Toynbee: the bullsh*t years

Even the BMJ are now allowing Polly Toynbee to repeat her tired arguments, I am somewhat lost for words. There is nothing new in this piece, it is the same old guff rehashed and cobbled together into a patchwork of propaganda. One of Polly Toynbee's tricks is the use of the pretence of conceding ground to encourage the reader to assume that a few of her 'facts' are true. She does this with statements such as:

'results have never been so good'

and

'If, on that May morning back in 1997 a soothsayer had told him what the results would be 10 years later, he might reasonably have expected to rank somewhere alongside Aneurin Bevan as a hero of NHS history.'

She tries to make the reader swallow these statements of Toynbee 'fact', however these so called 'facts' rest on very shaky ground indeed. Where is this evidence that everything is so much better and that results are so dramatically improved?

The crux of her article now rests on this initial dodgy premise; she goes on to claim that patients, the public and all the NHS staff are just too demanding and over expectant, in her eyes everything is better but people always want more than can be delivered. This argument rests on foundations of hot air, just where is Polly Toynbee's evidence that the NHS is so much better? Her evidence is nothing more than a Labour party political broadcast. She quotes the waiting time figures for A/E and for operations, she then talks of the greater number of doctors and nurses; at least Toynbee has enough sense to admit that rising life expectancy may not be just down to Tony's genius.

In fact no one doubts that the government's figures are better, but the manipulation of statistics has become this government's specialty. The Stalinist drive to meet centrally set targets has led to the measures themselves becoming entirely meaningless. Waiting lists may be less, but hidden waiting lists and the dishonest manipulation of the figures is largely to thank for this 'progress'. If something does not have an attached target then it is put on the back burner and the patients left to rot. The A/E wait is a prime example of this dishonest spin, this four hour target means that unwell patients do not take priority over patients with trivial problems who are about to 'breach'; many NHS staff have seen first hand how dangerous these targets can be, as clinical need is overridden by the desire to produce yet more political propaganda. The A/E target means that patients are moved from place to place to satisfy the targets, while no one really has time to properly sort the patient out during this game of musical wards.

It is strange that Toynbee does not mention the appalling record this government has as regards a very high maternal mortality rate that is going up and up, countries such as Albania and Armenia have lower rates than the UK. The UK's poor statistics regarding cancer survival are again something not mentioned by Toynbee. It is also strange that Toynbee doesn't even mention that vital medical treatment that is clinically indicated is being with held thanks to systems that Tony Blair has put into place; in some regions inguinal hernias are not operated on, varicose veins are ignored and certain radiological procedures have been outlawed. There are many more examples of areas that have been left to grow fallow thanks to selective use of targets. This is the real Brave New NHS of Blair.

Polly Toynbee then goes on to struggle in explaining the internal market of the NHS. Her slant does not really flow with any cohesion:

'Many of these closures had been due for years and this was just the inefficiency the market was designed to throttle'

'news of the accidental overpayment of consultants and general practitioners reached public ears.'

She continues to slip in her 'facts' which are not facts at all, merely her propaganda dressed as concrete evidence. The fact that Blair's 'babes', a loose use of the word I know, were caught plotting the deliberate closure of hospitals in opposition constituencies has passed Polly by. There is actually much more evidence that these closures are politically motivated that clinically motivated. The pay increases have received much coverage in the press and in blogosphere, it is funny that Toynbee tries to disingenuously describe paying doctors fairly for the work they do as 'accidental overpayment'.

There are some rather glaring omissions in Polly Toynbee's piece. How can she sum up Blair's record on the NHS without even mentioning the short sighted financial time bombs of PFI, the incredible waste of billions on creating and maintaining the ludicrous internal market in the form of CFISSA/PBR/PBC/ISTCs/C&B/WICs et al, the wrecking of medical training and selection via MMC/MTAS/PMETB, the dangerous empowerment of quasi-practitioners in many guises, and a Department of Health that has a remarkable knack of turning everything it touches into muck in its uniquely secretive and undemocratic manner. In fact Toynbee also forgets to even mention that productivity has been on the slide under Blair's never ending program of reform. I don't think that Toynbee's piece can claim to be credible when so many key issues are completely ignored.

"Voters asked about the NHS said it was a disaster, although when asked about their personal experience they reported that their local services were indeed better."

The NHS has indeed got better over the last ten years, health care will always continue to improve; however the key question is not did the NHS get better, but did the government's management of the NHS mean that all the money invested was put to good use in an effective and efficient manner? The answer to this is a emphatic 'No', and this Polly, is why the workers and the public are fuming. It is not because the public are a bunch of morons who naively believe all the scare stories in the press, as by this logic there would be someone out there who believed what you wrote, and I doubt that such a person exists.

Tony Blair's NHS legacy will be remembered for all the wrong reasons. He has broken his pre-election promises by reinventing the internal market and privatising services left, right and centre. His leadership has seen record levels of spending but the money has been wasted catastrophically. The money has been frittered away on gimmicky centralised initiatives and ideological reform, it is tragic that so little of this extra money has reached the front line. Depressingly his style of government has seen more unaccountable autocratic central control that ever before, a most nontransparent and secretive style that has infuriated the pubic.

"Tony Blair leaves with the NHS as his Iraq on the home front. But history may be kinder
if in a couple of years the new system has been allowed to bed down. The internal market
may work and good results may speed up. If so, Blair’s NHS legacy may be rewritten
more favourably, but his successor will have serious problems."

Polly Toynbee finishes as she started, writing nonsense. Her piece is full of disingenuous attempts to appear objective but the sycophantic light does shine through in the end, as it always does in her Labour party broadcasts. Blair and Toynbee are remarkably similiar in a number of ways; both are always trying to justify the unjustifiable with their unique brands of logic, both are great fans of using propaganda and spin to further their own interests, and both of them are living in a state of complete and utter denial.

Does she really think that history will judge Blair's record on Iraq kindly after a 'bedding down' period as she calls it? Ironically the comparison is valid in that both Iraq and the NHS have been unmitigated disasters thanks to Tony Blair and his dishonest malignant rule. The problems in the NHS now are symptomatic of the decay of open and transparent democracy under Blair; the policies that have brought us MMC and MTAS from behind closed doors are what he really leaves behind. I would not be proud of these achievements.

MTAS abuse of candidates

Another shocking tale of incompetence and gut-wrenching cruelty thanks to MTAS has come to light. I have obtained copies of emails that show quite clearly that some candidates had their hopes raised by being told that they had successfully got jobs, only for this to be retracted in a later email and the candidates told they had no jobs at all. This is the first email of congratulation:

"Dear Dr ......

Congratulations, please find attached letters. We look forward to hearing from you by 15th May 2007.

Regards"

A couple of emails later:

"Dear Doctor

You will this morning have received an email from my colleague, ***** *****. Unfortunately ***** was only attempting a draft email (you will see that it was not signed by myself or any other in the recruitment team) when the system automatically sent this to everyone on the complete list - not just those that were successful. This is purely an administrative error, for which we send our most sincere apologies.

Please see below text which you can expect to receive from the National office this afternoon. We are sending this to you in advance due to the administrative error that occurred this morning.

Dear GP Applicant,

I am writing on behalf of the Wessex deanery to confirm the result of your GP application.

The selection panel felt that you are suitable to be appointed to a GP training programme but unfortunately you did not score highly enough to be made an offer at this time. You are, essentially, on a “reserve” list and we will re-consider your application if any posts at the Wessex deanery are declined. In addition, we may also be able to consider your application at any of the other deaneries you originally applied to if suitable vacancies remain unfilled at those deaneries. If GP training programmes are still available, we will conduct a national clearing system and will contact you again if that is the case.

In the meantime could I ask you please NOT to contact either the NRO or the deanery at this very busy time. The Wessex deanery will be not be able to give you feedback on your performance at selection centre until after the current recruitment episode and you will be informed of the process to obtain this in due course.

Yours sincerely"

Unbelievable. MTAS is working so well for the GP application process. It is bad enough that there are going to be hundreds of excellent juniors left jobless after this unfair farce, but for them to be treated so barbarically is quite deplorable.

Its gets worse. It turns out all candidates who put GP as their 2nd to 4th choice, irrespective of their brilliance at the interview and selection centres, have not been offered jobs as yet and have been put on the reserve list. The scandal of this is that no posts are being held back for the reserve list.

This means that less able candidates are being handed out GP posts because they ranked GP as their first choice, while more able candidates have no chance of getting a GP job if they did not rank GP as their first choice. Can this be legal? I find it hard to believe it can be, especially when candidates were told beforehand that those offering jobs would not be able to know how a candidate had ranked their preferences; hence it should not have been possible to selectively hand out posts to only those who ranked GP as their first choice.

I fear this will not be the last tale of rank incompetence and unfairness thanks the cruel joke of MTAS.

I despair

Moves are afoot to prepare the health service for any moves that Gordon Brown may make to give it independence from day-to-day political control. David Nicholson, the NHS chief executive, has announced a drastic re-shuffle of the management team that will see a leadership team within the department led by the permanent secretary, Hugh Taylor, David Nicholson and Liam Donaldson. This 'top team' will include the aforementioned as well as Mark Britnell, Clare Chapman, Chris Beasley, Richard Granger and Chan Wheeler.

David Nicholson has the cheek to claim that this will 'provide greater clarity on accountabilities, a stronger focus on both our Department of State and NHS functions, and ultimately enables us to better lead the transformation of the health and social care system for patients and users.' When the Department of Health say one thing they invariably seem to do precisely the opposite.

David Nicholson denied they were trying to pre-empt the arrival of Gordon Brown to no10, another likely story. Incredibly the new commercial director general Chan Wheeler is a senior executive with the US health care giant United Health, I'm sure this dual role will suit her and United Health nicely, shame about the patients though. It seems Mr Wheeler will have to work hard to control things as he did back home. As we can see, this team is a combination of the SHA chief executives and director generals within the department who work most closely with the NHS, exactly the same people who have overseen so many recent catastrophes in the NHS.

Guess what? Their role is to:

· build strategic capacity and capability in relation to commissioning and system management;
· strengthen the operational grip on finance and performance in the NHS;
· ensure effective clinical engagement.

It seems that this bunch will have the job of continuing to bulldoze through the government's absolutely useless reforms. This is the same bunch of cronies that has brought as the joys of MTAS, MMC, PFI, ISTCs, WICs, PBC, PBR, NHS IT scheme, ENDLESS RECONFIGURATION, QUACKS, and more. I have seen little evidence of their work doing anything that hasn't been downright bad for patients in this country.

Whether it's Donaldson's MMC or Granger's IT we have seen absolutely useless policy rushed through without any proper consultation time and time again, and each time millions, if not billions, of pounds have been wasted. These incompetents have shown repeatedly that they are not fit for office, so what happens? They get shuffled about a bit and given new jobs in which they can wreak yet more havoc, while adding in someone from a big American corporation which has a track record in dodgy practice; that's the D'oH for you.

I wouldn't trusts this bunch of morons to tie my shoe laces, let alone run the NHS. This idea of freeing the NHS from direct political control may turn out to be one of the most dangerous ideas ever, especially if it is left in the control of a bunch of incompetent politically appointed cronies. Many of the appointees should be resigning now rather than being given new jobs, Sir Liam is one notable example of this. Everything Labour have done with the NHS has increased top down autocratic control, destroyed anything democratic that was present and reduced the efficiency of the service. The poor patients will be the ones to suffer as a result of this corrupt meddling. I despair, I really do.

MTAS - whats the point?

MTAS is now displaying the above message. Essentially applicants must now contact their local deaneries to arrange their interviews, MTAS is now being completely bypassed.

Each applicant in England now has one interview that is arranged locally via direct contact with the particular deanery involved.

The shortlisting process has been abandoned as it is useless psycho babbling hog wash.

However all interviews that have already taken place currently stand, thus those fortunate applicants who have had more than one interview will benefit from the unfair short listing process. The process is therefore blatantly unfair still.

Essentially MTAS is now not being used at all and has been the principal cause of this rank unfairness. It begs the question, what was the f*cking point of MTAS in thee first place?

MTAS scandal - Patterson's smoking gun

Below is the evidence that shows MTAS was used a research project for Professor Fiona Patterson to help validate her ideas for selection of doctors into higher training. This is a scandal.

The lives of thousands of junior doctors have been turned upside down by an inadequately researched and unvalidated selection system. I am shocked that the Royal Colleges let this happen. In fact there is evidence that the colleges “assumed” it would work form this document form the RCPCH here.

“Though not entirely reassured by this we, like most Colleges, assumed the process would nevertheless run better than has since transpired”

This is bordering on negligence. I cannot believe that the Royal Colleges could allow this to happen and just assume that it would turn out ok. We are talking about the lives and careers of thousands of doctors and they just let it happen without a serious fight and without the need to consult their members and fellows!

Please see these notes from the RCS Regional Representatives Meeting in June 2006. I refer you to pages 4 and 5 (but there is also some interesting stuff later in the document about cutting training numbers and DGH reconfigurations).

This document provides the evidence that the basis for MTAS was incompletely researched and unvalidated particularly for surgical training. It also confirms that this years MTAS was going to be used to validate the methods! Here are the crucial paragraphs:

"The background was to design a selection system that was defensible, reliable, valid, cost-effective and feasible as well as to develop and validate current criteria"

How are her selection methods valid and what is the evidence? Nothing solid on Pubmed.

"In terms of progress, the stakeholder consultations (stage 1) and job analysis and literature review (stage 2) have taken place. The current phase is the third which is the design of selection tools and scoring frames. The other stages are;
• Conduct pilots and evaluate outcomes
• Train selectors
• Implementation"

This meeting was held in June last year. MTAS opened in January !
No publications of her work on this have been seen in peer reviewed journals.

"A strong recommendation from the pilots was that it is extremely important to get standardisation of assessors/selectors"
But what is the evidence that a rushed half day training session achieves standardisation of assessors/selectors? Again, Pubmed no help.

"Although a literature review of 25 years worth of research was relevant, the challenge in designing a model for surgery was that none of this research had been validated for surgery and currently in the process of doing that"
She admits the lack of evidence herself.

"Early implementation is expected to take place next spring with the intention to do early validation work"
The smoking gun! She admits that the validation work will be done during in the Spring of 2007 i.e the actual MTAS process itself! This is scandalous.

"The next steps would be the piloting of the selection tools and validating them as that is the missing link"

"There are a number of challenges to the project including timeframes and engaging stakeholders, pitching assessment at the right level, calibrating of assessment and selectors as well as feasibility in the short term. Along with the challenges are opportunities"

Too right! Of course - the opportunities for Professor Patterson to churn out lots of research are incredible. The amount of data that she has amassed from 34,000 doctors is phenomenal.

It is clear that MTAS has been used as a research project for the future selection of doctors into specialist training. This is an absolute scandal. The Royal Colleges have allowed 34,000 junior doctors be guinea pigs for a baseless and unvalidated selection process.

We have ended up with a complete crisis because the colleges “assumed” it would be all ok. This has coincided with situation where 33,000 doctors are applying for 18,500 training posts, which is clearly a situation when you want the most robust selection method possible in order to ensure the best got the best chance of getting a training post. What we ended up with was a bloody pie in the sky research project with 34,500 guinea pig doctors. This is an absolute scandal. When are the Colleges, Deaneries, CMOs and DH going to put their hands up and admit that this was a terrible mistake and they are all to blame?

Don’t hold your breath….

Who is Garth Marenghi?

Garth Marenghi is the legendary horror writer, or 'dream weaver', the man who penned the critically acclaimed Darkplace. Garth plays Rik Dagless MD, the medic we all aspire to be, but cannot, as we know we will never be quite that perfect. It is one of the great crime of the 21st century that Channel 4 did not commission a second series, I suspect someone was scared of the unbridled genius on show, it was just too brilliant by far.

I salute you Rik.

Toynbee's toss

I'm afraid to say that Polly Toynbee wrote in the Guardian again recently:

"Spending has trebled, heart deaths are falling, waiting times for inpatients are at just an average 6.6 weeks and 90% of hospital patients report that their treatment was "excellent". By almost every indicator, ask any expert, there is no doubt things are very much better."

"Consultants have always found a way to run the show, and their power is little diminished, but even that little has made them dangerously incandescent."

"Some 50 Save Our Hospital campaigns are doing lethal electoral damage locally: shutting dangerously underspecialised A&Es is the right thing to do, but not at the same time as a savage clampdown on age-old deficits, so everyone thinks closures are cash - not clinically - driven."

Does this ill informed Blairite never cease to produce party propaganda that poses as a newspaper articles? It seems she was caught discussing anti-Tory ideas at a non-partisan, non-political charity event just before the general election. Polly is hardly the objective bystander.

There is some great reader opinion left below Polly's article, I would imagine that she probably doesn't bother reading this as the truth hurts a bit too much. I've heard Labour politicians use the same argument before, the one that claims that every 'expert' agrees with the government's reforms and that the NHS reconfiguration is based on clinical need alone. Unfortunately these arguments are nothing more than lies. The relationship between hospital closures and clinical needs are weak, and Labour ministers have been caught deliberately plotting closures in non-Labour areas behind closed doors. If Polly chose to digest anything other than Labour party political broadcasts then she may be aware that there are thousands of experts speaking out against the current health service reform. It's certainly hard to hear them when you have you fingers in your ears.

Frankly, Jasper, your laziness is embarassing

A journalist named Jasper Gerard wrote this piece in the Guardian on Sunday. As well as being irresponsible and ill informed, it could even be argued that Mr Gerard's piece was misguided vitriol posing as opinion.

Firstly his mocking of Phil Smith, the junior doctor who heckled Patricia Hewitt on question time, was remarkably arrogant and patronising in its tone; he also completely misrepresented the argument that Phil and other junior doctors have tried to get get across to the public of late.

Phil was not rude, in fact other than being necessarily loud he actually heckled in a rather courteous manner, if that is possible. Phil was trying to get across the anger and frustration that we are all feeling at the moment. We feel that way because the government has introduced a scheme with unparalleled failings and is trying to force it through at any cost. These failings have included lost applications, a useless shortlisting process and rank unfairness at every turn; surely even Jasper would want the best doctors selected for the available jobs? If Jasper cared to research a little more around the topics about which he writes, then he may find that the government and her agents have repeatedly acted dishonestly and lied as part of their efforts to push their failing scheme through. Phil Smith's outburst must been in this context, and even then he made his point eloquently enough without being 'rude'.

His comments on medical unemployment and the twisting of Phil's words were just lazy journalism at its worst. Junior doctors are not averse to competition, in fact many of us love medicine because it pushes us to make the best of our abilities and we thrive on the competition. If Jasper knew anything about MTAS then he would realise that juniors are angry because the process is completely unfair and a rank shambles. Also Jasper should read up on his MMC as he would then learn that the government is lowering training standards and dumbing down medical training; this is another reason why juniors are getting militant, largely because they want to provide a good service in the future for their patients.

Unemployment is a separate issue, but still one that Jasper fails to address sensibly. The question of unemployment has yet to even be properly answered by the government; Hewitt has been misleading the public at best and lying to them at worst, there may well be 14,000 unemployed juniors come August. In fact Ms Hewitt and other health ministers have refused to face these allegations when faced by the Channel 4 news team last month. The potential waste of billions of tax payer's cash was strangely not mentioned. The fact that the UK has the lowest doctor per head of population ratio out of virtually all developed counties was also absent from Jasper's musings. The government have also not expanded the consultant grade as they had previously admitted they must do, if they are to meet the needs of the population in the future; for example we are currently 300 plastic surgeons short, makes a bit of a mockery of Jasper's argument doesn't it. Any perspective on this issue was sadly lacking as Jasper even tried to defend Hewitt's limp argument; it would be hard to see mass medical unemployment as a good thing in this miserable context.

I expect this kind of drivel from an anencephalic Sun hack, but journalists with more than one grey cell really should know better. There is no defence for the sloppy misrepresentation of events and facts in this way, it is simply bad journalism. As Jasper was so keen to suggest that Phil learnt some manners, I would like to give Jasper some useful advice; it would be sensible to properly research the subjects that he writes about, so that he can avoid making such a complete and utter arse of himself.

Blogging in 'a roaring, foam flecked sea'

I was alerted to this piece in the Guardian by Nick Cohen by Dr Crippen. It seems that someone is rather keen to go on the attack against the blogging medium in a rather clumsy and hap-hazard fashion. The piece centres around the esteemed author being one of the judges for the 2007 Lulu Blooker prize. Reading between the lines it seems that this policeman of culture concurs with the following 'in general':

"Bryan Appleyard of the Sunday Times and Andrew Keen, author of the forthcoming The Cult of the Amateur, both argue that the web destroys culture because when editing goes and every opinion becomes equally valid, anyone who tries to distinguish between Shakespeare and a fool is dismissed as a bow-tied dinosaur."

and

"In an article for the Guardian, political commentator Oliver Kamm argued that, far from democratising intelligent debate, the 'citizen journalists' of the political blogs were sallow dogmatists who screamed abuse from behind the coward's cloak of anonymity at any writer who confronted their lame prejudices. 'Blogs typically do not add to the stock of commentary,' he wrote. 'They are purely parasitic on the stories and opinions the traditional media provide."

It is amusing that Mr Cohen comes up with no solid argument of his own, he simply repeats the statements of others on the matter. He is also rather keen to hint that bloggers are typically those with 'lame prejudices'. Is there not an incy wincey smidgen of hypocrisy here?

The argument of Appleyard and Keen seems to reek of the logic of arguments around moral relativism. It seems ludicrous in the extreme to argue that a lack of editing leads to all opinions becoming equally valid. Does Mr Cohen really think that readers are so thick that they have no ability to discriminate between the validity of different sources? Editing can be both good and bad, as it is sculpted by individual opinion, very much like blogging! For example would Mr Cohen argue that the Sun is valid opinion because it is edited? Thus I fail to see how this argument, backed up by an almost Utopian faith in editing, holds at all. In fact the vote was only won in this country thanks to a lot of hard work from people such as the Levellers who exploited the unedited medium of leaflets, for example does Mr Cohen think that their leaflets should have been produced via the official edited channels?

Mr Cohen carries his argument on to insinuate that all journalists can be assumed to be 'fine writers' just because their stories end up in print; if only he cared to venture across the Guardian's corridors towards Polly Toynbee's desk, then he might see first hand how wrong this assumption is. He also thinks that bloggers are merely parasites feeding off traditional sources, it appears that numerous examples of traditional sources feeding off original blogger stories may well have passed Mr Cohen by.

Mr Cohen thinks that we should all see things through his eyes, then we would all be able to see his uniquely 'valid' view. Unfortunately I do not choose to freely believe all the edited material I read in the Guardian comment section; it is just the chatter of people like you or I, or much more highly evolved people like Nick Cohen who are therefore qualified to tell us exactly what to think. It is healthy to have a good mixture of sources from which the reader can choose, no one medium will ever be justifiably proven to be the objective holy grail. People are no fools and do not deserve to be treated as such, there is simply no need for an autocratic 'thought-police'. I wonder if someone doth protest too much?

(Ironically wasn't Shakespeare's success down to his immense popularity - people did not need to be told to go out and buy his unedited works by the 'culture-police'?)

The Chief Medical Officer must resign

Sir Liam Donaldson, the Chief Medical Officer, has been the architect in chief behind many of the most disastrous recent reforms of medical training in the UK.

A large amount of blame for the shambolic MTAS must be laid at his door, while the danger of MMC is looming as it is rushed through in a most dangerous and incoherent manner.

He has sold out the profession, he has helped catalysed the destruction of good medical training overseen by the Royal Colleges and tried to replace it with dumbed down psychoquackery overseen by the malignant PMETB.

He has hidden from the public and from the media as his department has hopped from disaster to disaster. The heads of MMC, Profs Crockard and Heard, have been scathing in their criticism of the CMO in their resignation letters; while the ex-student adviser to the CMO has hammered yet more nails in his coffin.

The people behind this mess must be held accountable for their incompetent meddling. As the Chief Medical Officer and as a chief architect of these disastrous schemes from the very beginning, Sir Liam Donaldson must resign at once.

http://petitions.pm.gov.uk/CMOresign/

Sign up, before it's too late, we must rescue good medical training from being savaged by these peer seeking cronies.

Paying for failure

The Department of Health appears to think that the poor private companies that fail to win lucrative PFI contracts deserve compensation for their failure to the tune of 2% of the total contract costs.

The telegraph covered this story on Sunday and pointed out that this scheme is already up and running on a trial basis in Bristol for a 374 million pound hospital. In this case the runner-up may be paid around 6 million pounds, while the third placed company will most likely be paid too.

It is simply astounding that the DoH thinks that it is appropriate to pay off these companies for merely for taking part. This is when it is forecast that PFI schemes are set to waste the tax payer several billion pounds over the next few years.

It is yet more evidence that the DoH is run by incompetents with no discernible grip on reality, and they are throwing our cash on the bonfire.

Arrogance and denial - new MTAS lows

Some rather sad Internet geeks (tongue firmly in cheek) have managed to unearth some rather worrying and humorous (for all the wrong reasons) PowerPoint presentations that Sarah Thomas has made regarding MTAS in the last few years. The above image is taken from this rather embarrassing slide show. I have stored two more of her gems here and here.

The more I flick through these slides, the more I am shocked by the casual jokey nature of the presentations and I get the distinct impression that Sarah Thomas was in such a state of denial that she never entertained the possibility that her hair brained scheme was doomed to fail. Events have proved her to be very wrong indeed, whether this was down to stupidity or downright arrogance I do not know. It may never be known how much pressure was put on her from above to drive this idiotic reform through.

Competency based selection

• Establish key competencies using thorough job analysis involving stakeholders & experts
• Develop work-relevant exercises testing POTENTIAL in key competency domains
• Multiple assessment, multiple assessors
• Each competency assessed 3 times
• Each exercise demonstrates 4 competencies
• Assessment exercise / competency MATRIX

This slide sums up the incomprehensible psycho babbling mumbo jumbo that MTAS was based upon, I took the liberty of translating this slide to mean 'joined up twattery by numpties'. I write this as there is yet more documentary evidence revealed that proves that the Royal Colleges were ignored by those who sculpted MTAS.

Today the results of a National Poll conducted by Prof Morris Brown et al were released. Over 80% of juniors and consultants wanted a consultant boycott. Only 15% of those who took part chose the MTAS one interview approach. Just one final prophetic slide:

I have gleaned from this research that MTAS is indeed shit and should be flamed.

Orthopods do not mince their words

"There cannot be anyone here who is unaware of the complete chaos that has resulted from this arrogant, ignorant and mendacious government's indecent haste in its efforts to rush through the implementation of MMC despite the remonstrations of our various representative bodies.

Unfortunately, the association of our College with this scheme has in the eyes of many fellows been viewed in poor light and many, particularly our members, feel let down. The price of co-operation is now plainly evident.

The appearance of PMETB we regard as an ominous development and a challenge to the independence and governance of the royal colleges. It can be no more than a poorly disguised attempt to bypass the offices of those colleges.

We believe that the College and its fellows should dissociate themselves from this organisation and take no part in its affairs.

We implore the president to request all or any fellows presently on that board to resign.

We ask what form the College will take once the government has taken over the training and standards of surgery. The College will be subject to the whims and dictates of the government, simply a tool of its policies. It will be disempowered by the board, surviving perhaps to be no more than a society of surgeons.

Does anyone of this assembled company really believe that the government seeks to improve on surgical training and standards? Is it really interested in perfection, in the craft, surgical expertise and care, for the ultimate benefit of patients?

This meeting proposes that the Royal College severs its links with PMETB as soon as possible with appropriate disclosure to the media. "

This is a motion that is due to be recieved at the Annual General Meeting of the Royal College of Surgeons in June 2007. The President has already hinted at the malignant nature of PMETB:

"You may be aware of the Independent Review into MMC, announced earlier this week by the Health Secretary to be chaired by Professor Sir John Tooke. I am attaching the terms of reference for information. He telephoned me several days ago and I had the opportunity to discuss the review with him. I have written to him today, expressing my concern that there is no specific mention of the role of PMETB in the terms of reference. I have asked him to confirm that PMETB’s involvement to date and its future is addressed in this review. I will expect changes to be made before we can offer our support."

The message is clear. PMETB is simply a vehicle used by the government to take over medical training so that they can railroad through yet more useless policy. It is obvious that training standards will be devastated if this coup is not resisted. The choice is a simple binary one and it is disappointing that this was not realised sooner.

Any form of co-operation is used as consent for any new railroaded reform, even if in reality that co-operation amounted to vociferous remonstrations that were brushed aside. The choice is this:

Either continue to co-operate and remonstrate; then PMETB will continue to take over training while standards are destroyed and patients suffer thanks to more woeful government policy

Or unilaterally withdraw all co-operation in order to save what power the colleges have left so that training standards can be maintained and policy can be based on something other than brainless ideology

I know which I would choose.

my demon?

Brilliant heckler sums up the frustration

"I just felt upset and angry.

Months of anxiety, not just for me but for all my colleagues and friends - people like me whose only aim is to be the best doctor they can. I have never seen so many friends cry and be demoralised by people who have no idea what life is like on the 'shop floor'. I was on that march when thousands of doctors turned out - a very emotional day. I have admired the hard work RemedyUK have put in, as well as the BMA who I am also sure have ploughed many hours of time into their work. But Patricia and co arrogantly ignored this. She has used spin as a way of defending the indefensible. Shame on her. How dare she patronise and lie - not just us - but the public at large.

Those that know me, know I wear my heart on my sleeve. I am sure there are many who may criticise my heckling, many who won't. Either way, she was being allowed to spin once more and I couldn't bear to sit there and listen to it. I was angry. But I did also try to articulate a few points the best I could. The programme is not edited, and as you can see it is not easy as an audience member to get a word in. I did my best and ultimately I do not regret showing Pat a small degree of the anger and frustration so many of us feel. I just hope that something good comes out of all the hard work many people in RemedyUK and BMA are doing, and that we can all get back to doing what we all do best - being doctors."

I would like to personally thank Phil for his brave and courageous performance on Question time. The presenter clearly didn't want anything too taxing for Patricia Hewitt, however Phil gave him no choice; he stuck it to her in an angry but controlled fashion.

There are thousands of juniors like Phil. We are fed up with being treated like crap and lied to by this corrupt government. We all want to be as good a doctors as we possibly can be for our patients and ourselves, this government is working against this grain. The government and its crony network that includes the DoH and PMETB is trying to destroy the medical profession and everything that has made medical training great in the UK. We must all use the fire in our bellies to fuel our rebellion against this malignant autocracy, they must be defeated at all costs.

MTAS - Sarah Thomas must resign

This was an E-mail sent from John Black - the chair of the SAC in general surgery, to Sarah Brown in February 2006. It ominously warns of the potential problems regarding MTAS and suggests the practical alternative of selecting on a regional basis. These warnings were spookily predictive of the problems that actually occurred.

The point of this leaked email is that is proves that Sarah Thomas, one of the masterminds behind the flawed MTAS, was aware of major concerns of stakeholders and she did not address these concerns. If she had listened and acted, we might not be in the mess we are in today. Notably it was Sarah Thomas and Fiona Patterson's flawed research that was responsible for the short listing farce this year, even the independent review panel scrapped this useless competency based short listing process.

It is imperative that Sarah Thomas is made accountable for her actions and that she resigns at once. Apparently at the moment there are plans for her to be promoted into Shelley Heard's position, this is just rumour currently. Sarah Thomas is the Lead Dean for National Electronic Recruitment, and this system that has now been shown to be fatally flawed beyond doubt on many levels. The chaos that has resulted from her demonstrable incompetence was so avoidable, she simply has to be brought to account over this.

"Dear Sarah,

This is an extract from a recent email I sent to Gordon Williams, giving the view of the General Surgical SAC on selection. It is also the view I will be putting forward next Wednesday at the second MMC meeting, at which I will be representing the Royal College of Surgeons (of England).

“As you say, time is now short, which introduces some very welcome realism into the debate. We have only eighteen months to go. All the talk about e-based selection and assessment centres is cloud cuckoo land. No government computer system ever works. Who will pay? Is it validated? Is it fair? Who can run an assessment centre? How are they validated? What is wrong with our present methods?

I can see only one way out of this. The imperative is to put all the F2 output (plus the transition group) into ST1 in August 2007. Why not just let individual Deanery Schools of Surgery put together ST1 programmes in line with the requirements of each specialty, and appoint regionally by advertisement and interview, as we do at the moment to SHO rotations. Once people get into ST1, progress to the award of an NTN should be based on success in the MRCS, assessment by trainers and a competitive interview, just like a present SpR appointment, but with a time limit. This might be at ST1/ST2, or ST2/ST3, depending on the specialty. Those happy to select from F2 can do it at F2/ST1, and give the NTN at this stage.

As to exams, with eighteen months to go, there is only one option namely the current validated MRCS. I think we all want it modified. General Surgery would like it to be changed back to something very like the old Primary, as basic sciences are no longer taught in medical school. ENT want it to be specialty specific. Others want different things. All these changes are highly appropriate, but cannot be done by August 2007. Surely we have to go in with the present model and make the desired changes gradually.

Is this too simple or am I missing something?”

I’m sure this approach is compatible with what the Physicians and the Anaesthetists, the other two “acute” Colleges want.

I will try to talk to you on Wednesday.

Regards,"

MTAS- an 'exam' of sorts

It is hard to write when one is thinking of violently beheading certain individuals, but here goes; the Information Commissioner has responded to calls forcing MTAS scores to be released by accepting the Department of Health explanation that MTAS is an 'exam'! Un-bloody-believable.

It turns out there are 'exceptions' in the Data protection act:

"the Act also contains a number of exemptions which allow data controllers to refuse or postpone a response to a subject access request in certain defined circumstances. One such exemption relates to examination marks. This allows the data controller to postpone responses to subject access requests for examination marks for either a period of 5 months from the date that the subject access request was received or forty days from the date of the announcement of the examination results, whichever is the earlier. The purpose of this exemption is to ensure that the examination process is not prejudiced by candidates obtaining information about their results before the date on which these would normally be announced."

and

"When I queried this with the DoH I was informed that, having taken legal advice, the Department had decided that the MTAS short-listing process equated to the definition of an examination in the Act and therefore considered that it was reasonable to delay responses to subject access requests until such time as all appointments into the speciality training programme for the year were completed."

The definition of an exam under the Data protection act is here, and I find the argument that MTAS can be considered as an examination to be wafer thin to say the least.

If MTAS was an exam that it was probably the worst exam ever. There were no exam conditions as candidates had two weeks in which to prepare their answers. The marking schemes were leaked which meant that certain candidates had a massively unfair advantage. There were also companies selling the answers and marking schemes, not the most level playing field really. Some sets of answers were lost while others were marked by untrained examiners. There was no way of detecting plagiarism effectively and the examiners did not have adequate time to do the job properly. The exam was even finally admitted to be complete and utter pants by those who had devised it!

It was truly the worst shambles of an 'exam' that I have ever sat. Come to think of it, I wonder if I passed, surely they'll be dishing out A*s for all? It is New Labour after all.

I can say nothing more

What Methods?

"The Medical Training Application Service (MTAS) is the IT service that supports recruitment to medical training programmes in the UK . The performance of the service, the details of which I have already shared with you clearly do not warrant the criticisms that you are making of it. In order to protect the commercial interests of our supplier, I must insist that you do not make any further claims about MTAS without providing evidence that can be investigated."

These are the words of Patricia Hewitt in reply to Andrew Lansley who questioned the dubious performance of MTAS. This letter was written on the 30th of March. It is rather obvious given recent events that Patricia Hewitt was wrong to brush aside these concerns in such an arrogant and almost intimidating fashion. I have been doing some relevant digging.

Andersen consulting (now Accenture) were the sister group of the Arthur Andersen group, a firm that had been banned from all public contracts by the Tory government in the 80s due to their role in the DeLorean Cars fraud scandal in Belfast. Andersen Consultants advised Labour on its economic policy for government, including maintaining tight public spending limits set by the Tories. Three of the key consultants that worked with Labour’s Gordon Brown, now chancellor of the exchequer, went on to become special advisers to the Blair government after it won the 1997 general election.

Patricia Hewitt, deputy chairman of the Social Justice Commission at the time and now health secretary was the first Labour stooge to take up a position with Andersen, as a “consulting director of research." Another great example of corruption and consulting is that of Alan Milburn. Accenture's bungling role in the NHS connecting for health IT scheme hardly escaped the attention of the press. Accenture was also let off very lightly by the government when it withdrew from 2billion pounds worth of contracts, they were fined less than 10% of the possible maximum fine despite their woeful performance. The NHS IT scheme continues to turn from disaster to disaster.

Methods Consuting are the firm behind the disastrous MTAS. Incredibly one of Methods' directors, a certain Mark Thompson, used to work for Andersen and states in his CV:

"is currently Chief Independent IT Strategy Advisor for the UK Shadow Cabinet under George Osborne, for whom he is working to develop IT policy initiatives that include the increased use of open source IT and procurement infrastructures across UK government, and addressing the 'Digital Divide'."

It turns out the role of Methods consulting has already been questioned in parliament:

Sir Paul Beresford: " To ask the Secretary of State for Health what tendering process was completed by Methods Consulting prior to the award of the contract for the recruitment of dentists from Poland; and what expertise they have in this field."

and

Sir Paul Beresford: " To ask the Secretary of State for Health pursuant to the answer of 10 March 2005, Official Report, column 1976W, on dentistry, whether Methods Consulting is under a contractual obligation to his Department to meet the target recruitment figure of 230 Polish dentists by October 2005; and what steps will be taken to meet any shortfall in the target figure."

Then more recently:

Andrew Lansley: "When is it expected to resume? Methods Consulting runs MTAS. The Secretary of State referred to a breach of contract. What action is being considered about that? Could the actions—or inaction—of Methods Consulting or others amount to a criminal offence under data protection legislation? Will that be investigated? Will a thorough, independent investigation—not by a company that Methods Consulting brings in—take place into the causes of the security lapses and to ascertain whether other breaches, about which we do not know, occurred?"

David Taylor: "Will she bring in the Office of Government Commerce to consider the lamentable lapse by Methods Consulting, which seems to have been instrumental in this latest debacle?"

Rob Harris: "Can she tell me whether Methods has had its contract terminated over those two security breaches, and if not, why not?"

Ms Hewitt: "No, we have not terminated the contract with Methods. It is responsible for the MTAS site."

I thought I would highlight one of Patricia Hewitt's answers:

Ms Hewitt: "I have already explained what we are doing about the two lapses that took place last week, and the failures of Methods—human failings rather than inbuilt system failings—which allowed that to happen."

It is astonishing that she tries to defend the Methods consulting system by pinning the blame on individuals. Surely if one or two small errors can wreak such havoc then the system is far from foolproof? Any system failure could be pinned on indivudals in this way, I've seen this in the NHS on many an occassion.

Ms Hewitt: "I have already explained what we are doing about the two lapses that took place last week, and the failures of Methods—human failings rather than inbuilt system failings—which allowed that to happen."

I am sure there is more corruption to be unearthed here. It is certainly going to be a little harder for Methods consulting to escape the public's radar. Will they be held to account for this disaster, or more likely will they recieve a little slap on the wrist followed by yet another juicy government contract?

What about these children Patricia?

In the House of Commons on the 24th of April this year a question was slipped to Patricia Hewitt that escaped the notice of the mainstream press:

Greg Mullholland (Leeds North West, Liberal Democrat)

"On 17 March we heard the devastating news that the proposed new children's and maternity hospital in Leeds would not go ahead, despite having been approved by the then Secretary of State for Health in July 2004. Why has the project been pulled despite leading local specialists having said on 27 March that current services are "not fit for purpose" and that they are anxious about the continuing safety of children in hospital? When will the people of Leeds get the children's and maternity hospital that they so badly need?"

The Secretary of State for Health's answer was typically lacking in relevant content. Tony Blair was even asked a similiar question recently in Prime Minister's questions. He also avoided giving an answer and simply waffled on about more staff and more investment under Labour. He also claimed that they were 'committed to that extra investment in the health service', it's just a shame this 'committment' is nothing more than hollow chatter up in Leeds.

This story originates from plans to build a new Children's hospital in Leeds as part of "Making Leeds Better" back in the nineties. The aim was to save money by investing in infrastructure to shift activities to the community, and to use these savings to build a new dedicated Children's hospital; the centralisation was designed specifically to improve 'patient safety'.

The Children's hospital promised by Labour has failed to materialise. This has left the children of Leeds exposed to unacceptable levels of danger; as with several major specialties split between the two sites there are significant problems with transferring extremely sick children, I quote a trustworthy insider source:

"We have had a number of near miss episodes where this approach gave significant risk. This was avoided in one case by the surgical team coming over for a patient who needed urgent surgery and who would have likely died had they been put in an ambulance. They were able to do this but only because they were not operating on the other site at the time."

There are certainly children suffering as a direct result of this, while much worse could well have taken place. The doctors think that the risks are most definitely at an unacceptable level, an eminent paediatric Professor states that children's lives are being put "at greater risk than we feel is appropriate". There are many in agreement over this issue.

As the predicted cost of the hospital soars, the controversy shows no signs of abating. I shall quote my insider again:

"The Trust Board met with the PCT and decided that although one of the main reasons for MLB was to generate money to build the new hospital, that instead it should be pocketed by the Trust to pay off it's debts. This decision was not released to the staff in the Trust or even to very senior medical & managerial staff, but was leaked to the press and published in last Friday's Yorkshire Post. The first most of us knew was on the following Monday, when the cat was well and truly out of the bag. This from a Trust that sent an e- mail to all staff about acceptable behaviour and being open and honest at all times."

It sounds pretty typical of an NHS culture that applies one code of conduct to frontline staff, while those at the top are seemingly free to behave as unethically as they so choose. This shocking example demonstrates very well how the enforced deficits are having devastating impacts upon real patients on the ground. These are deficits imposed by central government in a quite deliberate attempt to artificially expand private sector provision by running the NHS into the ground. Children are most likely dying as a result of the government's pursuit of a baseless ideology.

This is a government that makes cynical and corrupt decisions about NHS cuts that are only motivated by the desire to salvage a few votes here and there. This has been exposed by the media on more than one occassion. It is quite appalling that a government that claims it is making reconfiguration decisions purely based on clinical need is in fact ignoring clinical need to grab a few cheap votes. Another scary element to this reform is that hospitals with Foundation status can now have their board meetings in private, so much for open and transparent decisions then; more 'ash cash' behind closed doors then.

Recently Patricia Hewitt was approached by journalists on her way to a Children's 'Cancer Centre' and she nauseatingly avoided questions by suggesting the she was dealing with the far more important issue of children's cancer on that particular day. I would like to suggest to her that if she really had any genuine concern for children, or patients for that matter, then she would scrap these centrally imposed deficits that are running the NHS into the ground throughout the country. If she does not, then more children and adults will continue to pay the price for the government's game of 'ideological pursuit' with their lives. I will finish as my insider finished:

'The risk to patients will continue, Making Leeds Better is making me sick'

Millions flushed away

It has been brought to my attention that Scotland has a national hand hygiene campaign brought to the fortunate public by those luvvies at Health Protection Scotland. Not only is money being spent on TV adverts but also on 'sonic washroom posters' that are located in not only toilets but also bizarrely at cashpoints. I'd imagine people will get quite a shock when a poster starts booming 'Clean hands, clean conscience' at them, did anyone consider the accidents these 'sonic' posters may cause? Maybe another campaign is needed to warn of the dangers of these posters? Will new diagnoses of schizophrenia be on the rise as loads of mad Scots insist that some poster told them they were filthy and needed to scrub more vigorously?

The TV advert can be viewed here, apparently:

"Washing your hands properly with soap and warm water is the single most important thing you can do to help reduce the spread of infections and help protect you, your family and those around you."

Really? I thought a good faeces sandwich was a good way of building up the immune system, is that still ok as long as you wash your hands afterwards? There is a serious point here. I am not denying the benefits of appropriate hand washing, but is this campaign an appropriate use of 2.5 MILLION POUNDS in today's NHS climate?

Yes I do not lie, 2.5 million pounds has been spent telling people to wash their hands at a time when enforced NHS deficits are leading to cuts in services and consequent harm to patients. Staff are being laid off, wards are being closed, training budgets are being cut, operations are being cancelled, good treatments are denied, properly trained staff are being replaced with untrained quacks and yet 2.5 million pounds is found to fund this quango to tell us the bleeding obvious.

That's the NHS under Labour for you. Billions wasted on centralised nonsense while the frontline is starved of cash. It's no wonder we're in a pickle.

Deluded or just an idiot?

Patricia Hewitt has yet again been rather generous with the truth in the House of Commons. This afternoon she tried to deflect attention away from herself, the government and her useless department by blaming other people for the MTAS disasters. This is wholly unacceptable for a minister; she does seem to be developing a bit of a penchant for this kind of behaviour though.

She stretched the truth to pretend that the MTAS security breach only affected one group of applicants, when it affected all MTAS applicants. She tried to pin the blame for the 'leak' on an individual in an attempt to cover the systematic incompetence of MTAS. She again tried to propagate her myth of there being a widespread agreement that MMC is great, would she like to read the Lancet? She also tried to pin the enitrety of the blame on Methods Consulting, the company behind MTAS, despite the fact that she had already reassured Andrew Lansley at the end of March that there was nothing to worry about:

'The performance of the service, the details of which I have already shared with you clearly do not warrant the criticisms'

She turned out to be very wrong here. Last but certainly not least she tried to pin some blame on Channel 4 news, as always Patricia had a quite unique take on things; luckily Dr Crippen has catalogued exactly what went on that day. It is no wonder that doctors tipped off the media, as they have zero trust in the establishment and their ability to deal openly and honestly with these kind of problems. I cannot comment on what the ferret fancier was up to on the afternoon in question.

I could bore you with more detail of her dishonesty and incompetence, however I'm sure you won't need any more convincing. I don't think John Snow and Channel 4 will let this lie. It amuses me that in the eyes of Patricia Hewitt everyone is to blame but her, her department and the government. Either she is deluded and has started to believe her own propaganda, or she really is so stupid that she thinks she can get away with this disingenuous game. Either way she should resign.

I also just wonder whether there are echoes of the Gilligan affair here, are Hewitt's comments regarding Channel 4 a deliberate attempt to intimidate the media? She certainly does not have the courage to face those that she is so keen to accuse; she has withdrawn from an interview on Channel 4 news this week despite promises that she would attend.

(Dr Grumble expertly points out that these security issues are hardly an one off, there were significant problems for weeks and weeks before things came to a head.)