Mangling Medical Careers - Gordon and Labour's ghastly legacy

With the election looming I thought it worth emphasising just what 'new' Labour have done to the NHS and doctors since they came to power in 1997. Instead of working with professionals, they have demoralised and undermined them with their megalomania and top down control freakery. This short tale is from one of many who have had their career destroyed by Labour in such a heartless fashion, it gets across just what this current regime represents:

"In short, MMC has destroyed my career. In the space of 18 months, I went from being told I had the natural talent be one of the best cardiac surgeons in the world by my consultants to being dumped on the scrap heap. I got a LAT registrar post in London Deanery after only 12 months as a cardiothoracic SHO only 6 months of which were adult cardiac. With only that 6 month SHO experience, I went on to perform my first skin to skin set of grafts after only 5 and a half months and over 10 first operator cases by the end of my first year as a reg.I then went on to start a PhD and suddenly MMC started.

The goalposts changed overnight and I went from being perfectly positioned to be able to start applying for a number to being "too experienced". My research, papers, logbook of cases, experience all count for nothing; if fact they are a burden. There were no gaps in my CV and application form last year. I had all the exams, courses, cases, presentations, publications, research, everything. I could operate. My bosses wouldn'e even come in for major trauma or emergencies knowing full well I was capable of dealing with it. I didn't even get shortlisted yet my SHO who couldn't even take a saphenous vein without help got an NTN in cardiothoracics.That's just the start.

Since I graduated in 2001, the NHS has changed beyond recognition. At work, management treat us with disdain and contempt, doing everything they can to show us who really is in charge. I can't even plan to go out in a couple of weeks as I don't know what my oncall rota for May is. With some luck, it will be out before next weekend but not necessarily. My fiancee, a GP, now spends more time doing paperwork than she spends seeing patients. Not only that, but she's forced to do extended hours for no additional pay, just the threat of a pay cut if she doesn't. Childcare is a nightmare as both of us often have to work at times when none is available. The boys are now used to doing their homework in the surgery and falling asleep there as they are still there till well after their bedtime, or sometimes in the back of her car while she's still doing visits.There are now more administrators in the NHS than doctors and every new target begets a new layer of management with no change in the number of doctors or even a reduction. Enormous sums are bing wasted on useless initiatives and there's no money available for the things that really matter.

There are a lot of other things going badly wrong with medicine but it doesn't end there. The economy is total mess. GB's chancellorship saw the worst raids on public assets there ever has been. Our pensions have lost a huge amount since his changes in 1998. His irresponsible borrowing, reckless sales and expenditure means we'll be paying the price of his wastage for decades to come. The current tax burden on those in actual employment is higher than it ever has been, even the 90% income tax for the highest earners back in the 70s. The fabric of society has been eroded such that nobody feels that they have any responsibility for anything anymore yet everyone has a firm belief that they have many unquestionable and irrefutable rights. Our civil liberties have been eroded so much that 1984 isn't fiction anymore."

Thanks Gordon and thanks Tony, thanks New Labour. When you hear Gordon talk of how they value the NHS and its staff, I suggest you read the above and remind yourself of the reality of the situation. Gordon and his cronies pretend they care for the NHS, they clearly do not. Maybe the next lot will be no better, one thing is sure though, it is hard to see how they could treat the medical profession with any more disrespect.

The vote: an insult to those who fought for it

As the election fast approaches, one could be forgiven for getting carried away with all the excitement about polls, TV debates and campaign trails. If one takes a bit of step back then one can see our democracy for what it really is, a steaming pile of dishonest horse manure.

The vote should mean something, many people have fought and died for the right to vote, politicians even claim to this day that not voting is an insult to those who fought for the right, I disagree with these politicians. The vote has come to mean very little and this is one great shame.

There is no genuine choice, despite the endless shiny waffle and propaganda in the mainstream media, if one quickly scratches beneath the surface then one soon sees that all the major political parties have pretty much identical policies on the key issues. The vote is practically meaningless, it is a token gesture, party politics is corrupt and has run out of democratic steam.

Take the health service for example, there is simply no choice for voters on policy, all the major parties are not questioning the market ideology, the PFI schemes that are wasting billions, the privatisation agenda, the dumbing down and dis empowerment of the educated professionals. The mainstream media are silent on this scandal, bloggers are the only genuine voice against this disgrace and the election propaganda goes on and on.

Politics is broke, meaningless superficial Television debates will not fix this problem, unless someone in a position of power does something about this disillusionment of the general population, then the time bomb will keep on ticking and eventually it will go off.

Quacking chiropractors exposed as Singh gets justice

Calling a spade a spade should not leave one liable to be sued, yet this is precisely what happened to Simon Singh when he took on the quackery of the British Chiropractic Association. The claims made by the BCA that spinal manipulation could be used to treat children with colic, ear infections, asthma, sleeping and feeding conditions and prolonged crying were nothing but utter hogwash. Singh's decision to call their claims bogus has been shown to be 100% correct by the Court of Appeal.

The Court's judgement can be read in full here, and this really is a victory for common sense and for scientific progress. Quacks should not be allowed to make unfounded claims about their dodgy treatments, whether this be companies peddling nutritional supplements, practitioners of alternative therapies such as acupuncture, herbal medicine, chinese medicine, homeopathy and on and on, there are just so many quacks out there.

The way in which the British libel law was used to intimidate by the BCA is rather scary and it makes the case strongly for a proper overhaul of our antiquated and repressive libel laws:

"The ruling, by England's two senior judges, Lord Judge and Lord Neuberger, together with Lord Justice Smedley, was scathing of the way the BCA began libel proceedings rather than taking up the Guardian's offer of a right to reply. It acknowledged that the action had a "chilling effect on public debate". The BCA's actions had created the "unhappy impression" that it was "an endeavour by the BCA to silence one of its critics" "

I would urge anyone reading to sign the petition here are the libel reform site and have a look at the senseaboutscience site here. The likes of the BCA need to be shown up for the dishonest rip off merchants that they are.

The arrogance and idiocy of politicians

This eloquent letter sums up so much that is wrong with the way that the government creates policy. Obviously this letter refers only to the ACMD (Advisory Council on the Misuse of Drugs) but the same problems are present across the board. The government's policy should be crafted in the best interests of the general public, when one sees what has happened as regards drug policy one can see that policy is created to satisfy political expediency and not the long term best interests of the public.

The same is true on health, policy is not based on the evidence or on the best expert advice, it is created by politicians and government cronies who have no proper education or knowledge of that particular area, and it is created to satisfy the short term needs of politicians and the Daily Mail, not the best long term interests of our country. Anyway the letter is an excellent insight into the disastrous way in which our stupid politicians create useless policy:

"Dear Home Secretary

Resignation from Advisory Council on the Misuse of Drugs [ACMD]

With regret and sadness, I am tendering my resignation as a member of the Advisory Council on the Misuse of Drugs.

I was honoured to be appointed to this position and I had hoped that my substantial experience of managing drug prevention and treatment services might help influence the committee, and thereby the government, to think about drugs as more of a public health issue rather than focusing narrowly on the criminal justice aspects. This has not been the case.

My main interest and competence is in the field of prevention and early intervention with young people. I have grown increasingly disillusioned not only with the lack of attention paid to this by politicians and the media but also by the ACMD's apparent lack of interest in the subject (with a few individual exceptions).

At our meeting earlier this week, the update report on Pathways to Problems, published on the same day, received scant attention. Indeed, there was no time for questions on the report due to the haste with which we were being pushed to make a decision about classifying Mephedrone; this so that the chair could come to meet with you later in the day and you could do a round of press announcements.

Re: Mephedrone; we had little or no discussion about how our recommendation to classify this drug would be likely to impact on young people's behaviour.

Our decision was unduly based on media and political pressure. The report was tabled to the whole council for the first time on Monday; the chair came to brief you before the whole council had even discussed all of the report. In fact, I still haven't seen the final version.

When, as home secretary, [Charles Clarke] announced that the entire classification system would be reviewed, I welcomed it and was disappointed when the idea was shelved. This needs urgently to be revisited.

We need to review our entire approach to drugs, dumping the idea that legally sanctioned punishments for drug users should constitute a main part of the armoury in helping to solve our country's drug problems. We need to stop harming people who need help and support.

At the end of last year, I decided not to resign over the sacking of David Nutt, preferring instead to see how things panned out and to hope that the ACMD could develop a work programme which would help prevent and reduce harm, particularly to young people.

I have no confidence that this will now happen, largely though not totally due to the lack of logic of the context within which the council is constrained to operate by the Misuse of Drugs Act.

As well as being extremely unhappy with how the ACMD operates, I am not prepared to continue to be part of a body which, as its main activity, works to facilitate the potential criminalisation of increasing numbers of young people.

Yours sincerely,

Eric Carlin"

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.

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.

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.

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.

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.

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.

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”. "

Mid Staffs and the systematic failure of targets

It was no surprise that our esteemed leaders have tried to pin all the blame for the appalling standards of care at Stafford Hospital on the local NHS managers, this was to be expected, the fact that many hospitals around the country are also compromising standards of care in exactly the same manner as a result of the systematic mismanagement of the NHS is not something that Gordon and his friends in government will mention.

The gross failure of the top down centralised control of the NHS via a depraved culture of targets, bullying and intimidation is the real reason for the shocking standards of care in certain hospitals such as Stafford. This is touched upon by some of these letters to the Guardian on the topic, obviously the cowardly morons at the top like Gordon Brown will always try to pin blame locally, this is despite the clear fact that local managers have their hands completely tied, they have no choice but to obey the top down diktats from Whitehall or else. Dr Grumble hits the nail on the head with his analysis of events in Stafford:

"If there is one lesson to be learnt, I suggest it is that people must always come before numbers."

This above statement is Staffordshire inquiry. The problem is that everything the government has done in terms of NHS reforms from targets to the privatisation of services has resulted in numbers always being prioritised instead of people. This talk is hollow, so so hollow. There are so many examples of the top down nature of the NHS and how this harms patients, the way in which the Baby P whistleblower has been treated sums this up perfectly, sadly there are just so many other examples. The Witch Doctor's excellent summary of the coverage of the Staffordshire scandal is well worth a prolonged read.

The latest example of this corrupt top down agenda of reform is the bullying used to force through a program of 'polysystems', basically a way of trying to shut down yet more local hospitals and shunting their work to various private firms. The 'polysystems' reform will lead to less cash for hospitals, this will then result in hospitals being forced to squeeze standards to stay afloat, meanwhile patients will get a much poorer standard of care in attending various new substandard services delivered by primary care providers. The aim of this is to save money and privatise, no wonder standards of care will suffer, again the top down orders will be forced through, local managers will lose their jobs if they refuse, the numbers are prioritised again ahead of the people. Some things never change, centralised power and local blame, numbers before patients.

The BMA explain exactly how corrupt and ineffective the government's reforms have been with their 'Look after our NHS' campaign. Diane Abbott has tabled this excellent early day motion the same topic, if you have time to copy and paste this short letter and send it to your MP then please do, it only takes a minute and the more MPs than sign up to it the better:

Dear.............

As one of your constituents I am writing to ask you to support and sign up to Dianne Abbott’s EDM 889.

COMMERCIALISATION OF HEALTHCARE PROVISION (EDM 889)“That this House believes that for the NHS to provide high-quality, comprehensive healthcare for all, free at the point of use, it must be publicly-funded through central taxation, publicly provided and publicly accountable; is concerned about the damaging effects that commercialisation of the NHS is having through market reforms including the use of independent sector treatment centres, imposed GP-led health centres and polyclinics, the transforming community services initiative and expensive private finance initiative projects; further believes that public money should be used for quality healthcare and not profits for shareholders; further believes that the NHS should care for patients through co-operation and not competition; supports the British Medical Association's call to abandon the market in the NHS in England; and urges Government to restore the NHS as a public service working co-operatively for patients, not a market of commercial businesses competing with each other for financial gain.”The founding principles of the NHS are under serious threat and it is therefore imperative that Parliament holds a debate on this very important matter. I am grateful for your consideration of this request and would appreciate a reply if possible.

Yours sincerely...........

Simpy copy and paste and send it to your MP: http://www.theyworkforyou.com/

The 25,000? The thromboembolism lies

Following up on my last piece on the government's spinning of the thromboembolism death statistics, it turns out that less than three thousand people die as a result of venous thromboembolism per year, this is according to the 2008 statistics.

The Department of Health and NICE both reference the Health Select Committee on this 25,000 figure. Strangely the Health Select Committee was presented evidence back in 2004/5 by a surgeon by the name of Linda de Cossart.

Linda De Cossart’s evidence talked of an incidence of pulmonary embolism (PE) of approximately 23 per 100,000 per year with an associated mortality of 12%. If one assumes that our population characteristics are similar to the US’ then this would make the number of fatal PEs in the UK only approximately 1600 per year. Apparently the US have the best data, so this would be a reasonable ball park figure.

Either way it seems that the evidence has been misinterpreted or spun by politicians. It appears that a la David Nutt saga the politicians are ignoring the science in determining policy. The real number of deaths secondary to venous thromboembolism appear to be around three thousand per year in the UK, so the talk of 25,000 is hogwash, the talk of 25,000 being 'preventable' is beneath hogwash.

Thromboembolism propaganda from HMG

The government is trying to convince us of the massive threat of venous thrombembolism (VTE), for some reason the threat of deep vein thromboses and pulmonary emboli has been hyped up beyond all proportion in recent years. Sometimes myths get propagated from nowhere as no one has bothered to check the actual facts from scratch, in my opinion this is the case with venous thromboembolism. This is a direct quote from the Department of Health's document on the subject:

"In 2005 the Health Select Committee estimated that there were around 25,000 deaths each year from VTE in hospitals in England and that the cost of treating the long-term disability caused by VTE was around £640 million a year. In 2007 there were 16,670 recorded deaths in England and Wales where pulmonary embolism and deep vein thrombosis (VTE) were mentioned on the death certificate (Office of National Statistics)."

This is disingenuous to say the least. Clots in the leg veins (DVTs) are common, pulmonary emboli (PEs) are much rarer and deaths from PEs are even rarer again. The government is spinning the evidence and facts. There were only 16670 deaths in one year with DVT or PE on the death certificate, so a DVT or PE was only the leading cause or a contributory cause in this number. They then go on to say that there are many more that are not put on the death certificate, in actual fact this is their faulty assumption. In reality DVTs are common and are by far the most common reason that VTE will end up on a death certificate, however equating a death certificate with a DVT as a contributory factor as being a preventable death directly due to VTE is simply preposterous, it is the logic of spin doctors, not scientists, no wonder this 25,00o fugure came from the Health Select Committe and not a proper medical journal.

To then jump to the conclusion that there are 25,000 'preventable deaths' a year from VTE is utterly ludicrous, there are probably way under this figure in terms of deaths, so to assume that 100% of these deaths are preventable is utterly ludicrous, utterly utterly ludicrous.

Medicine and life is a game of risks and balances. The government and NICE have come up with VTE prevention guidelines which mean that virtually everyone in hospital needs to be treated with blood thinners. Basically by making the above faulty assumptions they are forcing blood thinning drugs on a hell of a lot of patients and probably doing a lot more harm than good. For one there is no good evidence that any prophylactic agents can reduce the risk of fatal VTE, also the blood thinning drugs have some very well documented side effects, some of which are rather rare but extremely serious and life threatening.

To illustrate just how ludicrous the government's figure of 25,000 preventable deaths is, I have done a little mathematical calculation. Interestingly this figure of 25,000 was not produced by scientists or in a reputable medical journal, it was made up by the politicians of the Health Select Committee. Anyway if one assumed that every single person in the country had a hip replacement in one year, one would then expect there to be about 40,000 deaths from VTE that year, of note hip replacements are a very high risk procedure for death from VTE. So even if the whole country had a hip replacements then it could still be argued that we would not even get to 25,000 'preventable' deaths.

This whole sorry saga is rather reminiscent of the whole swine flu hype. The weak and corrupt state wants to make itself appear powerful and clever by creating a massive threat and then trying to stamp it out, hence creating the massively exaggerated threat of death from VTE and then try to combat it. As part of the same process a lot of drug companies and their friends on government panels like NICE are making a lot of money from selling a lot of over hyped drugs that thin the blood. At the same time patients are probably worse off as a result of the various side effects of these drugs, while the rate of death from VTE will not really be affected at all. Same old politics, a new topic for abuse and propaganda.

Hinchingbrook disgrace and PFI nonsense

Apparently the struggling District General Hospital in Hinchingbrook is to be taken over and run by a private company, according to the government and politicians this is not 'privatisation', it is about providing high quality services by using a leading provider. Interestingly Hinchingbrook's trouble must have nothing to do with various PFI schemes in which it was involved. It was also nothing to do with the PCT staving the hospital of funds because it was committed to throwing money at various private providers like a new treatment centre, as ordered by central government. These are the real reasons for the debt of poor Hinchingbrook:

· the Trust had lost out under Payment By Results;
· its NHS Treatment Centre had been starved of referrals by its own PCT;
· its caseload had been further squeezed by Foundation Trusts seeking
surpluses and by PCTs seeking economies and redirecting patients away
from hospital care;
· its budget had been further cut, and the cash used to send NHS patients
to private hospitals;
· and the merger of Cambridgeshire’s PCTs lumbered Huntingdonshire’s
health services with new deficits from elsewhere in the county.

The companies in the running include Circle Health, a company that specialises in 'John Lewis-style employee partnerships to boost productivity'. From their website regarding share ownership '50.1% is owned by Circle International plc'. This is the investment vehicle that blue chip City institutional investors have subscribed to for shares by providing the capital for Circle. So the controlling majority are not working 'partners' like John Lewis but sleeping 'partners' like banks. Care UK are also bidding, they are the firm that has been paying Andrew Lansley off for something that he can hopefully do when he steps into office later this year.

The perverse nature of this selling off of NHS contracts is there for all to see. Hospitals only get into debt because they are forced to comply with the top down market based reforms enforced by Whitehall, essentially they are being underfunded for doing the work that they have to do for patients. The market and payment systems are artificial, patients' illnesses are not, so when the system's error results in hospital debts, it is only the patients that will end up suffering.

Ironically these private firms will not give their money to improve the service, they will reduce the quality of the service and asset strip in order to generate profit for shareholders, this is the world of the short termist in business. Even more perverse is the fact that many of the scandalous PFI deals that are forcing numerous NHS trusts into massive debt are run by some of the big banks that were recently bailed out by billions of taxpayer pounds. The government is corrupt, foolish and acting against the interests of the public.

The likes of RBS and Lloyds are making shed loads of easy cash from numerous poorly thought out public service PFI schemes, and having been bailed out by the taxpayer, they are now partly owned by the taxpayer. Yet the government insists that these PFI schemes are good value and will not renegotiate them, meanwhile NHS trusts go into debt and are bought by big private firms that may even be partly owned by the very same banks. The banks cannot lose, the taxpayer and the patient simply cannot win, this game is rigged and it is a complete and utter disgrace.

Hinchingbrook is not an exception or an aberration, it is the inevitability of the destructive market based reforms that this corrupt government has indulged in. The top down market and privatisation agenda makes the like of Hinchingbrook's failure an absolute inevitability, the government knew this when it set about introducing the ghastly NHS Plan in 2000. Hinchingbrook will not be the last, it will be the first of many, the market based reforms have enriched many private firms for providing low quality services for a lot of money, the market is now set to bankrupt a lot of NHS hospitals, these hospitals will now be sold off and be used as yet another money making vehicle for the private sector. It is enough to make one weep.

Managers and the pathetic HSJ

If the public based their opinion of doctors on the picture painted by the media and not on their actual first and second hand experience of doctors then they would hold us all in incredibly low regard. Fortunately the vast majority of the public are much cleverer than the media give them credit for, doctors routinely do pretty well in various surveys of public opinion and levels of trust.

As Dr Grumble remarks, if one reads the Health Service Journal (HSJ) then one would think that doctors are evil blood sucking scum and that managers are lovely good willed angels. In fact the HSJ is not really a journal, it produces nothing of any quality, it is generally a magazine of selected opinion and discussion, one could almost go so far as to say it is a piece of propaganda, in fact I will. Compare the woeful HSJ to the journal of the British Medical Association, the BMJ, the BMJ is never so flagrantly partisan, it is never so overtly biased, it produces some decent balanced articles and some decent research, it might not be the New England Journal but it is reasonable.

The HSJ is an embarrassment, it is a Heat magazine style production, there is rarely anything of any substance in it, one will not find decent researched evidence used in any discussion or opinion pieces, one just gets baseless speculation and ideology. The Jobbing Doctor has exposed this with help of the excellent Clive Peedell. The likes of the HSJ fail to show any kind of objectivity in covering all matters health related, whether it be the government's complete mismanagement of GP Out of Hours care or the Consultant contract, you can be sure that only one warped side of the story will be spun.

In fact the government and the managers are the main two groups of people who routinely ignore the clinical needs of patients, they merely care for their own jobs and livelihoods, therefore spinning about their own success is all that matters, they would rather have a service that looks good on paper which lets patients down than an excellent service that doesn't look quite so perfect on paper. These two groups are strangely quiet when it comes to the selling off of the NHS to Richard Branson, Boots et al, it doesn't take a genius to see who this lot are looking out for and it ain't the patients.

Power corrupts absolutely - Berger, the BMA and the rot

The recent case of a young career politician being dubiously slotted in as the official Labour candidate for Wavetree is demonstrative of the fundamental problems within our corrupt political system. The fact that Berger lived at the house of the person running this 'selection process' obviously had nothing to do with her selection, it was simply down to her remarkable life knowledge and experience. She certainly has some money and connections, her shiny website is strangely closed to any comments. Interestingly it says at the bottom of this website that the very same Peter Dowling promotes the site, he is the partner of the Ms Kennedy who Luciana Berger stayed during the selection process.

People like Luciana Berger are the reason why are political system is going to the dogs. She is typical of a new breed of professional politician that knows nothing of real life but is highly skilled at meaningless gassing hot air. Berger is a close friend of the repulsive Euan Blair, another one of this cohort of young know it alls. The people of Wavetree should stick two fingers up at the likes of Luciana Berger by voting for the candidates with some real world experience.

This new breed are invariably ex-student politicians who spent their student days sliming around debating and greasing each other on committees rather than doing normal human activities. They then typically study vague and useless subjects such as politics and business, it is unusual for them to study something proper like a hard science. Then they will never get a real job which exposes them to the reality of life, they will instead lubricate with other greasy slime balls in an industry such as pubic relations, management consultancy or lobbying. They then become career politicians at a young age, they have no interest in serving the public, they are serving their own career interests. The only thing they are capable of by this stage is talking the dishonest doublespeak of a politician, they are now destined for a life of hypocrisy as self serving liars. They are of no use to anyone but themselves.

The medical equivalent to this contemptible breed is the career medico politician. Liam Donaldson is a great example, a colossal tool who couldn't cut the real world of clinical work, a man who preferred to tell the government what they always wanted to hear than actually serve his profession or the public. Carol Black is another example, a lady who is on more committees than John Terry has had lovers, she is a typical career medico politician, her malignant work in recent years has seen her sell her soul to the government in shafting junior doctors and the whole medical profession.

The process of gaining extra pay as a doctor is intrinsically corrupt, the 'clinical excellence awards' system is a corrupt old boys network that is used by medico politicians to control the workers, anyone who dares go against the politicians and managers will be partly discouraged from doing so by pay cuts that can result from the corrupt nature of this process. The GMC/government's new revalidation process for all will be yet another weapon with which to beat dissenters, the GMC's new local officers will be empowered to intimidate anyone who would dare speak out about malpractice or systemic failures, the conflicts of interest between the Trust/PCT management's interests and the roles of the local officers in protecting the public will be glaring, however this is what the government wants, a corrupt nepotistic system that will cover up problems, not an effective open system that will learn from its mistakes.

The corruption and anti-democratic nature of the way in the medical profession's union, the BMA, works is also another prong of this dysfunctional web of corruption. The talk from the likes of the BMA's Jonathan Fielden always sounds good, but the reality of it is that these Chameleon like creatures will say whatever is required for them to get to the next level of the food chain, they are only serving themselves like two year olds who pretend to be hurt in order to get an extra sweety. Back here Jonathan Fielden pretended to care for what the BMA membership felt in order to force Jim Johnson's resignation, I wonder how long it wil take for Fielden to metamorphose into the new Jim Johnson.

So what's the point of this wandering rant? Well, it is obvious that power corrupts and that those who seek power are the least suitable to wield it. Corrupt systems fade and grow in cycles, but the corruption will only wane if people start making some tough decisions, it is not an inevitability. The people of Wavetree need to make a stand against the shallow career politician that is Luciana Berger, however it is not quite so easy for the NHS and the medical profession. Hopefully every little stand will help, every time a target is ignored to give a patient a better service, every time people speak out against the lack of representation provided by the BMA, every time a consultant tells a manager to stick it when fighting for patients. Maybe with enough small pushes, the big pushes will start to follow.

Campbell cracks, if only the inquiry had some balls

Unfortunately I have been too busy to catch most of the Chilcot 'inquiry', if one can call it that, from the bits I have caught it does appear a completely limp and toothless sham. Most of the interviews I have heard have consisted of vague nothingy questions which allow the skillful liars, the politicians, to side step any awkward areas. The people doing the interviewing are clearly not skilled interrogators, if anything was to come of it then the questions had to be very salient and based on clear facts, Blair and Co will not be caught out when asked 'Hello magazine' style questions as to whether they have any regrets or not.

Dr Grumble alerted me to this moment on the Andrew Marr show when Alastair Campbell pretty much gave the game away, he was completely lost for words, I'd imagine this was because he got to a point in the road at which he could no longer lie to travel onwards. This point in the road that involved Blair misleading parliament, something Campbell tried to deny would ever be the case no matter of other hypothetical facts, this was a big error from Campbell, as if the evidence was not there on the WMD then it would be obvious that Blair had indeed misled parliament.

It is a sad indictment on the Chilcot inquiry that two of the biggest breakthroughs have come thanks to Fern Britton and Andrew Marr on their TV shows. This says more than anything else. In the end Campbell couldn't answer the question and after a few moments of silence, claimed 'Tony Blair is a very honorable man', he then tried to pretend he cared and was upset at events, my heart bleeds. The facts are clear, there was no decent evidence behind the claims that Iraq and Saddam had WMD, Blair had no decent evidence, the weapons inspectors openly stated there was no evidence, yet our government proceeded and spun things the way they wanted. It was never 'beyond doubt' that these WMD were around, it may have been 'beyond doubt' that Tony wanted to believe there were WMD because he wanted war anyway irrelevant of this. Blair, Campbell and all their cronies are liars, cheats and a disgrace to our country.

Polysystems, NICE killing, Mike 'O'Brien et al

There is just so much moronic drivel spewing forth from the government and its cronies that it's hard to know where to start. I shall start by the drive in London to decimate primary care there. The government is trying to make primary care cheaper and privatised, the problem is that all the changes to service delivery along with their new associated bureaucracies end up costing more money than just leaving the old system in place. Then when it is realised that the reforms are very expensive, the service ends up being cut and patients end up suffering as a result.

This is Lord Darzi's legacy in London. The 'polysystem' madness current being rushed through is exactly the politically driven policy disaster that doctors expected. There is simply no logic behind plans to centralise GPs into these poly-shambles centres, it is a massive waste of money and highly inconvenient for patients to have to travel far greater distances. In reality polysystems are just a shallow excuse for dumbing down the standard of primary care even further, more patient consultations will be handled by those without proper medical training (nurses), while the quality specialist led care of district general hospitals will be eroded by shutting these hospitals and dishing out the work to less trained doctors and other quacks. This is all about cheapening medicine and pretending it's in the best interests of patients when it quite clearly is not.

NICE is a another government organisation that is about as useful as a bullet in the head. Their guidelines are not only overly simplistic and frequently wrong, but they are also a hazard to patients. NICE's drive to lower the blood sugar levels of diabetic patients to such low levels that it actually increased their chances of dying was just one example of this. Another great example of this is NICE's drive to give everyone drugs to thin the blood to prevent the incredibly rare and infrequently fatal pulmonary embolus (PE). The danger of thinning every one's blood is obvious, you get more problems like thrombocytopenia and other bleeding complications. In fact there is a lot of evidence emerging that the blood thinners do very little to prevent clots, but they do increase the risk of some very nasty complications. First do no harm should be NICE's motto, alas it is not, many of their guidelines seem to have been written by those with some rather glaring conflicts of interests, as a result the guidelines end up serving pharmaceutical firms and not the patients that they are meant to help.

A fascinating exchange between a rather thick government minister and David Colquhoun has taken place in the BMJ this week:

"Secondly, and far more importantly, he is wrong to say I was mistaken to claim that "you cannot start to think about a sensible form of regulation unless you first decide whether or not the thing you are trying to regulate is nonsense." If it were irrelevant that the subject you are trying to regulate was nonsense then why not have statutory regulation of voodoo and astrology? The Pittilo proposals would involve giving honours degrees in nonsense2 if one took the minister’s view that it doesn’t matter whether the subjects are nonsense or not. Surely he isn’t advocating that?"

In my opinion the government minister, Mike O'Brien, comes across as a thick plank of the highest and densest order. His idiocy is well demonstrated in his illogical rambling. The government's policy making invariably ignores the actual scientific evidence, the people making these decisions seem barely able to tie up their own laces, let alone decide how to create new laws that should best serve the public interest. It is perfectly summed up by Gordon Brown's completely ill informed comments on cannabis while his own government completely fail to tackle the most dangerous drug in this country, alcohol.

Liam Donaldson also seems to have forgotten his science and has become rather too political with his swine flu exaggerations. The global warming nonsense is another good example of how what should always have been a scientific debate has become completely wrecked by its politicisation, the way in which this bullying bandwagon has been created on dodgy foundations reminds me a lot of the MMR scandal, hopefully bloggers will continue to dismantle the rubbish that our mainstream media and governments try to feed us.

European Law the problem

The coroner has ruled that a patient's death was unlawful after an incompetent German doctor who couldn't speak English properly gave him a fatal overdose of diamorphine. The case of David Gray has been well known and shows just how lethal the free labour market of the EU is. It is something I have harped on about here many times before.

It is simply beyond belief that the GMC are not allowed to check the English speaking and the medical competence of doctors who are registered with non-UK European countries who then wish to work in the UK. This is thanks to European law and it is a complete farce.

The German killer Daniel Abani is only the tip of the iceberg, every doctor, myself included could tell you numerous stories of various completely incompetent EU doctors who have worked upon these shores in recent years. The GMC's hands are tied by European law.

The government and DoH will try to pin the blame on the PCTs, this is rubbish, there are over one hundred PCTS and it would be ludicrous to expect these organisations or other employers to individually assess the competence of doctors they employ, this should be done by the regulator, the GMC.

The fault here lies squarely with the government for signing us up to these ridiculous and poorly constructed European laws, they have signed away our autonomy and our ability to properly run our own shop, in the process numerous bungling incompetent doctors are now free to work on our shores and there appears very little that can be done about it.

Niall Dickson, the new GMC chief, is in full agreement with me on this, he wants the GMC to be given the powers to regulate doctors properly, after all if it can't do that what can it do? The most shocking thing is that the current European system is a lethal farce, Daniel Abani is still able to work in all EU countries other than the UK, he is only struck off here.

'Personal health budgets'

The government's current idea of introducing 'personal health budgets' for patients is one of the barmiest and most stupid that I have ever heard. It can initially sound like a good idea to those who are unaware of the actual implications of such a pile of steaming pig sh*t. The government will talk of 'patient choice' and the efficiency of the market in trying to convince patients and the public that this reform is in their best interests.

In reality it is an utter disaster waiting to happen, here are just a few of the grave problems I can think of at just a drop of a hat. The bureaucracy needed for such a system would be enormous. Not only would one need to work out just how much money each different patient with differing health problems would be given for a set period of time, this in itself would be an imperfect and highly expensive process. Also any mistakes in giving patients funds could lead to some being over funded, thus wasting extra cash, and some being underfunded, what on earth would happen if a patient runs out of cash to pay for their treatment?

The PCTs cannot even organise a piss up in a brewery, so something like this than would challenge the most able would be a complete disaster if handed to the fools at PCTS up and down the country. A system like this would make it impossible to efficiently ration care and services, it would be impossible for public health needs to be planned for and met as the funds would be in the hands of the patients. Another serious problem would be that most patients would have no idea which services to use with their budgets, this would undoubtedly lead to the largest rich private firms with the best advertising doing a lot of smaller providers of better quality services out of business.

Another massive problem with any market based system is one that the pro-marketeers will never admit to being a problem, the fact that for any market to work it has to assume that all the patients/consumers will make fully informed decisions all of the time, a ridiculous assumption at the best of time, this results in the inevitable rigged market in which the big and powerful will always profit. It is impossible for patients to become fully informed, even the most educated and able would struggle, and those most in need of service would be the old and frail, the chances of these patients wanting their budgets is virtually zero and their ability to be adequately informed to make the best choices for themselves is also next to zero. The system would also lead to a very inequitable system as those with budgets may well get treated very differently to those without, the 'two tier' system is a result.

As you can see 'personal health budgets' are a complete and utter disaster waiting to happen. They will be an inefficient and massively expensive way in which to burn yet more money in making a health care system more inequitable and unfair, while making it's quality of service no better, arguably much worse. The motive for this? Well it is rather obvious that this idea is just another way in which the government can introduce more privatisation by stealth.

Interestingly 'patients being given a cash entitlement to buy the services and treatments that they thought best suited their needs' is not allowed under current rules, it depends upon the enactment of the Health Bill 2009, which is due for its second Commons reading on June 8, following debate in the Lords. So it's yet another bit of legislation that is being hurried in via the back door than will allow the government to carry on privatising the NHS. I am sure the big private firms are rubbing their hands with glee, they will soon be able to advertise their services direct to patients and the money will start flowing. Whatever happened to the NHS being a public service, recent reforms have made it look more like a cash cow for various greedy private health care corporations. The planning for the health care needs of the public to be met as efficiently and productively as possible is being replaced by an inefficient bureaucratic monster that throws money to private firms at random.

Inquest shows grave flaws in system

The inquest into the very preventable death of a 70 year old gentleman who was given as massive opiate overdose by a 'dithering' German locum GP is underway. From what I know of the systems that are in place for the registration of EU doctors in the UK I can say that Professor Steve Field's comments are a massive cop out:

"In this case, it appears it was a binary systems failure.....The full abstract was alarming and we requirement to see lessons from that, and I conceive we are doing now."

This cannot just be written off a a 'systems failure'. There are certain parts of the system that are clearly to blame and that have been blatantly failing patients for some time.

It is far too easy for any old doctor from the European Union (EU) to register with the GMC and then work in the UK. Despite the fact that a lot of medical degrees from certain EU countries are not worth the paper they are written on, the GMC is bound by European law to accept them all as being good and proper. Despite the fact the English is spoken very poorly by many EU trained doctors they can still obtain registration with the GMC without any formal testing of their command of the English language.

The government and GMC will try to claim that this 'systems failure' also involved the PCT who are involved in hiring these doctors, however it is clear in my eyes that the buck should stop with the registration of these doctors, and the blame lies squarely at the GMC's door in my opinion.

As a result of the government's short sighted and racist reforms it is very hard for now for non-EU doctors to work in the UK, ironically many doctors from countries such as Australia, New Zealand and India have a much better command of English and a much better training background than a lot of EU doctors. Bizarrely Australians and New Zealanders have to sit an English language test to work in the UK, why on earth the same does not apply to the Germans and the Poles for example, I have no idea.

The EU's free labour market is a shambles. Not only has it led to a lot of racial tension as a result of unemployment pressures and an excessive pressure on state services as a result of rapid uncontrolled population shifts, but it has led to the UK being forced to accept a lot of dodgy foreign qualifications as being good enough when they clearly are not, it has also stopped out own governing bodies from being able to safely regulate certain specialist labour markets such as doctors. Until the GMC sorts its act out and is empowered to be properly able to weed out the incompetent, then preventable deaths like Mr Gray's will continue to happen.

BMJ - the rapid responses

As a result of its large readership the British Medical Journal remains a very important publication. Although one can argue that it may publish some rather politically motivated dross at times, the BMJ still does a pretty decent job at exposing some rather unscrupulous practices in the medical world.

One thing that the BMJ has done which I think has been a bit of a revelation is the idea of allowing the online response of readers to all that they publish, obviously only a small minority of these are reproduced in print; however it has been a good thing in general for allowing the voice of reason to triumph over certain foolish opinions that normally manage to hide so well from any open reasoned criticism.

The Tamiflu scandal was also a very good story with some excellent reader responses, strange how the government and media never really invested any effort in informing the public of this scandalous bit of pharmaceutical misinformation. Recently there have been some excellent responses on the ex-CMO Liam Donaldson and the government's spreading of propaganda about swine flu, I particularly enjoyed this one from Hugh Mann in the US:

"The climatologists and epidemiologists at the Henny Penny institute of pseudo-science have inadvertently performed a public service. Climate-gate and flu-gate have immunized the public against media-spread alarmism."

The responses on the simulation regarding NHS 'commissioning' were also rather poignant, demonstrating some rather glaring flaws in the whole idea behind the simulation and 'commissioning' itself. When I was younger I used to think that if I was unable to understand something it must have been my fault, now I realise that there is another explanation, if something cannot be understood it may well be because that thing is utter nonsense and that no one understands it properly, like NHS 'commissioning'.

Anyway my message is to keep your eye on the BMJ rapid responses. Maybe I'm overly cynical but it appears to me that the BMJ may bury some of the best responses because they are a little close to the bone for some people, that's why I always keep my eye on the online responses.

Lines in the sand drawn by idiots

Apparently the NHS is to be central in the Conservative Party's Manifesto. David Cameron wants to meet 'mothers' needs' and more maternity care reforms are in the pipeline. Childbirth in the 'non-emergency setting' is nothing new and ironically a lot of dangerous rubbish in this policy area has been forced upon unsuspecting mothers by Labour. When it comes to maternity care the biggest problem is a shortage of Obstetric consultants, the public do not need yet more gimmicky rubbish from politicians that pushes woman into giving birth in dangerous locations.

"Health inequalities in 21st century Britain are as wide as they were in Victorian times... We must target resources at the worst-off areas"

This is disingenuous tat from David Cameron. The reality of health inequality is that it cannot be dealt with adequately by a system that runs with an internal market. The commissioning bureaucracy and market structures mean that the most effective central planning that can best deal with health inequality cannot be used. The tried and tested model of using the best evidence as advised by Public Health experts to guide spending has been thrown out in order to allow the NHS to be privatised with the divisive and inefficient internal market. Politicians who back the market but talk of reducing inequality have no shame, they are either liars or just plain stupid. David Cameron and Gordon Brown may be many things, but they are not stupid.