The Darzi Report

An Empire building robotics expert who hate 'Doctors', yesterday.

We resisted an immediate reaction to the Darzi report. (Actually we were all busy elsewhere, or just too lazy.)

But the national press have been active on the issue and the overall impression is quite funny.

We have a Stalinist government, run in a highly centralised and paranoid way. (By the way yes we are all out to get you out!) Private Eye’s caricature “From the Desk of the Supreme Leader” captures Brown beautifully. Then we get the fun of the Broons, reborn to scunner Broon and his depleted and deserting army.

The Russian Empire was brought down ultimately by the unsustainable farce/tragedy of trying to maintain an illusion. Eventually empty supermarket shelves spoke louder than “Tractor production quotas achieved” and all the efforts of Comrade Stakanovich. As Robert Conquest puts it, (The Dragons of Expectation: Reality and delusion in the course of history p47, Penguin edition)

“The crux is less intelligence than a failure to confront that intelligence with reality-and even a drive to use that intelligence to deny or pervert reality.”

We seem to be getting the same sort of reaction to Darzi. Firstly medical leaders haven’t flown off the handle at it, and have commented, “it’s good in parts” Even Remedy UK have found something to welcome with the repairs to the MMC/MTAs system that has failed so badly (that's state central planning in action for you).

Something much more subtle seems to be happening. The report has been greeted quietly, and the responses seem to vary from “another government report” to “might be good, if ever implemented.” However some most welcome, splendid ridicule is emerging:

Oliver Pritchett does an excellent demolition job on the notion of patient choice in the Telegraph.

Brendan O’Neill at Spiked lays into the illusion of choice New Labour offers. (well nothing new Labour has said is real is real is it?)

Simon Hoggart has a fit of the visions, and sees jargon from top to bottom.


The Public no longer trust the government on NHS reforms. The Telegraph suggests that the NHS might be right for retirement. A bit early perhaps, but it’s an old system, and not up with modern ways.

Harriet Sergeant weighs in the Mail today. The NHS will end not with a bang, but with a door being closed quietly on the last bureaucrats meeting as the agreement to close the last bed in the last hospital is reached. This develops her previous authoritative report “Managing not to manage” for CPS.

Dr Crippen finds the report “offensively inoffensive”

Daniel Finkelstein in the Times finds the whole report to be a dangerous document, because it has nothing to say about reality. It promises much, but it’s unlikely it can deliver anything. Under performing and over promising is a desperate political strategy, rather than any way to run a business or organisation.

Somewhere behind the vision is a realm of fog, where the way forward is entirely unclear. And there is no honesty about this unclarity. The word “Rationing” looms up in the mist, and present fears are less than horrible imaginings such as top up fees. Karol Sikora may be the man to insist we find a way through it.

Meanwhile the ever awful Ben Bradshaw pops up to insult GPs, and accuse us of “gentleman’s agreements” between practices, and other shenanigans. Ben Bradshaw is rapidly becoming as loathsome as Patsy Hewitt remains. About the only thing we don’t hold against him is his homosexuality. He’s plainly lost his connection with reality as this quote shows. On the subject of the National Programme for IT, a scheme dogged by cost overruns, failing public confidence, delays, and doubts over its benefit to patients[6][7], he commented:

"Our use of computer technology in the NHS is becoming the envy of the world. It is saving lives, saving time and saving money. If you talk to health and IT experts anywhere in the world they point to Britain as example of computer technology being used successfully to improve health services to the public."[8]Credo est, quia absurdum.

This government has two years left before we can boot them into touch. They have had to U-turn on many policies recently. Let’s hope we can stop them doing too much damage to the NHS before they go.

Next to no GPs, except the now discredited David Colin-Thome, will support Labour at the next election. Any Labour MP wanting to visit the Ranting House Surgery will be persona non grata.

New Labour are currently ridiculous. History repeats itself, first as tragedy, then as farce. In this government’s case we are suffering a tragedy, and their efforts to sort it are farcical.

The NHS at 60: It’s great…BUT

It’s the 60th anniversary of the great institution we both love to love and love to hate. Dr Rant couldn’t resist a birthday card to the dear old NHS. So here it is:

The NHS is great because it provides care free at the point of need, to the whole population of the country. All health systems have to be paid for somehow, and paying tax is as good or bad as paying an insurance premium.

The NHS is great because it takes monetary considerations away from the immediacy of the doctor-patient consultation…but this is bad as it simply makes rationing covert.

But once we have stated the good in the NHS we need to acknowledge the significant downsides of the NHS.



1. The NHS is such a good system that no other advanced industrial economy has one.

In the old days we were taught to see the irony in “They’re all out of step except my little Johnnie!” It seems we have a blind spot about the merits of American and European systems. Must be the great education we all get under Commissar Balls-Up.


2. The NHS has no co-payments. It just prefers people to die!


3. The NHS results in terms of successful treatment of serious illnesses are less good than those of our European neighbours.
Somehow our system isn’t getting the sickest patients the best treatment. Somehow the Europeans and Americans have got things better organised than we have. We still have much mortality amenable to healthcare.


4. Despite the NHS, health inequalities in the UK are worse than in past generations.

This is not a failing of the NHS itself- Medical treatment only patches up the casualties of the battle, it doesn’t stop the battle going on. In this battle health is more or less an outcome of education and wealth, and ill health a consequence of poor education, poor housing, and lack of money. The failure of Government policies to do anything about this is well illustrated by the health statistics from Glasgow East. The role of the NHS in keeping unemployment down by classifying everyone as incapacitated is also well shown there.


5. The NHS treats everyone…eventually

The NHS works as a sausage machine production line. We treat everyone, but the service to patients is far from great. Consultations are rushed, and we regularly order tests to get people out of the door. The NHS is becoming ever more efficient at throughput measurement, but is steadily destroying the therapeutic alliance (a relationship of respect, listening and trust going both ways) between doctor and patient. The NHS prattles a good deal about “ patient centeredness” but this is simply becoming a term of rampant consumerism. “ I pay my taxes, and you Dr are my servant and must do what I say” Most of the people who praise patient centeredness see very few patients. We see the idiocy that those people, who can actually do the work and see patients, are accused of not being patient centred…by twaterati who will do anything else other than see patients!


6. Access and convenience

These are far from great. People like NIKU would have you believe that doctors make patients wait for the fun of it. Actually we don’t. We’d actually prefer to run to time. When doctors are running late it’s actually not because we are having a cosy chat with our favourite nurse over coffee whilst leaving 40 patients fuming in the waiting room. The NHS has never been run to the convenience of doctors.

Doctors in primary and secondary care are usually attempting to do too many things too quickly, as routine. Then extras are added in.

And the NHS superstructure is so efficient that getting patient, doctor, notes, and results together in one place is far from guaranteed. So more delays, and more waiting, and time wasting for both doctor and patient. Fortunately most patients are tolerant…and sometimes I have been grateful to patients for reducing my frustration. They have maybe done more for me than I can for them some days.

And patients often want and need more than the allotted time. So we overrun, and get delayed, and so frustrated. Forgive us that we get rushed, frustrated, fed up, and sometimes this shows. We sometimes use arrogance to shut people up. It’s not actually that we are uncaring. It’s that we are using our defence mechanisms to prevent ourselves from being overwhelmed. Ultimately there are more symptoms in the world than we can ever hope to properly deal with.

The NHS arrangements for bringing doctors and patients together are time poor, awkward and militate against good medicine. They prevent the development of relationships, and of mutual understanding and learning between doctor and patient. The fact doctors still get on well with most patients despite the handicaps the NHS generates is a tribute to resilience and good sense of doctors and patients.

Even so the obvious problems here are:

• Poor communication
• Poor understanding
• Poor compliance or concordance with treatment plans
• Risk of complaints and litigation over “failure to explain risks fully”
• Excessive testing
• Loss of follow up
• Patients not knowing whether they are coming or going
• Important results going unacted upon
• Collusion of anonymity- the buck is passed between several people but never actually stops anywhere.
• Much rushing, too little listening.

These can be observed any day in primary and secondary care settings. They cost the NHS a lot of money, and they show the system not making care of the patient its first concern.


Managers only care about throughput figures (18 week target etc) The Darzi report on raising quality may help a bit…but it still does not get into the basic clinic or surgery environment and look at what needs to improve to enable better doctor-patient communication. It’s sad, as improving this would significantly reduce the need for tests and investigations, whilst increasing patient satisfaction. But tests are cheap, and doctors are clearly obstructive, overpaid skivers as any fule such as Ben “Fotherington Thomas” Bradshaw kno.


7. Comprehensive coverage

The NHS provides great comprehensive coverage unless:-

• It’s a dental problem.
• It’s dementia: your needs are social and not medical you see, and be a good taxpayer and sell your house to fund your nursing home bill.
• Fertility- we’ll pay for contraception and abortion…but we don’t to create new babies.
• It’s a new cancer drug.
• You need rehab rather than curative treatments.
• You need adaptations to your house.
• You don’t want to wait.
• You have a mental health problem.
• You want a permanent and recognisable psychiatrist.

Yes the NHS is a very comprehensive service…that over time has comprehensively and covertly reclassified problems so that they are not medical any more but social…and so come out of a different budget.


8. High quality service

Except that:-

• It ignores foreign comparisons.
• It actively manages against its staff achieving this.
• It sets targets for quantity not quality, and refuses to admit that there is a trade off to be made here.
• The criteria for high quality are poorly defined.
• Pretends that “excellence comes as standard” which, as any fule (except Alan Johnson, Ed Balls, Darzi, Bradshaw and Donaldson) kno, is an oxymoron.
• Pretends that guideline implementation and measurement and compliance is an assurance of quality.
• Dreams that a computer (or nurse drone) could replace a thinking human being.
• Believes that rationing is merely a technical issue rather than a moral issue.
• NHS direct still exists (see below).
  

NHS Direct: A bit shit and not cheap

9 A cheaper pooled service

“The NHS used to be underfunded and inefficient. Now it is only one of these”

Nigel Hawkes' succinct summary captures this well.

The NHS is now expensive, ineffective and inefficient. It has squandered a fortune on a useless computer system, botched management reorganisations, increase internal transaction costs, management, and management consultants.

Yes the whole of the NHS funding increase has pretty well been wasted entirely. Gordon Brown had no idea what he was buying from the NHS and it shows.

Clinics and surgeries are in poor state, new builds are PFI or LIFT on the never, never and the barbarians of private profiteers are at the gate. The CBI is frothing at the mouth, and Sir Richard may drop by as well…as long as he only treats the young and healthy patients that is. He doesn’t want any of those old so and so with multiple problems- not worth the capitation fee you know. Not a viable business proposition to anyone.

So there we have it. We love our NHS but it is failing to deliver on:-

• Finance
• Cost control
• Clinical effectiveness
• Accessibility
• Computing and record keeping
• Quality
• Comprehensive coverage
• Relationship based care to patients
• Staff satisfaction

It is delivering on:-

• Corporate bullshit
• Redisorganisations
• Meaningless waffle
• Meaningless meetings
• Visions into vapour
• Squandering money
• Laying up future debts under PFI
• Paying more heed to management consultants than medical consultants
• Staff disengagement
• Bureaucratic processes
• Increasing negligence bills

Happy Sixtieth Birthday NHS!

Virgin on the Ridiculous

Bringing 'Spanish Practices' to General Practice

Thank the lord for the miracle of markets and free enterprise. Dr Crippen has beaten us to it again, but this one is too important not have a rant about.

Dr Rant has been alerted to Branson Pickle by whistle-blower John Spencer. Have a good look the website, and this bit in particular.

It is abundantly clear that Virgin Healthcare see ethics and legislation as a bit of an inconvenience, and they will circumvent these irritations in every way possible in pursuit of profit. They will also use clumsy and incompetent threats of legal action along the way to bully anyone who doesn't have several billions pounds worth of funding in their back pocket.

It would seem that the bearded one is an even fatter cat than us GPs are supposed to be. He'll be making a bit more than £250,000 per year and playing a whole lot of golf if his Virgin Healthcare shower of shite get their foot wedged in the door.

It is important that both patients and staff understand this:

Patients will be worse off because continuity and quality of care will fall.

The staff will be worse off because your contracts will be inferior and you will loose control over what you do and the clinical decisions you make.

The tax payer will be worse off because they will cream every penny they can out of this and IT WILL COST MORE.

Richard Branson and his daughter will be better off.

As a taxpaying doctor who also relies exclusively on the NHS to look after myself and my family, I'm pretty fucking pissed off off I can tell you.

Polyclinics? Oligoclinics more like!

Darvos Says: Exterminate 'That fantastic relationship between the GP and the patient'!

Has any one else noticed the distinct lack of mention of the fabled 'polyclincs' in Lord Darzi's report? We have. Back-tracking? Surely not!

Anyway, apologies for the distinct lack of action on here recently. That's the problem with the summer - the Dr Rant Team are either on holiday, or they're having to work twice as hard because half their colleagues are!

The fact that fewer people get ill in the summer, doesn't seem to translate into reduced demand for GP appointments or home visits. Funny that isn't it?

I'm bloody knackered. The Darzi report will have to wait.

Here's another photoshop to be getting on with.......

Lord Darz Vader

Desert Island Dick

Darzi: Lovely bunch of coconuts.

Dr Rant has just had the nauseating, but frustratingly gripping, experience of listening to this week's Desert Island Discs. This weeks 'castaway' was Lord Darsehole of Islington.

Once again, thanks must be extended to the BBC for making the situation so crystal clear. I think I've got this right;

A bloke who grew up in Baghdad with his Armenian family, moved to Dublin to study medicine where he met and married and Irish woman and trained to be a surgeon. After becoming ever more specialised as a surgeon, he ends up getting the gig to destroy the least shite bit of the NHS - General Practice in England.

Well that make perfect sense doesn't it?

Guess what he chose as his 'luxury'? Go on have a guess!

A PENCIL

Yes, that's right - a fucking pencil. What a guy!

If anyone has any suggestions for what Lord Darzi can do with his pencil, answers on a postcard to the usual address........

50 ways to kill your GP

Thanks to Crippen for pointing out an excellent US medical blog Covert Rationing.

There, Dr Rant was unsurprised to find a reference to a New Scientist article about research that revealed that between 1:50 'normal' patients and 1:20 sick patients have homicidal thoughts about their GP.

That's around 50 patients per average GP.

Ah, the joys of being at the front end of a shit system that does not want to treat people because it costs money....

You just can't get enough.....

Dr Rant has been putting himself about a bit. Britain's second most popular medical blogger ^TM is delighted to announce that he has joined the Remedy UK Magazine as a guest columnist.

Remedy UK is a truly extraordinary achievement considering it was conceived by junior doctors staring over the edge of the precipice of the abyss that Modernising Medical Careers was throwing their careers into. The fight continues, but now with a degree of slickness and professionalism that is truly staggering considering that they all have medical jobs and a fraction of the funding available to the BMA.

Dr Rant is proud to support them and play a small part in their endeavours.

Remember, it's free to join......

^{CLICK HERE for RUK magazine.}

Frank has gone missing........

This latest entry of Dr Rant was smuggled into Rant central offices by someone calling himself only ‘Mr Davis’. We have no idea where Frank currently is.

Property of HMP. Now wash your hands

Cuntslime. Utter, lying, vexatious cuntslime. That what Nu fucking Labour are. I don’t know where I am, save for the fact that two Nu Labour stormtroopers have thrown me into what looks rather like a cell. When I demanded to see my lawyer, they murmured something about a 41-day wait. So, here I am, dressed in Guantanamo orange, with an arsehole like a hula-hoop, having had a cavity search from someone with bigger hands than the local orthopaedic surgeon. And all I did was sign a petition.

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Property of HMP. Now wash your hands

So, the BMA have finally grown some balls. Tiny ones, almost like shrivelled-up sultanas, but testicles, never the less. They have organised a petition to campaign against polyclinics, a proposal by Lord Darsehole so monumentally fucking stupid that even capitalist groups such as the King’s fund recognise that they won’t work. The argument is astonishingly simple. With a finite amount of money available, and a limited number of trained GPs, if you build a large number of brand shiny new buildings, and fill them with GPs, then the GPs and the money are going to have to come from somewhere else.

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Property of HMP. Now wash your hands

So, unless the government suddenly finds a huge sum of money from somewhere (it ain’t going to be the national gold reserves, or Northern Rock), or finds a large number of foreign GPs willing to work for peanuts (maybe, but they’ve all pissed off following MTAS), then something is going to have to give. Yup, local GP surgeries will be shut, and the money used for polyclinics. So, with their newfound bollocks, the BMA organised a campaign : Support Your Surgery. This audacious campaign made the following wild and outrageous demands : Spend money on improving existing GP services rather than polyclinics, and to stop private companies taking over GP surgeries.

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Property of HMP. Now wash your hands

In just two weeks, the BMA collected well over a million signatures from patients. One in sixty people in the UK signed it, in only 14 days. One would have to assume that means that the public recognise polyclinics for the crock-of-shite that they are. And what happened when the BMA released the results of the petition? Well, the government moaned like a French whore taking it up the arse. Rent-a-gobshite Ben Bradshaw, of whom Dr Rant has written plenty about before, was wheeled up to come up with the typical Nu Labour spin that we are all sick to the back teeth of.

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Property of HMP. Now wash your hands

And that spin showed that Nu Labour are frightened. Bradshaw said that the BMA campaign was ‘misleading and mendacious in nature’, as he shat his Y-fronts. He told the BBC that he was disappointed that the BMA was ‘opposing investment and painting a distorted picture of what it would mean’ as his bladder dribbled piss down his leg. And he pointed out his concern over the ‘misleading and inaccurate statements’ that the BMA had made, as he quivered in the sort of terror that bullies get when they realise that the whole school playground is about to give them an utter fucking kicking.

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Property of HMP. Now wash your hands

And eventually, Gordon Brown, the clunk-jawed dictator was wheeled out, clearly annoyed that his plans to turn Britain into a police state had been disturbed by a million people writing to him. The corpulent Cyclops chortled his disapproval. ‘The issue is about increasing access to primary care, not replacing GPs’, he grunted. Right. So just where the fucking fuck are the polyclinic staff going to come from? ‘We want GPs to be open for longer hours and at weekends’ he demanded petulantly. Who does? Not 86% of the electorate, Gordo. ‘And if that is not possible, we want to provide other source of care’ he postured. Which is, dear reader, known as privatising the NHS.

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Property of HMP. Now wash your hands

The state-run media, know as the BBC (Bradshaw’s former employer) was happy to blast out that ‘Brown bashes GPs’ on the airwaves, in between announcing that some thick, ugly bloke had won the Apprentice. However, everyone who isn’t brainwashed realises that this shameless dribble of cuntphlegm is a transparent scheme for back-door privatisation. Even the Times newspaper realised just how utterly crap the scheme is. But will Nu Labour listen? Will they pay attention to over a million people, to a hundred thousand doctors and even the King’s fund? Of course not. In fact the only public body to support the existence of polyclinics was the NHS confederation, a body of NHS managers, whom if told by Gordon Brown ‘I am going to shit a massive steaming turd up your nostrils’ would reply ‘certainly Sir. Would you like to use my left one first?’

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Property of HMP. Now wash your hands

Nu Labour are out to wreck the country. They are out to privatise the NHS. They will ensure that large parts of the NHS are run by private companies. And this will be their retirement plan. Because you can bet that for every private company who runs part of the former national health service, there will be an ex Nu Labour minister on board. The current government are evil control freaks. They will take away your right to free health. They will call the most trusted profession in the country liars. They will take away your liberty. They will imprison you for 42 days without telling you why, while they tell the public that you are a terrorist. And all the time, they look for more groups to accuse of being such ‘terrorists’. And I would like to write more, but I really need a shit, and am running out of paper. So, lots of love, and yours truly,

Frank. x

Please tear here

Common Sense Centred Medicine

The Dr Rant Foundation is please to announce the imminent publication of its seminal report on guidance to the medical profession entitled:

'Common Sense Centered, Reality Based, Organ Grinder Delivered Medicine.'

This new doctrine is designed to supercede and consolidate the recent splurge of dogma driven Grandmaternal Egg-sucking guidance dictats from on high such as 'Evidence Based Medicine', 'Patient Centered Practice', 'Reflective Practice' 'The Duties of a Doctor' and 'Good Medical Practice'. Furthermore, it is anticipated that interested parties will be able to read it without becoming comatose through boredom or contemplate self harm half way through the second paragraph.

The authors note with dismay the tendency for these earlier attempts at guiding doctors to become subject to high-jacking by fundamentalists who seek to push their individual interpretation of the texts in a pseudoreligious manner. Specific concerns were raised about self-flagellating 'Reflective Practitioners' who seek constant criticism in their quest for enlightenment, and 'Evidence-Based Ayatollahs' who haven't yet worked out the difference between failing to prove that something does work, and having proof that it doesn't.

Potential readers can also rest assured that neither Sir Liam Donaldson nor Dame Carol Black have had anything whatsoever to do with its inception, and we can categorically deny that they were consulted at any point during the process leading to publication. The DRF hope that guidance created with reference to doctors who actually see patients will be sufficiently uncommon to prick the enthusiasm of our colleagues at large.

The lead Author Dr Francis X Rant, a common or garden variety type General Practitioner and social and golf secretary of the Rantingshire Division of the BMA, describes the overriding aim of the report as "Stating the bleeding obvious as clearly and concisely as possible so we can all get down the pub".

The key points outlined within the report are:

1. The patient is your first concern, not the electability of whichever shower of shite is in government, nor the knighthoods of the upper echelons of the medical establishment.

2. Try to imagine that the patient is a member of your own family - would you treat them differently if they were?

3. Try to consider the possibility, no matter how remote, that you might not be right.

4. None of the World's major religions believe that God is a doctor. They may have a point.

5. You don't have to take any crap from anyone. Self-respect and dignity are also important for doctors as well as patients. No one is right all the time, and few people are wrong all the time.

6. If you are not very good at something then don't confuse the words 'practice' and 'practice'. Ask someone who is competent to help or take over.

7. It is both your right and your responsibility to enjoy your job. If you do not enjoy your work, your job is either wrong for you, or you're wrong for your job. You can't do your best at something for 30 years otherwise, and that's not fair on anyone, least of all you.

8. You do not have the option to 'not do politics'. Your ability to care for patients is a pure function of politics, and it is your duty to understand the wider issues concerning your practice, to form an opinion and act accordingly.

(Note to Editors - The Dr Rant Foundation is a not for profit think tank that aims to improve patient care and maintain the sanity of doctors though the employment of invective, bile, sarcasm and cathartic apoplexy via the medium of the blogosphere.)

Toothless Wonder

Well. Yet again gaping holes in Gordon Brown’s brain, sorry NHS dental services, emerge.

Patients don’t get regular dental check ups. They get dental abscesses and then need to bother GPs and A+E departments and hospitals. The documented the extra work here.

Totally needless suffering. Totally wasted resources, and misdirection of patients. Yet another success for new Labour and national contracts.

This government is soon to be come a Shakespearean tragedy, Sans teeth, sans eyes, sans taste, sans everything…and sans any professional left able or willing to do anything about it. A nation fit only for the unemployed, the incapacitated, or managers in meetings.

Not as we like it at all.