The National Health Service Constitution. Part 3

Let's stuff their ears with Bullshit!

NHS Constitutions

The NHS will strive always to provide vaccination and screening programmes as recommended by the appropriate national advisory bodies. (pledge) (on the cheap. Anyone for Gardasil? Oh, it's the NHS so no. Genital warts all round!)


Respect, consent and confidentiality:

You have the right to be treated with dignity and respect. (unless you are old. Do behave now Auntie Annie. The dignity nurse and the modern matron are coming to see you!)

You have the right to accept or refuse treatment that is offered to you, and not to be given any physical examination or treatment unless you have given valid consent. If you do not have the capacity to do so, consent must be obtained from a person legally able to act on your behalf, or the treatment must be in your best interests. (However, if you bring in yet another Daily Mail article about simvastatin, your GP has the right to lose the will to live.)

You have the right to be given information about your proposed treatment in advance, including any significant risks and any alternative treatments which may be available, and the risks involved in doing nothing. (motherhood and apple pie)

You have the right to privacy and confidentiality. (but we aren’t keen on you opting out of our oh so safe and secure data spine. After all the rest of your data is oh so safe in government hands. It's a surprise to us even where we have left it. And isn't it strange how it's never there if you need it?)

You have the right to access your own health records. These will always be used to manage your treatment in your best interests. (assuming they are available, or legible, or useful, or accurate)

The NHS will strive to share with you any letters sent between clinicians about your care. (pledge) (They don’t even manage to share letters amongst clinicians yet!)


Informed choice:

You have the right to choose your GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse, in which case you will be informed of those reasons. (In the real world, like any other business, GPs would have some right not to be chosen, but this is the NHS after all)

You have the right to express a preference for using a particular doctor within your GP practice, and for the practice to try to comply. (However, feel to free to have a hissy-fit at the receptionists if Dr Nice has the temerity to go on holiday with his family and can't see your verruca in the next 50 seconds).

You have the right to make choices about your NHS care. The options available to you will develop over time and depend on your individual needs. Details are set out in the Handbook to the NHS Constitution. (We will tell you what choices you have, and you can't choose not to choose choice.)

The NHS will strive to inform you about what healthcare services are available to you, locally and nationally. (pledge) (Yes in glossy brochures and patronising leaflets)

The NHS will strive to offer you easily accessible information to enable you to participate fully in your own healthcare decisions and to support you in making choices. This will include information on the quality of clinical services where there is robust and accurate information available. (pledge) (But we’re not too sure about this so we fluffed the first attempt we made at this as MD described in Private Eye (No 1218 page 12 on mortality rates after abdominal aortic aneurysm repair recently)


Involvement in your healthcare and in the NHS:

You have the right to be involved in discussions and decisions about your healthcare, and to be given information to enable you to do this. (fair enough)

You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. (not that we’ll listen to anything anyone says, and we’ve got our own agenda we’re busy implementing thank you. It’s all for your own good you know, but if any doctor tries such paternalistic nonsense on you can get him struck off)

The NHS will strive to provide you with the information you need to participate effectively to influence the planning and delivery of NHS services. (pipe dream)

The NHS will strive to work in partnership with you, your family and carers. (pledge) (Paediatricians will not even contemplate the “benign parentectomy” operation in future.)

[The final part of our NHS constitution will follow soon- Ed]

Why can't I see the fucking stock market at the weekend?

It's 4.31pm Piers: Fuck the Proles - Time for a Flaming Ferrari!

Dr Rant is a hard working person with an important job. So why is it that I have to take time off during my busy week to watch the banks lose all of their share value?

Does the market not have any idea how important my time is? What - exactly - are those red-braces beclothed bastards doing all weekend? I know they used to sit and count all the money they had made, but times have changed and I think that the City needs to change too.

I want to watch the world burn at a time that suits me, not just 9 to 5 on weekdays.

I'm sitting here bored fuckless waiting for the markets to open on Monday morning and the carnage to start again. By which time I'll be seeing patients, which is no fucking use to me.

I mean, it's not as if I'm going to be spending lots of free time in a happy retirement any time soon, is it?

I suppose I'll just have to pop down to my local polyclinic to see some random doctor nurse* about some minor problem to pass the time.

At least the NHS is still a capitalist bastard organisation. The so-called free market could learn a thing or two from Lord Khazi, I can tell you.

Thank fuck for markets in other time zones, otherwise I'd probably have ended up spending quality time with my spouse and children and I wouldn't be the divorced, alcoholic, bitter, sad bastard that a life spent in general practice has made me.

[*Edited for metropolitan realism - Ed]

BMJ Stifling Free Speech?

We recently wrote about Prof Paice's deanery lying about the Scot Junior thing in the BMJ.

At least one rapid response had been posted to the BMJ website before our first post about this, and the Forum Moderators on DNUK have now confirmed that there was no request by Paice or the London Deanery to have Scot Junior's comments about Dame Carol Shit taken down.

So why does the BMJ still have the false version on its website and the (also false) comment:

There are currently no responses to this article

Freedom of speech?

I think not. Remember how the mainstream media wouldn't print stories about Scot Junior. At least one MSM reporter told bloggers (including Dr Rant) that there was editorial pressure not to print the story.

Dr Rant knows from past personal experience that New Labour lawyers will use tactical nuclear weapons if they feel they need to to suppress a story like this that they don't like from reaching the MSM.

We remember how little coverage there was in the MSM (C4 news aside) about the doctors march re: MTAS last year.

We know the BMA spent their own members' money to argue for the government and against their own members in court re: MTAS last year.

Democracy?

I don't think so.

Every cloud....

It struck me today, as I watched my retirement turn into my 'work until I am physically unable to fucking move from old age because I now have no penion'-ment, that the Dr Rant comments section has been strangely quiet recently.

One of the things that Dr Rant started out to do was to rail against the pseudoreligeous cultist Free Market Nutjobs who were running around telling everyone that the reason the NHS was shit was not the chronic underfunding and constant revolving political reforms but the lack of a Free Market.

As a result we have had various neo liberal narcissists sitting on the site posting their bullshit since we first set up the blog.

Just give us our money and we'll pay for our health care....

Just let the market work by itself free from interference and we will get better health care....

The NHS is the last bastion of the failed socialist experiment....

Well where the fuck are they now?

Their all running around pissing their pants at the total fucking ballsup that their cult has created.

It turns out the last great bastion of socialism and nationalisation is the British Banking sector. Perhaps everyone just being a selfish bastard who is out for themselves in an unregulated market wasn't the best way to run a civilization after all.

Ho. Fucking. Ho.

Still, at least all these high flying city types being unemployed will mean the whole 'I need to see my own personal GP at 4am even if it means that grannies, babies and all those other losers get a worse service and the NHS should provide it because I'm sooooo important' brigade are going to be hard to find.

Productivity

Is there an echo in here?

Despite the BBC being momentarily distracted by the (not entirely unpredictable) results of the banking system's combination of greed and fraud, that has been euphemistically described as 'exuberance', normal service has been predictably resumed today - GP Bashing!

Apparently, the Public Accounts Committee has declared that our 'productivity' has fallen despite a 'massive increase in pay'. How the fuck do you measure the productivity of an activity that 'produces' the infinitely subjective and unquantifiable concept of 'health'? Could this be yet another example of their obsession with measuring the immeasurable and trying to value the priceless?

Has life expectancy got worse? Are chronic diseases like asthma and diabetes now not better and less expensively managed than they were (thanks entirely to General Practices)?

The report even states:

"The cross-party group of MPs also said GP consultations had become longer as nurses had taken on extra responsibilities including asthma and diabetes reviews. This also meant family doctors were offering a wider range of services - in recent years they have started taking on care traditionally done in hospitals, such as minor surgery."

...completely scuppering the premise of the headline!

Neither does it address the fact that GPs were both overworked AND underpaid in the past, and some redress was long overdue. The toll that was being extracted on a stressed and ageing workforce's health, family life and finances was totally unsustainable, and the Primary Care system (the only world class bit of the NHS) was in real danger of collapse. 5 years down the line, the miracle of workforce planning means that a much greater proportion of GPs are approaching retirement or are actually women with families, many of whom won't do 'extra hours' at any price, and why the fuck should they? If you're ill enough to a see a GP, you've got 10 hours per day to get yourself organised and down the surgery.

Having said that, there are some GPs who are taking the piss and pocketing the money and not employing more partners or other doctors, and their patients are struggling to get appropriate access during the existing hours, but why spread those hours around? The minority are causing the rest of us a BBC sized pain in the arse.

So where are we now? I earn less than the supposed average, and work longer hours than those quoted in that report. My patients are healthier despite being older and more of them can appropriately manage self-limiting trivial illness without coming to see me because of the time I've invested addressing their 'ideas, concern and expectations'. I offer fewer, but longer appointments and actively look to stop people getting ill in the first place. Importantly, fewer of my punters have to go to the (expensive, inefficient and MRSA ridden) hospital now because I sort them out in my surgery.

I still earn less than a 'Banker's Bonus', less than my dentist (who works fewer hours than me) and less than my MP once 'expenses' are taken into account (they've sneakily taken mine into account in their report). I rarely eat my lunch in peace, play golf once a year and see my kids awake twice a week.

If you pay peanuts, you will get monkeys.

If productivity for MPs can be measured by standing aroung talking bollocks for a whole thirty-odd weeks per year, or by the amount of meaningless bullshit paper reports produced by committees, then we can be prodigiously proud of ours.........

The National Health Service Constitution. Part 2

My Yers are bleeding listening to this shite!

NHS Constitutions

Patients and the public – your rights and NHS pledges to you:

Everyone who is entitled to use the NHS should understand what legal rights they have. For this reason, important rights are summarised in this Constitution and explained in more detail in the Handbook to the NHS Constitution, which also explains what you can do if you think you have not received what is rightfully yours. This summary does not alter the content of your legal rights. This Constitution also contains pledges – those things the NHS strives to do above and beyond its legal requirements.


Access to health services:

You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.

You have the right to access local NHS services. You will not be refused access on unreasonable grounds. (But if we have closed your local service that’s entirely reasonable)

You have the right to expect your local NHS to assess the health requirements of the local community and to put in place the services to meet those needs as considered necessary.(Still waiting for the punch-line on that joke).

You have the right to seek treatment elsewhere in Europe if you are entitled to NHS treatment but you face undue delay in receiving that treatment. (We won’t get NHS right any more. Actually you may do better in Europe.)

You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, religion, sexual orientation, disability (including learning disability or mental illness). (No we’ll give an equally bad service to all, with equally dire results)

The NHS will strive to provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution. (pledge) (but we'll 'hide' convenient services from you if the waiting list hits 12 weeks)

The NHS will strive to make decisions in a clear and transparent way, so that patients and the public can understand how services are planned and delivered. (pledge) (Jesus wept! What fucking planet are we on?)

The NHS will strive to make the transition as smooth as possible when you are referred between services, and to include you in relevant discussions. (pledge) (Actually, we will introduce as many dangerous 'interfaces of care' as possible to increase the probability that bureaucracy or overshite will conspire to bugger things up)

Quality of care and environment:

You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation. (unless the they're too busy doing paperwork)

You have the right to expect NHS organisations to monitor, and make efforts to improve the quality of healthcare they provide, taking account of the applicable standards.¹ (expecting and experiencing are subtly different)

The NHS will strive to ensure that services are provided in a clean and safe environment (But you won’t mind some C difficile or MRSA amongst friends will you?) that is fit for purpose, (yes, ever more luxurious meeting suites for those all important meetings) based on national best practice. (pledge)

The NHS will strive for continuous improvement in the quality of services you receive, identifying and sharing best practice in quality of care and treatments. (just as it does at present. Time for the Porcine Aviation Committee to reassemble) (pledge)

Nationally approved treatments, drugs and programmes:

You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you. (But if we can persuade him or her to just not mention it even better)

You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you. (but don't expect them to change their minds unless you're in a marginal constituency near an election)

1 The current standards are set out in the Handbook to the NHS Constitution.

2 NICE (the National Institute for Health and Clinical Excellence) is an independent NHS organisation producing guidance on drugs and treatments. ‘Recommended’ means recommended by a NICE technology appraisal. Primary Care Trusts are normally obliged to fund NICE technology appraisals from a date no later than three months from the publication of the appraisal.

Thoughts on Sir Ian Blair’s Departure

Politician does the right thing shock!

Image from Beau Bo D'Or

The ousting of Sir Ian Blair this week is a sign of the end times of this ever more discredited Labour government. Sir Ian was a classic new Labour appointment- good on paper, said all the right things, but not able to do the job.

Now in the NHS we too have a lot of over-promoted twaterati who can talk the talk, but who would run from any real medicine as quickly as they could. Dr Rant wonders how many of them are lined up for the chop when the new Government emerges when we voters avenge ourselves on Brown’s awful government.

Image from Beau Bo D'Or

This Labour government has made many awful appointments, in the NHS and elsewhere. Seeing Sir Ian Blair go raises Dr Rant’s hopes that some useless, unfit for purpose medical leaders will follow him out of the door.

London Deanery: lying cunting bastards

Image courtesy of Dr Wayne

From the BMJ:

A spokesperson from the London Deanery said that when Professor Elisabeth Paice, head of the London deanery, became aware of the inappropriate material posted on the website doctors.net.uk, she acted in accordance with standards set out by the General Medical Council, Good Medical Practice Guidelines.

No she fucking did not. How many fucking times do you have to be told that she acted AGAINST GMC advice.

Dame Carol Black IS a shit. She IS NOT a colleague of Dr Junior. There is NO GMC breach of good medical practice by Dr Scot Junior.

The unprofessional bastards that should be struck off are Dame Carol Black, Elizabeth Paice and Gillian Needham.

Fucking lying cunting bastards. They just lie and lie and lie and lie. And they fucking run the GMC, and the BMA, and the Royal Colleges. Cabal of fucking cunting bastards. Is there a name for that? A gaggle of geese but a cuntion of lying fucking power-hungry medicopolitical bastards?

“Professor Paice alerted the web managers to the nature of the material and they removed the offensive elements of the posting. They also reminded their members that postings should not contain offensive, inflammatory or potentially libellous content. Professor Paice then notified the relevant Scottish Deanery, as the junior doctor was working in Scotland.

How many fucking lies can you fit in one fucking paragraph? Is this a plot to make Dr Rant's fucking head explode? Are you trying to see how fucking fast I can type?

LIES! LIES! LIES! Where is my fucking gun?

Here is a much more moderate rapid response posted by a doctor on DNUK:

I am not sure that this statement on behalf of Professor Paice is factually correct.

I have a close association with the Doctors.net.uk web site being one of their voluntary forum moderators. It is my understanding that the offensive post was removed at the request of the poster within a few hours of it appearing. I also understand that the suspension preceeded the website being contacted.

I would be grateful if the BMJ could look into this to ensure that the facts are being correctly reported.

Yeah, I'd be grateful too. You useless, arselicking bunch of useless fascist bastards.

A 'spokesperson' from the London Deanery, yesterday

Wow, those politicians are soo big and strong.

England CMO Sir Liam Donaldson proving that big tough guys get all the chicks

During the whole Scot Junior clusterfuckathon, dozens of doctors signed letters to the Scottish Chief Medical Officer and the Scottish Health Secretary.

Let's see what the two most important medical politicians in Scotland made of the gross abuse of power, silencing of free speech, abuse by a state employer:

Thank your for the letter.

Dr Burns understands that the suspension was a decision taken by NHS Highland no the Postgraduate Dean.

And after a preliminary investigation the Dr's suspension was terminated on the 16th September and he returned to work.

I'm speechless. What insight. What wisdom. What a crock of total fucking cack. I'd use a lot of other adjectives but frankly, having read that letter, I'm too fucking stupefied. Which I think was the whole point.

Politicians have spent the last twenty years researching the art of how to communicate constantly with everyone without ever saying anything about anything to anyone. I see the MSM have finally twigged that the entire NHS complaints system is just a huge scam to wear people down until they die or give up.

Ok, so the CMO is a cunt. What about the Scottish Nationalist Party. Not long in power, a minority government, keen to show that they are not just the same old shits with a different colour of tie:

Thank you for your letter to Nicola Sturgeon, Cabinet Secretary for Health and Wellbeing about the suspension of a junior doctor employed by NHS Highland. As as employment issue this is a matter wholly between the individual and their employer.

However, I understand the individual concerned was suspended by NHS Highland and is now back at work. The background to why the Junior Doctor was suspended is matter (sic) between the individual himself and his employer.

Wow. I'm in awe. Thanks Nicola. Abuse of power by state organsisations? Clearly a matter for David and Golliath to sort out between themselves. After Nicola makes sure David's sling has been confiscated. Wouldn't want an unfair fight now, would we?

Dr Rant is particularly interested that the SNP Scottish Secretary had no interest in a group of NuLabour fanatics ganging up on a junior doctor for an attack on a NuLabour figure.

And here I was thinking she was just ugly.

The National Health Service Constitution. Part 1

Nye would be very proud wouldn't he?

So the NHS is to gets its own constitution. What a wonderfully empowering thought that is, and Dr Rant welcomes this document with alacrity and considers it to be almost as good as the old 1991 Patient’s Charter. It’s still up for consultation, so we though we’d be helpful and offer some feedback (that the DoH mandarins will surely devour with glee) for as everyone knows, “Feedback is the breakfast of champions,” and Gordon Brown is such a prize champion isn’t he?

In this piece, the original DoH text is in bold type and our comments on it in italics. In recognition of the fact that most of our readers have shorter attention spans than a guest on the Jeremy Kyle show, we've broken it down into bite-size, easily digestible chunks of goodness............

"The NHS belongs to the people. (Apart from those bits we have sold off under PFI, or to property developers. The fact your grand mother gave money to buy the land originally is really not very relevant and modern now is it?)
It is there to improve our health, (but sadly we don’t have a good definition of health to use) supporting us to keep mentally (ah yes another successful escapee from care in the community has probably written this) and physically well, (unless you are staff in which case we won’t even send flowers to your funeral) to get better when we are ill (unless you want an expensive drug for cancer, or ARMD) and, when we cannot fully recover, to stay as well as we can. It works at the limits of (economic) science-bringing the highest levels of human knowledge and skill to save lives and improve health. (Well it should do this….but it doesn’t) It touches our lives at times of basic human need, when care and compassion are what matter most. (True, but they are a bit expensive to provide aren’t they?)

The NHS is founded on a common set of principles, values and commitments that bind together the people who it serves – patients and public – and the staff who work for it. (Yes we’re all one big happy family of shiny happy people aren’t we? And I do so much hope the managers are still enjoying the away day to Mars. Now there’s a work at the limits of science. How many tons of bureaucratium can a rocket lift?))

This Constitution establishes the principles and values of the NHS in England. It sets out commitments to patients, public and staff in the form of rights to which they are entitled and pledges which the NHS will strive (but fail) to deliver, together with responsibilities which the public, patients and staff owe to each other to ensure that the NHS operates fairly and effectively. All NHS bodies and private and third sector providers supplying NHS services will be required by law to take account of this Constitution in their decisions and actions. (but it’s not legally enforceable, and actually there are enough fudge factors that we haven’t left any hostages to the legal eagles)
The Constitution will be renewed every ten years, with the involvement of (carefully hand picked) patients, public and staff. It will be accompanied by the Handbook to the NHS Constitution, to be renewed every three years, setting out current guidance on the rights, pledges, duties and responsibilities established by the Constitution. These requirements for renewal will be legally binding. They will guarantee that the principles and values which underpin the NHS are subject to regular review and recommitment; and that any government which seeks to alter the principles or values of the NHS, or the rights, pledges, duties and responsibilities set out in this Constitution, will have to engage in a full and transparent debate (just like Labour have done the last 11 years) with the public, patients and staff. (Oh yes it’s a difficult issue so better call for a “ National Debate” But make sure you know the answer first)

Principles that guide the NHS:

Seven key principles guide the NHS in all it does. They are underpinned by core NHS values which have been derived from extensive discussions with staff, patients and the public. These values are set out at the back of this document.

1. The NHS provides a comprehensive service, available to all irrespective of gender, race, disability, (unless you need long term rehab in which you’re a social services case mate, not NHS) age, (unless you need long term nursing care) religion or sexual orientation. (It pays to prevent and kill babies, but not to make them!) It has a duty to each and every individual that it serves. (Unless it’s dental work, long term geriatric care, infertility treatment or NICE says we can’t afford it) At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population. (Ah yes, Glasgow East- Labour’s little secret- Government spending doesn’t work)

2. Access to NHS services is based on clinical need, not an individual’s ability to pay. (Unless it’s the local IVF service) NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

3. The NHS aspires to high standards of excellence and professionalism – in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population. (Sadly aspirations are no guarantee of performance)

4. NHS services must reflect the needs and preferences of patients, their families and their carers. (Of course, which is why we close services and make people travel miles to the alternative. But that’s so much more patient centred isn’t it?) Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. (However we circumscribe what choices they can make, and if they vote Tory they deserve their local hospital closing down and a forty mile round trip to their nearest other one.)

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. (We squabble endlessly about the difference between social and health care, whilst the bed blocker rots in bed 5) The NHS is an integrated system of organisations (which just don’t talk to each other) and services bound together by the principles, values and commitments now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and wellbeing. (Of management consultants)

6. The NHS is committed to providing best value for taxpayers’ money (of course, as exemplified by PFI and NPunFIT for anything) and the most effective and fair use of finite resources. (Like keeping hospitals open in Labour constituencies) Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves. (That'll be big business, consultancy firms, PFI companies, and ex-Ministers like Warner and Hewitt then?)

7. The NHS is accountable to the public, (How? Through a lap dog backbench MP?) communities (How? By closing down community health councils? By local democracy? Or not at all?) and patients (well if they moan enough, or sue for negligence) that it serves. The NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. (Central credit and local blame works so well) The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to public, patients and staff. (It is. The minister is always right, and the doctors and nurses are just whinging malcontents) The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose. (It will be self revalidating and force doctors into ever more agonies of expiation) In addition, all NHS organisations will give patients and the public the opportunity to influence and scrutinise their performance and priorities; and patients, public and staff will be involved in relevant decisions about the NHS which affect them, either directly or through their representatives. (Provided we have vetted them properly first. We don’t want the hoi polloi entering now do we? Or even some of those oiks who can’t distinguish their mushy peas from the guacamole can we?)"

[Join Britain's most popular borderline personality disordered medical blogger for part 2 of the NHS constitution deconstruction soon - Ed]