BBC: Have Your Say (again), Fuckwit

The BBC's pointless 'You're a totally clueless fucktard, but we're too lazy to do an editorial ourselves, so you might as well have you say' section has turned once again to the thorny issue of GPs and Out Of Hours Care.

This time, they pose the question 'Should more doctors be available around the clock?' to their usual baying mob of self obsessed, whinging, reactionary shit-for-brains, with chips on their shoulders the size of Luton, that seem to believe believe their opinion carries merit, simply because they can be bothered to form one without recourse to developing an understanding of the subject in question.

Is it just me, or does this already sound like it's a bit of a foregone conclusion? Why not ask a cohort of Daily Mail readers whether they'd like to pay no tax, live forever, ban house price falls or abolish foreigners?

Well, let's look at a few examples of what passes for the wisdom of the British public shall we? Please also bare in mind that these salt-of-earth types, who claim to work so much harder than their doctor, managed to leave their comments during working hours when then could a) be seeing their GP and b) actually doing some fucking work for a change........

GP's are now so well paid they do not need to work much. The ones near me seem to only work 4 days a week anyway.

Robert Taylor, Bury St Edmunds, United Kingdom

Well Robert Taylor, seeing as you commented at 11.21 am, it looks like you don't even work 4 days a week, so fuck off! Of course the GPs near you don't bother to keep up to date with medical practices by attending courses, actually administering their business or entering into correspondence with the hospital about their patients. They play golf.

Am I willing to pay more for overnight cover? - Not on your nelly. The average GP earns four times what I do, I bet they don't work four times as hard. Make them do it.

Alun Williamson, Chepstow, United Kingdom

Hello Alun. Well you're not doing any work at 9.49 am on a monday are you? I bet your GP spent four times longer than you at university and in training, and gets in fours times the trouble if they fuck things up at work. It's called recognition or professional experience and responsibility. I bet they do work harder than you anyway, so you can fuck off too. I've been to Chepstow..........

"Ask yourself do you want to work unsocialble hours?

Mark Rudd, Staffordshire, United Kingdom"

Heck no, which is why I didn't go to university to study a profession that is meant to fix or aid the 24 hour human body. Next: Soldiers who don't like the sound of explosions....

WillJ, Bournemouth

No WillJ! What's next is a BBC Have Your Say Comment from someone with a bit more than monkey shit between their ears. Actually, come to think of it that'll never happen.

Turning up on time for the start of surgery hours would be a start.

Thelate KingZog

Same goes for 'Patients' as well you twat! In fact 'turning up at all' would be a good start for a significant proportion of my patients who book appointments.

Why not, many of us are on call 24/7 for a lot less money than they get

Polly McLeod, United Kingdom

Well Polly, I didn't spend 6 years at university learning to use a mop or ask 'have you tried turning it off and then on again?'. 'Duty cleaner to aisle 6 please'. Hear that? That's why you get paid less than me you dappy bint.

Of course the poor lambs shouldn't have to work nights. It's up to the rest of us to be sick during surgery hours (sorry, minutes).

Jim McDermott, Daventry, United Kingdom

Yeah Jim! Ten and a half hours a day, that's only 630 minutes isn't it? A good point well made that doesn't make you look like a cunt at all.

My doctors is open 8.30am-10am and 4.00pm-5.30pm monday - friday - i would love to know what they do the rest of the time.

Rachel, Sheffield

Trust me Rach, it's unlikely that you would have the intellectual capacity to comprehend what we do with our time because it doesn't involve watching the Jeremy Kyle show or stuffing our fat faces with chips you stupid bitch.

Yes they get paid enough and millions of others do shiftwork with far more stress than your average gp.
Lets face it unlike the old days when you always felt better once you had seen a doctor,these days all they are are glorified clerks. They look at you and dispense paracetomal but if its anything serious they tick a few boxes and put you in a queue to be seen by the NHS specialist who knows what hes doing. But you might be in a hospital queue for a long time.
so yes.

jimbo, Wales

Perhaps Jimbo, in the 'good old days' you felt better seeing the doctor because it meant that you weren't underground at the time filling your lungs with coal dust, you sheep bothering simpleton. My advise would be to take some 'paracetomal' and shut the fuck up.

It might be wiser to start with getting right the normal hours of practice. I dont often hear good things about Doctors, often their attitude is that of a Demi God, who grants you a 5 minute audience. They get paid too much, work too few hours and are arrogant with it. If anybody thinks in their right mind they can get a Doctor to work around the clock as a servant to the people and their profession they are in cuckoo land. Doctors dont really like working, it gets in the way of golf.

Anna, Halifax

Well you obviously don't like 'thinking' or 'listening' do you Anna. Does it get in the way of 'Big Brother' or looking at the pictures in 'Now!' magazine? Doesn't your GP drop everything if you chip a nail? Are they too busy being harangued by the other vapid harpies with a bloated sense of self importance round your way? You're right about the Golf though.

Since golf courses are rarely open at night, I thought that doctors would be queueing up to do nights. They normally have a very stressful time trying to fit their work around their golfing schedule.

Will de Beest, Spain

Ah! A lone voice of sanity in the maelstrom of intellectual deficiency.

Both Sides Of The Fence

As the dangerous empowerment of the under trained continues with the decision to hand nurses the power to make crucial decisions about whether to resuscitate a critically ill patient, a voice of reason has been heard on Doctors.net:

"Just got up and switched on my computer to read this on the BBC site. I am a final year med student, about to apply for F1/2 jobs and looking ahead to finals in a few months. In a previous life I was a registered nurse, including working for over four years in that role before deciding to do medicine.

I am utterly disheartened by this statement, as for me it is almost the straw that breaks the camels back after the MTAS uncertainty, the recent announcement of our likely salary without banding and an e-mail yesterday implying that because of the large number of EU grads applying for F1 we may not be able to apply for a run-through F1/2 programme this year.

I went to medical school for a number of reasons. I wanted to stay in healthcare, I wanted to challenge myself and develop myself. I did not want to be a charge nurse or nurse manager and I did not want to be a clinical nurse specialist or whatever because I felt that even with advanced practice courses I would not have the knowledge and skills that I believed were necessary to do the job that I wanted to do - i.e. practice medicine. So, I put my money where my mouth is (and believe me, with a young family to support it has been a hell of a lot of money) and I applied, was successful and went to medical school. Now, on a personal level I am very pleased to have done, but looking at it objectively, I wonder if I have been a bloody fool. All this expense, effort and sacrifice only to find I have joined a profession apparently despised, and certainly devalued, by this government, neglected by the 'union' (the BMA) and for some reason, not apparently widely supported by the media. Doctors are apparently superfluous in today’s society.

Nowadays, we have nurses running around trying to be second-class doctors, instead of first class nurses, taking on more and more extended practice, instead of actually nursing patients on the ward? This leaves HCAs or Auxiliaries nursing the patients, a task that 20 years ago required three years of quite rigorous training in anatomy, physiology etc (pre-dumbing down) and the passing of exams, on the basis of no training. Meanwhile, doctors are sold down the river and the junior doctor is increasingly handicapped in terms of what procedures we can and cannot do.

This is not the anti-nursing diatribe people might perceive it to be. I believe I speak from experience of both systems of education, and practical experience of nursing, plus the feeling that there was nothing in my nursing training that would have remotely prepared me for some of the decision making now devolved to nurses. And if I thought that before I started medicine, I know it for sure now. Nurses should nurse, doctors should doctor. If one wishes to change roles in either direction, retrain. Or better still, save all the time and money myself and other nursing colleagues now at medical school have spent, learn less, busk your way through without medical training and earn more.

I cannot wait to get out of this country, I really am finished with it here. At least until sanity returns to the government, the BMA and whoever else is responsible for (a) trying to destroy medicine and (b) standing by and letting it happen.

One question: I left the BMA a while ago as it is clear they are firmly on the side of the anti-doctor. Who could one join that might in some way represent doctors & medical student's interests effectively?

Rant over, I apologise if this seems OTT, it is just the way I see it."

This is the way things are, a thorough education and proper training are no longer seen as being essential for positions of great power and responsibility. The BMA and the government have a lot to answer for, excellent doctors are quitting medicine as nurses are empowered beyond their means. Just hope and pray that you have a doctor looking after you when you are critically ill.

New Labour Cures Cancer

Dr Rant is glowing with pride following a restful night's sleep after official confirmation that NHS Targets have been responsible for cutting the cancer rate in the UK.

During Prime Minister's Questions in parliament yesterday, the following was said according to Hansard:

Mr. George Howarth (Knowsley, North and Sefton, East) (Lab): I wonder whether my right hon. Friend could help me with a little problem that I have been wrestling with. [Interruption.] If the Government were to abolish public service targets, how would we know how well they are doing?

The Prime Minister: My right hon. Friend is absolutely right. As a result of the targets that we have set, cancer is down 17 per cent in this country....

There you have it! It must be true, and we look forward to Gordon Brown producing the evidence that the targets his party foisted on the NHS have reduced cancer by 17%.

Targets have apparently meant that 1 in 6 people who would have otherwise developed a malignant tumour through the inactivation of tumour supressor genes coupled with gene mutations, within a cell line have been miraculously spared.

We also expect the imminent announcement that management consultants within the NHS have been responsible for the recent reduction in deaths due to extreme weather conditions.

Dr Rant would like to thank the indomitable Dr Barry Monk for pointing him in the direction of this marvelous news.

C. diff - Who's fault?

The latest Research from the Dr Rant Foundation has highlighted the antibacterial properties of leeks, sheep and coaldust as well as the cleansing potency of close harmony singing.

Dr Rant thought that you might be interested in this piece written by Dr Barry Monk, a hospital Dermatologist from Bedford who also intends to stand for parliament at the next General Election under the 'Save Bedford Hospital' Banner. He has written several pieces on his blog on the subject of Clostridium difficile infections in hospital:

I know of no one who has not been appalled by the story emerging from Kent of the outbreak of Clostridium difficile infection which has affected so many mainly elderly patients, and killed a substantial number.

But it emerges that the situation in many NHS Trusts is not so different.
According from the official figures from the Health Protection Agency during the period January 2006 to March 2007, there were the following number of cases of C difficile infection:

Maidstone : 542
Kettering Hospital : 757
Luton and Dunstable : 477
Bedford Hospital : 485

I quote these hospitals just because they are local, but it is clear that there is a huge national problem in the English NHS. I say English, because curiously Wales has not been similarly affected. Why is this? As far as I am aware Offa’s Dyke and the River Severn have no magical antibacterial properties, and indeed in parts of the West Midlands it is routine for English patients to be admitted to Welsh hospitals and vice versa. There is only one obvious difference between hospital medical practice in England and in Wales, and that is that in England there has been a rigid application by hospital managers of waiting list targets.

Wales: Tidy.

The impact of this obsession with targets is that there has been an insistence on admitting non urgent patients even when there is a bed shortage, and even when wards are contaminated by infected patients. Wards were not designed for occupancy rates close to 100%, and the reason for this is that when occupancy rates rise, so does the risk of hospital acquired infection.

The real tragedy is that all this misery could and should have been avoided; contrast the sorry situation relating to C. diff with how the recent outbreak of Foot and Mouth Disease has been handled. Infected animals were immediately isolated, movement of animals was stopped, and the situation resolved itself. Obviously we can’t cull patients, but it seems obvious that when there is an outbreak of hospital acquired infection, the first thing to do is to stop admitting non-urgent cases.

So who is to blame? I appreciate what appalling pressures managers were placed under by their political masters; they were told, as I understand it, that if they didn’t achieve their targets that they would be fired. Equally, ministers were probably too stupid to understand the consequence of their actions. The people who I blame, were, firstly, the Chief Medical Officer, whose duty it is to explain the potential implications of policy to politicians, and secondly the Medical Directors of hospital trusts, whose duty it was to explain the dangers to hospital managers. Perhaps it is time for a few of them to be sent to the GMC for failing in their duties.

Stereotypes ©Dr Rant 2007

If you have a glitch viewing this piece with Firefox - click Here

If............

I refer an asthmatic to Secondary care they see the Respiratory Nurse Specialist.

If, I refer a diabetic to Secondary care they see the Diabetic Nurse Specialist.

If, I refer someone with Multiple Sclerosis to Secondary care they see the Multiple Sclerosis Nurse Specialist.

If, I refer an epileptic to Secondary care they see the Epilepsy Nurse Specialist.

If, I refer a prostate problem to Secondary Care they see the Prostate Assessment Nurse Specialist

If, I refer an person with crippling osteoarthritis to Secondary Care they see a Physiotherapist

If, I refer a schizophrenic to Secondary care they see the Community Mental Health team.

If, any of these people have a knowledge-base greater than my own I will eat Lord Darzi's (rarely dirty) surgical scrubs.

There's a hole in my tooth.

Ben Bradshaw MP, NuLabour gobshite yesterday

There's a hole in my tooth.

Do you promise to tell the tooth, the whole tooth and nothing but the tooth?

Well if you are a British NHS dental patient you might very well not be pulling out your hair but your teeth in agony or frustration.

Dentistry is one of several gaping holes in the government's record. People feel that value for money has disappeared in to a hole bigger even than the caries in Ben Bradshaw's brain. For ill informed ministerial twaddle this statement, "If people are in pain or need urgent treatment, they should go either to their GP or to their primary care trust and demand what is now their right" is about as sensible as Bottler Brown not calling an election because he would have won it.

Crippen and Rant have both covered NHS dentistry before. We have pointed to the gaps in provision, which are almost as big as the huge empty synapses between the neurones in Ben Bradshaw's brain.

Just for the record. Dr Rant is a general practitioner of MEDICINE.

He is not an ersatz dentist. He is not nearly a dentist, or a good substitute for a dentist.
Dr Rant is a general medical practitioner- and good at what he does.

He does not do DENTISTRY.

Dentists are better at dentistry than he is. Dentists are much, much better at dentistry than he is.

And 3Ps (paracetamol, penicillin, piss off) is not good treatment for dental problems.



So Mr Bradshaw, please go back to your ministerial hell hole, stay there, and stop making stupid statements that will add to my work, get patients to the wrong place at the wrong time, bugger up my access targets generally do nothing fuck all to get any more dentists working for your clapped out NHS organisation.

The American media is loving stories of our "comprehensive socialised medicine" failing to provide universal cover.

However their insurers are far from fully comprehensive.........

Delay, Diminish, Deny and Blame: What the NHS can learn from American health corporations

“I once tried to explain to a Norwegian woman why it was so hard for me to find health insurance. I'd had breast cancer, I told her, and she looked at me blankly. "But then you really need insurance, right?" Of course, and that's why I couldn't have it.”
Barbara Ehrenreich, journalist and author

One of the arguments that frequently surfaces on here is that an insurance based healthcare system would be more efficient and customer responsive than our state funded NHS. Now we don’t believe that the NHS is perfect, or that it cannot be improved. However collectively we don’t see much future in market based solutions to the NHS.

Indeed we tend collectively to see market based solutions as anathema to a well functioning health service here in UK, and in other parts of the world. And despite the protestations of DK, Tim Worstall and the redoubtable and persistent 'Anonymous', we are still convinced that healthcare is not just another product in a market to be sold. Or at least if it is a product, it is a product that should, at least in basic form, be available to anyone on the basis that they are ill and suffering, not their ability to pay or their moral worth. To us the 100 million Americans with too little cover and from these the 47 million with no cover at all represent a moral outrage. They also seem daft in a healthcare system that spends such huge sums of money. (15% of the huge US GDP)

Fundamentally medical care is expensive (highly trained staff, many of them, lots of technology, lots of capital equipment, drugs, devices etc). The money for it has to come from somewhere and the options are:-
1. From general taxation
2. From user charges
3. From insurance cover
4. Some mixture of the above.

Of all these we tend to support Julian Tudor-Hart’s contention that the pooled risk across a whole society via general taxation funding is the fairest system.

We also contend that the old NHS which kept its transaction costs to the absolute minimum was cleaner, cared more about the patients, more effective, and had greater staff loyalty than the current michmash of policies will ever generate. The current reforms to us seem to increase transaction costs, generate ever more need for management, but not alter the fundamental interactions of patients, nurses, GPs and specialists. Indeed we have said on here that if all the managers were sent off to Mars we’d not miss them.

Some evidence from America supports our fears about insurance based systems and in this piece we want to display some highlights, and link you through to the original report.

(Seumas Milne picks up a similar theme in The Guardian)

In USA the provision of health insurance is a large and profitable business. Even so called “non-profits” have large “reserves” of income over expenditure.

Now as any business knows to make profits you need to get more income in than you pay out. So regular premium income in is good. High risk clients (those likely to claim) are bad. Paying out is bad for business, and should be as little and as late as possible. You mustn’t do this too obviously or people will start complaining that “We’re not getting what we pay for.”

It seems that in USA the patients are not getting what they have paid for. As a piece of consumer feedback this report is devastating for US health insurance companies. They seem to be an example of unfair trade, of taking money for not providing a service. We should consider this report very carefully indeed before letting them have any influence in UK health provision. The USA should consider carefully how much longer it will let them provide US health care.

Anyway here are some great slogans that advertise health care companies. “Over 195 years of wisdom” (Almost as long as Hippocrates) “Nothing is more important to us than the ability to be there when our customers need us following a disabling accident or illness” A friend of mine at university ran for office on the platform of “SLOGANS, not solutions” He did very well on it. But fortunately he was only wanting to run Hikesoc.

Here are some key quotes from the report

“Because of the conflict of interest between health insurance company profits and
necessary health care for all, millions of people in the US do not receive necessary health care and disability benefits, and suffer significant negative consequences”

“Built into institutionalized blame is the assumption that the basis for the health or disability claim is a mental condition, or a personal defect of the individual. One of our interviewees stated, “You are guilty until proven innocent”.

Over half of the twenty people interviewed in our study described feelings of personal
responsibility for their condition or were told by doctors, nurses, or claims managers that the problem was their own fault.”

(Such questions may arise in UK NHS, but don’t stop people from getting treated)

“As mentioned above, we uncovered psychological patterns of accusation and suggestion of fraud as well as blame placed on individuals for their own health and disability problems. Inducing self doubt and frustration into a claimant’s life is a way of psychologically encouraging a patient to terminate the pursuit of rightful benefits. Some of our participants suffered from severe disabilities and spent years fighting their insurance companies for benefits. The average time spent per week in trying to get benefits among our twenty interviewees was 6.5 hours, which included waiting on hold, call transfers to multiple representatives, travel to insurance company
doctors, gathering medical records, and filling out paperwork.”

(How much time and money is being wasted here in endless checking? Are the US people so dishonest and fraudulent that they deserve this level of checking? Or would the patients and doctors do better without the transaction costs this bureaucracy generates?)

“A 2003 study in the New England Journal of Medicine estimates that spending for the administrative costs associated with health care amount to over $320 billion per year, or about thirty-one percent of overall health care costs in the US.”

(To us this spending this percentage of health care dollars on administration must be a waste of money that could have better been spent on getting on with treatment. To the UK Department of Health McKinsey et al are becoming all the rage. Encephalitis bureaucratorum as we doctors know it. They set up great systems…for getting money from taxpayers into their accounts)

“In some cases, the claims process lasted years. One person reported seeing twenty-one different doctors during the course of the claim.”

(This has to be squandering patient and doctor time.)

“Delays by the insurance industry were the most prevalent practice reported by our interviewees. All of the participants interviewed experienced numerous delays including long waits between correspondences, unreturned phone calls, and asked repeatedly to communicate all the details of their case to insurance company representatives.”


(In UK at least we try to treat first.)

“The [disability company] closed my claim while I was going through surgery for
lack of medical documentation. This delay has cost me dearly. The process of
making contact with the [disability company] was a severe hardship during my
chemotherapy and [continues] until this day.”

(UK cancer patients mostly don’t have this worry. They may however have a struggle to get the chemotherapy their doctor recommends. Looks like in USA they may have a similar problem, just at a different point in system)

“Another method of delayed treatment that many of our interviewees experienced was the request for excessive information. People who are disabled are also attending doctor’s visits, taking medication, and trying to survive daily life. Companies demanded that claimants attend multiple doctors’ visits and submit all copies of their medical records. Additionally, interviewees reported that companies requested financial and employment information and would speak to friends, colleagues, and employers; gathering information that was sometimes completely unrelated to
their claims. Interviewees stated that insurance companies requested copies of the same records multiple times.”

(Just like the UK, except that here the bureaucrats work for the government rather than a private company!)

“In 2001 1.458 million American families filed for bankruptcy…About half cited
medical causes, which indicates that 1.9–2.2 million Americans (filers plus
dependents) experienced medical bankruptcy annually. Among those whose
illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start
of illness; 75.7 percent had insurance at the onset of illness. Medical debtors
were 42 percent more likely than other debtors to experience lapses in coverage.
Even middle-class insured families often fall prey to financial catastrophe when
sick.” (Health Affairs, 2005)

(The NHS doesn’t do this to anyone. For all its flaws, there in no-one in UK going bankrupt to pay off medical bills)

“People in the US have a choice. They can continue with the profit-driven private insurance health care system leaving many millions to languish without care, and many millions more to face the frustrations of systematic delays, diminishment, and denials of promised benefits. Alternatively, they can build a common pool health care system that provides necessary health care to everyone– for less than we are paying now”

(The UK and rest of Europe made this choice after WW2. Paying for bureaucracy whilst getting little is rank bad business, and one of the reasons why team Rant is so sceptical about the current UK NHS reforms.)

“Each person interviewed for this study had insurance at the onset of his or her malady. They paid monthly premiums through employer sponsored plans or had purchased individual/family policies directly from insurance companies. The people in this study believed they would receive the benefits they were promised in the event of an accident, disease, or illness. The management practices of the health or disability insurance company delayed, diminished, and denied payment for expected benefits.”


(Buyer regret and customer disappointment. Not a good way of doing business.)

“Each processor is ordered to deny a set dollar amount of claims each month and if the target was not achieved, they lost their jobs.” (personal communication, February 2007)
(It’s a deliberate tactic by the insurance companies to deny benefit to some claimants)

This report from Sonoma State University California shows that US health corporations are far from being a good way to finance health care. The incentives to private companies (profits) mitigate against paying out when needed. The strategies of blame, delay, diminish and deny all work against the interests of insured patients.

The NHS in UK has many faults, but at least we cover the whole population most of the time.

Well at least we used to. Sadly the move of dentistry to the private sector, and the debacle of C Difficile in Kent may be the tipping points where the British start to abandon our collective loyalty to the NHS.

There must be a better way of organising health care than either the NHS (with its excessive bureaucracy, long waiting times, and monolithic response to change) or USA health insurance (with its excessive bureaucracy). Have the continentals discovered it?

Evidence Expert is Expert of Nothing

There is a new kind of fundamentalism creeping its way onto the medical scene, it is Evidence Based Medicine Fundamentalism. NICE are a centralised organisation that demonstrate this kind of fundamentalism very well indeed with their never ending protocols and guidelines. In fact NICE have recently been in the news with their frankly stupid osteoporosis guidelines, they continue to restrict the prescribing power of specialists while empowering the incompetent PCTs. Numerous specialists have come out against NICE on this issue and the National Osteoporosis Society has gathered thousands of signatures in a petition against NICE's proposals.

This is hardly the first time that NICE has tried to enforce their flawed interpretation of scientific evidence upon the whole medical community. NICE has become a political rationing machine and is undermining good medical practice based on the scientific evidence. On many occasions NICE is dictating its guidelines to top specialists in that particular field, when these guidelines have been crafted by people who are very far from being experts in this field. In this way moronic centralised totalitarianism is replacing local excellence.

The man photographed is Professor Paul Galsziou, a Professor of Evidence Based Medicine, and the reason that he is being mentioned alongside the fundamentalists of NICE is a recent piece that he wrote in the BMJ. Prof Glasziou, a GP by trade, elected to treat a radial head fracture without seeking advice from the local specialists because he thought that a quick literature search would be good enough:

"I went to the Clinical Queries section of PubMed Central (which is bookmarked on my Firefox toolbar) and used the narrow version of the "therapy" filter (which filters for randomised trials). I entered search terms to describe the condition "fracture and radial and head," which brought up seven studies. Two of these studies were not trials and three were not relevant (two looked at different types of internal fixation, and one looked at different methods of reduction), which left two that were relevant. I used the most recent study (2002)1 because it was more relevant to this patient's problem and I had access to the full text. I had access only to the abstract of the second trial,2 but this seemed to be consistent with the findings of the first trial. My search took only a few minutes."

So here we have it, he performed a quick literature search and only read one paper in full; he then felt adequately prepared to have a crack at treating his patient. Professor Glasziou is demonstrating the NICE tendency towards Evidence Based fundamentalism here, shown by his rather naive and arguably dangerous assumption that anyone can manage specialist problems that they have minimal or no experience of by performing a quickie Internet search. This consultant plastic and hand surgeon sums up rather well how low Professor Glasziou has sunk.

There are so many flaws in Professor Glasziou's approach that it is hard to know where to start, whether it be his assumption that the radiology report is correct or his belief that clinical experience of a specialty is unimportant compared to the 'evidence'. Anyone working in a particular specialty will tell you that you need years of experience of that specialty before you can go about understanding the evidence, let alone managing individual cases based on the evidence. Unfortunately for the standard of medicine in this country, the government is intent on cutting costs by shunting work away from the properly trained to the inadequately trained, and the likes of Prof Glasziou will back them up with his flawed take on the evidence. As one consultant respondent commented:

"There is a very pernicious process at work indeed when a family specialist feels able to write an article in the BMJ about fracture immobilisation. That process involves, along with generic referrals, practice-based commissioning, exceptional treatment panels and much more, the total dumbing down of British medicine."

The BritMeds 2007 (41)

Welcome to the Dr Crippen BritMeds. Dr Crippen has kindly asked for the Dr Rant team to take turns with him hosting the BritMeds, so please send all of your BritMed suggestions to BritMeds@DrRant.net.

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Crippen redux

He's back!

The time has come for Dr Crippen to spring back into action. Normal service will be resumed on Monday, 15th October.

The planned two month break has stretched to nearly three months - apologies for that, and thank you for all the emails.

[John has kindly offered to let Dr Rant continue to do the BritMeds turn about with him (or something along those lines) - Ed]

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Government survey

OurNHS asks:

Why was Professor Darzi selected to review the NHS?
His track record of toeing the party line
His objectivity and intelligence
Deliberately losing to Tony Blair at tennis on sundays
He holds a special place in Gordon's heart
Gordon likes using his robots for personal pleasure
He doesn't like doing his NHS clinical work
He begged Gordon for an easy job with a predetermined course

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I check my baby every night...

Nobody wears a white coat anymore:

I went into her room when her parents were out, and stood there, just looking at a perfect little baby under a brightly lit warmer and couldn't stop from crying. Morning rounds were subdued this morning, as A presented her case. Nobody asked many questions - we all just listened.
Her grandma wanted to know, he said, if there was something she could do to help someone else.

read on here.

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Clostridium difficile : more diarrhoea

John waste's no time getting his teeth into the C diff outbreak:

The official Healthcare Commission on Maidstone and Kent NHS Hospital trust does not not provide happier reading.

Shambolic mis-management or, to be more precise, lack of management of infection in a Kent NHS Trust. A depressing catalogue of incompetence. Lack of leadership from the top – and by that I mean from Consultant Microbiologists, doctors with specialist training in infection and bacteriology - was the main problem. Add to that government pressure on non-medically qualified managers to increase hospital turnover with inadequate nursing resources and you have a receipe for disaster.

more here.

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NHS Hospital Killings


Barry Monk has this to say about the figures quoted on BOM:

This is not a problem restricted to a few hospitals.

Past Secretaries of State for Health need to stand trial for corporate manslaughter

and also:

The story about Clostridium difficile from Kent is pretty horrific, but it now emerges that there are TWENTY hospitals with a higher infection rate than Maidstone.

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Health care acquired infection - who takes responsibility?

Staying with C diff, Life in the NHS [one of the few NHS manager bloggers - also a nurse, wife, mum, and now MSc so one wonders when she has time to write stuff - Ed] is worth quoting too:

In a world where blame needs to be laid at someones door it would be easy to accuse nurses of not caring, cleaners not cleaning and managers failing at allocate money to the right areas of the health system. However, like most things just blaming one or two groups of people for individual failings would mean that people missed the point. In my very humble opinion what we have here is a whole system failure, many years of under investment (or at least in the right areas) and an obsession with counting the number of people with one infection while failing to notice that people were in fact dying from something else under their noses.

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Devil in the detail

The Devil, having had all he wanted to say said by Crippen, has saved Dr Rant the trouble of pointing out that:

as you doctors should know, the second section of the name is not capitalised.

Call me a pedant if you like, but it is Clostridium difficile not Clostridium Difficile...

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Root and Branch Reform

Front Point Systems on the same story:

So James Lee, the chairman of Maidstone and Tunbridge Wells NHS Trust falls on his sword but not before releasing a “astonishing” letter to Alan Johnson.

“We have been struggling with a state pretty close to bankruptcy,” he said. The trust’s clinical income last year increased by 1.5% in cash terms when staff pay rates were rising by over 5%. “We knew the Treasury was pumping money into the NHS, but quite frankly none of this seemed to be getting to the coalface.”

As income fell, hospital activity rose by 11%. The trust cut costs by more than £40m in an attempt to break even. It struggled to cut maximum waiting times to 18 weeks. But this was “never really achievable”.

“The NHS is run on the basis of command and control. I personally have never experienced such centralised or detailed control … This way of managing things is fundamentally incompatible with the whole concept of independent trusts … I have done my best.”

more here.

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Breaking good news

HospitalPhoenix has an interesting post on something that I now suddenly realise is not talked about enough:

After I'd endoscoped her, I was able to break the good news: she didn't have the cancer she'd been dreading, she had a mild, benign condition which could be easily alleviated. She was delighted. I fed back to the ward sister, who got quite emotional, and insisted I speak to the patient's daughter. She began dialling on her phone and I stopped her, offering to speak to the daughter in person. She began dialling again, telling me that the daughter wasn't at work today but that she'd want to speak to me on the phone. She greeted her friend, then thrust the receiver at me. I introduced myself to my patient's terrified-sounding daughter, then delivered the good news. The daughter burst into tears and began hysterically telling me how grateful she was. By the time I said goodbye, the ward Sister was dramatically wiping tears from her own eyes and getting back to work.

Perhaps it's because I've become accustomed to trying to second-guess the emotions of dumbstruck patients who've just heard bad news, that I wasn't prepared for the outpouring of emotion which came with the delivery of good news. I didn't feel uncomfortable, but there was something particularly bizarre about it.

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The spin and the reality

Dr Ray's focal spot focuses on the spot again this week with:

The Spin - Happy Shiny People from the DoH "A New Ambition for Stroke" document which sets a target for CT scan within 60 minutes for patients thought to have suffered a stroke.

The Reality - "Many of the buildings, especially at the Kent and Sussex Hospital, were old and in a poor state of repair. Many of the wards did not have sufficient storage, space in utility rooms, or hand basins, making the control of infection difficult. The beds on several wards were much too close together, making it difficult to clean between them and seriously compromising the privacy of patients. Although there had been improvements generally in cleanliness and hygiene since the outbreak was declared, there were still some serious concerns. When we visited, we observed levels of contamination that were unacceptable, such as bedpans that had been washed but were still visibly contaminated with faeces."

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Bloody Beetroot

Inspector Gadget finds a suicide and the comments upset Wife of a Schizophrenic:

A man in his fifties has blown his own head off, and is spread out dead on the lawn. The shotgun is beside him. I take a sharp step back and place my boot in the vegetable patch next to the border. I sink up to my ankle in mud. Bloody Beetroot!

The victim’s wife isn’t too good. Sergeant Dan is with her. He comes out when he hears that I’ve arrived. “It’s OK Boss, it’s not sus” he says cheerfully.

“What do we think has happened here?” I ask, trying to sound inclusive. He tells me and I nod. “So there isn’t anyone outstanding then?” I ask. No. We both act like there isn’t a headless body at our feet.

But there is.

This is a suicide, and despite the Sergeant Dan’s assessment, all suicides are suspicious until declared otherwise by a Detective Inspector. At this time of the night we can wait an age for one of those.

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Dear Doctor

Militant Medical Nurse is really pissed off:

Dear Dr. Napoleonic Complex Hospital Consultant:


I am writing this letter to you because I think that you need to be made aware of a few issues. You are about to get your ass handed to you on a plate and I want you to know why. I hope that this letter will open your eyes. You do not spend any amount of time on hospital wards and are very unaware of what exactly is occurring.

Your lack of knowledge, your ignorance, your attitude problem in conjunction with an ego that is writing checks your body can't cash and a propensity to lash out with opinions that have no grounding in reality often makes you look like a wanker. I am writing this in the hopes that in the future it prevents you from the misfortune you had today of looking like a complete asshole in front of your patients.

Currently our hospital is short staffing the wards to the point that we have so few registered nurses that we are completely ineffective. You know this is true unless you are completely stupid.

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Abusing the NHS

We have missed Crippen here at Team Rant:

It is easy to forget that most patients with genuine illness are either old or very young, and none of them work. They prefer to come during normal working hours. It is only the pretentious, middle-class, focus-group attending, Rolex wearing, alfresco dining, BMW driving, foreign-holiday booking (“Do you know how much the safari is costing? Why should I have to pay for those Malarone tablets?”), BUPA subscribing, well-off “worried well” who demand the “right” to see a doctor in the evenings and at weekends. Sebastian is 27 and wants to “pop in” on Saturday afternoon to discuss the merits of regular PSA monitoring. His partner, Harriet, is with him and wants to know if intestinal yeast is a possible cause of her Irritable Bowel Syndrome.

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London Medicgirl gets on her soapbox

about GP-bashing:

I have a feeling the rest of the world (and I guess we do live in a instant gratification society) don’t really understand the concept of General Practice and illness.

If you are ill- needing medication and the like- go to your doctor… the fact that you are having to take time off work to do so shouldn’t be that much of an issue remember- because you’re ILL.
If it is out of hours, you have a choice- are you SO ILL you cannot wait until the morning? In which case, you need to go to A+E because otherwise you might die.
If it is some routine thing that you need to get done? I don’t know, like injections for your fun little holiday coming up? Well, you’re going on holiday so one can only presume you can afford to take a morning off. And if its a routine appointment for a long term illness? Well, again- this is presumably what sick days are for.
The one place that I can see that would actually benefit from decent out of hours GP service is in the countryside, where the GP is going to get to the patient faster than an ambulance in many cases; my mother would not be here to day were it not for our local GP schlepping out to give a very necessary injection of adrenaline one summer evening.

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Criminal Defence Services Direct

Life With Leukaemia has spotted this terrifying news story which we missed:

I am not kidding!

Although I am now developing a concern about the independence of the media regarding our government’s policies towards our socialised and wonderful health service, I notice this worrying report by a (perhaps courageous) BBC journalist on, or relegated to, the bottom of the BBC’s UK news webpage.

Apparently, from February next year in the UK, those arrested for “minor” offences, will no longer have the legal right to the physical presence of a lawyer or solicitor, but will instead be allowed to phone a “call-centre” run by a private company staffed by non-legally trained ex-police officers!

You’re worried by NHS Direct?

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The Ferret on MTAS

Tons this week from the Fancier on MTAS here, here, here, and here:

Just after the Tooke review has been released, hopes were high that the powers that be would be forced to change their incompetent ways; a reality check is often only just around the corner and it has come rather quicker than many expected.
The new Foundation Programme application form is available for all to see online and it contains the same white space questions that caused such uproar in MTAS 2007. These white space questions have been used to select for Foundation Programmes for several years and I have yet to find a trainee who thinks that they are not an utterly useless load of rubbish. Here they are:

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And finally:

Courtesy of Militant Medical Nurse:

Top ten reasons to become a nurse:

Pays better then fast food, though the hours aren't as good.
Fashionable shoes and sexy white uniforms.
Needles: "Tis better to give then receive"
Reassure your patients that all bleeding stops...eventually.
Expose yourself to rare, exciting and new diseases.
Interesting aromas.
Courteous and infallible doctors who always leave clear orders in perfectly legible handwriting.
Do enough charting to navigate around the world.
Celebrate all the holidays with your friends- at work.
Take comfort that most of your patients survive no matter what you do to them.

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

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

Our personal NHS

Dr Rant enjoyed this post over on Doctors Net.UK. It's the account of a doctor who describes his recent experiences on the receiving end of NHS maternity care. The author has kindly consented to us sharing it with you, and I am pleased to report that mother and baby continue to do well!

Two days ago my wife had a tiny baby born early at 33 weeks. Both mother and baby are doing well, but the whole episode was sudden and unexpected (no pun intended), stressful and emotional. My wife had high blood pressure during the pregnancy and attended her GP for a scheduled check, was referred to the hospital, admitted, told she had severe pre-eclampsia, transferred due to lack of neonatal cots, sectioned and delivered of a 3lb, 5oz healthy but tiny little boy.

During this time, while feeling like a bystander to the medical action, I was struck by two thoughts.

One was how much I was in awe of how my wife was coping with all of this. I think if they had said they needed to cut off a leg to help deliver a healthy baby, she would just have asked which leg they wanted.

The second thought was how great the care she was getting was. She was 100% under NHS care, and we have both been totally impressed by the personal care, compassion and support given by all the staff, from the obstetrician to the tea lady. Even the car park security guy turned a blind eye to an expired ticket or two.

We received a very personal NHS, but it was obvious how busy and pressured staff were. The wards were full, with alarms and phones and other noises constantly ringing and staff running from one to the next. They seemed to be completing reams of paperwork at the bedside and also at their stations. It is also obvious there were too few trained staff, or indeed staff of any sort on some wards. Despite all of that, even I as the father who gets in the way a lot have not felt that anyone wanted me to get lost (even though they possibly did).

Perhaps the most difficult part of the episode was the day after admission when the staff told my wife and I she needed to be transferred because their neonatal ward was now full. We had become comfortable with the ward and staff and a transfer was potentially quite distressing, not to mention inconvenient knowing the baby would be in hospital for quite a while and my wife would shortly be off the road for 6 weeks. The staff told us this was a constant problem in the south east and the list of possible transfers covered a radius of well over 100 miles. A couple of the hospitals, we were told, never had any beds, and the online systems were always out of date, so the telephone was the only was of chasing beds. As it turned out, we were transferred from a tertiary centre to a DGH, but it has worked out well so far.

If Mr Brown wants all patients to receive a personal NHS, it is really quite simple. Give staff the time to offer personal care to all patients. Give the patients enough staff cover so they do not feel they are making annoying demands on stretched staff. Let people care for patients rather than complete reams of paperwork. Provide more neonatal beds so that anxious parents who have bonded with ward staff and learned to trust them are not moved at the time of peak anxiety and have to start all over again.

It is not about IT systems or patient charters or other political fluff. Doctors and nurses have always wanted, and known how to, give personal and individualised care. They just need the time, space and facilities to care for their patients, but the so-called reforms on recent years have made this so much harder and have had exactly the opposite effect to that now promised.

Request for an Inquiry into how the NHS dealt with the whistleblowing concerns on Ward 87 North Staffordshire NHS Trust in 1998

Dr Rant has received a copy of the following letter from Rita Pal to the Health Secretary:

FAO Alan Johnson

Dear Sirs,

RE: Substandard Healthcare on Ward 87 City General Hospital (North Staffordshire NHS Trust ) Stoke on Trent.

I refer to the Inquiries Act 2005.

Brief Summary

1. As the Department of Health is fully aware, I raised serious concerns regarding the substandard treatment of elderly people on Ward 87 North Staffordshire NHS Trust in November 1998. My concerns were as listed below and are summarised by Professor Bolsin's report available here.

2. My concerns were as follows

a) Lack of basic equipment such as drip sets
b) Lack of adequate support for junior doctors
c) Lack of basic care for patients
d) Repeated DNR notices
e) Gross shortage in staffing levels

These concerns were raised internally with no result at the time then externally which instigated the 2001 Creamer Report.

3. Despite documentation being sent to the Prime Minister and the Department of Health between 1999-2000, no action was taken to rectify these issues.

4. In April 2000, I raised these concerns in the Sunday Times 2nd April 2000. The issues were also raised through other media outlets.

5. In April 2000, the issues were also raised to the GMC. Professor Griffiths Director of Public Health ( working for the goverment) for the West Midlands intentionally misled the GMC at the time. As a civil servant, his study conducted on the same data was diametrically opposite to that of the two internal Trust reports ( 1999 and 2001). The GMC then wrongly questioned my mental health resulting in legal action which I initially won and the GMC settled. The details of this case is available here. I have never had a mental illness. The GMC had not been informed of the two internal reports verifying my concerns. The existence of these reports were known to Professor Griffiths but he opted to conceal them. A complaint to the GMC resulted in a 2 year investigation where the complaint was initially thrown out then reinstated. The result is available here. Professor Griffiths is criticised but the GMC took no action against him.

6. The two internal reports were listed in 1999 and 2001. The 2001 is available here and concluded that my concerns were well founded. These were disclosed to me in 2005 after a great deal of effort from me. The 2001 Executive Summary stated the following Amongst other things, it concluded that:
(a) “Patient care was clearly affected by the failures identified”;
(b) “The Directorate failed to take appropriate action when the allegations were made in a statement by Dr Pal”;
(c) “Although medical and nursing staff were concerned about the range of issues...no one voiced their concerns except Dr Pal which either demonstrated a general acceptance of the issues or staff felt unable to raise concerns”.

7. The GMC has consistently victimised me and details of this is available on request. The GMC is currently subject to a Judicial Review - our main argument being one of malicious intent to silence a whistleblower by repeatedly instigating vexatious complaints thereby affecting my livelihood which they have now done. The highlight of the GMC defence and the nub of their case in R Pal v GMC was " a typographical error made by me" and the fact that I read Stephen King books. Following on from that the recent case taken up by the GMC was of a "link" on a blog of a public document. Once judicial review papers were instigated against the GMC, the case was dropped and I was cleared. This though resulted in the loss of my job. This behaviour has been detailed in the submission to court by my solicitors. On each occasion, there has never been any concerns raised regarding my clinical work.

8. The issue has been raised at all forums - the results are as follows

a. Consultants responsible for Ward 87 and neglect of patients. Screened out by the GMC at Registrar's stage.
b. Complaint made to the NMC - no response despite follow ups for 2 years.
c. Complaint made to the Health Commission. No investigation done for four years. Referral apparently made by Labour MP Mark Fisher. The Health Commission could find no record. Mark Fisher has refused to respond to my emails. I believe the referral was never made by this Labour MP.
d. Health Ombudsman. She failed to read any of the documentation provided. She also failed to address the important issues in medical regulation and the risks to patient care in relation to doctors raising concerns. She refused to investigate the issues because no MP referred this case to her on time. In my view, there is a lax attitude to doctors who are whistleblowers. Tony Wright though did kindly make a referral to the Ombudsman. This decision is undergoing an internal review.
e. Despite a-d - no authority can stipulate what the death rate was on Ward 87 North Staffordshire NHS Trust. Infact, accurate death rate data was never kept. No wider data study was ever done. The Ward was shut in 2005 to avoid an investigation and inquiry and to ensure that no one else questioned these issues. I note that it is not compulsory to record the death rate of a ward or hospital.
f. The Coroner has been informed. He has stated that a whistleblower cannot report a death because he/she is not an interested part under the Coroner's Act.
g. I have no MP representation in the Midlands. This has been a continued problem. In addition, I have obtained all the evidence enclosed and it has taken me more than 8 years to do so. The Information Commissioner has been dealing with my requests over these years and will confirm that the documentation flow has been very slow. In (d) despite my efforts, the Ombudsman has in effect laid the blame at the whistleblowers door while no valid independent investigation has ever taken place by the Health Commission and the Ombudsman to date. It is my contention that most of the documentation is extensive - so much so that the salient features are not grasped by them.
h. To date there has been no broader data study on the impact of an severely under-resourced hospital on patient care. Only a minor handful of patients (1 weeks worth) has been considered with damning results. It is almost impossible for any doctor to obtain wider data yet this is expected by the authorities. All authorities have left the accountability issues on the shoulder of the whistleblower while failing to take any responsibility for investigating the serious issues of patient neglect.
i. The GMC, Department of Health and the Trust have all denied me a full copy of the 2001 report. The Information Commissioner recently ruled against the Trust in question for non compliance under the Data Protection Act.

There is therefore a catastrophic failure in the current system that cannot address justified concerns raised by a whistleblower ( without in effect shooting the messenger) thereby placing patients at risk. The vendetta developed by the General Medical Council is an example of the overall culture described by Professor Steve Bolsin within his report. The lax attitude of the authorities has in effect resulted in a assassination of my medical career. This was described by a number of whistleblowers both in the Shipman and Bristol Inquiries. It is clear that nothing has changed. The above case is an example to show that the system cannot effectively address concerns at all. Moreover, the recommendations provided in the Bristol and Shipman inquiries are currently ineffective. This should be addressed urgently.

For the above reasons, I would like to request an public inquiry into how the NHS dealt with justified concerns raised by whistleblower to ensure lessons are learned for the future. Recommendations and changes should be implemented so that doctors feel it is safe to whistleblow. I have copied this to Mr Tony Wright who I hope will recommend a public inquiry into this issue that is in the public interest. If this is not done and the current situation not improved, no junior doctor can ever effectively raise concerns. This inevitably will place patients at considerable risk.

I hope to hear from you.

Regards

Dr Rita Pal

Dr Rant has seen how the NHS deals with whistleblowers over the years. It is cold, it is brutal, and it is almost always fatal to the whistlblower's career (and often their health).

Dr Rant recommends that everyone read the BMJ's Everything you always wanted to know about whistleblowing but were afraid to ask.

Psychobabbling delusion

The dust has settled since the scandal that was MTAS hit the headlines. One person who was highly involved in the MTAS process was Professor Fiona Patterson, of the notorious Work Psychology Partnership, and this BMJ piece neatly sums up just how misguided their selection process became. Several details concerning precisely how it was decided to appoint a group with no medical experience to run medical selection for the whole country are currently being withheld by the DoH, interestingly the DoH is also refusing to release documents detailing the real motives behind Modernising Medical Careers, funny that.

Anyway it seems Fiona Patterson has come out of hiding, she must have spent the money she earnt from MTAS a bit quicker that she had expected; she replied here to the BMJ piece, the only strange thing was that her original reply was amended after legal advice. Dr Rant is a firm believer in free speech, so we have decided to show the piece that was edited out:

"This is illustrated in Dr Nachev’s weak and potentially defamatory analysis(http://www.bmj.com/cgi/content/full/335/7620/615) with many factual inaccuracies."

was changed to:

"This response has been amended on legal advice."

Read into Prof Patterson's changes what you will, Dr Rant has his own opinion about Prof Patterson. Professor Patterson really should know better than to react in such an aggressive and unpleasant manner, when it is undeniable that she played such a large role in creating such a flawed selection process. It is true that Prof Patterson is not the only person who should take the blame, however she should take the blame for her part of the MTAS shambles. The DoH were the main felons, as Tooke pointed out:

"The companies tendering were not asked to deliver the selection methodology for doctors in‘transition’ via ST2, ST3, ST4, nor for FTSTAs."

However this still doesn't take away from the fact that Patterson's methods were and are still crap. The selection process that she has masterminded has been used to abuse Foundation doctors for years, and was clearly not up to the task. The selection process of MTAS 2007 which included the psychometric mumbojumbo questions was not fit for selecting goldfish, let alone highly skilled junior doctors.

Patterson should never darken the doors of medical selection again, and she would have done better to have apologised for her negligent part in MTAS, rather than to waffle on and on in arrogant self justification. Psychologists like Patterson are responsible for a lot of idiocy in the world today, they value pseudoscience over good old fashioned common sense, unfortunately Dr Rant fears we will be hearing more from Prof Patterson in the not too distant future; do not fear though, Dr Rant is on standby to give her a vigorous fisking.

Dr Rant has just learnt that the infamous white space questions of MTAS are to be regurgitated for the selection of Foundations trainees this year, this comes just after the Tooke review had given doctors hope that things may about to be changing for the better. There is clearly no room for complacency, the same morons are in charge and unless these incompetents are forced to account for their negligent actions of last year, then the Tooke recommendations will be nothing but more hot air; it is imperative that incompetent organisations that have been found wanting like the Department of Health are properly cleared out, so that the salient lessons can be learnt and more needless mistakes avoided.

Just how corrupt is our government?

The scandal of 90 deaths in Kent from poor infection control policies is a surprise only to anyone who has not been in an NHS hospital in the years since the NuLabour target-obsessed junta came to power.

Mr Johnson said he was shocked by the findings, but denied accusations the problems were caused by staff being put under pressures to meet government A and E targets.

Scapegoat the local managers, Alan. Great plan.

Central Control Local Responsibility

The reality is that even good managers are unable to function in the world war I trench warfare that is NHS management today. I know lots of good managers, yet they achieve nothing. Many burn out, many leave in disgust and frustration. Some stay on trying to do something good in a fucked up world.

Institutional Corruption

I also know lots of bad managers - either incompetent or evil. But the real target of our loathing should be the lying cunts in government who have institutionally corrupted the NHS.

• Targets to please voters.


• Outsource cleaning to cheapo private companies that pay 17 year olds £3.50 an hour to sit around chatting.


• Fire anyone who doesn't give you the answer you want.


• Cut bed numbers to save money.


• Cut nurse:patient ratios to save money.


• More and more and more and more paperwork to produce lying statistics to please voters.


• Force hospitals to jam patients too close together.


• Force hospitals to move patients around constantly in a constant battle to cope.


• Shunt all the money into Big Business to keep shareholders happy (GB is shunting this to 'local' level - does that mean he realises what a rip off this is, or is he simply moving the blame locally?)

It's the Bed Occupancy, Stupid

Infection levels are directly linked to one major factor: Bed Occupancy Levels.

Hospitals in the NHS are running at 90%+ average bed occupancy. This is very efficient. It is also very deadly. Infection rates shoot up when bums on seats climbs over 70% average bed occupancy.

Another victory for Management Cuntsultants.

The BritMeds 2007 (40)

Welcome to the Dr Rant BritMeds. The Dr Rant team will be hosting the BritMeds on behalf of Dr Crippen during his summer recess [It's October! Is John ever coming back? - Ed], so please send all of your BritMed suggestions to BritMeds@DrRant.net.

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Rant: losing it

The Devil is not referring to the BritMeds tardy Tuesday publication of late but:

Generally, I enjoy Team Rant,