Sunday, 28 March 2010

Most dangerous target yet and thinking tank?

The ferreting award for the most stupid, dangerous and idiotic NHS target ever has to go to the Trust which is bribing the Ambulance service not to take patients to hospital. This is unfortunately no joke. Money should not come into clinical decisions like this and it will only result in more needless deaths as a result of the under trained being pressurised into making reckless clinical decisions for which they have not been adequately prepared. This is rather similar to the equally dangerous scheme that was bribing GPs to not refer patients on to hospital specialists.

David Fisher had a history of heart trouble, he collapsed at home, but thanks to the bizarre system of targets and payments he was not greeted with an immediate ambulance, his call was downgraded in urgency and he was fobbed off with a telephone helpline. Untrained idiots on a phone line won't cure cardiogenic shock, so Mr Fisher was left to die at home. The dangerous way in which non medically trained people are now being empowered by protocol is beyond belief, it really is.

The market that we have is a disgrace, we now have an epidemic of managers to oversee this barbaric rationing of care, we are spending more and more money to avoid actually treating patients, this money would be better spent actually dealing with medical problems, not hiding from them via payment systems and tonnes of meaningless paperwork. The number of managers in the NHS is now 84% greater than in 1999, that is one hell of a statistic. Even Kafka would have trouble writing a book on the bureaucratic nightmare that is today's NHS and its dysfunctional network of SHAs, PCTs and Whitehall monkeys. No wonder private firms are using think tanks as a dishonest way of bribing politicians so that they can get greasy hands on this easy money as the NHS is sold off bit by bit. Cooperation is being replaced by dysfunctional competition, doctors like myself are fuming and patients like David Fisher are needlessly being left to die thanks to the substandard services on offer. The managers and politicians presiding over this shambles should be shot.

Sunday, 21 March 2010

Nothing we didn't know: corrupt politicians for hire

This investigation for the Sunday Times reveals the tip of the iceberg in terms of business bribing politicians for direct reward. It is simply scandalous and it has been going on left, right and centre in every area of policy from health to defence for years and years. The politicians caught indulging in this should be locked up and the keys jettisoned. This is blatant corruption at the very root of our so called 'democratic' system of government, it is nothing but a complete and utter disgrace.

Monday, 15 March 2010

Obstructing patient care - quack quack

It's a familiar tale in today's NHS, rather than primary and secondary care cooperating in order to help patients we have a system that revolves around the market with primary care and secondary care competing against each other. This has become a bit of a tit for tat war, the PCTs gradually squeeze funding for both with primary and secondary care engage in a pathetic battle of niggling for payments. This has led to the absurd situation of referral management centres, a set number of admissions that are paid for (if this is breached then the hospital is not paid) and the empowerment of administrators ahead of clinicians.

This ridiculous market based system is much more expensive, as competition results in the efficiency of cooperative networks being lost. It is also leading to a tremendous dumbing down of medical decision making because with the privatisation of services comes the cost cutting that results in the inevitable reduction of service quality. There are now numerous layers that obstruct a patient getting from a GP to a proper medically trained consultant doctor or surgeon. Virtually all of these 'reforms' result in the empowerment of less trained workers, whether in be the nurse who can now act as an approved mental health 'clinician' , the HCA being given the unsupervised job of a nurse on the wards or the paramedic who thinks it is their job to reduce A&E attendances by diagnosing chest pain as being anxiety related and not related to serious pathology.

I don't blame these new empowered staff, it is simply the fault of the establishment that allows the service to be dumbed down and wrecked in such a manner. At the end of the day patients are being let down by a crap service, the privatisation of services has led to the deliberate disempowerment of properly trained staff in order to empower the ignorant, it is easier to sell of the NHS in bits if no group of skilled workers has a monopoly on a providing a particular part of that service. Phil Peverley sums this up with three examples of how the decent care of patients is being obstructed in today's NHS, these are not rare one offs, they are more and more becoming the norm, we are letting our patients down by allowing this woeful dumbing down to continue:

Patient 1 came to see me a year ago after he’d crocked his knee playing football. I thought he’d damaged his anterior cruciate ligament and I referred him to an orthopaedic surgeon. I saw him again this week, and he was apologising for wasting my time. ‘I saw a physio nine months ago. She agreed with you I needed surgery, and she said she’d sort it out, but I haven’t heard anything. I phoned her but she’d left. I don’t know what to do.’ A call confirmed the physio had indeed high-tailed it out of the NHS, but had done nothing for my patient, other than discharge him.
Patient 2 has had bilateral tennis elbow for years. I referred her to our upper-limb surgeon, and after a few months I got a letter from a physio saying she was no better. My patient confirmed this; ‘I don’t know why I saw a physio. I thought I was supposed to see a surgeon. They poked a vibrating thing at me and it’s much worse.’ I wrote to the surgeon asking, in essence, ‘Why did this waste of time occur?’ and he wrote back answering, in essence: ‘I dunno. I never saw the letter.’
Patient 3 is undoubtedly more serious than the other two. This doughty, self-deprecating, highly-decorated World War Two hero started pissing blood late last year. He was due a diagnostic cystoscopy in November, but a nurse in the pre-op clinic managed to put a stop to that. ‘Your ECG looks funny,’ she told my patient. Actually it didn’t. I’ve seen the ECG and it looks normal, but the ECG machine thinks it looks funny. But then every ECG machine ever made thinks every ECG ever taken looks funny. You just can’t trust the little plastic bastards. It’s best to rely on your own expertise. If you’re a doctor, that is.Our pre-op nurse handed our noble but frail war vet a copy of the dodgy ECG (but no letter or any other communication) and told him to go to his GP to: ‘Get this fixed. Your GP will send you back when you can have your operation.’ Instead he went private, this man to whom we all owe so much, wasted fifteen hundred quid on unnecessary cardiac investigations, and was told there was nothing wrong with his ECG. He had his cystoscopy this month. His cancer is now inoperable. It might have been inoperable before. We’ll never know.
Stand up and be counted, you unqualified time-wasting shitehawks. Account for yourselves. Why are you standing between me and the consultant I wish to refer my patient to? Exactly how have you helped my patients get treatment? What are you FOR?Okay, so you’re just nurses who have been overpromoted into the jobs doctors used to do. Maybe you don’t know you’re only there to save money. The real culprits are those cynical managers – the medical stooges who collude with this managerial idiocy and the bureaucratic bean-counting tyrants who have forgotten what the NHS is actually supposed to be there for.Hang your heads in shame. If I could do to you what you’re doing to my patients, I wouldn’t hesitate for a second.

Saturday, 13 March 2010

For once the GMC is spot on

After several recent rather high profile deaths a lot of light has been cast on the topic of the way in which medical practitioners are regulated in the European Union. It is not something I thought I would ever say, but the GMC are talking some sense for once on this issue:

“Free movement of labour is fine but, in our view, patient safety trumps free movement of labour.”

It is hard to disagree with much that Niall Dickson says on this issue. It is just strange that it has taken the GMC so very long to say something about this, it has been a massive problem for many years, one can't blame Dickson for this as he has only been around for five minutes.

Essentially European law means that the GMC cannot test EU doctors competence or ability to speak English, despite the fact that many have a rather limited command of English and that some of their medical degrees are not the most rigorous of qualificiations.

Medical degrees in different countries are very variable. The US and Canada have a pretty robust training system in place, they invest a lot of money in making sure that their medical students are exposed to a lot of clinical work and clinical training. The UK's system is decent but less clinically based, the more clinical a training system the greater the cost. The EU is a completely mixed basket going from some excellent systems to some awful cheap ones in which there is very little clinical teaching at all.

The GMC is right on this issue. It is dangerous that the UK is forced to register any EU trained doctor without testing their English language skills or medical competence. This cannot be left to local PCTs, this should be done by the GMC and if the law prevents this, the law must be repealed or changed.

Tuesday, 9 March 2010

Join the dots: Privatisation=bed cuts=corridor medicine

A survey of nurses has revealed what a lot of NHS workers and patients already knew, that patients are routinely being treated and housed in storage areas, offices, TV rooms and outpatient clinics.

This comes on the back of news that massive cuts in the London NHS could well result in the loss of 5,600 beds, this is almost a third of the total number of beds available in the capital.

Bed numbers go down and down thanks to PFI schemes and the internal market's forced cuts, targets forced patients to be shunted out of AE quicker and quicker, it's really no wonder that patients are spilling over into TV rooms and storage areas.

It's all so predictable and it was all so very preventable. The internal market and the government's program of enforced privatisation has left us with this disastrous legacy of patients dying in corridors, at least the private providers are making their healthy profits come what may.

Sunday, 7 March 2010

Dishonest, antidemocratic and lazy

The shambles that is the coverage of health and health policy in the media is exposed by this excellent lecture that Dr Grumble pointed me towards. It is a topic I have spoken about many times in the past, the fact that that so many of the journalists that cover health and health policy have no education or training in this area is an utter shambles. The lack of decent educated journalists for health has combined with the problems with the mainstream media (that has been dumbed down as a result of reducing revenues that have led to much cheaper, lazier and more poorly researched stories) to quite devastating effect.

This has led to the current shambles. All one reads in the mainstream media on health is the cheap and easy reproduction of press releases by short cut taking hacks, these press releases from lobby groups and government direct the direction and news follows. There is no sensible analysis of the drivel that is fed to them in the form of press releases, the journalists just churn out manufactured partisan dross. The point made in the above lecture is a good one, this key point is that the public are now so unaware and uneducated on these serious issues in health that the government is able to get away with wasting billions of taxpayer's money on the current corrupt and grossly inefficient privatisation agenda. The government has done this quite deliberately, if the public were aware of what was going on thanks to an open and well informed media then they would not stand for it, as things are when people wake up to it, it will all be too late to do anything about it and turn back the clock.

Saturday, 6 March 2010

NMC leaves public at 'serious risk of harm'

The Council for Healthcare Regulatory Excellence, a body that oversees the performance of the NMC and nine other healthcare profession regulators, has found that the NMC is seriously letting down patients with its shabby and low quality regulation. The Council's audit revealed several glaring problems with the NMC's processes:

“very poor file and case management, with poor control of delegated decision making and poor practices in gathering and analysing information"

The Nursing Times covers the story here. This fits with what I heard of the NMC and the fact that it comes out of this as by far the worst of all the health regulators is not a surprise.

The NMC has supervised and condoned the empowerment of nurses in doing whatever they see as within their 'zones of competence'. If the GMC did the same all hell would break loose, the NMC seems to think that training and qualifications don't matter, that nurses can just be let loose to do as they see fit, then when the sh*t hits the fan they just brush it all under the carpet. Interestingly for all the rather ignorantly pro-quackery commentators the GMC seems to be doing a lot more right than the NMC, they wouldn't tell you that though. I'm not fan of the GMC but at least they are fairly thorough in investigating claims, the same can certainly not be said for the NMC:

"This includes the fact that some cases have been closed “without sufficient information to assure the NMC that the registrant is not a risk to patients”. "