Thursday, 31 December 2009

Congratulations, what deserved awards

As always the names included in the honours list resemble much more a government ball lickers convention that anyone who actually gives a flying f*ck for public service. In fact in the current climate anyone who actually fights for the public interest is more likely to end up dead in a forest than on the honours list, that's thanks to the bunch of crooks we have in charge at the moment.

David Nicholson is to be knighted for his great services to the government, er sorry, the national health service I meant. So what has David done to deserve such recognition? Well he's been the NHS chief executive whilst the administration costs have gone through the roof, while the layers of bureaucracy and useless quangos have proliferated like randy rats on viagra, while numerous failed reforms have been forced through from the top where David incidentally resides in his big fat comfy chair.

David has been the NHS chief executive whilst such great schemes as the PFI, Choose and Book, Practice Based Commissioning, Payment by Results, the NHS IT farce, ISTCs and MMC have been forced upon the unsuspecting public. 'Reform' when it comes to the NHS has come to mean wasting billions in fiddling around with the process of actually delivering health care, rather than actually working out ways in which money can be spent effectively to improve the service.

David Nicholson has been one of the key men in driving through this agenda of expensive drivel, he has frequently been there to defend these bogus reforms by spouting some meaningless newspeak of the most disingenuous kind. He is now being rewarded for his loyalty by this corrupt award, this is how government works. Simply do a terrible job, act against the interests of the general public by serving your elite masters without ever questioning their right to dictate their dross and then you will be rewarded.
Professor Steve Field has also been rewarded for his loyalty to HMG, this man was a key proponent of MMC and MTAS, one of the most catastrophic failures in government health policy in recent years, he has also been involved in the governmnet's incoherent and shambolic handling of the swine flu 'crisis'. It is no wonder that the NHS is guaranteed to fail when failure is rewarded so very openly and corruptly bu our lovely government.

Tuesday, 29 December 2009

NHS Parking: Media misses the point

The BBC and mainstream media seems pretty interested in the government's talk of making parking fees fairer at UK hospitals. In my opinion it has long been unacceptable to expect patients and relatives to pay inflated parking fees for various essential hospital visits.
The most outrageous thing that has gone on the last few years has not been these fees for patients and relatives, it has been the introduction of huge fees for staff to park where they work. Virtually every single NHS trust I know now charges staff extortionate fees to park at their place of work. This is an absolute scandal. Not only has pay been going up at rates well below inflation but staff are essentially having their pay cut with these despicable parking fees. I wonder which other companies charge their employees such large lumps of their pay for the privilege of parking at work? Which other employers treat their employees which such utter contempt and disdain?

Sunday, 27 December 2009

The waste is as a result of privatisation

As I slowly recover from recent purulent events it appears that the NHS does not stay far away from the headlines at any time of year. The Telegraph leads with a story which has been championed in these parts on more than one occasion, it is about the rank waste that is going on as the government has fiddled around with the bureaucracy needed for an internal market. Make no mistake this is not the waste of a 'Soviet-style' system, in fact before the internal market was introduced around two decades ago the NHS was very light administration wise.

It is no coincidence that administration costs have proliferated since the government created the internal market and started to privatise a state delivered system. The current system may be state funded but it is increasingly not state delivered, and this means that the increasingly complicated networks of bureaucracy set up in order to stage manage this corrupt network of pseudo-competition are costing more and more and more to run. The actual figures are rather scary, the rise in 50% over four years is nothing short of a national scandal. The fact that the Tories are claiming to be able to cut these costs sound very dubious given that their health policies consist of yet more right wing ideological drivel.

David Cameron has been caught meeting with an ex-nurse with some rather dubious intentions of Nurses For Reform (NFR). NFR have some rather strange ideas and are typical of numerous politically corrupt groups that trot out the same repetitive ideology that is based in fantasy and not reality. Look beneath the surface and NFR are just another part of the political network that consists of the likes the the Adam Smith Institute, Free Market Cure, Libertarian Alliance et al. These people pretend to be acting in the interests of the public, but in reality they are simply vultures representing the interests of various private interests that pay their way. Helen Evans and her kind are the worst kind of politician, they pretend to care when they clearly care for no one but themselves.

The problem is that in the UK at the moment we have no choice between the lame health policies of one party and the lame policies of another. All the major parties are too weak to stand up and do what is right for the public, they are all putty in the hands of the currupt lobbying network that is meant to represent democracy these days. It is refreshing to see President Obama taking this corrupt system on and fighting for the good of the people, it has been no surprise to see that complete lies and vitriol that have been spewed forth by the right wing morons stateside in trying to hold onto their useless rich man's system. State run medicine has its problems, but compared to privatised medicine they are trivial in nature, and despite what some right wing cretins may say there simply is no utopia when it comes to health care or anything else.

Thursday, 24 December 2009

Feeling the pain and fighting another day

As a doctor it is certainly true that one's experiences as a patient can really open one's eyes, not that one is keen to have too many of these experiences of course. However not many of us are that lucky. I had a bit of a niggling abdominal pain at work last week, tried to ignore it, slept on it and then woke up in the early hours shivering in absolute agony. Even a whacking dose of morphine didn't touch the pain, fortunately for me I was rushed to theatre on the next day's list and they whipped my appendix out, as well as draining a few hundred mls of pus from my abdomen.

The pain had only just begun. I was shortly moved out of my side room onto an open bay ward that was pretty much as noisy as Paddington station 24/7. My small bowels were on strike, the perforated appendicitis had resulted in a paralytic ileus, not something i would wish upon my worse of enemies. It is hard enough to recover from the aforementioned in pleasant surrounds, but when one cannot get a minute's shut eye for love nor money this kind of experience can become a true living nightmare. One night I did not even sleep five minutes as a result of the combination of tortuous devices that the hospital possessed. If it wasn't for the support of those close to me then I truly don't know what would have happened.

The buzzers are so loud that even the deaf from miles around are kept awake, why no one has ever thought to have a light activated system rather than one which wakes up every patient every single time one patient buzzes for help is quite beyond me. The noise and light generated by patients being admitted directly from A&E to the ward as a result of the 4hr targets means that the bay ward is routinely a busy well lit admissions unit at night time, not appropriate when there are sick patients trying to recover from some rather serious conditions. The complete and utter lack of discipline and leadership on the wards was obvious, visiting hours were not enforced at all, noisy families stayed for hours on end making far too much noise gassing on mobile phones and disrupting the rest period of the sick. The night nurses were routinely noisy and seemed not to consider the fact that patients may wish to sleep at night.

I did not want to stay in hospital a minute longer than I had to and this should not be the case. The surgical care I received was great, the nursing care was great other than one nurse who did not care and whose command of English was a disgrace, even the food wasn't that bad from what I saw because I wasn't eating for a great chunk of my stay. Hospital should be a place in which patients can recover from illness, it should not be a orderless frenzy of chaos in which the sick are driven mad in trying to get a moment's peace and quiet. Sleep, rest and relaxation and all so important as part of the body's healing processes, it is a great shame that we show them so little respect at times. Happy Christmas and New Year one and all, thank you for reading and special thought goes to anyone unfortunate enough to be spending Christmas in hospital this year.

Saturday, 12 December 2009

Tamiflu fog and the swine flu hype

I always suspected that the 'swine flu' hype would turn out to be nonsense, the weak government and its stooges like the CMO, Liam Donaldson, wanted to create a wave of public fear and profit from exaggerating the dangers of the disease. It is class Orwellian stuff for a weak regime to exaggerate an external threat so that they can profit from trying to appear all powerful and masterful in dealing with the threat that inevitably turns out to be not much of a threat at all.

The much hyped threat of 'swine flu' appears to be dying slowly as a frenzy of controversy surrounds the drug company Roche which has made billions from flogging lots of its 'Tamiflu' drug to numerous governments around the globe. This week's BMJ makes fascinating reading for once, I would strongly urge anyone with any interest in medicine, political corruption and conflicts of interest to take note of all that has been written on the subject. In particular I find the weak defence of Roche by Roche to be extremely limp.

The way in which a drug company made billions by flogging a pretty ineffective drug 'Tamiflu' based on the misrepresentation of trial data that was never fully released and certainly never subjected to the rigor of a peer review is very very dodgy indeed. It demonstrates just how the full and real scientific evidence is never properly out in the open and how the system is so very open to manipulation in the name of profits against the interests of patients. This is not just the sale of overpriced mineral water for profit, it is the sale of an expensive and ineffective drug that has some rare but serious side effects. Roche and the world of big Pharma have a lot more to do before they can come anywhere near a pretence of honesty, they should be deeply ashamed of themselves in my opinion.

Tuesday, 8 December 2009

Baby P: the systemic malaise

If a doctor or nurse acts negligently then there are well trodden paths for their punishment, there is the GMC for doctors and the NMC for nurses. 'Self regulation' is a bit of a misnomer to say the least, as both the GMC and NMC are effectively government run organisations and this needs to be considered when one considers just why some doctors and nurses are so harshly punished.

It is undeniable and obvious that any organisation with an open and honest approach to dealing with its problems will deal with them quicker, better and more effectively. The NHS invariably deals with its problem in a dishonest and hidden manner, this is because it is not run for patients, it is run for the needs of politicians and as a result they do not want their corrupt motives to be seen out in the open. As a result of the government's malignant intentions there is currently a massive conflict of interests between the frontline clinical staff (the doctors and nurses et cetera) and the managers. The managers are the agents of the state while the frontline staff want to give their patients as good a service as possible, hence the obvious conflict.

The Baby P case is a great example of this glaring conflict and it has shown us that the managers did nothing until a child died, despite multiple warnings of the obvious problems from the frontline clinicians. Obviously the Trust in question tried to scapegoat a doctor, but it is rather clear that the clinicians were stretched well beyond any reasonable limits in this case. There have been quite a few sackings following the baby P case but does anyone out there really believe that the real villains have been identified? The baby P report is a whitewash that seeks to pin blame on paediatricians and whistleblowers rather than pin blame where it is deserve, ie at the door of the politicians and unelected cronies who have made the decisions to cut costs and consequently the standard of service.

To me it seems that the problem here runs right to the top of the health service management, those politicians who have been behind the privatisation the NHS at all costs are most to blame. The problem is that patient care is no longer the most important thing in the NHS, the government has made numerous things more important than patients such as financial deficits (because of the loony internal market), foundation status, performance targets such as the 4hr wait and on and on. The HCC/Ofsted and CQC are only interested in gathering their political propaganda for the government, the message is that you will be rated 'good' or 'excellent' if you fiddle the stats to keep the politicians happy.

We have a network of organisations and bureaucrats working to keep the supreme leader Gordon Brown happy, if a few patients such as Baby P get killed in the process then our leaders don't mind. In their eyes the ends justify the means, a privatised health system justifies the shabby standards of care that patients have had to put up with a result of this gross waste of funds on these lunatic ideological reforms.
Doctors and nurses can be struck off in the process, and sometimes this is a way of pushing blame away from those that make the really negligent decisions. I just find it strange that those that really have the power to make the big decisions in the NHS, that can kill lots of people when they go wrong, are never held to account for their actions. Politicians and managers are just moved sideways, doctors and nurses are sacked or struck off, where is the justice? Until whisteblowers are listened to and not burnt at the stake the NHS will continue to rot and the baby Ps of the future will continue to die in such very avoidable circumstances.

Friday, 4 December 2009

Hospital regulation: CQC vs Dr Foster

Personally I have no confidence in either the Care Quality Commission or Dr Foster. One is a quango run by government appointed stooges and the other is a private firm that has been very cosy with certain government figures in the past. In fact the history of Dr Foster must be understood to realise just what vested interests are at play here.

A big problem is that the CQC is clearly an ineffective regulator. Their inspections are announced and can therefore be sidestepped quite easily by failing hospitals. There are also a number of problems in that whistleblowers are not protected and are in some cases being gagged by their NHS contracts.

Dr Foster is also far from neutral and its methods are far from robust. Dr Foster relies on the HSMR (Hospital Standardised Mortality Ratio) and this is not a reliable measure. For one thing hospitals serve very different populations and for another the HSMR can be fiddled by dodgy coding. The HSMR also only counts those that die in hospitals, so if you can discharge your patients before death then the HSMR will notice absolutely nothing wrong.

It is clear to me as a professional that works in the NHS that we need much better and much more robust hospital statistics that are independently gathered and analysed by a neutral group of proper statisticians with no vested interests. This would be the best way of rooting our problems with our health care system. As things stand the government regulator is useless and the statistics out there are rather crude and unreliable, trust the CQC or Dr Foster at your peril.

Tuesday, 1 December 2009

Walk in Centres - money up in smoke and the cancer farce

It turns out that Lord Darzi of Denham's great idea, the nurse-run Walk in Centre (WIC) been an expensive disaster. Not only have these WICs provided a dodgy service that has led many people to be simply referred onto AE or an actual General Practitioner with a medical degree, but they turn out to be incredibly expensive at over 50 pounds per consultation.

Walk in Centres are bad in many ways, they result in further fragmentation of the continuity of care that is so important for decent patient care, they are also often put into place in a way that undermines local services by taking a lot of money away from far more efficient services. The APMS route is clearly a corrupt farce. Professor Pollock sums it up well for WICs, they are great for:

"the instant gratification for the walking well"

And not much else from what I've heard and seen myself. Some of the mickey mouse medicine that goes on at these Fisher Price units beggars belief. They really demonstrate nicely the fact that the government wants privatisation at any cost, quite literally.

ps it is funny in a dark and sad kind of way that the government is trying to blame GPs for taking too long to refer cancer patients to hospital specialists, strange that this is from the same government that can't spare a few million to save the NHS as numerous PCTs run out of cash and order GPs to cut their referral numbers. So on one hand GPs must refer less as there is no money, but on the other they must refer more to increase quick cancer diagnoses, can GPs possibly win?