Saturday, 26 September 2009

ISTCs and the disgraceful wasteful marketplace of doom

As with many recent government health reforms that have revolved around ideological nonsense and the enrichment of various groups with close political links, there has been no effort from the start to monitor the safety or performance of ISTCs from the very start. It is only thanks to some excellent local units that we are starting to discover just how much damage has been caused by these devastating reforms. This is without doubt only a small iceberg tip.

It is worth reading the full article and observing just how poor the record of these ISTCs is. The ISTCs have shown to be doing joint replacements that are failed at a rate of around 20% at three years, this is about twenty times the national NHS average rate, this is blatantly negligent and it doesn't need a statistician to tell one this. It is worth noting that this bodged surgery is costing the NHS a fortune to put right, add this to the fact that the ISTCs are often getting paid way more than the NHS for the same work. They are dangerous and bad value for money, the market is a clear failure in this context. The DoH is as always in complete denial as it is just pushing through ideological rubbish at the expense of patient care:

"Patient safety is top priority with all contracts with the independent sector. The Department of Health requires all Independent Sector Treatment Centres to have robust policies and procedures in place. All ISTCs operate under standards monitored by the Care Quality Commission, the independent health watchdog. The CQC... have not raised concerns with the Department about the safety of ISTCs."

What a lie and what a cop out. Like many new government reforms such as Walk in Centres and the contracting out of OOH (out of hours) work to private firms the effects in terms of patient care have not been monitored at all, it is a national disgrace. For example at ISTCs they are employing ' consultant' colleagues from other EEA states and many of these consultants have never worked in the UK before. They will, therefore, be working outside their comfort zone. They are often appointed with nothing like the formalities of an NHS Advisory Appointments Committee and sometimes appointments have even been agreed over the 'phone without any interview or meeting. This is dangerous practice and should be a risk management ' red flag '. Many of these consultants are not members of the respective UK academic college and are working in isolation from UK colleagues.

Millions of pounds of cash are still being dished out to ISTCs and there are simply not the systems in place to monitor just what they are doing in terms of harming patients. This is unacceptable, when those at the top of the political tree keep going on about standards and governance, why are these expensive unregulated disasters still being rolled out? Any changes to care delivery should be rigorously piloted and monitored to ensure that standards are not being compromised, this simply has not happened for the plethora of awful reforms we have seen in the NHS in recent years.

Whether it be your paramedic refusing genuinely sick people trips to hospital having been empowered by a short dumbed down course in being a doctor, your EEA GP with a limited command of English being flown in to do GP OOH work for a cost cutting private firm, your walk in centre quack pretending to be a GP and mobilising their Fisher Price (TM) stethoscope after a two week course in medical diagnosis or your EEA Orthopaedic specialist having a go at joint replacements in an ISTC with techniques which they have never done before, there is no excuse for this erosion of standards. The damage done is very hard to quantify as there has been no attempt to monitor the impact of any of these changes to practice, some things like Orthopaedic outcomes can be more easily eye balled retrospectively as has happened with the Cardiff ISTC but the vast majority of outcomes are almost impossible to measure without well though out prospective analysis, something it appears the government has avoided at all costs because it knows that this marketisation is doing harm to patients. The dumbing down continues.


the a&e charge nurse said...

Correct me if I'm wrong, Ferret but your article seems to provide prima facie evidence that it is DOCTORS (working in the ISTC environment) that are providing suboptimal care or even harming patients? - on this occasion you are able to supply published data corroborating these serious concerns.

Yet despite a decade of activity you have been unable to furnish us with comparable (or any) data reflecting the disastrous performance of the toy stethoscope brigade.

Curious .......... ?

Garth Marenghi said...

they don't do joint replacements yet.....

(thank the lord)

ps the point of what i have said is that very few things are like orthpaedics in this instance, it is very hard to measure hard outcomes

this is an exception to the rule

for example if you have a really shitty ae dept who treat a few non life threatening things very badly then it is very very very hard to quantify or measure this, hence to prove it

it is the principles, the logic, the common sense that i am arguing for, and that you so frequently deny

the a&e charge nurse said...

"for example if you have a really shitty ae dept who treat a few non life threatening things very badly then it is very very very hard to quantify or measure this, hence to prove it".

What about Stafford?

I can find few (if any) cases of quack incompetency on the MDU website - we have already established that no studies exist proving quacks are dangerous, quite the opposite in fact

Given that 2.5 million attend walk in centers each year while many more are seen in A&E (by quacks) surely there would be some sort of clinical trail if the quacks were anywhere near as bad as the ITSC orthopods?

Garth Marenghi said...

actually no

mortality is about the only thing that ever gets noticed

quacks only ever get let loose on gp/minor injury type stuff and patients don't die from these being mismanaged

that's the point

all the studies have been incredibly piss poor, they have been very badly designed and only look at very weak outcome markers like mortality

the a&e charge nurse said...

Have I got this right, Ferret?

All the studies done on quacks over the last 10-15 years are crap?
The pitfalls associated with GP-type-stuff is too sensitive to be picked up by a study?
The absence of quack cases (on the MDU list of clangers) is not relevant?

I doubt if Dr Crippen would share your dismissal of primary care problems (although he hates quacks even more than you do, of course) - he always gave the impression that GP stuff is far more complex than a production line dealing with a single pathology?

And even though the service is provided by doctors (without a quack in site) ISTCs are still doing badly according to the data you have highlighted?

Anonymous said...

Erm the MDU insures doctors, doctors and only doctors.

Why would they have stories about quacktitioners on their website?

Garth Marenghi said...

very very tedious CN, indeed the evidence is indeed very very poor and very very minimal as i have commented on many/many times in the past

good point anonymous

as regards complaints, it appears the nmc broom knows no bounds if you know what i mean

the dumbing down is in progress

the point is that people not properly training are being let loose, it's a simple one....

i don't particularly care whether these staff are doctors/nurses or monkeys

if you train people less then you'll get a crapper service on the whole

the a&e charge nurse said...

The MDU insure quacks, anonymous (and have done for many years) I've been with them for 6 years now.

Here's the advisory helpline number if you wish to verify this fact - 0800 716646

Ferret - you seem to be just as ignorant as our anonymous contributor regarding MDU insurance policies ............. disappointing.

Garth Marenghi said...

frankly i don't really care about this irrelevant little fact cn, the general point made by anon still holds as i think the vast majority of mdu members are doctors,

the nmc sweep all the nurse negligence under the carpet, 'competency' means nurses can do whatever they feel like and blame it on someone else when the shit hits the fan,

in fact midwifes are the first nurse practitioner and a rather large number of them cannot get insurance because they are so dangerous, so that's one example for you that you seem to have ignored,

the nhs pays out a hell out a lot in negligence claims but it is invariably the trusts paying and admitting liability, hence it is very hard to know who is responsible,

a lot of these relate to maternity care and i bet a hell of a lot come down to midwives, hence they are uninsurable in certain forms,

what i can see is that someone cannot see the wood for the trees,

i have no problem having an argument or agreeing to disagree, but there comes a point when the repetitive whining becomes very tired and boring,

you're not going to convert me with your never ending tirade, your argument doesn't cut it for me and never has, i just wish you could respect that rather than repeat it over and over and over and over...

the a&e charge nurse said...

I'm not trying to 'convert' you Ferret - I'm just pointing out that while you make some very good points about problems within the NHS many of your comments about quacks do not bear scrutiny.

Admittedly the MDU was a small matter but neither you, nor our anonymous contributor had the decency to put your hand up and say, yes, I was incorrect to make those assumptions (failing to appreciate that the MDU insures quacks)- no, you simply plow on with your usual blinkered tirade.

Conflating midwives and quacks is a very strange line to take and it suggests to me that you are rather clutching at straws because you have no objective proof to substantiate your claims against nurses who have ventured into the quack arena?

Surely you can see why those in the know expect a bit more than anecdotery or medical trades unionism?

Garth Marenghi said...

utter rot

if you choose to come here and comment on what is written then fine, but to come here are repeat yourself over, over and over again borders on rude

midwifes are quacks, they are the original nurse practitioner, nice try to sidestep that one, but you fool no one again

on this argument, there is no decent evidence either way, that's why we're having an argument

my argument has some logic behind it, yours does not, that's the difference,

pay peanuts you get monkeys

train monkeys you get monkeys

the a&e charge nurse said...

Quite right, Ferret, this has been done to death.

Since you are clearly unable to address any of the substantive points relating to the quack issue I will consider the debate with you finally closed.

Sorry if you found my comments upsetting, but when YOU say things like ...... "your walk-in-centre quack pretending to be a GP and mobilising their Fisher Price (TM) stethoscope after a two week course in medical diagnosis" - you can hardly be surprised if one or two take umbrage since this is exactly the kind of medical arrogance that makes the NHS an even harder place to work than it already is.

The irony of course is that it is the ISTC orthopods, supposedly the brightest of the bright, who are fucking up granny's hip - ah, well.

Garth Marenghi said...


you have been repeatedly unable to answer my arguments and points

you simply resort to side tracking things to meaningless trivia

debates are never closed

if you chose to stop repeating yourself over and over then fine

i have no problem with comments, it's just don't say the same thing over and over and expect it not to become tiresome

i am not upset, i'm just bored with the repetitive brand of argument that you use which has no cogent logic attached to it

what makes the NHS a harder place to work is muppets posing as masters when they do not have the sufficient training to do the job

whether this is EU orthopods or nurse quacks in a WIC i don't discriminate on the basis of doctor or nurse

both do not have the training to adequately do their job and that is the point

the NHS is a harder place to work such a dumbing down has been allowed to happen

pointing out that less training results in a poorer service is not arrogance, it's stating the bloody obvious

as always another weak get out, use the politically correct card, not a robust way or arguing i'm afraid

the sad thing is that some NPs are let loose to practice independently after the most minimal of training in clinical diagnosis and that's a complete disgrace

it's a complete dumbing down and it's not arrogant to point this out, that is a complete and utter cop out i'm afraid

by the way i've never tarred all nurse pracs with the same brush, some are great in certain roles, others not

i look at this issue objectively, it's about maintaining decent standards, it's not a battle against one group of people

denying the dumbing down is just a complete and utter lie in my opinion

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