'Personal health budgets'

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

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

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

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

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

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

Inquest shows grave flaws in system

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

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

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

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

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

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

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

BMJ - the rapid responses

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

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

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

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

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

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

Lines in the sand drawn by idiots

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

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

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

Congratulations, what deserved awards

As always the names included in the honours list resemble much more a government ball lickers convention that anyone who actually gives a flying f*ck for public service. In fact in the current climate anyone who actually fights for the public interest is more likely to end up dead in a forest than on the honours list, that's thanks to the bunch of crooks we have in charge at the moment.

David Nicholson is to be knighted for his great services to the government, er sorry, the national health service I meant. So what has David done to deserve such recognition? Well he's been the NHS chief executive whilst the administration costs have gone through the roof, while the layers of bureaucracy and useless quangos have proliferated like randy rats on viagra, while numerous failed reforms have been forced through from the top where David incidentally resides in his big fat comfy chair.

David has been the NHS chief executive whilst such great schemes as the PFI, Choose and Book, Practice Based Commissioning, Payment by Results, the NHS IT farce, ISTCs and MMC have been forced upon the unsuspecting public. 'Reform' when it comes to the NHS has come to mean wasting billions in fiddling around with the process of actually delivering health care, rather than actually working out ways in which money can be spent effectively to improve the service.

David Nicholson has been one of the key men in driving through this agenda of expensive drivel, he has frequently been there to defend these bogus reforms by spouting some meaningless newspeak of the most disingenuous kind. He is now being rewarded for his loyalty by this corrupt award, this is how government works. Simply do a terrible job, act against the interests of the general public by serving your elite masters without ever questioning their right to dictate their dross and then you will be rewarded.

Professor Steve Field has also been rewarded for his loyalty to HMG, this man was a key proponent of MMC and MTAS, one of the most catastrophic failures in government health policy in recent years, he has also been involved in the governmnet's incoherent and shambolic handling of the swine flu 'crisis'. It is no wonder that the NHS is guaranteed to fail when failure is rewarded so very openly and corruptly bu our lovely government.

NHS Parking: Media misses the point

The BBC and mainstream media seems pretty interested in the government's talk of making parking fees fairer at UK hospitals. In my opinion it has long been unacceptable to expect patients and relatives to pay inflated parking fees for various essential hospital visits.

The most outrageous thing that has gone on the last few years has not been these fees for patients and relatives, it has been the introduction of huge fees for staff to park where they work. Virtually every single NHS trust I know now charges staff extortionate fees to park at their place of work. This is an absolute scandal. Not only has pay been going up at rates well below inflation but staff are essentially having their pay cut with these despicable parking fees. I wonder which other companies charge their employees such large lumps of their pay for the privilege of parking at work? Which other employers treat their employees which such utter contempt and disdain?

The waste is as a result of privatisation

As I slowly recover from recent purulent events it appears that the NHS does not stay far away from the headlines at any time of year. The Telegraph leads with a story which has been championed in these parts on more than one occasion, it is about the rank waste that is going on as the government has fiddled around with the bureaucracy needed for an internal market. Make no mistake this is not the waste of a 'Soviet-style' system, in fact before the internal market was introduced around two decades ago the NHS was very light administration wise.

It is no coincidence that administration costs have proliferated since the government created the internal market and started to privatise a state delivered system. The current system may be state funded but it is increasingly not state delivered, and this means that the increasingly complicated networks of bureaucracy set up in order to stage manage this corrupt network of pseudo-competition are costing more and more and more to run. The actual figures are rather scary, the rise in 50% over four years is nothing short of a national scandal. The fact that the Tories are claiming to be able to cut these costs sound very dubious given that their health policies consist of yet more right wing ideological drivel.

David Cameron has been caught meeting with an ex-nurse with some rather dubious intentions of Nurses For Reform (NFR). NFR have some rather strange ideas and are typical of numerous politically corrupt groups that trot out the same repetitive ideology that is based in fantasy and not reality. Look beneath the surface and NFR are just another part of the political network that consists of the likes the the Adam Smith Institute, Free Market Cure, Libertarian Alliance et al. These people pretend to be acting in the interests of the public, but in reality they are simply vultures representing the interests of various private interests that pay their way. Helen Evans and her kind are the worst kind of politician, they pretend to care when they clearly care for no one but themselves.

The problem is that in the UK at the moment we have no choice between the lame health policies of one party and the lame policies of another. All the major parties are too weak to stand up and do what is right for the public, they are all putty in the hands of the currupt lobbying network that is meant to represent democracy these days. It is refreshing to see President Obama taking this corrupt system on and fighting for the good of the people, it has been no surprise to see that complete lies and vitriol that have been spewed forth by the right wing morons stateside in trying to hold onto their useless rich man's system. State run medicine has its problems, but compared to privatised medicine they are trivial in nature, and despite what some right wing cretins may say there simply is no utopia when it comes to health care or anything else.

Feeling the pain and fighting another day

As a doctor it is certainly true that one's experiences as a patient can really open one's eyes, not that one is keen to have too many of these experiences of course. However not many of us are that lucky. I had a bit of a niggling abdominal pain at work last week, tried to ignore it, slept on it and then woke up in the early hours shivering in absolute agony. Even a whacking dose of morphine didn't touch the pain, fortunately for me I was rushed to theatre on the next day's list and they whipped my appendix out, as well as draining a few hundred mls of pus from my abdomen.

The pain had only just begun. I was shortly moved out of my side room onto an open bay ward that was pretty much as noisy as Paddington station 24/7. My small bowels were on strike, the perforated appendicitis had resulted in a paralytic ileus, not something i would wish upon my worse of enemies. It is hard enough to recover from the aforementioned in pleasant surrounds, but when one cannot get a minute's shut eye for love nor money this kind of experience can become a true living nightmare. One night I did not even sleep five minutes as a result of the combination of tortuous devices that the hospital possessed. If it wasn't for the support of those close to me then I truly don't know what would have happened.

The buzzers are so loud that even the deaf from miles around are kept awake, why no one has ever thought to have a light activated system rather than one which wakes up every patient every single time one patient buzzes for help is quite beyond me. The noise and light generated by patients being admitted directly from A&E to the ward as a result of the 4hr targets means that the bay ward is routinely a busy well lit admissions unit at night time, not appropriate when there are sick patients trying to recover from some rather serious conditions. The complete and utter lack of discipline and leadership on the wards was obvious, visiting hours were not enforced at all, noisy families stayed for hours on end making far too much noise gassing on mobile phones and disrupting the rest period of the sick. The night nurses were routinely noisy and seemed not to consider the fact that patients may wish to sleep at night.

I did not want to stay in hospital a minute longer than I had to and this should not be the case. The surgical care I received was great, the nursing care was great other than one nurse who did not care and whose command of English was a disgrace, even the food wasn't that bad from what I saw because I wasn't eating for a great chunk of my stay. Hospital should be a place in which patients can recover from illness, it should not be a orderless frenzy of chaos in which the sick are driven mad in trying to get a moment's peace and quiet. Sleep, rest and relaxation and all so important as part of the body's healing processes, it is a great shame that we show them so little respect at times. Happy Christmas and New Year one and all, thank you for reading and special thought goes to anyone unfortunate enough to be spending Christmas in hospital this year.

Tamiflu fog and the swine flu hype

I always suspected that the 'swine flu' hype would turn out to be nonsense, the weak government and its stooges like the CMO, Liam Donaldson, wanted to create a wave of public fear and profit from exaggerating the dangers of the disease. It is class Orwellian stuff for a weak regime to exaggerate an external threat so that they can profit from trying to appear all powerful and masterful in dealing with the threat that inevitably turns out to be not much of a threat at all.

The much hyped threat of 'swine flu' appears to be dying slowly as a frenzy of controversy surrounds the drug company Roche which has made billions from flogging lots of its 'Tamiflu' drug to numerous governments around the globe. This week's BMJ makes fascinating reading for once, I would strongly urge anyone with any interest in medicine, political corruption and conflicts of interest to take note of all that has been written on the subject. In particular I find the weak defence of Roche by Roche to be extremely limp.

The way in which a drug company made billions by flogging a pretty ineffective drug 'Tamiflu' based on the misrepresentation of trial data that was never fully released and certainly never subjected to the rigor of a peer review is very very dodgy indeed. It demonstrates just how the full and real scientific evidence is never properly out in the open and how the system is so very open to manipulation in the name of profits against the interests of patients. This is not just the sale of overpriced mineral water for profit, it is the sale of an expensive and ineffective drug that has some rare but serious side effects. Roche and the world of big Pharma have a lot more to do before they can come anywhere near a pretence of honesty, they should be deeply ashamed of themselves in my opinion.

Baby P: the systemic malaise

If a doctor or nurse acts negligently then there are well trodden paths for their punishment, there is the GMC for doctors and the NMC for nurses. 'Self regulation' is a bit of a misnomer to say the least, as both the GMC and NMC are effectively government run organisations and this needs to be considered when one considers just why some doctors and nurses are so harshly punished.

It is undeniable and obvious that any organisation with an open and honest approach to dealing with its problems will deal with them quicker, better and more effectively. The NHS invariably deals with its problem in a dishonest and hidden manner, this is because it is not run for patients, it is run for the needs of politicians and as a result they do not want their corrupt motives to be seen out in the open. As a result of the government's malignant intentions there is currently a massive conflict of interests between the frontline clinical staff (the doctors and nurses et cetera) and the managers. The managers are the agents of the state while the frontline staff want to give their patients as good a service as possible, hence the obvious conflict.

The Baby P case is a great example of this glaring conflict and it has shown us that the managers did nothing until a child died, despite multiple warnings of the obvious problems from the frontline clinicians. Obviously the Trust in question tried to scapegoat a doctor, but it is rather clear that the clinicians were stretched well beyond any reasonable limits in this case. There have been quite a few sackings following the baby P case but does anyone out there really believe that the real villains have been identified? The baby P report is a whitewash that seeks to pin blame on paediatricians and whistleblowers rather than pin blame where it is deserve, ie at the door of the politicians and unelected cronies who have made the decisions to cut costs and consequently the standard of service.

To me it seems that the problem here runs right to the top of the health service management, those politicians who have been behind the privatisation the NHS at all costs are most to blame. The problem is that patient care is no longer the most important thing in the NHS, the government has made numerous things more important than patients such as financial deficits (because of the loony internal market), foundation status, performance targets such as the 4hr wait and on and on. The HCC/Ofsted and CQC are only interested in gathering their political propaganda for the government, the message is that you will be rated 'good' or 'excellent' if you fiddle the stats to keep the politicians happy.

We have a network of organisations and bureaucrats working to keep the supreme leader Gordon Brown happy, if a few patients such as Baby P get killed in the process then our leaders don't mind. In their eyes the ends justify the means, a privatised health system justifies the shabby standards of care that patients have had to put up with a result of this gross waste of funds on these lunatic ideological reforms.

Doctors and nurses can be struck off in the process, and sometimes this is a way of pushing blame away from those that make the really negligent decisions. I just find it strange that those that really have the power to make the big decisions in the NHS, that can kill lots of people when they go wrong, are never held to account for their actions. Politicians and managers are just moved sideways, doctors and nurses are sacked or struck off, where is the justice? Until whisteblowers are listened to and not burnt at the stake the NHS will continue to rot and the baby Ps of the future will continue to die in such very avoidable circumstances.

Hospital regulation: CQC vs Dr Foster

Personally I have no confidence in either the Care Quality Commission or Dr Foster. One is a quango run by government appointed stooges and the other is a private firm that has been very cosy with certain government figures in the past. In fact the history of Dr Foster must be understood to realise just what vested interests are at play here.

A big problem is that the CQC is clearly an ineffective regulator. Their inspections are announced and can therefore be sidestepped quite easily by failing hospitals. There are also a number of problems in that whistleblowers are not protected and are in some cases being gagged by their NHS contracts.

Dr Foster is also far from neutral and its methods are far from robust. Dr Foster relies on the HSMR (Hospital Standardised Mortality Ratio) and this is not a reliable measure. For one thing hospitals serve very different populations and for another the HSMR can be fiddled by dodgy coding. The HSMR also only counts those that die in hospitals, so if you can discharge your patients before death then the HSMR will notice absolutely nothing wrong.

It is clear to me as a professional that works in the NHS that we need much better and much more robust hospital statistics that are independently gathered and analysed by a neutral group of proper statisticians with no vested interests. This would be the best way of rooting our problems with our health care system. As things stand the government regulator is useless and the statistics out there are rather crude and unreliable, trust the CQC or Dr Foster at your peril.

Walk in Centres - money up in smoke and the cancer farce

It turns out that Lord Darzi of Denham's great idea, the nurse-run Walk in Centre (WIC) been an expensive disaster. Not only have these WICs provided a dodgy service that has led many people to be simply referred onto AE or an actual General Practitioner with a medical degree, but they turn out to be incredibly expensive at over 50 pounds per consultation.

Walk in Centres are bad in many ways, they result in further fragmentation of the continuity of care that is so important for decent patient care, they are also often put into place in a way that undermines local services by taking a lot of money away from far more efficient services. The APMS route is clearly a corrupt farce. Professor Pollock sums it up well for WICs, they are great for:

"the instant gratification for the walking well"

And not much else from what I've heard and seen myself. Some of the mickey mouse medicine that goes on at these Fisher Price units beggars belief. They really demonstrate nicely the fact that the government wants privatisation at any cost, quite literally.

ps it is funny in a dark and sad kind of way that the government is trying to blame GPs for taking too long to refer cancer patients to hospital specialists, strange that this is from the same government that can't spare a few million to save the NHS as numerous PCTs run out of cash and order GPs to cut their referral numbers. So on one hand GPs must refer less as there is no money, but on the other they must refer more to increase quick cancer diagnoses, can GPs possibly win?

Clinicenta death and contract suspended

This recent story is just the tip of the ISTC iceberg. Recently another private firm's dangerous practice had led directly to at least one very preventable patient death.

It seems that despite getting paid at a rate at which the NHS can only dream of, Clinicenta is struggling to provide a safe service in London and their work has been transferred back to the local NHS providers. What a sad waste of tax payer's money.

These kind of failures seem to be largely buried in the news and the general public is not as aware is it should be of the disasters that have gone on as a result of this shady program of unaccountable privatisation. The health service's running should be completely out in the open, not hidden as a result of commerical confidentiality. Some people need to start joining up the dots.

What value a medical degree?

It seems that the Australians have more balls than the British, down under the Australian government is trying to force through various destructive dumbing down reforms that empower those without medical degrees to jobs that previously required much higher levels of education and training. The Chairman of the Australian Doctor's Fund is clear with his message:

"Who would subject themselves to the rigours of a medical degree when it is so much easier to obtain a nursing degree and be jumped into a medical role?

In other words Ms Roxon has to decide whether she wants doctors or nurses to be the ultimate decision maker on the care of patients. Sadly our leaders seem to be unaware of the problem or seem to think that simply by announcing it, their job is done. Sadly those driven by ideology rarely succumb to reasoned argument; backed by million dollar budgets and armies of public servants they play with their half-baked ideas and impose them on those who know better.

It is our duty and our intent to prevent these destroyers of the culture of medicine from achieving their goals. It is our duty to assert and intervene in all possible ways to make sure that a medical degree, and all the discipline required to achieve it, is given its rightful place, namely signifying leadership in medical care.

This is the model that has delivered Australians world-class medical treatment. There is no reason or compelling case to dismantle it.

When I worked in England many years ago I was appalled that there seemed no one who took personal responsibility for a patient. Let us not go down the same road here."

Ms Roxon is the Health Minister who is coming up with the half-baked ideas, the parallels to the UK are obvious, and these half-baked ideas are very much a threat to world-class medical treatment, once the dumbing down starts it is hard to stop. The Australian Government is also trying to replace GPs as the cornerstone of Australian medical practice, in a way that draws striking parallels to what the Labour government has done here in order to usher through the privatisation of the NHS. A former Australian Medical Association chief has this to say:

" If nurses want to be doctors, trained to take a history, examine, investigate, diagnose and
formulate a management plan with the depth of knowledge required for the possibility of
differential diagnoses, then they should apply to medical school…."

This quote from another big cheese shows how the Australians are trying to push through exactly the same dumbing down agenda as has been done in the UK, it matters not what education, skill or training anyone has, you can all be 'doctors'! But then what will the word doctor come to mean?

"And, interestingly, there is a push for another change – namely, that all practitioners
working in primary care, irrespective of their qualifications and expertise, be now called
“doctor”. Such a collaborative model readily brings to mind the sovietisation of health
care."

There is a problem with bananas, this half-baked philosophy of cutting the number of properly trained staff won't even save money; it is expensive, bad for patient care but it does allow the government to push through it's privatisation schemes more easily. The NHS Skills Escalator looks like it were drawn up by a braindead slug on crack, but sadly this is a creation of our retarded overlords in government and it is being pushed through regardless of its utter stupidity.

Good luck to the Australians in resisting this destruction of their excellent health care system, it will be hard as the government have buddied up with the Australian Nursing Federation and seem determined to repeat the damage that has been done in the UK. They have established a 'National Health Workforce Agency' which may well be another prong in their attack on medical professionalism and standards.

It is sad that there are so many people out there who are too stupid to see the wood for the trees. It matters not whether people are called doctors, nurses, paramedics or monkeys. The labels to things do not matter, relabelling a useless product does not make it better. It is as simple an argument as less education and training makes for a lower quality of care. After all if the government announced plans to train doctors in about three months then I am sure everyone would be up in arms, so why do some idiots find it acceptable to convert nurses into doctors with an even shorter period of training? There isn't even any decent evidence to show that it is safe. In life you get what you pay for, less investment in training people properly will get you a poorer service, it won't magically save you money and provide as good a service.

"The Cochrane Collaboration summary on the equivalence of GP-led and nurse-led care has more disclaimers than a set of K-Tel steak knives. Most damning is the statement that these findings “should be viewed with caution given that only one study was powered to assess equivalence of care, and many studies had methodological limitations”. So, Australian policy-makers, reformers and governments beware – 50 years of general practice hard slog has resulted in international benchmarking for key health outcomes, and unsurpassed general practice patient satisfaction."
(Prof Claire Jackson, The ‘little sick/big sick’ myth of general practice, Australian Doctor, 19/10/09)

Junior doctors deserve no rights

According to this 'consultation' document from the Department of Business, Innovation and Skills the rights of junior doctors are to be completely ignored yet again; apparently medical deaneries, the bodies that are responsible for the recruitment and training programme of junior doctors to NHS Employers, should be 'exempt' from employment agency legislation.

It begs the question, why should deaneries be exempt from employment agency legislation when they are effectively acting as employment agencies? It is a bit like saying that one particular murderer doesn't have to be prosecuted because the law doesn't apply to him like everyone else. The pathetic justification for this is:

"This is based on evidence that the potential consequences could be to seriously hinder the recruitment and training arrangements of junior doctors with a subsequent impact upon both cost and staffing for the NHS"

This is a disgrace to put it mildly. The government are effectively saying that they want to treat junior doctors as subumans because this way it is cheaper and easier to fill the jobs up. If sticking within the law is so hard for deaneries and the government then they should take a long hard look at the shabby and substandard way in which they treat junior doctors, shepherding them around like cattle and not giving a minute's thought that they may be entitled to lives and rights like other human beings.

At least the BMA will stand up for the junior doctors, right? No, wrong, the BMA have met with the Department of Health to discuss treating junior doctors like slaves and they are to draw up a completely toothless code of conduct that deaneries will just ignore because it's not the law. Interestingly Remedy were not invited to this 'discussion forum', strange that. So much for all humans being equal, it seems in the eyes of the government junior doctors do not deserve the necessary protection of the law when seeking employment, it is just too costly to treat them as humans.

Who will do the nursing?

Much talk has taken place in recent days on plans for all nurses to be trained to degree level from 2013. I think a lot of the chatter and debate has missed the point. 'Degree level' is just a label, it doesn't mean a great deal on its own, I think the problems with nursing training are similar to the problems with medical training that have become apparent in recent years.

Good old fashioned basic nursing has become devalued as an entity in recent years, it seems that an apprenticeship in one's trade is simply no way to learn the ropes in our current politically correct times. Basic things such as feeding patients, washing patients and attending to bedpans are beneath some modern nurses. A little knowledge can be a dangerous thing, a quick superficial glance at the science behind medicine seems to have inspired quite a few nurses to bit off a bit more than they were able to chew.

I do not wish to single out nurses, the same types of problems exist with the training of doctors. The basic science has been dumbed down, the apprenticeship has been lost and the ward hours are just not there anymore. The same is the case for nursing training, the ward hours and apprenticeship has been lost at the expense of satisfying politically correct mumbo jumbo spewed forth by educationalists. The subspecialisation of educationalism is to blame for a lot, invariably idiots who were not very good at the job end up doing all the teaching despite the fact that they haven't been on the front line for years.

This loss of the apprenticeship and the reduction of basic standards is a direct result of one thing, money, the government does not want broadly trained competent workers who have learnt the ropes adequately, they want to isolate individual competencies and shift work down to people who have had way less training than in years gone by. To see this in action all one has to do is see who does most of the basic nursing on wards, it is done by 'health care assistants' who have had very minimal levels of training, they are the modern day nurses.

Nursing is no longer good enough for modern day nurses, a lot of them now go into nursing as an easy route to becoming a quasi-doctor or 'noctor'. In life you get what you pay for and less training and knowledge inevitably results in a lower quality of service for patients. Many nurse specialists who specialise in areas which are suited to their skills and training, for example stoma care nurses, district nurses or various sub speciality liaison nurses, are a great asset.

The problem comes when nurses are promoted into jobs that demand a broad based understanding of medical diagnosis and management, for example the nurse in the Walk in Centre who practises independently or the scarily 1984-esque nurse 'consultant'. Some experienced nurses can just about get away with it, some of the time, however when inexperienced nurses are given these roles the consequences can be rather disastrous as well as expensive. One example is the massive failure of nurse-run Walk in Centres to reduce referrals to other health services.

The government cares not for quality of care, all is interested in is privatising the NHS and selling it off to private corporations. Breaking the medical profession's monopoly on doctoring has been part of this corrupt privatisation process. A side effect of this has been the devaluing of proper nursing which is sad to see. There is a real need for patients to be properly nursed and in the future we'd be better off having nurses doing nursing, rather than letting anyone with a couple of weeks training take their place and moving trained nurses into jobs that are outside of their expertise and training.

Who will do the caring?

The BBC has reported on a government report which claims that around 2,000 people's deaths each year are contributed to by the innappropriate prescription of anti-psychotic drugs for patients with dementia. The report claims that:

"But the expert review - commissioned by ministers - said the treatment was unnecessary in nearly 150,000 cases and was linked to 1,800 deaths."

This is all well and good, but when one sees the prescription of anti-psychotic drugs in the context of a care system that has been almost entirely privatised and ground down to the very bare bones, then the government's sticky plaster of a response is nothing but pissing in the wind.

The government wants better access to other kinds of therapy, more training for care workers, more monitoring and a new national director. I wonder where all the money for this will magically appear from given the NHS' budget crisis?

Also it is strange that the government has done so very little to regulate the care industry in the UK in recent years. It used to be largely publicly owned, but after the last twenty years or so of destructive reforms, it is largely privately run for profit. This also means that the government cannot force changes upon the system anymore, as the private firms hold all the card in terms of ownership and lobbying power, they have been very resistant to proper regulation in recent years.

This has meant that many care homes are dangerously short staffed and the staff present are invariably not sufficiently trained for the jobs they do, the government watered down regulation changes a few years back that would have forced a maximum number of patients per staff member. No wonder anti-psychotics are being dished out like smarties, there simply has not been the right number of properly trained staff to adequately manage the most tricky patients with dementia.

The privatisation of a service that should be accountable to the public has led to it being run down in the name of profit. This government and previous governments have caused the care of our elderly to be so woefully neglected, they simply don't want to pay for people to be cared for properly to the grave. This report is yet another dishonest piece of spin designed to take attention away from their own failings.

PCT deprives NHS of cash to to council's job

I read this story in the newspaper that demonstrates how completely stupid those in charge of alot of the NHS' cash are, the Mail covered this story of Durham and Darlington Primary Care Trust (PCT)'s decision's to spend 1 million pounds of NHS money on gritting the county's roads.

"This money will be spent in a variety of ways but, in particular, on gritting extra paths and pavements which will result in improving the quality of life for the elderly who often fall and fracture bones in icy weather. It will also go towards additional road gritting as road traffic accidents have a major health impact and often cause death or lifelong disability for the individuals involved."

This is the logic of a fool. By this logic PCTs could spend money on filling in pot holes, repairing roads, checking vehicle safety, renovating old buildings, improving playgrounds, arresting dangerous criminals, policing the roads, collecting rubbish et aliter. Many other areas of policy can affect health, but this does not mean they should be funded directly with NHS money. This is plain barking mad.

As hospitals are being starved of cash by PCTs, because the uneducated morons in charge of the PCT's funds decide to fritter away money on non-health related issues and on health related schemes that have sod all good evidence to back them up, we see the banks continue to be propped up by the government because they cannot be seen to fail. Why can hospitals be seen to fail because PCTs are wasting all the money they need to provide decent local services for local people?

It has been many years in the making, but the way in which the most educated and knowledgeable are not involved in deciding where NHS funds should be allocated is a national scandal. Epidemiologists and Public Health specialists are now routinely uninvolved, while empowered general managers with no understanding of medicine in tandem with a sprinkling of uneducated idiots are literally pouring petrol on this bonfire of tax payer's cash.

Johnson and Brown: two idiots of the highest order

The Prof Nutt saga is not going away unfortunately for the incompetent duo of Gordon Brown and Alan Johnson. The disgraceful sacking of the eminent Professor is turning into quite s sh*t storm, and quite rightly so. The more information that comes to light, the more corrupt and stupid the politicians appear. Dr Grumble has pointed out yet more flaws in the government's weak line of logic.

Alan Johnson accused Professor Nutt of becoming political with his statements, in fact what he said prior to his sacking was simply a well rehearsed and well researched scientific argument that was backed up by solid evidence. All of Brown and Johnson's comments on drugs have merely shown an immense lack of understanding of the evidence and a pathetic tendency to appeal to the lowest scaremongering sections of the tabloid press.

Skunk is not 'lethal' as fat Gordo stated, in fact by Johnson's logic Brown should resign as he is clearly straying into the scientific domain with this political statement. Johnson is just as bad as Brown with his illogical statements that he has released in order to justify the unjustifiable.

This is a simple issue and it comes down to the government having no balls. Brown is a weak incompetent leader who will do anything, no matter how wrong or dishonest, to win a few votes. Brown has routinely ignored experts on issues of which he and his fellow morons in power have no clue, he is too stupid to have any insight into his own lack of knowledge, he is a first class buffoon. This affair is not going away, it is about important principles, the resignations continue and I sincerely hope that it has done some good in exposing the rank stupidity and arrogance of those leading our country.

Ex-postman sacks Prof Nutt: government shows contempt for independent advice

Professor Nutt has been told to resign as chairman of the Advisory Council on the Misuse Drugs (ACMD) after a series of controversial outbursts including accusing ministers of ignoring scientific evidence to distort the drugs debate.

This is a disgrace. It makes an utter mockery of the government bothering to have any so called 'independent' advisers. Prof Nutt had the audacity to tell the politicians how it was, i.e. that the politicians were pandering for votes by spreading propaganda and scaremongering, and in the process they were ignoring the scientific evidence.

Policy should be based on evidence as best it can, it should not be made up in order to satisfy the tabloids and it should not be drawn up by people with no detailed knowledge of the particular policy area. Just imagine what this kind of pathetic bullying does to all the government's independent advisers, they are hardly going to be inspired to giving their honest opinion in the future are they?

This government is an utter disgrace.