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.

Rate your doctor

I have recently been ranting about the dangers of a one way doctor patient relationship, and since then I have been alerted to the rather interesting website RateMDs.com which allows patients to rate their doctors online.

It could almost seem like a good idea if one had left one's brain in the car park, however there are many reasons why this kind of website are a complete waste of time. For one it is completely insecure, meaning that anyone can submit a doctor and anyone can rate the doctor. There is absolutely no check at all of anyone's identity, it really does beggar belief.

In fact there a few famous UK doctors have already been rated, Sir Darzi, Sir Liam Donaldson and Dame Carol Black amongst the elite few. If you fancy rating them or anyone else, then go for it, the site is completely insecure!

I am sure this kind of hair brained scheme will be coming to the NHS very soon, despite the fact that using 'patient satisfaction' as a surrogate marker of care quality is about as reliable as a Roulette wheel, our political masters just want sticks to beat and bully us with.

The people running these schemes are invariably the politically climbing of the medical profession, people who have sold their souls in order to chase money and honours. Organisations like the GMC are now run by selfish politicos who are keen to sell out their colleagues in producing yet more layers of needless and useless regulatory bureaucracy. It is also strange that nurses and other HCPs are not subject to the same mechanisms of command and control.

Dr Crippen has also recently written on how Primary Care is being wrecked by these traitors. Ironically as the quangos and these new gimmicky schemes proliferate, the patients will be the ones to suffer as good local services will be destroyed and doctors will find their job of caring for patients increasingly obstructed by the hair brained new ideas.

The world has gone mad

When I was a youngster at medical school I remember being taught the importance of the doctor patient relationship, it was interesting stuff at the time, and even then it was emphasised how the relationship could be varied to get the best outcome out of it for the patient. Many factors affect this complex relationship, the personalities of the doctor and the patient, the issues being dealt with, the time available et cetera. Sometimes the patient wants a more paternalistic approach, and sometimes the patient wants to be involved more in the decisions making process.

Frequently what the patient wants is not best for the patient though. Whether it be the overweight smoker who does not want to listen to a doctor politely explaining the implications of their lifestyle, or the women with breast cancer who wants to be told that herbal medicine can be used to treat her cancer instead of the effective modern approach. These patients would be happy to be badly managed by their doctors, demonstrating the serious problems with assessing doctors by relying solely on patient satisfaction surveys. Ironically Harold Shipman was very popular amongst his patients, likewise I have seen countless examples of patients who have been negligently managed who have also been very happy with their care.

Teachers are being plagued by the same politically correct nonsense, I'm sure many of us can recognise that our best teachers were frequently not our favourite teachers at the time. I wonder how long it will be before all parents are forced to respond to all the unjustified complaints from their offspring, it may well result in TV all day with ice cream for breakfast, lunch and tea. Some of the new breed of Health Care Practitioner such as the nurse specialist love this new method of assessment, as they simply defer tricky problems that might make them unpopular to the doctors, while they have so few patients to see in so much time that they can afford to indulge the patient with plenty of ego massaging attention and a few cups of tea.

The world is going mad. Junior doctors already have things hard, they are easy targets for bullying from other staff due to the short nature of their placements;they are now an easy target for other HCPs thanks to the wonders of the 360 degree assessment which allows the assessors to criticise in a completely unaccountable fashion. What next, all doctors being forced to enlist themselves with websites that allow patients to rate their care in a similarly unaccountable one way fashion?

The doctor patient relationship should be a two way street, not the one way street that our nonsensical politically correct culture is trying to force upon us. While it is important that patients have sufficient power to comment and complain, it is equally important that doctors are not subject to unfair abuse and bullied by manipulative aggressive patients. I wonder what the reason for the deteriorating discipline in patients, pupils and children is these days? It couldn't be anything to do with out politically correct culture empowering them way beyond the limits of common sense?

Doctors do not have an easy job, they frequently have to choose the lesser of two evils and it is not uncommon for some people to be offended in the process, even when the best option is chosen in the most polite way humanly possible. Opening yet another avenue in which patients can unaccountably vent their spleens promises to benefit no one, except the politicians who want to enslave our profession. I wonder, will this new set of chains enable us to feedback on the management prowess of Sir Darzi, Sir Liam and Dame Carol? I very much doubt it.

Pharmacy and the 'clinical practitioner'

It seems to have been smuggled in by the back door, but now even pharmacists are allowed to have a crack at history taking, examination, differential diagnosis and the management of medical disease. Pharmacists, albeit being quite handy at pharmacology, have bugger all training in anything else but for some reason the government thinks it's safe to let them loose as yet another prong in the ever expanding army of pseudo doctors as 'clinical practitioners'.

One wonders what the government's precise motives are, just why would they be dangerously empowering those who tend to work for large pharmaceutical corporations while trying to undermine self employed doctors? Labour is struggling for funding these days, and Boots et al have been known to be rather cuddly with el Gordo and his greasy pals.

Pharmacists up and down the country are opening up their small cupboards and acting doctor in these pseudo doctor's rooms, some of them are quite happy to get their stethoscopes out and start playing doctor. Whether it be managing the complex medical complications of Diabetes or the brittle Asthmatic, the new 'clinical practitioners' will feel quite at home playing around in waters well out of their depth.

This dangerous empowerment won't even save money as GPs are already paid to do the same job for less, so the government is wasting money and dumbing down standards at the same time, how very priceless. When this is combined with legislation that acts in the interests of big pharmaceutical firms and not patients by restricting GP dispensing, here we have a government that is frittering away our cash in order to keep big business happy. It seems this government will do anything to get their dirty mitts on more cash, it's just lucky for us that money can't buy them trust anymore.

World class idiocy

Type the words 'world class commissioning' into google and you'll unearth a goldmine of utter tosh, starting from the DoH's page on the subject. Apparently there are four key parts to this large hunk of management turd:

"a vision for world class commissioning, a set of world class commissioning competencies, an assurance system and a support and development framework."

Have a read and if you can honestly make any sense of the undecipherable management speak then please get in touch, because I can't. The document is littered with meaningless guff like 'adding life to years and years to life', it is utterly cringe worthy. Essentially all they're saying is that they intend to make health care better with world class commissioning, in the most long winded and nonsensical manner humanly possible.

The meat of this reform is hidden in the FESC section, that's Framework for procuring External Support for Commissioners in long. This is essentially privatisation by the back door again. PCTs will be enabled to directly commission work from independent providers, private providers in other words.

FESC is designed to privatise the NHS further, the PCTs will undermine the local NHS services by starving them of funds by commissioning their work to private firms instead. PCTs are turning into the biggest joke in the NHS, their bureaucracies never stop expanding and instead of actually paying those who know what their doing to do their jobs, ie the hospitals and local NHS services, they would rather burn our money in commissioning their own hair brained schemes.

It would be far too simple to fund our hospitals and local services properly, our PCTs want to starve these services of cash while lining the private sector's pockets. In this manner PCTs spend lots of money trying to avoid paying GPs and hospitals for the work that they actually do, increasing the bureaucratic inefficiency of the system.

The way in which DoH stooges try to dress up this agenda of privatisation as some kind of revolutionary breakthrough in the science of commissioning has to be seen to be believed, have a read of the incomprehensible Helen Bevan's explanation:

"The biggest risk is that the transformational aspirations of tomorrow get hijacked by the thinking of today."

No Helen, the biggest danger is that people will see through your camouflage of management mumbo jumbo and see world class commissioning for what it really is, yet another dishonest attempt to privatise the NHS that will have a devastating effect on local NHS services and standards of care. Mark Britnell's limp words sum up the Kafkaesque nature of this government campaign.

It may have passed the the moronic DoH apparatchiks who read the Health Service Journal by, but their ilk have been wrecking the NHS for the last eleven years, therefore why on earth should anyone believe the faeculent management speak that is spewed forth from their treacherous behinds. These apparatchiks are very good at producing meaningless waffle that claims they will make things better, but if these hollow words are not backed up by meaningful action then surely these failures should be shown the door? Unfortunately for us this government rewards lying and failure with promotion, so we have an NHS run by a proliferating network of dishonest cretins who have only just mastered shoe lace tying.

So as 'world class commissioning' grows, expect to see your local GP and local hospital starved of cash resulting in essential services closing, then watch and weep as the private sector is paid large sums to do the same work less well. This is world class idiocy.

Utterfraud in the Times

I don't believe I am on my own in stating that Thomas Stuttaford doesn't half love to pretend to be a master of everything. His latest offering concerns Deep Vein Thromboses (DVTs) and their sometimes fatal complication, the clot in the lungs called the Pulmonary Embolus (PE).

Dr Thomas comes out with some rather dubious statistics that the Department of Health has recently plucked from it's arse:

"DVTs and pulmonary embolisms are estimated, according to a recently published Department of Health report, to account for 25,000 deaths a year in British hospitals."

I would love to know how the DoH 'estimated' this figure, it may have involved the arse plucking that I suggested earlier. Dr Thomas doesn't stop there though:

"The figure of 25,000 fatalities may well be an underestimate because many patients thought to have died from a post-operative chest infection may in reality have initially suffered from small pulmonary emboli."

It may well be a massive overestimate too, as this figure is a complete guesstimate, this doesn't appear to have occurred to Dr Thomas though. His final paragraph then claims that many of these deaths are preventable and that a new drug called 'Pradaxa' will help in this regard:

"If adequate precautions were taken before someone undergoes surgery associated with a high risk of DVT, many of these deaths could be prevented."

Actually Dr Thomas you are completely wrong in this regard, there is absolutely no evidence to back up this statement that you make. DVT prevention (aka prophylaxis) in the form of various drugs has been shown to have no effect at all on mortality and symptomatic DVT rates.

Large cohorts of high risk patients who have received no prophylactic treatment have been shown to be at no increased risk of death compared with their counterparts who have been treated with expensive blood thinning drugs. Dr Thomas doesn't mention this, he seems very keen to blow the trumpet of expensive new drugs, is there a conflict of interest here that he is not revealing?

Hot air from Darzi

"Education, training leadership and the NHS review" was the topic for debate held at the Royal College of Physicians on workforce, education and training led by Lord Ara Darzi with Professor John Tooke, Professor David Sowden of MMC and Clare Chapman, Director General of the NHS Workforce.

Darzi talked of improvements needing to be made and a framework of accountability, but never touched upon how this would actually be done, while he also ignored calls for ring fencing training budgets. There was also a lot of banter about 'learning agreements' that were seen as some kind of magical fix by some, however how on earth they would force Trusts to take training seriously was not explained adequately.

Sir John Tooke saliently pointed out that there was no one in charge of training, that there was no one to blame if things went wrong. An excellent question was posed by Richard Marks of Remedy UK as regards the workforce planning as regards junior doctor numbers. Do we appoint trainees in a number proportional to the consultant posts that will be available in the future or related to the service needs? Clearly the government wants to flood the market with 'training posts' in order to force down wages by creating a sub-consultant non-training grade, this must be opposed.

Clare Chapman farcically talked of 'openness and honesty', I don't think she intended this as a joke but this is how it came across to me. Given that her malignant Department is behind the dumbing down of training and the deliberate creation of a surplus of demoralised doctors, I doubt her comments would pass a lie detector test. An excellent workforce point was made by Sir John and one Oncology trainee, who both pointed out that demands for particular specialists may change massively over short times; meaning that it would be sensible to ensure that all trainees receive several years of more generalised training before sub specialising, so that they are more prepared to adapt to future workforce needs.

Some superb comments were made about the naivety of educationalists who think that more training content can be easily achieved by fiddling with the bureaucratic elements of training. Darzi was then thoroughly unconvincing when he tried to explain the massive cynicism that the audience felt towards politicians, Darzi claimed that this cynicism was all part of 'democracy', he should have added in the word 'corrupt' before the democracy I feel.

The general dumbing down of undergraduate education was mentioned, as was the massive step backwards that competency based training assessment methods have been. Trainees have gone from being closely monitored by one senior clinician to being grossly unsupervised in their training. The excellent point was also made that doctors are being downgraded in the context of the MDT, doctors in training have to take a lot of the clinical responsibility but are treated with a lack of respect and sometimes disdain by other members of the MDT. If this kind of lack of respect and disdain was shown by doctors to other members of the team, then the doctors would be in great trouble; unfortunately with the current ethos of all Health Care Professionals being equal doctors are being downgraded and routinely bullied to satisfy the government's need to enslave the profession. Clare Chapman was quite pathetic in her comments on this topic.

Overall Darzi appeared all talk, there was a lot of hot air expressed as regards how genuine his role was and how things were so different at the top, with clinicians being engaged. This battle is only just starting, but it was clear from the overall opinion expressed that doctors are not happy with being treated undervalued and bullied by their employers; medical training needs to be completely depoliticised so that patients can be better cared for in the long term. Doctors genuinely want better training because they want to be good at what they do, hence they are fighting the government's desire to dumb down training in order to catalyse the privatisation of the NHS. I'd love to get Darzi on a lie detector.

PMETB - wrecking medicine

As entry standards for medicine at University are dumbed down in a rather politically correct fashion, PMETB continues to oversee the wanton destruction of decent medical training, with years of knowledge and expertise being thrown in the bin because the political stooges at PMETB would prefer to implement the unwieldy psychobabble that spews forth from the recta of educationalists.

Educationalists have a lot of waffle that they used to justify their half witted rubbish, they believe that they can pull the wool over our eyes by repeating words like 'reliability' and 'validity' until the cows come home. In fact A Levels and GCSEs have been dumbed down in the same manner as the Royal College membership exams, the MRCP and MRCS, by making everything so objective that is ceases to be a useful measure of anything at all.

Educationalists do not allow experienced clinicians to use years of their expertise and knowledge to judge candidates, they insist upon replacing tried and tested exams with tick box exercises that allow no room for subjective manoeuvre. In denying the value of subjectivity PMETB regulations have forced the Colleges to comply with their vacuous plans that enforce the dumbing down of training standards, in this way the surgical vivas and clinical exams that are assessed by top consultants are being replaced by OSCEs that can be manned by non-medically trained technicians. This is happening across the board.

PMETB has also dumbed down what 'training' actually means. The poorly worked Foundation program and MMC have resulted in thousands of posts that were previously non-training posts magically becoming 'training posts' overnight, despite the fact that these jobs still have no proper training content. This means that thousands of doctors in training are struggling to get the necessary experience because their job simply does not give them adequate exposure to the core of what they need to learn.

Competency based assessment is then used to pretend that the overtly woeful training is actually thorough and comprehensive. In the old days one had to do decent chunks of a wide variety of specialties to progress, meaning that one needed a broad base of skill and experience to progress to the next level. Now all one needs is a few bits of paper signed that prove one has done a few things once, and one is magically transformed into a super-competent doctor. The wonders of competency based training never cease.

In reality the great irony is that competency is not encouraged by competency based training. Competency is a very grey entity and one cannot prove one's competency by doing something once, and then getting a piece of paper signed. PMETB produces more turd burgers than the biggest dairy farms in the land, it is an organisation that has been found wanting in recent inquiries and investigations into it's complete failure throughout the implementation of MMC. So why on earth is PMETB still being listened to? Why are PMETB's educationalists still allowed to carry through the implementation of the dumbing down of medical training? Why are the competency based fundamentalists being allowed to triumph? PMETB should be wiped out of existence and we should only listen to the sound of it's explosion.

Who needs beds?

The imminent loss of 5,000 Oncology beds has been hitting the news this weekend. Apparently in order to improve our radiotherapy and chemotherapy services, these beds will need to be cut to fund the investment. It's all part of the great Darzi review that pledges to force reform upon the whole country in its uniquely undemocratic manner.

As has been pointed out to me by the ever aware A&E charge nurse "the UK population has grown by 17% since 1951 while the number of NHS beds has fallen by 40% since 1959 - we have one of the lowest bed per 1000 patients in Western Europe: 3.3 compared to 6 beds in Germany, to cite just one example."

Certainly keeping some people out of hospital is a good thing, however many of the DoH's reforms have wasted money in ineffectively trying to keep people out of hospital and in forcing patients out of hospital when it is clearly the most appropriate place for them to be. I also heard in the news that the budget for elderly care is to be trimmed by several billion over the forthcoming years, another example of the lack of joined up thinking in government, as with an ageing population and an increasing demand for care for the elderly, these short sighted cuts will only result in yet more inefficiency with old people blocking acute hospital beds as there is nowhere else for them to go.

The cut in Oncology beds is bizarre, as anecdotally I have heard of cases of there being such a shortage of beds locally that sick Oncology patients are having to be treated as in patients in waiting rooms and day rooms. Oncology patients get sick quick, radiotherapy and chemotherapy have some pretty serious side effects such as neutropenic sepsis, and these cannot be adequately managed in 'cottage hospitals' as the government seems to think. The Darzi philosophy seems to be all about cutting services and beds, while shifting sick patients into the community to save cash, I personally don't recognise this a progress.

The national bed shortage and near 100% bed occupancy rates have so many negative knock on effects in terms of patient care and efficiency that I could bore you with them all day . Around the country numerous operations are needlessly being cancelled because there are no beds in which to admit patients for their stay, meaning that surgeons, anaesthetists and theatre staff are often left to twiddle their thumbs in empty theatres because of this knock on inefficiency. Patients are frequently not cared for in an appropriate ward to suit their particular illness, as bed shortages mean that any bed sometimes has to do; this can sometimes be deeply inappropriate with adults being cared for on paediatric wards, and it can also result in significant morbidity and mortality as patients may be significant distances from their medical staff, while their specialist nursing staff may well not be familiar with the particulars of dealing with another specialities' patients, surgical nurses looking after oncology patients for example. The link between high bed occupancy rates and hospital acquired infection is for another day.

Overall the beds are cut and the inefficiency increases, economies of scale are ignored as the short sighted penny pinching results in the flushing of bank notes down the toilet on a rather regular basis. It makes me weep to see stooges like Darzi pretending that these reforms are in the best interests of patients up and down the country. If my mother was lumped on an orthopaedic ward with her neutropenic sepsis I would not see this as progress, I just wonder why Ara Darzi is so happy with this dismal state of affairs.