Remedy calls for accountability

The government continues to ignore criticism and consultation, while forcing through destructive reform after destructive reform; as the political beast gets nearer to the ends of its life, it seems to be thrashing around senselessly and trying to leave as great a mark on history as possible. That mark is not going to be a good one unless we can force them off their destructive path, their time bomb of reform must be exploded away from civilians.

MTAS and MMC were catastrophic disasters, the effects of which will come home to roost over the next few years, as rotas lie seriously short staffed and the service suffers thanks to this complete lack of foresight and planning from the government. Despite all the talk of a better NHS, Darzi's codpiece of a review and the chatter about accountability; we have seen no one held to account for MTAS and MMC as yet, while doctors on the ground have the nooses around their necks tightened that little bit further thanks to the likes of revalidation and IWGC.

Remedy needs you to sign up to their call for accountability over MMC and MTAS, their letter in the Lancet is a call to arms:

"Your May 17 Editorial1 states that “many of those responsible for MMC [Modernising Medical Careers] still fail to appreciate the human damage caused by their ‘inept’ decision making”, and the Health Select Committee report2 was peppered with words such as “defective”, “unsafe”, and “disastrous”. It found that “the leadership shown by the Department of Health was totally inadequate”. Despite these highly critical accounts, not one of those responsible for this avoidable catastrophe has been brought to account for the misery they propagated.

The Chief Medical Officer, Sir Liam Donaldson was the architect of the reform. During the project's development it became apparent that there were multiple risks, and there were calls for delay.2 These calls were ignored. Sir Liam chose not to take on a clear leadership role and has evaded responsibility for the 2007 crisis, and we concur with the British Medical Association that he should resign.

We also believe that the small elite group of senior doctors who led this project and who failed to heed these warnings when they were in a position to do so should now consider their future positions in the management of the National Health Service. The General Medical Council (GMC) has issued clear guidelines for doctors who take up management roles, and it has taken action in the past against doctors who have failed to maintain public confidence in the profession or to uphold standards in non-clinical roles. The intervention of the GMC might be necessary if we are to restore public confidence in the accountability of medicine."

You can genuinely make a difference by signing up to this on the Remedy website, simply follow this link and read what they have to say, then sign up if you are in agreement. It's about time those that love to control our every move were held to account for their rank incompetence, the hypocrisy of their safe position in their ivory towers is rather insulting to those working so hard for the patients on the ground. So get along to the Remedy site and let's try to force these political meddlers to account.

Bacon manufacturing more porkies

Dr Neil Bacon has spent a fair few hours this week peddling his propaganda to the press, for example he appears in the Oxford Mail this week telling us all how a majority of doctors are right behind his scheme (thanks for spotting that Dr C). He doesn't stop telling porkies there, excuse the pun, he goes on to talk of the site's great security, how useful it will be and on and on.

To put Dr Bacon's hypothesis to the test, I just wonder how many people will respond to this Mail article and agree with the might Bacon? I wonder? I may have to retire from blogging for good if a mass of doctors suddenly crawl out of the woodwork to show their solidarity for Neil's position. Somehow I suspect this will not be the case. Neil is getting rather desperate, after all a lot is on the line for him now, both he and his wife are involved in this new venture. Should IWGC fail dismally I wonder what this will mean for Dr Bacon?

Many gaps in Bacon's defences

Neil Bacon in consultation with the DoH and GMC has set up Iwantgreatcare, a new website that allows anonymous punters to say whatever they want about named doctors. There is no right of reply for the doctor, the patients can just say whatever they want and this is then meant to result in better patient care. Quite how I cannot quite see myself.

The motivations behind this site are strange as it appears that Neil Bacon may be struggling somewhat financially, hence this may be a desperate last ditch attempt to rescue his economic well being. Bizarrely comments added in support of doctors are being removed, while those slagging them off are allowed to stand; this hardy seems fair when those who are indulging the character assassinations can do so completely anonymously and unaccountably.

Giving patients a free shot at doctors is a very dangerous business indeed. Why I hear you ask? Well the kind of patient that is likely to indulge in vindictive abuse is most likely a particular type of character, for example this kind of racist and bitter individual:

''If they think that all these years we pay national Insurance , yet if you walk into XXXX Medical Centre . You will find I line of Migrants trying to get free services on our backs . Including Somalians , Eastern Europeans etc... I was told I only had 10 minutes to see a doctor . So , after paying national insurance for so many years , I only get 10 minutes . I don't think so !! Kick them the migrants out ! Its time this government realised this country is not a dictatorship . I refuse to pay for the rubbish and the scum that comes hear to steal and turn this country into the biggest toilet in the world.''

This shows just what a stupid idea this website is. There are so many hypothetical cases that would guarantee the unfair abuse of doctors that I could list them all day. What about the deluded and aggressive psychiatric patient who resents being forced into necessary treatment for their mental illness? What about the fat smoker who didn't like being told to stop smoking and lose some weight?

What about the worried well from middle England who expect several hours of a doctor's time in clinic despite the fact that the doctor has other patients that need to be dealt with? What about the woman with breast cancer who thinks homeopathy will cure her cancer and who gets angry when the surgeon tells her that that this is not the case? What about the surgical patient who suffers an expected complication from their surgical procedure? And on and on.

All these individuals may well want to abuse their doctors on Iwantgreatcare, and all their doctors will have been acting in a completely professional manner, certainly not deserving the abuse that they would be likely to recieve on Neil Bacon's poorly thought out site. Likewise any good comments will be meaningless as who knows where they came from, after all it's all completely anonymous.

The first examples of unfair criticism are already starting to appear, Neil Bacon must be so proud for the noble work that he's doing for his bank balance and high quality patient care, he's almost as devastatingly brilliant in this regard as Lord Darzi. From a personal point of view I remember one patient in particular who would have loved to slag off a consultant of mine on IWGC.

My consultant was a very eminent surgeon indeed and spent many minutes patiently explaining that there was no evidence that any alternative therapies would cure his condition, while there was good scientific evidence behind the surgical option. This patient refused to take no for an answer and almost refused to leave the consultation room after half an hour of protestation, the mild mannered consultant almost had steam rising from his ears by the end. Only in the NHS would a scenario like this occur. IWGC is yet more power to patients at the expense of doctors, whatever happened to the doctor-patient relationsip being a two way thing as I was taught at medical school? Soon why not let these patients prescribe their own drugs and book their own operations, they seem to think they know it all.

Iwantgreatcare - farce in the making

Taken from Iwantgreatcare.org, a new insecure website created by Dr Neil Bacon for the government which enables anonymous patients to feedback on individual doctors (see the Jobbing doctor for a good lowdown on this story):

"Q: I objectively believe this is damaging to doctors, can't you just drop this whole idea?

Respectfully, no. It is clear from the evidence base that effective communication improves clinical outcomes, improves patient satisfaction, reduces the risk of medical errors and reduces the risk of litigation. The evidence also clearly reports patients can effectively judge doctors' communication skills to this effect. If you are aware of any peer-reviewed evidence that contradicts this summary, please email details to adminservices@iwantgreatcare.org.

If you are fixed in your belief that iWantGreatCare is damaging to doctors, please consider that iWantGreatCare is advised by a range of respected doctors and the emerging requirements for revalidation make patient ratings of your care fundamental to the measurement of your work. It is also clear, even with superficial knowledge of medical history, that this is not the first and will certainly not be the last new way of working that is challenging for some doctors. "

Dear Dr Bacon and GMC/government cronies,

There is also an abundant amount of evidence that useless poorly designed insecure websites can result in a lot of damage being done very unfairly to people who do not deserve it.

In fact a lot of websites have found themselves in legal trouble for allowing the baseless assassination of people's characters on their pages, what a shame if this happened to your great website.

I like it how one can only rate doctors if they have been one's colleague recently, I find it strange that there is no mechanism for rating doctors in politics or management despite the fact that their work has a massive impact on our working lives.

Why can we not rate Lord Darzi for his work proving the government with backing for their continued destructive privatisation of the NHS?

Why can we not rate Sir Liam for his pitiful work that failed to represent the profession regarding MTAS and MMC and his hermit like existence ever since?

Why can we not rate Dame Carol for taking on a lot of responsibilities and then failing to do her job properly by neglecting glaring problems that were staring her in the face?

I wonder if this is anything to do with the fact the Iwantgreatcare was created in consultation with the GMC, the Department of Health et al.

I wonder if this is because the likes of Iwantgreatcare sum up the the complete lack of accountability that is present in the political and medicopolitical establishments which is present from the very top.

Those like myself who work on the front line are already very accountable for our actions, it is remarkably easy for a patient to complain given the mechanisms in place, the argument that Iwantgreatcare will improve patient care is disingenuous.

The real motives for it are revealed by Professor Bulstrode's slip of the tongue:

'Doctors will feel threatened'

Our morally bankrupt leaders want to control and bully the only accountable people in the NHS a bit more, it is the sign of the Stalinist system that we live in today, those at the top are free to do as they see fit and would only leave office if doctors launched a military coup to depose them from power.

Respectfully you can stick your poor excuse for a website where the sun don't shine. I have no problem receiving feedback from my patients, however if this is to be done it should be done in a very regulated and secure manner so that no unnecessary harm can result from baseless vindictive slander. The good feedback is also meaningless as the website is not secure.

So overall the site is of no benefit to anyone and could potentially result in a lot of harm coming to a profession that already has amongst the highest rates of mental illness of any profession.

Respectfully if you genuinely cared about improving patient care then you would be better off investing your efforts in forcing those in positions of power in politics and in the medical establishment to act in the best interests of doctors and patients, rather than bullying doctors and acting in their own self interest, while remaining completely unaccountable for their negligent actions.

For example in medical training the DH, PMETB, Royal Colleges and government have been found to be grossly incompetent in their actions and this must be having a massive negative negative impact on patient care. However I see that no one has been called to account yet.

One rule for us and another for our masters, again, it's alright for you though Dr Bacon, you've now engineered a position for yourself that is away from the trench rot of front line accountability. Congratulations, I hope you are proud of your achievements.

ps Have a look at the mickey take site www.iwantgreatbacon.com, very amusing indeed; Dr Crippen and Rita Pal have also had their say, while apparently Iain Dale has been defending the site on the BBC. It's funny how politicians are so keen for doctors to be subject to anonymous abuse while politicians are frequently completely unaccountable for their mistakes.

Chewing Darzi's cud

Not a pleasant thought I know, however I thought I'd deliver my general thoughts on Lord Darzi's NHS review. Given Darzi's background of providing the DoH with what they want to hear, only the ultra naive would have thought that Darzi's review contain something insightful and intelligent. Alas Darzi's review has arrived echoing many government cliches that we have been accustomed to enduring such as 'world class commissioning' and 'patient choice'.

The Darzi review is verbose but lacks detail in the few areas in which it has any promise. For example as regards the formation of a new 'independent' body that will oversee medical training called NHSMEE, one has to assume that the body will be genuinely' independent' for it to have any hope of working, given PMETB's similar 'independent' status one could forgive a few groans from the medical establishment. There is no attempt to address the problems that EWTD have created in training with Darzi appearing keen to fall back on more educationalist fodder in the form of 'modular credentialing'.

As regards Primary Care the review is just more privatisation dressed up in the same old lies. The Darzi 'GP-led' health centres have been railroaded through by the DH in very PCT independent of the local needs that Darzi pretends to care so much about. I suspect the disingenuous 'GP-led' nature of the them will mean that it will be rather hard to see a doctor in Darzi's New NHS. There is more emphasis in 'reinvigorating' commissioning and 'patient choice', again this is the government's way of handing out sweeties to its friends in big business while pretending to give a monkeys for the sick and elderly. Dr Crippen has aleady commented on this being rather lucrative for Branson and chums.

There are many other little chestnuts hidden in the many pages of DH propaganda and spin. NICE is presented as being the envy of every other country in the world, while the word 'clinician' is dishonestly re branded in Orwellian manner as meaning anyone who has every seen a patient in their lives. PBC is seen as an overwhelming success, while PCTs are set to be handed even more power to waste millions of our money on 'healthy living' schemes. There is also a lot of talk about more and more measurement of care quality, surely another surefire way to waste money on more bureaucracy and QUANGOs.

The question as to the nature of Darzi's motivation is posed by Dr Grumble, this report offers me little choice but to go for the 'tethered goat' option. The worst thing about Darzi's review is the pretence that it has been constructed in partnership with front line NHS clinicians, nothing could be further from the truth. Darzi's review represents yet another pretence at consultation by this dishonest regime, a pretence at listening and a pretence at responding to local needs. The only needs being represented by Darzi's review are those of the ruling political classes who see further developing a market in heath care as the best way for them to continue their privatisation campaign.

Darzi's review has been a sham from the start, the consultation process was beyond a joke while the reform started even before the interim report had been produced. The reforms will result in good GP practices closing while the sick have to travel further to see less trained staff for lower quality care. The continuation of these destructive reforms will see health inequalities worsen, more money wasted on bureaucracy and more money gifted to the cherry pickers from the private sector. There is no easy answer, we can either have a locally driven service with a postcode lottery or have a Soviet style top down disaster. The artificial state managed market in health care will only be good for the cherry picking private sector, it's about time it was scrapped, the chances of seeing this bulldozer being stopped are pretty slim though. I'd like to finish by summing up Darzi's review as being:

"Centrally driven by a politician for politicians against the interests of both doctors and patients"

BBC acts as government arsehole

The BBC doesn't seem to understand rather basic concepts of good journalism, either that or they are deliberately spinning things in the government's favour. The following letter has been taken with the author's permission as it demonstrates nicely just how low in standard their journalism is. The BBC often presents both sides of the story, even when one side is clearly lying, making things appear 50:50 when in reality they are nothing like this. However when the government is lying then they do not present the other side of the story, making the government's line appear to be fact. I would be embarrassed if I were them:

"I am not a GP but I would like to formally complain about the reporting of the Today programme's top story http://news.bbc.co.uk/today/hi/today/newsid_7486000/7486975.stm. Essentially the BBC reported the comments of Health Minister, Ben Bradshaw, that GP's are in effect running a cartel with a "gentleman's agreement" to avoid taking on patients. Yet the BBC did not challenge Mr Bradshaw to produce any evidence to support these claims. Further on the BBC's website http://news.bbc.co.uk/1/hi/health/7475985.stm, Mr Bradshaw claims that there is one GP practice with only 2 patients, again no journalist has challenged him to produce any evidence to back this claim. There was no second source to this story in effect.

Yet just over a year ago I was interviewed by the BBC's Michele Paduano in March 2007 when I accused 2 ministers of Health (Patricia Hewitt & Lord Hunt) of either lying or misleading Parliament over the data in the relation to the junior doctors training scandal , MMC . The BBC even had a second source for the story, an e-mail from XXX which entirely backed my claims. Yet that interview was never broadcast, as the XXX mysteriously couldn't remember where they got the figures from. I was told by the BBC that since the Andrew Gilligan/David Kelly affair that they will only run a story if they have 2 sources.
Yet the Today programme is quite prepared to run a scurrilous rumour from one junior minister without presenting any evidence to back the story up....or indeed a second source.

I think this is dreadful and frankly when a programme like Today fails to take a government minister to task over such a rumour, they are failing in their jobs as journalists. I would also point out that Mr Bradshaw is a former BBC journalist and his partner works for the BBC, could this explain why the BBC are being so soft on him?

I await your reply.

Yours sincerely"

Little Red Riding Hood

Little red riding rood once had to deliver a parcel of food to her poor sick grandmother. She had to negotiate her way through the woods in order to get to her grandmother's house, but there was a big bad wolf that wanted to digest her, however he was afraid of doing so in public, so he approached her to find out where she was going, she naively spilt the beans...

The wolf beat her to the house, tricked little red's grandmother into letting her into her house, ate her and dressed up in the grandmother's clothes, then lay in wait for little red riding hood. Little red arrived a little later and was swallowed whole.

Luckily for little red a hunter came to her rescue and cut the wolf open to free both little red and her grandmother, all ended happily with the wolf being killed off by some large stones.

Incidentally Darzi's review was released today proclaiming 'Change – locally-led, patient-centred and clinically driven', maybe it's just me, but the very same government that has been wasting billions on centrally controlled, politician centred and politically driven health care reform appears to be very much in control of this one, while the calls for more 'personalised' care driven forward in an 'accelerated' manner looks like a wolf hiding in a 'quality' sheepskin jacket to me.

I fail to see how any of the following will improve 'quality': undermining high standards in medical training, allowing more private sector cherry picking, allowing more money to be wasted by PCTs on healthy lifestyle guff, more quangos, more reorganisation with no accountability, more inaccurate measurement of care quality by the use of patient satisfaction surveys (remember the botched ISTC jobs) and more care delivered by workers with lower levels of education and training than ever before. I could go on but you get the picture of our hairy and rather toothy bedfellow.

The medical profession is in the woods. The big bad wolf is ready and waiting, our grandmother is long gone and probably in the terminal ileum by now. Do we naively believe all we are told or do we get ready to hunt our wolf, the choice is yours.

A blogging rut, happy 60th NHS

If I knew the secret to writing inspiring masterpieces week in week out I'd be a billionaire by now, and if I could just intermittently write the odd masterpiece I'd be content. Finding the drive to write is difficult in the ruts, sometimes one thinks its better to just write nothing when there's no creative spark, at other times one thinks it would be better to grind through regardless.

I can't find the inspiration at the moment and I have no idea why. Work has been fairly busy, but then work is always busy, so that's no decent excuse. The NHS is 60 years old this year, so I should be celebrating this great landmark, but for some reason I do not feel like celebrating.

It is not the NHS that should be celebrated in my opinion, the system and the structure leave a lot to be desired in my eyes. From my few years of practice it is the humanity of the staff and the patients that should be celebrated, and this is frequently in spite of the system.

No matter how the government grind us down there are some things that they cannot take away from us, no matter how hard they try. The satisfaction and sense of achievement that one experiences at a job well done makes the daily grind well worth it. The variety and complexity that a career in medicine brings to one's life cannot be converted into pounds and pence.

I'm sure the government will try to spin the 60th birthday into some propaganda peddling extravaganza, luckily the majority of us stopped listening a long long time ago. Despite all the negativity and gloom, working in the NHS gives me a faith in humanity that stops me falling off in the ruts. Even though the government want to turn us all against each other in order to further their own short sighted self interest, through my daily contacts I see that they will never break us down.

Child dies

A sad story has emerged in which paramedics elected not to bring a child into hospital following a head injury, the child died a few hours later after another ambulance had been called.

Whatever the facts of the case, it is clearly unfair to put paramedics in this decision making position given their minimal levels of training in medical diagnosis and treatment. In the NHS these days managers frequently pressurise paramedics to leave patients at home.

This is a high risk strategy to say the least, these kind of decisions are hard enough for fully trained and highly experienced doctors, so it is not safe or fair to put paramedics in this position.

This is a familiar tale in the NHS today. Those without sufficient knowledge and training are routinely empowered to make decisions outside of their so called 'spheres of competence', the system is set up to encourage this dangerous practice. It's very sad indeed and it just isn't good enough.

R-UK goes live

The one flower to have blossomed following the MTAS explosion has been that of Remedy UK. The only group that showed the courage and determination to represent the opinion of doctors was Remedy, and as others floundered Remedy was strong.

Remedy have launched a new online Magazine and it's a site that's well worth popping past. Anyone can read the magazine, while everyone is also free to register and join the online Remedy community.

I would therefore urge everyone to be part of Remedy's solution, this is no time for apathy, admittedly many of us are feeling the strain after many months of unrelenting grinding against the system, however if we do not stand up now and try to make ourselves heard then we never will.

Darzi, Johnson et al are currently pushing through their antidemocratic reforms which promise to reduce the standard of care while privatising what is left of our National Health Service. We need to unite against this common evil, we need to believe that we can make a difference as individuals combining to destroy this malignant growth.

The power of public opinion is potentially huge and enough to stop any tyrant in their tracks, so it is up to us to find more ways in which to educate and engage the public, so that they can unite with us against this common enemy. We have the truth on our side, so despite our relative lack of finances and propaganda merchants, we can hit the bastards for six if we believe in ourselves a little bit more.

Rate your doctor

I have recently been ranting about the dangers of a one way doctor patient relationship, and since then I have been alerted to the rather interesting website RateMDs.com which allows patients to rate their doctors online.

It could almost seem like a good idea if one had left one's brain in the car park, however there are many reasons why this kind of website are a complete waste of time. For one it is completely insecure, meaning that anyone can submit a doctor and anyone can rate the doctor. There is absolutely no check at all of anyone's identity, it really does beggar belief.

In fact there a few famous UK doctors have already been rated, Sir Darzi, Sir Liam Donaldson and Dame Carol Black amongst the elite few. If you fancy rating them or anyone else, then go for it, the site is completely insecure!

I am sure this kind of hair brained scheme will be coming to the NHS very soon, despite the fact that using 'patient satisfaction' as a surrogate marker of care quality is about as reliable as a Roulette wheel, our political masters just want sticks to beat and bully us with.

The people running these schemes are invariably the politically climbing of the medical profession, people who have sold their souls in order to chase money and honours. Organisations like the GMC are now run by selfish politicos who are keen to sell out their colleagues in producing yet more layers of needless and useless regulatory bureaucracy. It is also strange that nurses and other HCPs are not subject to the same mechanisms of command and control.

Dr Crippen has also recently written on how Primary Care is being wrecked by these traitors. Ironically as the quangos and these new gimmicky schemes proliferate, the patients will be the ones to suffer as good local services will be destroyed and doctors will find their job of caring for patients increasingly obstructed by the hair brained new ideas.

The world has gone mad

When I was a youngster at medical school I remember being taught the importance of the doctor patient relationship, it was interesting stuff at the time, and even then it was emphasised how the relationship could be varied to get the best outcome out of it for the patient. Many factors affect this complex relationship, the personalities of the doctor and the patient, the issues being dealt with, the time available et cetera. Sometimes the patient wants a more paternalistic approach, and sometimes the patient wants to be involved more in the decisions making process.

Frequently what the patient wants is not best for the patient though. Whether it be the overweight smoker who does not want to listen to a doctor politely explaining the implications of their lifestyle, or the women with breast cancer who wants to be told that herbal medicine can be used to treat her cancer instead of the effective modern approach. These patients would be happy to be badly managed by their doctors, demonstrating the serious problems with assessing doctors by relying solely on patient satisfaction surveys. Ironically Harold Shipman was very popular amongst his patients, likewise I have seen countless examples of patients who have been negligently managed who have also been very happy with their care.

Teachers are being plagued by the same politically correct nonsense, I'm sure many of us can recognise that our best teachers were frequently not our favourite teachers at the time. I wonder how long it will be before all parents are forced to respond to all the unjustified complaints from their offspring, it may well result in TV all day with ice cream for breakfast, lunch and tea. Some of the new breed of Health Care Practitioner such as the nurse specialist love this new method of assessment, as they simply defer tricky problems that might make them unpopular to the doctors, while they have so few patients to see in so much time that they can afford to indulge the patient with plenty of ego massaging attention and a few cups of tea.

The world is going mad. Junior doctors already have things hard, they are easy targets for bullying from other staff due to the short nature of their placements;they are now an easy target for other HCPs thanks to the wonders of the 360 degree assessment which allows the assessors to criticise in a completely unaccountable fashion. What next, all doctors being forced to enlist themselves with websites that allow patients to rate their care in a similarly unaccountable one way fashion?

The doctor patient relationship should be a two way street, not the one way street that our nonsensical politically correct culture is trying to force upon us. While it is important that patients have sufficient power to comment and complain, it is equally important that doctors are not subject to unfair abuse and bullied by manipulative aggressive patients. I wonder what the reason for the deteriorating discipline in patients, pupils and children is these days? It couldn't be anything to do with out politically correct culture empowering them way beyond the limits of common sense?

Doctors do not have an easy job, they frequently have to choose the lesser of two evils and it is not uncommon for some people to be offended in the process, even when the best option is chosen in the most polite way humanly possible. Opening yet another avenue in which patients can unaccountably vent their spleens promises to benefit no one, except the politicians who want to enslave our profession. I wonder, will this new set of chains enable us to feedback on the management prowess of Sir Darzi, Sir Liam and Dame Carol? I very much doubt it.

Pharmacy and the 'clinical practitioner'

It seems to have been smuggled in by the back door, but now even pharmacists are allowed to have a crack at history taking, examination, differential diagnosis and the management of medical disease. Pharmacists, albeit being quite handy at pharmacology, have bugger all training in anything else but for some reason the government thinks it's safe to let them loose as yet another prong in the ever expanding army of pseudo doctors as 'clinical practitioners'.

One wonders what the government's precise motives are, just why would they be dangerously empowering those who tend to work for large pharmaceutical corporations while trying to undermine self employed doctors? Labour is struggling for funding these days, and Boots et al have been known to be rather cuddly with el Gordo and his greasy pals.

Pharmacists up and down the country are opening up their small cupboards and acting doctor in these pseudo doctor's rooms, some of them are quite happy to get their stethoscopes out and start playing doctor. Whether it be managing the complex medical complications of Diabetes or the brittle Asthmatic, the new 'clinical practitioners' will feel quite at home playing around in waters well out of their depth.

This dangerous empowerment won't even save money as GPs are already paid to do the same job for less, so the government is wasting money and dumbing down standards at the same time, how very priceless. When this is combined with legislation that acts in the interests of big pharmaceutical firms and not patients by restricting GP dispensing, here we have a government that is frittering away our cash in order to keep big business happy. It seems this government will do anything to get their dirty mitts on more cash, it's just lucky for us that money can't buy them trust anymore.

World class idiocy

Type the words 'world class commissioning' into google and you'll unearth a goldmine of utter tosh, starting from the DoH's page on the subject. Apparently there are four key parts to this large hunk of management turd:

"a vision for world class commissioning, a set of world class commissioning competencies, an assurance system and a support and development framework."

Have a read and if you can honestly make any sense of the undecipherable management speak then please get in touch, because I can't. The document is littered with meaningless guff like 'adding life to years and years to life', it is utterly cringe worthy. Essentially all they're saying is that they intend to make health care better with world class commissioning, in the most long winded and nonsensical manner humanly possible.

The meat of this reform is hidden in the FESC section, that's Framework for procuring External Support for Commissioners in long. This is essentially privatisation by the back door again. PCTs will be enabled to directly commission work from independent providers, private providers in other words.

FESC is designed to privatise the NHS further, the PCTs will undermine the local NHS services by starving them of funds by commissioning their work to private firms instead. PCTs are turning into the biggest joke in the NHS, their bureaucracies never stop expanding and instead of actually paying those who know what their doing to do their jobs, ie the hospitals and local NHS services, they would rather burn our money in commissioning their own hair brained schemes.

It would be far too simple to fund our hospitals and local services properly, our PCTs want to starve these services of cash while lining the private sector's pockets. In this manner PCTs spend lots of money trying to avoid paying GPs and hospitals for the work that they actually do, increasing the bureaucratic inefficiency of the system.

The way in which DoH stooges try to dress up this agenda of privatisation as some kind of revolutionary breakthrough in the science of commissioning has to be seen to be believed, have a read of the incomprehensible Helen Bevan's explanation:

"The biggest risk is that the transformational aspirations of tomorrow get hijacked by the thinking of today."

No Helen, the biggest danger is that people will see through your camouflage of management mumbo jumbo and see world class commissioning for what it really is, yet another dishonest attempt to privatise the NHS that will have a devastating effect on local NHS services and standards of care. Mark Britnell's limp words sum up the Kafkaesque nature of this government campaign.

It may have passed the the moronic DoH apparatchiks who read the Health Service Journal by, but their ilk have been wrecking the NHS for the last eleven years, therefore why on earth should anyone believe the faeculent management speak that is spewed forth from their treacherous behinds. These apparatchiks are very good at producing meaningless waffle that claims they will make things better, but if these hollow words are not backed up by meaningful action then surely these failures should be shown the door? Unfortunately for us this government rewards lying and failure with promotion, so we have an NHS run by a proliferating network of dishonest cretins who have only just mastered shoe lace tying.

So as 'world class commissioning' grows, expect to see your local GP and local hospital starved of cash resulting in essential services closing, then watch and weep as the private sector is paid large sums to do the same work less well. This is world class idiocy.

Utterfraud in the Times

I don't believe I am on my own in stating that Thomas Stuttaford doesn't half love to pretend to be a master of everything. His latest offering concerns Deep Vein Thromboses (DVTs) and their sometimes fatal complication, the clot in the lungs called the Pulmonary Embolus (PE).

Dr Thomas comes out with some rather dubious statistics that the Department of Health has recently plucked from it's arse:

"DVTs and pulmonary embolisms are estimated, according to a recently published Department of Health report, to account for 25,000 deaths a year in British hospitals."

I would love to know how the DoH 'estimated' this figure, it may have involved the arse plucking that I suggested earlier. Dr Thomas doesn't stop there though:

"The figure of 25,000 fatalities may well be an underestimate because many patients thought to have died from a post-operative chest infection may in reality have initially suffered from small pulmonary emboli."

It may well be a massive overestimate too, as this figure is a complete guesstimate, this doesn't appear to have occurred to Dr Thomas though. His final paragraph then claims that many of these deaths are preventable and that a new drug called 'Pradaxa' will help in this regard:

"If adequate precautions were taken before someone undergoes surgery associated with a high risk of DVT, many of these deaths could be prevented."

Actually Dr Thomas you are completely wrong in this regard, there is absolutely no evidence to back up this statement that you make. DVT prevention (aka prophylaxis) in the form of various drugs has been shown to have no effect at all on mortality and symptomatic DVT rates.

Large cohorts of high risk patients who have received no prophylactic treatment have been shown to be at no increased risk of death compared with their counterparts who have been treated with expensive blood thinning drugs. Dr Thomas doesn't mention this, he seems very keen to blow the trumpet of expensive new drugs, is there a conflict of interest here that he is not revealing?

Hot air from Darzi

"Education, training leadership and the NHS review" was the topic for debate held at the Royal College of Physicians on workforce, education and training led by Lord Ara Darzi with Professor John Tooke, Professor David Sowden of MMC and Clare Chapman, Director General of the NHS Workforce.

Darzi talked of improvements needing to be made and a framework of accountability, but never touched upon how this would actually be done, while he also ignored calls for ring fencing training budgets. There was also a lot of banter about 'learning agreements' that were seen as some kind of magical fix by some, however how on earth they would force Trusts to take training seriously was not explained adequately.

Sir John Tooke saliently pointed out that there was no one in charge of training, that there was no one to blame if things went wrong. An excellent question was posed by Richard Marks of Remedy UK as regards the workforce planning as regards junior doctor numbers. Do we appoint trainees in a number proportional to the consultant posts that will be available in the future or related to the service needs? Clearly the government wants to flood the market with 'training posts' in order to force down wages by creating a sub-consultant non-training grade, this must be opposed.

Clare Chapman farcically talked of 'openness and honesty', I don't think she intended this as a joke but this is how it came across to me. Given that her malignant Department is behind the dumbing down of training and the deliberate creation of a surplus of demoralised doctors, I doubt her comments would pass a lie detector test. An excellent workforce point was made by Sir John and one Oncology trainee, who both pointed out that demands for particular specialists may change massively over short times; meaning that it would be sensible to ensure that all trainees receive several years of more generalised training before sub specialising, so that they are more prepared to adapt to future workforce needs.

Some superb comments were made about the naivety of educationalists who think that more training content can be easily achieved by fiddling with the bureaucratic elements of training. Darzi was then thoroughly unconvincing when he tried to explain the massive cynicism that the audience felt towards politicians, Darzi claimed that this cynicism was all part of 'democracy', he should have added in the word 'corrupt' before the democracy I feel.

The general dumbing down of undergraduate education was mentioned, as was the massive step backwards that competency based training assessment methods have been. Trainees have gone from being closely monitored by one senior clinician to being grossly unsupervised in their training. The excellent point was also made that doctors are being downgraded in the context of the MDT, doctors in training have to take a lot of the clinical responsibility but are treated with a lack of respect and sometimes disdain by other members of the MDT. If this kind of lack of respect and disdain was shown by doctors to other members of the team, then the doctors would be in great trouble; unfortunately with the current ethos of all Health Care Professionals being equal doctors are being downgraded and routinely bullied to satisfy the government's need to enslave the profession. Clare Chapman was quite pathetic in her comments on this topic.

Overall Darzi appeared all talk, there was a lot of hot air expressed as regards how genuine his role was and how things were so different at the top, with clinicians being engaged. This battle is only just starting, but it was clear from the overall opinion expressed that doctors are not happy with being treated undervalued and bullied by their employers; medical training needs to be completely depoliticised so that patients can be better cared for in the long term. Doctors genuinely want better training because they want to be good at what they do, hence they are fighting the government's desire to dumb down training in order to catalyse the privatisation of the NHS. I'd love to get Darzi on a lie detector.

PMETB - wrecking medicine

As entry standards for medicine at University are dumbed down in a rather politically correct fashion, PMETB continues to oversee the wanton destruction of decent medical training, with years of knowledge and expertise being thrown in the bin because the political stooges at PMETB would prefer to implement the unwieldy psychobabble that spews forth from the recta of educationalists.

Educationalists have a lot of waffle that they used to justify their half witted rubbish, they believe that they can pull the wool over our eyes by repeating words like 'reliability' and 'validity' until the cows come home. In fact A Levels and GCSEs have been dumbed down in the same manner as the Royal College membership exams, the MRCP and MRCS, by making everything so objective that is ceases to be a useful measure of anything at all.

Educationalists do not allow experienced clinicians to use years of their expertise and knowledge to judge candidates, they insist upon replacing tried and tested exams with tick box exercises that allow no room for subjective manoeuvre. In denying the value of subjectivity PMETB regulations have forced the Colleges to comply with their vacuous plans that enforce the dumbing down of training standards, in this way the surgical vivas and clinical exams that are assessed by top consultants are being replaced by OSCEs that can be manned by non-medically trained technicians. This is happening across the board.

PMETB has also dumbed down what 'training' actually means. The poorly worked Foundation program and MMC have resulted in thousands of posts that were previously non-training posts magically becoming 'training posts' overnight, despite the fact that these jobs still have no proper training content. This means that thousands of doctors in training are struggling to get the necessary experience because their job simply does not give them adequate exposure to the core of what they need to learn.

Competency based assessment is then used to pretend that the overtly woeful training is actually thorough and comprehensive. In the old days one had to do decent chunks of a wide variety of specialties to progress, meaning that one needed a broad base of skill and experience to progress to the next level. Now all one needs is a few bits of paper signed that prove one has done a few things once, and one is magically transformed into a super-competent doctor. The wonders of competency based training never cease.

In reality the great irony is that competency is not encouraged by competency based training. Competency is a very grey entity and one cannot prove one's competency by doing something once, and then getting a piece of paper signed. PMETB produces more turd burgers than the biggest dairy farms in the land, it is an organisation that has been found wanting in recent inquiries and investigations into it's complete failure throughout the implementation of MMC. So why on earth is PMETB still being listened to? Why are PMETB's educationalists still allowed to carry through the implementation of the dumbing down of medical training? Why are the competency based fundamentalists being allowed to triumph? PMETB should be wiped out of existence and we should only listen to the sound of it's explosion.

Who needs beds?

The imminent loss of 5,000 Oncology beds has been hitting the news this weekend. Apparently in order to improve our radiotherapy and chemotherapy services, these beds will need to be cut to fund the investment. It's all part of the great Darzi review that pledges to force reform upon the whole country in its uniquely undemocratic manner.

As has been pointed out to me by the ever aware A&E charge nurse "the UK population has grown by 17% since 1951 while the number of NHS beds has fallen by 40% since 1959 - we have one of the lowest bed per 1000 patients in Western Europe: 3.3 compared to 6 beds in Germany, to cite just one example."

Certainly keeping some people out of hospital is a good thing, however many of the DoH's reforms have wasted money in ineffectively trying to keep people out of hospital and in forcing patients out of hospital when it is clearly the most appropriate place for them to be. I also heard in the news that the budget for elderly care is to be trimmed by several billion over the forthcoming years, another example of the lack of joined up thinking in government, as with an ageing population and an increasing demand for care for the elderly, these short sighted cuts will only result in yet more inefficiency with old people blocking acute hospital beds as there is nowhere else for them to go.

The cut in Oncology beds is bizarre, as anecdotally I have heard of cases of there being such a shortage of beds locally that sick Oncology patients are having to be treated as in patients in waiting rooms and day rooms. Oncology patients get sick quick, radiotherapy and chemotherapy have some pretty serious side effects such as neutropenic sepsis, and these cannot be adequately managed in 'cottage hospitals' as the government seems to think. The Darzi philosophy seems to be all about cutting services and beds, while shifting sick patients into the community to save cash, I personally don't recognise this a progress.

The national bed shortage and near 100% bed occupancy rates have so many negative knock on effects in terms of patient care and efficiency that I could bore you with them all day . Around the country numerous operations are needlessly being cancelled because there are no beds in which to admit patients for their stay, meaning that surgeons, anaesthetists and theatre staff are often left to twiddle their thumbs in empty theatres because of this knock on inefficiency. Patients are frequently not cared for in an appropriate ward to suit their particular illness, as bed shortages mean that any bed sometimes has to do; this can sometimes be deeply inappropriate with adults being cared for on paediatric wards, and it can also result in significant morbidity and mortality as patients may be significant distances from their medical staff, while their specialist nursing staff may well not be familiar with the particulars of dealing with another specialities' patients, surgical nurses looking after oncology patients for example. The link between high bed occupancy rates and hospital acquired infection is for another day.

Overall the beds are cut and the inefficiency increases, economies of scale are ignored as the short sighted penny pinching results in the flushing of bank notes down the toilet on a rather regular basis. It makes me weep to see stooges like Darzi pretending that these reforms are in the best interests of patients up and down the country. If my mother was lumped on an orthopaedic ward with her neutropenic sepsis I would not see this as progress, I just wonder why Ara Darzi is so happy with this dismal state of affairs.

Health Committee bottle it - first thoughts

The Health Select Committee released their report on the mess that is also know as Modernising Medical Careers (MMC) today. A bunch of politicians with only a little understanding of medical training were never going to produce anything as insightful or intelligent as Sir John Tooke. Overall the report talks the talk, pointing out a lot of glaring errors that occurred along the way, but fails to walk the walk, as it does not call anyone to account or propose any sensible changes that would help prevent similar mistakes being made in the future.

The report states the obvious failings that occurred time and time again throughout the botched MMC process. The DoH rushed the reform through negligently without listening, where have we heard this before? The leaders of numerous quangos and the so called 'leaders' of the medical profession let us all down time and time again. PMETB and the GMC are muppets. The CMO won't even take responsibility for his own nappy.

Tooke's report was infinitely superior to the Health Committee's inelegant and cumbersome blunderbuss of an effort. They seem to have been sucked in by certain porkies concerning the glorious success of Foundation training according to the DoH and Deaneries, what neutrals these people are in describing their own lovechilds. They were not sucked in as regards to completely useless process that was the infamous MTAS 2007. While the Committee's comments on the consultant grade appear ominous to say the least.

Overall though the Health Committee have just produced a lot of paper and hot air, there is not much at the end of all this that will prevent such disasters happening again in the near future. No one is being forced to account, meaning that many of chief MMC culprits are being left in control to 'fix' their own mess, the useless MMC programme board carries on regardless. NHS:MEE and Tooke have been neatly sidestepped, it is simply not good enough to say that the DoH must listen in the future, they have been told this time and time again, but they never listen because no one is ever responsible or accountable for their wreckless decisions and reforms. The problems of EWTD and the sub-consultant grade will not magically dissappear, likewise the evil of competency based fundamentalism is also ignored. What is the role of the doctor? One hopes that bending over to be regularly shafted by the government is not part of the job description.

One thing I have learned from this disatrous MMC and MTAS experience is that unless we all unite and force the hands of the so called 'leaders' then we will continue to be led down the garden path towards the dung heap. The DoH, the GMC, PMETB, Ara Darzi, the Colleges, our so called 'leaders' and the BMA will not suddenly grow testacles and brains in order to save medical training from the MMC blender, we will have to do that for ourselves somehow.

I don't know if I can do this anymore

This DNUK extract is well worth a read, the doctor who wrote the original piece has kindly given me permission to reproduce his words here. It sums up the way in which the front line doctors of the NHS are frustrated beyond belief at a system that continually obstructs the thing that they want to do to the best of their ability, namely care for their patients:

"I love medicine. I think I wanted to be a doctor from about the age of eight. Although I'm sure this sounds like a cliche, it's true; I wanted to be a doctor since I was a kid.

A hospital chaplain once said to me that one person only has so much patience, compassion and energy. I think he is right.

I have just finished a long set of nights in a moderately busy emergency department. It is a relatively good department, in a relatively good hospital.

A lovely gentleman presented with very severe chest pain and back pain. His family were even more lovely. I did a heart scan that showed his aorta, the largest blood vessel in the body was tearing. This is called aortic dissection and is to understate things, a surgical emergency.A CT scan of his chest and abdomen showed that the dissection extended from his heart all the way into his abdomen.

I contacted the local cardiothoracic surgical centre and spoke to the surgeon who would be able to fix this probably fatal condition. In a rather embarrassed tone he told me that there were no available beds on his unit.

Meanwhile the patient sits opposite me. I advised his wife that they should try to get all his available relatives to see him, as he might die suddenly. Each one arrives, and comes to thank me for "all that I am doing".

After two hours I had spoken to four other surgical units. None of them had any beds.

Another family member arrives, walks over to his relatives. They point at me, the relative walks over touches my arm and smiling thanks me for all I am doing.

What am I doing? Am I colluding with a system that is letting this man and so many others like him down. I am trying to tread water in a what sometimes seems a third world system. A system crippled by short sighted targets and budgets. A system where a waiting list is more important than an intensive care bed. A system where the four hour target means that patients are rushed through the hospital, not getting the correct diagnosis, waiting in corridors, in pain and critically ill.

I don't know if I can do this for another 20 years."

I think the nation's professionals all feel this incredible frustration, and the blame lies firmly at the door of an increasingly centralised and controlling state. The state has steadily made it harder for all professionals to do the jobs that they love to the best of their ability, professionals work better when they are treated with respect and trusted to do their jobs by their employers. The current top down micro managed state of affairs is not helping anyone, and certainly not our patients.

ME mincing

Logic has been cast aside as some geneticists have got more than a little carried away in trying to subdivide ME/CFS into genetic subtypes. Firstly I would like to state that I am not of the opinion that everyone with the ME/CFS label has nothing medically wrong with them.

However I think it is completely stupid to claim that all people with a ME/CFS label have the same 'disease', as the 'disease' has no specific symptoms, no specific signs, and no decent diagnostic tests. I think the medicalisation of these kind of so called 'diseases' as discrete entities when one cannot even define what the 'disease' is creates far more problems than it solves. That is not to say that many of these people do not have very real pathologies, however to lump them all together under the ME umbrella is nothing but foolish and short sighted as we are no way near understanding this condition as yet.

There are other conditions that are very poorly defined and hence come into the same trouble as ME/CFS, many of them rather vague and sometimes bogus psychiatric diagnoses, and one can't help but feel that the diagnosis of Irritable Bowel Syndrome is another steaming pile of poorly understood conditions that have been lazily dumped together in an attempt to feign a pretence for understanding things that are simply not yet understood.

Back to the case in hand, how on earth can geneticists claim to be able to subdivide up a condition into genetic subtypes when they cannot even define or diagnose this condition in the first place? I would argue that they cannot. More importantly pretending to understand things that are not understood is dangerous, as it prevents people from openly and honestly trying to understand these conditions better, as anyone who questions the existence of ME/CFS as a discrete pathological entity is written off in a rather annoying politically correct fashion.

There are also many cases of people who have had clear diagnoses missed and then been inappropriately labelled with ME or IBS, meaning that their real diagnosis went untreated. Also the more we medicalise the poorly understood then the more normal people with no problems will become medically labelled, and then start acting up to their label; I don't think this is a good thing either. The worried well will be happy though, the ever growing band of fashion conscious Gluten avoiding bored housewives will have a new act to follow.

Brace yourselves

"The Health Committee will publish its Third Report of Session 2007-08 on Modernising Medical Careers (HC 25-I) on 8 May 2008 at 00.01 am. A Press Conference will be held at 10 am on Wednesday 7 May in Committee Room 5, Palace of Westminster. Please note: that all comments made at this press conference will be strictly embargoed until publication of the report at 00.01 am on Thursday 8 May 2008. Embargoed copies of the report will be available from Committee Room 5 on Wednesday 7 May at 9.30 am."

I wait with interest to see what the Health Committee will have to offer when it passes judgement on MMC. I expect this type of political committees to swallow a fair amount of the DoH's propaganda, however there are limits and surely they must be able to see what a dismal failure MMC has been thanks to some rather corrupt political agendas lurking beneath the surface that have been pushed through by some rather compliant 'leaders' of the medical profession.

Medical training should be sculpted with the interests of patients at its heart, unfortunately MMC has been crafted with the aim of deprofessionalisation the medical profession and privatising the health service, and this has worked directly against the short and long term interests of patients in this country.

The deprofessionalistion has gone hand in hand with a national initiative of devaluing proper education and training via the Skillification advocated by Labour crony Lord Leitch. In the NHS this has seen the dangerous empowerment of a wide variety of undertrained and undereducated workers, justified by the logic of people with no experience of medicine and health care provision.

The aim is the opening up of the market, as this is seen as the holy grail in the naive free market fundamentalists' warped master plan. In their pea sized brains there is no danger in empowering the ignorant to do things way beyond their means, as the market will magically prevent any harm being done. In reality harm does result, as consumers are not perfectly educated and perfectly informed to make sensible rational decisions. In reality a lot of useless and/or dangerous rubbish can be peddled successfully in the 'perfect' free market, as the brainwashing of consumers with manipulative advertising and the exploitation of the consumer's uneducated ignorance can combine to devastating effect.

One only has to take a small glimpse around to see the garbage that is peddled dishonestly in the name of improving one's health; back street surgery by untrained surgeons, multivitamins, Chinese medicine, homeopathy, osteopathy, reflexology et al. I wonder what the free marketeers would say to this, the consumer does not appear to behave at all rationally or cleverly with these stupid decisions.

Anyway I digress, but the point I'm trying to make is that MMC is part of a perverse and stupid vision for health care provision that has been plopped out of the back passages of idiots who have no concept of what it takes to provide a sustainable high quality service for patients. The Modernisation of MMC stands for dumbing down and crushing high standards of medical training and working towards a useless competency based system that will allow anyone to have a crack at anything, I just hope the Health Committee have the honesty to describe MMC for the steaming turd that it is.