BMA Press Release

For immediate release: Wednesday 26 September, 2007


Government proposals to prevent another training disaster are a complete fuck up, warns BMA

Proposals to prevent a repeat of this year’s ‘MTAS’* medical training disaster are unsatisfactory, the BMA says today (Wednesday 26 September, 2007). It warns that any computer system to recruit junior doctors in future must be “at least as good as, if not better than a ZX spectrum and have better graphics capability for proper games”, and says there should be no limit on the number of lives or ammunition for players of Halo 3.

The English Department of Health is currently ignoring anyone who's actually got a fucking clue on a new system to select junior doctors for specialist training in England in 2008. It has stated that demand for jobs will be higher than in 2007, with a possible ratio of three applicants to every post because under EU law Polish postmen have equal rights to apply for training posts as UK trained junior doctors. The BMA believes that the lottery for many posts will be even more fucked up than this.

Responding to the consultation, the BMA highlights the bleeding obvious fact that there was no back-up to the crazy digital cuntathon national computer system that failed, the the rest of New Labour's health policies, this year. It calls for any computerised selection system in future to actually work and not be the IT equivalent of a fucking big hat and 30,000 bits of paper.

Mr Ram 'Alamadingdong' Moorthy, who was elected new chairman of the BMA’s Junior Stooges Committee on Saturday, says:

“Given the intensity of competition for posts it’s absolutely vital that the system is fair and efficient. MTAS was neither. We should be rewarding excellence in medicine, not just competence. At the moment, the government is a long way from guaranteeing that the most talented doctors make it to the top.”

The BMA says that all of the shortlisting options outlined by the government are complete and utter bollocks, and calls for all shortlisting of doctors to be carried out locally rather than nationally. It says there should be no limits on the number of applications they can submit and describes the suggestion in the government document that they should be offered only one interview as 'total fuckwittery'.

Mr Moorthy says: “Offering doctors only one opportunity to get into training would be completely unfair. It would put huge pressure on them, and risk a further waste of talent.”

The BMA is calling for smaller ‘units of application’ – a change from this year, where doctors had to apply to a large geographical area. For example, a candidate hoping to work in London had to apply to a area half the size of England but could end up working in the Falkland Islands.

The BMA response highlights the need for thorough workforce planning, including medical school intake. It also states:

*There should be multiple entry points to training, so that doctors who do not get a post in August can compete to enter training again.

*The government should consider an ‘inverted pyramid’ model where opportunities to enter long-term specialist training increase each year.

*All doctors who were appointed to long-term specialist training this year should have their appointments honoured.

*There should be a UK-wide co-ordinated timetable for applications and offers, and dates must be decided now.

*New ideas for selection must be properly piloted.

*Do we have to come down to Westiminster and inflict pain on you bunch of cunts or are you going to use your ears this time? Can we get a witness?

Ends


*Notes to editors

‘MTAS’ stands for Medical Training Application Service - the online application system used as part of the process for appointing doctors to specialist training posts in 2007

the report can be found at
http://www.bma.org.uk/ap.nsf/Content/mmcresponse0907

The BritMeds 2007 (38)

Welcome to the Dr Rant BritMeds. The Dr Rant team will be hosting the BritMeds on behalf of Dr Crippen during his summer recess, so please send all of your BritMed suggestions to BritMeds@DrRant.net.

This week's BritMeds are late due to the fact that I am still out of the country and had no internet access until today. Normal service should resume next week - Ed.

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Head Banging Reality

Firstly this week, BOM tackles a subject close to Dr Rant's heart - the reality gap:

As Gordo spoke, we were once again en route to visit my 92 year old father-in-law, who is currently in a big NHS hospital. There, not only does the left hand not know what the right hand is doing, the right hand doesn't even know what the right hand is doing.

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La La Land (Aka the NHS)

Midwifemuse has been blogging since March, but Dr Rant has only just discovered her (thanks to H for emailing us the link).

As far as I can see we are now going into the realms of some horribly distorted fantasy with regard to costcutting in the Maternity Services. Today I was told that there are no, none, delivery packs. Interesting one that. Instead we are to use a vaginal examination pack as our equipment when we are at a homebirth. In a delivery pack:-

1 bowl 500mls (cleansing the perineum)
1 cord clamp ( for baby’s cord )
10 cotton wool balls (extra large) (wiping ‘bits’ down)
1 green wrap 75 x 110cms ( for putting under the woman )
1 gallipot ( useful little receptacle for KY )
1 dressing pad ( for when the baby is out )
paper crepe 100 x 150cm ( wraps everything up )
pulp kidney dish ( if she vomits )
4 x swab 10 x 10 cms ( cleaning up so you can see if suturing is required )
Quilted paper baby wrap ( giving baby a good wipe over )
plastic tray ( for the placenta )

All this is sterile so you hope you are not introducing any bugs into the immediate area. In a vaginal examination pack:-

1 bowl 250mls
5 cotton wool balls ( small )
1 gallipot
1 paper crepe 40 x 40 cms

I think there might be a few problems here but what the hell, it’s saving the Trust money. That’s a relief, they might have had to get rid of a few managers. Probably just one really would have saved them the amount of money they will save by, once again, devolving all their cuts down to where the work happens with the people who require the equipment because one of them is having a baby ( it is the MATERNITY services after all ) and the other one is crawling around on her hands and knees helping a new life come into the world. Yes I am cross, seething and absolutely incredulous that things have come to this hand-to-mouth way of providing care to women.

More here.

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Letter to MP

The Brown Stuff is in letter-writing mode:

Norman Baker MP
23 East Street
Lewes
East Sussex
BN7 2LJ
Dear Mr Baker
I am a GP and am not one of your constituents, although my practice lies in Polegate. However, I am responsible for the health of approximately 2000 of your constituents. I am however sending a similar letter to David Lepper, the MP in whose constituency I live. I am also a member of the East Sussex Local Medical Committee, representing GPs.
I am heartily fed up with the current vogue in Government to blame GPs for the ills of the NHS. The recent media circus promulgated by the Prime Minister (among others) does nothing to actually alleviate the problems faced in Primary Care today. It serves only to cause a significant increase in the stresses of the job and consequently is directly responsible for the dramatic reduction in morale I see in my colleagues.

Excellent. Read on.

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Dr Ray's 15 minutes of fame

My description of the Citizen's Jury in Birmingham on the 18th (see previous blog) caused quite a stir and propelled the normally quiet and reclusive Dr Ray into the limelight of publicity.

Events unfolded with amazing speed after the Dr Rant team picked up the story. Within 24 hours all the major medical blogs had reproduced or linked to the story and even the political bloggers and the blogging MP Iain Dale gave it extensive coverage. Three separate threads started on doctors.net.uk and by Monday one of the threads had reached the top quality postings and the person who started the thread reached the weeks top author. By Monday afternoon, Hospital Doctor had picked it up and included it as top medical blog for the day.

Journalists and politicians were emailed and the word went out to uncover Dr Ray.

More here.

The Devil's take on the story is here:

New Labour's Consultation Process on closure of NHS District General Hospitals

Just when I thought I'd finally run out of goats, my attention is drawn to this post by Dr Ray about the consultation process for NHS District General Hospital closures.

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On Rationing

DB picks up on the Covert Rationing Blog:

One does not need an economics degree to work through the reasoning. If I give you X dollars to spend and you have X + Y dollars of demand, then you must deny Y dollars of care.

As DrRich points out, the current US system also rations, albeit illogically and covertly.

We need (and will not likely get) a logical plan for rationing health care costs. We must prioritize, understanding that not all patients will receive every test and every treat.

The alternative is to spend an ever increasing percentage of our dollars on health care. That is a possible alternative, and some would argue a reasonable alternative.

But few politicians will discuss these issues frankly because the discussions will not win votes. The discussions require stage 2 and stage 3 thinking, yet the electorate generally responds to stage 1 thinking. Sigh!

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General GP Moan

geepeemama is annoyed by the media attacks on GPs:

last night the diatribe from some government minister was that we are "too 9-5" and all shut on Wednesday afternoons and weekends and need to work more hours. Well, my actual appointment times do start at 9 but that's because I find it hard to guarantee being here any earlier. I am pretty much always here by 8.25 but I can't guarantee it. Surely it's best not to keep people waiting if I can avoid it. My last official appointment time is 5.30 because, outrageous as it clearly is, I like to get home to see my children before they get to bed. If my last appointment is 5.30 then by the time I clear any emergencies and paperwork I get to leave at 6.45. I work solidly through from 8.30 till 6.45. I eat my lunch at my desk (the lunch I make at home because, despite my outrageous salary, I actually can't afford to buy lunch daily). I fill in enough paperword to destroy half a rainforest daily. My surgery is open from 8-7 all day every day and we never refuse to see anyone. I don't want to work weekends. I will of course if we are paid enough or, as is more likely, they threaten to take away enough of my salary. But I already work weekends for the emergency GP service and I think that is a) a brilliant service and b) enough. People shouldn't come to the GP on a Saturday morning for routine stuff, they should take time off work. Emergencies are catered for superbly by the system that exists (in this area at least) - I've never kept anyone waiting more than 20 minutes.

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Patient Data on eBay

Dr Grumble picks up on an interesting story about NHS patient data concerns:

When you get rid of your old computer it's no good deleting your sensitive data. It will look as if it has gone but actually it's still there. All that has happened is that it has become invisible to you. So eventually computers with NHS data were bound to end up on eBay. And apparently they have. Odd the press haven't made more of this.

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Nearly No Grumble

Staying with Dr Grumble:

[The community support officers who failed to leap into a pond to rescue a drowned boy] were following a protocol; they hadn't been trained for rescue. Now those few of you that know Dr Grumble's identity may know that he has some expertise in sea survival so he knows a bit about how people should be rescued. And he knows how people die trying to rescue others and how people die trying to rescue dogs (who invariably escape unaided). Of course the community support officers have come in for more stick than they deserved because everybody realises they are police on the cheap. Just as healthcare assistants are nurses on the cheap and nurses are being passed off as doctors. People don't like being duped in this way but in the NHS the public have swallowed it hook, line and sinker.

Anyway, Dr Grumble commented to Mrs Grumble that the hapless community support officers had done the right thing. Mrs Grumble did not agree and told Dr Grumble that he would have jumped in to attempt a rescue. Dr Grumble did not agree and then Mrs Grumble reminded him that a good few years ago he had done just that.

Read on here.

The Ferret also discusses this topical story here:

Nurses are being dressed up as Doctors and given roles for which they are inadequately trained. While Health Care Assistants are dressed up as nurses and asked to do tasks for which they are also not properly trained. PCSOs are the example of the dumbing down in the police service, while classroom assistants are given tasks at school that they are simply not adequately trained to do as well as proper teachers.

It is dishonest, it is dangerous and it damn well stinks. Wrapping up a turd in a banana skin does not turn the turd into a banana, and one does not need to taste the turd to find this fact out. How many lives will have to be lost before this negligent dumbing down is stopped? It appears to me that this government cares not for lives.

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I think I may have a slight headache

DundeeMedicalStudent is working hard defending GPs:

Dr Raj a well respected and experienced doctor providing an almost life line service to Whitfield one of the most deprived areas in Scotland. The doctor after 23 years in Whitfield is closing the practice after years of violence and vandalism, the man was even attacked this week going to the post office. For full details go here or the Dundee Courier. The article I've linked to doesn't mention that Dr Raj is the only GP at the health centre- currently NHS Tayside have not made any decision about what will happen to his list- hopefully another GP will take over but it's unlikely, I can't imagine I'd go jumping into a job where the last person to have the post was chased out of the job.

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My balance of power

Nursing Student Museings has a nice image on this piece:



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Apportioning blame

Life in the NHS reminds us that nurses still are more vulnerable than doctors when it comes to clinical mistakes:

A patient presents in the emergency department and is assessed by a relatively junior doctor as requiring a particular drug. The doctor tells the nurse to administer the drug to the patient and that nurse does so. Error number one is that there is no written order and as a nurse you should not take a verbal instruction for a drug. However perhaps as a doctor you should not actually try to give one. Error number two is that the dose is inappropriate (perhaps the drug is inappropriate too but that is another story). The nurse gives that wrong dose, with serious results (thankfully not fatal). The nurse ends up being suspended from duty, and the doctor is ’spoken to’.

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Letter from the Nursing and Midwifery Council

Mental Nurse has the right attitude to the NMC. Mrs Rant could not agree more.

Dear Zarathustra

You snivelling little worm. So you went and finished your nursing studies, did you? Well, you may have spent the last three years trying to live off £6000 a year, and as a result be about £8000 in debt, and you may be still waiting for your first month’s pay, but we’re still going to have our wicked way with you.

We want £76 off you. Just for the right to be able to call yourself “nurse”. Yep, 76 quid. Just make the cheque out to “My New Overlords and Masters, The Nursing and Midwifery Council”. While we’re at it, can you also bend over and drop your trousers so we can get some “executive relief” in your cornhole?

Yours Sincerely

The Nursing and Midwifery Council

PS You are now our bitch. And you will be forever. Well, at least until we decide to strike you off.

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Another rant about nurse education

Mental Nurse has a lively debate sparked off by some of our nominations in last week's BritMeds(2007,37):

OK, so looking at the Britmeds blog summary on Dr Rant, there were a couple of posts from nursing blogs, one of which - it was purported - was about the parlous state of nurse education. It was, in fact, a moan about some tedious training provided by a medical devices company about how to use one of their products. However, a comment or two there that “of course, there’s something wrong with nurse education” made my hackles rise. Basically, I am more than a little tired of people whinging about nurse education. People see crap new staff nurses and their crapness is blamed on the education they received as if that was the only factor involved. So I’m here to set the record straight.

You can follow the debate here, and also in this other Mental Nurse follow up piece.

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The Hospitalist - What the heck is that?

This facinating insight into the way US hospital medicine and general practice is evolving into a form more recognisable to an NHS doctor is particularly interesting to Dr Rant as he was asked if he would be interested in doing shifts in such a post by a hospital in Canada just the other day:

The average American doesn't know that a revolution has occurred in medicine and there is a new type of doctor called a "Hospitalist". It is the fastest growing branch of medicine and there are 20,000 doctors today that practice only hospital medicine. Most hospitals in America employ Hospitalists and if you are admitted to a hospital, it is likely that he/she will be your main attending doctor...not your primary care physician.

The Hospitalist is a doctor with Internal Medicine or Family Practice training, who is always on site. They are available to admit patients, manage care during the day, review tests, change medication, and respond to the patient and nurses instead of rushing in at 7 AM and then back to the office to care for a full day of patients. Hospitalists don't have an office practice, nor do they follow patients once they are discharged.

Also, the reported experience of patients interests Dr Rant, as our NHS practice is considering re-starting the practice of regular visits to the local hospital by a member of the practice team to keen an eye on our patients in an attempt to improve some of the dreadful discharge results we have been seeing (and reduce the extra workload this puts on us in the practice).

Many patients are shocked that their own doctor is not the attending (although many do still visit their patients in the hospital). There is concern that care will be fragmented and the Hospitalist won't have the full past history.

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NHS Choices??

The often uncomfortable-read that is Life With Leukaemia has a couple of posts (here and here) this week on the subject of choice:

Get out or she dies. Choice ?


11 am Sunday morning. She’s not bleeding, she’s not broken, she’s not crying.


But we are in the local Out-of-Hours Walk-In Centre after an hour or so on two out-of-hours buses … in the pouring rain.


Fortunately, we’re early enough to miss the Saturday night casualties of drunken domestic violence and nightclub brawls – instead our company is concerned Muslim mums with, like us, sick kids.


“See your GP tomorrow”.


“Look at this”. We tender the doctors’ report from here. “Oh … now would you prefer the A & E down the road?”


“No – we want to see a doctor”.


“Which one do you want to see?”


“Any fucking one!”


“Well, at the moment, there is only one … ok … just take a seat …”


… “ok, we’d like to take her up to Paediatrics (you know it’s closing soon?) to see the doctor there but, of course, if you want to go, at your own cost, to Paediatrics 20 miles away and which has a far better reputation than our own … of course, if she dies on the way …”


“Let us see a fucking doctor!”

and

I’ve been reading the minutes of first meeting between the UK Parliament’s all-party Health Committee and our new Secretary of State for Health, Alan Johnson back in July.


Our Health Secretary believes we the patients and carers will override our GP’s recommendation of a particular consultant on the basis of hearsay.


However, Drs Rant and Crippen and the Committee have noted that Choose and Book does not allow them to choose individual consultants. So neither the GPs’ recommendation nor the patient’s preference for a particular consultant can be exercised.


This is, in my opinion, also demanding that the patient/carer make some clinical decisions. Our Health Secretary thinks we, the patients and carers, can make decisions on the advantages and disadvantages of invasive or non-invasive surgery for our particular condition. Yes, I have the right to weigh up advice from my GP or my consultant on this, but I really do not have the medical knowledge not to follow their recommendations.


And I have a Masters degree.

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Hey, Mr Duck, giz a bite of yer sandwich!

Dr Thunder, from Two Weeks on a Trolley, has been in New Zealand for a week.

So, week number 1 down. New Zealand is great. Weird great, but great nonetheless. We're short staffed. Nothing new there. We have 4 registrars at the minute. We should have 7. Bummer, you'd think. That's me doing a 1 in 4, you'd think.

But no.

Here, when there's a shortage of staff they do the following.

1) They ask if anyone fancies a few extra quid doing extra shifts

2) If that doesn't work they try to find a locum

3) If that doesn't work, the consultants do the shift!!!!

So, my consultant is on nights this weekend, because we don't have a reg. That, I must say is a culture shock.

I have less patients than I had in the UK, and by and large they're less sick.

That is, except for the Maori population.....


They get REALLY sick.

I thought deprivation was as bad as it gets when I worked in Glasgow. But last night I saw a 14 month old girl. She lives in a small house with 15 other relatives!!! She was covered in boils. She has a skin infection. She had a shocking mouth and gum infection. She also has bilateral ear infections, and both ears are bleeding.

More here.

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So now you know

Finally, staying with the them of emigration, it's not just doctors that are fleeing this land. Fellow blogger PC Copperfield has moved to Alberta in Canada to work with the Edmonton Police Department.

Finally, here's a picture of me looking incredibly smug after just having passed all the entrance tests for the Edmonton Police Service. I can't profess to be an expert about the EPS, I went on a couple of ridealongs (that weren't filmed as part of the documentary), and they seem like a good bunch. I hope nobody goes away thinking that I'm "disillusioned" with the job, because I'm not, I just happened to answer an advert in Police Review and one thing led to another (a bit like this blog really). The thing about the police is that once you've done it for a bit, it's difficult to imagine doing anything else, so I'm just hoping to be able to carry on with more of the same: it's a mistake to think that policing somewhere else in the world is going to be a paradise, free from the familiar pressures of manning, crime-recording and performance. It's not all about the job either, I'll only be three hours away from my brother, Ed, who's been out there for a few years and it's not too far away for friends and family to visit. I'm also looking forward to getting out into the Rockies and doing some hunting in the season.

(In passing, I'm sure PC Copperfield would agree with BOM's piece on Great Detective Fiction, which is well worth a read).

The Ferret has some thoughts after watching Copperfield on Panorama:

Watching the Panorama involving the blogger PC Copperfield reminded me more than just a little of the NHS. In fact it was quite remarkable to see how the government's stupid target based approach is failing in policing and in health care in the same ways.

More here.

The Dr Rant team wish PC Copperfield the best of luck. Who knows, we may be on the same plane to Canadia.....

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Please send your recommendations for next week’s BritMeds to: BritMeds@DrRant.net

The BritMeds will now be published from Saturday morning to Sunday evening, so please let us have your recommendations by Friday evening latest.

Operation Deep Clean

Who needs Barry Scott?

So El Gordo is going to "deep clean" the NHS from bacteria such as MRSA and C. difficile and have yet another new NHS Quango to oversee this.

Let me get this straight.........

1. MRSA and other nasty deadly superbad killer virusbugs^® enters a hospital, not by Royal Mail or the sewers, but via people as in patients, visitors and staff who carry it in with them.

2. The New NHS^® is high people traffic (load factor) and high turnover (no stop over - get them in-get them out) methodology so beloved with the no frills cheap on-line booking UK airlines such as Easyjet/Ryanair/Jet2.com/Flybe.

3. If people bring the bugs into a hospital and you increase the volume of people travelling through and have a shorter turnaround time (so ensuring no time for proper cleaning from the subcontracted private companies in the NHS) then you will bring more bugs into hospital to infect more people - which no "deep clean" will cure.

4. Now remind me who came up with the idea of high volume/high turnover of patients? - Why politicians of course!!!!


When you speed up the system things will go wrong - anyone with experience of the no frills turn-em-around now airlines will know that the safety margins fall to potentially dangerous levels when the margins are cut to facilitate targets i.e. time and money. Of course you won't actually see these dangers, but trust me, there are a few aircraft flying around in the no frills sector that adhere to the safety book/regulations by the skin of their teeth and all because time is money and high volumes (load factor) and short turnaround - is seen as cost effective on
the balance (not safety) sheet.

For some additional explanation of why Gordon is a Moron, see Devil's Kitchen and The Ferret Fancier.

Originally posted on DNUK.The Editor would like to the author for permission to reproduce it here.

I'm afraid Polly Filler hasn't a clue

What is it with GP bashing in the media at the moment? Has it become a national sport?

Dr Rant started sobbing into his coffee when he read this piece by Charlotte Ross, a Polly Filler clone of exceptionally limited ability. Rather than give pointless opinions about how the media have treated the McCann family, she now decides to have a rant about access to GPs. Well, if there is one person who knows how to rant...

For a start, this clueless moron hasn't had time to check any of her facts (the key pillar of any sort of journalism). Her argument in this attempt at an article seems to be that she has difficulty seeing her GP. Well, going through the article bit-by-bit:

• "When [I moved house] the old surgery ... bumped me [off their list] with uncharacteristic efficiency". That's because they think you are a whining, vexatious little cunt, and were fed up with you bad-mouthing them.
• " the new surgery has moved at the pace of a disabled snail [to register me]". See point one. Do you wonder why?
• "Surgery hours clearly suit stay-at-home parents of small children, pensioners, the unemployed and those who are already off work sick." As do hours at solicitors, accountants, dentists, bicycle-repair shops, etc.
• "[Alan Johnson] claims 84 per cent of us are hacked off with the lack of suitable appointments". There are lies. There are damn lies. There are statistics. And there are misheard quotes from gobshite journalists used to prop up their flimsy thin arguments. The Department of Health figures were that 84% of people are satisfied with availability of access to GPs. What kind of fucking planet is she from?
• "Three years ago 90 per cent of [GPs] decided not to be available to patients outside daytime hours on weekdays". No. They. Fucking. Didn't. The government shifted out-of-hours care from the responsibility of GPs to Primary Care Trusts, most of whom are run by the government. If you want out-of-hours care, it is the responsibility of Primary Care Trusts to provide it, not of individual GPs. Blame the organ-grinder, not the monkeys.
• "[GPs] now work on average seven hours fewer a week, while bafflingly their pay has increased to more than £100,000. The rest of us are working longer hours". There has been plenty written by Dr Rant about this issue. GPs are now paid for 128 hours less work each week, having had out-of-hours care transferred to PCTs. Dr Rant works on average from 8am to 6.30pm Monday to Friday. I'm sure even that is more than Charlotte Ross.
• "Every type of paid-for health care, from dentists and opticians to physiotherapists and Pilates studios, is open - and inundated - at weekends and evenings". Really? Finding an NHS dentist out-of-hours is harder than finding an intelligent gossip columnist. And there is a good reason why glasses sales-shops are open out-of-hours. It is because that is when they can make lots of money. As for pilates being health care, just fuck right off. By all means compare GP opening hours to those of a Post office, but don't compare them to some version of hippy aerobics.
• "Busy friends regularly pay up to £100 to visit one of London's growing number of private surgeries". I expect they pay similar amounts, if not more, to solicitors, accountants, plumbers, electricians and vets for out-of-hours support.
• "A side-effect of this may be to force GPs into opening at times that suit the modern world". You and whose army? The government negotiated the current GP contact, and made an utter fuck-up of it, mainly by not recognising the value of out-of-hours care.
  
• "But I'm not sure my patience will last that long". Do I give a flying fuck? Erm, no. I don't.

The inability of this pathetic excuse for a writer to manage her work-life balance is of absolutely no concern of Dr Rant's. But just to help her a little, he'll tell her the following tale.

When he was a teenager, all of Dr Rant's friends were partying. He spend his time preparing for exams. When he was at university, Dr Rant's fellow students spent most of their time drinking and smoking dope. He spent it studying and at very long lectures. When he started work, Dr Rant's colleagues worked short days and built up credit-card debt. He worked 100 hour weeks in shit-hole hospitals paying off his student debt. And now he has a contract that rewards hard work with a bit of time off with his family.

Is there an embarassing void between your columnist's ears?

Except cunts like Charlotte Ross want to force him back to working antisocial hours for them benefit of her own social life. Well, either she can fuck off, or Dr Rant and 40,000 other GPs will, and she can find out just how expensive private medicine really can be.

UPDATE: The online article has mysteriously disappeared. I hope we haven't offended anyone.

What Not To Wear

The Government's new Infection Control Tsarinas yesterday

Reflecting on Gordon Brown's new desire to consign hospital aquired infections to the history books, the Dr Rant Team's very own Mr Salmon brings you his personal take on the recent debate about doctor's clothing.

Mr Salmon attended his general surgery clinic today. The clinic Sister started giggling when she saw what he was wearing, and Mrs Jones, his first patient, was almost dumbstruck. You see, he had followed the latest dikat from the Department of Health, to the letter.

Perhaps an explanation is needed.

Change in medicine happens at varying rates. For example, for Mr Salmon to change how he does an operation requires several steps. It requires a review of previous literature. It then requires the design of a robust clinical trial. Then, an ethical committee must approve the research. The research is then carried out, and sent to a peer-reviewed journal for approval among the medical community. And then, finally, he will change his practice.

This is because Mr Salmon is a surgical doctor.

For other parts of hospital care, the process goes like this. A doctor or nurse in the infection control team thinks up an idea. This idea is typed onto large posters and pinned around the hospital (blue-tak is no longer used is it is an infection risk). Anyone not following these orders faces a disciplinary meeting.

That is because they are part of the infection control team.

Recently, Mr Salmon has been told not to take his briefcase into the operating theatre, as it is an 'infection risk'. There is currently no place in the changing room to put his wallet, phone and medical journals, but he is not allowed to leave them on the desk in the theatre, which is some 30 feet away from any operating. However, parents wearing workboots are allowed to follow their children in when they are being anaesthetised.

Leading by example

Mr Salmon has been asked to remove his watch, as it is an 'infection risk'. The clock in the surgery department has not worked for months, yet staff are not allowed to wear timepieces. Of course, knowing the correct time is not considered as important by the infection control team as it is by medico-legal lawyers.

Mr Salmon has been asked to remove his tie, as it is an 'infection risk'. He is told that it may transfer 'germs' from one patient to another. Mr Salmon thought that having beds 18 inches apart may have more to do with this that his Royal College of Surgeons (of England) tie, which is boil-washed by Mrs Salmon at least once per-week. However, bullying Mr Salmon about his tie is a far easier target for infection control than preventing the ludicrous level of bed occupancy.

Mr Salmon has now been asked to remove his White coat and his long sleeves as they are both an 'infection risk'. The white coat has been a symbol of the medical profession for years, although you are more likely to find a pharmacist wearing one than a doctor in most current hospitals. Mr Salmon found his white coat useful as a junior doctor as he could put his Oxford Handbook of Medicine in one pocket, and his lunch in another. However, the robe designed to prevent blood and shit from splattering over one's suit now seems to be confined to the dustbin, or at least to butchers and greyhound track handlers.

How clean is your hospital?

Bit by bit, Infection Control seems to dictate how Mr Salmon should practice his medicine, and with little more than level 5 evidence to back up their demands. How long is it before Mr Salmon is asked to shave off his beard because it is an 'infection risk'?

And so, he ploughed on through his clinic, seeing patient after patient, many of who questioned Mr Salmon's choice of costume. He thought that a pair of dark brown swimming trunks from the 1970s would be appropriate, as he has little else that seemed to fit with the new rules. Gravity, and the 30+ year change in Mr Salmon's waistline may have been unkind, but rules were rules.

'They're for infection control' he told them all proudly.

Mr Salmon modeling his 'budgie smugglers' before gravity was invented.

Lying, cheating and corrupt. NuLabour is listening to you.

The Pyongyang NHS Citizen's Jury in full flow yesterday

Dr Rant is a dyed-in-the-wool sceptic, and whilst I get angry about things, I am very rarely surprised by the depths of moral depravity to which our fuckwitted-cuntathon of a government and their malignant DoH admindroids routinely sink to. I am however suprised and disturbed by Dr Ray's latest post about 'NHS citizen juries'.

You probably saw this on the news this week - Gordon and cronies attending a carefully managed event that made a North Korean 'We love the Dear Leader' rally look like the height of spontaneity.

Yesterday evening I had an insight into the workings of Nulabours "consultation" process on the planned closure of NHS District General Hospitals and replacement with dumbed down polyclinics.

A few weeks ago invitations to attend a public consultation were sent to consultants at our Trust. We were only given one day to reply for the meeting in the near future even though we have to give 6 weeks notice of leave because of "choose and book".

Obviously this meant that most of us could not attend but one consultant did take up the invitation...........

Is anyone else struck by the irony of Gordon 'The Pot' Brown calling Robert 'The Kettle' Mugabe 'Black' this week? I suppose that we should at least be thankful that we haven't got inflation of 6000%! Praise be to Gord for our economic miracle!

Please read the whole article on Dr Ray's blog and leave your comments. Email your friends with a link to the article. (click on the blue text above if you are a technotard-Ed)

Tell everyone you can. This is not too complicated for anyone. If you have sufficient mental capacity to tick a box in a polling both, then you can understand this. It is simple fraudulent, dishonest, deception This is the essence of our democracy today. Be afraid.

STOP PRESS: For Video of Gordon at the NHS Citizen's Jury event, have a look at this piece on Witch Doctor's Blog.

Wanless is Clueless?

Walk in Centres
A&E 4 hour targets
SHAs
Treatment Centres
Extra bureaucrats and Quangos

Out of Hours Privatisation
Financed via PFI schemes

Modernising Medical Careers and MTAS
Other hairbrained schemes like PBC/C&B
NPfIT/NICE/NHSDirect
Endless reorganisation of the PCTs and health authorities
You get the picture, where has our money really gone?

One could quite easily be forgiven for asking the questions 'What does Sir Dellboy Wanless know about healthcare?' and ' is this another example of the arrogance of those who believe that management and business somehow transcend experience and expertise?'. After all he is a banker (literally - not rhyming slang this time - Ed), and therefore has questionable insight into the danger of extrapolating his experience of bean counting into the measurement of health care 'productivity'. It isn't like the NHS has ever really experienced consensus based or expert lead reorganisation is it? So why is this precursor to yet more pointless organisational jiggery-pokery any different?

Obsessing with health care productivity becomes very similar to a cat chasing its own tail, in that one would be better off ignoring the tail and concentrating on other more pertinent challenges. Interestingly Sir Dellboy managed to ignore all of the above when reporting on billions wasted, very strange that. The pay issue is a convenient scapegoat for this political stooge, no one ever argued that paying staff fairly would increase productivity, it was simply about some kind of justice.

The woeful record on productivity comes about from the endless top down tinkering in the form of the internal market, PFIs, Choose and Book, Reconfiguration of services and management structures et al. This is nothing to do with staff, staff do their best under increasingly difficult and Stalinist circumstances. The top down control freakery in the form of endless targets is no way to improve productivity, it is a way to make political priorities more important than clinical ones, this is not progress.

The way to improve the NHS involves investing in the front line services, treating staff better by trusting them to make sensible clinical decisions, stopping this never ending drive to monitor and measure everything; after all when something becomes measured, you then change the meaning of what you are measuring, a principle this thick regime has never cared to grasp. Again no one has really thought what health productivity means, I strangely get the feeling that our controllers have no real interest in understanding these issues; they have only their selfish interests at heart.

Corrupt Bastards Incorporated

The government spent over £10 million of our money surveying thousands of us to find out that a rather large majority were actually very happy with our local General Practice service. I am a sceptic and believe that if there was any dirt to be found, then the government would have found it with this leading and manipulative survey. There was no dirt, on the whole people were found to be happy, unfortunately the government didn't stop there; it is always worthwhile remembering that HMG will always sink that little bit lower in its attempts to undermine genuine democracy.

The CBI have now thrown their corrupt hat into the ring, they have allied with the government on this issue because they want to make a killing, both financially and literally, by opening numerous tacky cubicles in their high street stores and supermarkets. To do this they have decided to produce yet more poorly researched propaganda to undermine the country's rather enviable General Practice system. Based on a rather small and flawed survey produced by the highly 'neutral' Alliance Boots, a large company that stands to make huge profits from privatised primary care, the CBI has naively pronounced that the UK economy is losing £1 Billion a year due to GPs not working around the clock.

The CBI's flimsy argument does not take more than a few milliseconds to robustly deconstruct. It would actually be very easy for them to allow workers more flexibility to see their GP, it would also be decent of them to provide decent occupational health services at work; some would say it should be expected of them, given that many of these businesses are rather large with thousands of employees. The CBI's argument also assumes that this small survey is representational and that people are telling the truth when they claim they have been at the GP's; one must remember that the DoH's rather bigger survey contradicts the CBI's statement. I would also bet that there are many other issues that cost the CBI's members many more billions than this so called inflexibility; how about delays on public transport, child care, bank visits, optician and dental appointments, home deliveries, getting the car serviced and on and on. In fact most GPs are open from as early as 8am and up until 6pm, hardly bad for non emergency medical care is it? I also wonder how many NHS staff lose many hours every year taking time off work doing routine things like servicing the car, sorting things at the bank or getting an electrician or plumber in? Should all these workers be on 24hr call as well? The government's propaganda machine, the BBC, is also jumping on the bandwagon; by their logic we should all be doing nothing but working, working, working- has anyone thought of the poor pillow manufacturers?

If you agree with the CBI then you are in the minority, and I would suggest that you look at the underlying motives. Alliance Boots was in fact taken over this year by none other than KKR. It is therefore a strange coincidence that Labour peer Lord Hollick is an adviser to KKR, while the Labour party has received several rather large donations from such private equity firms. These are the very same private equity firms that seem to enjoy profiting from stealing peoples pensions. I am more than a little suspicious that these people do not intend to plough money into health care to provide a better service for patients, I suspect that they want to get their greedy mits on some more easy money and that the government is only too willing to oblige.

If these corrupt profiteers get their way then it will only be bad news for patients. British General Practice is actually a remarkably high quality service that comes at a relatively low cost, one of the things that makes it so precious is the continuity of care that it provides. This will be lost if this short sighted privatising agenda is allowed to continue, catalysed by dishonest pretences at consultation by the illiterate Alan Johnson and the malignant Labour crony Ara Darzi. These big businesses do not care one jot for their workers' health or well being, they are simply intent upon fleecing the tax payer by uniting with a corrupt Labour government that has come to represent the exact opposite of what the Labour party should stand for. Depressingly the way it is going, I fear for the future of British General Practice, and it will not be possible to recreate the brilliant concept of the local doctor who actually knows you when it has been ruthlessly destroyed by this Brownite dictatorship. All we will be able to say is 'I told you so'.

Golf

The BMA's Rantingshire Division Council 2007 yesterday

Golf was once solely the preserve of men who needed a 'safe environment' to dress like colour-blind accountants with bipolar disorder, or sometimes just men who wished to escape from the female dominated, celebrity obsessed, world in which we now live for a few hours.

Today, Golf seems to have taken on a whole new mythical and euphemistic significance in a world where one need not feel ashamed if you earn a decent living, unless of course you happen to be a General Practitioner or some other brand of work-shy medic. Apparently we're all at like mad, without respite or distraction. If we're not replacing lost prescriptions for paracetamol at 3 in the morning, it's because we're all on the golf course. In fact, it has recently been scientifically proven that if your heart stops going 'du-dum', then statistically you are more likely to survive if you are on a golf course than in the emergency department of a major teaching hospital with a half empty intensive care unit, and that's a fact. This is because the number of doctors per acre is much higher on the 1st Tee than in A&E. Even Radio Four's illustrious Today program routinely appends 'golf course' to any sentence used in the discussion of NHS primary care provision, so there must be more than a grain of truth to it.

Rod Liddle

Arrrgghhhh!! What the fuck is it with our country's lazy, ignorant hacktard journalists at the moment? They are really doing my head in on a daily basis.

The latest ignorant fuckwit to stick his head above parapet is one of our personal favourites: Rod Liddle

The former 'Today' program editor and New Labour speech writer is now penning witless drivel for the Sunday Times as a 'columnist', although yesterday's effort was more 'colon' than 'column'.

I particularly enjoyed this bit:

"It is time we started treating doctors the way they treat us. Doctors in supermarkets should be made to wait six weeks at the checkout till for an appointment and then have half their purchases thrown out of the trolley for being “unhealthy”. In off-licences they should not be served at all. In banks they should be told that they’re not getting any money until they agree to be on call at weekends and evenings and stop killing the rest of us through their incompetence. Remember - 30,000 people a year die as a result of medical mistakes."
© A. Twat 2007

Let me let you into a bit of a secret Rod - doctors don't treat everyone like that. We only treat YOU like that because we think you are an utter cunt. It's a national conspiracy to piss you off, and we had a great time at last year's secret 'National Treat Rod Liddle like the Cunt he is Conference 2007', and much laughing behind your back went on. Then we played golf.

The BritMeds 2007 (37)

Welcome to the Dr Rant BritMeds. The Dr Rant team will be hosting the BritMeds on behalf of Dr Crippen during his summer recess, so please send all of your BritMed suggestions to BritMeds@DrRant.net.

Apologies for the lateness of the BritMeds this week. I'm on holiday this week and the internet connection at the house we have rented is not working so I've had to go in search of a local coffee shop with wifi. The time difference here doesn't help either.

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Why am I so Angry?

We wanted to mention the arrival of Militant Medical Nurse in the blogosphere last week, but MMN hadn't actually posted anything on the blog by last Sunday so we had to wait until now:

I am angry because the nursing profession has been destroyed. Nurses are working harder than ever in a rapidly changing environment. Changes in medicine and the way health care is delivered has tripled the workload of hospital nurses. Nurses are caring as well as hard working and we DO CARE about our patients.

The problem is that even the most wonderful, professional, hardworking and caring nurses in the world are not able to cope with their workloads. On average a nurse spends less than 15 minutes with each patient during her 12-14 hour shift. Yet he/she is working so hard that they probably worked 14 hours without eating or even being able to pee. Not only is your nurse working 12-14 hours or more without being able to eat or pee but she is absolutely terrified. Nurse needs to be 10 places at once or someone will suffer or die and nurse gets into big trouble with the law. Patients and visitors want a one to one handmaiden with no concept of how many other patients a nurse has or what is going on with them. Nor do they understand the consequences of the nurse not prioritising correctly. Where are the managers in all this? They are intentionally short staffing the wards knowing full well that the public will take their anger out on the one nurse running her ass off between 30 patients.

Why is this happening? Hospital managers (whether you are in the USA or the UK) only care about money. They are INTENTIONALLY SHORT STAFFING THE WARDS. They are refusing the hire. They don't want to retain their nurses and love to see them burn out and quit. Good nurses are leaving the profession in droves because they are overwhelmed and frightened and cannot stand seeing their patients suffer. I am going to use this blog to focus on these issues. The managers need to be dealt with and the public needs a reality check and they also need to understand what is really going on.

Oh, I like this. Mrs (Nurse) Rant really likes it. More please!

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Found: The Rectum of crap nursing

In the meantime, continuing the nurse-blog theme, Nursing Student's Museings has come out with another cracker of a rant about how totally shite nursing education is:

The training was for BM monitoring. Now, I thought this was simply the companies making a plug for selling their equipment. Turns out that for once, I was wrong. The reason this was to be done was (and I quote) "Before using ANY piece of equipment in the trust, you must be trained on how to use it...including thermometers". What? A bloody thermometer? The thing you put in the ear and take the temperature with? I am not suddenly finding myself in an alternative dimension of time and space where this is a name for a technical bit of surgical equipment? Unfortunately, no. I really could not believe what I was hearing. No wonder nursing is so disorganised and shit this day and age. I happen to know a fir bit about anatomy and physiology. I spent time studying ambulance aid so know of fractures, cardiac conditions, spinal injuries, the systems of the body, and read up on drugs. In the nursing school, none of that was considered important. BASIC NURSING CARE! Where was that? BASIC does not mean the same as SUPERFICIAL.

More of the same here.

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Witch Hunt

The Ferret discusses the worrying developments in the hunt for Maddie:

The McCann story is a great case study in how the modern media operates, and how sensationalist and dumbed down current affairs coverage has become. The media jumped on the story, milked it and has now started to turn on the McCanns in their rather typically incoherent and inconsistent manner.

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NHS - England, Northern Ireland, Scotland, Wales

While Dr Thunder gets settled in Down Under, Dundee Medical Student gets settled in to a new term (readers tell me DMS is female, so apologies for referring to her as 'he' in last week's BritMeds), and the Phoenix decides which box to tick on the Royal College of Surgeons of Edinburgh ballot form, Life With Leukemia considers the Kings Fund report into UK healthcare:

Looking at the Kings Fund/BBC Today reports into NHS in the four regions I am somewhat surprised.

NHS Scotland’s report runs to 24 pages, NHS Northern Ireland 18 pages, NHS Wales 13 pages and NHS England to 10 pages. Same questions.

NHS Scotland obviously has better statisticians or realises the importance of data for planning or has more statisticians per head of population or pays them more or …

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Patric Holford - No Comment

The Quackometer and DC's Improbably Science continue on their mission to offend spaktards of all shapes and sizes. This time it's "celebrity nutritionist" Patrick Holford who is getting upset:

Patrick complain[s] about a rather silly comment I posted on the article? I have written lots of things about Patrick and never received any other sort of complaint. I feel rather miffed. Here are some things he might like to complain about...
A long article on how Patrick's views of nutrition has diverged away from science and how 'Optimum Nutrition' has become just one more alternative medicine.
An examination of how Holford's view of psychiatry and medicine is convergent with scientology, and how he is involved with a scientologist's anti-psychiatry organisation, and how he has been mentioned as receiving awards from UK scientologists.
An investigation into how Patrick Holford uses questionable diagnostic techniques that have been widely associated with fraud.
An look at Patrick's shaky grasp of physics as he tries to sell anti-EMR gadgets.
And more shaky physics as he helps the Wi-Fi scare mongers.
A critique of the Food for The Brain schools charity and how it places too much evidence on food supplements and not enough emphasis on science.
A puzzled look at how Patrick can get basic personal facts wrong on his own CV.
My anagram of 'Institute of Optimum Nutrition' - 'Nut Into Tummies Tuition Profit'
Professor Colquhoun is quite right to be very worried about many aspects of what Patrick Holford advocates. As one of Britain's most prominent pharmacologists, the Professor has every right to question the Patrick's recent appointment as a visiting professor at Teesside university when he has so few academic credentials, and the facts of some of those credentials were wrong on his CV. Also, playing with ideas that Vitamin C might be better for HIV than scientific medicine is playing with people's lives. In Africa, millions of people are denied access to proper treatment and one of the reasons for this is that senior politicians are in the sway of people with similar views to Patrick about nutrition and so advocate the use of potatoes and lemons to cure AIDS. Remember, Patrick is a man who wrote a book called, "Food is Better Medicine than Drugs'.

This is truly scary.

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Feeling Fraudulent

Shiny Happy Person has mixed feelings (no pun intended) about the well-dervered blog award from PsychCentral for the top 10 bipolar blogs:

I am flattered...and a little confused. I have very few posts on this blog relating to my illness, having recently removed most of those posts due to concerns about my anonymity, which I now rather regret. Even prior to that, my illness was a fairly small part of what I write about. I do not really feel worthy of an award specifically for writing about bipolar disorder.

I did not intend Trick-cycling For Beginners to be a blog about manic-depression. It is, and will continue to be, a blog primarily about my work - about being a doctor in the UK, about my training, about being a psychiatrist, and about my thoughts and beliefs relating to psychiatry and medicine. My having manic-depression is relevant and important, and I will continue to write about it when I see fit, but it is not what my blog is about.

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What does it take to get paid?

Everything Health is having cash flow problems:

Most primary care doctors are running a small "mom and pop" business and any business will fail if payment is not received. A review of "ageing reports" (accounts receivable) can be eye opening for the doctor. Thirty-60-90 days past due can be a financial disaster. But what about bills that are not paid for over a year? It is not uncommon for active patients who get prompt return phone calls, easy access when needed and seem to be very happy with the service to just ignore the bill.

Seeing this list of patients who just won't pay their bill is usually a shock for the doctor. All of these statements were first sent to insurance companies. The insurers delayed as long as possible (60 days or more) and either made a partial payment or paid zero because it was applied to the patient's deductible, or the patient wasn't even insured at that time.

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How much does the DoH cost?

Dr Grumble:

What about the Department of Health? Quite a few of Dr Grumble's patients work for the NHS. That's not surprising. It's big employer. But what surprises Dr Grumble is the number of his patients who work for mysterious NHS bodies. They are mostly rather intelligent people and Dr Grumble would guess that they have good salaries. In as gentle a way as possible Doc G asks what they actually do. The answers are as mysterious as the bodies these people work for.

Now, if Dr Grumble were to tell you that elective patients cost the NHS about £6 billion a year and non-elective patients £9 billion a year, how much do you think is spent on central budgets (the DoH and other centrally funded organisations)? What do you think? Inpatient care is pretty expensive. It doesn't come cheap compared with office work. So how much do you think goes to the DoH and the rest of the central office staff? A billion perhaps? Could it be as much as £2 billion? That's one third of the cost of all elective patients in the land. No, it can't possibly be that much.

Dr Grumble has strung you along too long. Here's the answer. The central budgets consume £18 billion. That's more than a quarter of the whole NHS budget. How can this be? Can it possibly be true?

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Chloe O'Brian from '24'

Shrink Rap asks a question that has bothered Dr Rant for some time: what is Chloe's problem?

If you have watched the Fox show, 24, you know Chloe O'Brian, CTU's O'Brian, CTU's best analyst. Dinah and I were talking and it seems she thinks Chloe's character (played superbly by Mary Lynn Rajskub) Rajskub) has Schizoid Personality Disorder, while I think she has Borderline Personality Disorder. What are your thoughts?

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2nd October

Barry Monk is organising a public meeting as part of his Save Bedford Hospital campaign on the 2nd of October.

The Save Bedford Hospital party has organized a public meeting to explain our views on what is going on in the NHS.

Do please come along; it's at Biddenham Village Hall, Nodders Way, Biddenham at 8p.m (Nodders Way is just opposite the Three Tuns pub.

(oh, and by the way, bring your friends)

Go Barry!

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Medical Blogs That Are Better Than Dr Michelle Tempest's

MentalNurse is still upset about Michelle's top 10 medical blogs list:

I’m still slightly miffed about Dr Michelle Tempest’s list of Top Ten Medical Blogs . Not just because she put her own utterly ghastly “Gosh, isn’t trite pop-psychology great! Vote Tory!” blog as second-best medical blog on the Internet. I’m also slightly annoyed that her list is composed entirely of doctors and medical students. No nurses? No ambulance staff? No OTs, physios…or Cthulhu forbid…some actual patients?

So, I’m going to address that by creating a list of Medical Blogs That Are Better Than Dr Michelle Tempest’s.

Yes, ladies, gentlemen and eunuchs, this is called catharsis.

Categories include doctors, nurses, ambulance service, managers and patients/service users.

Anyway, here goes…

[I thought the list was simply a 'top 10' and not meant to be in any order - Ed.]

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Wasting Police Time

And finally, Dr Rant would like to give a non-medical plug to the cop-blog PC Copperfield (no relation to medical writer Tony Copperfield, as far as we are aware) who will be on a Panorama programme with the same title as his book, 'Wasting Police Time', on Monday 17th of September. It is a disciplinary offense in many forces in the UK to be caught reading PC Copperfield, and many of the problems with crap top-down management that the police face are the same ones that NHS staff face, so it should be interesting. (Is he going to out himself?)

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Please send your recommendations for next week’s BritMeds to: BritMeds@DrRant.net

The BritMeds will now be published from Saturday morning to Sunday evening, so please let us have your recommendations by Friday evening latest.

The Wanless Report

The Wanless report appeared this week. It's a major report, and will take time to digest properly. Here's our initial response to it.

The Mail's report is a good summary. Good ranty comment (which I hope the author won’t mind us quoting):

“Billions poured into the NHS.
Result: scarcely any sign of improvement.

Billions poured into education.
Result: scarcely any sign of improvement.

For those of you who cannot identify the trend, I assume you that must fall into one or more of the following categories;

1. Under the age of two.
2. Recently passed 10 GCSEs, all A grades.
3. A member of the present bunch of clowns who laughingly call themselves a Government.
4. A private sub-contractor milking State finances with your inflationary pricing.
5. A trade unionist who believes that 'bankrupt' is term which can only apply to the private sector.
6. A doctor who drives a £40,000 4WD vehicle, whilst preaching that people need to exercise more by leaving the car at home.
7. A graduate dentist who uses NHS facilities for training and then goes into private practice.
8. A teacher who thinks early retirement is their divine right.
9. An ostrich.”

The more intellectual version is Nick Bosanquet in the Telegraph I'd accept his points 1,2,4,5. As most of us here I am very sceptical there is any benefit from "NHS internal markets" And as for practice based commissioning in which GPs commission services from their mates with "service provision companies" in which they have a stake....that's another rant. Under present rules it's virtually a licence for insider trading supported by the government which really just wants to close hospitals by fair means or foul. MD summarises it beautifully in the current Private Eye (No 1193 14.9.07 page 10)- "If Brown allows hospitals to close and manages to blame to GPs for it, he truly will be Blair's successor."

The Telegraph’s main report here

The Times main report and Nigel Hawkes devastating summary , “The NHS used to be underfunded and ineffective. Now it is only one of these.”

Harry Cayton, the former patient czar is ruder now he’s out of office. Patients have been let down by NHS reforms.

The FT has devastating analysis of the MTAS fiasco. How can Sir Liam Donaldson stay in office? Or sleep at night? The NAO are going to investigate value for money of this once the Tooke review is done.

The Wanless report is a major document. However it is becoming increasingly clear that the NHS reforms have failed to deliver what is wanted or needed. Patients, taxpayers, doctors, NHS managers, and probably the politicians themselves are feeling let down.

There are fundamental reasons why this is so.

1. Government spending is far, far less efficient than personal spending. It’s to do with ownership, and I am far more careful with mine, than “everyone’s”
2. Spending on medical activity does not generate health. You cannot buy health. Medical activity is purely remedial, and at best gets you back to your starting point. The doctor will not make you better in either a physiological or moral sense.
3. NHS management is useless
4. The doctors know what they want to do. The patients know what their symptoms are. The managers have no idea how the interaction between doctor and patient works.


NHS management is largely useless, and could be got rid of. The generous version is to say that NHS managers are well intentioned but asked to deliver an unspecified result from an unspecified task, with a disappointed overseer who will change the task and the organisation at will whatever the hapless manager does or doesn’t do. Thriving on vague objectives as Scott Adams puts it.

The cruel version says that the problem with the management of the NHS is the management of the NHS.

The rising tide of criticism of the NHS raises a fundamental question:

Will the taxpayers continue to be willing to pay for an expensive failing organisation?

He's just doing his job........

"I'm just doin' me job mate. Now that will be £260 to take it off."

Following on from the last article about Ben Erhman's questionable journalistic techniques, the discussion seems to be polarised into 2 camps: The 'Disgusted of Tumbridge Wells' camp in which I'm proudly toasting my marshmallows on a stick, and the 'He's just doing his job' camp that Dr Blue has pitched his tent in.

Doing his job eh?

That doesn't actually reconcile with his industry's code of ethics.

It's from an American association of professional journalists, but seeing as it offers comprehensive guidance, and is actually written by journalists, you can't really argue with it.

I quote:

"Avoid undercover or other surreptitious methods of gathering information except when traditional open methods will not yield information vital to the public. Use of such methods should be explained as part of the story"

Claiming to have attended a university you haven't, or to have attended a girl's school isn't open is it? How about:

"Recognize that private people have a greater right to control information about themselves than do public officials and others who seek power, influence or attention. Only an overriding public need can justify intrusion into anyone’s privacy."

I don't know about you, but there is no conceivable situation in which Ben Erhman, using this 'technique' could possibly uncover anything I need to know. You may be interested in this story which is your prerogative, but don't tell me what titillates you is in the public interest to know.

Would anyone here like to claim they have either a need or a right to know what Kate McCann was like as a flatmate in university 15 years ago? Go on, I dare you.

Secondly, the fate of the little girl is uncertain and this should be respected. Conjecture helps no one.

Thirdly, do you really think that asking a cohort of 40 year old doctors for gossip is going to yield anything that he actually wants to print? These people are not going to volunteer any significant 'dirt' or reveal a significant insight into the person in question because the GMC would be rather interested I'm sure. Unlike a journalist, a doctor's code of ethics isn't voluntary, and the sanctions are extreme for those who transgress. The bloke is obviously a lazy fuckwit.

He could always just play News Makey-Uppy like most of his colleagues. After all, you wouldn't want to let the facts get in the way of a good story.