Reconfigure your Bullshit!

Having got more than a little warm under the collar about
politicians crapping on about their 'difficult
decisions’, I have realised that there’s another bit of
political word salad that seems to crop up every
time a bus is driven through local health services by
Patsy Fuckwit et al. As you can see from Dr Mustard’s
astoundingly life-like representation of Ms Hewitt doing
the job for which she is most suited, the latest bit of
New Labour bullshit to get my goat
is…….'reconfiguration' .

Basically, when it has been decided that a particular ward
or hospital should cease to exist, it has not been cut back, slashed, axed or destroyed - the service has been reconfigured!

New Labour found out about the average person’s irrational
dislike of having their local hospital shut at the 2001
general election, when Dr Richard
Taylor stuffed them in the Kidderminster constituency.
Since then, the reciprocal fear of being
Kidderminstered has loomed large in many Labour
MP’s consciousness. Therefore, Hazel
Blears’ seemingly brave actions this week look
slightly less altruistic, and slightly more like ‘own
bacon-saving’ to the trained eye. Ms Blears’ actions
don’t quite come up to the standards set earlier in the
year by the resignation of junior health minister Jane Kennedy who
even Dr Rant can’t criticise.

After the Kidderminster disaster, the government
introduced a marvellous new Quango called the Independent
Reconfiguration Panel. This august body was supposed
to act as an apparently independent expert body to rubber
stamp closures and deflect some of the blame from the
government, as part of the central decision making -
local blame tactic that hasn’t fooled anyone yet.

So a new Quango was born, and one that could only pass
comment on cases referred to it by the Secretary
of State of Health. How many times 2003 has the
illustrious IRP been woken from its expert slumber? Dr
Richard Taylor asked the same
question in parliament earlier in the year:

What has happened to the panel? We asked another
Minister at a Health Committee meeting a few weeks ago.
The answer was that eight cases had been referred by
overview and scrutiny committees to the Secretary of
State, and at that time only one of them had been passed
on to the panel. One had been withdrawn, one awaited
decision and five had been decided by the Secretary of
State without reference to the advice of the panel.

So there you have it, reconfiguration is
yet another meaningless load of bollocks brought to you by
our marvellous leaders. To illustrate this, the team has
tried to think of a situation outside the hallowed
corridors of power where using the word ‘reconfiguration’
wouldn’t make you look like a pretentious
twat……and we failed. However, as you can see, Dr
Mustard had a good go….…….

Bad food, Short Life

The food giants are fighting the Food Standards Agency over its planned Traffic Lights system for food information.

Alastair Sykes is chief executive of Nestle UK. Their website announces 'Nestle - Good Food, Good Life', but in the Guardian, Alastair admits that all of Nestle's sweets and most of their cereals would have a red light warning for high sugar/fat/salt:

Are we saying that people shouldn't eat confectionery? We're driven by consumers and what they want.

If you are so driven by consumer's wants then put the fucking Red Traffic Light on your unhealthy food and let the consumers decide. If they still want to eat sugary cereals dressed up in healthy-looking packaging, then fine.

But if they choose not to choose Nestle, then you'll know that you were fucked up by 'consumer wants'.

Drive that up your backside, Alastair Sykes.

Giving patients what they "want"

A friend of mine had a bit of a drug problem as a young man.
It was the usual story of getting involved in recreational substances as a student, and then things getting more than slightly out of hand.
He developed a quite marked depression out of it, and only got better with the help of close friends.

Recently, he had a minor RTA.
He hurt his neck and attended his new GP.
Now, like a few charlatans I know [and like all professions, medicine has its share] , the twit started feeding him diazepam in huge quantities for “stress”

The result?
Now, a few months later he is on the slippery slope he occupied as a young man.
He has undergone a personality change, and encouraged by his idiot of a GP has adopted the sick role with a vengeance.
What he really needed was a bit of support, but a firm series of instructions as to how to get himself better.

Instead, for reasons that appear more to do with “giving the patient what they want” , hence basking in the reflected glory of your own saintliness, we have a guy who is now out of work, and falling into a hole of iatrogenic addiction.


Sadly, I see this sort of thing not infrequently.
In most cases it seems to stem from Doctor need [ the need to be loved by your patients, by giving them exactly what they appear to wish for] rather than good medical practice.

We are responsible for our actions, and often we need to protect the public from themselves.
Making you patient an iatrogenic addict isn’t big, nor clever.

Of course, the idiot concerned has been doing it for years, and will no doubt continue to in the future.
He is one of the great and good…a fully paid up Cardie……and…..I wouldn’t personally let him treat my dog, but, as he gives his patients whatever drugs they desire, be they benzodiazepines or antibiotic, he is loved and adored.

Sometimes I do wonder if prescribing responsibly, and protecting my patients is really worth it…..

“You’d think you were fucking paying for them doctor….!”


I would rather look myself in the mirror when shaving than court the “Ooooooh, he’s such a lovely doctor…isn’t he?” brigade by having a free for all.

We need a vaccine for stupidity

What the fuck is wrong with people?

The Observer's front story on Christmas Eve was Row over cancer jab plan for all schoolgirls.

Really? A row? It's a cure for cancer, for fuck's sake.

I don't see any safety concerns. It's going to save lives. It's going to mean an end to cervical screening. Screening which was intrusive and invasive, and which had a huge psychological and physical cost on half of the population. A simple, preventative, cure for a disease that kills increasing numbers of women in their prime.

So, I ask again, what row?

The move will be controversial with some parents, who fear the jabs will encourage unprotected sex or send confused messages about the right age for girls to lose their virginity.

So basically a handful of right wing christian nutterfucks are banging on again about sex being bad again? Well, yes and no.

Hugh McKinney of the pressure group the National Family Campaign* questioned the wisdom of immunising such young girls. 'Vaccination against cervical cancer makes full sense to bring down occurrences of this dreadful disease. The only question is at what age is this most appropriate, and many people will question whether 12 years is too young to be undertaking a vaccination programme that is important for when girls become sexually active,' he said.

That sounds quite sensible for a christian pressure group. Wrong, but not foaming at the mouth. The reason for the young age is because you need to lock the door before the horse bolts (fuckwit), which is probably what the DoH is trying to say in its own useless way when it says 'information on impact of vaccination on sexual activity' would be necessary to address parental concerns. That's why we used to give Rubella vaccination to girls at the same age - because rubella is dangerous in pregnancy - and I don't remember anyone getting hot under the collar about that.

So what the fuck is the Observer doing giving this a front page headline?

The new jab also adds to the long list of vaccines to which children's immune systems are subjected and which some parents worry put too high a burden on young bodies.

Oh, not that old chestnut again. I mean, it's getting pretty old after over 100 years. How is a vaccination any worse than catching a cold, which children do around eight times a year (and that's just the symptomatic ones). It's certainly a damn sight less of a 'burden' to the body than dying horribly from aggressive cancer.

And don't even get me started on the whole 'cost' thing - apparently although the vaccine is expensive, it's ok because the NHS will save money from not having to treat cancer patients in the long run. So curing illness and saving lives is only worthwhile if it saves money? What the fuck is wrong with people? Is Totalitarian Capitalism the only 'religion' that counts any more? Whatever happened to actually wanting to do some good in the world? Sad, twisted, fucks.

The headline should read 'Doctors cure nasty cancer - nobel prizes all round!', and shame on the Observer for this appalling piece of opportunistic scaremongering**. Even the Daily Wail sounded sensible in comparison. Fuck, I think I need to lie down.




Notes:

* If the National Family Campaign have a website, I can't find it

** Of note is the fact that the article was written by Gaby Hinsliff, the Observer's political editor, and not Jo Revill, the Health Editor

Humbug

I`m one of the few who works over xmas these days and frankly I`m amazed at how the great unwashed British public lack any form of common sense......

2am on Xmas day.....sore throat for 1 week....

4am on xmas day......I want my father/mother/husband/insert family member as appropriate, admitted to hospital cause they are "doin my head in"


Oh, and not forgetting the modern disease of children as white goods....

When my washing machine breaks, I call a little man to fix it.
When my children fail to perform as "normal"....call the doctor and demand the same.
When he/she suggests that little Johnnie is suffering from a self limiting viral illness, and antibioitics will NOT shorten the course, proceed to argue for 10 minutes as to why your precious little dumpling [who is care for at least 75% of the time by some form of "childcare" service] needs it, as you refuse to take any time out of your busy schedule to care for him/her....

24 hour filling stations?
24 hour Safeway?

Why not 24 hour , on demand doctors for all those little problems that important busy people cant be arsed dealing with during the day.....

To the 95% of decent , sensible human beings, I wish you a merry xmas.
To the 5% of selfish yummie mummies, or scummie mummies who would rather spend 5 quid on 20 Benson than a taxi to the OOH centre, F**K OFF you parasitic tossers, and may you reap the rewards you so greatly deserve in 2007.

Easy on the Mustard

Dr Rant team members are a bit like Dr Who - they can die and regenerate.

Usually, this is because a team member is just too damn lazy...er...I mean...too busy saving lives in the busy NHS to keep posting on Dr Rant. Or they just fancy a break. Or someone tells them about joint and several liability in libel actions.

Team members usually post as Dr Rant (and can also post as his diametric twin, Dr Cardigan). They can also post comments as themselves.

Anyway, the Dr Rant team would like to welcome the 'new' Dr Mustard to the team. He's an NHS GP who's posts on DNUK Dr Rant has always admired, and we are really looking forward to reading his rants on here.

Difficult Decisions and the NHS

Normal people, like Dr Rant for example, have the good fortune not to be faced with ‘difficult decisions’ on a daily basis. To us, choices like ’eight iron or nine iron?’, ‘do I give this patient white pills or blue pills today?’, or ’how am I going to tell this lady she has cancer?’ barely trouble our decision making powers or prick our emotions.

However, the intellectual and moral titans of Westminster and Whitehall have such difficult choices thrust upon them, that their broad altruistic shoulders sometimes struggle to cope. They are also failing to cope with the subtleties of the English Language, issuing forth a torrent of monotonous, bland bullshit and repetitive phrases that are intrinsically meaningless.

Dr Rant’s personal favourite over the past year has been the machine gun like use of the term ‘Difficult Decisions’ by anyone vaguely connected with government when discussing the latest NHS crisis that New Labour has created. In fact, quantifying this by typing NHS difficult decisions into Google, you get……..

1.46 Million hits!

They’re all at it, from Tony Blair right the way down to junior monkey boy Andy Burnham. What’s more, they seem to have no hesitation in declaring their decisions ‘difficult’ given even the slightest opportunity. Patsy Hewitt even manages to use the phrase no less than SIX times in a single page of transcript from the house of commons.

Here’s The Dr Rant Difficult Decisions Google Hit-Parade® for 2006:

6. Rosie Winterton with 26,000
5. Andy Burnham with 36,800
4. Patricia Hewitt with 91,000
3. Lord Warner with 97,900
2. John Reid with 198,000
1. Tony Blair with 295,00

What a surprise – the Emperor of Insincerity himself has stormed to the top of the Blockbusting Bullshit ® chart just in time for Christmas. Oh, how we’ll miss him.

So what are they trying to tell us?

Is it we should admire their ‘selfless’ sacrificing of our essential services, and give thanks that we aren’t burdened by such quandaries?

Is it that we should be grateful that they have the moral courage and fortitude to shut our local hospital to put right the problems that they created?

Is it that we’re not clever enough to understand why they are shutting out local hospital for our own good?

Is it that the cuts are necessary because the NHS overspent by £500m last year, but the NHS IT project overspend of £20 billion has nothing to do with it, and that only a fuckwit would try to link the two?


In the end, isn’t it a bit like somebody smashing up your Mercedes, and then making the ‘difficult decision’ to take money off you to repair it?

What do you think?

It's not privatisation....

....it's.....it's.....what the fuck is it?

Care UK has won preferred bidder status on a contract to run Royal South Hants Hospital and Lymington New Forest Hospital.

But this is "not privatisation" we are told: "because the state remains entirely responsible for paying the bills and ensuring that the quality and quantity of services provided are up to scratch".

So that's patient care fucked, then.

But hang on, how does this 'not privatisation' guff fit with the comments that "Care will have day-to-day responsibility for administrating the medical establishments from top to bottom. It will do everything from ensuring that surgeons are suitably supported in operating theatres to seeing that gardeners have the wherewithal to keep the hedges trimmed"?

So, let me get this straight. They do everything that a privatised hospital management would do. But it's not privatisation.

Er, no, still don't get that. So let's look up a definition of privatisation: Privatisation is the process of divesting the government stake both in terms of money and control from public companies.

Let's just compare that to our checklist for Care UK's bid:
NHS divesting money - yes.
NHS divesting control - yes.

That's what I love about this New Labour government. It's the Orwellian genius for altering the English language to suit their world view. They are not lying, they are 'referencing alternative truth pathways'.

Let me just bring a bit of reality to this. (1) This is privatisation. (2) New Labour are sick, twisted, lying fucks.

Clear enough?

Prime Minster Practitioners - PM(P)s

I think Tony Blair has an unhealthy monopoly on being Prime Minister (at least for now, chortle, chortle).

So, I've decided to introduce Prime Minster Practitioners - PM(P)s.

The days of some people being 'better' at a job than others are over. Just look at the debate over those pesky physicians who think that medical practice (diagnosis and treatment) should be reserved for an elite of trained 'doctors'. Who do they fucking think they are? Acting all superior just because they are highly trained and experienced. How fucking hard can it be? It's always a fucking virus.

Anyway, I think voters too deserve real choice, and of course there are substantial cost savings to be made because PM(P)s won't be paid. And they won't have private secretaries. Or specialist police security details. Or bulletproof Mercedes S class limousines.

Anyone who wants to be a PM(P) can become one. Just like the real job of PM, there is no formal training, and the only requirement of the job is a sick, meglomeniacal desire for power.

Thus, from now on, you can call me Prime Minister Dr Rant (PMP). And I expect much bowing and scraping from you unwashed serf bastards out there - you know who you are!

My first act as PM(P) will be to have that evil stupid twat Spewit arrested and sent to The Tower.

Minister for Health Practitioners (MfHPs), anyone?

Who needs enemies when we shoot ourselves in the foot?

Dr Rant enjoys his vantage point on the absurdities of the world. Amongst these, working out whether the enemy is weaker, or the attacker rotten on the inside, must rank high. A bit like watching creationists and evolutionists slugging it out, you often think that opposed protagonists deserve each other.

So in a week in which the enemy are losing one of their main ministers , and have been slammed by the House of Commons Health Select committee in a damning and thorough report, I am sad to see some of my profession indulging in a hand wringing frenzy.

So the poor dears don’t think the new contract is very good and that people won’t like them for earning a lot of money. And many GPs wouldn’t vote for the new contract again. Ah diddums. Dr Rant was one of the 20% who voted NO and NO to the new contract. He saw the flaws in it, and that it provided a poor basis for GP practice. Watching his colleagues wake up to what was obvious gives him little pleasure. A contract that converts patients into a means to financial ends, rather than encouraging doctors to treat patients as an end in themselves, is always vulnerable to moral challenge - especially if you believe in the Kantian Deontological imperative.

However we are left with a contract that is largely a utilitarian imperative to improve the health of the nation, and maybe individual patients will be better off too. The new contract commits GPs to hitting various public health targets. Dr Rant has long been keen on being a doctor, and not the public health department’s foot soldier. The number of people who believe that the GP is “ideally placed” to tackle any and every problem in life is huge, and they get their wishes under this new contract. The fact that no one has any good system for restraining the British public’s passions/addictions for eating and sex is beside the point. The GP is ideally placed to sort it, whatever it is. It’s all so stressful I might have to go out to a good restaurant with a thin and sexy drugs rep to relax.

Whatever the merits and demerits of the new contract Dr Rant has moved on from it. He predicted at the time that many of those who voted for it would regret it and the NO voters (who won the intellectual battle hands down) would make the best of the new contract. I’ve read my Hazlitt and am aware of the dangers of being too far ahead of my fellows.

And for all I disliked Simon Fradd’s arguments for the new contract at the time his comments on the new contract today are absolutely right. GPs have gained a lot from their new contract, and if we keep going with it we might do better still. The current pension dispute between the BMA and the DH is largely down to Fradd’s framing of the pension part of the deal. He was about the only one (on either side of the negotiation) who understood it then, although Andrew Dearden may understand it now.

So Dr Rant is now a partner in a businesslike practice that is well run, and profitable. He is fortunate to enjoy a good combination of satisfaction, salary and support in his work, and he hopes he supports his colleagues reciprocally. He earns well, and tries to provide a good service to patients that meets their needs. The access is far from perfect but his practice is collectively taking steps to improve this, and it will get better in 2007. He works hard and fast when he is in the surgery, and takes responsibility for running it with his colleagues. In short Dr Rant is making the new contract work for his patients, the practice and himself. And if the government made mistakes well that is its problem. It should buy accountancy services rather than over priced, limited utility consultancy.

He sees his earnings as a fair return for service. He thinks his earnings are earned fairly and honestly, and reflect the going rate for highly skilled professional workers such as doctors, solicitors, and accountants.

As the hospital doctors get ever more micro-specialized (“I'm afraid only deal with the left big toe, Sir”) Dr Rant is rapidly becoming one of the few doctors able to pull a patient’s story into a whole, as opposed to his specialized colleagues who break the patients' stories down into ever finer parts. The balance between specialist and generalists can be endlessly debated but the indefatigable Barbara Starfield has clearly shown that health systems with a generalist orientation save lives whereas those excessively biased to specialists are expensive, and less effective at saving lives. In short primary care can be a highly effective low cost health system, and - as long as referral is appropriately selective - secondary care can work better too.

So, in primary care we have autonomy, good relationships with most of our patients, and many new opportunities to develop our practices. We also have great evidence for our effectiveness, and any health system that tries to remove or damage primary care will come to harm.

And my colleagues run round like latter day Sergeant Frasers with the medical equivalent of “I’ll dig your grave” in his dour Scottish accent.

The Department of Health (DH), like the Labour Party is currently in disarray and my colleagues manage to get disheartened when we are about to win, to establish good services, and make the intellectual case for good general practice. Whether the DH or the GPs will decay first remains to be seen.

Dr Rant is intending to do permanent things in 'bale out' times, and push on with developing his practice as a service to patients. Even if he does end up selling out to a private company he will have made the business so good a going concern that it will be well worth buying.

When GPs get thinking sensibly we are powerful and intelligent actors, and we should celebrate this.

It’s no wonder the Department of Health is scared of us.

Calling HospitalPhoenix

The Dr Rant team are worried about the disappearance of HospitalPhoenix's blog, as first reported by Dr Crippen.

We would like HospitalPhoenix to contact us privately.

Closing hospitals, killing patients

I've just been out to deal with an emergency call from a patient.

Severe abdominal pain. Needs to see a surgeon. I call the nearest surgeon and he agrees to see her. I call an ambulance.

"Can't take her there doc" they tell me. "Too far. We're the only ambulance on for this area after midnight, so there will be no cover if we go."

They want to take her to the local hospital. But it's been downgraded and only has a GP on duty. Not much use, I point out, when you need to see a surgeon.

They head off to see if they can arrange to meet another ambulance en route and swap the patient over. At night. In a lay by.

The good news, they told me, is that there are more cuts in ambulance numbers in the neighboring areas on the way, so the problem is set to get worse.

So when Tony Blair said that 'closing hospitals saves lives', he was either being inappropriately ironic or a Big Fucking Liar.

Like Crippen, I hoped New Labour would save the NHS. Now I hate them.

Lies, corruption, and deceit.

Lord Warner goes

Alleluia.

Lord Warnerhas done the decent thing and retired. First useful service he’s given to the NHS since his appointment. Tony Blair describes him as a competent minister. If Warner is competent I dread to think what an incompetent minister would look like.

He will not be missed in general practice where the BMA are considering suing him for breach of contract over the pensions agreement that was part of the GMS2 contract that the profession voted for in 2003.

He has succeeded in annoying most of the professions within the NHS, becoming almost as detested as his boss Mrs Hewitt. He’s also been in charge of CfH that very successful, secure and competent IT project.

Lord Warner’s going is an improvement to the NHS. Now all we need is Mrs Hewitt’s head and we might get somewhere better still

“All’s had, nought’s gained if our desire is got without content” Well the NHS reforms have poured billions into the NHS for little return, as they have been driven by ignorant and pig headed politicians who prefer their cronies in management consultancies to dealing with the real issues faced by competent and experienced professionals who know something about their patients. Warner has been a big part of this idiocy and his departure is welcome.

Keep a watch out for the size of his pension, and which consultancy firm signs him up.

Chest Pain Scenario

This piece by Mark McCartney is one of my favorite posts on DNUK just now. Thanks to Mark for letting me post this on Dr Rant:

glossary for the non-medical:
NHSD - NHS Direct
ENP - Emergency Nurse Practitioner
OOH - Out of Hours
Thrombolysis - clot buster treatment for heart attacks
Angioplasty - surgical treatment for heart attacks
ECG - Electrocardiogram, heart trace used to diagnose heart attacks



Caller: I was just trying to get to speak to a doctor about some chest pains I am having

NHSD: Your surgery is closed and you have been transferred to NHSD, I will get a nurse to call you back

NHSD nurse: Please answer these questions and I will work out the best way to help……….
NHSD nurse: Your chest pain does not sound cardiac, but you need talk to the OOH service, I will get them to call you

OOH triage nurse: Please answer some questions and I will work out the best way to help…..
OOH triage nurse: Your chest pain does not sound cardiac, but we need to see you within 2 hours. Unfortunately we do not have a clinician available within that time, so can you please call 999

Ambulance control: Don’t worry help is on the way, but please answer some questions and I will work out the best way to help you

Paramedic 1 (to OOH triage nurse): We have been called to a man with chest pain but it does not sound cardiac and his ECG is normal, what would you advise?

OOH triage nurse: I will arrange for one of our clinicians to visit in the next two hours, we now have an emergency care practitioner (ECP) available, but it is safe for you to leave the patient

ECP (to OOH triage nurse): I am with this patient with chest pain, his ECG is normal but I am uncertain about the cause of the pain

OOH triage nurse: The nearest doctor is 50 miles away and is busy speaking to another ECP, but I will get him to call you back

OOH doctor (to ECP): the pain you describe could be cardiac, the patient needs to be transferred to hospital, can you please call 999

ECP (to OOH triage nurse): Paramedic 2 has arrived and done another ECG which shows ST changes. Unfortunately the ambulance service is busy and sent a paramedic in a car to meet the 999 target. There is transport available in 45 minutes, should we thrombolyse at home?

OOH triage nurse: I will get the OOH doctor to call you back

OOH doctor (to paramedic 2): You need to speak to the A&E department

A&E doctor (to paramedic 2): the patient meets our criteria for thrombolysis, but would be better transferred to the regional centre where an angioplasty could be done

Paramedic 3 (to A&E doctor): we have just arrived to transfer this patient to the regional centre, but they have no beds, what should we do?

A&E doctor: maybe you should thrombolyse now and bring him here

Paramedic 3: unfortunately paramedic 2 has gone to another call and I am not fully trained for thrombolysis, can I bring him straight in?

A&E doctor: maybe that’s what should have happened in the first place

Do Not Pass Go

Thanks to Dr Adrian Mackie for letting Dr Rant post a copy of his excellent Modernising Medical Careers (MMC) spoof which is currently the top rated post on DNUK.



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93C3

93C3

That's what you need to say to your GP. "Please 93C3 me, doctor".

93C3 is the health code for 'refuses consent to have health records transferred to central database'.

Might not work of course, since New Labour has announced that anyone objecting to their highly confidential medical data being uploaded to a central server will be ignored.

Never mind that the new data spine will be physically accessible to almost 1 milllion NHS workers. Never mind that the 'sealed envelopes' they say will protect sensitive information haven't been invented yet.

But that doesn't matter, they tell us, because the data being uploaded now in the pilot areas just contains medication and allergies.

So that's ok then.

For those of you planning to hack in to Tony Blair's medication list, lithium is a treatment for mania.

Support for the NHS reforms

So, Tony Blair wants my support for his health reforms does he? (GP magazine (8.12.06 page 1 “PM wants GPs to promote NHS changes") Tony Blair said, “We need to make the case for these changes and in that task I hope clinicians will be ambassadors…" GP magazine also quotes him as saying “This is a one off chance for the NHS to prove it can make these changes work" He said taxpayers would no longer be prepared to support the NHS if reforms failed. I think a taxpayer revolt is long overdue

It was said that an ambassador was a man sent abroad to lie for his country. I wonder if ministers are ambassadors to their own country. I think I will be a very good ambassador for the NHS reforms.

So, here it is. And may I say just how much of a pleasure it is to give his health reforms my full support. If you wanted an A1 demonstration of how to push gargantuan sums of money into the pockets of private businesses, management consultancies and Tony’s Cronies you need only examine new Labour’s record on the National Health Squandering. As one treasury official described it sotto voce, but overheard, the NHS has,

“paid out a fortune, failed to boost productivity, and at the same time achieved the seemingly impossible by infuriating the staff in the process"

Lucy Chapman explains why staff are so infuriated. Infuriatingly good writer she is. Chris Lancelot also gets near the truth

Viktor Frankyl
the great German-Jewish psychiatrist described how towards the end of the war the Germans were so desperate to get fighting men into the army that they asked some concentration camp inmates to volunteer in return for some food and a pardon for their crimes. Somehow even concentration camp inmates managed to turn down this generous offer.

Blair must be desperate to be seeking professional backing for his plans. Apparently Hewitt thinks the reforms are just not sold well enough. OK Blair and Hewitt have their medical courtiers, who have to back the DH line- Sir Liam Donaldson, (CMO, who may privately be appalled by his ministers, and the struggle he will have to get his report into effect) Sir George Alberti, (Urgent Care Tzar, who probably has not done a night on A+E or urgent medical care for many years) Dr Roger Boyle (cardiology Tzar) Dr David Colin-Thome (ex Labour councillor and now GP Tzar) but these guys are no longer the sharp end of medical practice even if they are the smart end of medical suits. (Sir George is particularly dapper) The NHS confederation are his management cheerleaders

Blair and his team have spent the last 9 years trying to portray doctors as being against patients and against reform. My great insight from 17 years of medical practice is simple, “The patients are not the problem." I can enjoy speaking with patients most of the day, sometimes about medical predicaments and sometimes about their lives. The politicians and the managers are the problem.

Blair thinks he can get doctors to make the case for closing for closing down hospital wards. If the case is made by doctors the thick, ignorant general public will think it’s all OK. Whereas if it’s made by conniving, scheming politicians no one will believe a word of it.

The public are absolutely right not to believe a word of it. And any doctors supporting it are quislings of the highest order.

There is next to no support from medical professionals for the current changes in the NHS. The changes are crap, unhelpful, incoherent, muddled, flawed, expensive, ineffective, useless. They are disconnected from reality, and they are no answer, of any sort, to any conceivable question. They are the deluded ravings of the loonies who currently inhabit the department of health. Mrs Hewitt, Lord Warner and Mr Burnham need sacking as soon as possible. Along with them we need Professors Julian Le Grande, Paul Corrigan and Alan Maynard to go too. This is the only policy significant numbers of doctors, nurses, physios, radiographers and the rest of the NHS will support.

The changes transfer public money into the coffers of management consultancies, private companies, PFI companies , useless redisorganisations and on ex Labour ministers on consultancy work They transfer no money into front line medicine. The doctor still meets the patient and together they have to struggle with a bureaucratic system that hinders both parties every move.

The current NHS reforms will destroy the NHS. They will get no support from doctors as we are too intelligent, can see them for the faeces they are, and they will not help us to give a better service to the public.

In these dark days for the NHS we need to go back to Kirkegaard’s great insight that, “Whoever has a why to live will find a how to live." As a doctor I know what I am doing and why. Somehow I will find a how to live. But these new Labour health reforms are not it, and they will do no doctor, no NHS staff member and no patient any good.

To double the money going into the NHS and end up sacking doctors, nurses, and hospital secretaries has to be mismanagement on a gigantic scale. I cannot support dishonesty about NHS services, incompetence, sleaze and cutbacks

We need a reconfiguration of government very urgently indeed.

Tony Blair,
GO NOW.
That will be your biggest service to your country. And take Hewitt, Warner and Burnham with you.

Inappropriate emissions from the Institute

Yesterday's Guardian.

This is a seriously scary report, even if it is only in draft at present. This is a new body set up by Labour to help shape NHS “thinking” Patricia Hewitt says it’s vital to the NHS’s future. That should tell you what you need to know about it. Dust to dust, ashes to ashes and the most expensive institutional funeral in history will soon come, no doubt as advised by management consultants.

There seems to be a fixed delusion amongst senior NHS managers and ministers that there are too many NHS beds and that lazy GPs have nothing better to do than send people into hospital to fill them up and keep their hospital colleagues in work.

It’s far better to close expensive hospitals down, sell the land for housing and turn former inmates onto the streets to kill people. The care in the community policy has been such a success in mental health that clearly we can map it across to acute medicine.

So the report is suggesting that serious illnesses should be cared for at home. Now I know that some illnesses can be cared for at home safely but this is usually as:
1. The person is not severely ill
2. The person is severely ill, but knows what to do and has good support
3. The person is so ill that they are as likely to die in home as in hospital

In all these scenarios the doctor needs to have the patient and the patient’s family onside in the decision made. It’s a good rule in medicine to try and avoid presenting families with unexpected corpses. It’s sensible and humane. It also avoids many complaints driven by the family’s grief turning into anger. Sadly we live in a blame and claim society and as a doctor I would rather not be on end of medico-legal complaints. I’d also prefer it if my patients and their families never felt the need to launch such against me. I’d like to be known as a doctor who gets most things right first time. It’s just good medicine, and into that “just” has gone a lot of time, energy, reading, experience and reflection.

And now here is a policy emerging that is designed to keep people out of hospital, who really should be in hospital. And they want to leave families picking up the corpses and GPs picking up the blame, whilst they try and save a few quid on hospital beds.

This is a policy document that needs strangling at birth. In the UK GPs do their best NOT to send people into hospital. However the NHS cannot have it both ways. GPs are cheap, use minimal technology, underestimate the severity of illness, miss diagnoses and often under refer patients to hospital. We pay our defence premiums to pay compensation for our messes. Mercifully we usually get our decisions right, but every so often we will make mistakes, however hard and conscientiously we try to avoid them. GP services look after 90% of all episodes of illness and try to keep the less severe illnesses well away from hospitals. We are the risk sinks of the NHS and we assess risks every minute of every day of our professional lives. It’s what GPs are particularly good at doing, and the NHS will break down if we stop performing this function.

When it becomes obvious that the illness is either already too severe, or could rapidly become too severe, then hospital admission is the necessary back up to the GP service. Without adequate back up from hospital services it is not possible to practise safely as a general practitioner.

If the NHS will not provide adequate hospital back up to GPs then general practice will become an unsafe speciality. It will become a medico-legal disaster zone with many aggrieved patients and relatives complaining and suing. This is not a good outcome either for doctors or patients or relatives.

So the suggestion that serious problems such as pulmonary embolus (Blood clot on the lungs) and ectopic pregnancy could be managed at home strikes a practising GP such as me as utter madness. The medicine is all wrong. Any medical textbook will tell them this.

The people writing this report are medical illiterates, suggesting substandard care for patients. They are not doctors, and do not have the best interests of patients at heart. It is doubtful that they have ever even seen a patient in the flesh, still less ever had to make a decision with, about, or for a scared, ill, patient.

As a doctor I am frustrated with people who know no medicine trying to direct the practice of medicine. We need to send them packing, for the sake of my sanity, and for the health of the patients.










Or let’s treat seriously ill people at home by letting them die?
One wag said it was a great idea…..as he earned a lot for doing autopsies for the Coroner.

There seems to be a view amongst the many very ill informed, never seen on wards, senior NHS managers, and management

BEDFORD: Politicians - they're all the same

Fuck, I hate politicians.

You're talking to them, and you can see them get that far away look that says 'there is something in this for me'.

And few of them have any concept of a fair fight.

Take the Lib Dems in Bedford. [Please! Ba da boom! - Ed, sorry]

Our hero, Barry Monk, announced to the BBC on the 18th of September that he was standing for parliament and had set up a political party, Save Bedford Hospital.

Now the Lib Dems have their eyes on this key marginal for the general election. In 2005, Labour's Patrick Hall just held it against Tory Richard Fuller (17,557 votes vs. 14,174 votes). Although the Lib Dem, Michael Headley, came third with 9,063, there was about a 6% swing in votes from Labour to the Lib Dems, which followed a similar 3% swing in 2001.

So, they need a 10% swing to take the seat in the next election. That makes Barry Monk a godsend to them (and the Tories) because, by taking unhappy Labour votes, he makes a larger swing more likely.

But of course, he might do too well, and take Lib Dem votes too.

Dr Rant was googling for Save Bedford Hospital to research Deadford Hospital - every patient can go fuck themselves, and was surprised to find that all the top results seemed to lead to Lib Dem web pages like this one.

What was going on? Was this great minds thinking alike?

So I decided to follow the domain names. A quick search shows that all of the main 'save bedford hospital' domain names have already been registered.

Let's start by putting savebedfordhospital.co.uk into whois:

Domain name:
savebedfordhospital.co.uk

Registrant:
Tim Prater

Registrant type:
UK Partnership

Registrant's address:
16 Riveria Court
Sandgate High Street
Folkestone
Kent
CT20 3RP
United Kingdom

Relevant dates:
Registered on: 18-Sep-2006
Renewal date: 18-Sep-2008

Registrant Tim Prater? Who's he? Turns out Tim Prater is a Liberal Democrat Town Councillor for Cheriton, sitting on Folkestone Town Council.

Notice the registration date - 18th of September. That date sounds familiar. Looking back in my notes, I see it is the date the BBC announced that Dr Monk had registered the political party 'Save Bedford Hospitals' and was planning to stand for parliament.


Let's try another:

Domain name: savebedfordhospital.com

Registrant Contact:
dynamoo.com
Conrad Longmore (dynamoo@spamcop.net)
+44.1234325328
Fax: +44.1234000000
192 Wilstead Road
Elstow
Bedford, ST MK42 9YD
GB

Status: Locked

Creation date: 18 Sep 2006 16:29:04
Expiration date: 18 Sep 2007 16:29:04

I'm beginning to see a pattern - this was also registered on the 18th of September. No hint who registered it from this info, but since the domain points to this Lib Dem webpage, it doesn't take a genius to deduce who they work for.


Want to try another? Why not?

Domain name: savebedfordhospital.net

Registrant Contact:
dynamoo.com
Conrad Longmore (dynamoo@spamcop.net)
+44.1234325328
Fax: +44.1234000000
192 Wilstead Road
Elstow
Bedford, ST MK42 9YD
GB

Status: Locked

Creation date: 18 Sep 2006 16:29:09
Expiration date: 18 Sep 2007 16:29:09

Ok, this is getting boring. Same registrant same date, and - you guessed it - this domain also points to the Lib Dem page.




So, on the day that Barry Monk announces his new party name, the Lib Dems register all its key domain names, and point them to That Lib Dem webpage.

No wonder all the Save Bedford Hospital google searches pop up the Lib Dems as their top result.


You see how these guys like to do things.

Of course, this behavior is a breach of ICAAN regulations on the registration of domain names. Its the kind of thing that dodgy cybersquatters and criminals do. Nice company for politicians then.


I hope the voters show up the politicians for what they are. Self-serving, narcissistic, lying, cheating, lowdown scum.

Vote for Barry Monk - the real 'Save Bedford Hospital' candidate.

Deadford Hospital - every patient can go fuck themselves

Barry Monk, the highly regarded consultant Dermatologist at Bedford Hospital who is standing as an independent at the next election on the Save Bedford Hospital ticket, has just found out how New Labour deal with critics.

He's been given his notice. [Presumably they were running low on polonium-210 - Ed, trying to be topical]

Barry has done an excellent job of making Patricia Hewitt look very old and tired. He also was the catylist for one of Dr Rant's favourite TV moments when the ill fated PR officer at Bedford made a rabid and unprovoked attack on a BBC camera crew trying to interview the local union rep about the story (the PR officer promptly 'resigned' we subsequently heard).

Now, in a document entitled “Defining Our Future Role”, Bedford management have indicated that Dr Monk’s highly regarded department is not required.

Barry has commented in a press release that “the dermatology department at Bedford Hospital deals with patients who are affected by severe skin disorders which cannot be adequately managed in the community; we are highly regarded by our patients, and by our local GPs, we meet every government target, and we actually generate income for the Trust."

ie For 'care in the community' read 'crap care'.

"One can only speculate as what motivates these proposals.", continues Dr Monk. Well, Dr Rant can hazard a guess. Barry obviously can too, because he goes on to say "In the NHS we have become used to irrational decision making, but when personal spite is allowed to intrude, something has gone very seriously wrong.”

Something seriously wrong in the NHS? New Labour control freaks wanting to get rid of anyone who criticises them, no matter what the cost? Surely not. Not that lovely Patzy Hewitt. She seems such a nice person.

A trip to the Bedford Hospital website reveals that their hospital logo reads 'every patient matters'. Well, apparently some patients matter more than others.

Barry Monk will survive because he'll shortly be an MP - as MD says in this week's Private Eye, with a majority of only 3,000, "the smart money is on Monk". Any patients with a sneaky melanoma might not be so lucky.

I wish we had 600 Barry Monks, but in the meantime my suggestion is a change of logo. How about 'Bedford Hospital - we do fuck all because dead patients are cheaper than sick ones'.

Anticipate the result

Thieves broke into to Richmond House last night and found the results of next year’s GP access survey.

They passed them along with other motions. The results show that patients want access to GPs at all times. Said one, “An Englishman’s right to a GP is greater even than his right to freedom of speech. How is one to cope with life without professional help to empower one available at any time of day or night?” Another said, “GPs should open all hours just like MPs, banks and lawyers do.” The demands for greater access reached a crescendo and Mrs Patricia Hewitt acclaimed the results saying, “They showed just what we wanted them to show. In fact I couldn’t have put the answers, oops sorry, questions, better myself. My proactive policy of starting with the press release pays off again. Spin Doctors 1, Real Doctors 0.” In this spirit of joyful triumph she went on, “My spin doctor’s so good that he solves problems before they happen. How many of your so called real doctors are this good? Is this why so many people keep getting ill?”



The inconvenient fact that the public had not yet even been consulted did nothing to dampen her enthusiasm. “I learnt from Brecht” she said, “and early on decided to elect myself a new people, worthy of the great trust that we in government place in them so long as they are properly directed. I respect their opinions entirely.”



The Government psychiatrist would have prescribed olanzapine at this point but he had been cut in the latest round of cost cutting. He had been redeployed to treat and re-educate recalcitrant doctors who just did not understand the concept of progress, or recognise it when they saw it. Anyway Mrs Hewitt liked listening to the voices in her head, and so she had exercised her empowered patient choice to tell the silly old psychiatrist, and his silly beard, to go elsewhere and do something useful. The psychiatrist being very patient centred demurred and fled, grateful to escape.



The thieves were not so lucky and were later arrested. As they were being led away the thieves said “It’s easier to make money as a management consultant than as a good honest con these days. And Dr Rant still hasn’t paid us for this story.”



The management consultancy “Leading questions RUs” laughed at any suggestions that leading questions led to foregone conclusions. Their Chief Executive Mr Luscious Loot Jr the Third retorted, “There is no evidence to show that leading questions lead to foregone conclusions. And anyway we don’t frame them until we have fully appraised ourselves of the scope of our client’s needs in this area. We only launch them when all stakeholders are signed up to a set of agreed principles. Going forward we want to boldly obfuscate where no one has obfuscated before. It’s like science, but backwards as soon won’t become clear, but will become profitable.”



The survey results are due in May 2007. Mrs Hewitt’s departure is long overdue.



originally published 30Nov2006, but republished (unedited) due to technical problems

Lord Warner is talking shite

The relentless New Labour attack on GPs continues as figures show that GPs average income in England and Wales reached £106,000 in the first year of their new contract.

You would think the bastards would be happy that GPs are doing such a great job. The whole point of the new contact was that the government thought GPs were doing a shit job, so they made their pay performance related. But, what's this? GPs were doing a brilliant job all along? So they scored very highly on their quality and outcome points (QoF), and they got a pay bonus.

Now that fuckwit Lord Warner (anyone else notice how these old Labour grandees don't seem to mind becoming peers?) is spouting about expecting GPs to spend their bonuses on patient care.

Name me one other situation in which a company or employer is expected to give up it's performance related bonus. One example. One. Any one. Go on. I dare you, Lord Warner. Aw go on, go on, go on, go on.

You can't. Because it's never happened. Because it is illogical. It's a performance related bonus.

Besides, the GPs hit all the fucking targets you set them. So, where exactly could they spend the money better?

Oh, I see a pattern here. Patzy Spewit and her crazed pals like Lord Howler want GPs to work weekends and evening again. But Spewit does want to pay for it (or Brown won't let her). GPs already gave up 6% of their budget, or around 12% of their pay, as part of the new contract so they could give up weekend and night work.

I know, why not put a couple of loaded questions in the patient surveys this year about weekend and evening opening hours, then criticise 'greedy' GPs for being better at their jobs than the DoH goons thought they were, and let's suggest that their bonus should fund better care. Er, weekend surgeries perhaps?

Add to this the fact that much of the trumpeted 'pay rise' (the £250,000 'pay' headlines that were floated earlier in the year, that actually referred to the GPs budget which paid for rent, nurses, equipment etc.) was partly made up by the classic New Labour financial slight of hand of transferring the pension contributions for doctors and their staff from the treasury budget to the practice budget, and then including this in the 'new spending'. Incredible, but true.

It's not the GP bonus that is the problem for the NHS budget. It's the proliferation of useless crap like NHS 24, community matrons, hospital at night, National IT project, and all the other multi-million pound useless pet projects largely aimed at undermining the doctors who stand in the way of these meglomaniacs in government.

Evil, sick, toady, fucks.



originally published 30Nov2006, but republished (unedited) due to technical problems

Technical problems

Apologies for the fact that there have been no posts for a couple of weeks.

DrRant.net was quiet for a week anyway, but this has been exacerbated by problems we are having uploading posts to our server from blogger.com (which is the fault of our hosting company who appear to be upgrading their servers).

You may find some pages do not load properly until the servers have been upgraded (and they have given us no specific timeframe for this, which seems like a pretty rubbish service to us).