New Labour's NHS: 10 Wasted Years

Well, well, well. Here we are again. Ten years into a government and we’ve had enough of them. They say that governments loose elections rather than oppositions win them.

In New Labour’s case losing the plot has been obvious almost since they first came to power. They began by criticising the internal market, and Frank Dobson enthusiastically abolishing it.

Then they realised that wouldn’t work and they embraced the internal market with more enthusiasm (and directorships and consultancies) than any Tory would have dared to dream of.

Meanwhile billions of pounds have been poured away on a pseudo market, ever more quangos, circular structural changes (arriving back where we started and still not knowing the place at all), and ever grosser computer disasters.

Let's go round again: Labour's 10 year journey back to where we started.

Throughout New Labour’s time in office there has been a persistent refusal to face the truth about the NHS. The spin doctor has outplayed the medical doctors; the management consultant has more say than the medical consultant.

The last ten years have been a complete disaster for the NHS. Billions of pounds have been wasted, the front line staff is frustrated, or unemployed, and patients still aren’t getting what they either need or want. They are getting things they don't want.

Lady Macbeth says, “All’s spent, nought’s had, when our desire be got without content.” Richard the Third says, “Now is the winter of our discontent.”
The discontent is getting ever more obvious both from patients and doctors.

Doctors are pleased that the Labour party is bringing the curtain down on the failed new Labour project. We hope the voters in the council elections this week kick them very hard. PLEASE DO VOTE, whether for something or against something.

We, and many of the public, look forward to Blair and Hewitt deservedly departing office a.s.a.p. They have done no good to the NHS and far, far, too much harm.

Any doctor who had done so much harm would be struck off. Let's make sure that Blair and Hewitt go far, the further the better.

What Was That Again?

On Sunday 12th November 2006, the Observer published this letter.

Sir

We believe that patient safety is being put at risk by changes to the way that doctors in the UK are trained.

The royal colleges, which have trained doctors and surgeons for centuries, have been coerced by politicians into handing over the main educational responsibilities to a government-appointed independent body called the Postgraduate Medical Education and Training Board.

The political agenda behind Modernising Medical Careers (MMC) is rapidly to produce a breed of 'specialists' that can be employed as cheaply as possible. By the admission of Professor Sir Alan Craft (exiting president of the Academy of Medical Royal Colleges) and Professor Alan Crockard (national director of MMC), these 'specialists' will be less experienced than consultants are now, and will need to work in teams to ensure patient safety. In surgery for example, training time will fall from an average of 30,000 hours to less than 10,000 hours [as highlighted by The Observer in September].

The MMC plan is being rushed through with little or no consultation with doctors or patients. A whole generation of junior doctors face a significant chance of their careers being ruined because of a lack of specialist training posts and an ill thought-out computer-based selection system. We believe the public should know of this looming crisis.

We are proud of the NHS and are fighting to stop the government devaluing and de-skilling doctors in the interests of saving money. We call on the Department of Health to defer implementation of the MMC until August (2008) to allow for proper consultation.

Dr Clive Peedell
Consultant Clinical Oncologist
JCUH, Middlesbrough
and 509 members of Doctors.net.uk

That's right! More than 500 doctors warned the government and the powers that be that MMC and the MTAS system was going to be an unmitigated disaster, so no one can claim that somehow this, this and this is all a surprise now can they? Can they? Surely they can't! What, you mean they are?

Lord Hunt: Still not listening, yesterday.

What will make them listen other than a Banana Republic style coup?

Democracy? It hasn't worked yet, but there's not much else we can do.

For God's Sake: VOTE!

They only get away with this kind of shite because WE let them.

Patsy's Poodle

"Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority"

"It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda" Alex Liakos, former student advisor to MMC


Today we turn our attention to the Chief Medical Officer for England, Sir Liam Donaldson. This man is, for all intents and purposes, the 'top doctor' for the UK, and one of the very few who is in a position to exert genuine influence over the government. However, he is an unelected hand-picked yes-man who gives the government's health policies a veneer of medical approval; the archetypal NuLabour apparatchik.

He has also been strangely silent during the unfolding disaster that has been the introduction of MMC and MTAS, offering no explanations, no apologies and no support for the government- he doesn't even have the balls to lick the hand that feeds him. He has sold 30,000 junior doctors down the river with a flawed and incompetent attempt to change the way doctors are trained in the UK, the primary aim of which is to produce cheap, minimally qualified, and above all politically docile, doctors who won't embarrass future governments.

The man is also a hypocrite. As can be seen from his Wikipedia entry, his early career was an unhurried one spent trying his hand at numerous things including Surgery and General Practice. That is to say that he benefited from the flexibility of the old system before settling on his ultimate career intention of self agrandisement and creating a weakened and subservient medical profession. The irony is that Donaldson's precious MMC effectively forces medical students to decide upon their career path whilst they are practically still in the womb. No longer will young doctors be able to gather a wide experience of different specialties before deciding upon the one for which they are most suits them (and their patients!).

There has been a stream of high profile resignations, including Alex Liakos who we have quoted, from the MMC committee that is effectively under the authority of Donaldson. It's former chair Prof. Alan Crockard wrote in his resignation letter to Donaldson:

"From my point of view, this project has lacked clear leadership from the top for a very long time."

In summary, Sir Liam Donaldson has not just lost the respect and confidence of the entire medical profession, he has done irreparable damage to it. The effects of this damage will be felt for many years to come, starting this August. We are not just doctors - we are patients too. Patients can be justly fearful about the quality and numbers of hospital doctors that we will have in the future, because even those in positions of power like Sir Liam Donaldson, haven't got a clue either.

It is time for Donaldson to be held to account over the MMC debacle. He is the chief architect and executioner.

What can we do?

Have you seen coverage of MMC/MTAS on the news and want to register that is is a significant problem for everyone - not just young doctors.

Well, there's an online petition calling for Donaldson's resignation that you can sign. You can also leave a comment, which as a cathartic exercise comes highly recommended. Please remember to use your name.

Click HERE!

On Campaigns

Nowadays, it seems as if no chronic disease is complete until there is a campaign against it. The campaign will portray heroic doctors battling to save suffering humanity from some dreadful blight. St George slaying The Dragon will scarcely have been more daring. So for example we find a “Defeat Depression Campaign” and a “Petition for a Bill of Rights” for Asthma patients.

Now whilst I am all in favour of good treatment of chronic illnesses I find a large element of absurdity in having campaigns against them. The problem seems to me to be the lack of any opposition that could possibly exist to these campaigns. Who would support poorer care of patients with whatever disease? Who wants the depressed to get even more miserable? Who cares if some people still have fungal nail disease?

And as we start looking at these campaigns we start to notice their sponsors. Many appear to be grassroots organisations of patients. Look more closely and you find vocal patients, prominent physicians armed with background funding from pharmaceutical companies lobbying for more money to be spent on this particular disease area. The feeling grows that the campaign is a device to market a disease and its associated treatments.

Something is rotten in the state of campaigning. The campaigns never feel to me, a regular GP, to be about to make much improvement at the level of my surgery. There will be lots of leaflets, and lots of pharmaceutical representatives come and go, and sponsored educational events but then it will all go quiet again and I will be left with the doctor, the patient and the illness.

I, as a Don Quixote of General Practice, will once again take up my lance and tilt it at the whirlwind of leaflets, and blizzard of guidelines drawn up on GOBSAT rules. Good old boys and girls sat around a table, often sponsored by big pharma.

Meanwhile patients come and patients go. They and I both do our best to make some sense of life. Strangely very few people offer me much help with this, and no-one seems to be running a concerted campaign to drain the swamp, yet many seem to love shouting encouragement from the sunlit uplands of a campaign against something. Somehow single disease campaigns seem to make little sense when dealing with the complexity of life, illness and death that is the arena of general practice.

Myths and Truths about your GP

Myth 1:
Your GP has had a huge pay rise

Truth:
In 2003 your GP’s contract was changed.
They now have to pay their own employers pension
contribution so 14% of their “pay rise” goes to replace
what their employers were paying anyway. This is not some
special GP’s pension – every NHS worker gets the same
employer’s contribution paid for them.
The basic income for looking after patients stayed roughly
the same though there was now no increase for inflation.
Performance pay was offered to improve the care of
patients with Asthma, Diabetes, Heart Disease and other
chronic illnesses. Most GP’s were trying to improve
patient care anyway so they were happy to work harder to
look after patients better. This was extra pay for extra
work which the Government agreed needed to be done. The
wages for doing this work were agreed in advance and it is
dishonest to behave as if the cost was unexpected after
the work has been done.


Myth 2:
GP pay rises are bankrupting the NHS

Truth:
The NHS is roughly 3,000 million pounds in debt. The cost
of the GPs performing better than expected in the chronic
disease targets is 200 million. The 12,000 million pounds
being spent on the new NHS computer system completely
dwarfs any problems caused by GP’s achieving excellent
patient care.
For the past 2 years there has been no increase in basic
pay or performance pay to General Practices to cover
inflation or staff wage rises. Your GP has had to cover
these extra costs out of their own pocket. Although there
was an initial rise in GP pay with the new contract, GP
pay is roughly the same now as it would have been if the
old contract had continued.


Myth 3:
The NHS can extend the hours that GP’s are available to
patients at no extra cost without affecting quality.

Truth:
If you call out a lawyer or dentist or plumber in the
evenings or over the weekend you will pay more than during
normal hours. GP’s are no less professional and it costs
more to provide a routine GP service at unsocial hours. If
the NHS cannot afford to pay extra for routine care in
unsocial hours the only option will be to reduce the
quality of the service by using cheaper staff.
We have seen what happens when the NHS tries to provide
services 'on the cheap' with the out of hours services.
Your GP was offered £3 a year to provide medical cover for
you for evenings, nights, weekends and bank holidays. When
GP's were unable to do this the NHS tried to provide the
service using cheaper staff and the problems which arose
have been well publicised


Myth 4:
General Practice is inefficient and needs modernising.

Truth:
Your GP gets paid £50-60 a year to provide you with
unlimited appointments and home visits if necessary. This
is outstanding value for money and is less than a third of
the cost of a similar private scheme which does not
include free home visits.
In recent years the majority of our highly experienced
Dentists have been forced to leave the NHS and see
patients privately because their NHS funding has been cut.
Your GP is unlikely to strike because they are
professional and care about their patients. However if the
current cuts in funding to practices continue they may
have no choice but to leave the NHS to retire, emigrate or
become Private GP’s.

GP leaders have put these points to the politicians but
this has not changed the pace of the reforms forced upon
the NHS. Ultimately politicians will listen to voters at
election time and if it is important for you to keep your
NHS GP we would urge you to contact your MP and let them
know that it will affect how you vote.

It's the End of the Health Service, Hewitt (and You Feel Fine)

Put your hands together for the talents of Mr Beige:

listen to 'It's the End of the Health Service, Hewitt (and You Feel Fine)'

Lyrics

That's right, it starts with a soundbite, words and
rights, an error made and Tony Blair is not ashamed
Leader of the campaign, listens to her own spin
Turd serves her own needs, bigger shit than John Reid?
Feeding off of Newspeak, plus untruth,
Patricia's on a mission in the spotlight, downright
liar pants on fire, obfuscating real aims
and a government for hire by the PFIs.
Left a mess and all the patients falling into calling NHS Direct.
Try to keep the public baffled, dump better staff
Look at that low-paid grind, then,
Uh oh, minimum education, come and go, but it'll do to
Save the Health Service's Wealth Service own needs
listen to your MPs dumbing down the doctors and
the nurses and your rights, right. You histrionic,
misanthropic, sham plight, gobshite, sounding pretty
trite.

It's the end of the health service Hewitt.
It's the end of the health service Hewitt.
It's the end of the health service Hewitt and you feel fine.

Sack the doc; patient power. Wait in A&E for hours.
Watch and learn, return, stitch it up yourself and
Pass it on, misinforming, back-turning, blood-sucking
Every manifesto prating patient-centred Welfare State
Find the scandal quite emotive. QUANGO tango.
Watch the numbers crunch, crunch, uh-oh, this means
No clear benefit. Better feed bullshit.
Turn 'em into, turn 'em into, turn 'em into lies.
Offer free prescriptions, offer me initiatives and I divine:

It's the end of the health service Hewitt.
It's the end of the health service Hewitt.
It's the end of the health service Hewitt and you feel fine.

The older version valued lives, not economic Class divides.
Patients pay in ten years' time. I'm no Einstein.
Liam Donaldson, Andy Burnham, Gordon Brown.
Labour party, piss-take, wooden horse ruse! You
hypocritic, patronising, scum bag gits, right? Right.

It's the end of the health service Hewitt.
It's the end of the health service Hewitt.
It's the end of the health service Hewitt and you feel fine.

Time you left us all alone





©Mr Beige, 2007

The Curate's Egg

The curate’s egg is a classic story of tact, deference, and the inability to speak truth to power.

In 2007 it can be seen amongst BMA and Medical Royal College spokesmen and women who try to find some good (“constructive” and “engaged”) things to say in the face of changes deleterious for the NHS, the profession and for patients.

On Dr Rant we are clear that the whole set of changes inaugurated by new Labour from 1997 to now are a load of old Ratners. They are not in any sense good even in part, and they are a disaster taken as a whole. Even the Labour party's own are beginning to realise this as this astonishing confession from David Hinchliffe shows.

Is that clear enough?

The patients are not the problem

Dr Rant has been around for a few years now and has worked in many different settings. His great insight from all the places he has worked is simple;



"The patients are not the problem."



The scenery changes, the accent changes but the fundamentals of health and illness remain the same. A basic rule of good medicine is not to break rapport with anyone unless you really need to. The old rule, “Oh Lord, make my words as sweet as honey, for tomorrow I may have to eat them” applies here.

On Dr Rant we haven’t said huge amounts about patients, and we thought we should redress the balance a bit. This lack arises as on the whole we get on seeing patients day by day and as far as I can tell we do a reasonable job for them. (The Dr Rant team are not pathological caretakers (apart from dear old Carey Cardigan and are not after 100% satisfaction ratings.) My patients are a part of my life, and if I didn’t like patients I would be a sad doctor who should go and do something else.

Any job is a combination of satisfaction, salary and support and on the whole I currently have good levels of all of these. The medical dissatisfaction and lack of support arises from frustration with the NHS structures, not from the patients.

Patients are human beings. They have problems which emerge out of their lives and have medical, social and psychological components. As doctors we try and disentangle the threads, helping with medical intervention where it will help and with other suggestions if they might help. The old surgical maxim applies:

“A good surgeon knows how to operate. A great surgeon knows exactly when to operate”

As GPs we can open up old wounds in patient’s lives, or make new ones, or we can help things heal over. On the whole the third option is infinitely the most sensible.

We make errors of omission and errors of commission and our patients do the same. On the whole doctors and patients get on reasonably well.

Of every 100 patients I see, I find that about 90 are straightforward help seekers. Sometimes I can help them and sometimes I cannot but the basic transaction makes sense and the patient and I reach a shared understanding, which is a sensible route for both parties.

About 5 are medically complex: that is I have to think across many areas of medicine at once to achieve a sensible balance for the patient. This is the area of co-morbidity and GPs should be good at this. This is where my medical knowledge gets stretched, and where I and the patient learn new things.

About 5 are just flipping awkward- they are some combination of mess, chaos, illness and social dysfunction. They reject help, then they want help but won’t take any suggestion off me, they have very messy social (maybe criminal) lives, they are feckless, they miss multiple appointments, they behave badly for whatever reason. They turn a problem into a drama, and create a mess wherever they go. I think if I swapped notes with PC Copperfield we’d name the same names. The social workers would know them, as would the local magistrates’ court. The teachers would have excluded them.

The more experienced I get the quicker I am to put boundaries in on the flipping awkward ones, and give them “tough love.” There’s a way of handling the flipping awkward ones and as I get better at it I can sometimes enjoy the challenge they present.

A simple rule for heartsinks is that if my heart sinks when I see a patient then it’s probably my problem. If I find that all my colleagues have the same reaction to the patient then the patient has a problem. I was working in a small market town once and spent 30 minutes with an awkward customer (this was when I was much younger). The patients waiting for me got restive. However when they saw who it was who had held me back they said “Doctor, you poor soul. How do you stand seeing that person?” 10 minutes of free counselling later I had made friends with another patient…..who then got his problem sorted another day!

So to sum up, the impression of the Dr Rant team is that the patients are not the problem in the NHS.

The problems arise as the systems are not set up well to deal with patients, and for all the hollow talk of a “patient focused NHS”, the reforms currently being implemented look likely to give rise to ever poorer patient care. This is the tragedy of the NHS at present, and why Dr Rant and colleagues are so upset.

The NHS: What is to be done?

Dr Rant has been thinking. He’s taken a holiday and thought about some of the comments made by various “anonym users” and feels he needs to respond positively to one of them. This blog is mostly run on reactive criticism, and there’s no shortage of rubbish against which to react e.g. Patsy on choice in delivery suites and the Mail’s misleading report here . But he’s looking beyond such rubbish today.

As anonymous has said eventually you have to stop criticising and suggest positive alternatives. So in this piece I want to do just this.

(And I do wish anonym users would at least number themselves off so I know if there were one or more voices on the blog! I’m more mellow now though as the olanzapine works very well, thank you, and Dr Rant has at least 11 voices in his head!)

Now any argument is usually made in two parts, namely what is wrong with what has gone before and what is right about what is to come. Philosophers (and bloggers) are much stronger at criticism of what is wrong than they are at saying why what is right is so.

To get the NHS right we first need to stop several things. These have been discussed on here before and it is sufficient here to say that,

The NHS needs to stop:-

-Patsy Hewitt
-Tony Blair
-Gordon Brown
-Andy Burnham
-Liam Bryne
-Lord Hunt
-Sir Liam Donaldson
-Spin doctors being preferred to medical doctors.
-Wasting money on PFI
-Wasting money on management consultants
-Wasting money on managers
-Wasting money on redisorganisations
-Wasting money on computer projects
-Wasting money on useless wheezes such as walk in centres, "">independent sector treatment centres
-Wasting money on stillborn administrative idiocies
such as practice based commissioning and payment by results (which are arcane concepts, even to their authors.)
-Wasting money on useless ideas such as “choice” and “choose and book”
-Wasting money on NHS direct
-Wasting money pandering to the “worried well” rather than those who are sick
-Wasting money on clinical governance
-Wasting money on arm’s length QUANGOS such as NICE and NPSA and the modernisation agency
-Wasting money on unused and unwanted “guidelines”
-Wasting money paying out negligence claims
-Wasting money and peoples’ lives in useless schemes such as MMC and MTAS
-Wasting money training midwives and physiotherapists for no jobs at the end of their courses
-Wasting money on non jobs such as “five a day eating co-ordinators”
-Wasting time on meetings that reduce hours to minutes, and their participants to tears.
-Listening to people who pretend to know something about healthcare but actually don't
-specifically Alan Maynard, Julian Le Grande, Paul Corrigan, Simon Stevens, Alan Milburn, Lord Warner, and the false expertise of spinmeister management consultants.
-Stop pretending that it can deliver all healthcare to all people
-Stop pretending that patients can have whatever they want
-Stop pretending that the NHS is in any way “patient centred” or “patient focused” (It isn’t, never will be, and never should be for reasons I’ll demonstrate in a future rant)
-Stop dealing with well people.

I predict that if we stop squandering money on the useless activities listed above we might find we have some spare money to use on developing a functional NHS.

The tragedy of the current NHS is that all the activities listed above and all the people employed in them could be sacked immediately and the organisation would get better, rather than worse.

There is much deadwood in senior NHS thinking and we’d be healthier as patients, as doctors, as taxpayers, and as a country without them. The tragedy of seeing all the billions of pounds in the NHS being wasted on the crap listed above breaks Dr Rant’s and the RCN's heart.

A map of what a functional NHS would look like:-

Dr Rant is a keen hill walker with over 200 Munros to his credit. He loves the detail of maps and knows well how to read them. He also knows Korzybski’s great statement, “The map is not the territory, it is a representation of the territory and useful in so far as it corresponds to the territory.” Dr Rant has stravaiged across many miles of NHS territory and knows well both the clarity of the sunlit uplands and the mess of the boggy valley bottoms in which most NHS work is actually done. Too many of the people who presume to advise on how to run the NHS work only from the sunlit uplands and have never had to deal with the messy mixed social and medical lives of real patients, hindered by late communications, inadequate information, shortage of time and resource that combine to make the average day spent treating patients harder than it need be.

There is no current map of what a functional NHS would look like. I now need to draw one and from this move to propositions for what the NHS needs to do to move towards becoming a functional co-ordinated healthcare provider.

1. I think we need to be realistic about rationing. The NHS is a great system as far as it goes. However at root it is a £1500 per person per year compulsory insurance scheme. This will buy a certain amount of healthcare, but will not buy everything. No insurance can cover everything or buy everything, and all policies have exclusions. To pretend the NHS can do otherwise is misleading and logically futile. The NHS has sloughed off most dentistry, most chiropody, most long term geriatric care and most infertility treatment into the private sector. The promise of “Cradle to Grave care” begins to look ever threadbare, and the mendacity that goes into maintaining the fig leaves of cover intact is a waste of energy when the truth could set us free. We here includes patients, health professionals, taxpayers and politicians.

2. I think we need to realise that market mechanisms are anathema to any health service, and increase transaction costs rather than health gain. Julian Tudor-Hart has shown this by his life and work summarised here and here

The Dr Rant Foundation contains various shades of political opinion but even the bluest of them retain great respect for Dr Tudor-Hart’s vision of the NHS. Conservatism is often presented as favouring accumulation of personal capital (think “loads a money” pastiches from Harry Enfield, but then think Goldman-Sachs $16 billion bonuses under Labour!)

However Conservatism must of necessity value social capital as well, and although personal wealth is nice private affluence and public squalor is an unappetising combination. Health is one of the pillars of social capital, and extremes of income inequality such as those seen within USA and UK are actually very bad for health, both for the rich and the poor. Michael Marmot summarises the relationship well in Status Syndrome. Any health scheme must deal fairly and equitably with all members of society. It must do this on the basis of pooled risks.
To do other is a denial of justice

And the Biblical injunction is very clear, both in Old and New Testaments:-

“He hath shewed thee, O man, what is good; and what doth the LORD require of thee, but to do justly, and to love mercy, and to walk humbly with thy God?” (Micah 6:8)

And

“Heal the sick, cleanse the lepers, raise the dead, cast out devils: freely ye have received, freely give.” (Mat 10:8)

Providing a just health service is a deeply held moral imperative, derived from Judeo-Christian tradition, but few humanists would demur from this ideal. The current NHS reforms take us further than ever away from this ideal.

3. We need to distinguish between remedial treatment of disease from health generation and promotion (Salutogenesis) We should have a government ministry for salutogenesis, but the Department of Health should not be it. Doctors are experts on disease causation, diagnosis and treatment, and are rarely expert on health. The medical enterprise is devoted to remedial treatment of illness and disease, and this does not usually generate health, it simply returns a patient to the status quo ante, (at its best) and stops the progress of disease (sometimes) The NHS and the medical profession should focus on treating genuine illness and should resist attempts to increase its remit beyond this aim. There’s enough in this remit to keep doctors and patients busy. The current NHS is really not even achieving this core role adequately yet as some of the links above demonstrate.

The creeping medicalisation of all life is a form of madness that we will live to regret.Petr Skrabanek sounded the alarm, and I will sound it again now.

4.The NHS needs to work better across its interfaces. This might seem basic, but it is so basic that management consultants recommend sacking hospital secretaries and hospital executives are stupid enough to follow the advice. As Mayur Lakhani says, “interfaces of care are dangerous places for patients” and in the NHS the casually poor communication between primary care, secondary care and psychiatric sectors is a major failing in our care of patients. Simply getting these people to talk more to each other would vastly improve the running of the NHS. It would be good for both doctors and patients, making life easier, safer, and more enjoyable. I can write this piece and post it edited properly within 24 hours. You can read it anywhere in the world straight after. Meanwhile Dr X is writing to me today in my local hospital 3 miles away and the letter won’t arrive at my surgery until about 2-3 weeks later.

5. Access needs to be better. The current pattern of opening hours and clinic scheduling is about as modern as Jurassic Park and the graphics are less good. This doesn’t mean the same doctors working longer hours; it means the same doctors working rescheduled hours. An inaccessible service might as well not exist as far as its patients are concerned

6. Referral pathways need to work well both to get necessary referrals dealt with quickly and just as importantly stop unnecessary referrals from being made.

7. The importance of primary care needs to be appreciated. Barbara Starfield shows just why this is so. (Full essay on her contribution to come) The key thing to say here is that the patient’s care must be continuous through time, and through healthcare sectors. Systems that have well focused primary care with long term continuous supportive relationships between doctor and patient working as co-creators of the relationship will achieve better results than those which simply provide episodic reactive care (e.g. multiple visits to the emergency room) In the UK GPs are the last doctors who see the patient as a whole, in their life context. The acute hospital sector (at organisational level…some specialists are all too sharply aware of the idiocy they are working under) has largely given up thinking about longitudinal care for patients instead thinking in terms of “completed consultant episodes” and “procedures reimburse under the payment by results tariff.” Consultants are now encouraged to discharge everyone they can……which then results in the patient being referred back by the GP at a later date. (New patients are paid at a higher rate under payment by results than follow ups so this works to hospital’s advantage. That’s a great result of this system isn’t it?)

8. Everyone is entitled to good care. However the articulate middle classes always do better. No system will ever get round this inbuilt advantage that proactive people who can think, plan and act will always maintain over those who drift, react and panic.

9. Disadvantage accumulates with one problem leading to ever more social and medical problems. It’s called “Co-Morbidity” Doctors dealing with these harder cases need more time and resources. How a society deals with its weaker members, “the widow, the orphan and the resident alien” is a touchstone for its moral development. Currently there is much bleating about the topic, but no real shift of resources to help deal with it. And before Gordon Brown thinks it, making the rich get poorer through higher taxes simply makes beggars of us all!

10. If you want more than the NHS basics you will have to pay for it.


So what would the NHS spend its money on if it was a functional system?

1.Well qualified and trained professionals-
Nothing is as empowering for patients as an accurate diagnosis and speedy treatment. Good professionals will help achieve this.
As Red Adair puts it “if you think professionals are expensive you should see what an amateur costs!”

2. Communication
At all levels between doctors, patients, and relevant others. Hospital secretaries would rule the world and managers would be roasting in the Devil’s kitchen

3. Ensure continuity of care to provide better care to patients and to avoid unnecessary referrals (and their expense)

4. Speed of access to diagnosis and treatment.

5. Minimal management to achieve 1-3 above. Alexander the Great once asked the Cynic Philosopher Diogenes what he could do to help him. Diogenes replied with the classic, “Please get out of my light” The medical profession is asking the managers to do just this.

6. Right patient, right treatment, right time
Doing the job right first time would be simpler and safer than trying to sort out mistakes later. Treat patients well and put lawyers out of business.

7. If 5 fails get a reliable complaints system in place. No scape goating. No blame displacement. No management involvement.

8. Contracts in place to ensure the viability of long term patient-doctor relationships.
(The new GP contract signally fails to do this)

9. Prevent fragmentation of care. Fragmented care is less good, and more expensive.

Nothing I am asking for here is unachievable within present NHS spending. However the current political will is to squander the NHS resource on useless and expensive projects, rather than to understand or value the detail of individual doctor-patient relationships and see what is needed to allow those to work more effectively.

Until the NHS focuses its attention on the doctor-patient relationship and creating the context within which it can work better there will be no progress in developing the NHS.

Change and modernisation is not always for the best. The current unfocused blizzard of initiatives is utterly useless for managers, doctors and patients, and meanwhile basic simple improvements go unmade. What a total waste.

Greedy Doctor Scum

A brilliant and insightful report from the National Audit Office (NAO) has proved beyond a reasonable doubt that NHS consultants are big lazy fat bastards who gorge themselves on tax payer's money while doing minimal amounts of work. Before the new consultant contract in 2003 it was rumoured that the greater spotted consultant could occasionally be observed moving between their Rolls Royce and the hospital entrance, however these days consultants are more likely to be spotted shifting their obese derrieres between private jets when transferring from one golfing holiday to the next.

The NAO report also cleverly pointed out that there had not been a proportionate increase in productivity to go with this bath tub note-lining exercise. Health economists are the most incredibly reliable and trustworthy economists of all, and when they measure something you would normally be confident enough to gamble your house on the accuracy of their razor sharp predictions. Indeed it has been proposed that Jesus himself was a health economist, given the glowing halo he wore and the genius of his every word.

The NAO advised the DoH that it was wholly unaccaptable to pay consultants a decent wage for the hours that they actually worked. They also suggested that a much better way to extract more work out of the fatties would have been to tie them to their desks with their armani suits, slap their fat bits with DoH 'NHS improvement' manuals and drip hot wax on their goolies until they gave in, deciding to work 133 hours a week for free. What is the point in paying people fairly and working in harmony when you can bully and initimidate them to work for free?

The NAO report has hit the nail on the head as it is consultants that are solely to blame for this 'best year ever'. There is no way that these productivity problems should be blamed on the internal market, payment by results, frontline services being starved of cash, billions spent on quangos and centralised buttock munching, endless lunatic reform et cetera; that would be crazy, it is all the consultants' fault.

Given that people always work much better when they are treated like shit by their employers, there is only one logical way forward; new legislation and bureaucracy is needed that will create a complex system of payment for productivity and brutal punishment for poor performance for each individual consultant.

Given the DoH's skill in bringing through daring reforms so seemlessly that you barely noticed they even happened, until you saw the dramatic improvements eg MTAS; they would easily be able to make the NHS more efficient with this clever new system. It would probably need at least two bureaucrats to be employed for each consultant, each would spend half their time following the greedy bastard and the other half filling in 'payment for productivity' paperwork. In this way, using brilliant formulae devised by health economists, the bureaucrats could pay and punish each fat cat accordingly. The new legislation would involve using the regulatory reform act to rush through laws that meant the human rights of doctors could be ignored in the best interests of patients, after all a good beating every now and again would probably be a good way of improving consultant performance.

The NHS is in dire straits thanks to these selfish scum, the doctors; the only way to remedy this is more bureaucracy, more measurement, more targets, more bullying, more propaganda, lower morale and lower doctor salaries. It's pretty damn obvious really, I just can't imagine how we got in this mess in the first place?

Vive La Revolution!

"De temps en temps il faut tuer un admiral, pour encourager les autres"
Voltaire

The winds of change are gathering strength, and the weather forecast for Tavistock Square is looking decidedly stormy. Could the BMA be about to succumb to a coup d'etat from within?

There is a move afoot to force an Extraordinary General Meeting (EGM) in response to the BMA leadership's woefully inadequate handling of the disaster that is 'Modernising Medical Careers' and the computerised MTAS job tombola used to decided on young doctor's futures.

The instigator of the this move is a chap called Iain Varley. He plans to call for a vote of no confidence in the Chairman of the BMA James Johnson, and the chair of the Junior Doctors Committee Jo Hilborne.

You can see the details here.

Iain Varley needs needs nearly 1400 signatures to force an EGM. Dr Rant and the Team have signed, and we urge everyone of you who are able to to do so as well.

Why?

Those of you who are not intimately familiar with the arcane and murky structure of the British Medical Association share something in coming with the vast majority of doctors. The reigns of power are tightly held to protect the status quo, and directly elected officials are neutralised by 'ex officio' grandees.

The BMA's usual defense against criticism is 'why don't you get involved then?'. Predictably, there is a marked lack of enthusiasm at the highest level for this particular effort to stimulate the involvement of the 'grass roots'. Apparently, a 'change of leadership at this critical time is not the answer'.

Yes it is!

The BMA is paranoid that upsetting the government might lose them their 'negotiating position' (and presumably knighthoods). The rest of us are left wondering why we are so keen to negotiate with a bunch of synaptically challenged fuckwits that regard our profession's adherence to moral, ethic and educational principles as 'elitist' anyway. We should be in open opposition to New Labour and other politicians meddling with healthcare for their own ends. We could not be worse off as a profession than we are now.

We must not let the Government's threat to 'recalculate' the pensions of a few older doctors hold the integrity of our whole profession to ransom.

Let's vote for change!

Where the sun don't shine

Patricia Hewitt has issued an 'apology' of sorts to junior doctors:

"Mr Speaker, this has been a time of great distress for junior doctors and their families and I apologise unreservedly to them for the anxiety that has been caused. I believe that we now have the right way forward for this year’s recruitment to general practice and speciality training and that applicants can be confident they will be treated fairly."

Immediately after the apology she began a disingenuous and dishonest tirade of spin that will have had junior doctors steaming at the ears before she had finished. She proclaimed that the system had now miraculously become fair, that MMC and competency based learning were the best things since sliced bread and that her haemorrhoids were getting tired from so much flapping in the breeze. This was no apology. Metaphorically she offered a hand up to junior doctors but she then booted them vigorously in the balls.

This woman is speaking out of her stinking rodent infested rectum. Will her back passage never stop emitting her repulsive stream of propaganda? I would recommend an immediate colostomy crafting as this may be the only way to instigate some kind of control over her never ending noxiousness.

"But all involved must feel confident that the pursuit of excellence remains at the heart of the system."

The only way that this could be achieved would be to gather all the creators of MMC and MTAS together on a small isolated desert island for a 'quiet break' or self congratulatory 'conference'. In the meantime Dr Rant would be trained up as an expert fighter pilot specialising in death by napalm. Having ensured that all the guilty were present, Dr Rant would be unleashed from a nearby aircraft carrier to teach the sorry crew a lesson they would never forget. Fire in the motherfucking Hewitt hole! Money cannot not buy the kind of priceless image that this conjours up in Dr Rant's imagination......

I love the smell of Napalm in the morning!

Stick This Poll Up Your Arse Patsy!

A recent(ish) opinion poll has come to the attention of the Dr Rant Team, although it is now a year old. It was conducted by ICM who asked 1012 adults a series of questions. The research was sponsored by Reform (another bloody Think Tank) but a couple of the results are rather interesting.

None of the political parties are setting out attractive new ideas for delivering a better healthcare system:

Agree Strongly 39%
Agree somewhat 29%
Disagree somewhat 16%
Disagree strongly 11%
Don’t know 6%

This comes as no surprise does it? 'Clueless politician fuckwits haven't got a clue' isn't even up the Daily Mail's standards of shit headlines either.

However, the next question reveals that the British public know the score despite perpetuating the the status quo through their apathy.

Politicians ought to be removed from the day-to-day running of the health service :

Agree Strongly 52%
Agree somewhat 23%
Disagree
somewhat 13%
Disagree strongly 8%
Don’t know 5%

So 75% of those polled believe that the health service should not be run by politicians. The usual justification for the involvement of politicians is 'democracy', but this has about as much credibility as North Korea's claim to be the Democratic People's Republic of Korea does it not?

Let's face it; you could stick a red rosette on a pile of donkey shit in Darlington and it would get elected as MP (already happened-Ed) , and the converse applies in Kensington and Chelsea. 20,000 votes (from people who would rather eat their own children than vote for the other side) makes you an expert in health does it? A few years working as a management consultant teaching grannies to suck eggs makes you an expert in health does it? Well it would certainly seem that 5 years at medical school and 20 years practice doesn't. Democracy my arse!

Here's a democratic idea: There are 140,00 doctors in Britain yet the Prime Minister gets to appoint whatever lickspittle brown nose 'yes' man he wishes to tell him what he wants to hear. Why not ask doctors who should be chief medical officer?

One wonders whether the results would be even more damning a year on, despite it being the best year in the history of the NHS.

Dr Rant is not 'backwards in coming forward' when it come to finding fault with the way in which meddling politicians are destroying healthcare in Britain, which leaves us open to the reasonable criticism that all we do is succumb to impotent rage.

However, Dr Rant will soon be publishing the solution to the problems that make us so angry. We hope to encourage the belief that there is another way, and it will be our 'manifesto'.

In the meantime, if anyone would like to try to explain why politicians should be running the NHS, feel free to tell us in the comments section. We like a good laugh!

Reposted 17/04/07 to open up comments and correct idiotic spelling errors.

You will not believe this!

I would like to draw your attention to a fine piece of ranting on Rhetorically Speaking.

In a nutshell, it refers to a Daily Mail reader who is trumpeting his decision to stop his daughter having the new Vaccine against the virus that causes cervical cancer.

He believes that giving preteen girls a (safe) vaccine that stops them from getting cervical cancer 'encourages them to experiment with sex'.

What a tosser!

Not only that, he has the conceited arrogance to believe his brainless moralistic paroxysm deserves disseminating to other neuropaenic Daily Mail reading reactionary spacktards.

Listen up - the perception that cervical cancer is effectively a sexually transmitted disease is NOT widely held outside of the medical profession. At no time is the past has concern about cervical cancer influenced the sexual behaviour of teenage girls, so why would freedom from concern about cervical cancer have any influence? Of course it fucking wouldn't. Paul Dean would actually like to encourage fear in order to exert influence over these girls' autonomy.

In the meantime, Paul Dean's 5 minutes of fame has come at the price of his daughter's exposure to needless risk.

Dr Rant's daughters will be first in the queue I can assure you.

May I also commend to you the comments section under the Daily Mail article - it's a hoot, especially the 'I don't trust drug companies/doctors' brigade!

NHS University: waste, lies, and spin

Dr Rant reads on the Monk's site (the crusading consultant in Bedford who is standing for parliament in protest against NHS cuts), that Rod Ward has finally got hold of the report into the waste involved in the failed 'NHS Institute of Healthcare Innovation and Education' (or the NHS University).

Having refused to give him a copy, then refused a Freedom of Information Act request, then appealed against an Information Commissioner ruling ordering them to give Dr Monk the information, they dropped their objections just before the appeal was to be heard.

Rod says 'It suggests that in the light of the £72 million investment up to March 2005 "the Department of Health is exposed to significant embarrassment if the value for money delivered by the NHSU were to be probed".'

Cheating, lying, spin-bound, tossers.



Dr Rant would like to apologies to Rod Ward for initially attributing this tenacious piece of investigation to Barry Monk himself. Thanks to Front Point Systems for spotting the original reference and letting us know in the comments section.

(Post edited to correct this error 1350hrs 14.04.07)

A Picture Paints A Thousand Words........

This great picture was in the The Sun today.

Dr Rant would have put something subtly different, on his placard if he were there!

Thinking Blogger

Thanks to Crippen for listing us as one of the five medical blogs that make him think (of what? one has to ask....).

From his post, apparently:

The participation rules are simple:

1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think.

2. Link to this post so that people can easily find the exact origin of the meme

3. Optional: Proudly display the ‘Thinking Blogger Award’ with a link to the post that you wrote


I'm assuming that you are supposed to choose blogs that have not already been chosen by others higher up in the meme, but I could be wrong.

We're going to be medical and list the following blogs:

Of Short White Coats and Stethescopes - I like this 3rd year UK medical student's blog because it still has an innocence and awe. It's nice to remember what we were all like when we started out on the road to Hell. A bit like reading the first few chapters of The Lord of The Rings, before the shit hits the fan.

Hospital Phoenix - having risen from the ashes once more, the Dr Rant team are always keen to hear what McBitch is going to get up to next in this hospital doctor's blog.

Save Bedford Hospital - Even if Dr Barry Monk had not been the catalyst that resulted in the Bedford NHS Press Relations Officer getting herself fired for going ape at a TV news camera crew, he would still be a hero for taking on the bastards running the NHS into the ground at their own game. Interstingly, since his unit got closed down after he announced he was standing for parliament, his blog as become much more interesting. Presumably, he has more time to devote to writing and causing trouble. Vote 4 Barry!

Dr Grumble - always worth a read has been doing a particularly good job of covering the MMC/MTAS fiasco.

The Ferret Fancier - a relatively new medical blogger who has been putting up some excellent posts. In fact, worth visiting just for the Attack Ferret Security Co. logo.

Front Point Systems - the oddly named FPS Ltd has been producing some excellent medical blog posts, and appears to be getting more militant all the time.



Editor's comment 1858hrs:
Dr Rant, whilst a genius at medicine, obviously can't count. That's SIX links. Idiot!

Wrong again, Splatzy

"The new system of MMC I think everybody supports"

Patricia Hewitt, SoS Health, BBC 3rd April 2007.


I mean how wrong can one ignorant, evil, stupid, loathsome, lying, bitch be?

When this quote was put up on Doctors.net, nearly 1000 doctors have indicated that they disagree. They don't support MMC. Period.

Perhaps Patricia Lying Cow Hewitt means that 'everyone' she pays to say 'yes' to her supports the system. Perhaps she means that 'everyone' who she has offered a peerage to supports the system. Perhaps she means that everyone in her old marketing consultant company, Andersons, supports it.

Who knows. But one thing we do know, many doctors don't support it, and that means that 'everyone' does not support it, which means that once again Patricia has been caught lying to the public.

Say it with me: resign, resign, resign you lying evil ugly troll.