Trust. The only way to save the NHS?

The I Pay Your Salary brigade, such as our very own resident IPYS acolyte, No-One, are well known to public servants throughout the country. Presumably every country has them, but the British ones seem to be the most rude and extreme ones in my experience. Perhaps that's because rudeness and mistrust are so endemic in Britain. France has the highest levels of mistrust of public figures in a recent study.

Mistrust and public rudeness are very negative things for an economy, business climate, and social structure. Modern economies are founded on systems of trust and when either that trust breaks down or is perceived to break down the economy suffers badly.

Tony 'Scars on my Back' Blair did not trust public servants. Neither did Thatcher. In fact, mistrust and systems-of-control (financial in the case of Thatcherism, structural in the case of Blairism) are central to the Blatcherite ideology.

We see this, in the NHS and elsewhere, expressed as a constant Reform culture. The NHS keeps getting worse, and the current ideology says that this must be due to public servants that are selfish, lazy, and/or stupid. The intuitive solution is: more management.

And yet, as more management is applied, things continue to get worse. So, of course, more management must be the solution. The promised land is just over the next rise! More management! Like the cultists who stuck with their leader even after he falsely predicted the end of the world over a thousand times, the failure of reform to work is seen as a sign that we did not reform enough. The ideology allows no other solution.

And yet, it seems obvious to me that the more reform is applied, the worse things get. Sure, there are some positives - for example, the four hour target has put more resources into a chronically underfunded A&E system. But, on the whole, these positives are accidents. You could have had a far better effect on A&E waiting times, without the dangerous corruption of the service, by simply providing more funding to professionals who were working flat out to keep times down all along.

Meanwhile, the percentage of the NHS budget spent on management continues to climb. And the percentage of time spent by highly trained professionals - GPs, consultants, and senior nurses - on management continues to climb. And climb. And climb. Bear in mind that the NHS budget has shot up so the amount spent on management, as the percentage of that budget climbs, is huge.

At it's inception, the NHS spent 2% of it's budget on management. The Tories never trusted the professionals, and started an enquiry aimed at showing that better management was required and that the professional-led service was inefficient. That enquiry showed the opposite. The NHS was efficient. Nonetheless, the politicians have never been able to believe this. When Thatcher introduced her reforms in the 80s it climbed to 12% of the budget.

But simply trusting professionals to get on and do the best job possible for patients. It is counter-intuitive for people like No-One. They will never accept it. They will continue to blame the 'professionals' for all of the problems. Will the No-Ones of this world every grasp the truth? Will they ever be forced - screaming and kicking - to look into the mirror of their own guilt and folly? History would suggest they will go to their deaths convinced they were right.

I once had fun driving a reverse-stearing Land Rover on an off-road course. The No-Ones, Tony Blairs, and Thatchers are driving a reverse-steering NHS: no matter how often turning the steering wheel left results in the car going right, they refuse to accept that they might be getting it wrong.

In the meantime, I'm going to dream of an NHS utopia with no managers. No targets. No intrusive distrust. A utopia where doctors and nurses get on and do the best for their happy patients.

I'll leave you with one interesting thought: the most efficient health care system in the world is arguably the Japanese one. It's hospitals are almost bankrupt, and it's doctors don't earn much, but it is efficient and popular. Japanese patients beam with delight at being able to simply turn up at a GP clinic during office hours and wait to be seen. They may wait a couple of hours, but they think this is a great system. The GP only sees them for an average of three minutes, but the Japanese love it. I knew a single-handed GP that ran a similar system. His patients loved it, but they were a self-selected group (there was another practice next door that ran a more traditional 10 minute appointment system). I wonder how No-Oneites would feel about such a system? Would they be as gushing about it as the Japanese patients I saw were?

Oh how the government despises Nurses!

Yet another example of how much our 'government' cares about the people that work in the NHS. Or perhaps it is just an example of how the government cares about people in general. (BBC Story)

Basically, the NHS poached a third-world nurse because so many UK trained nurses leave the profession because the UK taxpayer is too fucking mean to pay a reasonable amount of tax to pay nurses properly or provide staff:patient ratios that are not inhuman.

Having ripped off the Phillipines, who can ill afford to pay to train nurses and then lose them to the NHS, the NHS then goes and kills the poor fucking nurse during childbirth.

Not content with this, the Home Office then deports her husband and children.

Normally I would rail about patients lying in their own shit, vomit, and blood at this point. However, today I think patients deserve it. We are a corrupt, selfish, nasty, little country. And we voted for it.

The Dr Rant Trollonymous Competition

Will No-One attend the prize giving ceremony?

Regular readers will have noticed that No-One/Anon is off his meds again.

The Dr Rant team is, as always, grateful to the yawnonymous guru for boosting traffic to the site, but as always we are bemused as to just what kind of person would spend all of their time trolling medical forums in this way.

So, please post below your preferred diagnosis, description, motivation, guttural attack, or imagined life circumstances that they feel best fits everyone's favourite medical Troll.

The poster of the wittiest (or, failing that, most offensive - we are not picky) description will receive a free copy of Allyson Pollock's NHS Plc (or another of the 'Dr Rant reads' selection of their choice from the sidebar).

Happy Troll Hunting!

Frank 'n Team

Junior Doctor Training a Fiasco Shock!

Dr Rant is astonished to discover that MPs have branded last year's Modernising Medical Careers as a disaster.

The cross-party group of MPs said there had been inappropriate governance, management and communication by the Department of Health, while chief medical officer Sir Liam Donaldson had failed to take responsibility despite being the architect of the reforms.
And they said the new application system, which has now been scrapped, was little more than a "creative-writing" exercise that failed to recognise the best applicants.

The BMA comes in for criticism too. The bastard NuLabour-loving BBC helpfully does not distinguish between the Quisling BMA leadership arse-licking the DoH and the Heros of the Revolution Remedy UK who the BMA stabbed in the back with doctors own money, the evil fucks.

The Devil has a more accurate take on the BMA:

is it not the case [Dr Meldrum] that you are now head of the BMA only because your predecessor had to resign?

And is it not true that the main reason for said resignation was because of the BMA's unquestioning support for the government's position?

And is it not also true that, so egregious was your support for government policy on MTAS and MMC, doctors set up a new organisation—Rememdy UK—to represent their interests?

Further, is it not true that the BMA supported the government to such an extent that it even testified on behalf of the government against Remedy UK?

And, finally, do you think that—just maybe—all of this might fairly be described as "a damning indictment" of the BMA's "failure to listen" and, as such, that you should shut your fucking face, you fucking hypocrite?

Well, knock me down with a feather! Who'd have guessed it?

MMC - Medicine Mismanaged by Cunts (blast from the past!)

The fuckers. noun

Fucking fucks. adjective

Fucking fucked. adverb

The fucking fucks have fucking fucked the fucker. entire sentence

FUCK ! FUCK! FUCK! exclamation

FUCKETY FUCK FUCK poetry


The thoughts going through doctor's minds as the slow motion train wreck that is Modernising Medical Careers hits the buffers this week.

Modernising. Yes, I suppose you could say that turning a highly regarded education system which is one of the best in the world into a kind of cheap, bargain basement, like-it-or-lump-it, farce that it has now become is a very modern thing to do. Not a good idea, but a modern one. Presumably we'll be able to spot modern patients because they'll be the ones dying horribly in a pool of their own vomit and blood while their 'modern' doctors scrabble around to find a physician who trained before 2007 who actually can do the job (after all, their 'modern' nurses don't nurse any more, so why should 'modern' doctors be able to doctor?).

Medical. We'll, yes, it is medicine. But not as we know it, Jim. No, this is not an ancient profession. This is not a highly trained elite who have an age old code of ethics. No, medicine is now a technician level job done by people who are willing to bow down at the alter of Fundamentalist Capitalism and worship. These will not be the doctors of old who say 'First do no harm!', these will be test-monkeys who will do their masters bidding. In the future doctors will not dare to question the policy of throwing the poor and the infirm out on the streets still sick and dying. They will not question the inequalities that their predecessors fought so hard to eliminate - overcrowding, poor housing, child poverty, poor education. The Victorian era of the rich riding roughshod over the poor and the infirm is once again with us, and New Labour (what an irony that the party of the working people should be taken over by Blacherites who worship extreme capitalism) cannot afford to have professionals stand in the way of their capitalist utopian dream. Fuck the poor. Fuck the infirm. Fuck the poverty stricken. Fuck the hopless. Fuck the ill. They are all a drain on our society. They cost MONEY! The great God Of Capitalim must not be angered. No money? Then Fuck off! Swore an oath to protect the poor and the infirm, did you doctor? Fuck off! Bring in the Medical Technicians!

Careers. Yes. Careers. The careers of a generation of high achievers. The best we have. The Altruists who chose not to chose the money and power of Law and Accountancy and The City. Good people who say at their interviews 'I just want to help people'. Heros who study hard, work long hours that they are often not paid for, and do the hardest jobs. They tell people they are going to die. They tell them their children have died. They put their hands inside bodies to try and fix broken people. They experience things that other people only see in times of war. But, what the fuck. Let's just flush them down the toilet. Who needs idealists in a time when the POUND/DOLLAR/YEN are all that matter? Who are these fools who could have had real jobs working with money and made far more income than they do in medicine? What a bunch of idiots. Wanting to help people. Spaktards every one.

No, this is not 'Modernising Medical Careers'.

This is 'Medicine Dumbed Down and Patients Murdered in Their Tens of Thousands by Evil Self-aggrandizing Shits'.

But M.2D.P.M.3T.E.S.S. just doesn't have that 'modern' Management Consultant ring to it (and, therefore, no doubt costs several million pounds less than the snappier 'MMC').

Oh, and the Quisling doctors (ie: the Great and The Good of the Royal Colleges and the BMA) who helped this happen, or failed to stop it, had better pray that they die before they have to suffer at the hands of this 'Modernised' NHS. I figure things will really start to go wrong when most of the consultants that trained properly under the old system have retired. About 10 year from now.


This article was first published on 03.03.07 and is republished to co-incide with the MP report into MMC.

Private is better!

After the roaring, internationally renowned, success that was the opening of T5, Dr Rant thought it would be sensible to look at the privatisation of that other useless pinko-lefty commie organisation full-a-wasters, the Royal Mail.

About time too! Dr Rant has for far too long had to suffer from a single national carrier that delivers 95% of it's first class letters next day, and a world-leading parcel service. What I really want is to drive the Royal Mail out of business so I can pay much more for an inferior service. Oh, and by strangling The Royal Mail to death slowly, I really would love to suffer from strike-induced problems too as the unionised workforce suffer death throws.

It brings us all much joy to watch the same process make every new year another 'Best Year Ever'.

We celebrate 30 years of uninterrupted Blatcherism next year. Joy.

Agents of The State

A New Labour Propoganda Poster promoting changes to the General Medical Council, circa 2008

We are now in the last days of of the age of doctors and nurses as Patient Advocates.

The State, and I mean here the Thousand Year NuLabour Third Reich [Surely, Third Way? - Ed], does not like professionals. Professionals are self-regulated groups that operate to a code of honour. Professionals do their best for their patients, not because they are paid well, or because they are 'appraised', or 'monitored', but because they are professionals. Should they fall short of their professional code, they they will lose their honour.

The clash is essentially an ethical and philosophical one. Professional codes are, in essence, Kantian. Something that is wrong is always wrong - such as killing patients. Politicians, however, are basically Utilitarians: things are wrong or right based on circumstances. If killing patients will lead to another term in office, then it is The Right Thing To Do.

The State has had plans in motion for some time now to neutralise these problematic professionals. Firstly, it has reduced the Burden of Proof in professional fitness to practice cases. The General Medical Council and the Nursing and Midwifery Council are already prosecutor, judge, jury, and executioner. The new rules on a 'sliding scale' of proof, now also allows them to decide how much proof is required on a case by case basis. Basically, they can just make it up as they go along.

The second part of the plan is to remove professional self-regulation. Previously, the members of the professional court were elected by the professions. In future the NMC and GMC are almost certain to be run by State-appointed members.

Now, some people will point out that if the GMC had done it's job in the first place none of this would be happening. And you are probably right. Dr Rant has seen two GMC 'investigations' into dangerous doctors up close, and the only thing I can say is that the GMC are utterly useless. Both 'investigations' consisted of writing a couple of letters to managers - the first doctor continued to practice for another two years until someone unrelated to the GMC actually visited the doctor's practice (ie: what I'd call an 'investigation). The second doctor is, to my knowledge, still practicing. You could say that the GMC is lowering the burden of proof because it is too lazy or useless to raise the standard of its 'investigations'.

However, whatever the faults of the GMC and NMC - and they are huge faults - they are less frightening than what we will soon have: The State in control of the professional bodies. The State will control who is prosecuted, for what, and what standard of evidence is required. The State will act as sole Judge, will appoint the jury, and will decide on the punishment.

Leaving aside the fact that lowered burden of proof means that any psycho now gets a 50:50 chance of success from a free shot at any doctor of their choice (and paediatricians involved in child protection are already subject to a co-ordinated barrage of malicious complaints from a small number of individuals), basically if you are a Good Nazi then you will be allowed to practice and if you are not, then For You The War Iz Over.

Agents of The State do not put patients first. Agents of the State put their Political Masters first.

Long Live New Labour!

I don't think I can do this anymore

The Ferret has posted this excellent item on why doctors should leave the NHS.

"Another family member arrives, walks over to his relatives. They point at me, the relative walks over touches my arm and smiling thanks me for all I am doing.

What am I doing? Am I colluding with a system that is letting this man and so many others like him down. I am trying to tread water in a what sometimes seems a third world system. A system crippled by short sighted targets and budgets. A system where a waiting list is more important than an intensive care bed. A system where the four hour target means that patients are rushed through the hospital, not getting the correct diagnosis, waiting in corridors, in pain and critically ill.

I don't know if I can do this for another 20 years."

Anonymous will no doubt suggest that the doctor who wrote this should have done the complex cardiac surgery himself on the kitchen table while being paid minimum wage.

I fucking hate Anonymous.

Give GPs a break!

Dear Dr Rant,
Please find below a peice I've written for Centreright.com going up tomorrow [Two weeks ago now! Sorry, Julia, this one got missed at the time - Ed]. It's a family channel so the language is tame - but wondered if you'd hightlight it on your sites as 2020health is running a petition in support of GPs! Also attached as you loose the italics.
yours
Julia Manning

Give GPs a break!
I remember his words like they were yesterday “I’m quitting the NHS”. Last year, this GP who had given 30 years of his life to caring for patients looked at me with tears in his eyes but a wan smile on his lips. Pain from the resignation and disappointment; relief from the burden and battle. “I’m an effective doctor because I know my patients, their history, their families, their jobs and their neighbourhoods,” he went on. “Up until now I’ve adapted and changed to the Government’s whim, but no more. They behave like we cannot be trusted – I can’t work for a boss that doesn’t trust me”.
You may have noticed, barely a day goes by when GPs are not being criticised and maligned, or pushed and shoved. No matter how much the Government messed up the GP contract resulting in a few doctors being paid a six figure salary, is this the way our health ambassadors should be treated? Our confidant in sickness? The professional who we trust with our most intimate care?

More here.

Thanks Julia.

IPPR - thick cunts

Get your 'Think Tank' off our lawn!

The news has been flooded this morning by stories based on some 'fresh new' research from the Institute for Public Policy Research that is calling for more top down meddling and monitoring for teachers to contend with. Surprisingly none of the media, for example the BBC, have even mentioned who the IPPR are, who they are funded by and what their conflicts of interest are, strange that. You can look through their raft of cracking new ideas here, amongst them are the following gems:

"Introducing a higher tier of managers, selected from head teachers due to retire in the next five to ten years, to improve the advice and support given to head teachers, and keep expertise in the system.

Rant: yep, more tiers of management, what a great idea, taking yet more experienced teachers away from actual teaching.

Using psychometric testing alongside exams to assess each candidate’s personality and suitability for teaching.

Rant: psycho babbling rubbish that has no evidence behind it, another brilliant part of their rafting turd

Improving performance management, with all teachers required to observe four lessons by colleagues per term and take part in six-monthly appraisals.

Rant: Yes, patronise teachers more, treat them like children and subject them to useless appraisals which simply serve to increase the rate at which rain forests are chopped down

Strengthening links between pay and skills and development.

Rant: vague political waffle, another idea that in practice would simply waste more money trying to make improvements that simply would not materialise as the IPPR do not have the brains to think through their nonsensical plans"

Has anyone at the IPPR bother to engage their slimy brains? I think not. The reason that a lot of the brightest and most able do not go into teaching, or quit teaching having given it a go, is because the government's top down control freakery has ruined teaching as a profession.

The government treat teachers as they treat doctors, with no respect and no trust, they have also enforced a 'raft' of controlling measures in the form of inspections, appraisals and box ticking that have done nothing to improve teaching standards, they have actually served to lower standards by wasting teachers' time and encouraging people out of the profession.

Less Stalinist monitoring of teachers, less bureaucracy, a bit of continuity and less tinkering with curricula, less changes to exams and the associated bureaucracy that goes with it, less wanky new subjects like citizenship, more power for teachers to discipline pupils who misbehave; these changes might go some way into improving teaching and attracting more excellent teachers into the profession.

Interestingly when one has a peek at who is funding the IPPR, then one sees quite a few friends of the government there including Lord Sainsbury, Accenture, PwC, London Development Agency and none other than the General Medical Council. It's funny how the wankers at the IPPR are so confident in their ability in telling teachers how to do their job better, when I doubt that any of their esteemed researchers has been anywhere near a real classroom since they were at school themselves. Cunts. I can tell you that the vast majority of teachers do a damn good job under very difficult circumstances, cirumstances that have been inflicted upon them by greasy fuckwits in Whitehall who rely on the illogical drivel that is spewed forth from think tanks like the IPPR, because none of them have a clue what is really going on the ground.