Indefensible

The appalling security breach by MTAS, that has left copious amounts of personal information regarding young doctors open to access by anyone with access to the Internet, is as flagrant breach of the Data protection act as is humanly possible. Junior doctors can expect certain rights to be respected under this act:

"(iii) The right to take steps to prevent your personal data being processed if the processing is likely to cause you or someone else to suffer substantial damage or substantial distress which
is unjustified.

(vii) If you have suffered damage and distress as a result of a data controller failing to comply with the Act, you have the right to claim compensation from the data controller."

I am not sure if iii) would justify a mass boycott of MTAS, however it is definite that vii) entitles junior doctors to claim for compensation. The first port of call for compensation is via contacting the DoH, the 'data controller' in this case.

I would strongly encourage juniors affected to complain to the Information Commissioner's Office. This can be done here with this form. As if the ICO find that the DoH/MTAS has broken the Act then compensation claims could be taken to court. Click here for advice if you are particularly worried about the potential for the fraudulent use of your data.

Its hard to find words to describe how shocking this latest gaff is. Matt Jameson-Evans from Remedy UK summed up very well the way junior doctors are now feeling:

"I'm absolutely gob-smacked, I don't know whether to laugh or cry. I'm not going to be able to laugh because it's so serious. After I've scraped my jaw up off the floor I'll say that I'm not really surprised - it's a level of ineptitude that has characterised this whole process. It takes the concept of a botched IT job just to a new dimension."

I think a great way of making this deeply incompetent government pay for their literal crimes would be for all juniors affected to claim compensation and donate these funds to Remedy UK. Remedy UK has been the only organisation that has fought hard for juniors and they are one of the few rays of light in an otherwise grim looking landscape.

The spineless nature of the government and Patricia Hewitt in particular was emphatically demonstrated by another no show on the Channel 4 news, which was her umpteenth no show for that matter. Meanwhile the BBC reported on the matter in a typically Labour tinted manner, no surprise there then. The Telegraph and the Guardian have covered events a little better. On a tangent, take a look at this hilarious piece by Dr Crippen which shows just how Labour have lost the plot. Why do these incompetents hide in times of trouble when the public deserves to hear some answers from them?

This latest balls-up must draw into question the plans for NHS Spine, as if the DoH cannot organise a few thousand doctors applying for jobs centrally without leaking all their personal information; think of the potential for mayhem of a far greater magnitude. The Health Select Committee is due to investigate this soon and evidence has already been submitted, surely this MTAS breach will impact upon their thinking?

I have argued with many people over the past few weeks over the dubious benefits of centralisation in certain circumstances. Even if things go smoothly, it is still arguable that there is no need to centralise as the potential benefits may not outweigh the great cost; however we have seen in recent weeks and years, that these grandiose schemes frequently go anything but smoothly in the hands of HMG.

Channel 4 shocker

An astounding revelation on the Channel 4 news revealed that there was 'new evidence of incompetence that will shock medics across the country'.

MTAS (medical training application service) was demonstrated to be insecure from at least 9am 25/4/2007. This meant that extremely personal data including criminal records, sexual preferences, phone numbers, addresses and more were all accessible on line to anyone who had the URL address. The URL was insecure and no one is quite sure how long the data was available, while MTAS claim they do not even know how many people have downloaded the deeply personal information.

The DoH was then informed of this problem and managed to shut the security breach. As usual no one from the government or DoH could be bothered to appear on the channel 4 news. The serious nature of this breach could lead to criminal charges and the Information Commissioners office is on the case. Junior Doctors organisations had already warned the DoH of potential security problems with MTAS, it seems these warnings were not heeded. The potential identity theft and data theft is yet another thing for junior doctors to have to worry themselves over during this stressful period.

John Snow, the legend that he is, offered the cowardly Patricia Hewitt an open invitation to appear on the Channel 4 news. It seems standard practice these days for Labour politicians to resemble hermits when it comes to appearing in the media.

Instead Andrew Lansley appeared and pointed out several glaring examples of failings as regards the DoH, Hewitt and MTAS. He also said 'Hewitt will go'.

The next item before I switched off the box was yet another example of Blair's overtly unaccountable and corrupt regime. Blair is refusing to investigate intelligence leaks about anti-terrorism operations that 'could have cost lives'. It's yet another example of corruption in this nontransparent government. Could it be that the leaks are deliberate in an attempt to whip up a certain level of fear in the public? Blair's attempts to prevent this being investigated make this appear to be the case.

Blair and his cronies have well and truly lost the plot. They are demonstrating a genuine contempt for the democratic process on a daily basis, as well as incompetence of unprecedented levels. I have had enough.

On the record

I have decided to sift through Hansard from the MMC debate yesterday and summarise the most important quotes which must not be forgotten. There are some rather revealing admissions and statements, and the exposure must be exploited if the 'patient safety danger' MMC is to be stopped:

Patricia Hewitt 'Those problems should not have arisen'

Quite right for once. They should not have.

Hewitt 'we have a system for this year that is fair to junior doctors and enables the NHS to make the right appointments to all the posts involved.'

We overtly do not, hence the legal challenge is essential.

Hewitt 'The first part of the new system—the two-year foundation programme—was successfully introduced in 2005.'

This is contentious. There are so many problems with Foundation training and many trainees are very unhappy with the quality of their training.

Hewitt 'The applications system has actually been working well in many places, particularly for GP posts.'

This is pretty much a lie. It has worked better for GP posts than for non-GP posts, but 'well' is a generous lie.

Hewitt 'They will still, however, have their job.'

She claimed there will be no unemployed doctors.

Hewitt 'Each hospital trust, and the board of each trust, has a responsibility to its patients to ensure that on 1 August, or any other day, the right number of the right staff are available to provide safe, high quality care.'

She tried to preempt a crisis and pin blame locally for the inevitable crisis on change over day in August.

Hewitt 'The issue of the changeover date is nothing new.'

In fact it is. Change over on this scale has never happened before in the NHS.

Hewitt 'That is why the headlines about 10,000 unemployed or redundant doctors are simply wrong.'

She again denied the unemployment issue.

Hewitt 'I stress once again that it will be completely independent'

When talking of the independent review she claims it will be completely independent.

Normal Lamb 'The royal college described the system as “deeply flawed, and unpiloted”—it had specifically requested that the system be piloted.'

So much for the cooperation with the colleges.

Rob Harris 'I wrote last autumn expressing concern about the system and I was assured by the then Health Minister, Lord Warner, that it would be all right on the night.'

No one has been disciplined for this clear failing.

Evan Harris 'The Minister must explain whether medical schools were expanded in order to fill an expanded consultant grade, or whether they were expanded in order to fill trust-grades, clinical fellowships and staff-grades—all non-training posts, which many people do not want to occupy even though they are in such posts? Does he expect that the consultant expansion we need will take place? In 1997, a British Medical Journal editorial noted that “consultant expansion was insufficient.” That editorial was written by a Dr. Evan Harris, but 10 years on, I see that there is still no expansion—'

This is a key point indeed. An answer must be sought on this.

Several members of parliament pointed out that the member of Tooke's review panel had not been named, this is something that needs to be probed vigorously.

Andrew Murrison repeated two of Patricia Hewitt's earlier comments in the house:

"On 19 March, the Health Secretary said that

“shroud-waving about unemployed doctors is absurd”—[ Official Report, 19 March 2007; Vol. 458, c. 582.]

On 16 April, we had more assurances from the Secretary of State when she said that she wanted to take

“the opportunity to refer to the thoroughly misleading statements made in recent weeks about the prospect of thousands of junior doctors finding themselves without work. This is complete nonsense.”—[ Official Report, 16 April 2007; Vol. 459, c. 46.] "

She must be held to account over this.

Andy Burnham 'One of the interesting things about today’s debate was the degree of agreement on both sides of the House, expressed by almost every Member who spoke, about the principles behind MMC'

I would amend this to the 'claimed' principles behind MMC, as FOI requests have been stone walled as regards the real motives hiding behind a smokescreen of noble principles.

Andy Burnham 'The difference between us and some Opposition Members is that they suggest that all the measures were hatched in secrecy in the Department of Health and that we did not involve anybody else in drawing up plans for this stage of the implementation of the MMC programme. That is not the case'

He claims the measures were not hatched in secret, why are certain MMC FOI requests being with held then?

Andy 'the comedian' Burnham 'The difference is that those unharnesses were not out in the open, in the transparent way that they are now— [ Laughter. ]'

That was funny.

Andy Burnham 'The hon. Member for North Norfolk spoke about the lack of a pilot for the scheme. In fact, the electronic portal for foundation recruitment was piloted in 2006. The application form was based on an existing form used in the London area, and the current form was piloted pre-launch in at least two deaneries. At the end of the day, we can review the programme and consider whether there was enough piloting and I shall take on board the conclusions of the review. However, it is not the case that the scheme was rushed through with no attempt to consult or to pilot.'

This will need to be probed in detail. I sense some forthcoming ferreting on this.

Andy Burnham 'Those unsuccessful this year will be able to reapply next year.'

This must be respected.

Overall there is a great deal to take away from the day, there was little chance of winning the vote given Labour's contempt for democracy. There are several key points that must be pursued:

1. Andy Burnham has claimed MMC was not hatched secretly.
2. HMG has claimed there will be NO unemployed junior doctors.
3. Andy Burnham has claimed MTAS was properly piloted.
4. Evan Harris got NO answer to his question about the motives behind increasing doctor numbers.
5. No one has been held to account for the mess including several examples of ignoring valid warnings.
6. John Tooke's review panel is claimed to be completely independent.
7. Every unsuccessful candidate will be able to reapply next year.
8. The potential for mishaps on change over day were ignored by the government and dishonestly described as 'nothing new'.
9. HMG claims Foundation training is a success.

If I have missed anything then please leave a comment and I can add it in. I just hope this important day can be adequately capitalised upon.

The parliamentary debate on MMC

The issue of Modernising Medical Careers was debated in the House of Commons today. In summary the opposition gave the government an absolute roasting on the rank incompetence that had been exhibited with their management of medical training. Patricia Hewitt and Labour offered the same old lame defences, and amazingly tried to claim credit for trying to remedy the 'teething problems'. Incredibly Patricia Hewitt left the house shortly after speaking, demonstrating her utter contempt for the junior doctors that she has royally shafted with her reforms. The human and economic cost were very well emphasised by the opposition, and by Nadine Dorries MP in particular. Importantly it was revealed that John Tooke's review group members have not been revealed by the government. The cutting of medical training budgets by 136 million pounds was also mentioned, the government had promised the opposite. Hewitt did return to the house eventually so that she could further insult junior doctors with a typical show of insensitive brazened arrogance in the background.

The Channel 4 news covered proceedings very well, well done to Dr Nicholl for remaining so calm under the pressure and performing so well.

I have summarised what went on in the debate today in my typically long winded manner:

Andrew Lansley (Conservative shadow health secretary MP) started by outlining his aims, which included outlining a way ahead as regards medical training and trying to find a workable solution that is acceptable to the medical profession.

The lunacy of the MTAS process were well exposed, as was the inadequacies of MMC as regards its undervaluing of clinical experience. He exposed various examples of the government ignoring warnings on the issues of MTAS, these warnings have since turned out to be true. An excellent point was made that a demoralised sub consultant led service would hardly be progress. It was also cleverly pointed out that one of the aims of MMC was to provide an extended choice and more flexibility for juniors, this has demonstrably failed with MTAS and MMC.

Several speakers reinforced the point that it is a negligent waste of tax payer's money to lose so many talented highly trained juniors. The mocking of the idea of using VSOs from this leaked DoH document was well done. Lansley went on to say that the application process had become 'arbitrary' in trying to be objective and that a lot of the best doctors may well be emigrating. The lack of continued expansion of consultant numbers that had been promised by Labour was also exposed. Hewitt's calling the unemployment issue 'absurd' was rammed down her throat vigorously, Lansley pointed out that this went against even her own department's views.

Lansley then went on to present one interviewing consultant's views of the interviewing process which described it as 'the antithesis of a fair process'. Hilariously one speaker then asked the Prime Minister if he would appoint the cabinet using a similar technique to MTAS, this was greeted with guffaws of laughter from the house. Hewitt was also mocked again and she responded with one of her condescending sneers.

Andrew Lansley used the information obtained by the ferret fancier's FOI request on the review group to expose the lack of independence present. He also commented on John Tooke's review, and made it very clear that the members of this review group must be announced. He also validly made the point that John Tooke's review would only come to a head in September, one month after jobs had been dished out.

Lansley next pointed out the unfairness of restricting candidates to only one interview, the difference between different countries and the overwhelming consultant opinion against the MTAS process. It was also mentioned that it was simply not fair to protect Foundation year trainees, while simply dumping senior house officers on the scrap heap. The idea of converting non training posts into training posts was mentioned, Lansley said this was possible but that currently Labour were raiding the training budgets due to their financial mismanagement of the NHS.
A very amusing point was made by an MP who suggested that we ban non-UK EU grads from applying for this year, as it would take the EU so long to reply that it could be got away with! It was emphatically stated that the government had not expressed their regret for the complete shambles of MTAS.

Hewitt then took the stand.

She limply trumpeted the triumphs of the independent review group.

She tried to pretend that the old system was worse than the current one, this hardly condones her departments horrendous mismanagement of the new process.

The same old lame defence that all the royal colleges and 'representatives' of junior doctors were involved was used by Hewitt. Hewitt was accused of using a 'straw man' in trying to divert attention away from the real issues. The Foundation program was trumpeted as a great success by Hewitt, no mention of the lack of decent training in so many posts unsurprisingly.

Hewitt then denied that it had been an 'unmitigated disaster'! She pretended that the GP process was a remarkable success, and amazingly she then wanted credit for dealing with the problems! Unbelievable. Yet again she ignored the real issues and rambled on about the great progress of the review group, the record just never changes.

She was asked explicitly if she had been informed of any potential problem as regards the unemployment of juniors, this was ignored. There was another question that asked her what she would do to guarantee to that the government would live up to its promise of jobs for all juniors, again this question was not answered. She instead said that more doctors would be needed but did not mention how this was going to be done.

She then came out with yet more meaningless waffle about support for juniors and work that was being done to remedy the problem. She couldn't resist mentioning her poodle Neil Douglas and his review group again.

The dangers of the August switch to patients, when all juniors will be moving posts and therefore be attending induction, was side stepped in typical Hewitt fashion in that she didn't answer the question at all! She even said it 'was nothing new' for all juniors to be changing jobs at the same time; actually it is the first time it has happened on this scale and Hewitt has been caught out yet again. She even claimed that "every trust grade will continue their job on August 1st", so the changeover will not be a problem; this is yet another lie.

She then mentioned that the NHS 'has far too many cardiothoracic surgeons' as a result of changes in practice. I think several recent publications as regards the benefits of CABG over less invasive procedures may even change this considerably. Hewitt then tried to defend the VSO matter and she lambasted the media for being irresponsible on this matter. She also claimed that there would be a round 2, this runs contrary to several leaked documents that make in pretty clear that there will be no time for this to happen before the August deadline.

Amazingly she carried on claiming that there would not be unemployed junior doctors come August, the gap of over 10,000 between jobs and applications didn't seem to enter her thinking. She again mentioned that she had announced the terms of reference of John Tooke's review group, importantly there is no mention of who will make up this review group, a rather key mission. Hewitt's main point was then that it was all 'best for patients' and that she should get some credit for doing so much good in dealing with the problems with the system.

Norman Lamb (Liberal Democrat shadow health secretary) MP then took over making some excellent points including that MMC was a 'straight jacket' and that it shortened training. He also stated that there were grave concerns over the 'unpiloted' MTAS process, he asked how could such a system be introduced without piloting. He also wanted to know who precisely was responsible for this mess? 'How on earth was this introduced without proper piloting?'

The same MP also pointed out that the BMA and the royal colleges had been ignored when warning of potential problems with the system. It was revealed that an MP who wrote to Lord Warner had his letter expressing concern ignored, no one has been disciplined for this error. Another MP interjected that the old system was 'total chaos', I don't think many people would agree with this opinion.

It was pointed out that Prof Crockard and Heard had both resigned citing 'a lack of leadership from the top' and 'MMC losing the goodwill of colleagues'. He then challenged the government to release all the discussions that have taken place as regards MTAS and MMC, so that these mistakes can be learnt from.

He then claimed that Patricia Hewitt had stated that all the interviews could be completed in a four week period in May 'with considerable effort', the massive logistical problems with this were pointed out, as well as the devastating impact these interviews would have on waiting lists and patient care. Apparently the NHS will be running on bank holiday staffing levels for the August change over, despite this being a very busy holiday period.

He then challenged the government to confirm exactly how many juniors would be unemployed come the summer, he tried to nail Hewitt down about her previous comments that have arrogantly dismissed all claims about junior doctor unemployment. The scale of incompetence was 'quite remarkable' in his opinion, he also said that he hoped Remedy succeeded with their legal challenge. Another MP asked how big a disaster must occur before someone resigns? Just who is responsible for this mess? Evan Harris MP mentioned that dead end jobs are not the answer to the crisis.

Two points of order were made because Patricia Hewitt left the chamber before she had listened to the speakers that followed her! Absolutely disgraceful, her hypocrisy was pointed out in that she had been previously on record stating that people should stay to listen to comments after they themselves had finished speaking.

Next John Mann MP waffled on about the great progress of the NHS under Labour, he just went on and on and on about irrelevant issues that were nothing to do with MMC. Mann was asked why he was not commenting on the real issues. The Labour MPs attempts to divert attention away from the real issues was truly pathetic, they were visibly squirming under the pressure, cynical divertionary tactics of the lowest order.

The odious John Mann eventually stopped his spouting of sewage. An opposition MP reiterated the rank incompetence of the government as regards MTAS and he wanted the government to ensure that juniors would not be forced out of training.

The debate then somewhat fizzled out with a bit of a whimper, the same points were made again and again. Although it was again mentioned by David Kidney MP that all juniors would have a job, I'm sure they will be held to account over this. Although not as inadequate as Hewitt or as offensive as Mann, Kidney was pretty limp and rehashed a few of the same old flawed defences of MTAS/MMC; to be fair he did mention that he intended to pursue what would happen to those doctors who ended up in dead end jobs and that the workforce planning needed to be improved.

Nadine Dorries MP then reinstated a bit more tempo to proceedings, a lot of respect must go to her for really getting across the terrible predicament that juniors find themselves in. She really got across the human element of things, she mentioned that juniors had been breaking down in tears on a regular basis at work. She finished by asking the absent Hewitt 'what is going to happen to the unemployed junior doctors?'

A few more opposition MPs repeated earlier points about the arrogance of the government, the disaster of poor workforce planning, the shambolic nature of MTAS et cetera. Near the end one MP Richard Taylor brilliantly summarised some opinions of senior consultants involved in medical training as regards the MTAS process. The consultants' opinions brilliantly summarised just how bad MTAS has been, interestingly the consultants mentioned that they were ignored when they expressed their concerns to the establishment. Some consultants had expressed to him that MTAS must be completely completely scrapped. He also mentioned that even Malaysians were appalled at the way medical training was going in the UK, and that they would not encourage their trainees to come to the UK for experience in the future; a sad indictment on this government's achievements. Justine Greening MP also did some good work in criticising the role of the government in presiding over the farcical MTAS. The secretary of state for health will certainly have her work cut out trying to come up with some more lies to answer these questions.

Andrew Murrison MP repeated the fact that no one had 'taken the rap' for what has been described as the biggest ever crisis in medical training in the UK. He beautifully described NHS employers as a 'metastasis' of the NHS confederation. It was emphasised that the 'second to one' training was thanks to the Royal Colleges, who have now been sidelined by the useless quango PMETB. The issue of cost of the whole mess was repeated. He was absolutely scathing with his criticism of the dead end nature of the government's grim vision.

Andy Burnham MP was next up, although it was hard to concentrate on his words when Hewitt could be seen in the corner of the screen nodding away in her typically annoying manner. He claimed that the reforms had been conducted openly and not 'behind closed doors', strange how certain FOI requests regarding MMC are being denied. A lot of laughter greeted Burnham's lame defence of MTAS as he tried to claim that it was progress that all the problems were now out in the open! He then claimed that MTAS had been piloted and that the consultation had been adequate. He talked next on the issue of recruitment and failed to make any decent points. His final points on the so called 'double cohort' and his conclusion merely cemented his role as a mincing weener.

Hewitt's overt arrogance in the background simply could not be missed, joking around and chatting casually while serious points were being made.

They then voted.

Labour won by a majority of 71. Another triumph for democracy.

Anyone who voted against this motion should be deeply ashamed of themselves. It must be noted that a lot of MPs seemingly appeared out of nowhere to vote, when they clearly had not been present for the debate.

Thinking blogger

Many thanks to Dr Rant for listing the fancier as one of the five blogs that make him think (six if we're honest and good at maths).

These are the rules:

1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think.

2. Link to this post so that people can easily find the exact origin of the meme

3. Optional: Proudly display the ‘Thinking Blogger Award’ with a link to the post that you wrote

After much deliberation I have come up with five blogs that I have enjoyed particularly of late, I know I am nominating some again but

1. MMC 360. A truly excellent appraisal of the government's MMC reforms, an essential read for anyone at the DoH who is allowed to read anything other than their own homegrown shiny propaganda leaflets.

2. Front point systems. A blog I only discovered very recently, but thank God I did, I still don't know how he/she manages to write so much bang on stuff.

3. Barry Monk's blog. I know Barry has already been nominated but given the legendary stand he is taking I think he deserves another nomination. I salute the courageous Barry Monk.

4. Black and White. Although only a recent addition to the blogging community, I would strongly recommend watching this space closely for some undoubtedly insightful and interesting opinion.

5. Arseblog. I am more than slightly partial to the angry rantings of this wild gooner, brilliant stuff in my biased eyes, even though it is not medical I have made an objective exception to the rule.

Just to add, to every single blogger out there, keep up the good work - you are showing the media how they should be doing things!

(with the odd exception, David Milliband for example, only joking David)

The remedy mass lobby

The grass roots organisation representing junior doctors Remedy UK has organised a mass lobby of parliament today, today is also the day on which MPs are due to have a debate on Modernising Medical Careers (MMC).

This government is trying to wreck medical training. It is another prong in their multi-faceted assault upon the autonomy of the medical profession. The public need to realise that the government reform of medical training will have devastating impacts upon their health care in the future.

Juniors are emigrating, juniors are quitting, while those who are staying on with the NHS are massively demoralised and near breaking point. The potential waste is absolutely staggering, at both a human and an economic level.

I have my fingers crossed that this brilliant effort from Remedy can make a real difference, they are showing some other people how it should be done. You can donate money to the Remedy war chest here.

The mass exodus begins

Modernising Medical Careers is being debated in the House of Commons tomorrow, unfortunately any potential action on this front has come too late for some. There is already a considerable human cost as a result of the government's shambolic reforms of medical training and the NHS is general. The following letter was sent from one junior doctor to another in the last few days, I believe it gets across the devastating human impact of the reforms, the low morale in the NHS and the immense frustration present universally in doctors across the country:

"Am quiting medicine

Have had enough of being treated like crap, of watching mediocrity being advanced as fast (if not faster!) than excellence. Of having no life whatsoever, of working all the time, being tired all the time, and looking after so few genuinely sick people.

Modern Britain seems to be populated by people who take no personal responsibility for anything they do, whether health or otherwise, its always somebody's fault not their own. The NHS stumbles from one crisis to the next treating its staff like consumable items. Its constantly fudging avoiding the big issue of which everyone is aware. We cannot, as a country, afford a health service that is free to all at the point of access, after all not one single other country has this system...why is that do we think? Do we know something that they all don't? Is the economics of Britain something special?
Why have we given interest rate control to the Bank of England, recognising that politicians are ill-suited to make important strategic desicions yet leave health in their hands. The net result being health matters are driven on a four year election cycle with the fundamental motivating factor being "visible" tabloid results. Health, like education and economics, requires 30 year planning. I simply state childhood obesity as a case in point.
The best outcome of my career as it stands is a minimum of 6 years running around at the bottom of the heap, being moved form pillar to post within a vast region, plugging gaps as they occur, followed by a probable "junior" consultant post (aka the old SR) resident on-call. Even as a "senior" consultant you are likely to be working nights and weekends, on call or resident, till you retire. At 70. Since they can't afford the pension scheme. Check the studies, the later you retire the earlier you die.
Whether you believe in an eternal life or not no one can be sure, best make best use of the life you have now, after all potentially you're a long time dead.

Here endeth the rant. Here endeth my time in medicine.

And no i don't know what the feck I'm going to do either, but i know this, I'll be happier because I'll get my life back."

Enough said I feel, I just wonder how many junior doctors will leave the country or the profession in the weeks ahead. Unfortunately it will be the NHS and the patients who will suffer as a result, while the corrupt politicians who orchestrated this mess will be enjoying an early retirement with a nice juicy pension courtesy of the tax payer.

Utter balls

Patricia Hewitt answered a few readers questions in the Independent today, it was a rare 'public outing' for the much maligned minister; you'd think she was hiding from the public given her low profile these days, can't think why that might be. Here are a few golden nuggets that I have extracted from her words:

"Thousands of people at risk of a heart attack are alive and well today because of the new contract."

It is more than a little nonsensical to claim that the new GP contract has saved thousands of lives; doctors keep up to date with changes in preventative medicine and hinting that the contract is the driving force for these medical developments is a pretty misleading.

"It is simply not true that 12,000 doctors will be without posts."

We've already discussed this one Patricia, unless you are going to start counting VSOs as posts then you may struggle to live up to your promises.

"Eight out of 10 patients tell us they're happy with their local out-of-hours service"

It seems to be a recurring theme that she relies on small DoH surveys of opinion to get herself out of rather large holes, it's hardly impressive that 20% of patients are not happy with their local out of hours service.

"But where the independent sector can help give NHS patients better, faster care, we will use it."

Wrong again Patricia, the DoH has no evidence that the independent sector can give better or faster care, so I really don't know where you have plucked this from. In fact the independent sector has been shown to be more expensive and slower than the public sector in providing quite a few services, there are also several examples of shoddier care from independent providers.

"Talk to the consultants who are already using the digital imaging system (Pacs). They love it. No more time wasted, waiting for delayed or lost X-rays; GPs and specialists able to view images simultaneously; more accurate, faster diagnosis for patients. As for PFI, we couldn't have built or refurbished over 100 new hospitals without it."

I think the NHS IT scheme is a little more than just PACS! As for PFI Patricia, several trusts wouldn't be laying off staff if it wasn't for them having to service huge PFI contracts.

"I agree. It's the responsibility of the employer - hospital, primary care trust or GP practice - to ensure their employees can speak English well enough to care for patients properly."

This is a very limp answer when asked about the need to test EU doctors as regards their English speaking ability, it is simply not good enough to leave the responsibility with the employer.

Again Patricia Hewitt has the same old dodgy record grinding out the same old dismal tune, it really is getting a little tiresome. Given that recent opinion polls have shown that rather large numbers of people think that all the political parties are offering no decent strategies as regards the NHS and that a majority of people want to see politicians removed from the day-to-day running of the health service, Patricia Hewitt's very selective use of dodgy opinion polls convinces no one except possibly her dimwitted-self. Patricia Hewitt could do a lot worse than reading Dr Rant's brilliant NHS manifesto, I just wish that the public had a choice over the way they wanted the NHS to go; as things currently stand we have no choice and all the major parties are fundamentalist believers in the ridiculous 'internal market'.

MTAS 'choices' deadline

Current Order	Level	Specialty	UoA	Change Choice Order	Wage	Work permit needed	FTSTA only
1	ST45	Unemployed	flexible		Dole	UK residency required to scrounge
2	STUCK	Voluntary service overseas	Non UK		Unsalaried	None needed
3	SToz	Australasian training post	Australasia		Salaried	Temporary residency required
4	STcity	City slicking job	London		Salaried	UK work permit required

A shocked junior doctor has forwarded me his amended MTAS application form, it is frankly amazing how much choice this great new system affords juniors. MMC and MTAS are such frightfully good ideas I am rather surprised that no one thought of them sooner. We live and learn though.

No evidence behind quacks - D'oH

Following yet more badgering via the Freedom of Information act, further light has been shed on the scanty evidence base upon which government reform is based.

It seems that everyone one turns these days there is some kind of untrained monkey being handed more responsibility while the service is being stripped of the properly trained professionals. It is happening in the health service with nurse practitioners, health care assistants, emergency care assistants and physicians assistants; while there classroom assistants and community support officers in other areas to name just two examples. It is not rocket science to point out that you generally get what you pay for to some degree, and that the never ending erosion of proper education and training cannot be good for services in the long term. I am already getting hot under the collar just thinking about it.

Anyway on the topic of physicians assistants it turns out the DoH has no decent evidence behind their introduction:

"Please see website www.aapa.org. Although the PA role is new to this country there is a growing number of testimonials from Consultants and General Practitioners who have worked with PAs. "

That is it. They can only refer me to the far from objective American Association of Physicians Assistants and point to anecdotal evidence that hasn't been documented. This is pathetic.

For those of you that don't already know Physicians Assistants are 'health care professionals' that are trained very quickly and cheaply to do certain jobs that doctors would normally do; the DoH claims that it's all ok because they are so clever that they instinctively know when they stray 'outside their area of competency', it's a shame that this chat is nothing more than class A tripe.

Don't forget that the government is spending millions on this reform when there is about to be a massive glut of unemployed junior doctors; the DoH tries to justify their own massive incompetence as regards workforce planning:

"You then ask if it is cost effective to have an excess of trained staff over the number of jobs available. Arguments can be made to support this view – equally, arguments can be made to suggest it is more cost effective to plan for slight under training. Workforce planning is not an exact science, especially for an organisation of over 1 million staff, many of whom take several years to train. It is likely that at any one time there will always be some temporary under training or over training."

I don't think the public would agree with this lame duck justification; given that junior doctors cost several hundred thousand pounds per head to train, this bit of DoH incompetence may end up costing several the tax payer several billion pounds.

This is not merely a matter of money either, there is the slight issue of 'patient safety' that the DoH loves to ramble on about. These under trained workers will inevitably make more errors and the patients will be the ones to suffer.

Another alarming feature of this dumbing down is that the under trained are often handed responsibilities that they are not even meant to have, take classroom assistants teaching classes unsupervised on a regular basis in a manner that is outside their defined job description; incidentally the same happens in hospitals with health care assistants as they are frequently handed work that only nurses should be doing.

While the DoH and the CMO Sir Liam Donaldson waffle on about 'patient safety' and an 'open' culture in which mistakes can be learnt from, it is rather apparent that they are knowingly leading the health system down a very dangerous dumbing down path that is propped up by a culture of nontransparent authoritarian leadership. This culture of top down fear driven management comes from our beloved politicians and the very same DoH; just one example of this is brilliantly documented here as regards the dangers of whistle blowing in the Stalinist NHS. This recent attempt by certain MPs to exempt themselves from the Freedom of Information act is pretty symptomatic of the continued erosion of key democratic pillars by our politicians.

Unfortunately I believe that this lack of openness, honesty and transparency is evident in in many other areas of government policy, not just health. The difference with health is that people will die directly as a result of this baseless reform agenda.

I would challenge anyone reading this blog who doesn't believe that dumbing down kills patients to try to chat to a doctor about it, unfortunately a vast majority of us have already seen real examples with our own eyes.