The dustbin of training

Whatever one chooses to prioritise can have massive knock on effects on other things, many of which are completely unforeseen. It's similar to engineering, when you change a certain property of something deliberately, it may alter other properties that you did not expect and it may have a quite catastrophic effect. The Titanic is a great example, supposedly unsinkable, however as we know it's design left it open to massive disaster.

The government's butchering of the health service to satisfy short termist political demands has had so many devastating knock on effects. Few politicians would have predicted the untold damage that the blanket Accident and Emergency 4 hour wait target would have had. AE is now no more than a glorified triage service thanks to the 4 hour target. The best way to improve AE care would have been to increase AE capacity so that a high quality service could have been developed to attract more talented doctors and nurses. Instead the 4 hour target has created a triage service that drives the best staff away and that has no incentive to sort out patients properly. The 4 hour target and the unnecessary excessively rapid movement of patients has also been a rather key driver in the rise in certain Hospital Acquired Infections (HAIs).

Likewise the current top down bullying from the DH to enforce the 18 week target. Superficially it seems like a sensible idea, however when one learns of the unforeseen side effects in does not seem too clever. A lot of patients simply do not need to be turned around in 18 weeks, they have minor problems that are causing them only minor symptoms, often a bit more time waiting is good for some conditions, it can result in a lot of them going away during the waiting period. The worst aspect of this target is that it is not clinically driven, for example the patient who is living in agony and needs a joint replacement quickly cannot be prioritised as well as they should be, as there are numerous other patients with much milder symptoms who have to be turned around within the 18 weeks. The 18 week target has also led to a culture of fiddling the statistics, as if there is no increase in capacity then no more work can be done anyway.

The long term sustainability of the health service has never been at the top of the government's agenda, they only care for the next election, much like our economy, it's no surprise that we meandering down sh*t creek without a paddle in this regard. Our economy has been run in an incredibly unsustainable short termist manner, we are now seeing the rather significant side effects of this stupid policy.

Training is a key if one hopes to sustain a high quality health service, no wonder the government has completely ignored training in recent years, all the policy has been directed at improving superficially gimmicky statistics to spin their network of dishonest propaganda. The current thrust at increasing output has seen trainees struggle to get the experience that they so desperately need to become the high quality doctors that they want to be. In surgery for example Trusts are under so much pressure to increase output that the training of tomorrow's surgeons is no priority at all, trying to get operative experience in this climate is not easy at all.

The government has also taken power away from the independent professional bodies, the Royal Colleges, and handed a lot of unaccountable power to useless organisations like PMETB and the GMC. Training posts are now ten a penny, the training content of jobs is not regulated properly, meaning that trainees are woefully inexperienced for their grade. Medicine is no longer the apprenticeship that it once was, the educationalists and politicos have far too much say in the training process, their emphasis on waffle and paper chasing have done nothing to improve training. Nursing training has also been subject to a same ridiculous politically correct forces, the loss of the apprenticeship has seen standards in training plummet.

The emphasis is also not changing. The short termist policies are the drivers, and training is still being left to rot. Darzi's review does nothing for training, the establishment of NHS MEE is just a token gesture, it is simply a powerless advisory body that will be made up of the same old government friendly cronies who have overseen the disasters of MMC and MTAS. Hospitals are invariably run by jumped up morons with clip boards who care nothing for the quality of care provided, they simply have certain top down government objectives to satisfy or else, and if the quality of care and good training get in the Trust's Stasi's way then they will trample over them. There are rumours this week that first year doctors are not being allowed to put in IV lines due to 'infection control' concerns, if there was an example of the lack of joined up thinking that our short termist politicos have forced upon us then this is it. The economy is crumbling, as is medical training, and this is because the politicians care only for today and never tomorrow.

A system built by lunatics

I am possibly being a little kind in describing those that continue to tinker with the structure of the NHS as 'lunatics', there are other words that better fit their misguided actions. It is tricky to get across the sheer stupidity of the way the system is run to people who peer into the goldfish bowl from the outside. Although I reside within the bowl I shall try to describe it for someone who is looking in.

Lord Darzi's recent NHS review talked a lot about improving quality, and we know when the government talk a lot about something they invariably are about to do the exact opposite, just like the NHS constitution in fact. This NHS Review also talked a lot about reform being locally driven and patient centred, this was just as central government ordered Lord Darzi's portacabins to be erected in every PCT so that the old and vulnerable would have to walk that bit further to see their varying not so local doctor; in fact they may no longer be able to see a doctor, this government seems intent on empowering anyone to do jobs that used to be done by people with lots more training and medical degrees, quality, err, anyway that's another story.

In surgery the government pays hospitals for the operations that they perform, this initially sounds sensible, however when one probes beneath the surface it is far from sensible. This is because the tariff system was not thought through, they forgot about numerous surgical procedures, meaning that the most complicated and specialist surgical procedures frequently result in the same remuneration as the most simple and straightforward procedures. This is results in the big specialist surgical centres routinely losing money as they are taking on the most complicated, expensive and unrewarded work. These big centres of excellence dared to point out to the hair brained managers that the payment system was stupid, the managers just said that the specialist centres were inefficient.

Meanwhile ISTCs are paid for work they don't even carry out, and a lot of their work appears to be slightly shoddy to say the least. The tariff based system doesn't even work for the NHS alone, as centres that carry out lots of bad, quick and cheap operations will make lots of money, while centres that carry out lots of tricky specialist work well but expensively are being driven out of business. Take fractures of the neck of femur for one example, if one treats this with a bad and arguably negligent operation which is also cheap then one can make a lot of money, however if one carries out a good total hip replacement in some patients one will start to make a lot less money. The same goes for many other fractures, where fixing fractures badly with cheap materials is much more profitable than fixing fractures well with expensive devices.

I'm sure you get the point, the system is barmy, it has been created by morons who were obsessed with the gimmick of the market who understood nothing of the clinical practice of medicine. It results in market forces pushing standards of care lower against the best interests of patients. As I have been rather frantic at work recently I haven't had much time to read, but I always try to find time to read Dr Grumble, he has a wonderful knack of being able to succinctly sum up the daftness of the NHS we live and work in.

PCTs sum up the daftness, they used to be small organisations, they are now huge bureaucratic monsters which are run by people who have no understanding for what they throw money at. It is simply amazing that people with no medical training are allowed to spend thousands of our money on evidence-light health initiatives without a public health doctor in sight, it is as barmy as a country being run by ministers who are shuffled around so frequently that they barely have time to learn the name of their new department. The more they talk of quality, the more you should feel very very afraid.

Ambling into the abyss

Apologies for my recent lack of blogging, have had my finger in many a pie recently, shame not many have been particularly fragrant, that's the NHS I guess. Quite a lot has been going on as regards the infamous Dr Scott, he's now back at work but at what cost, only time will tell I feel. I certainly feel that the abuse of power that appears to have gone on in this case is merely the top of the iceberg on this intimidatory front.

The medical hierarchy seems rotten to the core. Many a doctor has been subjected to this kind of disproportionate venom in recent years, frequently the suppliers of the venom are remarkably powerful people bullying people with much less power, and those with the power do not seem to be particularly accountable for their actions.

A recurring theme throughout the failed reforms of MMC and MTAS has been just how unaccountable those in positions of power have been, no one will take responsibility and no one takes the blame when things go tits up. Hence the same people remain in their ivory towers running the dismal show. Darzi's review is simply a game of rearranging the deckchairs, it's not the formation that matters, it's the fact that our deckchairs are bloody useless.

There is a hell of a lot more to this Dr Scott story than one might imagine, I will leave the rest to your imaginations. There's a nice summary of events here, it doesn't fill one with much hope for the future. This is bigger than the odd individual for me, this is about a system that does not work, a few institutions have become far too powerful over time and they react to criticism in the only way they know how, with the iron fist. The problem stems from Whitehall and the tentacles extend locally to the Deaneries and centrally to the GMC.

The worst thing is that the behaviour of those in power goes against everything that we are taught to do as good doctors and it stifles progress so absolutely. Those who dictate the 'duties of a doctor' seem to think that they themselves are exempt from the same rules because they wrote them, they are hypocrites on high.

The clinician on the front line is so very accountable for his or her actions, as well as being an easy target should they fail to comply with the centrally enforced directives pushed onto them by small minded managers. Meanwhile the medico politicos and the managers are completely unaccountable for their own errors, this is no healthy state of affairs. However it does explain why those in power are so keen to crush dissent with so little regard for the law, they are desperate to keep hold of their positions of power, and they can see that if they are exposed for what they really are, then their time will most certainly be up. They are most definitely afraid and that is our best weapon.

Obesity - it's all the NHS' fault!

There's always someone to blame for the obesity epidemic, except that if it's the fatties talking then they will never blame themselves and if it's central government then they will also never blame themselves. For example this overweight fatty thinks the NHS should take more of the blame:

"Yes, we are letting ourselves down by being overweight and it’s my choice what I eat, but if someone makes that big decision to access services, even if they are just a couple of stones overweight, the resources should be there."

Indeed it is your choice, I also agree that the resources should be there, however largely (what a pun) I do not mean NHS resources. This is because much of the money that is being thrown at anti-obesity treatments and resources is a complete waste, as there is no decent evidence that they will do anything to make our fatties less fat. The drugs are rubbish, and as for PCTs handing out slimming vouchers, don't get me started on that.

Most of the problems come from a complete lack of holistic management and policy making from central government. Where are our cheap and excellent communal sports facilities? Where is our excellent school sport and healthy school food? Where are our green open spaces? Where is our excellent public transport that would encourage us to walk a bit more rather than using the car for everything? Where is that cheap subsides and tax free fruit and veg? Where are the fast food grease pits that have been taxed more heavily to make profiting from heart attacks that bit more tricky?

You get the picture. Doctors can at best do very very little to help their fat patients, they can refer the fattest for bariatric surgey which is only a very last resort with significant morbidity and mortality attached, they can prescribe drugs that cost a lot and do sod all, or they can refer patients to services that also do sod all.

Unless people start taking more responsibility for their weight and stop blaming their genes, then we will just carry on getting fatter, by the way if it was all in the genes then we would have all been this fat fifty years ago. Also the government could also do a hell of a lot more to counter this growing problem in all areas of policy making, blaming the NHS and staff is utterly stupid as well as futile. This is a big systematic problem rooted in our rather short termist culture, and untiul we start to address the real underlying causes, this tide of lard will only gather momentum.

The rise of the incompetent jobsworth

I obviously do not claim to speak for anyone other than myself, but for me Labour's reign has seem an utterly ridiculous empowerment of the ignorant and a continual belittlement of genuine talent and achievement. A lot of this has been undertaken in the name of 'equality' in a rather politically correct manner. It seems that knocking down the motivated while empowering lazy jobsworths is Labour's idea of great management. I'd argue that this approach is both inefficient and stupid.

The attitude demonstrated by this PCSO is typical for that of Labour's empowered ignorant, they tend to possess a very in-your-face aggressive streak that those with genuine intelligence and knowledge would never dream of revealing. They are completely unaware of their rank lack of training and expertise, they think that their title or position entitles them to treat other humans without any respect of dignity. They demonstrate quite succinctly just how power has the potential to corrupt so absolutely.

This agenda of dumbing down is not cheap, a PCSO is paid a very handsome wage, especially considering the lack of qualifications, training and competition for places. The same is true in other sectors, for example the health and legal sectors have also seen the properly professionals undermined at the expense of fulfilling a corrupt government reform agenda. The driving force behind this is not the unfortunate individuals who have been inappropriately empowered on the front line, it has been the unaccountable ever proliferating network of managers that have presided over this tremendously poorly planned waste.

Despite numerous management failings and programs of dangerous wasteful reform, those who have run the show in government and in the Department of Health continue to force their dross upon us and there seems to be very little we can do to stop it, short of organising a full blown military coup. The catastrophic waste is so beautifully encapsulated by the wasted millions of the NHS University, bear in mind that this is only the tip of the iceberg.

In the NHS those who prevent the show from going under have been those who have been routinely castigated and bullied by the management regime. It is the consultants, the GPs and the nurses on the front line who have had to take all the blame for various problems that should really be dumped at the door of their managers. The managers want all the power but will take none of the responsibility. The government is afraid of those with expertise who the public trust, so no wonder they hate the front line staff who do their best to care for patients when their hands are tied.

Some NHS managers do do a good job, however I am struck by the routine nature of bullying and similar jobsworth type behaviour that is shown by these managers to many of their fellow NHS staff. Good management should involve listening, accepting constructive criticism and working together with people in a cooperative manner to make improvements. NHS management involves ordering people around despite not knowing anything about the implications of one's orders, not listening to any criticism, bullying those who constructively criticise and then carrying on regardless of one's crass incompetence.

The point I'm trying to make is that it's not the fault of the under trained PCSO if he or she fails to do their job competently, it's the fault of the regime that has created a system that empowers the ignorant. Those who have changed the way the system works are completely unaccountable for their work. For example as regards HAIs (hospital acquired infections), the recent government decision to make certain potentially toxic antibiotics available over the counter flies in the face of the government's pretend attempts to combat C.Diff et al.

The medical profession has it's own malignant branch of this empowered jobsworth, and it seems that they frequently hide away from clinical duties, preferring to bully those on the front line by exploiting their many handy crony-based connections. I know I've significantly digressed from my original point, it's partly because I could rant on inanely for hours on this particular pet hate of mine.

I carry on because I love my clinical work, but it's incredibly frustrating to see progress stifled by such an incredibly backwards culture of top down bullying and incompetence from uneducated jobsworths. There's almost too much to criticise, so much so that the criticism is dissipated over a wider area, there are so many leaks in the NHS roof that it feels as if we're in the shower. The re branding of PCTs is the latest example of this foolish campaign of regression.

So if any of you jobsworths happen to be reading then I hope you realise just how much top talent you are forcing out of out public services such as the NHS. I recently encountered a very experienced and talented ex-nurse who had quit her job as a senior AE sister because she was so fed up with seeing the damage inflicted by the 4hr AE target. She loved her clinical work, however she was sick of seeing doctors bullied by jobsworth bed managers, she had had enough of fighting against this tide of empowered small minded incompetence. I just hope enough of us keep fighting, otherwise the outlook for out patients is not good.

The NHS Stasi

There has been a lot of recent talk about a junior doctor who was suspended from work for comments made on a private Internet forum. On one hand it seems that our medical leaders cannot take a bit of banter on closed Internet fora, while on the other hand they are happy to nonchalantly wreck thousands of lives without expecting any punishment at all.

It is rumoured that the doctor's ridiculous suspension has been lifted, apparently some big media cheeses were sniffing around the story and this prompted some action from our esteemed medical leaders.

Dr Rant also remarks at just how unlikely it is that the likes of Liz Paice and her buddies will be investigated by the GMC for their cowardly acts which could be seen as a gross abuse of power by some.

Amazingly doctors such as myself have no choice but to pay almost 400 pounds every year to the General Medical Council. Some would say that the GMC selectively punishes various enemies of the state, so in this context is seems very strange that doctors have to fund yet another outpost of government?

It all makes Remedy UK's campaign to hold those behind MMC to account all the more important in my opinion, 1430 signatures so far, surely those behind this negligent reform should be punished? Or maybe swearing on a private Internet forum is more important in the grand scheme of things.

I'd better stop there, as I'm sure the Department of Health will be monitoring my words and telephone conversations using RIPA. Better keep quiet and sing Carol Black's praises then.

The GMC is great, they would never ever selectively punish doctors at the request of people that they are close to. MMC is great, modernisation for the sake of it is progress, even if it results in a terrible dumbing down of standards and the butchering of thousands of hard work professionals' careers. We do not live in a country in which the government continues to empower itself in a rather Stalinist manner, in a way that threatens the liberty of its citizens.

We live in a parliamentary democracy, we should be grateful, our politicians would never ever slip dodgy legislation through that spits in the face of freedom. Or would they?

Walk in Centre comedy

I do not normally steal stories, however for this little Pulse gem I shall make an exception. Steve Nowottny tells us just how his trip to the Walk in Centre turned out:

"Pulse's senior reporter Steve Nowottny was impressed by the local walk-in centre. Luxurious, accessible, friendly. All the things you want the NHS to be. There was only one thing wrong. No-one could help him with his problem.

At Pulse I spend a lot of time writing about primary care. But as a young, fit and – touch wood – generally healthy journalist, it’s not every day I get to see it at the sharp end.

For the past three weeks though, I’ve been suffering from a low-level cough, and yesterday I finally caved in and decided to seek help.

The thing was, I didn’t want to go to my GP. After two years of covering extended hours, polyclinics and the rise of the commuter patient, I probably should have known better.

But I didn’t want to have to make an appointment, I didn’t want to wait and I didn’t want to have to stay at home.

So I went to the walk-in centre.

It turns out there’s an NHS walk-in centre just a ten minute bus ride from Pulse Towers in central London.

It’s a little hard to find, tucked away in a shopping arcade behind a railway station. But the sign in the window promised they could deal with coughs, and once inside it was a thing of a beauty.

Luxurious padded brown leather seats. Friendly receptionists. And best of all, just two patients ahead of me in the queue.

I sat and waited my turn. It took about ten minutes, and a nurse came to get me. She was very professional. She took my blood pressure. She took a detailed history. She listened to my chest.

But she was also very candid. I didn’t appear to have anything serious, but she couldn’t be sure, and wasn’t qualified to say.

My cough shouldn’t have lasted as long as it had (this I knew already). There was a small, a very small, chance it could be something serious.

TB was even mentioned. I could try some over-the-counter treatments, she said, and reeled off a couple of names.

But my best bet, she told me - and this was before we even started - was to go and see my GP.

I rather enjoyed my trip to the walk-in centre.

As one of those young professional patients Gordon Brown wants so badly to help and private companies are advised to target, I couldn’t help thinking it was everything the NHS should be.

I was able to turn up and be seen straight away. It was easily accessible and centrally located. It was beautifully decorated. I left feeling decidedly warm and fuzzy about walk-in centres, Lord Darzi, and the health service in general.

There's was just one niggling thing. The only thing it couldn’t do was help me with my cough. Or tell me for sure it was not something to worry about.

Tomorrow, I'm calling my GP."

This amusing little tale sums up just how unproductive this government's fiddling with the public sector has been. A lot of money has been wasted creating shiny and entirely useless gimmicks. At first glance, things look great, however the government has merely created a stage upon which it acts out this pathetic game. There is no end product for all the gloss. We have numerous empowered ignorami, but alas they can do nothing of use. The NP, the PCO et al, what a great waste of our money.

Prof Paice - what a leading light

News has been circulating that a junior doctor has been suspended for comments made on a private internet forum. The exact ins and outs of this story have yet to emerge and I do not wish to comment more until more facts are known.

Moving on I thought I would share some golden nuggets with you, these nuggets are some of Prof Elisabeth Paice's finest comments in recent years. She obviously has a very high profile position and a lot of power in medical circles, these quotes show you just why MMC and MTAS have been such glowing successes:

"…one might have feared a tidal wave of applications, but that has not happened.
Obviously, people are targeting the post they want…they are spreading their
applications so that across the country people are getting applications in the
thousands, though not tens of thousands. Therefore, so far so good"

So Prof Paice thought MTAS was running smoothly in 2007, she also thinks medical education should be lumped in with everything else:

"Professor Elisabeth Paice of the London Deanery argued that creating an organisation dedicated specifically to medical education would make it more difficult to integrate planning and would isolate decisions about the medical workforce from their wider context: I would hate to see medical isolationism as the outcome of this and a step backwards from the integration of service strategy and financial planning, using medical education, if you like, as an enabler for service change and reform."

Hmmmm. MMC and 2007 were 'good for patients' apparently:

"Obviously, those people turned up elsewhere and are doing extremely well. It is good for patients that good people are all over the country, but it is very sad for individual doctors who perhaps have set their heart on particular placements. One of the outcomes is that people have applied for jobs and have got them but feel very distressed at the outcome."

Prof Paice is also a big fan of PMETB's standards and thinks that these are able to magically cope with EWTD's reduced training hours:

"With the European working time directive and so many changes in the health service the way we deliver training has to change; and we have to change the way in which we assess people so be more reliable and robust. A lot of this change is being driven,
rightly, by PMETB and the standards set by it."

She also squirmed when asked as to whether COPMED and the deaneries had been speaking with one voice:

"I think we have been speaking absolutely with one voice through what has been an extremely difficult time. It is correct that the experience has been different. If one asked whether this had been smooth one would get two answers, yes and no, but that is not the same as not being together in what we are trying to achieve."

MMC and MTAS are good for patients then. I stand corrected. The raft of unaccountable bureaucracies and organisations are all speaking with one united and representative voice. With the likes of Prof Paice in charge I find it very hard to understand anyone can dare to question the noble motives of our esteemed medical leaders. We are lucky to have experienced the glowing success of recent years, we should feel privileged to have been stroked by the hand of medico political genius that has been guided us to such fresh fertile pastures. It is just terribly unlucky that we all landed in a big cow pat and not on the lovely lush green grass than our medical leaders inhabit.

Silence is no sign of success

MTAS and MMC are still not seen as failures by a small minority of arrogant and self serving fools in the medico political establishment. Some of these people would not be able to recognise failure even if it punched them square in the chops, they are in denial, while the others are just plain psychopaths.

There has not been the mass outcry this year, but this has not been due to a system that has been run slickly and the fact that doctors are content, far from it. Many people have battle fatigue and are so disillusioned that they do not have the energy to cry out as they are beaten, after all no one seems to be listening. This apathy has been learnt as those in positions of responsibility continue to refuse to listen, they also remain unaccountable for massive errors that have had massive impacts upon patient care. Sir Liam, Carol Black et al drive onwards and upwards, oblivious to their gross failings and inability to work for the long term interests of our patients.

I will not deny that the application process has been improved since last year, however speak to anyone who took part and you will quickly discover that the system was riddled with major faults which once again resulted in a lot of very preventable heartache for doctors in training. A barbaric process that only allowed a short window of 48 hours in which to accept an offer meant that many were left with impossible decisions due to a rigid and inflexible application process. The lack of a decent coordination in job advertisements made it very tricky for doctors to juggle long hours with completing long winded application forms, while the short listing and interview processes were hard pressed to be fair given the time pressures associated with having all jobs having fo be filled at the same time every year.

The wheel has been reinvented, by trying to stamp out a problem that never existed, Sir Liam has created many new problems of much greater significance and potential to do harm. Currently numerous junior doctor posts remain unfilled, meaning that many people are being forced into working illegal numbers of hours and the large gaps in rotas are also reducing the quality of training for large numbers of trainees. Add to this the demoralisation of so many doctors and the great difficulty in obtaining elective locum cover, then you have a veritable disaster in the making. Obviously I wouldn't want to forget the massive numbers of doctors who have quit the NHS, or will do in the next few years as a result of these poorly planned reforms.

Well done Sir Liam et al. There is no doubt that you have left your marks, it's just a great shame that none of these marks represent anything remotely positive.

Medical student prefers court to revision

She told BBC News Online: "In normal day life, you don't get given multiple choice questions to sit. Your patients aren't going to ask you 'here's an option and four answers. Which one is right?'"

With logic like this I can't imagine why she hasn't passed her MCQs?

Patients also don't present as short answers questions, essays, clinical examination stations or OSCEs; however this doesn't mean that all these methods should be stuck in the waste paper basket.

"They don't let me express my knowledge,"

My heart bleeds.

Maybe I'm being a heartless bastard, but if you can't pass the exams then hard luck, you can't become a doctor, it's not as if the exams are harder than they used to be, in fact from what I've heard medical school exams have been significantly dumbed down especially at places like Peninsula.

Society has gone stark raving bonkers in my opinion, so much so that political correctness obliges that anyone should be allowed to do anything, completely irrespective of the fact that that person's attributes or lack of them may completely prevent them from doing their job properly.

For example should the job of a junior doctor be done adequately by someone who is deaf? I would argue not, as so much of the job involves communication and a lot of this is by telephone, making it impossible for large amounts of the work to be done. A blind pilot, a surgeon with a massive tremor, a maths professor who just can't do his times tables or a dentist with a phobia of teeth- you get the picture. Maybe I'm just discriminating unfairly in the eyes of the law.

One could argue that jumping words and reading much slower than other people might have some rather big implications for the health of her patients and her ability to be a doctor. Drug charts are not very forgiving for small errors, this is just one example.

How long are we away from thick people taking exam boards to court because they can't pass them?

Not far away it seems, everyone can get an extra few hours these days for some manufactured learning difficulty (if you pay a psychologist then anything is possible), and students can now get extra marks for their pets dying or getting the flu before an exam.

Bonkers I say.

Remedy calls for accountability

The government continues to ignore criticism and consultation, while forcing through destructive reform after destructive reform; as the political beast gets nearer to the ends of its life, it seems to be thrashing around senselessly and trying to leave as great a mark on history as possible. That mark is not going to be a good one unless we can force them off their destructive path, their time bomb of reform must be exploded away from civilians.

MTAS and MMC were catastrophic disasters, the effects of which will come home to roost over the next few years, as rotas lie seriously short staffed and the service suffers thanks to this complete lack of foresight and planning from the government. Despite all the talk of a better NHS, Darzi's codpiece of a review and the chatter about accountability; we have seen no one held to account for MTAS and MMC as yet, while doctors on the ground have the nooses around their necks tightened that little bit further thanks to the likes of revalidation and IWGC.

Remedy needs you to sign up to their call for accountability over MMC and MTAS, their letter in the Lancet is a call to arms:

"Your May 17 Editorial1 states that “many of those responsible for MMC [Modernising Medical Careers] still fail to appreciate the human damage caused by their ‘inept’ decision making”, and the Health Select Committee report2 was peppered with words such as “defective”, “unsafe”, and “disastrous”. It found that “the leadership shown by the Department of Health was totally inadequate”. Despite these highly critical accounts, not one of those responsible for this avoidable catastrophe has been brought to account for the misery they propagated.

The Chief Medical Officer, Sir Liam Donaldson was the architect of the reform. During the project's development it became apparent that there were multiple risks, and there were calls for delay.2 These calls were ignored. Sir Liam chose not to take on a clear leadership role and has evaded responsibility for the 2007 crisis, and we concur with the British Medical Association that he should resign.

We also believe that the small elite group of senior doctors who led this project and who failed to heed these warnings when they were in a position to do so should now consider their future positions in the management of the National Health Service. The General Medical Council (GMC) has issued clear guidelines for doctors who take up management roles, and it has taken action in the past against doctors who have failed to maintain public confidence in the profession or to uphold standards in non-clinical roles. The intervention of the GMC might be necessary if we are to restore public confidence in the accountability of medicine."

You can genuinely make a difference by signing up to this on the Remedy website, simply follow this link and read what they have to say, then sign up if you are in agreement. It's about time those that love to control our every move were held to account for their rank incompetence, the hypocrisy of their safe position in their ivory towers is rather insulting to those working so hard for the patients on the ground. So get along to the Remedy site and let's try to force these political meddlers to account.

Bacon manufacturing more porkies

Dr Neil Bacon has spent a fair few hours this week peddling his propaganda to the press, for example he appears in the Oxford Mail this week telling us all how a majority of doctors are right behind his scheme (thanks for spotting that Dr C). He doesn't stop telling porkies there, excuse the pun, he goes on to talk of the site's great security, how useful it will be and on and on.

To put Dr Bacon's hypothesis to the test, I just wonder how many people will respond to this Mail article and agree with the might Bacon? I wonder? I may have to retire from blogging for good if a mass of doctors suddenly crawl out of the woodwork to show their solidarity for Neil's position. Somehow I suspect this will not be the case. Neil is getting rather desperate, after all a lot is on the line for him now, both he and his wife are involved in this new venture. Should IWGC fail dismally I wonder what this will mean for Dr Bacon?

Many gaps in Bacon's defences

Neil Bacon in consultation with the DoH and GMC has set up Iwantgreatcare, a new website that allows anonymous punters to say whatever they want about named doctors. There is no right of reply for the doctor, the patients can just say whatever they want and this is then meant to result in better patient care. Quite how I cannot quite see myself.

The motivations behind this site are strange as it appears that Neil Bacon may be struggling somewhat financially, hence this may be a desperate last ditch attempt to rescue his economic well being. Bizarrely comments added in support of doctors are being removed, while those slagging them off are allowed to stand; this hardy seems fair when those who are indulging the character assassinations can do so completely anonymously and unaccountably.

Giving patients a free shot at doctors is a very dangerous business indeed. Why I hear you ask? Well the kind of patient that is likely to indulge in vindictive abuse is most likely a particular type of character, for example this kind of racist and bitter individual:

''If they think that all these years we pay national Insurance , yet if you walk into XXXX Medical Centre . You will find I line of Migrants trying to get free services on our backs . Including Somalians , Eastern Europeans etc... I was told I only had 10 minutes to see a doctor . So , after paying national insurance for so many years , I only get 10 minutes . I don't think so !! Kick them the migrants out ! Its time this government realised this country is not a dictatorship . I refuse to pay for the rubbish and the scum that comes hear to steal and turn this country into the biggest toilet in the world.''

This shows just what a stupid idea this website is. There are so many hypothetical cases that would guarantee the unfair abuse of doctors that I could list them all day. What about the deluded and aggressive psychiatric patient who resents being forced into necessary treatment for their mental illness? What about the fat smoker who didn't like being told to stop smoking and lose some weight?

What about the worried well from middle England who expect several hours of a doctor's time in clinic despite the fact that the doctor has other patients that need to be dealt with? What about the woman with breast cancer who thinks homeopathy will cure her cancer and who gets angry when the surgeon tells her that that this is not the case? What about the surgical patient who suffers an expected complication from their surgical procedure? And on and on.

All these individuals may well want to abuse their doctors on Iwantgreatcare, and all their doctors will have been acting in a completely professional manner, certainly not deserving the abuse that they would be likely to recieve on Neil Bacon's poorly thought out site. Likewise any good comments will be meaningless as who knows where they came from, after all it's all completely anonymous.

The first examples of unfair criticism are already starting to appear, Neil Bacon must be so proud for the noble work that he's doing for his bank balance and high quality patient care, he's almost as devastatingly brilliant in this regard as Lord Darzi. From a personal point of view I remember one patient in particular who would have loved to slag off a consultant of mine on IWGC.

My consultant was a very eminent surgeon indeed and spent many minutes patiently explaining that there was no evidence that any alternative therapies would cure his condition, while there was good scientific evidence behind the surgical option. This patient refused to take no for an answer and almost refused to leave the consultation room after half an hour of protestation, the mild mannered consultant almost had steam rising from his ears by the end. Only in the NHS would a scenario like this occur. IWGC is yet more power to patients at the expense of doctors, whatever happened to the doctor-patient relationsip being a two way thing as I was taught at medical school? Soon why not let these patients prescribe their own drugs and book their own operations, they seem to think they know it all.

Iwantgreatcare - farce in the making

Taken from Iwantgreatcare.org, a new insecure website created by Dr Neil Bacon for the government which enables anonymous patients to feedback on individual doctors (see the Jobbing doctor for a good lowdown on this story):

"Q: I objectively believe this is damaging to doctors, can't you just drop this whole idea?

Respectfully, no. It is clear from the evidence base that effective communication improves clinical outcomes, improves patient satisfaction, reduces the risk of medical errors and reduces the risk of litigation. The evidence also clearly reports patients can effectively judge doctors' communication skills to this effect. If you are aware of any peer-reviewed evidence that contradicts this summary, please email details to adminservices@iwantgreatcare.org.

If you are fixed in your belief that iWantGreatCare is damaging to doctors, please consider that iWantGreatCare is advised by a range of respected doctors and the emerging requirements for revalidation make patient ratings of your care fundamental to the measurement of your work. It is also clear, even with superficial knowledge of medical history, that this is not the first and will certainly not be the last new way of working that is challenging for some doctors. "

Dear Dr Bacon and GMC/government cronies,

There is also an abundant amount of evidence that useless poorly designed insecure websites can result in a lot of damage being done very unfairly to people who do not deserve it.

In fact a lot of websites have found themselves in legal trouble for allowing the baseless assassination of people's characters on their pages, what a shame if this happened to your great website.

I like it how one can only rate doctors if they have been one's colleague recently, I find it strange that there is no mechanism for rating doctors in politics or management despite the fact that their work has a massive impact on our working lives.

Why can we not rate Lord Darzi for his work proving the government with backing for their continued destructive privatisation of the NHS?

Why can we not rate Sir Liam for his pitiful work that failed to represent the profession regarding MTAS and MMC and his hermit like existence ever since?

Why can we not rate Dame Carol for taking on a lot of responsibilities and then failing to do her job properly by neglecting glaring problems that were staring her in the face?

I wonder if this is anything to do with the fact the Iwantgreatcare was created in consultation with the GMC, the Department of Health et al.

I wonder if this is because the likes of Iwantgreatcare sum up the the complete lack of accountability that is present in the political and medicopolitical establishments which is present from the very top.

Those like myself who work on the front line are already very accountable for our actions, it is remarkably easy for a patient to complain given the mechanisms in place, the argument that Iwantgreatcare will improve patient care is disingenuous.

The real motives for it are revealed by Professor Bulstrode's slip of the tongue:

'Doctors will feel threatened'

Our morally bankrupt leaders want to control and bully the only accountable people in the NHS a bit more, it is the sign of the Stalinist system that we live in today, those at the top are free to do as they see fit and would only leave office if doctors launched a military coup to depose them from power.

Respectfully you can stick your poor excuse for a website where the sun don't shine. I have no problem receiving feedback from my patients, however if this is to be done it should be done in a very regulated and secure manner so that no unnecessary harm can result from baseless vindictive slander. The good feedback is also meaningless as the website is not secure.

So overall the site is of no benefit to anyone and could potentially result in a lot of harm coming to a profession that already has amongst the highest rates of mental illness of any profession.

Respectfully if you genuinely cared about improving patient care then you would be better off investing your efforts in forcing those in positions of power in politics and in the medical establishment to act in the best interests of doctors and patients, rather than bullying doctors and acting in their own self interest, while remaining completely unaccountable for their negligent actions.

For example in medical training the DH, PMETB, Royal Colleges and government have been found to be grossly incompetent in their actions and this must be having a massive negative negative impact on patient care. However I see that no one has been called to account yet.

One rule for us and another for our masters, again, it's alright for you though Dr Bacon, you've now engineered a position for yourself that is away from the trench rot of front line accountability. Congratulations, I hope you are proud of your achievements.

ps Have a look at the mickey take site www.iwantgreatbacon.com, very amusing indeed; Dr Crippen and Rita Pal have also had their say, while apparently Iain Dale has been defending the site on the BBC. It's funny how politicians are so keen for doctors to be subject to anonymous abuse while politicians are frequently completely unaccountable for their mistakes.

Chewing Darzi's cud

Not a pleasant thought I know, however I thought I'd deliver my general thoughts on Lord Darzi's NHS review. Given Darzi's background of providing the DoH with what they want to hear, only the ultra naive would have thought that Darzi's review contain something insightful and intelligent. Alas Darzi's review has arrived echoing many government cliches that we have been accustomed to enduring such as 'world class commissioning' and 'patient choice'.

The Darzi review is verbose but lacks detail in the few areas in which it has any promise. For example as regards the formation of a new 'independent' body that will oversee medical training called NHSMEE, one has to assume that the body will be genuinely' independent' for it to have any hope of working, given PMETB's similar 'independent' status one could forgive a few groans from the medical establishment. There is no attempt to address the problems that EWTD have created in training with Darzi appearing keen to fall back on more educationalist fodder in the form of 'modular credentialing'.

As regards Primary Care the review is just more privatisation dressed up in the same old lies. The Darzi 'GP-led' health centres have been railroaded through by the DH in very PCT independent of the local needs that Darzi pretends to care so much about. I suspect the disingenuous 'GP-led' nature of the them will mean that it will be rather hard to see a doctor in Darzi's New NHS. There is more emphasis in 'reinvigorating' commissioning and 'patient choice', again this is the government's way of handing out sweeties to its friends in big business while pretending to give a monkeys for the sick and elderly. Dr Crippen has aleady commented on this being rather lucrative for Branson and chums.

There are many other little chestnuts hidden in the many pages of DH propaganda and spin. NICE is presented as being the envy of every other country in the world, while the word 'clinician' is dishonestly re branded in Orwellian manner as meaning anyone who has every seen a patient in their lives. PBC is seen as an overwhelming success, while PCTs are set to be handed even more power to waste millions of our money on 'healthy living' schemes. There is also a lot of talk about more and more measurement of care quality, surely another surefire way to waste money on more bureaucracy and QUANGOs.

The question as to the nature of Darzi's motivation is posed by Dr Grumble, this report offers me little choice but to go for the 'tethered goat' option. The worst thing about Darzi's review is the pretence that it has been constructed in partnership with front line NHS clinicians, nothing could be further from the truth. Darzi's review represents yet another pretence at consultation by this dishonest regime, a pretence at listening and a pretence at responding to local needs. The only needs being represented by Darzi's review are those of the ruling political classes who see further developing a market in heath care as the best way for them to continue their privatisation campaign.

Darzi's review has been a sham from the start, the consultation process was beyond a joke while the reform started even before the interim report had been produced. The reforms will result in good GP practices closing while the sick have to travel further to see less trained staff for lower quality care. The continuation of these destructive reforms will see health inequalities worsen, more money wasted on bureaucracy and more money gifted to the cherry pickers from the private sector. There is no easy answer, we can either have a locally driven service with a postcode lottery or have a Soviet style top down disaster. The artificial state managed market in health care will only be good for the cherry picking private sector, it's about time it was scrapped, the chances of seeing this bulldozer being stopped are pretty slim though. I'd like to finish by summing up Darzi's review as being:

"Centrally driven by a politician for politicians against the interests of both doctors and patients"

BBC acts as government arsehole

The BBC doesn't seem to understand rather basic concepts of good journalism, either that or they are deliberately spinning things in the government's favour. The following letter has been taken with the author's permission as it demonstrates nicely just how low in standard their journalism is. The BBC often presents both sides of the story, even when one side is clearly lying, making things appear 50:50 when in reality they are nothing like this. However when the government is lying then they do not present the other side of the story, making the government's line appear to be fact. I would be embarrassed if I were them:

"I am not a GP but I would like to formally complain about the reporting of the Today programme's top story http://news.bbc.co.uk/today/hi/today/newsid_7486000/7486975.stm. Essentially the BBC reported the comments of Health Minister, Ben Bradshaw, that GP's are in effect running a cartel with a "gentleman's agreement" to avoid taking on patients. Yet the BBC did not challenge Mr Bradshaw to produce any evidence to support these claims. Further on the BBC's website http://news.bbc.co.uk/1/hi/health/7475985.stm, Mr Bradshaw claims that there is one GP practice with only 2 patients, again no journalist has challenged him to produce any evidence to back this claim. There was no second source to this story in effect.

Yet just over a year ago I was interviewed by the BBC's Michele Paduano in March 2007 when I accused 2 ministers of Health (Patricia Hewitt & Lord Hunt) of either lying or misleading Parliament over the data in the relation to the junior doctors training scandal , MMC . The BBC even had a second source for the story, an e-mail from XXX which entirely backed my claims. Yet that interview was never broadcast, as the XXX mysteriously couldn't remember where they got the figures from. I was told by the BBC that since the Andrew Gilligan/David Kelly affair that they will only run a story if they have 2 sources.
Yet the Today programme is quite prepared to run a scurrilous rumour from one junior minister without presenting any evidence to back the story up....or indeed a second source.

I think this is dreadful and frankly when a programme like Today fails to take a government minister to task over such a rumour, they are failing in their jobs as journalists. I would also point out that Mr Bradshaw is a former BBC journalist and his partner works for the BBC, could this explain why the BBC are being so soft on him?

I await your reply.

Yours sincerely"

Little Red Riding Hood

Little red riding rood once had to deliver a parcel of food to her poor sick grandmother. She had to negotiate her way through the woods in order to get to her grandmother's house, but there was a big bad wolf that wanted to digest her, however he was afraid of doing so in public, so he approached her to find out where she was going, she naively spilt the beans...

The wolf beat her to the house, tricked little red's grandmother into letting her into her house, ate her and dressed up in the grandmother's clothes, then lay in wait for little red riding hood. Little red arrived a little later and was swallowed whole.

Luckily for little red a hunter came to her rescue and cut the wolf open to free both little red and her grandmother, all ended happily with the wolf being killed off by some large stones.

Incidentally Darzi's review was released today proclaiming 'Change – locally-led, patient-centred and clinically driven', maybe it's just me, but the very same government that has been wasting billions on centrally controlled, politician centred and politically driven health care reform appears to be very much in control of this one, while the calls for more 'personalised' care driven forward in an 'accelerated' manner looks like a wolf hiding in a 'quality' sheepskin jacket to me.

I fail to see how any of the following will improve 'quality': undermining high standards in medical training, allowing more private sector cherry picking, allowing more money to be wasted by PCTs on healthy lifestyle guff, more quangos, more reorganisation with no accountability, more inaccurate measurement of care quality by the use of patient satisfaction surveys (remember the botched ISTC jobs) and more care delivered by workers with lower levels of education and training than ever before. I could go on but you get the picture of our hairy and rather toothy bedfellow.

The medical profession is in the woods. The big bad wolf is ready and waiting, our grandmother is long gone and probably in the terminal ileum by now. Do we naively believe all we are told or do we get ready to hunt our wolf, the choice is yours.

A blogging rut, happy 60th NHS

If I knew the secret to writing inspiring masterpieces week in week out I'd be a billionaire by now, and if I could just intermittently write the odd masterpiece I'd be content. Finding the drive to write is difficult in the ruts, sometimes one thinks its better to just write nothing when there's no creative spark, at other times one thinks it would be better to grind through regardless.

I can't find the inspiration at the moment and I have no idea why. Work has been fairly busy, but then work is always busy, so that's no decent excuse. The NHS is 60 years old this year, so I should be celebrating this great landmark, but for some reason I do not feel like celebrating.

It is not the NHS that should be celebrated in my opinion, the system and the structure leave a lot to be desired in my eyes. From my few years of practice it is the humanity of the staff and the patients that should be celebrated, and this is frequently in spite of the system.

No matter how the government grind us down there are some things that they cannot take away from us, no matter how hard they try. The satisfaction and sense of achievement that one experiences at a job well done makes the daily grind well worth it. The variety and complexity that a career in medicine brings to one's life cannot be converted into pounds and pence.

I'm sure the government will try to spin the 60th birthday into some propaganda peddling extravaganza, luckily the majority of us stopped listening a long long time ago. Despite all the negativity and gloom, working in the NHS gives me a faith in humanity that stops me falling off in the ruts. Even though the government want to turn us all against each other in order to further their own short sighted self interest, through my daily contacts I see that they will never break us down.

Child dies

A sad story has emerged in which paramedics elected not to bring a child into hospital following a head injury, the child died a few hours later after another ambulance had been called.

Whatever the facts of the case, it is clearly unfair to put paramedics in this decision making position given their minimal levels of training in medical diagnosis and treatment. In the NHS these days managers frequently pressurise paramedics to leave patients at home.

This is a high risk strategy to say the least, these kind of decisions are hard enough for fully trained and highly experienced doctors, so it is not safe or fair to put paramedics in this position.

This is a familiar tale in the NHS today. Those without sufficient knowledge and training are routinely empowered to make decisions outside of their so called 'spheres of competence', the system is set up to encourage this dangerous practice. It's very sad indeed and it just isn't good enough.

R-UK goes live

The one flower to have blossomed following the MTAS explosion has been that of Remedy UK. The only group that showed the courage and determination to represent the opinion of doctors was Remedy, and as others floundered Remedy was strong.

Remedy have launched a new online Magazine and it's a site that's well worth popping past. Anyone can read the magazine, while everyone is also free to register and join the online Remedy community.

I would therefore urge everyone to be part of Remedy's solution, this is no time for apathy, admittedly many of us are feeling the strain after many months of unrelenting grinding against the system, however if we do not stand up now and try to make ourselves heard then we never will.

Darzi, Johnson et al are currently pushing through their antidemocratic reforms which promise to reduce the standard of care while privatising what is left of our National Health Service. We need to unite against this common evil, we need to believe that we can make a difference as individuals combining to destroy this malignant growth.

The power of public opinion is potentially huge and enough to stop any tyrant in their tracks, so it is up to us to find more ways in which to educate and engage the public, so that they can unite with us against this common enemy. We have the truth on our side, so despite our relative lack of finances and propaganda merchants, we can hit the bastards for six if we believe in ourselves a little bit more.