Antibiotics for back pain? Conflicts of interest?

The 'antibiotics for back pain' study has not been out of the headlines this week, certainly the PR campaign that has seen headlines made across the board in the likes of the Guardian and the Mail has been successful.  Really one has to look in depth at the paper and the literature to appreciate just how overly sensationalist and hysterical much of this media reaction has been.

Firstly 3 of the 4 authors are involved with a private company that appears designed to make money out of patients and clinicians in diagnosing and treating back pain with antibiotics.  Indeed these 3 authors are all MAST 'Academy' members.  The first major problem I have with their study is the fact that they declared to the journal that they had 'no competing interests'.  This appears dubious at best.  It is also dodgy that Peter Hamlyn, a surgeon from London who is also a member of this 'Academy', is quoted in the papers saying some very positive stuff without any hint that he may also have a rather glaring conflict of interest:

"More work needs to be done but make no mistake, this is a turning  point, a point where we will have to re-write the textbooks.....It is the stuff of Nobel prizes."

The 'MAST medical' concept appears rather dubious in itself.  Patients with Modic changes are encouraged to pay money to have their MRI scans interpreted, while clinicians are encouraged to become 'MAST certified' so that they can treat patients with Modic changes!  Why on earth an experienced clinician needs accreditation by 'MAST Medical' before treating a patient with antibiotics is beyond me, this just appears a cheap money making stunt.  It would be interesting to know just what the authors' exact financial interests are relating to MAST Medical.

There are also some rather significant problems with the study itself.  The bacteria attributed to be the cause of so many patients' back pain has been researched for many years, in fact since being reported as a cause of back pain in 2001 in the Lancet, Proprionobacterium Acnes (P Acnes) has been linked with other problems including shoulder arthritis.  The problem with this bug is that is is notoriously hard to grow in the laboratory, it is of unknown pathological significance and many groups have failed to replicate much of the P Acnes research.

The biggest flaw I have seen in the research is that about 50% of the patients treated with antibiotics had had previous spinal surgery, so it is highly possible that the benefits of antibiotics only apply to patients who have had previous surgery, so the way the study has been reported in the media is highly misleading.  P Acnes seems likely to be a bug that is only problematic after medical intervention like injections or surgery, there simply isn't any good evidence out there that it is likely to be a cause of back pain in the 'virgin' or 'intervention naive' back.

Overall this all just reminds me a bit of the MMR scare, but it is obviously the reverse of a scare.  The problem is that the way the study has been written, reported and spun out of context mean that many patients are going to be extremely let down when they realise what the reality of this study actually is.  A majority of the authors have significant conflicts of interests which they failed to declare, the benefits of antibiotics may only apply to patients who have had previous injections or surgery, and more research is badly needed to confirm this work with a more rigorously defined group of patients taking part.  Sadly the reality of the research wouldn't make any headlines and it certainly wouldn't have attracted as much attention for 'MAST Medical'.

The GMC on Francis - not clear

Following up on my synopsis of the implications of the Francis report, here is the GMC's response to the key recommendations relating to medical training:

" 155. The General Medical Council should set out a standard requirement for routine visits to each local
education provider

GMC - We are committed to a thorough and consistent inspection regime and we are addressing all of the issues raised in points a-d of this recommendation in our review of quality assurance in education.

161. Training visits should make an important contribution to the protection of patients.

a. Obtaining information directly from trainees should remain a valuable source of information – but it should not be the only method used.
b. Visits to, and observation of, the actual training environment would enable visitors to detect poor practice from which both patients and trainees should be sheltered.
c. The opportunity can be taken to share and disseminate good practice with trainers and management.
Visits of this nature will encourage the transparency that is so vital to the preservation of minimum standards.

GMC - We agree that visits/inspections are an important tool for assuring high quality training and protection of patients, and they form a major part of our existing quality assurance programme. The education QA review is looking at how we can strengthen the role of visits/inspections and at how we report on them. In the meantime, from the summer of 2013, where we have validated any concern about an educational setting we will publish that information on our website."

I am slightly concerned by the GMC's comments for several reasons. Firstly they have not stated that they will reinstated routine training visits to all local providers as Francis has recommended. Secondly they refer to their 'education QA' in their answer to both key Francis recommendations, as if their review is the ultimate truth and that this may overrule Francis.  Thirdly in their answer to 161, they state that visits form a 'major part' of the current system, this is worrying as it is exactly this system that failed at Stafford and that will fail again unless the GMC comes out of its state of denial.

Perhaps I am just paranoid, maybe, but I am deeply concerned that the GMC is going to ignore the key piece of advice from Francis, that being the reinstatement of routine workplace visits for all providers of medical training.  We need to hold the GMC to account on this, perhaps they will take it all on board and I will be proven to be a paranoid fool, but perhaps not, and if so we need to have anticipated this fact.

The Francis report and what it should mean for medical training - part 3

Now to part 3, in parts 1 and 2 I have highlighted Francis' key observations relating to training, that being the failing regulatory system.  The key recommendation is that routine visits to all local providers should be reinstated:

"The General Medical Council should set out a standard requirement for routine visits to each local education provider, and programme in accordance with the following principles:

- The Postgraduate Dean should be responsible for managing the process at the level of the Local Educational Training Board, as part of overall deanery functions.

- The Royal Colleges should be enlisted to support such visits and to provide the relevant specialist expertise

where required.

- There should be lay or patient representation on visits to ensure that patient interests are maintained as the

priority.

- Such visits should be informed by all other sources of information and, if relevant, coordinated with the work of the Care Quality Commission and other forms of review."

Francis also makes it clear that the DH must support this process and that the system must take these routine regulatory visits into account:

"- The Department of Health should provide appropriate resources to ensure that an effective programme of monitoring training by visits can be carried out.  All healthcare organisations must be required to release healthcare professionals to support the visits programme. It should also be recognised that the benefits in professional development and dissemination of good practice are of significant value.

- The system for approving and accrediting training placement providers and programmes should be configured to apply the principles set out above."

Francis also mentions that the role of routine visits in terms of patients safety:

"Training visits should make an important contribution to the protection of patients:

- Obtaining information directly from trainees should remain a valuable source of information – but it should not be the only method used.

- Visits to, and observation of, the actual training environment would enable visitors to detect poor practice from which both patients and trainees should be sheltered.

- The opportunity can be taken to share and disseminate good practice with trainers and management.

Visits of this nature will encourage the transparency that is so vital to the preservation of minimum standards."

Francis also adds that LETBS should have a medically qualified postgraduate dean:

"All Local Education and Training Boards should have a post of medically qualified postgraduate dean responsible for all aspects of postgraduate medical education."

Overall Francis' recommendations are good.  Routine regulatory visits have needed reinstating for some time.  It is utterly vital that the Colleges have a prominent role in this new regulatory structure.  The concern I have concerns the role of visits in terms of patients safety.  Of course if trainees mention things relating to concerns for patient safety then there must be mechanisms in place for ensuring that these are dealt with appropriately. However it is important that visits are primarily about training quality and training problems.

It is also vital that those  who are entrusted to take part in these visits are trusted by trainees and are properly independent.  I sorely hope the government act on these recommendations and do not ignore them as they did with John Tooke's excellent report.  It is a little worrying that there is no mention of medical training in the government's initial response to Francis.

The Francis report and what it should mean for medical training- part 2

Here is my part 2. The first chunk is extremely significant, it highlights the gross failings of the current regulatory system.  PMETB, the GMC and the Deaneries are all mentioned, it is made abundantly clear that the system was superficial and that it was not properly looking at training experience on the ground. Francis reiterates much of what I have already said in a BMJ Careers article, the system is toothless and ineffective:

" Deanery/universities

1.84 The system of regulation and oversight of medical training and education in place between

2005 and 2009 failed to detect any concerns about the Trust other than matters regarded as

of no exceptional significance. There were a number of factors contributing to this:

-While patient safety was theoretically given primacy in the system, the domain to be monitored was unduly limited to the potential risk posed to patients by the trainee.

-Insufficient consideration was given to the relevance of good quality training of practice in a setting which complied with minimum patient safety and quality standards, and to the professional obligation to protect patients from harm.

- The Postgraduate Medical Education and Training Board (PMETB)/GMC/deanery wide reviews focused on deanery systems of quality management, resulting in only superficial examination of the standards being observed. Such reviews did not consistently consider compliance with patient safety standards.

- When concerns were raised about inappropriate pressure or bullying by staff towards trainees these were not followed up or investigated.

- Systematic communication of indications of serious concern, such as the HCC investigation, was almost completely lacking between the regulators, and between them and the deanery.

- A reluctance to prejudice the provision of a service or the training of trainees has resulted in the implied threat of removal of approval for providing training places being largely theoretical."

The next two  paragraphs make the obvious but necessary point that training cannot be allowed to take place in clinical areas in which patient safety is not adequate:

"1.85 While requirements for remedial action must be proportionate, training should not be allowed to take place in an environment where patient safety is not being adequately protected. Perceived difficult consequences should never be permitted to hinder steps required to protect patients, and the oversight of medical training should not condone or support unacceptable practice. As elsewhere in the system, a sense of urgency may have been lacking, even after the scale of the deficiencies at the Trust had become apparent.

Medical training and education

1.172 Medical education and training systems provide an opportunity for enhancing patient safety. Students and trainees should not be placed in establishments which do not comply with the fundamental standards, and those charged with overseeing and regulating these activities should, like all other participants in the system, make the protection of patients their priority. A number of recommendations for this purpose have been made."

Overall these sections I have highlighted sum up all that is wrong with medical training as things currently stand.  The regulation of quality is poor and as a result it is far too easy for trainees to be put into dangerous clinical environments.  Francis hits the nail on the head in my opinion.  Part 3 is still to come.

The Francis Report and what it should mean for medical training -part 1

Obviously the problems at Stafford are complex and I have no hope of summarising everything in one.  For my first stab I go back to the first report by Francis in 2009, it is interesting to go back this far as some of the key messages and themes recurred in 2013's report.  Here is recommendation 4 from 2009:

"Recommendation 4: The Trust, in conjunction with the Royal Colleges, the Deanery and the nursing school at Staffordshire University, should review its training programmes for all staff to ensure that high-quality professional training and development is provided at all levels and that high-quality service is 

recognised and valued. "

Then one sifts through the lengthy document and finds some rather key comments concerning the regulation of training:


"72. I received a set of comments about the lack of any system requiring regular monitoring or approval visits by the various clinical Royal Colleges or the general medical and nursing councils.
73. In a letter to the Inquiry the Royal College of Obstetricians and Gynaecologists said that it had had no involvement in the Trust since its visit in 2002. Responsibility for visiting and approving hospitals for training passed in 2006 to the Postgraduate Medical Education Training Board.
74. In another letter, the Royal College of Physicians referred to representations it had made to the Health Select Committee about the loss of regular visits to trusts in the early 2000s.  These were linked to medical training but “were a valuable source of intelligence about clinical issues locally”. The letter also said that “[the] Royal Colleges’ professional networks are invaluable” in cases falling between those resolved locally and those that are reported to regulators.
75. Royal Colleges do continue to operate an invited review system. The Royal College of Surgeons conducted reviews at the Trust in 2007 and 2009. "

I don't want to force opinions into your heads, just read through the above and consider things for a moment.  I shall be back with Part 2.

Calling all BMA members on GMC social media guidance

The BMA are keen for all members to email them with any concerns they may have over the GMC's social media guidance.  I have written an email summarising my concerns and it is below. Feel free to use the letter yourself, or do email me at bendean1979@gmail.com if you are a BMA member and you want me to add your name to the letter, obviously email me your BMA membership number with your name!

"Dear BMA

I am writing to you regarding several concerns I have about the GMC's social media guidance:

1. "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

This piece of guidance appears to contravene the Human Rights Act, article 8, which entitles doctors with the right to a private life.  'Any material written' could refer to political opinion, sporting opinion or even gardening.  Surely every doctor should have the right to anonymity in the social media unless they are giving out clinical advice to individual patients.  This needs further clarification and if the GMC state that this applies to all material written, then legal advice must be sought and the guidance challenged, as it appears in breach of the Human Rights Act.

2. "You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession."

This piece of guidance is incredibly vague.  It is again arguable that doctors, when discussing non-clinical matters in their private time on the social media, have every right to behave in any way that they choose, providing that this is within the law.  It is arguable that this contravenes the Human Rights Act, article 8, again.

3. "Good medical practice says that doctors must treat colleagues fairly and with respect.  This covers all situations and all forms of interaction and communication.You must not bully, harass or make gratuitous, unsubstantiated or unsustainable comments about individuals online"

This piece of guidance is extremely vague and needs further clarification.  What is a 'colleague'? Most people would define a colleague as someone they have had direct contact with at work (face to face or by telephone for example).  If 'colleague' refers to any doctor on the GMC register then this piece of guidance has truly bizarre implications.  It may mean that criticising a politician who is a doctor may be something that the GMC could investigate and punish.  Again, surely doctors should be able to behave as they see fit in their private time when discussing non-clinical matters in the social media.  There is again an argument that this contravenes the Human Rights Act by interfering with the right of doctors to a private life. 

Yours Sincerely"

Stop Cameron selling of the NHS!

Unfortunately our political system is bent and this means that all our major political parties are very happy to ignore the well being of the public in order to keep a few rich elite party donors happy.  The endless privatisation of our public services is a great example of this, there is no evidence that it will be of any benefit to the public, rather the opposite in fact.  However the major parties have all been complicit in the privatisation of several of our key public services.

The NHS is just one of many chunks of the public sector that our corrupt government is intent on selling off.  They want to drive the NHS into the ground in order to catalyse its takeover by numerous huge multinational health care corporations.  Billions have been wasted doing this and the new system will be far less efficient due to a burgeoning bureaucracy that is needed to enforce the corrupt privatisation process.  International trade agreements are a key part of this antidemocratic process that works against the best interests of the general public.

The sad fact is that the political parties are largely funded by rich elite businessmen in whose interests it is to sell of vital public services such as the NHS.  The corporations owned by this rich elite will destroy the NHS and cut services in order to increase their profits, as soon as they have got their foot hold in the system.  The only hope we have of stopping this process is by putting pressure on David Cameron to exempt the NHS from the US/EU free trade agreement that is to be discussed later this year.  So please click on this E-Petition and sign on, every little helps!  The politicians should be the pawns of the public and not the evil weapons of elite billionaire businessmen.

The GMC on doctors and the social media

The GMC's guidance on doctors' use of the social media has attracted much comment and for very good reason. I would firstly urge anyone to actually read the GMC's full guidance before commenting, I have done and here is my two pence worth.

Firstly I think guidance has to be clear to be interpretable or meaningful, and this is one area in which the GMC's guidance badly falls down.  There are numerous elements to their guidance which are poorly defined and consequently extremely vague in terms of meaning.  When treating 'colleagues' fairly and with respect, what is a 'colleague'?  Most people would see a ‘colleague’ as someone one has come into direct face to face or telephone contact with in the workplace about a clinical matter, not a random person encountered on the web about a non clinical matter.  Also 'fairly and with respect', what does this mean?  The social media sees numerous very different people interact, people are routinely offended, often unintentionally, and this is a huge can of worms in itself.  Here is another massive vaguery:

"You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession."

This is so vague and so incredibly subject to the interpretation.  Why on earth should a doctor's conduct in their private life, as long as it is within the law, have to be any different to that of a general member of the public?  Personally I think the GMC's guidance in this regard rides roughshod over the Human Rights Act, which clearly states that all of us have a right to a private life.  Conduct in the workplace is different, but this is contact in the private lives of doctors that the GMC is referring to, and do they have any right to offer this guidance?  I think not.  It is akin to regulating how we behave on the sports field, with our children or at a social event.  Arguably the most contentious piece of guidance refers to 'confidentiality':

"If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

This piece of guidance is based on foundations of sand.  For one thing it is rather insulting that the GMC assumes that the general public are so stupid that they take everything said by a doctor as being the complete truth, this borders on the nonsensical for me.  It is also ludicrous to assume that the views of one individual doctor will be taken to represent the views of the profession.  Also how does being named help with these stated problems?  It doesn’t and it shows that the GMC may well be hiding the real, potentially more sinister, motives for clamping down on our anonymous use of the social media.

Overall I am deeply unimpressed with the GMC's guidance.  I took the choice a long time ago that I would not be anonymous in the social media, however I can appreciate that for many people this is not possible, for example it is impossible for psychiatrists given their job, it is also impossible for those who are effectively whistle blowing online, there are many other good examples of where doctors must keep their anonymity online or risk serious physical harm to them or their families.  The GMC's logic for doctors having to name themselves in the social media is weak and arguably incoherent.  Most seriously the GMC appears to be paying scant regard for the rights of doctors to have a private life that is free from the interference of government or regulatory bodies, as laid out in the Human Rights Act, and this kind of disdain for the rights of doctors shows the GMC up in a very bad light indeed.  I am very deeply unimpressed. 

ps I would also urge everyone to sign this petition which urges the Department of Health to rethink this invasion into the private lives of health care staff

The friends/family test is moronic rubbish

"From April 2013 all patients will be asked a simple question to identify if they would recommend a particular A&E department or ward to their friends and family. The results of the test will be used to improve the experience of patients by providing timely feedback alongside other sources of patient feedback. It will highlight priority areas for action."

For any of you who didn't know already, the government, in its infinite wisdom, has decided to bring in a new test, the 'friends and family' (FF) test.  One would think that if lots of money were to be spent on introducing a new test like this, it would have been well tested, validated and confirmed to be of meaning in health care.  One would think that, but with the government this is often not the case, it appears that these kind of hare brained ideas are plucked from the back side of some uneducated inexpert 'special' adviser and then forced on hospitals up and down the country, without even the glance of an expert, without even a thought that this may not be a great idea.  

Sadly for us, as tax paying members of the public, the FF test is a complete waste of our money, unless Jeremy Hunt knows something that the academic experts do not know, something I think is rather unlikely, I have seen insects with more intelligence than the insincere smug Hunt.  This is taken from a recent article in the New England Journal of Medicine:

" Limiting patient-experience measurement to a single dimension may exclude the interactions that most strongly affect experiences and outcomes. This fact alone could explain why many studies show no relation between outcomes and patient experiences."

Patient surveys to measure satisfaction are excellent tools to measure various aspects of their care, there is no doubt of this, the problem is that there are certain things one must do for one's questions to lead to meaningful answers and the FF test simply fails to do these.

The FF test is one general, vague and therefore meaningless, and useless way of gathering information about the quality of health care received by patients.  It is not focused on specific aspects of the care, it is therefore likely to result in answers that are of no meaning at all, as the answers will be skewed by so many things that may or may not be of any relevance at all.  The FF test is also unvalidated in health care, it has been plucked from business and just thrown into the NHS without any testing in this context.

So the end result of all this is that a lot of completely meaningless data will be gathered and analysed to give a lot of meaningless results, and a lot of our money will have been wasted in the process.  Sadly rather than consult any of the UK's academic experts in patient satisfaction, the Department of Health has acted on the whim of an idiot or idiots.  Typical lazy slack jawed work, how very depressing.

Stafford is the result of failing government policy

The Francis report has been in the headlines for much of this week and everyone has had their opinion as to what precisely went wrong.  Certainly blaming one part of the system on its own is not sensible, many things have to fail for things to go as badly wrong as they did in Stafford.  The health care system is a very complex beast, a bit like a human body in some ways, and for something to be painful, one not only needs problems with the peripheral tissue, but one also needs pain to be signalled up to the spinal cord and then to the brain.

Many hospitals provide a very good standard of care, in fact I would say a large majority of NHS hospitals are in this category, however to pin this success on the government and the Department of Health's door is completely wrong in my opinion.  Many of the successes of the NHS are despite the terrible top down style of management led by our 'esteemed' politicians and civil servants/'special' advisers in the DH.  It is only in this context that one can understand the gross failings of certain hospitals like Stafford.

The biggest factor in Stafford's failings was the terrible autocratic top down management system that exists in the NHS.  This is led by our politicians who are closely allied with the bullies in the DH, they then feed down to the SHAs, who then enforce things in the hospitals.  This top down bullying style is in place because successive corrupt governments have only been able to push through their awful damaging privatising reforms by force.  The front line staff and the good managers care for quality and for patients, the government and the  politicians do not, they care only for themselves.  The corrupt policy being pushed through, the current example being Lansley's deadly reforms, has to be bullied through, as it is fundamentally antidemocratic and corrupt by its very nature.

Essentially our corrupt political system has led to a top down bullying system of NHS management, the so called 'command and control' model.  All three major parties are behind the current privatisation of the NHS, against the democratic will of the electorate, and all three parties are partly to blame for this terrible dysfunctional style of abusive management.  The 'command and control' style comes with top down targets left, right and centre.  One must obey or be sacked, whether a manager or clinician, the whistle blowers are gagged and buried.

The NHS has become overly bureaucratic and less efficient in the process, leaving a dysfunctional half privatised shambles in places, the simple efficient NHS that existed before the market came is no more.  The market has failed, yet the government continues to bully it through, the privatisation has failed, yet they persist in forcing it on us, the recurrent theme is obvious, unpopular antidemocratic policy has to be introduced by nasty force and nasty tactics.

The cure is obvious but incredibly unlikely given our stinking political system, he market must go, the NHS must be publicly funded and 100% publicly provided, we need local autonomy, we need the front line engaged, we need a functional bottom up system.  The problem is there is zero chance of this happening with Hunt and Cameron in power, the private sector know all they need do is throw a few pounds their way and these corrupt Tories will oblige, they will bully through more harmful disasters on the NHS like the corrupt Labour government that did the same before them.

The failings of medical training

The 'new and exciting' broad based training program is a sad indictment of the rushed reform of UK medical training that has taken place in the form of Modernising Medical Careers (MMC).  The fact that such a program is needed says more about the lack of consistent training value of many Foundation Year jobs than anything else, with the lack of a proper robust regulatory process overseeing medical training being a key factor in this failure.  There are also several significant flaws in this broad based program, including the obvious potential for a lack of medical experience for those wishing to pursue a career in hospital medicine.  

Key elements of MMC continue to be jettisoned in the dustbin; these include run through training in several specialities including Orthopaedics, the misuse of minimally validated workplace based assessments and shortened GP training.  It is just a great shame that the robustly regulated PRHO year of six months medicine and six months surgery cannot be resurrected.  What medical training really needs is the proper robust regulation of all training posts, not the reinvention of wheels.

Dear Dr Dan Poulter

In your most recent piece of spin you bravely claim Pete Deveson's New Statesman article is "factually inaccurate" but fail to explain why this is so?  Interestingly you also fail to answer any of Pete's simple 3 questions.  

It seems Dr Dan has been compelled into a response:

"Although in theory, until the full introduction of the EWTD, the maximum number of hours a doctor could work in a single week was 91 hours (7 consecutive 13 hour shifts). The process of ensuring proper continuity of patient care through patient handovers to colleagues and being present on the morning consultant-led ward rounds for handing over patients admitted overnight meant that the reality for doctors like me, in some specialities was a working rota pattern involving regular 100 hour weeks.

A typical obstetrics and gynaecology rota (as it appeared on the official rota) which I performed as a doctor as recently as 2009 was; 12 days of consecutive day shifts (including 7 days of 11.5 hour on call shifts) followed by two days off, followed by 12 further consecutive day shifts (including 7 days of 11.5 hour on call shifts), followed by 2 days off, followed by 7 consecutive 13 hour night shifts, followed by 6 days of compulsory rest and a week of training/annual leave (then working pattern repeats in a cyclical nature).

This was a gruelling and tough medical work rota by anybody’s standards, notwithstanding the fact that patient handover meetings and required attendance on post admission patient ward rounds were not ‘counted’ as officially timetabled hours on the rota. The demands of ensuring proper patient care and continuity of care, required junior doctors, like me, to work 100 hour weeks as recently as 2009."

Dr Dan is digging himself into a hole in my opinion. His claims of regular 100 hour weeks are based on a slightly dubious use of the word 'regular' and some rather interesting hand overs.

Interestingly Dr Dan also probably worked regular zero hour weeks if we take his argument to its logical conclusions. Strange he didn't spin this line in Parliament.

At best Dr Dan has been caught engaging in some blatant spin that is arguably highly disingenuous. Dishonest? Well, we simply don't have the facts to make this judgement but it wouldn't surprise me knowing most Tory politicians.

A successful day of Industrial Action

Despite certain biased media outlets including the BBC/Telegraph/Mail et al deliberately seeking negative views on our industrial action and despite the constant stream of dishonest propaganda from the Department of Health press office, I think today has shown anyone around a GP surgery or a hospital that there is a fair bit of support for doctors in our battle against the lying dictators in government.

A majority of our fellow workers and many patients were very much behind our decision to stage this day of protest and personally speaking, I was heartened by what many people had to say.  Of course there were a few people who did not agree with us, however this was inevitable and these people are entitled to their opinion, even if some of them were more motivated by petty jealousy than anything logical.

If this battle is to be won then we need to dig ourselves in, it will take repeated days of protest to make this corrupt regime listen to our calls for fairness and negotiation, not yet more unilateral arrogant dictation.  Well done to all the doctors and all those who supported us, for doing things in such a sensible and caring manner.  

Also please make the effort to sign this E-petition that calls for Lansley et al to pay the same % that doctors are being asked to pay.

Doctor pensions - stick it to Lansley!

Whatever you think of doctors, if you believe in fairness then you should sign this E-petition.  Doctors do not expect special treatment, all they want is fairness, and the fact that government are unilaterally forcing doctors to pay far greater percentages of their income into their pensions than other workers in the public sector is grossly unfair, there is no credible argument against this I'm afraid.

Unfortunately large sections of the media have swallowed up a lot of Lansley and the DoH's lies.  Well, if Lansley and the DoH think doctors should be forced to pay 14.5% of their incomes into their pensions, then Lansley and his DoH cronies should also pay the same amount.  Currently MPs like Lansley, civil servants like those at the DoH, teachers, judges and many other public sector workers pay nowhere near the 14.5% that is being unfairly forced on doctors.

Please sign the E-Petition, post it on Twitter and Facebook, let's help force Lansley and his cronies to pay the same as doctors, let's see if they are happy to eat their own pudding.  I doubt it.

Dear Joe Public - the doctor strike facts

There will be a lot of disingenuous and dishonest information spread by the government and various biased sections of the media in the forthcoming weeks ahead, and it is vital that you, the public, are informed of the facts so that they can make up their own minds as to whether a strike is justified.  Just remember that this is the same media that is being shown to be rather free of honesty and morals in the Leveson inquiry.

First and foremost a strike is completely safe and ethical, any strike will not involve emergency services, it will only affect anything that is non-emergency, in fact ironically emergency patients may well get better care than normal during a strike as all elective work will be cancelled.

Secondly there are several key facts that you will not hear in certain sections of the media, certain journalists and newspapers have massive vested interests, they cannot be trusted with their propaganda.  The facts that no one from the government can deny are as follows:

1. Our pension fund is in surplus of about 2 BILLION pounds per year.  It is sustainable and it is simply being raided by government to subsidise losses and deficits elsewhere.

2. Doctors have had numerous pay cuts and freezes over the last 20 years or so, compared to their peers from equivalent backgrounds and levels of education, doctors earn significantly less money over their careers.

3. Doctors agreed a new pension deal in 2008 which the government wants to tear up, this already increased contributions hugely, the new proposals which have already been enacted involve doubling the current contributions.

4.  Strangely the pension contributions of politicians and civil servants are not being plundered in the same manner, I wonder why this could be?  Surely the whole public sector should be treated in the same manner and doctors, who already pay a good chunk of their salaries, should not be selectively robbed.

I am biased, I will not deny this but a line in the sand needs to be drawn now and a strike is utterly essential for numerous very solid reasons.  The government is privatising the NHS as we speak and they have no democratic mandate for this.  They now want to steal money from the pension funds of doctors to pay for their errors, of note from pension funds that are accruing about 2 billion pounds of surplus cash per year.

We, doctors, need the public's support and we need you to ignore the dishonest bile that will be thrown in your direction from the likes of the Daily Mail and the BBC.  The vast majority of doctors feel this way.  I love being a doctor, however I am relatively poorly paid in comparison to most of my peer group who did not go into medicine, and all I ask is that our reasonable pensions are not plundered by the incompetent and dishonest fools in government who will tell you numerous porkies in order to make you think that I am greedy or selfish.  This is not the case, I just don't want the government to steal from my pension fund to pay for their negligence and incompetence.  Thanks for listening.

Risk-free profits for the vultures begin

This excellent article from Allyson Pollock sums up the disaster that Lansley's terrible NHS reforms are.  It is clear that the market is fake and that many private sector vultures are set to make massive profits at the expense of the tax payer.  It is an utter scandal.

There is no accountability or transparency, meaning that the market is a sham, there is no real competition.  This Bill has been created with the help of the private sector for the private sector, the conflicts of interest are a disgrace.  This is the Lansley and Cameron's idea of open accountable democracy:

"The public cannot make a fully informed judgement about the contract, because both the Treasury and Department of Health have refused to release key information, despite repeated requests under the Freedom of Information Act. "

Pollock sums it all far better than I can:

"The speed at which contracts have been let and the lack of public consultation inevitably seeds suspicions of corruption; but it is politicians who have seriously misled the public over the NHS.......The current lack of disclosure is a public scandal."

It is good to see the current corrupt government paying for their sins in the local elections, the problem is Labour are not much better, the real disgrace is that our democracy is but a sham, voters have no real choice and this will result in reducing voter turnout in elections, increased apathy and a rise in the extremist far right vote.  Thanks Cameron and Clegg, you are a disgrace to this country.

Dr No - nail on head? Can of worms exploding

I stumbled upon this excellent piece by Dr No on the proposals for extra years of training for GPs, I have to agree with Dr No, I do not trust the Royal College of GPs and suspect some cynical motives may be at play:

"There are of course those who see the extension of training as a cynical ploy by the general practice establishment to extend the pool of sub-GPs (and so cheap GPs) available for exploitation by the establishment. While this may indeed happen as an unwelcome side-effect, Dr No suspects the primary motive of those who wish to extend GP training is to enhance professional standing and status, and so distance the profession from its trade roots; and in this objective, Dr No believes the College proposals will fail."

I am not sure Dr No is right on this, however in the comments it is abundantly clear that there are major problems with medical training that continue to be ignored by the powers that be.

Medical training has been taken over by educationalists in Ivory towers, many of whom reside at the GMC, the focus is now barmy, it is all about paperwork and reflective practise.

There is no decent regulation of training.  There is no focus on hours and experience.  It is a joke.

The problem is that this situation is getting worse, there is a huge disconnect between those involved in training on the ground and those in the Ivory towers who are telling them what to do.  A key part of John Tooke's review talked about this disconnect and the lack of involvement of those on the ground in running training.

The GMC is not democratic, the Royal Colleges are not democratic, the BMA is not democratic, and all this combines to result in the continued disastrous reform of training.  It is nothing but a shambles.

Andrew Lansley - popular compared to Hitler

So the antidemocratic farce that is Andrew Lansley's 'Health Bill' has not yet been scrapped.  Today the deeply unpopular and arrogant health minister needed a police escort to visit an NHS hospital.  This really should tell the government and Lansley himself that things have gone far enough, if these cretins cared one iota for democracy they would have chucked Lansley's  deranged manifesto of privatisation firmly in their privatised dustbin.

If the NHS Bill does end up going through it will only prove just what a complete lack of democracy we now have in this country.  The wealthy people in power can push through terrible legislation that shafts the average man on the street but furthers their own selfish interests, it is such a sad indictment of the state in which we live.  Lansley need a police escort and a media blackout, yet even with this his every move is still a PR disaster, such is the idiocy of his Bill.

I hold out a lot of hope that Lansley's toilet roll will be flushed down the bog where it belongs.  The momentum appears to continue to gather, the Royal Colleges look close to full blown opposition, the public are getting angrier and some of the media are taking more notice.  It is just a great shame that so much of the mainstream media is so unable to call a spade a spade, there is too much corrupt conflict of interest around for the truth to be broadcast far and wide as it should be, even so lying Lansley has been found out, we all know that his bill is a dishonest piece of privatising filth designed for one thing, making the rich richer and the poor less healthy in the process.

Lansley on the run - write to your President now!

Lansley's disastrous Bill appears to drifting towards the rocks, the BMA, RCN, RCM, Unison and Unite already oppose the Bill.  The Colleges are not covering themselves in glory with their failure to oppose the Bill.

Now is the time for them to stand up, be counted and represent their members and the people of this country by openly stating their opposition to this destructive and incoherent Bill of idiocy.

It will not take long to email the Acadamy of the Medical Royal Colleges and your specific Royal College President to pressure them into opposing the Bill, so get emailing and do it now:

Everyone:(AOMRC) academy@aomrc.org.uk

Medics:     enquiries@rcplondon.ac.uk

Surgeons:   president@rcseng.ac.uk

GPs:        president@rcgp.org.uk

Anaesthetists: president@rcoa.ac.uk

Psychiatrists: cchurchill@rcpsych.ac.uk

Here is a brief letter template:

"Dear President

I am writing this email to complain about your abject failure to oppose Andrew Lansley's Health and Social Care Bill.

If you fail to publicly oppose this Bill then I feel you are failing your members, your patients and yourself.

Yours."

Lansleys lies some more

So Lansley is now claiming that nurses' and doctors' unions are opposing the health bill because of pay and pensions, what an illogical and incoherent view from this cockroach of a man.

The pension reform is part of the package that is the whole scale privatisation of the NHS, the white paper and the pension reform are all part of this antidemocratic privatisation campaign.  The pension looting is a quite deliberate part of this privatisation, as private firms will not take staff on if they have decent pensions.

We are against the NHS and what is stands for being destroyed, we are against patient care going down the toilet, and privatisation will do both of these things, and this privatisation is being catalysed by the white paper and the pension reform.

If a doctor had lied and lied in order to privatise the NHS in such fashion there would be a good case to strike them off for their rank dishonestly and lack of integrity.  Sadly this kind of malignant weasel-like behaviour has become standard for all politicians of all three major parties who have joined in the NHS privatisation in recent years.

The public do not want it, doctors do not want it, nurses do not want it, only Lansley and a few rich people with vested interests want the NHS sold off and it is quite disgraceful.  While Bevan is remembered fondly, Lansley will be remembered in quite the opposite manner and this will be thoroughly deserved. 

Quackery of the lowest form possible - exploiting dying cancer patients

Exploiting those who are dying of cancer for their very last pennies is one of the most contemptible and disgraceful things humanly possible, yet it does not appear to be stopping some 'cancer experts'. The story is of a poor chap with end stage metastatic lung cancer:

"The first of these people is the proprietor of Cancer Options. Cancer Options is a private consultancy offering advice to cancer patients. It is run by Patricia Peat who is a qualified nurse. My dad went to see her and she told him the good news, if he followed her advice he could be tumour free in 3 to 4 years. She advised him to have intravenous vitamin c, to have oxygen therapy, heat therapy and to take a myriad of supplements."

Words fail me. This poor man has been sucked in by this dishonest quackery, he has spent thousands of pounds on unproven nonsense in the vain hope of extending his life, he and his family have been lied to and deceived. I am disgusted and appalled the more I read of the nonsense peddled by these malignant charlatans. High Vitamin C does not prolong life in cancer patients, don't let any quacks tell you otherwise.

The 'cancer experts' at the heart of this scam are nurse Patricia Peat (registered nurse and Dr (not medical) Chris Etheridge. They work together at Cancer Options which they call 'private, cancer consultancy where you can obtain consultancy, research and coaching for all the different cancer treatments and therapies."

Cancer Options, as well as all of Ethergidge's other schemes including Integrated Cancer Healthcare, bear all the classic hallmarks of first class quackery. Firstly neither is a medical doctor, one is a nurse and the other has no medical training at all. Secondly they are clever in the way they have worded their scam, it is all about 'supplementing' and 'complementing' traditional treatments with their integrated hogwash.

The emphasis is on 'herbal remedies', 'diet', 'holistic therapy', 'detoxification', 'supportive regimes', 'natural complementary treatments' and on and on. It is expensive rubbish that will provide no benefit to cancer patients. These first class charlatans are exploiting the sick to make a handsome living, they are beneath contempt.

Spare a thought for the poor man with lung cancer and his family, he has been taken for a ride when at his weakest, he has trusted these Charlatans because no honest individual would pretend he can be cured. This all goes to show just how pathetic the government's regulation of 'complementary' medicine is, no medically qualified practitioner would escape the GMC's wrath for such unethical, immoral and disgraceful practice. It appears routine for companies and quacks to make false claims about their 'alternative' quackery, and nothing is done, the regulation of this dodgy industry is so very limp.

Beware of Charlatans like Peat and Etheridge, if a type of 'medicine' is described as 'complimentary' or 'alternative', then there is a reason for this, it is because there is no decent evidence that it works. One would be better off saving one's money, eating a few leaves from one's garden and keeping well away from this deplorable quackery.

Bevan's run - Save the NHS from Lansley!

The government's health bill is an absolute disaster waiting to happen, of course it is not anything completely new, it is a continuation of the destructive market based reforms that have been going since the days of Maggie Thatcher.  Having said that though, Lansley's terrible paper is a rather rapid turn along this road of doom.

The media haven't really explained things properly to the public.  The reality of the bill is that it is a fast track towards a privatised NHS in which the tax payer merely pays private firms for health care.  This has simply not been explained to the public.  Part of the problem has been Lansley's lack of honesty and part of it has been the media's lack of objective analysis for whatever reasons.

Two people who have always said things exactly how it is are Allyson Pollock and Clive Peedell.  I would strongly advise popping past the former's site and reading some of her fantastic analysis of Lansley's dog's dinner.  The latter has been working and campaigning harder than anyone, in fact he is organising a protest run, called Bevan's run:

"January 10-15th, 2012. 160 miles in 6 days from Aneurin Bevan's Statue in Cardiff to the Department of Health, Richmond House, Whitehall, London. To protest against the Health and Social Care Bill and NHS privatisation. Calling at Witney (David Cameron's constituency). Follow me on Twitter @cpeedell and #bevansrun."

Bravo Dr Peedell.  If only the BMA had such fight and guts, we would not be in such a mess.  I would strongly recommend than anyone who cares about the NHS pays Dr Peedell's blog a visit and considers joining him for a part of his protest run.  If everyone thought and acted like Dr Peedell then the likes of Lansley would never get their malignant bills through Parliament.  I would urge everyone to think about getting involved in Bevan's run and at a minimum, forwarding on this information to their friends and colleagues.

Do we really want to tell our children that as Lansley stood next to the NHS with his box of matches and can of petrol, that we stood idly by and did nothing? 

The NHS is in utter crisis - Trauma disaster

The way trauma care is handled in the UK is in the process of being centralised.  This means that a small number of more specialist centres are meant to be taking a far larger proportion of the workload in order to improve the patient outcomes.  That is the theory anyway.

Now for the reality.  The government is starving the NHS of cash and despite the current service reconfigurations the so called specialist centres simply do not appear to have the funds to be able to increase capacity and handle this extra workload.  The result is a disaster of pretty sizeable proportions.

David Goodier, an excellent and highly conscientious trauma surgeon at Barts and the London, has resigned due to systemic failings regarding the standards of care and management failing to take his warnings seriously.  This is an incredibly brave stance from a really noble surgeon.

His resignation letter can be read in full.  The concern I have it that this is no isolated example.  The same lack of care and concern from management that has resulted in genuine patient harm at Barts and the London is highly likely to be going on in many other hospitals and in many other specialities other than trauma surgery.

The combination of the government's target driven top down approach to the NHS combined with the failed reforms which have left numerous NHS trusts struggling for small change, has resulted in a management structure and system that ignores harm being done to patients, as long as targets are met.  It is disgraceful.  Bravo to David Goodier for taking this brave stand.

Support the pension strike

A lot of government misinformation has been and will be spread as the public sector unions' strike arrives this Wednesday.  The simple fact is that the government is using the recession as an excuse to dishonestly shaft millions of public sector workers.  Everyone should get behind the workers.

The BMA are to ballot members on potential action soon and many of us think more could have been done earlier, still the BMA are very much in support of the other public sector unions.

The simple fact is that the government reached an agreement on increased contributions to the NHS pensions of doctors in 2008, with our contributions increased massively to 8% at this point.  The government is now unilaterally trying to double the amount doctors pay into their pensions, despite this long term deal being agreed three years ago.

The government's behaviour has been an utter disgrace in this regard, not forgetting their dishonest privatisation of the NHS at the very same time.  The government is already making about 2 billion pounds in profit per year from the pension schemes of doctors as things stand.  It is outrageous that they are trying to shaft us in this way.

So get behind any public sector staff striking this Wednesday and don't believe the lies peddled by the government.  They will pretend that these cuts are essential and needed, they are most definitely not needed.  The government would prefer to pick on easy targets like public sector workers than bother to address massive issues like the massive corporations which avoid billions of tax every year.

Dr Rant rises above the storm

Dr Rant is back and has had some fairly interesting things to say on recent events:

"For Christ's sake people! GP commissioning is being taken off GPs and given to private companies to do the rationing, right under out noses!! This policy isn't even a 'Tory' policy - it's just plain fucking evil."

This is a very good point.  Petty niggling in the playground should be left precisely where it started, in the playground.

At the moment the current regime is forcing through the most destructive health care reforms ever seen in this country.  The government have lied in doing this and continue to do so, they are privatising the service and not admitting it.  We need to focus on the big issues and the biggest of the lot is the government's negligent white paper of doom.  

The one body that have been putting all their weight into the fight are the NHSCA, the NHS Consultants Association and I thoroughly commend all they continue to do.  If the BMA had used its weight as effectively then the paper may have been sunk by now, alas they have not.  There is still hope, although it is fading and I pray it is not too late to sink this fat corrupt duck.

Someone doth protest too much?

The ferretfancier does not wish to defame or incite hatred.  Obviously there has been a bit of medical storm brewing in the last few days and I only think it right that my readers are pointed in the direction of the information so that they can make their own minds up.

Dr Zorro and Dr No have some rather interesting tales to tell.  Una Coales has her side of the story.

Dr No's eloquent and logical rebuttal of Una Coales' allegations against him in his comments section is particularly key in my opinion.  It cuts like a knife through soggy butter.

One can often tell where the truth lies by looking at the nature of the debate, by analysing the little details, by looking for small inconsistencies and contradictions.  I sense someone doth protest too much and perhaps this gives the game away?

The GMC, the social media and our lives

It seems that the social media is an area of great fear and concern for many of us in the medical blogosphere these days.  With Dr Rant being take offline and in a state of deep paranoia, I decided to look through the BMA's guidance on the social media.

There are many obvious pieces of advice.  'Patient confidentiality' is key, personally I have never spoken of anything patient-related that has happened at my place of work on this blog and this is a wise thing to do.  'Facebook friends' - it is clearly unwise to befriend patients on the social media, still, this is a very grey area.

 'Defamation' this is a very important thing to bear in mind when on the social media.  Defamation relates to 'an unjustified statement about a person or organisation that is considered to harm their reputation ' and is a very subjective thing.  Obviously we all have a right to free speech and for something to be deemed 'defamatory' it has to be fairly extreme.  A good rule to go by is to pretend that what one writes is being published in a newspaper and if it seems acceptable in this context then it is highly unlikely to be defamatory.

I have looked back through all the ferretfancier's old posts and have found nothing that strays across these lines.  I have called Patricia Hewitt an idiot which is perfectly justifiable, I have labelled Liam Donaldon incompetent which is also very justifiable, I have not referred to any specific patient events, I have not been defamatory in my criticism, I have used evidence to prove my points and have not crossed the line into 'unprofessional' behaviour in my opinion.

'Professionalism' is where this all becomes very very tricky indeed.  In fact the human rights act makes it very clear that we all have a right to respect for private and family life, and if any public body starts trying to interfere with this then they will be on very very sticky ground indeed: 

"Article 8 

Right to respect for private and family life

1 Everyone has the right to respect for his private and family life, his home and his correspondence.

2 There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others."

It appears to me that unless a doctor's behaviour outside of the workplace breaks the law then the GMC or any other public body will be on extremely dicey ground in trying to punish this inidividual.  Article 10 on the 'Freedom of Expression' also makes it very clear that we all have a right to say what we want as long as it stays within the law and no public authority has a right to interfere with this.

It is perverse that the people who are endlessly calling for better patient care and 'patient safety' are the very same people who love to right roughshod over the rights of others to express themselves.  The more free speech and openess is stifled, the worse the implications for health care and patient safety, as we have seen time and time again that we need an open honest culture to drive progress.  A Stasi like system that runs on fear and that kills criticism unfairly with threats works in the very opposite direction to progress.

The GMC: a totalitarian regime?

Much bad in medicine in recent years has been allowed to happen because those in the positions of medical power have been looking out for themselves rather than the interests of doctors, the NHS and patients in general.  It is also true that much progress is stifled because certain vested interests at the top of politics, medicine and medical politics just wanted to serve themselves and will do anything to keep hold of the power they currently have.

"It is like a totalitarian regime: anybody who criticises it is said to be mentally ill - what used to happen in Russia."

These are the words of a high court judge and he was describing the GMC.  Classic signs of a totalitarian regime is its complete inability to react sensibly to criticism, rather than listening and acting to improve things, a totalitarian regime will silence any criticism at any cost, it will brutally throw around its power and ignore due process in trying to bully its own way.

Another thing that is true of totalitarian regimes is there complete inability to take a joke, they will react violently and aggressively to satire or humour when it is directed at them.  Anyone who is a regular in the medical blogosphere will have read the amusing, intelligent and sometimes overly offensive Dr Rant.  There are rumours concerning Dr Rant and the subject of this piece.  Certain fights are rather unwise as they will attract one hell of a lot of unwanted attention and I suspect this may be one of them.

Corrupt Bill edges through Lords

So as expected the Health Bill has won two crucial votes in the House of Lords today.  One would think that large numbers of those voting in the Lords would be objective and making a decision based on the evidence.  Unfortunately this is not the case, this Mirror piece today makes it rather clear that large numbers of Lords have rather significant conflicts of interest in this regard.

The BBC has reported things in their typically pro-government manner, interesting to see their question at the end of the article 'should doctors be given more financial power?', insinuating that the Bill puts power in the hands of doctors which is a great piece of spin.  Certainly some doctors will have some power in commissioning in the brave new NHS, however to pretend that the government won't be overseeing the new corrupt tendering process by favouring its friends in the corporate health care world is extremely naive.

Lansley is a lying corrupt toad and this government stinks for the way in which it is forcing through this dishonest disgrace of a piece of destructive policy.  The Bill does nothing other than privatise the NHS, it will introduce a new pseudo-market that will allow the government's friends in big business to profit from the easy health care work, while local NHS services and emergency care will be undermined and shafted.  Bevan is remembered as a great, Lansley will be remembered as the very opposite of great.

#Blockthebill and corrupt media

A mass protest is currently taking place on Westminster Bridge in London.  UKUncut has organised this protest against the corrupt and dishonest health Bill that is currently being railroaded through by the coalition government. 

The reasons for this protest are the same old reasons that we all have in opposing this dreadful destructive piece of legislation.  The public and the NHS staff are united against this Bill.  The worst thing about it is that the government have no mandate for the Bill, they promised they would protect the NHS, much like New Labour did before them, they have since gone back on their word and have set about dismantling and privatising our national health service.

The worst thing about all this is the way in which the mainstream media are yet again showing us their true colours.  Generally very few in the media have actually explained what the Bill means, maybe some of them don't understand it, it is also clear that some do not want to cover this issue objectively.

Today the media's lack of objectivity has yet again been demonstrated.  The BBC and SkyNews seem to be trying to ignore the blockade of the bridge, they prefer to concentrate on Paul McCartney's latest wedding, how very very tedious and what a sad indictment of their priorities.  At least the Guardian is making a proper effort to cover things.  I suspect the Channel 4 news will yet again show the BBC up with some far superior coverage of events tonight.

Thousands protesting about corrupt dishonest government health reform should be making the top headlines, it's a great shame that the media seem to be helping the government out with their policy of brushing the public's protests under the carpet.  It is sad that our so called democracy has been reduced to this.  If this Bill manages to get through the Lords it will truly be a very sad day indeed for this country.

Letter to the Lords

I have taken the liberty of repeating this letter than Dr Grumble has recently reproduced on his blog.  I would strongly urge anyone to sign up, time is fast running out:

"As doctors in England, we are writing to you to express our conviction that the Health and Social Care Bill will irreparably undermine the most important and admirable principles of the National Health Service, and to appeal for its rejection by the House of Lords.

Because it is universal and comprehensive, and publicly accountable, and because clinical decisions are made without regard for financial gain, the NHS is rightly regarded all over the world as the benchmark for fairness and equity in healthcare provision.

The transfer of services to private, profit-making companies will result in loss of public accountability and a damaging focus instead on low-risk areas that are financially profitable. A confused patchwork of competing providers will deliver a fragmented and inequitable service and any reliance on personal health budgets or insurance policies will further increase inequality. Because there will be a financial incentive for providing treatment patients will be over-treated, the potential costs of which are limitless. And the possibility of the commissioning role being outsourced to the private sector is also deeply concerning.

In forcing through this ill-conceived Bill, without an electoral mandate and against the strident objections of healthcare professionals, the Government is also ignoring overwhelming evidence that healthcare markets are inefficient and expensive to administer.

The public has been misled throughout, first by claims that no major reorganisation of the NHS would be undertaken, later by repeated denials that what is happening represents privatisation, and furthermore by suggestions that the Bill enjoys the support of the medical profession. We do not accept the argument that "things have already gone too far" - the enactment of some of the Bill's proposals has been premature and illegal, however some of its most damaging aspects may still be mitigated.

We believe that on moral, clinical and economic grounds, the Health and Social Care Bill must be rejected."

Email Jonathan.folb@nhs.net to add your name on.  Do not hesitate, every little bit of resistance helps.

The Bill of disgrace

I must apologise for my absence from the blogosphere over recent months, it has certainly been a strange old time in the NHS. The health news has been dominated by the Health Bill but the word 'dominated' doesn't really express the fact that the media have not covered this issue well or objectively in my opinion.

The bias and lack of objectivity in the media as regards health as been demonstrated perfectly by the way in which this destructive and dishonest government policy has been ushered through thus far. The media just haven't got to grips with the issues and it was almost swept under the carpet as the Bill narrowly passed through the House of Commons.

Dr Grumble's recent post shows just how deep the feeling is against this Bill, this letter gets across just how dangerous the Bill is and how it spells the end of a national service as we know it. The Bill is not what the liars of politicians pretend it to be, it is the blueprint for the mass privatisation of the NHS, anyone denying this is simply lying. The fact that the media have not widely acknowledged this makes it clear they have not bothered to read the Bill or they are liars.

The NHS has many faults but these can be worked on in many effective ways without the mass privatisation of services, in fact the mass privatisation is likely to drive down standards and reduce the continuity of care further. Arguing that the Bill is a dangerous corrupt disaster does not mean that I do not want some effective future reform, the point is that this 'reform' is not progress, it is a regressive and dangerous step backwards for the nation's health.

I just hope and pray that the Lords can stand up for the best interests of the people of this country, the politicians have already let the people down and the Lords are our last hope.

Infection control madness