Serco's Shite Out of Hours (SOOH)

Serco, the private company that NHS Cornwall gave their GP OOH contract to in April, were in the news yesterday because one of their doctors provided crap care for a 97 year old man at home by just giving telephone advice.

Of course, Serco should be used to taking the shit out, but instead their medical director, Dr Colin Barrett does a double whammy apology by first pointing out that the doctor was foreign (so that's fucking ok then, is it?), and then claiming that he "would have preferred to employ local doctors but [we] were unable to recruit them".

Fucking hell. Is Dr Barrett trying to blame the shite service he provides (and not just bollocks-bad in Cornwall) on local GPs for 'refusing' to work. The same local GPs who ran an excellent KernowDoc co-operative OOH service until NHS Cornwall decided to give it to Serco because Serco cost less.

So what Dr Barrett really fucking meant was 'we employ third rate foreign staff because they cost pennies, and how are we supposed to win NHS contracts if we have to actually pay proper rates to get decent local doctors to work for us'. Twat.

To show just how cheap Serco are, Dr Rant has been shown a letter that the OOH staff received from them when they took over the service:

From Serco to all OOH docs in Cornwall
Sent of behalf of ******** (SERCO)

Dear all,

It has been decided by the PCT’s that apart from toilet rolls. Tea, coffee, milk & sugar are no longer to be supplied by the OOH’s service. This applies to all Emergency Clinics, Cars and Cudmore House (Ops & Admin departments).
Staff are encouraged to bring their own supplies.

Regards

No wonder their profits are soaring.

Who thinks that those profit-hungry toss-buckets also put pressure on their doctors to deal with more patients over the phone to save money? Who thinks that perhaps this poor foreign peanut-paid gruntfuck was overrun because Serco were too cheap to employ enough doctors to handle the workload?

Yeah? Me too. Sick, twisted fucks.

Dr Blue on Reformation by Shredding

Labour’s reforms of the NHS are reformations in the same sense that a piece of paper is reformed by being shredded. They are reforms in the same way that a sinner is reformed by being burnt at the stake.

The language of reform has been misappropriated so that “change” comes to mean “reform” This linguistic slip has enabled a Labour government to unleash its domestic version of Operation Shock and Awe on the NHS and pass it off as “improvement.” All opposition to the so called improvement must be crushed as “a force of conservatism” or as “misinformed and badly educated”

I am well educated and I am fed up of Chairman Patsy’s uplifting little homilies. I would love the gales of creative destruction to blow through the Department of Health and flatten it.

I wish to reclaim the English language as a tool for direct communication and so expose the travesty of targets and activity that currently masquerades as thought and action. I have listened to Professor David Hunter describe the current NHS changes as “Incoherent, back to front, contradictory” at a meeting In Bradford in November 2005. Things don’t look any better now,
as the Lancet describes.

The biggest failure of this new Labour Government on health has been its inability or unwillingness to generate any coherent thinking about what is either needed or wanted from a healthcare system. The word that must not be named here of course is RATIONING

The justification for the NHS is its equity and its universal population coverage. Also that it controls overall health expenditure within the economy. The Americans have low equity, high cost, non-universal medicine that is good if you have enough insurance dollars behind you.

The difficulty with the NHS is that its laudable equity is equally bad, rather than equally good, for everyone. The current talk about high quality, dependable local services is a joke as there is no real competition to the NHS, so no real comparison is possible. The distorted version of competition that the government and its pals in McKinsey’s and other management consultancies have dreamt up bears the same relation to market competition as a gargoyle does to a portrait.
David Craig describes how it’s all been done in his useful book and the
review here is a good summary.

I suspect patients would be realistic if told that NHS resources are finite, and cannot provide everything for everyone. Already the NHS has given up on long term care of the elderly, a lot of optician and dental work, much chiropody, most infertility treatment and most plastic surgery. People seem to have adapted to this, although the Scots have gone back to providing long term care for their old folk without trying to separate out the nursing from other care needs. (The current distinction English social service department have to draw)

Most patients want accessible services, good communication with staff and good follow through on problems. They do not like inaccessible services, long waits, bad communication, having to repeat themselves multiple times, seeing a different doctor each time. As a GP I try to cater to these needs but everything in the NHS is making it harder for me to achieve and deliver what patients want.

Money goes not into more GPs, or better premises but into new stand apart facilities whilst existing NHS infrastructure is run down and staff laid off. The PCTs grow ever larger (back into the district health authorities that they started from, progress being a circular concept in the NHS) and ever more managers are recruited, but they don’t address the fundamental problems of lack of space and lack of real workers. They get in sound good initiatives like community matrons but block GPs getting extra practice nurses. They can get “five a day” health promotion workers but they can’t get dentists. Harriet Sergeant exposes the problem well here.
The manager working for £40K wonders why he cannot get radiographers on £25K in central London.

The current NHS changes are a disaster waiting to happen and they deserve opposition. They are no way in which to run any health service sensibly. As at present set up they will bring misery to patients and staff, and Labour politicians deserve to get it in the neck from their voters.

Whether the Tories can do any better remains to be seen.

However I can state with confidence the view that this current government is a disaster to the NHS and deserves evicting from office as soon as possible, on grounds of its NHS record alone.

The fact that teachers tell me that schools are just as bad only adds to the feeling of terminal incompetence that surrounds the end of this government.

And let’s not ask the troops in Iraq and Afghanistan how they feel about things.

Nurse Ratchet takes a kicking

Oh dear. It seems Nurse Ratchet's attack on a GP's handling of a patient with quinsy has resulted in a diatribe of abuse from doctors fed up with Nurse Quactitioners who want to play doctor.

Many non-medics have commented on the blog about their surprise and sadness about the level of hostility and rudeness NHS professionals have shown each other in the ensuing blogwar.

Yeah? Well, if you think being called a stupid bint is bad, then you obviously have never had to tell someone that their husband/wife/child/parent just died because someone fucked up their diagnosis.

Dr Rant has.

Sticks and stones.

PRESS RELEASE: RCGP Name Change

London, October 17th 2006

ROYAL COLLEGE OF GENERAL PRACTITIONERS TO CHANGE ITS NAME TO ROYAL COLLEGE OF GENERAL QUACTITIONERS

Professor Mayur Lakhani, chairman of the RCGP said: "There is an untapped potential for primary care to deliver even more services for patients."

The 94 year old GP matriarch, who was the only GP in the British Antarctic Reaserch Station from 1543 to 2004 when he moved to London to take up his new post as El Presidente, added:

"The Royal College of General Practitioners has come a long way from its first meeting, held in the back of an Austin Mini parked outside the Royal Albert Hall in 1998."

He went on to explain that the title Royal College of General Quactitioners (RCGQ) is more "capable of taking General Quactice into the 25th Century and beyond".

Lord Barking of Warner, his age overtaking his IQ (he held a quiet 12th Birthday last week for just family and the members of his school chess club), said "This is exactly the kind of lunatic fiddling-while-Rome-is-reduced-to-cinders type of thing that we want to see from doctors leaders just now".

Patrizia HowlingattheMoon took time out from inspecting yesterday's trooping of the New Labourite Imperial Stormtroopers and drive past of the 18th NHS and 2nd DoH Panzer Divisions, to tell Dr Rant that "The NHS is having its best year ever, there are more nurses, more doctors, illness has been totally irradicated, and the Labour Party will rule for a 1000 years...."

Journalists can obtain reprints and more details from:
J Goebbels
Truth Assistant
The Ministry of Truth
Richmond House
Whitehall
London SW1

tel: 0207 666 0666
fax: 1-800-PROPAGANDA



Thanks to Dr Crippin for the inspiration for this piece

Comrade, can you spare £20 billion?

You might think Dick Grangemouth might be wanting to keep a low profile. What with him squandering billions on a massive cock up of an IT project that has yet to produce any actual functioning systems, is £20 billion pounds over budget, is several years behind schedule, has been criticized by everyone who knows anything about IT and health care, has lost one of its main contractors, and is having another mission-critical contractor investigated for accounting irregularities and placed on High Dependency by financial analysts, while experts are uncertain if the system will ever be functional at any cost.

But no, this fucking narcissist thinks now is a good time to go on the offensive and compare the so useless we are barely sentient, how conservative can one organization be, don't rock the boat ever even if rocking the boat is the only way to save millions from suffering and death, I'll have an OBE thanks, British Medical Association with Arthur Scargill's National Union of Miners (or Mineworkers, to be precise).

More evidence that the upper ranks of the DoH have been taken over by brain eating alien life-forms now gone mad-drunk on an orgy of human suffering, if more evidence was needed.

Richard. Shut the fuck up! No really. Shut the fuck up, and sit the fuck down, and hide, you tossed up twat.

I mean, I understand that you don't give a flying fuck at a donut about the staff and patients, but at least have some thought for your poor family. Think how they must feel to see you degrade yourself in this unnecessary and embarrassing way.

Arthur Scargill. And the BMA. If any two organizations were ever less alike, I've not seen them. Personally, I'd love the BMA to be more militant. I'd love the BMA to stand up for their members. But it just is not going to happen. They are a bunch of gin-drinking, self-obsessed, ivory-towered, gong-hungry tossers. They will do anything to keep in with the government. "You want to shove all the patients into the hospital incinerator to save money, Patzy? Spiffing. Top idea! Too many proles around anyway...."

Just don't threaten their pensions......



(You did still manage to piss them off a lot though, Richard, but then who needs friends when you are a multibillion dollar failure?)

Operations at home? I give up.

Patricia, Patricia, Patricia.

You're most recent 'idea' is to have actual surgical proceedures carried out in the GP surgery.

Where, oh, where do I start with this one? I mean, there is just so much that you can satire. When the material coming out of the DoH reads like the script to Plan 9 From Outer Space, it's impossible to make it more silly.

So, I'll try and be more serious.

Ms Hewitt, this is a really, really bad idea. So bad, in fact, that I would go so far as to say that reckless.

1. This is not new - there are still some of us about who remember GPs doing tonsillectomys on the kitchen table. We also remember the complication and death rate associated with such poor and dangerous care.

2. One of my patients this very week nearly died when his hernia repair from a very experienced surgeon went horribly wrong. This is the first time I've seen such a thing, but we can expect a lot more if surgery is transferred back to the community.

3. The plan is not actually for GPs to do the operations, but for a surgeon to do it with a GP assisting.

4. The surgeon will spend time travelling to lots of different operating theatres, which is a loss of efficiency.

5. The surgeon will be working with lots of different GP/nurse teams, so losing the efficiency of an experienced team.

6. Rather than using a hospital theatre, which the NHS already has too many of, you will need to build lots of expensive new operating theatres in GP surgeries. Very expensive.



There really is no up side to this plan.

It can only have been dreamed up by a total fucking moron.

Which brings me nicely full circle back to Patricia.

Half of all Trusts must improve - surely some mistake?

The BBC is reporting that 43% of Hospital Trusts were caught by 'lie detector software'.

What does this tell us?

It tells us that the lie detection software gives a false negative 57% of the time.

Dr Rant uses a simpler test - ask hospital management a question, and then see if their mouths move when they answer.

The NHS runs on goodwill, fuckwit

Dr Rant has it on good authority that a local hospital has decided, on the advice of KPMG to stop funding the hospital nursery for staff, and are considering turning one of the staff car parks into a pay-and-display visitors car park. Volunteer workers in one hospital have had their free hot meals withdrawn.

What the fuckwits at these expensive consulting agencies don't realise (and neither have any SoSs for Health all the way back to mad Ken Clarke and his 'hospitals are supermarkets without tills' comment about staff pilfering*), is that the NHS was so cheap because of staff goodwill.

Many of today's politicians are a totally different personality type from health care workers, so lots of politicos tend to think that everyone is a lying cheat. The idea that people would do things simply because they want to help, is alien to them (I wonder where they get that world view from?).

Much of that goodwill has now evaporated, as even nice people can be pushed too far and start to say 'well, if you're not going to give me any perks, then I want paid for the work I do'.

Since the average unpaid overtime for most NHS staff was traditionally about 25% of their actual hours, this pushes costs up by 25%. Plus staff stop working at the kind of pace normally only seen in wartime outside the Health Service. So costs go up another 25%.

Nice work tossers. You've managed to destroy the one thing that actually was good about the NHS - the goodwill and dedication of the staff.

Still, at least the patients have some nice shiny new PFI hospitals to look at while they bleed to death alone in their own shit and vomit.

But then, dead people don't vote, so who gives a flying wank?





*Of course, Ken Twat-Clarke failed to point out was that the dressings and bandages that our dedicated doctors and nurses took home were used to treat minor injuries in the community to save the NHS time and money. Stupid fuck.

Coup D'Etat, anyone?

What do you think? Time the NHS workers threw off the shackles of oppression from the New Thatcherite Fourth Reich leaders and took over from the 'legitimate' government of this country?

Lets looks at the facts:
NHS: 1 million workers
Battle hardened Palliative Care squads trained in the use of lethal injections (of course, the enemy has to sign a form in front of two Dutch doctors saying they really want to die).
Surgical troops trained in the use of very-sharp-if-a-bit-short-knives.
Theatre sisters can deploy their terrifying personalities.
Canteen staff trained in the art of food poisoning.
Incompetent useless managers (who would need to be inserted into the enemy camp to cause confusion and demoralisation)
Outsourced Cleaning Units to spread disease and pestilence as a diversion.
Legions of Nurse Quactitioners who can be used as cannon fodder (charging tanks head on with just a screwdriver, a Fancy Title, and 6 hours training.....)


HM Armed Forces:
100,000 highly trained, heavily armed troops with tanks and fighter bombers.
99,999 of whom are currently really quite busy elsewhere.

I think we can take 'em!

When will this bitch leave the NHS alone?

Our Overlord and Supreme Ruler, Patricia Hewitt, 'stands by hospital cuts' according to the BBC. The only thing I want to see Patzy 'standing by' is an shuttle flight to the international space station, where her brain is waiting for her.

Now, I happen to think that Spewitttt is looking pretty ropey. Professionally, I can't help thinking that a breakdown is not far off. Much as I hate to see any human being suffer, this really can't come soon enough for the poor NHS patients and staff forced to suffer her leadership. Even by the quite tough standards of SoSs for Health, she is in a league of her own.

Basically, hospitals will 'not be closed' but 'will not be the same'. What she means is that many of the local DGHs which have provided a reasonably full range of medical and emergency care to local communities will soon become a very small Minor Injuries Unit in a very large building staffed by a spotty 17 year old YTS given four hours of training and a badge that says "Emergency Medical Care Fuck Knows Whats Wrong With You Mate I Can Put You To Sleep Just Don't Ask Me To Wake You Up Craptioner" and his pet hamster (who will be doing the telephone triage when NHS Dire falls over on a busy bank holiday). Oh, and you might get the odd visiting Nurse Practitioner doing a specialist clinic all by herself because she's had a 2 week course in being 'the best fucking doctor in the world except for all those losers who actually went to medical school'.

"We're not sitting in London trying to work out what the right solution is in different places.", she says. Well thank f&ck for small mercies. "It means that these decisions get made locally." she goes on. Oh, does it now? Locally, you say?

What kind of 'local decision making' exactly involves a bunch of unelected, unaccountable local tossers picked by fuckwit managers and DoH lackeys? Because, lets be brutally honest, the poor bastards who actually use the services are going to get absolutely zero input into the changes. NHS 'consultations' (and the emphasis is most definitely on the first three letters of the word) universally involves making a decision that ignores totally what local people asked for, telling the locals what that decision is and that it really is what they asked for (or that the big clever people in the Ivory Tower know best and the serfs are too thick to understand), and then of course blaming local people for not getting involved when it all fucks up.

And don't even get me started on the accountability of these 'local' organisations. The only possible way to get rid of them, no matter how corrupt, nepotistic, or just plain stupid they are, is with a boot load of Semtex and a short fuse. They define 'unaccountable'.

Lovely to see all those protesters out on the streets. One of the protest organisers was comparing the mood about NHS cuts to the poll tax protests in the 1990s. I don't agree - in the 1990s you could actually find some people who thought the Poll Tax was a good idea.

5 a day

This is another fabulous peice of masturbatory NHS health promotion.

Dr Rant personally thinks the correct way for government to change our diet is to tax sugar and ban advertising (but wait, that might piss off some politically well connected people). Or the government could mind their own business. Or they could simply put up a few posters outside fast food shops saying 'you really should eat more fruit and veg, love'.

But no, not content with dumbing down medical education and wasting money right, left, and center with Sitting On My Arse Practitioners and 'National What A Fucking Waste of Money It Doesn't Even Work Should've Bought a Few MedicAlert Bracelets Instead IT Framework', we now have £10 million being spent on 66 pilot sites for the '5 a day project'.

Pilot sites. Teams of staff, interviews, project planners, marketers, and fuck-knows-what-they-do staff getting paid 10s of thousands of quid each to go around telling people to eat more fruit. £10 million. Ten Million. Pounds.

I mean, fiddling while fucking Rome burns or what? For fucks sake, wake up and smell the napalm. The NHS can't even provide proper basic nursing care. It can't even get it's computers working, there are real cut backs from proper services all over the place because of 'budget overspends'. For fucks sake, focus on something worth doing.

I actually wouldn't mind if I thought this was going to actually improve people's diets. But, I just know that it's going to be a bunch of useless twats sitting around having 'meetings' about what meetings they should have to sort out some more meetings.

In fact, I'm going to put money on the fact that the '5 a day website' actually got its name from the fact that it gets an average of 5 hits a day. And four of those will be from the googlebot. And one will be a four year old in Scunthorp who was looking for the Tweenies home page and got lost.

Here - Patzy, let me save you a £10 million tax pounds:

OY! YOU LOT! YES, YOU, YOU FAT SPOTTY BASTARDS. EAT MORE FRUIT YOU GREASY FUCKS!

Sorted

(I'll expect a cheque in the post, Spewit).

Should Shameside DGH's management team be put up against a wall and shot?

Well, yes actually.

I love this one. Tameside General Hospital management recently dished out the usual 'kill the fucking whistleblower' treatment to surgeon Milton Pena.

The reason for the kicking was that Milt had gone to the press over the shitty nursing 'care' being given to his patients in Tameside. You know the kind of stuff, it's happening up and down the NHS since nurses stopped nursing - patients lying in their own faeces and urine for days on end, patients being left on trolleys unfed and uncared for, relatives having to come in and feed and wash patients because the nurses don't do it, relatives coming in with mops and buckets to clean the shit, blood and piss off the toilet walls because they can't face seeing their family in such a hellhole, people lying dead for several months before anyone notices [Dr Rant made that last one up, Ed.].

So did he get a medal? Did he get promoted? Did he get better nursing care for his patients? Did he fuck. He got threatened with dismissal and his career being ruined. Twisted, evil fucks.

Anyway, the way I heard it, Milt 'got off' with a written warning. Basically that's NHS management speak for 'next time you speak out, your career is toast, fucker'.

So, imagine Dr Rant's surprise when the local coroner tells the BBC that he is complaining to Shameside's chief executive over the 'chaotic and despicable' care patients are receiving there. Basically, he is talking about the nursing care ('basic care' he calls it, saying that the doctors and surgeons are doing a stand up job).

Did Shameside's managers tear their clothes and self-flagelate over their rush to judge Milton Pena. Did they fuck. They claimed to be "naturally concerned to read about the coroner's allegations" and it would act on the results of an internal investigation. Well, I'm sure they are concerned - concerned people might realise that they are corrupt, evil fucks who don't give a shit that patients suffer and die so long as no one finds out.

How about a written apology to Milt, and removal of the written warning you gave him? How about actually doing something about the nursing care rather than simply another 'we care so much it hurts' whitewash internal investigation (probably to work out how they can shut up the coroner).

Thank fuck they can't give him a written warning and fire him.

Bastards.

Northamptonshire PCT: bunch of morons

Northamptonshire PCT has 'asked' its GPs not to prescribe certain medicines to reduce costs.

The list includes Nicotine Replacement Therapy to help people stop smoking.

Great idea. Let's save 10p from our drug budget, so that in 10 years time all those people that we didn't help to stop smoking will have serious illnesses. Those that don't die quickly will cost Northamptonshire PCT around £50 trillion to treat.

So that's:

1. More dead patients.
2. Lots of money lost.

But, hey, who cares about costs in 10 years time - by then Northamptonshire PCT will probably have changed its name/letterhead/stationary/chief executive four times anyway. At far more cost than a few nicotine patches.

Stupid fucks.

Patricia 'Dalek' Hewitt and MMC

If Patricia has anything to say to the medical profession, it would seem to be EXTERMINATE.....EXTERMINATE.....EXTERMINATE.....

Determined at all costs to dumb down British medicine and castrate any political power that the medical profession may have, Patzy Howitzer continues to drive the 6th Panzer Division right through the heart of medical education.

MMC (Modernising Medical Careers - ho, ho) basically involves taking a system of training which used to produce some of the best senior hospital doctors in the world (the Consultant grade in the NHS) and turning it into a kind of cheap conveyor belt for badly trained, cheap hospital doctors.

Not a problem for Patty Howler, because she seems determined to do away with doctors in the NHS anyway, what with non-doctor 'practitioners' such as Health Care Practitioners (doctor's assistants with a fancy name), Nurse Practitioners (mini doctors who can prescribe anything after 38 days training, shame they can't actually make a diagnosis), Latvian Lap Dancer Practitioners (cheaper than traditional clap clinic doctors, but cheap as chips and popular with the male patients) . Ok, I made that last one up, but really it is quite difficult to top Nutty Pat even in jest.

Ok, so the best-of-the-best-of-the-best doctors with 45 A grade A levels each will suddenly become largely unemployed because there will only be training posts for a proportion of them. So, they will have to simply take 'Staff Grade' posts (cannon fodder for the day to day work) and will never reach their full potential.

So the patients lose out, the doctors certainly lose out, but Splatsy Spewitt is quids in. Cheap healthcare. Never mind the quality, feel the width, 40 squillion more doctors and nurses than when the original Thatcherites were in power, blah, blah, blah, blah.

Advice from the wise on doctors.net.uk: take the US exams and emigrate while you still can.