Deep clean, but still up to our necks in bullshit

Our gormless gawping prime minister Gordon Brown seems to have learnt a lot from his predecessor Tony Blair, he is continuing with the same gimmicky superficial policies that make it appear he is doing something important, when in fact his ideas are nothing more than half arsed turd polishing. It is most amazing that so many people are educationally challenged enough to fall for this hollow sham.

"NHS hospitals are to be ordered by Prime Minister Gordon Brown to conduct a "deep clean" to tackle the spread of infections such as "superbug" MRSA."

I have heard of better ideas from a filleted herring. The media has never really got to grips with the issues surrounding hospital acquired infection, or in the words of the Daily Mail 'super bugs'. The squeeze on the number of front line beds available has been rather notable in recent New Labour years, strangely it is not mentioned in the media and it has rather important implications for infection control:

"1999/2000 135,080
2000/1 135,794
2001/2 136,583
2002/3 136,679
2003/4 137,247
2004/5 136,184
2005/6 133,033"

If we choose to look at the actual science and evidence, as opposed to the illiterate squealing in our domestic media, then it becomes rather obvious that Gordon Brown's big clean is nothing more than a massive publicity stunt which will do absolutely bugger all to combat hospital acquired infection.

The Dutch have been pretty good at containing MRSA, methicillin resistant staphyococcus aureus, and it hasn't been related to 'deep cleans'. Their policy revolves around:

isolating and screening high-risk patient groups

screening low-risk groups
strict isolation of carriers
treatment of people carrying MRSA

This brings us back to the over stretched NHS front line and the shrinking number of beds available, as this has rather significant knock on effects on our ability to 'isolate high risk groups' and to 'isolate carriers'. Most people working on the front line will tell you that it is routine in many hospitals for known MRSA carriers to be nursed in open wards with patients who are known not to be MRSA carriers, it is therefore no wonder that MRSA is not being contained in the UK. The excessive pressure to move patients from ward to ward far too quickly without infection control being respected is arguably the biggest reason for MRSA's success in the UK, and the government continues to make this situation worse with more and more targets.

"However, the main cause of community-acquired MRSA is still selective antibiotic pressure. Patients and parents still pressure physicians to give an antibiotic when it isn't an appropriate choice,"

The unfair pressure put on doctors by patients to prescribe antibiotics is also another reason for MRSA's successful spread, this is rarely mentioned in the media though. In this way an all round clinical approach to halt the spread of MRSA is ignored, as short sighted political pressures drive the target-based system.

In conclusion we are now left with a completely haphazard uncoordinated approach towards hospital acquired infection that is doomed to fail. There is a massive over-emphasis on unproven quackery from infection control fascists, while basic steps that are proven to contain MRSA are not taken. Gordon Brown and his cronies continue to ramble on about superificial gimmicks like 'deep cleans' and 'matrons', without stopping to think what the root cause of these problems is.

It's no coincidence that there's an election coming up, El Gordo wants to move attention away from the government's centralised profligacy, he doesn't want you to know that over 25% of the NHS' budget is spent coming up with more useless glossy gimmicks. It just goes to show how damaging it is for the NHS to be the subject of ridiculous political whims. The politicians should realise that a good health care system must rise above the pandering to short term political objectives, it must be driven by long term holistic thinking based on solid evidence.

If Gordon Brown wasn't a greedy power hungry maniac then there would be a small chance that politicians would stop tinkering with the health service in this short sighted manner, unfortunately he is and he intends to fight the election on health. What a record New Labour have on health, it's a bit like fighting the election on Iraq, PFI/CFISSA/ISTC/WIC/PBC/C&B/NPfIT/MMC/MTAS, need I go on?

Labour limbo - new depths scaled

Just when it seemed that New Labour could get no sleazier, they have sunk lower than ever before as Dr Ray reports here. The cynics amongst us already knew that Prof Sir Darzi was yet another New Labour stooge dressed up in the clothes of an objective neutral, Dr Ray's observations prove that the consultation on NHS reform is nothing more than a corrupt dishonest scam:

"The location of the meeting was kept secret until three days before the event and when this consultant was eventually told the location and turned up in Birmingham for the "Citizens Jury" it turned out that medical staff were outnumbered 2:1 by laypeople specifically chosen by an agency to attend the event. The media were present and had obviously been invited to publicise the event."

Not only were NHS staff prevented from attending, but there were 'minders' present to advise those members of the public (that did conveniently manage to get invitations- were they on a Labour party mailing list I wonder?) precisely how to vote, a mysterious 75 pounds was also strangely donated to the New Labour 'yes' men, of course this could not be construed as a bribe:

"Following the "consultation" the medical delegates were told to leave but the other 2/3 of the audience were kept back and each given an envelope. My colleague was intrigued by this and managed to catch one of the "chosen ones" and ask about the contents. Each envelope contained £75 in cash!"

Dr Rant and DK have followed up on Dr Ray's excellent undercover work. This is the kind of behaviour from the state that one would expect to hear of in a country run by a vicious dictatorship, this should not be acceptable in modern day Britain. Sadly it is rapidly becoming the norm as our country slowly begins to resemble a banana republic. The Darzi review is a dishonest sham, it is designed to force through more cost cutting dumbing down reform that will result in the closure of many excellent specialist medical services up and down the country.

Patients will die from this dishonesty. I hope Gordon Brown and Sir Ara are happy with their achievements thus far.

Leslie Ash- celebrity bullshitter?

Leslie Ash just can't keep her whinging out of the papers, am I the only one getting rather tired of this has-been trying to cash in on bad science and misinformation? The Daily Mail has been serialising what I can only imagine to be one of the world's worst ever books. According to Leslie:

"After breaking two ribs in a freak accident while making love to my husband, Lee Chapman, I had caught MSSA – a close relation of the hospital superbug MRSA – and woken up unable to move."

Broken ribs are a common thing, they can occur after falls or even after being beaten by ones husband. For some reason Leslie Ash required an epidural for pain relief for these accidentally broken ribs. An epidural is very rarely used under these circumstances, most patients would take some oral painkillers or even some intravenous ones; however an epidural seems a bit strange for broken ribs. Possible reasons for this strange decision may be that the patient was unwilling to put up with any pain at all, thus demanding the epidural.

It is well known that epidurals can very occasionally result in spinal abscesses, at a rate of less than 1 in 50,000 patients. Anyone being treated with an epidural would be warned of the common risks and the rarer serious risks associated the epidural. I can only assume that Mrs Ash was warned of the possible complications. The bacterium involved was MSSA, methicillin sensitive staphylococcus aureus, which is in fact a very common skin commensal that many of us have residing on our skins. This is no super-bug, it is a common organism that causes boils and pimples. Developing an infection such as this would not be linked to the hospital being unclean, it most likely was one of Mrs Ash's residents in the first place:

'Do you mean I'm like this because I picked up an infection in a dirty hospital?' I whispered.

'Well, we don't know yet, but I think it is a strong possibility,' the lawyer replied.

This is just one example of the brain dead misinformed scaremongering that appears to be an ever present in Mrs Ash's tedious book. It is indeed unfortunate that she developed such an incapacitating complication, however the way she has reacted and tried to throw blame around has not made her look like a particularly impressive human being.

It could be argued that she is deliberately trying to profit from misinformed scaremongering and selling products of very dubious benefits, such as her 'Matron' handwash. I fear for us all if Mrs Ash sees herself as a spokesperson on MRSA related issues, as from what I have heard she has a grasp of science equivalent to that of a small insect. The media cannot escape blame either, as they continue to print utter rubbush masquerading as proper science. At a minimum they could at least check that their facts do not contradict wikipedia, would that be too much to ask of the poor luvvies? Moronic celebrities such as Mrs Ash end up doing much more harm than good with their negligent misinformation and scaremongering, it is time that they put a cork in it and the media should stop providing their mouthpiece.

Deathly dumbing down

The following story can be applied to the NHS, policing or even the classroom. It demonstrates the same underlying principles of a cost cutting dumbing down that the government has negligently forced upon an unsuspecting public. Tragically a young boy drowned and PCSOs (police community support officers) were called to the scene, unfortunately for the boy and his family the PCSOs were not trained to deal with this kind of 'major incident'.

It is not the fault of the PCSOs as they have not been adequately trained to do things that should be expected of staff that have the very important role of patrolling and policing the streets. It is the government's fault for replacing properly trained staff with less trained staff who are simply not up to the job, this is happening in many different areas of the public sector. Paul Kelly, the chairman of the police federation in Manchester, sums it up well and his logic can be applied across the board:

"The message is clear and unambiguous - it's the government, they are trying to fool the public.

"They take a person and dress him up as a police officer but they just don't have the same powers.

"Every single police officer I trained with left training school with a life-saving certificate of some sort."

He said the PCSOs might not have been able to swim and in that case they should not have risked their lives.

But he added: "People throw themselves into rivers and ponds to save people every day because it's the right thing to do.

"This is an accident waiting to happen again."

Precisely, the government are dishonestly trying to con the public with this shoddy second rate service. They are dressing up the untrained in the clothes of the highly trained and pretending that it will not make a difference, when it blatantly will. There are hundreds of accidents waiting to happen around the country as we speak.

Nurses are being dressed up as Doctors and given roles for which they are inadequately trained. While Health Care Assistants are dressed up as nurses and asked to do tasks for which they are also not properly trained. PCSOs are the example of the dumbing down in the police service, while classroom assistants are given tasks at school that they are simply not adequately trained to do as well as proper teachers.

It is dishonest, it is dangerous and it damn well stinks. Wrapping up a turd in a banana skin does not turn the turd into a banana, and one does not need to taste the turd to find this fact out. How many lives will have to be lost before this negligent dumbing down is stopped? It appears to me that this government cares not for lives.

Plain talking and more of the same

"If you agree with the CBI then you are in the minority, and I would suggest that you look at the underlying motives. Alliance Boots was in fact taken over this year by none other than KKR. It is therefore a strange coincidence that Labour peer Lord Hollick is an adviser to KKR, while the Labour party has received several rather large donations from such private equity firms. These are the very same private equity firms that seem to enjoy profiting from stealing peoples pensions. I am more than a little suspicious that these people do not intend to plough money into health care to provide a better service for patients, I suspect that they want to get their greedy mits on some more easy money and that the government is only too willing to oblige.

If these corrupt profiteers get their way then it will only be bad news for patients. British General Practice is actually a remarkably high quality service that comes at a relatively low cost, one of the things that makes it so precious is the continuity of care that it provides. This will be lost if this short sighted privatising agenda is allowed to continue, catalysed by dishonest pretences at consultation by the illiterate Alan Johnson and the malignant Labour crony Ara Darzi. These big businesses do not care one jot for their workers' health or well being, they are simply intent upon fleecing the tax payer by uniting with a corrupt Labour government that has come to represent the exact opposite of what the Labour party should stand for. Depressingly the way it is going, I fear for the future of British General Practice, and it will not be possible to recreate the brilliant concept of the local doctor who actually knows you when it has been ruthlessly destroyed by this Brownite dictatorship. All we will be able to say is 'I told you so'.

Dr Rant spells how exactly how disingenuous the government in combination with the CBI are being in their drive to privatise primary care. The damage that could potentially be done to the continuity of patient care is very worrying. Dr Grumble has reproduced an excellent piece by Dr Clive Peedell here, it sums up very well just how good we currently have it with General Practice in the UK.

Meanwhile Dr Grumble has saliently pointed out a rather alarming statistic to say the least. Our government is wasting 18 billion pounds a year on centralised budgets, not a small amount in any one's book.

I have also been reliably informed that the lame MTAS format is to be given a kiss of life by the politically correct idiots who seem intent upon destroying the medical profession. Students are to be selected for their first jobs, 'Foundation' year jobs, by using the same 'white space' questions; 'white space' can be translated into 'meaningless waffle' for those in the know. Apparently over half of the marks used for selection will be in the form of this manure maker's fantasy, while the rest of the marks are made up of the student's performance at medical school. Unfortunately this process is so dumb that all medical schools are treated as complete equals, despite the fact that students are rather more able and bright on average at the medical schools with the most competitive entries. This selection process appears nothing more than a cruel joke on medical students.

As if it wasn't bad enough for junior doctors already, having had to endure MTAS 2007, it appears the slide continues. The dumbing down of training gathers apace as Foundation jobs are made up of more and more attachments in which trainees gather no clinical experience. The 'Connecting for Health' Foundation jobs are just one example of this poorly thought out training system, there are many other examples of this around the country with trainees being sent out to work in PCTs for months instead of learning the basic bread and butter. I am sure this system will be good at producing more incompetent self important political medics like Sir Liam Donaldson, people who are so detached from the coal face in their comfy padded chairs that they are completely incapable of doing anything of use. In this way the NHS' cohort of medico political drones will be enlarged, as the emphasis is moved from clinical excellence towards political expedience.

Ringing all the bells

Watching the Panorama involving the blogger PC Copperfield reminded me more than just a little of the NHS. In fact it was quite remarkable to see how the government's stupid target based approach is failing in policing and in health care in the same ways.

The government cares not for protecting the public from crime or from ill health, they have put the emphasis solely on the gathering of meaningless political propaganda at any cost. In this way trivial misdemeanors are criminalised at vast expense, just so that the statistics can be spun. While in the NHS ill thought out blanket targets result in sick patients not being given the priority they deserve, ahead of those with far less urgent and more minor ailments.

The professionals, whether they be doctors or police officers, are treated like idiots by clip-board wielding halfwits who have no idea about the practicalities of doing a good job for the public. Clinical priorities are ignored by our political masters who do not understand the concept of clinical need, while practical policing is ignored at the expense of statistic gathering. The parallels are obvious, the government seems too stubborn to learn from its rather glaring mistakes; and the public are the ones to suffer, as we now have public services that are set up to manufacture propaganda, as opposed to providing a good service for the public who fund them.

MTAS revisited

The ball has been served into play, the MTAS 2008 ball that is, and the MMC Board have produced a document outlining the various options for next year. Here it is.

There are three issues that they are opening up to consultation, and this chance must not be missed: shortlisting, national or local application form and applicant preferences.

Strangely for shortlisting, there is no option of having locally arranged short listing; this is especially strange given that this is the only tried and tested method. I also strongly believe that marked application forms must be binned, only a proper CV that allows individual flair should be accepted by trainees.

As regards the application form, there is simply no need for a CV based form. The form should be locally determined and a CV should be attached, the idea of a CV-based core of an application form is a definite second best to a proper CV.

I feel strongly that more applications should be allowed per candidate and that this should be done 'concurrently' in the words of the MMC board. Their one-strike-and-out philosophy is nothing short of a disgrace.

If you feel strongly about this attempt to water down MTAS and feed it back to more victims, then I suggest you write to mmc.programme@dh.gsi.gov.uk to express you views. I have written a short letter than you may wish to send expressing a concise set of opinions that could not be misinterpreted.

"Dear Sir/Madam,

I am writing to reply to the 'Recruitment to specialty training -Proposals for improvements in 2008'. I have read the document in full and decided upon the following.

1. Shortlisting. This must be done locally and with proper CVs that allow individual creativity.

2. The application form must be determined locally and it must allow CVs to be attached in full.

3. Applicants should be able to apply for unrestricted numbers of jobs concurrently.

Kind regards,

Witch hunt

I choose to stray into a controversial area, away from the world of the government's destruction of the NHS, and into the world of the tabloid media and the McCanns. Whatever one thinks of recent events, I think that one would struggle to defend the pathetic behaviour of the media throughout. SJHoward points out just one example of the rank hypocrisy and lack of logic shown by the media, in this case the BBC.

The McCann story is a great case study in how the modern media operates, and how sensationalist and dumbed down current affairs coverage has become. The media jumped on the story, milked it and has now started to turn on the McCanns in their rather typically incoherent and inconsistent manner.

The media has continued to set people such a bad example in a way that condones the judging of others, without even being sure of any facts or any details of the complex situation that is being judged so righteously. The continuous speculation shows a complete lack of respect to those involved in this sad affair, and could be argued to be downright rude at times.

As a human being I believe we should always give the benefit of any doubt to people that are accused of anything. It is also not fair to speculate on their innocence or guilt unless one is well informed on the facts; in the McCann case I would argue that no one in the media is anywhere near the facts, so they should firmly put a sock in it and show some damn respect. Our legal system means that people have to be proven guilty, and there is a very sensible reason behind this that some people would do very well to remember.

Whatever the ins and out of events, there is absolutely no doubt that the media have shown their true, and rather shabby colours in the last couple of weeks.

Our NHS our future, my derriere Darzi!

The government is most likely trying to shut down health services near you, in a rather cynical attempt to save money by denying patients decent local medical care. A new 'consultation' exercise has begun which will undoubtedly stay true to the government's unique interpretation of the word 'consultation'.

I have set up my own consultation exercise here, so please feel free to add your comments regarding the NHS, its future, Sir Darzi or anything else you feel like commenting on. I will ensure that Sir Darzi is informed of my consultation exercise, it will be imperative that he listens to our voice, however judging on his past record he is more likely to be listening to big Gordon's voice.

I don't want to see the NHS reconfigured in a way that compromises patient care by replacing excellent specialist units at District General Hospitals with dumbed down polyclinics. The government wants to save money by continuing its antidemocratic privatisation program and by cutting services left, right and centre.

This is not good enough. I am fed up to the back teeth with our tax payer's cash being spent on endless disingenuous consultation exercises in which public opinion is ignored time and time again. I want to see less money wasted on targets, spin, centralised control freakery, the internal market and propaganda. I want to see more money going on front line services so that patient care can be genuinely improved. This government has become obsessed with spending money pretending to have a good health service, why not spend this money on the front line, then we would actually have a good health service.

http://ournhs.blogspot.com/

MTAS, the Orwellian nightmare

At last a brilliant piece in the press that sums up MTAS very neatly:

""Modernising Medical Careers" is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service.

The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if not a reactionary. Yet, like all systems of centralised planning,
this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.

Like most outsiders (and many insiders), I find it impossible to understand precisely what has happened, but having a daughter-in-law at the sharp end has helped. The outlines at least are clear. They also offer a classic example of how a government-run monopoly behaves.

What, then, lay behind the fiasco that Modernising Medical Careers
has become? There appear to be three causes.

First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.

Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.

Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.

As always, reasons existed for the shift to central planning: critics complained that the traditional apprentice system was riddled with favouritism; and the European Union's working time directive sharply cut hours for junior doctors, which not only necessitated a greater number of them, but also reduced the experience each would gain from a given period of training.

Some reform was presumably necessary. But this one is an object lesson in what happens when the government introduces a "big bang" shift to a centralised, computer-driven system. A bureaucratic monster replaced what had been a moderately flexible, albeit imperfect, system.

In the old system hospitals hired senior house officers; now they are sent them like a parcel of slaves. In the old system, if doctors did not get a job first time they could keep on applying; in the new system, they were to be given just one chance a year. In the old system, if they made a wrong choice it was relatively easy to change; in the new system, doctors must decide early and are then stuck with the consequences. In the old system, hospitals could change the mix of junior doctors relatively easily; in the new system, nobody knows what flexibility will exist.

Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must really be joking.

To put the point bluntly, these highly trained professionals, on whom you may depend for your lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone so treated?

To make the computerisation manageable, the doctors were allowed only very limited choices - far too few to eliminate random factors. As the chaos mounted, people were offered just one interview each.

The result was that those most likely to fail to get a job were the best, because they made the most desirable options their first choice. To make the computerised system "fair", much of the detail of people's careers and the detailed knowledge of those they worked for were also eliminated.

Centrally planned systems always eliminate latent knowledge, ignore human motivation and destroy flexibility. It was predictable that this Gosplan for the training of doctors would end up just as it has. It could not do anything else. This is a superb example of how the combination of centralisation of power with a belief in rationalistic planning works in the real world.

No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer. But bureaucrats are far too grand to be held accountable. It is doctors whose lives are disposable. Who cares that they have devoted up to a decade to the acquisition of knowledge and experience? Who cares that patients will be worse served? What matters is that the Department of Health is firmly in charge.

So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed."

Very apt.

Dumb me down scotty!

The Scotsman has exposed more government plans to save money by dangerously expanding the roles of the ominously titled 'health care professional'. It seems that the powers that be are considering plans to send out nurses to do the job of GPs due to a worryingly lack of doctors. The logic behind this dumbing down is sadly lacking:

"They are qualified to a degree where they can make an assessment of the patient. And they can call on the advice of a doctor if they need it.

"If it was a complicated problem, the nurse would have the professional knowledge to make a judgment that the patient would require a doctor or hospital."

Unfortunately for patients nurses are not trained as doctors, they are unsurprisingly trained as nurses. This means that they are not trained sufficiently in basic science, clinical medicine, differential diagnosis, pharmacology, medical management and assessing medical problems to be able to safely carry out the job of a GP in visiting unwell patients at home and making tricky clinical decisions.

Nurses are simply not qualified to the degree where they can safely make these kind of tricky clinical decisions, they have no medical degree along with the appropriate experience and training in clinical medicine and decision making. Nursing training and nursing experience does not equip a nurse to become a doctor, a rather obvious fact that the government seems to ignore with ludicrous statements like this:

"It is not a cheap option. It's about delivering a better service for patients and using healthcare professionals in a much smarter and better way."

It is a cheap option. This option is a direct result of a shortage of properly trained staff, therefore replacing the properly trained with those who are inadequately trained is nothing other than a cheap dangerous fix. It is no surprise that a majority of Scotsman readers disagree with the government's plans and want to be seen by properly trained doctors.

The truth is that patients are paying the price for this government's completely inept management of the NHS and in particular primary care services. Dr Rant has neatly summarised the reality of this government incompetence, and the way in which cunning spin is used to try to pin the blame on the GPs when in fact the blame lies solely at the government's door.

The dumbing down as described by the Scotsman is not only occurring in primary care, it is unfortunately putting patients at risk in hospitals up and down the country as nurses are dangerously empowered to do jobs that should only be done by properly trained doctors. This cheap and shoddy dumbing down process is most likely already happening at a hospital near you thanks to a wonderful cost cutting scheme called 'Hospital at Night', I shall leave that for another day though.

Will these idiots ever learn?

It has been revealed that the rather brain dead idiots who dreamt up the woefully inadequate selection process for junior doctors called MTAS want to carry on next year with more of the same brand of politically correct nonsense. The Herald has got hold of a leaked email that reveals just how these morons 'think':

"I expect the absence of a CV to stimulate some heat. I should emphasise that this decision was not an NES one and representations are being made. The justification for this is that it is not possible to anonymise a CV while the generic form has different sections that make this easy."

(Dr Colin Semple, associate postgraduate dean of NHS Education for Scotland (NES) in the west of Scotland, admits in his e-mail that using this system again will prove contentious.)

It seems that some people will never learn their lesson, they should be put out of their misery as they appear destined to never obtain even the smallest quotient of common sense. Colin Semple and his ilk are the kind of moron that have been behind the original MTAS disaster, where standard tried and tested processes were replaced by pscyhobabbling bull of the highest order. Does this breed of politico-educationalist not realise that they are going to sleep walk into another disaster unless they take a long hard look at their own self serving incompetence?

The likes of Colin Semple can stick their anonymized mumbo jumbo where the sun don't shine. Junior doctors must be selected fairly by a tried and tested process that uses the curriculum vitae, unless they can find a better process and conclusively prove it to be better than the old method in the next few months. I rather suspect that there is not enough time to design, test, validate and approve anything other than the old CV based process before the 2008 repeat.

Meanwhile those juniors who were lucky enough to get jobs are experiencing yet more disorganised chaos as regards their bureaucratic competency based training programs. It seems that a rather large number of trainees are being expected to fill in an excessive number of forms, decipher reams of unintelligible waffle, pay large sums for and organise their own training, work out how to use websites that are not yet ready for action over a month behind schedule while providing a service to patients, attending courses and doing exams at the same time. This is the bizarre, complicated and dysfunctional world of MMC's competency based curriculum. Even the programme directors and educational supervisors have been left in the dark with their trainees, as the powers that be appear to be leading us into another pointless and avoidable dark pit of despair. I seem to remember more than a few people mentioning that MMC was being rushed through far too quickly, how correct they were

It also begs the question, just who is actually in charge of this shambles? When MTAS went so horribly wrong, it seemed that everyone wanted to deny responsibility and shift the blame elsewhere. However now the dust has settled, several organisations appear to be behind this nonsensical march into the MMC quagmire that so obviously lacks a direction and a purpose. This complete lack of responsibility and accountability so typifies the approach adopted by many of the failed reforms in the NHS. In my opinion it is about bloody time that someone was held to account for this whole sorry affair. As seems to be the way with the NHS these days, we are more likely to see shiny brochures spew forth from numerous hapless Quangos as the responsibility is spread across even more incompetents. I am sure the government will continue to chatter more meaningless niceties, while in reality they will be railroading through more of the same from behind closed doors.

The slippery slope

The government's drive to empower less trained professionals continues, as prescribing powers are being handed out to more and more non medically trained workers. Optometrists are the latest to be handed extended powers, strangely it seems that the government thinks this is a good move for patients. I fail to see how handing prescribing powers to people without proper medical training in diagnosis, basic science and pharmacology can be safe.

More worryingly the government is also intent on handed extended prescribing powers to nurses, another dangerous move given that these 'specialist' nurses only have a ridiculous 26 days training which then magically turns them into safe prescribers. The government's reasoning seems to be that this move will free up doctor time, however the evidence points the other way with it arguably being more likely that more time will be spent mopping up after the nurse's mistakes.

This incredibly dangerous dumbing down sees a nurse handed extended prescribing powers after a brief 26 day course. The safety mechanisms in place to monitor the carnage are surprisingly non-existent, as seems always the way when the government tries to convert nurses into budget doctors. It will simply be left for the nurses to assess and police their own competence, a bit like allowing an air hostess to fly the plane and only call for help when he/she sees fit. The nursing regulatory authorities seem to have no concern for patient safety, as they allow the under trained and undereducated to have a crack at things that they are not adequately prepared for.

There seems to be a recurring theme here, the government sees it as progress to continue to empower workers with lower and lower levels of education a and training. This is allegedly all being done for patients. It is rather obvious to anyone with more than a small cluster of grey cells that this is a very disingenuous line to take. More power and responsibility being handed down to those who are not as adequately prepared for it is not progress, it is a regression that shows only a contempt for the high standards in medical care that we should be aspiring too. Poly-clinics, walk in centres and all these gimmicky new schemes are all part of this dumbing down of standards; it is simply shoddy health care on the cheap.

Unsavoury characters

The Daily Telegraph reported on a very unpleasant, misinformed and threatening letter sent by a certain shady agent of the state:

"The letter, sent by DoH Commissioning Director-General Mark Britnell, informs primary care trusts to come up with plans to persuade doctors to "respond to the needs and expectations of their patients, for instance by opening practices for longer periods". "

Dr Rant explains things succinctly here, there does appear to be no logic in Mark Britnell's stance; after all it was the government that has made several bad decisions in reforming and managing out of hours care in this country. It is at best misguided that Mark Britnell is writing such an aggressive letter ordering things to be done as he wants.

At worst it could be argued that Mark Britnell is a despicable scum bag who is keen to further his own medico-political career by helping the government privatise primary care. Unsurprisingly the apolitical Britnell was a Labour activist as a student. It seems Mark Britnell could also be accused of telling porkies on occasion:

"He had originally planned to become a lawyer but turned to the NHS after realising that the law was "more paper than people based."

Working in the public services also chimed with his aspirations: "I was attracted to running a big public sector organisation. It was about producing social value, about making a contribution."

His actions seem to contradict his statements above. It appears that Mark Britnell has one thing on his mind and it isn't 'the social value' of his work. He seems to be a rather menacing agent of the state, a man who values party loyalty above the public good and a man who will try to force through government reform at any cost.

It may come as breaking new to Mark Britnell but the government's very own survey revealed that the vast majority of patients were very content with their GP's service and opening hours. His bullying tactics are frankly beneath contempt, however they are something we have come to expect from a rather nasty bunch of authoritarians at the Department of Health. Shut it Britnell.

The NHS Confederation

The world has indeed has gone stark raving bonkers, maybe that's a slight exaggeration of events; it is however certainly fair to say that the NHS Confederation is a complete waste of space. If you don't believe me then simply have a look at this collection of suggestions from the 2007 NHS Confederation annual conference, it really isn't hard to work out why the NHS is in trouble when the people managing it are a bunch prize idiots. To quote Dr Rant these people really are a fine example of the 'twatterati'. Some of these suggestions really are rather unintentionally funny, however one's laughter can soon turn to tears when one realises that they were unfortunately not intended to be humorous:

"A quality improvement project for junior doctors, Jenny Rusby

Suggest to PMETB that a quality improvement project with rapid cycle and small changes would be more valuable in junior doctor "competency" assessment than "audit". Offer a prize for a completed project with most impact. Junior doctors could be an army of improvers!"

"Create improvement in the system, Carol Culshaw

I think it's very effective (as with the Engaging with Quality initiative to start with a Royal College) and (as with the Safer Patients Initiative to start with an organisation) to create improvement in the system."

"Develop a failure of the year award, Dave Dawes, European Nursing Leadership Foundation

Develop a "failure of the year" award, which celebrates and learns from innovation that doesn't work."

"Governance training in medical schools, Rob Keogh, Guy's Hospital

Implementation of comprehensive governance training in medical schools at our undergraduate level."

"Let the patients speak, Mike Evans, Atherton Evans Association

Let the patients speak. Let the clinicians listen!"

"Patients can make a difference, , Claire Allen, Royal College of Nursing

Making patients believe they can make a difference; acting on their enthusiasm and encouraging participation. Its all about belief and self-belief."

"Value clinicians at the coal face, Anne Howers, Sutton & Merton PCT

Valuing the role of clinicians at the coal face and coordinating their insights into national professional initiatives for young people. "Children are the future - we will not see" - Aynsley Green

We need to ensure investment in young people to improve the availability of future health in our country."

"More engagement with clinicians, Caroline Bollard, East Riding and Yorkshire PCT

To quote David Cameron for the next few years in NHS structure and policy, "Evolution not revolution".

More engagement with clinicians 'bottom up' and patient-centred policies.

The Health Foundation sum up exactly where things are going terribly wrong in the NHS, an organisation that waffles on about improvement and somehow manages to spend 20 million pounds a year on producing nothing more than offensive hot air. It is depressing that this settlement of gas manufacturers are simply too dim to see the great irony that their toothless organisation represents.

It is hard to find the words to describe the sheer lunacy of their extreme and nonsensical approach to health care 'improvement'. Their fundamentalist stance as regards care being completely centred on the patient defies belief and common sense; the doctor-patient relationship is a very complex entity but it is clear that, for it to be functional, the doctor must have more power than merely being a convenient listening device for the patient. If this lot had their way then doctors would never have time to learn basic sciences and subjects like anatomy that are fundamental to becoming a good doctor, they would be forced to endure years of communication skills and clinical governance teaching sessions instead, amazingly this is the way medical education is going; soon medical degrees will contain more teaching in waffling management speak than in areas which actually prepare you for practical doctoring.

Their offensive patronising chatter is rather symptomatic of the general malaise present in the overall management of the NHS today. The banter is of 'patient safety' and 'improvement' but practically they are pouring pound notes onto a bonfire, while creating yet another layer of useless bureaucrats who are happy to work against and stifle genuine progress. If they genuinely engaged with clinicians and believed in bottom-up management, then they would rapidly find that their organisation no longer existed. However as the NHS is run in an inefficient centralised fashion, it is no wonder that these kind of organisations keep springing up from unpleasant state orifices.

My failure of the year would go to the NHS Confederation and the utter hogwash that it represents. However I would not be celebrating this failure as I am not a moron. Doctors should be trained to do their job as doctors and once trained they should be trusted a bit more to get on with it, not forced to endure the incessant meaningless ramblings of these politically correct glossy-pamplet-loving quangopoops. Judging from these 'managers' comments they have about as much idea about working at the coalface as Paris Hilton, but perhaps the NHS confederation is simply a clever trick to massage the unemployment statistics?

My suggestion for the NHS Confederation 2007: cease to exist if you really want 'improvement'.

Healthspeak, a form of news speak?

"Has healthcare become infected with the wrong words?

Are health managers mired in management-speak? How good are clinicians at using language that patients can understand? The reform programme has introduced the language of the market, but for many it still sticks in the craw.

Nuffield Hospitals is initiating a debate about the vocabulary which has grown up around the delivery and management of healthcare.

Are there words and phrases you would like to see expunged from healthcare altogether?

Join the debate by clicking on ‘comments’ below. You don’t need a TypeKey or TypePad account to post a comment. The contributions will be reflected in a report to be published in November."

The government continues its drive to erode what it actually means to have done some training and been educated as a professional. It's strange that these days the word doctor is rarely mentioned, almost as if a medical degree doesn't really matter anymore. In an attempt to dumb down and cheapen standards everyone is being amalgamated into a 'practitioner' grade, training doesn't matter anymore, medicine is seen as something like baking a cake and everyone can have a crack.

The nurse 'consultant' has been created, whatever that is supposed to mean, personally I have no idea. The public are being tricked as the new breed of incompetent introduce themselves as doctors despite having the most inadequate of educations. In this brave new NHS with no proper standards we are all 'health care practitioners', everyone has been dumped in the same crate of faeces.

Privatisation without stealth

The government are pretty shameless in their auctioning of the crown NHS jewels, they don't even feel the need to hide their continued privatisation of the NHS from the general public. Personally I'm not even sure anymore if the government are cynical or just plain stupid, perhaps they are a mixture of the two.

As the good old NHS struggles to pay off deficits and staff are laid off as a direct result of this belt fastening procedure, one can rest assured that luxury juicy cherries are still being served up to the private sector. For example Capio seem eternally guaranteed to be dished up tax payer's cash, even when they don't bother doing the work that they were contracted to undertake. This is not an isolated example, there are private firms driving the NHS out of business in many other regions thanks to this central mismanagement which results in a rather uneven playing surface being forced upon us.

Capio and their ilk are like a pack of hungry lions drooling with anticipation as the government prepares them yet another course of expensive tax-payer-funded morsels, while the NHS is served up an empty plate of hot air. The NHS is simply the 'biggest privatisation opportunity' in Europe, in Capio's own words the NHS is merely a lump of profitable meat. Behind the hollow chatter about markets and capitalisation, this malignant monster is waiting to profit at the expense of all of us poor tax payers. Scandalously our own government is assisting the generation of private monopolies of health care provision that will see millions wasted in lining shareholders pockets; while democratic change will be impossible as the power will no longer lie with our own government, it will lie with a few very wealth businessmen who will have no obligation to respect the values of equality and justice that the NHS stands for.

Bile Broadcasting Corporation

More weight has been added to the rumour that the BBC is being used as a mouthpiece for the government press office by yet another misleading article regarding GPs and OOH care.

The headline "GP out-of-hours complaints soar" is not an overt lie but it is deeply misleading to the public. Thanks to the government/DoH's gross incompetence in handling health service reform the responsibility of out of hours care is now held by PCTs, yet somehow the blame for the government's errors is always handed to the GPs who try hard on the ground.

"It is a fact that patients are annoyed when they cannot see their normal doctor and I think this is more likely to make them complain about the care they receive."

This statement is pretty much right on the mark. Thanks to the government and the PCTs mismanagement of OOH care they have scrapped a good system where patients got an excellent service for great value, and replaced it with a poorer service that costs more with no continuity of care. The government sees this as progress.

More complaints and more mistakes are inevitable if patients are seen by doctors who firstly do not know them, and secondly do not have access to their proper medical records. More problems are also inevitable as OOH cover is made more skeletal with fewer doctors covering fewer patients, and thanks to non-doctors being handed more responsibility in taking clinical decisions for which they are not adequately trained or accountable.

The rise of phone advice by so called 'health care professionals' will have its undoubted cost in terms of patient mortality and morbidity. Even the most skilled and trained medically qualified struggle to assess clinical problems over the phone for unfamiliar patients, especially when the patient has not been assessed by a competent clinician. Hence the government's drive to shift more work that should be done in person to being conducted by phone is not in the best interests of patients.

Parallels can certainly be drawn to the government's mismanagement of front line hospital care. Doctors are thinner on the ground out of normal working hours, meaning that more work is being done by the non-medically qualified in a rather unsafe and dangerous manner. Clinical decisions are being handed down to many new forms of 'health care professional' despite the fact that they have not been adequately trained for the job, they are also not accountable in the same way as doctors are for their decisions. 'Hospital at Night' is a case in point, a cost cutting scheme that pretends it will make things better, when in reality it has been a metaphorical gun to many a patient head.

The BBC seems to think that all these problems are the fault of GPs and doctors; this is strange given that these people are the ones actually trying to fight what sometimes appears to be a losing battle against the Department of Health's drive to privatise and cheapen the service. It is also even more strange as GPs and doctors have not been the ones making these negligent errors in reducing the quality of the service, ironically they are frequently the ones fighting against this cost cutting dumbing down in the interests of their patients.

I suggest that you think long and hard about these issues before you blame the convenient medical scapegoat that the government has created in a quite blatant attempt to shift blame away for its own gross incompetence. The government and Department of Health like to pretend that things are always getting better and that they listen to concerns raised, however nothing could be further from the truth. In actual fact the government routinely ignores concerns from the medical profession about their malignant health reform program; they do not care if they kill patients with their cost cutting short termism, it is all about how they are perceived, hence more money is invested in spin and propaganda at the expense of patient care.

I am amazed that the BBC chooses to trust the government so much when they have been caught lying with their pants around their ankles on such a regular basis. The government's rhetoric never changes, the chorus of 'patients safety' and 'better care for all' is repeated ad infinitum; I suggest that you judge them by their actions and not their hollow words, their gross practical incompetence should speak for itself.

The NHS manager

There are many types of manager in today's NHS and judging from their end product it seems that something has gone terribly wrong in the land of the NHS manager. The logic of the NHS manager means that due to their inherent incompetence when they try to make things better, they inevitably make things worse; a more intelligent manager would then realise that a change of approach was required, but unfortunately the NHS manager tends to carry on digging their pit deeper and deeper by obstinately refusing to change tack. This assumes that their intentions are always benign, undoubtedly this is not the case for the cynical politically driven manager; their kind knowingly do harm in a rather amoral way. In their own eyes the NHS manager is never wrong. The NHS manager is also not helped by the fact that the NHS super managers in the Department of Health nerve centre have no intention of making the service better, they are simply the automaton enforcers of the government's will for us all, ie a cheaper shoddy health service for us all.

The NHS manager can be sub divided into a few broad categories, obviously there are no generalisations at all in this evidence based piece of research, however there is a small grain of truth in the ferret fancier's guide to NHS managers.

The common malingerers

The 'NHS University manager'- this is the born and bred NHS manager, trained in pure management with no knowledge of anything other than pure meaningless waffle; this results in a complete inability to understand what goes on in the real world, meaning that any attempts they make to affect change will be based on groundless management banter and will therefore only result in stifling the attempts of people who do the practical work on the NHS shop floor. They are named after the NHS University as this fine educational institution was an example of millions of pounds spent with precisely nothing to show for it.

The 'Impinging Nurse manager'- this is the extremely common sub type that plays a rather prominent role in stifling any possible progress that clinicians try to make on the ground. Invariably the weight of several packets of chips on their shoulders results in a complete inability to engage with anyone other than their fellow impingers, with whom they spend many hours snacking on lardy treats in expansive committee rooms that are only just large enough to permit the wobbling of their highly obstructive derrieres. Typically this nursing breed comes from a background of being rather useless at the real job of nursing, and from a enjoyment of bullying ones fellow employees; this lack of ability combined with a nasty vindictive streak results in a uniquely regressive style of management that many of us have the misfortune of experiencing first hand on many occasions. In their eyes the protocol can do no wrong, even when written in pigs faeces by a dyslexic crack-fuelled monkey.

The 'Donaldson'- this type of malodorous turncoat manager is named after our beloved CMO, Liam Donaldson. This type is medically trained but is very happy to sell out their own profession absolutely for the guarantee of honours, a nice office with a padded leather chair and a very occasional embarrassing appearance in public when the sh*t has really hit the fan thanks to some rather pitiful policy making. Personally I find this type to be particularly unpleasant, not only on the eye but also from an ethical viewpoint, as frankly this lot should know better. Unfortunately they are greedy egotists who have no care for anyone other than themselves, and this means that their management style always results in them enforcing the will of their master, the government. They care not for patients, the service or the staff on the ground; they are looking out for number one.

The 'Management Consultant'- this lot of smooth talking city slickers are particularly adept at being paid a small fortune for doing very little indeed, a quite remarkable talent. Despite invariably having no knowledge of medicine, healthcare and the NHS; the government seems to be rather fond of consulting these chaps using large wads of tax payer's cash. Despite the fact that many clinicians on the ground have been suggesting practical solutions to problems for years while going blue in the face, the government ignores this highly talented wealth of specialised knowledge and chooses to consult an overpriced source that doesn't really know that much about anything if we're honest. It's amazing how business seems to go ones way when one happens to donate a few pence to the political party in charge.

The 'Total Numpty'- this sub type of manager is the completely untrained breed of manager that can be found with remarkable ease in the NHS today. This type has very little knowledge of anything at all, they don't even have that precious managerial skill of being able to send you to sleep with a magic cloud of superwaffle. The NHS does have room for many types of incompetent who would not be able top find a job anywhere else, after all it is cheaper to pay them a low managerial wage than to fund their benefit claims. Strangely they do less damage than the more highly trained 'NHS university manager', as due to their complete ineffectiveness they can do no good, but also no harm.

Rarer manager types

Good manager - this exceptionally rare breed is trained in management but actually engages with staff on the ground, listens to constructive criticism and is able to learn from mistakes. Unfortunately these managers are often sacked for refusing to go along with destructive orders from above, while some of them become corrupted into the 'NHS university manager' sub type.

Ex doctor or nurse manager with no chip on shoulder and good intentions- this type is spotted in the NHS only very occasionally, a bit like the lesser spotted welsh warbler; these managers actually have the vision and insight to be able to save the NHS. It is therefore very sad to say that they frequently spontaneously combust thanks to the sheer frustration despair of having to engage with the more common forms of NHS manager. These noble managers have also been subjected to vicious smearing campaigns with little basis, and some have also been removed from office for not doing as they were told.

Overall this rather unique blend of the incompetent, the even more incompetent and the plain unpleasant results in one of the most dysfunctional management structures ever seen. The top down authoritarian lead of the Department of Health, under pressure from our corrupt politicians, has crafted this disastrously ineffective manure heap through many years of bullying and wrecking. The Department of Health has slowly amassed a team of incompetent bullies sculpted in its own malignant image. It results in those staff on the ground who are actually trained to care for and treat patients being obstructed by a complicated network of utter cretins. The staff on the ground cannot make sensible decisions in the interests of their patients anymore, they have become mere pawns taking part in a meaningless game of chess played by their idiotic managers, and the patient has been forgotten. We now routinely have untrained idiots making clinical decisions about patients in an overtly dangerous manner, as money is shuffled between different NHS bodies in a way that prevents patients from getting the care that they deserve; and this is all in the name of modernisation and progress. Brave new NHS indeed.

The 'ambitious innovative' MTAS

This is the picture that the BBC attempted to portray this evening on Newsnight, a report fronted by an Economics editor that woefully failed to get to grips with the real issues regarding MTAS and MMC. Junior doctors were unfairly portrayed as spoilt brats who had no right to expect to be treated humanely by their masterful employer, the NHS.

The illogical statements of Jim Johnson 'vascular surgeon', which claimed that crushing the hopes of thousands by forcing them into demoralising service grade posts would improve the service, beggared belief. While the spiteful Alan Maynard again showed his utter failure to understand anything about how to provide a good quality health service by hinting that doctors were simply too expensive now; I wonder if the patients would be happy to hear that the government thinks it is now too expensive to provide a high quality service run by doctors?

The program was a shoddy attempt at journalism concocted by a broadcaster which has consistently failed to get its head around these complex issues. How Channel 4 have shown them how it should be done over recent weeks. The patronising and insulting tone adopted by the aristocratic BBC journalists did appear more than a little hypocritical given their own secure careers, careers which they have forged by attacking easy targets such as junior doctors. It made me laugh that they portrayed us as a 'powerful' group, while our union the BMA were painted as a militant band; events this year have shown that we are far from 'powerful' and that the BMA are more of a damp squib than a militant mob.

The worst thing was that this BBC report failed to capture any of the human element of this disaster, by trying to portray the oppressed as spoilt and and powerful, they had only succeeded in making themselves appear as callous agents of the state. It is very sad that we have almost become so numb that all the upsetting stories do not have the impact that they should anymore. I sit and think that I should be sadder, or angrier, but the emotional tap has run pretty much dry. I have been left resentful and bitter, not a pleasant combination I know.

I find it hard to take in just how many people's hopes, dreams, lives, careers have been left in tatters thanks to this year's shambles. I think of close friends who I know have been let down and then I start to feel less numb, I can still empathise after all. But when it comes to trying to add up just how many doctors have been let down so very badly, I hit a brick wall, I cannot imagine so much neglectful destruction in one go.

So many have been left unemployed and shattered, so many have been moved miles from their homes, so many have had offers withdrawn, so many have been treated with disdain and scorn by various agents of the state, so many have been left in a state of depressed apathy that they so do not deserve to have to experience.

It is too much to imagine, would we be able to cope if we could imagine so much human suffering on such a scale? We must not forget this betrayal, if any of us make it higher up the chain of command we should always remember how this felt, there should be no excuse for treating people with so little respect.

The BBC thinks things have been 'overdone'. I am embarrassed for them that they are so happy to belittle the betrayal of a generation of hard working caring professionals in such a way. The government's admission that a high quality NHS run by properly trained doctors is just too costly is not newsworthy in the eyes of the BBC. But then I just a spolit junior doctor who happens to want to be trained to a high level so that I can do my job well in the future, what's so wrong with that?