most urgent cases. Experts will also tell you there is currently a crippling shortage of breast radiologists, meaning that it would be impossible to increase the capacity for the quick triple assessment of breast lumps anyway.

The antidemocratic decimation begins

It's not been the most clever, subtle or brilliant plan of the Department of Health's; however their resident incompetents have shown yet again that they care not for quality of service or for what people really want. Large surveys costing millions have shown time and time again that people just want good local services, and that the majority of people are very happy with their GP services. There is undoubtedly a problem in poorer areas, a problem that has been made worse by the new GP contract which makes it impossible for GPs working in poorer areas to earn as much as those in richer areas, thus further disincentivising GPs moving to these poorer areas. The DoH's tick box QOF medicine has done the exact opposite of what was intended, it has catalysed more inequality and wasted a lot of money on paperwork.

The Department of Health is now railroading through plans to privatise primary care, this is despite a groundswell of public opinion against such moves, and a rather lack of a transparent consultation process:

"Doctors have
accused the government of trying to privatise general practice after it
published guidance about setting up new practices in England.

Ministers have ordered health chiefs to create 100 GP
surgeries and 150 super-surgeries known as polyclinics.

The British Medical Association said the guidance works
against existing GPs from bidding for the contracts, leaving the field open for
private firms. "

The polyclinic is an appalling idea. It will mean those in deprived areas having to travel much much further to reach their local services, and one must remember that it is not easy for the sickest and frailest in society to travel the extra miles. So much for 'local' services, the polyclinic represents the worst of both worlds; not big enough to safely do what a hospital can do, but centralised enough to be a massive inconvenience to patients.

The Department of Health has no idea of business or medicine, thus when it tries to combine its thinking on the two, the end result resembles horse manure. The private sector is given a massively unfair advantage whenever it is involved, thus meaning that any gains of competition are lost immediately. Service will be sacrificed at the expense of profit, while the Department of Health conveniently forgets to audit or regulate the new private providers. We have seen in the past how negligently the DoH has been in helping the private sector to our money, whether it be in the form of the pitiful Walk in Centres or the ludicrously expensive ISTCs.

It is indeed a new year, however we still have the same bunch of corrupt incompetents in charge of the Department of Health. If these idiots worked for a business then they would have driven it bankrupt long ago, but alas they work for the state and this government seems to reward their incompetence with special favours. Their record of mismanagement spoke for itself in 2007, and I'm sure they will plumb new depths in 2008. Well done DoH, you truly are an example of how badly wrong top down state controlled ventures can go.

Merry Christmas to one and all

The year is finishing as it started, with more incompetence from the Department of Health, as yet more personal data has been lost by NHS Trusts around the country. The Department of Health cannot have it both ways as usual, they must shoulder some of the responsibility for the mess that they have created beneath them.

The new MMC website has been launched, for some reason they think that putting shit in neat packages magically turns the shit into good policy, it's a great shame for trainee doctors that this isn't the case; rather the reverse seems to be true, as the more money that is wasted on pretty packages the less money is left over the actually spend on the nuts and bolts of training. Read this and vomit:

"Modernising Medical Careers (MMC) is making radical changes to postgraduate medical education with the aim of bringing more structure into the career path for doctors and better training towards the very best care for patients."

One wonders how completely demoralising a generation by rushing through training reform far too quickly is going to be good for patients in either the short or the long term. MMC is a classic example of the DoH's complete lack of skill in making good policy, in fact the evidence from the Health Committee of late has shown how the DoH has a bunch of idiotic cretins making the policy who are completely out of touch with the clinicians on the ground. The MMC group had no one with a background in clinical medicine in the end, no wonder it was completely detached from reality.

The DoH has been found to have breached the Data Protection Act by the ICO, after last year's leakage of applicants' information during MTAS 2007. It's a shame that the pathetic punishment by the ICO consists of just a written warning and the DoH having to respect the law in the future, surely they should be punished properly for ignoring the law last year? That would be too much like accountability for the DoH though, and if they were accountable for their mistakes they would probably have no employees left by now.

Anyways a Merry Christmas to one and all, and a happy new year while I'm at it. Seasons greetings to Dr Grumble who does not quite see why so much money is being spent on computers, to Dr Rant who does not see the point in extending GP's opening hours, to the Angry Medic who details the impotence and malignant nature of 'Dr P' who has sunk lower than most with some rather vindictive lies (it seems some people have to resort to rather desperate tactics when logical argument has failed them), to Dr Ray who seems rather happy for a pleasant change, to Front Point who has been consistently impressing some excellent commentary as always, to Nursing Student wishing her all the best in her job search, to Random Acts of Reality who is as enjoyable to read as ever, to Barry Monk who has been campaigning as effectively as ever, and lastly to the Witch Doctor who is hopefully correct in saying that a daffodil may be about to bloom. Regards one and all.

Bureaucratic nightmare

There has been plenty of talk in the media of late on the subject of the EU's attempt for a free market in health. Obviously there would be some advantages to such a scheme, for example it may well lead to the dismantling of the ineffective internal market; however how on earth could such a scheme be practical?

"Under the draft plans - which are now expected to be announced in the New
Year - a patient would have to be referred by a medical professional and
demonstrate they faced an "undue" delay for treatment in their own country.

They would have to pay for the cost of their treatment up front, and
then claim it back from the NHS. The patient would also have to meet travel
costs themselves."

Is it just me, or would the potential costs in the form of the bureaucratic burden of this new scheme far outweigh any benefits that it may bring? Just imagine the potential for a proliferation in the costs of running and managing the market, let alone regulating it. At the end of the day people just want good local services, they do not want to travel to other countries for their operations. Also a lot of medical work is done as an emergency and cannot be done electively; the elective work is needed to keep a hospital ticking over so that it can provide its emergency care. Thus if hospitals lose their elective work then their emergency services will suffer, and who will pay the price for this? It will be those unfortunate enough to get ill in these areas.

Health Committee update

Some rather revealing information came out this week, I shall attempt to summarise it for you. Crockard and Heard pointed out that they were the only two with a medical background on the MMC specialist board, and when they had left there were no people with medical backgrounds left in the MMC specialist training committee. This is an amazing admission and a sad indictment on the way that medical training is being run by idiots with no understanding of what they are managing.

What about the 'drift' towards run through training? Well it seems here that the four CMOs made a policy statement which set the direction for run through training, and this appears to have never been properly consulted as the wording of the earlier 'Unfinished Business' left things quite open and flexible as regards run through training. The policy seems to have been rather ahead of the consultation process, and then for some reason run through training became a straight jacket that it never had to be.

It came out that Crockard and Heard were both rather in favour of run through training, and therefore rather unable to see the massive downsides to its rigid nature. They didn't touch upon junior doctors who change their mind about which specialty to pursue, they also ignored the fact that many people do several years of other specialties which adds to their all round skills. Crockard and Heard's naive love of Foundation training showed how detached from reality they are, they must have been living on another planet for the last few years to believe that Foundation training gives junior doctors a better all round grounding than the PRHO year. Thanks to Foundation training juniors can waste months in useless posts without getting enough exposure to the bread and butter.

Amazingly MTAS was set up in 2005 without any attempt to engage the MMC team in the process, from the sound of it the DoH railroaded through DoH ideas in a completely uncompromising fashion. Shelley Heard made it clear that in her opinion the use of the electronic modality was very badly thought out indeed, and stated that scoring of applicants should have been based on 'harder' information, surely a dig at the white space questions? It was clear that the DoH tried to 'go it alone' in limiting applications from HSMPs, the DoH ignored the Home Office in its great wisdom. It shows an astonishing arrogance and incompetence exhibited by the DoH. Even Alan Crockard had great difficulty in getting through to the CMO's ivory tower, he spoke the deputy CMO about his concerns but I wonder what actually happened between the CMO and his deputy?

Next came the BMA and BAPIO, including Jo Hillbourne. The BMA bizarrely hinted that the profession should take the blame to a degree, whatever that means, surely the BMA's job was not done properly as they are meant to be representing the profession. The BMA was asked whether Remedy and Fidelio were more representative of the profession and their answer was pretty limp. Remedy was described as a single issue pressure group, what patronising rubbish, and the BMA claimed that when it raised concerns of policy it was excluded! Does this mean our union should never raise its concerns because it may be excluded? This is pathetic.

Jo Hillbourne thinks the JDC did everything it could have done, but was not supported by the higher BMA. Jo Hillbourne still thinks that it was a good idea not to have withdrawn from the MTAS review process, she thinks that engagement was more productive than open withdrawal; interestingly she said that the Royal Colleges did not want the JDC on the Douglas review group. It was very clear the the BMA and BAPIO felt that workforce planning had been completely mismanaged by the DoH.

I am still only1 hour 40 mins through! I will try to find time to listen to the remainder and vent my fury.

DoH sees anyone who disagrees as just 'noise'

The first interviews by the Health Committee involved hearing some rather pathetic comments from the deputy CMO Martin Marshall; as he had to explain the reasons for railroading through MTAS 2007 against a massive majority of the medical profession:

Martin Marshall "On balance the benefits of continuing far outweighed the benefits of stopping the process"

( the benefits for the DoH that is)

When he was asked what the profession was saying at the time:

"There were a lot of letters, emails, blogs on websites that said that the process should be stopped, but I felt that the voice of those that felt it should continue was muted, particularly in the spring in the heat of the problems, their voice were expressed very strongly, by a lot of the candidates who had had interviews who wanted them to stand, by the service who didn't want a vacuum on August 1st, and by a lot educationalists as well"

Then when asked if there was an equal balance of people who wanted it scrapped and people who wanted it to continue?

"Not on volume, not on noise, certainly not, the people who wanted it stopped were making a much louder noise"

So then what was the justification for not listening to this noisy majority?

"It had to be a rational one, not one based on noise"

This sums up the contempt that the Department of Health routinely shows for the medical profession in trying to railroad through its unpopular and failing policy. It is hardly surprising that everything the DoH touches turns into manure, when they write us off as just 'noise'. If the majority of the medical profession are 'noise' then I would equate the efforts of Liam Donaldson and Martin Marshall to a gnawing 'sqeak' emitted from a dying rat. The recent Health Committee interviews with Crockard and Heard unveiled the fact that the MMC specialist training group contained zero, yes zero, people with a medical background.

We are being managed by buffoons. The health service cannot be adequately managed and run by people who have no understanding of medicine, the DoH are proof of this. Would it be acceptable if the Bank of England was run by people with no knowledge of economics and no background in finance? The DoH is even so foolish as to empower people with no medical degrees to diagnose and treat disease, this could only have come from people with no background in medicine. Negotiation with these fools is not productive, as they cannot detect sensible reasoned argument when it slaps them in the face. The police service has been treated with a similiar contempt by this government, and they have now realised that agitation and beyond is the only way ahead. How much longer must this go on before we do the same?

BMA drop an absolute clanger

One would have thought that following the BMA's negligent role in the MTAS affair of 2007, that they may have learnt something from the episode; unfortunately for junior doctors is Scotland it appears not. It turns out that the BMA's Scottish Junior Doctors Committee is backing run through training, despite it being against the wishes of the majority of its members.

In medicine for example, posts at the level of ST1 will be run through posts, as in MTAS 2007. This means that only Foundation doctors and non medical trainees will be able to apply for these run through posts, all other medical trainees will be deemed 'too experienced' to apply. The 'lost tribe' are being frozen out as these run through posts are not available for open competition.

The uncoupling of posts as suggested by the Tooke review is not something that the Scottish JDC appears to agree with. However around 66% of people disagree with the JDC on this, with only 22% agreeing; that's a ratio of 3:1 in favour of uncoupling. This majority of people must be delighted with the BMA's representative role here.

Another great achievement for the BMA, they really must be proud of themselves.

An obvious lack of skills for health

The Department of Health has been contacted as regards the scary 'Skills for Health' ladder, another seemingly idiotic reform that must have been spouted by someone who knows very little about providing a good standard of health care. This is the response received:

"Thank you for your email of 6 November requesting, under the Freedom of Information (FOI) Act, information about the Skills for Health Career Framework. Your email has been passed to me for reply.

I can confirm that the Department of Health does not hold the information you have requested.

The Career Framework for the NHS originated from the former NHS Modernisation Agency. A stakeholder steering group was established in 2004, chaired by Andrew Foster, former Director of Human Resources for the Department of Health. The aims of this Group were to determine priorities and timelines for the development of the framework, determine its aims and objectives, and to provide leadership.

The Career Framework was officially launched through the publication of a discussion document for open distribution in June 2004. Over 30,000 copies of this document were distributed. The document included an invitation to share comments, a number of which were received from healthcare professionals, education providers and professional bodies.

The Department of Health asked Skills for Health to take over further development and population of the Framework in summer 2005. The remit was to further develop and embed a competence-based career framework for health, where possible ensuring that the framework is capable of being applied on a UK basis. Initial priorities were given for population of the framework.

Since that time, work has been ongoing to test and refine the framework methodology and to develop integrated tools to enable the sector to use the Career Framework consistently as part of their approach to workforce development."

Sounds like a load of hot air to me, just like the "Skills for Health" framework. With this kind of useless government scheme it is standard that the very opposite of what is being claimed is actually true, ie "Skills for Health" would be better termed "Lack of Skills for Health".

This kind of pathetic numpty level thinking is responsible for the dumbing down of medical standards in this country. The rise of the Noctor is a worrying phenomenon whereby those without proper training are empowered to do jobs that they are simply not adequately prepared for.

Proper education, proper training, proper examinations, proper experience all mean nothing these days. All one needs is a short training course with minimal assessment, and one if free to have a crack at jobs that previously would only have been done by a registered professional. The rule for the gold standard of any system that many doctors apply is to think, would I be happy if my family member was to be treated by this new professional/system/process?

I can safely say that I would not want anyone I even knew, let alone a member of my close family, being medically managed by one of this new breed of health care professional who do not possess medical degrees. Yet again the government is dumbing down, and yet again it is a false economy. Money will be wasted as standards continue to fall, what fantastic progress, who needs skills for health?

MTAS 2008 - salvage of the wreck

The details of the application of system for junior doctor jobs for next year have been released and can be read in full on the Remedy Uk website here. It is undoubtedly true that some lessons have been learnt, however it does appear that some significant problems remain. The message for all applicants from the MMC team can be read here on the mmc website.

Applicants should do a few things which include getting an up to date CV written, subscribing to the mmc site for updates, working out where they want to apply and getting registered at NHS jobs on line. Worryingly it seems that there will be a very draconian deadline system for applications, with a narrow 2 day window present, outside of which applications will be rejected.

Lessons have been learnt to a degree, however the damage was most definitely done last year. I say this because there will be so few posts available at ST3 level because all the run through jobs given out last year will have to be honoured.

This is a huge problem because many hundreds of trainees will be frozen out because of last year's MTAS farce, a process that was acknowledged by all to be significantly flawed. Therefore hundreds of trainees have run through posts that have been gained via a deeply flawed system, and this is clearly very unfair on those who have been frozen out. There are hundreds of excellent ST3 LATs and hundreds of FTSTA2s who have only a very small chance of not being frozen out this year.

Many of these FTSTA2s and ST3 LATs are excellent trainees who are committed to one particular specialty. There will also be a significant number of run through ST2s who get ST3 posts in specialities which they are not particularly keen on. Personally I find this completely unacceptable. An ST3 lat may be 100% committed to Orthopaedics, but may find that a Plastics committed trainee has got the Orthopaedic run through post that they wanted, almost by default.

The government must take a large amount of the blame for this state of affairs for rushing through this badly thought through reform. However the Douglas group and the BMA must take a significant chunk of the blame for pushing for all run through posts to be honoured. The BMA sided with the DoH in the courts and this was arguably a key action that has led to this very preventable situation. The fall out of this mess will be around for years and years to come.

Yet more misinformation

Some journalists have been covering the exceedingly worrying trend of rising maternal mortality rather well, this excellent piece in the Independent draws quite a few strands together rather eloquently:

"The report reveals that the mortality rate among mothers giving birth is up to almost 14 per 100,000 people – an increase of more than 50 per cent since 1985-87."

This is a very scary statistic and these comments by Dr Gibb are a terrifying indictment on this government's management of this issue:

"The rise in deaths is no surprise to Dr Donald Gibb, a consultant obstetrician formerly based at King's College London who now runs his own clinic in Harley Street. "There's a lack of consultant input, not through lack of will, but through lack of numbers and time, as well as the ongoing shortage of midwives," he said. "I think we need to look at systematic failures of the organisation of care. There is a lack of availability of specialist expertise. The standard of 40 hours of consultant cover per week for every obstetrics unit, set eight years ago, has still not been met.

"The Government has not acted on repeated warnings, he added. "What really annoys me and other consultants, many of whom work in the NHS, is that in spite of repeated recommendations to increase the consultant cover in labour wards, nobody seems to have done much about this. A lot of consultants are disillusioned and burnt out.

"It seems as if the Department of Health doesn't listen to what doctors tell them. There's a political imperative to run units as cost-effectively as possible. But when things go wrong, for the small number of women that run into trouble, we're talking about life and death. The stakes could not be higher." "

The truth of the matter is that the government's drive for more deliveries in an environment with less back up is downright dangerous. There is also a serious problem with inadequate staffing levels of specialist doctors and nurses resulting in poor care.

The BBC chooses to take a rather disingenuous stance on this issue, strangely seeming to bury the fact that maternal mortality is rising so fast and concentrate instead on the role of obesity:

"Obesity is the fastest growing cause of women
dying in pregnancy or childbirth in the UK, a report shows."

This is a bizarre piece of misinformation in my eyes as:

"Substandard care accounted for 40 per cent of maternal deaths in the last
report and I am fairly sure the same will be true here"

So I wonder why the BBC chooses to highlight the obesity link, when such a staggering percentage of the deaths are so very preventable? The BBC also choose to buy into yet more cynical misinformation spreading concerning GPs by the Healthcare Commission, that 'independent' body:

"The watchdog found family doctors had measured the body mass index - used to
identify obesity - of 12.5m patients - but this was over 2m less than planned. "

This is yet another example of dishonest anti-GP propaganda. In fact the idea of measuring the BMI of millions of people is completely pointless, just another of the government's poorly though out exercises in gathering useless information for the sake of it. A tactic employed by the government to undermine GPs is to blame GPs for the obesity problem, when in fact GPs can do very little to stem the tide; primary care can only really pick up the pieces when it comes to obesity, the problem is a result of many decades of short termist policy making from central government in areas outside of health. The Healthcare Commission claims:

"The watchdog said these were essential in helping to prevent people with conditions such as heart disease, diabetes and asthma ending up in hospital."

I wonder how much evidence they have for this baseless statement. Putting people on registers for the sake of it doesn't keep people out of hospital, however good medical management of their chronic diseases does; I think it is rather more that good GPs help keep people out of hospitals, not the government's registers. The Healthcare commission appears to be yet another branch of HMG's health dictatorship that seems intent on bullying GPs, rather than adopting a more productive cooperative strategy.

The rising maternal mortality rate needs addressing, and this will involve dealing with staffing levels and the incompetent top down management of the health service by the DoH. Health inequalities need tackling too, and the best way to do this is by cooperating and engaging the medical profession, not by dishonestly bullying and intimidating doctors. The BBC should better represent the real issues and not swallow government propaganda piecemeal. It should be remembered that centralised registers do very little positive for people's health, and that GPs are capable of doing a lot more good work if encouraged so to do. As currently GPs are stifled by brainless top down diktats.