BMA IT Confidentiality Threat Vote

The BMA is advising members not to co-operate with the placing of patients' medical records on the NHS data spine, reports E-Health Insider.

Dr Rant agrees totally - I can't think of a single example of a patient coming to harm for lack of a national patient record in the many years I've been a doctor, yet I have seen patients come to harm because they failed to tell their doctor something they should have. An insecure national database will pose a threat to patient safety, and to the doctor-patient relationship.

Of course, that didn't stop the ignorant fuckwits who commented on E-Health Insider about 'luddite' doctors. It's amazing how people who have fuck-all idea about the practice of medicine seem to think they know more than the professionals about what is important. But that's modern society for you - a bunch of loud retards running around opining madly about things they don't know they don't know.

Doctors get taught that the things you don't know you don't know are the things that get people killed. Perhaps we should start adding that vital gem to degree course in Fuckwittery that seems to be so heavily oversubscribed these days.

Take them out and shoot them

The Czars go…….the further the better

One of the good changes happening with this new regime is some clearing out of the medical twaterati. The move to get rid of the medical tsars is to be welcomed. They have never been very popular amongst their colleagues, and never had any great either intellectual or democratic validity. Apparently Harry Cayton, the “patient czar” has gone already. Let’s just hope we get the head medical honcho out as well.

Then we could celebrate a good month with Hewitt, Granger, Burnham, the Tsars and the CMO out of DH. Warner already gone at Christmas. At least the poisonous people would have gone.

Whether Alan Johnson can draw the poison from the policies remains to be seen.

Also getting rid of Johnson from BMA is good. Hamish Meldrum is a sensible doctor and knows what he is talking about.

RCGP is getting a new Chair of Council in November who is likely to be a less divisive figure than his predecessor, Professor Sir Mayur Lakhani. May there be fewer stars in Steve Field's eyes.

Now we just need rid of the CMO and Dame Carol Black and we really will have had a high phosphate clear out of the discredited Twaterati.

Maybe a good start for July.

Newspeak for NHS Managers: Talking Bollocks Fluently

Well we know Patsy talked bollocks. At least she’s went this week.

But now we can see that talking bollocks has become an endemic disease in NHS management circles. It’s achieving a transformational change as the NHS launches into one of its periodic fits of excessive adjectival aggregation. Unlike Orwell's Newspeak ("the only language in the world whose vocabulary gets smaller every year."), this stuff is expanding at a frightening rate. Time to get the Rant toolkit out and deconstruct this mess. I claim the spirit of Sir Ernest Gowers and Darrell Huff as my guides.

OK. Let’s start with redundant adjectives.

“Transformational change” What would a non-transformational change look like?
“converging on one common goal” However you look at this at least 2 of these 5 words are redundant. Try converging on two goals at once.
“meaningful metrics” Well I suppose these will be an improvement on meaningless metrics so beloved of this government. Eight out of ten bishops take the Times, the other 20% buy it…etc.
“Implementing intelligent analysis” It might be an improvement on unintelligent analysis. In tests eight out of ten fat cats said they preferred it that way.
“meaningful engagement” In a very deep and meaningful way may I say that the more times I hear the word meaningful the less meaning I think is present.
“Engaging clinicians” We’re not engaging at all really- put us in the “hard to reach” group.
“Satisfy National mandatory criteria” (central credit) and “local demands” (local blame)
“Sustain truly healthy and independent communities” What would a falsely healthy community look like?
“Actual challenges faced” What would a non-actual challenge look like?
“Integrated framework” Try imaging a disintegrated framework. Oh sorry, you don't have to, the NHS is just one example, amongst failing law and order, the Iraq war, etc
“further training, upskilling and establishing joint learning procedures” Then we can learn how to really screw things up.
“Future long term gains” When else would long term gains come in? The past?

Then let’s be proactive together so that we can boldly go to
“cross sector commissioning frameworks”
“Transcend the DH Health and Wellbeing framework”
“Surpassing a purely financial and target driven culture” (We are surpassing ourselves today, aren’t we?)
“Actualise shared vision” (There isn’t one, that’s why mangers and doctors squabble.)
“cohesive working” (Lets hope this all hangs together)
“Overcome key challenges” at this “crucial” conference.
“capitalise on this unique opportunity” to drive the NHS into bankruptcy.

Welcome to the runway for the launch of NHS2.0

Onwards and upwards, looking out(for the knife in our back) rather than up (from whence cometh my help?) just as David Nicholson has instructed us. Whole systems knowledge and proactivity at the ready. And with our toolkit full of integrated frameworks, meaningful metrics, ready to drive transformational changes throughout our local health communities, fostering personal responsibility, in fully engaged scenarios, and breaking down the obstacles to redefining the roles of the emerging single pot model. And we’ll all do it together as we’re all individuals now, just as Mr Nicholson has told us to be.

I think I’ve got this conference right, but there will be a conference report summarising the key challenges and opportunities identified during the day, which will be produced after the event (Bit of a failure of proactivity here don’t you think?) and distributed to all delegates. This paper will be practical in focus, highlighting learning from elsewhere (Mars?) as well as tools and techniques that can support transformational commissioning for public health.

Some time ago Sir Harry Cayton (the Patient Czar- overdue for removal)wrote a piece in JRSM about "the Alienating Language of Healthcare." I don't know about you but I find the language of healthcare management pretty alientating too.

Makes Francis seem reasonable!

Dr Rant admires Bob Bury the friendly, intelligent and sensible radiologist from Leeds.

Here’s Bob on fine form giving our new Prime Minister some good advice in an open letter in the Yorkshire Post.

Add a few dozen four letter words, and you'd have exactly what we would say.

[Thank you to the doctor from Yorkshire for bringing this article to our attention - Ed]

The Most Selfish Patient, Ever?

Crippen mentions a comment that his stories about the disappearance of Maddy McCann generated on his blog.

"What about Gerry [McCann]'s patients? Presumably they are well down in the pecking order of concern."

Just how selfish would you need to be to think "That Dr McCann's a right selfish fuck. He might think that having his 4 year old daughter kidnapped, with no idea of whether she is alive or dead or having who-knows-what done to her at this very moment by some sick bastards, but what does he know about pain? I had my appointment for my ingrown toenail cancelled because of his slack attitude! People like Dr McCann shouldn't have gone into medicine if they can't put their patients first, that's what I say"?

Is this person the most selfish fucktard in the blogosphere? The most selfish patient I saw interrupted the cardiac arrest team as we were preparing to unload a cardiac arrest patient from an ambulance that was blue lighting into the A&E ambulance bay. His question? "When will someone take a look at my thumb?"

I have even heard of patients complaining about their appointments being cancelled because their doctor died.

You just can't make this stuff up.

Great minds think alike

Did anyone else notice that several of the bloggers that posted about Patzy Hewiit's departure as SoS for Health ran with the same headline: Ding Dong! The Witch is Dead!

We had that title up with our draft piece on the Dr Rant Sandpit yesterday, but didn't publish it on the public site until this morning. Meanwhile SHP had the same title for her post, and the Devil reported that he 'received a text message from my respected swearblogging colleague, Mr Eugenides, that simply read, "Ding! Dong! The witch is dead!"'.

Funny that.

Eugenides on Hewitt: One Last Time!

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As part of our goodbye to Splatzy, I'd like to tribute Mr Eugenides wonderful piece about Patsy and a DC-3 engine one last time. DK claims it is the definitive Anti-Pasty rant, and I have to agree.

In an ideal world, I would like to take Patricia Hewitt, tie her up, and slowly feed her into the propeller of a DC-3 - feet-first, naturally, so I could see that condescending fucking face contort in agony. I'd let the blades shear off her legs, and then hand her a mobile and dial NHS Direct, see how much fucking use that would be to her with some cretin in a call centre in Chelmsford asking her where it hurts, the patronising, incompetent, self-obsessed bitch. Later, after she'd expired from blood loss while waiting, in vain, for an ambulance that never came, I'd beat the corpse to a bloody pulp with a bound copy of one of her stupid fucking White Papers, until the only sign that this had been Her Majesty's Secretary of State for Health was the cheering crowd willing me onwards to commit ever greater acts of depravity against the lifeless body.

But I'd probably be breaking some law or other, so I won't.

Bless.

Ding! Dong! The witch is dead!

And so, Patricia Hewitt, farewell.

For the last two years, the NHS has been in the hands of a complete and utter failure. Her tenure as Secretary of State for Health has been an unmitigated disaster for the health service. Just as she finished her role as Secretary of State for Trade and Industry by decimating the MG-Rover workforce, so shall her term end with large numbers of junior doctors, nurses and midwives seeking a job. So, what was so bad about her time in office? Here is Dr Rant's top five:

5) Connecting for health. Or NHS-IT. Or NSH-IT as it is better known. There are many ways to piss £12 billion up the wall. Holding the Olympic games is one way. Another is to fund a computer system that no one wants and no one needs. Choose and book? Fuck off! Ask any patient who is not a self-obcessed borderline-autistic wanker what hospital they would like to go to, and they will either want to go to the nearest one or will ask for their GP's opinion. NHS broadband? Yeah, no one else provides 'dead-slow and stop' broadband, do they? And finally, The Spine. Big Brother style fascism by the back door. A concept with next-to-no valid use for health professionals, but a panecea for anyone who wants to collect data on you. Hewitt - you were in charge during this monumental IT fuck-up.

4) Bashing 'Greedy GPs'. A very smart move, Hewitt. Your party negotiated a new contract with GPs, and completely fucked up the value of two important factors - 'good will' and out-of-hours. The rest of the contract was a heap of steaming shite, but the ability to opt of of on call duties for only £6000 was an offer too good to miss. Many GPs would have paid double or treble that amount - out of hours is unpleasant work, with little reward. And 'good will' was the driving force that ensured GPs did activities such as monitor warfarin levels, take hospital sutures out, etc. When you devise a payment-by-results system such as QoF, of course a lot of these 'good will' activities will be dropped.
And as most GPs reached the meaningless targets generated by QoF, you decided to start the national sport of 'GP bashing'. Well, fuck you - you evil, vexatious cunt. Some companies reward their workforce who reach targets - not the DoH, you declare them greedy. Well, keep it up at this rate, and the humble GP will fuck off down the same path that the NHS dentist has. Do you fanct that happening?

3) PFI bullshit. The National Audit Office has recently finished looking at the record of PFI hospitals, having been assessing them over the last two years. This found that 70% of PFI hospitals has a bed occupancy rate higher than 85%, mainly due to the fact that they had fewer beds that the hospitals that they replaced. They also found that the cost of cleaning the PFI hospitals was higher than cleaning similar, non-PFI hospitals. The upshot of this is that there is not enough time, and non enough money to wipe the shit off the bed when one patient has finished with it, and a new one needs to use it. Little wonder that there is such public concern about MRSA and Clostridium difficile. By all means try and tell us that it is because Dr Rant doesn't wash his hands enough, but when the faecally incontinent dement in the bed next to you is only 18 inches away, where do you think the germs are coming from?

2) Blatant denial - the 'Best Year Ever'. What. The. Fuck? Utter, utter, bollocks: the wards are filthy, the morale of doctors and nurses is at rock-bottom, 13,000 nursing jobs are under threat and the NHS is in debt by £700 million (Dr Rant does not believe the figures showing that the 'books were balanced'). NICE is denying lifesaving drugs, even when long serving consultants need them, postcode prescribing is rife, and huge amounts of money is snorted up the noses of management consultants giving out shit advice. Just exactly how is this the Best Year Ever? What fucking planet was Patricia Hewitt on? How much dope did she smoke to come up with this transparent load of drivel?

1) Fucking Cunting MTAS. Much has been said on Dr Rant about the monstrous pile of twat that is MTAS. In the same way that MG-Rovers were buggered, junior doctors have been bent over a barrel and firmly rodgered up the arse. Hewitt, you were in charge of an unfair, unsecure system that has robbed thousands of hard working juniors of a job. The last few months has been a series of greater and greater fuck-ups. A Fuckupolympics of fuck-ups. An exponentially worsening Fuckupathon. It is hard to imagine anyone doing a worse job than you have done. However, most people who had any fucking insight whatsoever would have resigned. You couldn't even do that, and remained in charge of a problem that you could neither fix, nor leave alone. Well, in a months time they will be thousands of doctors short on the wards. Not because there are lack of recruits. No, it is because ultimately, YOU FUCKED UP.

And so, Patsy. Your legacy is a broke, filthy, demoralised NHS, with almost insurmountable staffing problems. You pressed ahead with uncalled for reforms, blinkered to the view that you became the worst health secretary in the history of Britain. Unable to recognise your astonishing inability to do the job, you had little insight into what was actually happening when the shit met the fan.

And then there was your voice. Oh, that voice! That vacuous, condescending, whine. A poor-man's Esther Ransen, attempting to sound reassuring; listeners,driven mad with distress, drilling their ears with Black and Deckers in a desperate attempt to find relief from the Wall of Whine

Well, now you are gone. Thank. Fuck. Don't come back. Better still, don't become ill. NHS staff have very long memories.



The Patzy Rants:
Hewitt. I was Hitler's lover
Patricia Hewitt, you lying, evil, murderous, hag. Resign.
Patsy eats the young...
Thanks for our 'best ever year'. Here's your P45, now fuck off.
Patricia has another friend and admirer
Stick this poll up your arse, Patsy!
It's the end of the health service, Hewitt (and you feel fine)
Wrong again, Splatzy
Patsy OUT!
Patsy talks bollocks
Patricia Hewit is a lying liar and here are the lies she told
When will this bitch leave the NHS alone?

Hewitt. I was Hitler's lover.

We had been saving this one for a rainy day, but thought we'd better get it up before the Brown says 'Goodbye Splatzy'.

PRIMARY CARE WORKS! In Praise of Barbara Starfield.

Dr Rant has various intellectual heroes, and one of them is Barbara Starfield. It is as a result of her contribution that he can make the title statement above with confidence. He can reference it, document it and generally give a very hard time to anyone who doubts it.

Primary care is the cornerstone of good medicine. It is relatively low tech. It is cheap. It is based on human relationships. It uses basic technology. It doesn’t rely on machines that go bleep. It is based on processes done well through time, rather than big events done at a certain time e.g. an operation. Its focus is on peoplein their life contexts and not on any specific disease or system.

But why, and how, does primary care work?

It’s easy to run down primary care. You can easily show that for most illnesses there are people wandering around with undiagnosed disease, under treated disease, inadequately investigated symptoms. And primary care has problems not always been accessible. Many research papers say, “The GP is ideally placed to spot all this” and the only sure prediction is that this stock conclusion will be just as true next year as it was twenty years ago. On this basis many specialist physicians or specialist researchers say that primary care is not fully effective.

And yet, primary care is actually the most effective part of medicine. Its main function is to keep people going in the community, and to keep them out of hospital. Not in the sense of rationing, or not admitting people who are ill enough, but in the sense of keeping people going so the question of admission doesn’t arise quite so often, or that people have their heart attacks later rather than earlier in life. As with most prevention work in later life we are talking about disease postponement, not total prevention. Heart attacks, strokes, and cancers will still get us, but on the whole most of us would prefer to wait a few years longer if possible before encountering them.

In the USA there are large variations in supply of primary care vs secondary care physicians. In those states where the focus is more on the primary care side the population mortality is lower. Starfield has shown similar data on international comparisons as well.

In this piece I have put together a brief introduction for those who don’t know Barbara Starfield’s work. It’s a major body of public health research and practice, and as a primary care physician she gives me an intellectual lift whenever I read her work. She confirms how much good I and my colleagues in primary care do, and why primary care and its longitudinal relationship based approach is so important. It also explains why as a GP we get upset by proposals that break this relationship (such as walk in centres and NHS Direct) in the name of shallow consumerism as opposed to real long term medicine.

She gives me the ammunition I need when secondary care based researchers go, “But GPs miss this…under treat that….are ideally placed….etc.” For all the mistakes we make, in primary care we are doing far more good than harm, and Barbara Starfield gives us the facts and figures on this. The power of long term processes and personal relationships is greater than that of high tech interventions in crises.

Thank you Barbara Starfield.


Other references:-
Starfield, B and Horder, J (2007) Interpersonal continuity old and new perspectives British Journal of General Practice 57:527-528 (July 2007)
Shi,L.,Starfield, B., Kennedy, B.P., Kawachi, I. (1999) Income inequality, primary care and health indicators. Journal of Family Practice 48:275-284
James Macinko, Barbara Starfield, and Leiyu Shi (2003)
The Contribution of Primary CareSystems to Health Outcomes within
Organization for Economic Cooperation and Development (OECD) Countries, 1970–1998 Health Services Research 38:3 ( June 2003)

Patricia has another friend and admirer.

Patricia has another friend apart from the silly old coote. This time it’s an OBN for this piece by Robina Shah.

Mrs Hewitt operates “like clockwork” Well that would explain a lot, the stilted language, the strange automatisms, and cuckoo clock like calls of “choice” and “patient centred” and “balanced books” It would also explain how she can be wound up. After all this is her best year ever, if only the press would report it accurately enough.

I’m sorry the central DH people are spending so long in their meetings. They’d do better to go home earlier and get treatment for New Labour’s worst diseases, Attention Deficit Hyperactivity Disorder or obsessive compulsive lawmaking.

It’s full of sound and fury but ultimately signifying nothing. That’s why Brown is so keen to get rid of her.

DK's wrong again

DK is guest blogging over at 18 Doughty Street

In his first post he suggests that doctors should be helping their managers rather than trying to manage themselves.

"The fact is that, whilst we acknowledge that the vast majority of doctors are very good at treating their patients, they are not managers.....ultimately, doctors are a financial commodity, just like any other employee"

DK, never one to let facts get in the way of his opinions, failed to mention that GP principals, who make up a large proportion of the medical workforce, are not employees but self-employed businessmen. And the bit of the NHS that works best (relatively) is General Practice. And the bit of the NHS that is still controlled and run by doctors and not managers is.....General Practice.

Hmmm.

Meetings, more meetings!

Dr Rant has long been an admirer of Scott Adams and Dilbert. He learned most of what he needs to know about management from “Dogbert’s Top Secret Management Handbook.” Adams protests that he tries to make his characters ever more absurd. His readers protest that management keeps on getting ever more absurd!

The UK NHS provides endless examples of mismanagement and may provide local and transatlantic visitors with some amusement.

In one Dilbert strip Dilbert is sitting with A.N. Other. Dilbert says, “There’s no purpose for this meeting other than my boss told me to have it…..so let’s just sit here silently until our time us up…..unless you have something better to do.”
Is there anyone who doesn’t recognise this scenario?

However real life is sometimes better than cartoons. And this gem comes from Helan Bevan in HSJ. In real life Helen is “director of service transformation” (Ed What the fuck is that about? Do Doctors turn into Pilots? Or Rabbits emerge from hats? Or buzzwords appear from strategic interstices) at the NHS Institute for Innovation and Improvement. (Ed. This organisation has never been known to darken a hospital or GP surgery in our living memory. Most doctors and nurses will never even have heard of this organisation. Dr Rant has no knowledge of any innovation or improvement that has come from its work. However it must be good as Quango Queen Dame Carol Black is on its board of directors. Apparently she's going to be its ambassador to medics, if there are any left after MTAS)

This piece carries self condemnation to new heights. Adams’ motto “Always postpone meetings with time wasting morons” is a good one. This quote shows why.

“The biggest problem was meetings. The leaders we studied typically spent 70 per cent of their working lives in meetings. Yet only 36 per cent of attendees made a significant contribution (ED so many?)to the meetings we observed. Only 27 per cent of meetings began on time and only 18 per cent finished on time. There was typically a lack of focus on actions, roles, responsibilities and deadlines and a lack of an effective protocol to ensure meetings added value.”

In short most meetings achieve absolutely nothing at all. Ronan Keeting sang “You say it best, when you say nothing at all.” In the NHS context this becomes the best management advice ever!

Now let’s just sit here in silence and contemplate the disaster the UK NHS has become. We’ll call it time for reflective learning, strategic thinking, direction setting and personal workload planning.

A Deeply Unhappy Family: Don't try to improve it.

Last week the NHS managers were at the NHS confederation conference. The HSJ has covered this event very helpfully. Dr Rant has been enjoying the coverage hugely. He hopes the managers are enjoyingy the viewfrom the spaceship already so far are their views distant from what’s happening on the ground. The Public Accounts Committee is even ruder about management consultants, who may have been rumbled.

Highlights included the instant classic, “Try to improve it”

This gem came from the NHS staff survey HSJ had done. Whoever gave this response has captured the feeling of millions of NHS workers both clinical and managerial. Our biggest fear is that Gordon Brown will, “Try to improve it.”

The survey is not good news and the NHS looks like it is in deep Gordon Brown over staff relations.

“Morale is low, belief in a better future thin on the ground”

“A decade of record investment, sharp pay increase and an unprecedented renewal of infrastructure has earned new Labour a zero per cent score for excellent morale, while two thirds say it is poor or very poor”

“Yet, despite a few glimmers of approval, the overwhelming picture painted by the HSJ’s survey is of a government and an incoming prime minister who have lost the confidence and trust of NHS staff both managers and clinicians”

Anyway the great and the good, including many medical Twaterati are still prattling on connecting false causes via false reasons to false outcomes. Let’s see some of them:-

Dame Gill Morgan is a good start. “Public slanging matches are damaging the health service” followed by, “Unison and the BMA were singled out” That’s splendid Gill. It was the unions what did it. The DH and its management lackeys would never try a spot of news management themselves would they? Wait for Patricia’s parting shot with the access survey spin. Still after her, another one, no better at best and maybe worse.

David Nicholson, the former communist, is going to give up central credit and local blame. Managers in future will be instructed to make it look as if they think for themselves. No doubt that’ll be an order then. Apparently in NHS management bullies thrive and middle managers are left to fail. But no one will dare say so.

Managers are worried that doctors lack skills and are not team players. We might join with them if they showed any understanding of medicine, doctors, patients, and the interaction between doctor and patient. Also of the constraints of time, money and numbers we work under. Perhaps it’s time managers learnt some medicine, and not the other way round?

McKinsey research finds gaps in NHS management. Well, there’s a surprise, and no doubt they have a solution just ready to be implemented too.

Sir Liam Donaldson urges NHS organisations to learn from medical mistakes. Such as MTAS? The departure of Richard Granger this week suggests that big failing computer programmes may not be what the patient needs. They may not be fit for purpose.

Gerry Robinson talks mostly good sense. Particularly when he acknowledges the fear that runs throughout the NHS hierarchy, which destroys all real attempts to improve the service.

The BMA, RCN and RCM attacks on government are beginning to have an effect, and I hope these organisations keep up the pressure on Gordon Brown as he enters office, apparently making the NHS his “top priority” I’m sure the great clunking fist will happily involve everyone who agrees with him. Participatory democracy is so empowering isn’t it?

Anyway it’s the BMA conference in Torbay soon. I don’t think Gordon Brown will enjoy the mood music coming out from there. Good. We need a proper debate about the dismemberment of local health services, and it’s time doctors stopped collaborating with the alien occupiers of the health service.

We may in time have to do a dentist, and leave the NHS if we want to practice good medicine. The manager’s conference showed great evidence that there is little connection between NHS central and NHS peripheral. There is currently next to no connection between the work of mangers and the work of doctors and nurses. This disconnection between the delivery of health care to real patients and central government bollocks such as choose and book will eventually destroy the coherence of the NHS.

Currently the NHS is an unhappy family. Tolstoy anticipated this with, “Happy families are all alike; every unhappy family is unhappy in its own way.”

Brown's Boneheaded Cretins

It's BMA conference time, which reminds me that I forgot to mention how the BBC coverage of the resignation of James Johnson, the ex-BMA chairman, made me chuckle. They allowed him such an opportunity to voice what even he himself admitted was his 'personal opinion'. It is especially strange that the BBC kept slipping in mysterious quotes from unnamed third-person sources and from unrepresentative wankers like Simon Eccles. To quote Brown's brown-nosing little lackies:

"However, this was a far from universal view. Some doctors the BBC spoke to expressed anger over the actions of junior doctors involved with the pressure group Remedy UK with one describing them as a "rabid mob"."

Dr Rant too has become aware of a significant body of third-person sources, and all three of them think the BBC are dragging journalistic standards even lower than the lie of Dr Rant's exceptionally large testicles [apologies to Dr White - Ed]. Some doctors we spoke to think that the BBC are simply a mouthpiece for the government's lame propaganda, while others have even expressed the opinion that the stench of faeces coming from the BBC's newsdesk could only be eradicated by a well placed nutrino bomb. It has even been mentioned by some extremists that Uniqua in the Backyardigans produces more intelligent political debate than the BBC.

Dr Rant would like to urge caution in believing that these malignant festering rumours are cynically inserted into shoddy news stories with the sole aim of spinning news in a particular desired direction. To quote Dr Squashedflycake of Lancashire:

"I am an utter cunt, please do not believe a single disingenuous word that spews forth from my dysmorphic and slightly rancid lips. The BBC does ring me up regularly for quotes with which they can pad out their lazy musings, however this is only because I am one of only three practising medics in the country who agree with the government reform agenda."

1984, corrupt government, newspeak and NPfIT

One of our regular readers has drawn Dr Rant's attention to a story running on Computer Weekly's weblog about the Department of Health subtly altering public records of expert's comments to negate criticism of NPfIT.

We have a term for this at Team Rant. The current government are a bunch of lying, cheating, bastard scum who will do anything to control The Message.

And the Devil is being a tosser too...

What is it with bloggers today.

The DK is ranting on again about getting doctors to shut the fuck up and get on with patching people up. All because doctors want anti-binge drinking policies brought in.

Stop being such a tosser, DK.

Much as I agree that the BMA should spend more time getting the basics right (such as MMC, NPfIT and so on) and stop fiddling while Rome burns, public health is the most important area of medical intervention.

Why should we keep pulling people half-dead out of the water, when we could save far more lives by putting a stop to the fucker who is pushing them in up river?

Have you heard of the Broad Steet pump?

Binge drinking is causing enormous problems and is fueled by a profit-hungry drinks and entertainment industry who show as much interest in public health as the tobacco industry did. Or do you think that attempts to combat the marketing power of the tobacco lobby are also an example of "when will these fuckers stop trying to involve themselves in things that they don't understand and just concentrate on the pill-rolling".

Exactly what are your qualifications to give an opinion on health policy, DK? How about you shut the fuck up about things about which you are, frankly, ignorant, and stick to euro-bashing.

There's a good Devil.


(I should point out that I agree with much - but by no means all - of DK's critique of much of what is wrong with the suggestions, such as prohibition not working, but am pissed off at the suggestion that we have no right to get involved in the debate).

John's being a bit of an old fart

Dr Rant loves John Crippen. But occasionally he can be a bit of an old fart.

Today he has a go at Dr Sarah Blayney, and I think he is totally off target.

Sarah works at Arrow Park hospital, and says that she wants more flexible training so that she can have a family as well as be a consultant.

John and I both had the experience of working regular 56 hour shifts without a break (I spent several years working 9hrs, 9hrs, 33hrs, 9hrs, weekend off, 9hrs, 9hrs, 24hrs, weekend off, 9hrs, 33hrs, 9hrs, 9hrs, 56hrs, 9hrs, 9hrs, 33hrs, and so on).

This took a terrible toll - I was regularly reduced to tears and despair by sheer exhaustion. For example, I once catheterised a patient after 42hrs on my feet without a break with a nurse holding a vomit bowl for me to vomit into occassionally as I was so exhausted.

And much of our time was spent doing other people's jobs because we received half-pay for overtime while others received time and a half pay. A junior doctor at the weekend in 1995 was paid less per hour than anyone else in the hospital, including the cleaners.

So it was right that doctors were paid fairly for on call, and paid to be up when they were needed (for emergencies that provided our experience) but in bed asleep the rest of the time (ie: not up all the time making up routine iv antiobiotics into bags because we were cheaper than either pharmacists or nurses).

What has gone wrong is that the Government has cynically used the Jaeger decision (that resident on call be classed as work time even if the person is asleep) on the EWTD to avoid paying doctos and replace them with cheaper, less safe, alternatives.

Are you noticing a patern here? Doctors are the cheapest labour at night in the 1990s, so managers had them up for 56hrs straight doing everyone else's jobs as well as their own to save money.

Then doctors started to get paid properly for working nights and weekends, so managers got nurses and paramedics (who are now cheaper) to do the medical work to save money.

NHS management has never been about providing good, safe patient care. It was about counter-productive attempts to save a few pennies in 1995, and it's still about counter-productive attempts to save a few pennies in 2007.

What the female doctor in your piece wants is not shorter training hours, but the same training hours provided more flexibly.

I could not agree more. Why should family life be sacrificed simply because the NHS can't provide flexibility. For too long the needs of staff and patients have been minced into the needs of managers.

Let's have creches in the hospital. Lets have more job sharing. Lets have longer training, with more sebatical and personal time (for families and travel).

The most telling comment about the old training system was that it was survival of the fittest, but that the fittest were not necessarily the best.

I think the best doctors are doctors that have a life. Not burnt out, bitter, alcoholic divorcees (present company exlcuded). There are compromises to be made, and we can't by any means have everything in life, but these compromises should not be made simply out of a macho mindset.

Appeal to Royal Colleges from Prof Brown team

Prof Bown and his team have published an open letter in the BMJ appealing to the Royal Colleges to stand by junior doctors.

Here is an email Dr Rant received from Prof Brown regarding the letter:

As the fallout from the MTAS disaster began to unfold last week, my group (now christened ‘Fidelio’ after the story about one innocent victim of the arbitrary exercise of state power) wrote to all the Presidents pleading for their help in making a united stand. We recognised that no solution could now be painless, but argued that the greatest pain would come from having no solution at all. We worry that making noises about Tooke is now seen as an acceptable alternative to recognizing the more urgent elephant in the room.

Today, we have published our letter to the Presidents online in the BMJ, prefaced by an update of headline results from our current poll. These appear to confirm our worst fears, but at under 2000 responses are open to the criticism of being unrepresentative. Nevertheless, they place the onus firmly on the DoH to publish their own figures immediately.

We have been criticized privately by some ministers and College presidents for being hysterical and ‘going too far’. We are now dependent on the silent majority’s taking part in an historic debate on whether there is a crisis and how it should be resolved. Despite MTAS-fatigue, we hope very much that you can go to [link to BMJ online] to submit a comment regarding the crisis, and the role the Royal Colleges must play in resolving this. It is equally important to register whether you think that a softly-softly approach working with the DoH is more likely to succeed in resolving this year’s crisis, or prefer a more robust approach from our leaders and a recognition of the gulf between the profession’s vision of medicine based on excellence and the DoH’s vision based on minimum competencies.

Please also continue to encourage junior colleagues to complete our poll about job offers, because the next few days and weeks will see a battle of numbers over what has really happened.

Many thanks.

Morris Brown

Smile when you answer the phone. The customer can tell the difference!

I love 'senior NHS managers'.

They've closed wards, reduced front line staffing levels, forced staff to meet daft targets even if it involves harming patients, made safe patient care a low priority, are obsessed with meeting centrally set budgets as if we were working for Wal Mart, and blame the staff for the high MRSA rates that their bed closers cause.

So, when it comes to fixing the NHS, what have they come up with?

"Smile and the whole world smiles with you!"

That's right - forget that you are working flat out beyond your paid hours looking after an impossible workload of of sick patients lying in pain in their own shit and vomit and that you know you are practicing dangerous medicine because you have too few staff and too few beds.

It's customer service that counts!

Staff will be happier if they could just be more 'customer focused'.

They have no fucking clue, do they?

There's No Business Like SHO Business!

Since the recent conclusion of 'Britain's Got Talent', 'Any Dream Will Do' and 'The X Factor', the interminable boredom of Big Brother has prompted the executive team at the Dr Rant Foundation to devise a new prime-time television extravaganza. It will hopefully also help to solve some of the heartache caused by the MTAS junior doctor jobs fuckwittery that has recently caught our attention.

Simon Cowell has already given his backing to our new show that will be open to the 10,000 experienced junior doctors who will be jobless in August.

The competition will be called:

The Greatest SHO on Earth!

Open interviews auditions will be held in each Deanery area, with the hopeful contestants aiming to impress our fearsome quartet of judges:

Patsy Fuckwitt
Liam Donaldson
Lord Rhyming-Slang of King's Heath

and

Charlie from Casualty


Contestants will be judged on their:

• Creative writing skills to see how much Bullshit they can fit into 150 words.
• Speed in getting forms signed by a bewildering array of simulated healthcare professionals.
• Creative 'hours monitoring form' filling
• Ability to interact with and break bad new to actors posing as patients
• Personality

Under no circumstances will displays of sincerity, enthusiasm, knowledge, experience or the ability to apply these under pressure be taken into account however. These are elitist criteria and hence are unfair to the talentless and feckless.

The lucky winner will receive a training job that will give them the opportunity to become the fully trained NHS senior doctor that they had always hoped to become. However, in order to maintain a degree of reality and excitement, the lucky winner will not be told in which specialty or which region the job will be in until 24 hours before the job starts. We were going to make the winner hitch hike from London to their new job but we decided that may be a bit unkind.

So, if your Saturday nights are getting a bit dull, there's hope just around the corner!

Also, coming soon to a 'Britain's 2^nd Most Popular Doctor-Blog^TM' near you:
Rant Idol

NHS computing update

iSOFT has been saved from financial ruin (again.) NHS trusts will be delighted by this news.

Only a consultant would transition between jobs. Richard Granger is going. Whether he jumped of his own volition, or realised his style wouldn’t survive the loss of Blair and Hewitt we don’t know. Anyway here’s a selection of his sayings to console us in our time of loss.

We have described problems with NPunFIT before here, here and here. Dr Rant does not yet feel he has got any value from the £20 billion CfH is costing.

What doctors' protest march?

You know what really pisses me off?

When I ask intelligent friends and acquaintances who read the Guardian and watch the BBC news what they thought of the 12,000 doctors that marched in protest at the MMC/MTAS disaster....

....and they have no fucking idea what I'm talking about because the bastard media barely mentioned it.

Shuffling The Deckchairs

So, MTAS is heading towards August 1st and across the UK there are about 15000 junior doctors who have no idea what job they will be doing, nor in which speciality, in which hospital, or even which region they will be doing it. The better qualified they are the less likely they are to have been offered a job.

Any pretence of appointing on merit seems to have been dropped. Sir Liam Donaldson came into his office to try and make medicine safer and more effective. Yet he has presided over the setting up of a system that chooses doctors on seemingly random grounds, and which will end up reducing the depth and length of medical training. In short newly qualified consultants in about 5 years time will be about as well qualified as a middle grade registrar was in the past. This is dumbing down of the highest order, and well justifies Raymond Tallis’s barb about, “Sessional functionaries robotically following guidelines”

Sadly that seems to be the kind of workforce the government wants you to have the choice of consulting. It’s like a selection of restaurants running from McDonalds to Pizza Hut. If you want the standards of Marco Pierre-White, Gordon Ramsay etc forget about having it on the NHS in future. No one in NHS will have the passion, or motivation to be bothered to do a good job anymore.


At the same time medical personnel officers are realising that they will have gaps in the rota in their hospitals on August 1st. These gaps will not be occasional and small, they will be huge and major. Hospitals may not have sufficient cover in place to safely care for patients. There may be emergency measures such as cancelling elective surgery needed. These excerpts come from an urgent memo circulating round a large teaching hospital in the north of England. (emphases mine) I suspect most hospitals in UK have similar memos in circulations.

“As Round 1 MMC comes to a close, the Trust needs to develop a process for minimising the risks to patients from Rota gaps at SHO level following the likelihood that all training posts will not be filled as of the 1st August 2007.”

(In previous years doctors knew where they were going, and trusts knew who to expect in August)

“Many Acute Trusts across Yorkshire are examining how services will be managed to maintain safety first and elective activity second from 1st August 2007. We urge you to prepare (if not already started) for this work as soon as it is clear as to the number of potential gaps. The SHA is writing to all PCT’s to warn them that they will need to work with their local Trust on this issue.”

(Big threat here to elective surgery, achievement of the 18 week target, breaches of 4 hour waits in A+E etc. Disorganisation. Chaos. Longer waits for patients. Less good care. More suffering. Higher risk of adverse clinical incidents- just the kind of thing Sir Liam Donaldson says he’s against!)

On August 1st the NHS is in grave danger of malfunction at the whole system level. A major significant event. Dr Rant’s advice to the public, and to himself, is not to be ill the first week of August.

Here we have new Labour’s NHS

MRSA infested,
Dumbed down doctors,
Gaps in services,
Pretend doctors,

Meanwhile new Labour tries to deflect attention away from their abject NHS failures with all this with talk about "choice" (of nothing- this is a socialist monolith instituiton we're talking about) and longer GP opening hours.

You’ll have lots of choice.
Leave the country or go private might be the best options.

I want! I want! I want! Why demands for evening and weekend routine NHS care are retarded.

Ok, let me be up front about this. I think the people demanding free evening and weekend access for routine NHS care are selfish hypocrites.

I'll tell you why.

The only people who can't attend routine appointments planned in advance between 9am and 5pm are people who work between 9am and 5pm (or people who depend on relatives that work between 9am and 5pm).

So, if you say you can't attend during office hours at some point during a normal working week, it must mean that you only work between 9am and 5pm yourself. Because, if you worked evenings/weekends yourself, then you would have time off in lieu during office hours and would have no problem seeing your GP during your days off.

Are you following my logic?

That means that the selfish gits demanding that GPs give up their evenings and weekends to provide routine care at a time that suits them, don't actually work evenings and weekends themselves.

That's right. The people who don't work evenings or weekends themselves are demanding that we do, just to suit them. Or, worse still, they could easily make it during the week but can't be arsed.

So let's list the businesses that do and do not provide evening and weekend access for routine, non-emergency, services:

-Lawyers: NO*
-Accountants: NO
-Plumbers: NO
-Electricians: NO
-Hairdressers: NO
-Banks: NO
-Small High Street Shops: NO (unusual)
-Small pharmacies: NO
-Opticians: NO
-Dentists: NO

-Restaurants: YES
-Supermarkets: YES
-Large retail outlets: YES

Lets look at health care staff who work unsocial hours to provide non-emergency work:
-Nurse: NO**
-Radiographers: NO
-Lab technicians: NO
-Physiotherapists: NO
-Ambulance staff: NO




So, basically, if you want us to work evenings and weekends just because (1) you fancy it, or (2) because you don't, then you should be paying for the privilege. If you are self employed and you work all the time, then you need to get yourself a life, not take away mine.

And don't give me any shit about how doctors are already overpaid, or the bullshit about average GP income being over £100,000 (it's not - there are tons of salaried doctors and locums on much less than that), or that GPs earn £200,000 (only a handful get near this, and they usually own several businesses).

In a totalitarian capitalist society like ours, GPs are worth twice what we get. You know it's true.





* The largest Edinburgh solicitors firm just announced average pre-tax profit per partner of over £500,000 per year.

** Ward staff look after inpatients who, by definition, are too sick to go home and are therefore not 'routine' care.

A little birdy told Dr Rant......

NOTICE TO READERS: The following fairy tale is entirely factual fictional. Any similarity to any Secretary of State for Health - living, dead, or in-between - is completely intentional coincidental. [Make sure these errors are corrected before publication - we don't want to give the impression this story is actually true! - Ed.]


One fine summer's day I awoke to the sound of birdsong, I wasn't sure if I was still dreaming but this story appeared to me in a rather mysteriously supernatural way:

There was a young queen called Queen Most Irritating Voice who ruled over all all the land. This country had a health system called the La La Land Health Service that enitled everyone to a good standard of health care based on their clinical need. Queen Most Irritating Voice was not very popular as throughout her rule she kept trying to sell off the LLLHS to her royal buddies.

One day one of Queen Most Irritating Voice's friends was diagnosed with a particularly nasty cancer that needed surgical removal. The operation was booked but there was a slight problem; her friend needed a special bed for after the operation,however all the special beds were full come the day of her friend's surgery.

So Queen Most Irritating Voice rang up the head of the particular hospital and ordered him to free up one of the special beds so that her friend could have the necessary surgery without delay. So scared at this order from on high was the head of the hospital, that he immediately made sure that a special bed was cleared for Queen Most Irritating Voice's friend.

In this way Queen Most Irritating Voice exploited her position of power to benefit her friend. Some might say that this act