Please God that health care does not get worse than it was in Mid Staffordshire NHS Trust. The Secretary of State has accepted the damning findings and recommendations of the independent report but still refuses to hold a full public enquiry. What is he scared off? A brief study of the bloated soviet-style bureaucracy that controls the NHS may provide an answer. In the NHS, there are dozens of interlinking commissariats which report to and on each other and they are run by an even larger number of commissars. The commissars all have portentous and similar sounding titles and move frequently between the various commissariats. Trying to ascertain who is responsible for what is challenging and often, just when you think you are there, the commissariats will be renamed and some poorly performing commissars, who should be sent off to the Gulag, are promoted out of harm’s way.
You may not have heard of the Care Quality Commission. It is an amalgamated quangopoly, which started work on All Fools’ Day 2009. It ate up the Health Care Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. You should have heard of the Health Care Commission. They are the ones who published the initial report on Stafford. The public did not and still does not understand how so many unexpected deaths went unnoticed and unreported for so long. To improve our understanding, we need still more information about commissariat structure.
Stafford hospital was under the governance of the West Midlands Strategic Health Authority until February 2008. The West Midlands Strategic Health Authority (SHA) had all the mortality data for West Stafford at the same time as the Healthcare Commission but, unlike the Healthcare Commission, West Midlands SHA did not understand the significance of the data. They thought the unexpectedly high death rate was merely a statistical aberration caused by faulty computer coding. So they ignored it. As was said in the House of Commons, the SHA “had the wool pulled over its eyes.”
The Care Quality Commission (CGC) is charged with monitoring and maintaining standards of care in the NHS. Commissar Cynthia Bower was the first Chief Executive at £200,000 a year. But just a minute. Previously, she was the Chief Executive of West Midlands Strategic Health Authority and so must surely take some responsibility for the Mid Staffordshire debacle. Or is that unfair? Perhaps one should not hold Cynthia Bower responsible. It takes several years for hospital services to become as bad as they were in Staffordshire. Cynthia Bower only took over that position in 2005. Some of the blame must surely fall on her predecessor, who was Comrade David Nicholson. He has moved on from West Midlands Strategic Health Authority too. He is now Sir David Nicholson, and is Chief Executive of the National Health Service.
Reform of the NHS is a difficult nettle to grasp as a general election approaches. The public may easily but inaccurately assume that much needed reform is a threat to the NHS principle of a decent standard of medical care being available to all, independent of means and status. They easily forget that such medical care has not been available to all for a decade or more. For those of us who work within the NHS, and experience the catalogue of waste that surrounds us, it is deeply depressing to see that there is a bi-partisan policy that can best be summed up as “leave the NHS alone”. Last April I described how easily the next general can be lost by the Conservatives.
The country may be tired of Gordon Brown, but the battle is not yet over. The election is not a foregone conclusion. The situation now more resembles 1992 than 1997. It is not enough to want to dismiss Gordon Brown. There must be an attractive alternative and, just as in 1992, certainly as far as health care policy is concerned, there is as yet no such alternative. I have long since stopped being doctrinaire about the NHS. We need to take the best of the private sector systems and the best of the public sector systems. We do neither. Look at the growth of Stalinist bureaucracy or the outrage of PFI and external IT contracts. Take your pick. The NHS currently encapsulates the worst of both public and private systems. We are in the middle of an economic crisis. Every day, vast sums of money are wasted on healthcare and still both parties are pledging not to cut expenditure on the NHS. Crazy. We looked before at the egregious waste of money on the NHS Centre for Involvement. Thankfully (watch the video) it has now been closed, but how many millions did it cost the taxpayer?
Over the next few weeks, I want to look at a few more of the many areas of waste about which the general public are unware. Let us start with the Director of Patient Experience…
Care UK is a leading independent provider of health and social care. Working in close partnership with local authorities, PCTs and SHAs, the company draws on over 25 years of experience to provide tailor-made service solutions, including residential, community, specialist, primary and secondary care.
GPs are educated consumers of secondary health care. We know who the best specialists are and, unlike the general public, we are not influenced by glossy brochures and other specious advertising techniques used by a certain sort of doctor, or a certain sort of medical organisation. PCTs in the north of England have take out a seven year contract for the provision of medical services with a private company called Care UK. Less than a third of the capacity of that contract has been taken up. I will not speculate as to why local GPs choose not to use this service, but it is their right to choose. Or it used to be. Now the PCTs are trying to force GPs to refer their patients to Care UK rather than to NHS hospitals. Today we learn that the wife of the chairman of Care UK has donated £21,000 to the private office of Mr Andrew Lansley, the shadow health spokesman.
I wonder why she made this donation? I wonder why it was accepted?
Over the last few months, amongst the chattering classes at any rate, it has become taken for granted that the Conservatives will win the next election. There has been some discussion about the size of the majority and, amongst Tory supporters, a considerable amount of schadenfreude as they list the Labour cabinet ministers who will lose their seats. But no one entertains the prospect that Labour might pull off an astonishing fourth victory.
It is strangely reminiscent of the run up to the general election of 1992. No one considered the possibility of a Conservative win. John Major had been written off. Robert Harris wrote an entertaining piece in the Sunday Times which started, “Right, that’s it. Unless Colonel Gaddafi kidnaps Dame Vera Lynn, Labour will win the election.” Then came John Smith’s fully staged, misjudged, faux budget in which he promised swinging tax rises. John Major meanwhile eschewed technology and spin and went out on his soap-box. It seemed mawkish, but it struck a note. Finally, there was Kinnock’s cringe-making performance on Sheffield Wednesday and John Major scraped home for another five years in office.
Seventeen years later, Dame Vera is safely at home, Colonel Gaddafi dines at top table and the outcome of the next election is, once again, thought to be certain. But a Sheffield Wednesday size disaster is approaching.
"The key to involvement is developing the learning capacity of everybody to recognise and realise the potential for involvement. The challenge for us is to find practical and creative ways of developing the capacity of everybody through learning and development opportunities both within formal learning and also in everyday work capacity."
Rachel Horley : the NHS Centre for Involvement
As we approach the next general election, the Tories are between a rock and a hard place when it comes to suggesting cuts in the health care budget. And yet, with expenditure now topping £2 billion a week, there is no better area in which to start economising. The amount of money that has been wasted over the last twelve years is breathtaking. Much of the waste comes from the government obsession with the process of healthcare as opposed to its delivery.
There is no better example of egregious waste than the NHS Centre for Involvement. The “centre for involvement”? What does it mean? Spend a few minutes on their website where you will find gems like this.
"The NHS Centre for Involvement supports and encourages the NHS and other organisations to involve patients and the public in health and social care decision-making. We engage with organisations in order to create, encourage and support a healthcare culture that involves individuals and communities on many levels."
Is that clear? If not, then watch the video above. Tubby Tritter, an NHS BLOG DOCTOR favourite, explains all. Please do not laugh. The government spends £millions a year on the NHS Centre for Involvement.
But could someone help me with the quote from Rachel Horley? What does it mean? Can anyone translate it into English?
A happy, smiling photogenic little girl eating cake. A young boy playing a video game. Both threatened with death. This advert makes me so angry I am lost for words. It is a reflection of the top-down, micro-managed, intrusive climate in which we now live. Are there no boundaries? Must we threaten our children in this way in order to improve their
I want you to imagine this. Your
mother is about to have a knee replacement. Mother can have the operation done
by that charming consultant orthopaedic surgeon, Mr Green. Or she can have it
done by that charming consultant orthopaedic surgeon, Mr Grey. Mr Grey has
nearly five times more experience that Mr Green. Mr Grey has done nearly forty
such operations in the past. Mr Green has done seven operations. Who is
your mother going to choose? Silly question. The answer is obvious. Actually,
the question is even sillier than you think. There is no choice. Mr Grey does
not exist. Mr Grey is naught but a distant memory. Mr Grey no longer exists
because of the EWTD.
An eminent consultant surgeon
The sad thing about this,
as indeed about many European Directives, is that most other European Countries
are ignoring it and put the lives of their citizens before a crass misplaced
desire to please the EU/unions etc. I
wish the Tories could run with it.
Some light relief for Christmas. The results of the NHS BLOG DOCTOR competition to chose the recent video that best demonstrates why the prime minister should go are now in. My favorite was the one above featuring William Hague, surely our best current Parliamentarian, but the readers only put it at number seven. For the full top ten results see: Ten Reasons why Gordon Brown must go.
The single most effective way of improving the care of hospitalised patients is the provision of good nursing care. Sadly, inexorably, over the last ten years there has been an exodus of trained nurses from the wards. The modern nurse-specialists do not “do” patient care. They are the “too posh to wash” brigade. They prefer to walk round with clipboards telling others to "wash their hands" whilst the real nursing care is delegated to auxiliaries, who call themselves nurses, but who do not have any real training. And there are not enough of them. So patients in UK hospitals are lying in their own excrement. The elderly ones become malnourished for there is no one to feed them. In this environment, MRSA and clostridium difficile thrive.
Now, a nurse-specialist writes in to NHS BLOG DOCTOR to reveal all.
[I am] …getting angry about the state of nursing, the lack of care, the prevalence of specialist and consultant nurses (God help me I am one). How did this happen to the NHS?
Please start a campaign to rid the NHS of specialist nurses...please save us from ourselves...
The nurse-specialist’s tale is here
It’s the top of Dr Crippen’s NHS wish list. It would be widely welcomed by the public. As a general election approaches, it would form an attractive and effective part of any political manifesto:
Whilst Gordon Brown attempts to bathe in the reflected glory of sixty years of the NHS, on the front line we have run out of the vaccines needed for routine childhood immunistations. We have ordered and re-ordered. We have emailed, faxed and written to the suppliers and to the Department of Health, all to no avail. We no longer have enough vaccines to provide routine immunisations for our children. And the government? They are refusing to admit that there is a crisis. They are telling lies. Flagrant, brazen lies.
“we are currently distributing more (vaccine) than is needed to vaccinate all infants…”
“…in order to maintain stability in matching deliveries to supplies, we will introduce ‘allocation’ of the above vaccines…” (full details here)
For the first time in my practice life, I am having to turn away small children who need routine immunisations. I cannot offer them protection against diphtheria. This is the reality of Gordon Brown's health service.
God knows what David Davis’ personal agenda is for this extraordinary resignation. It has unsettled the Conservative leadership and put them between a rock and a hard place. They cannot not support the Davis by-election campaign but David Cameron is not best pleased. We all know the meaning of “courageous” and “personal” in this context. Was it just gesture politics by David Davis? What is in it for him? Difficult to see any personal gain whatever the outcome. Or are we all too cynical about politicians? Could it have been genuine conviction politics without consideration of personal gain? A resignation designed to put civil liberty back on the agenda. Whatever the motivation, and however annoyed the Tory leadership may be, there is a real political opportunity here. When David Davis arrives back in the commons, as he surely will, he is not going to be back in the Home Office post. And yet he is too talented not to be in the Cabinet. But in what position? I suggest a new, roving portfolio as the first (shadow) Minister for Civil Liberty. A wide ranging brief to cover imprisonment without trial, the erosion of juries, CCTV, the uploading of personal medical records to central government computers, Oyster Card monitoring, DNA records, finger printing… the list is sadly endless. The Conservative Party needs to eschew lowest common denominator populism and show its real libertarian credentials. And David Davis is the man to do that.
Paediatricians and family doctors all over the country have been worried that there is a desperate shortage of vaccine for routine childhood immunisations. Following a leaked email sent to NHS BLOG DOCTOR I can reveal that there is no problem. The Department of Truth has confirmed that there is no shortage of Pediacel and all comrade children will be immunised on schedule. The email is from Dr Raj Nagaraj, a Consultant in Public Health medicine
We have a slight twist (good news) to the event now. When I contacted the DH this morning I am told there is no shortage but only a rationing of supply because of the high demand ….
…Meanwhile could you all keep me and members updated on developments. I am told this shortage is going run for sometimeand it is important that the message Pediacel is only for infant vaccination and not pre-school vaccination is communicated to GPs and more importantly to PNs who usually vaccinate.
Dr Raj Nagaraj
Consultant Public Health Medicine
"No shortage but only a rationing of supply because of the high demand."
*** "I’ve got a dental abscess", said my patient, opening a mouth that looked like the Black Hole of Calcutta. He asked me to prescribe antibiotics. Like every other GP in the country faced with this increasingly common presentation, I sighed, and suggested he went to see his dentist.
"I tried to get an appointment with my dentist this morning but he is very busy so he cannot see me until next Tuesday. And anyway, NHS Direct says you have got to treat it".
NHS Direct is indeed telling them to take their dental problems to their GP. (full report here) No wonder the government is constantly pressurising me to be available at all times of the day and night.
I do not blame the dentists for leaving Gordon Brown’s micromanaged NHS. They have been treated appallingly. I even understand the government’s cynical dishonesty about dentistry. Gordon Brown will continue to pretend that NHS dental treatment is widely available until the last dentist has left the service. The financial savings will be enormous. The only thing I do not understand is how the government has been allowed to get away with the abolition of NHS dentistry.
Why has there not been a public outcry?
As a follow up, a reader emails me to say that it is not just NHS Direct who is sending dental problems to GPs, it is declared government policy:
Following media reports of patients unable to access NHS dentistry and even treating themselves, the health minister said on the Radio 4 Today programme that this should not be happening. There was now a duty on primary care trusts to provide urgent dental treatment. Mr Bradshaw said: "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." (Medical News Today)
My father in law lives in London. He is into his eighties now but still fit and active. He has a bus pass which he uses frequently. Occasionally, when he wants to get somewhere specific in a hurry, he takes a taxi. He has just received a letter from the Mayor of London telling him that as he has paid to use a taxi, he can no longer use the buses.
Too silly for words. Equally silly are the cases highlighted in this morning’s papers of NHS patients who have decided to pay for drugs not available on the NHS and, as a result, have been thrown out of the NHS. This is classic old Labour “what’s yours in mine, what’s mine is my own” pseudo-socialism. Take your pick, comrades. Second rate care from the NHS or first rate care from the private sector. But you cannot “pick and mix”.
Few people can afford full private care; a much larger number may be able to afford to pay for an occasional upgrade. And the private medical insurance industry will easily be able to design products that underwrite occasional upgrades.
Into the moral maze we go. Hell, none of this is perfect. I don’t like the idea of people having to “top up” their medical care either. But we live in an imperfect world. All this stubborn, blinkered refusal to allow “pick and mix” does is ensure that first rate medicine remains available only to the super rich. How dare the government deprive a UK citizen of his right to NHS health care because he has chosen to take an occasional medical "taxi"?
Family doctors were furious with both the Government (Dawn Primarolo) and the BBC PM programme (Eddie Mair) suggesting that the main cause of the rising alcohol problems in UK is the failure of GPs to recognise such problems. Too silly for words. Alcohol problems are easy to recognise. And we are not just talking about the clichéd alcoholic, lying semi-comatose in the alleyway clutching a bottle of strong cider. We are talking of the housewife who drinks two bottles of supermarket plonk every night, the lawyer, the accountant and, yes, the politician even who starts the evening with two stiff gin and tonics (8 units), demolishes a bottle of claret over dinner (12 units) and finishes the evening with a couple of whiskey night-caps (8 units). That’s 28 units a day, and about 200 units a week. No one can drink that much and still stand up, you may say. They can. They do. And, during the working day, no one notices. Until one day, they turn yellow.
Labour’s attempt to blame the medical profession is absurd. We need to change the drinking culture. We need to start with children. It can be done. Drinking is “cool”, and tough and macho. Smoking used to be like that but, slowly and surely, there has been a change. It can be done with alcohol too.
Where would I start if I were a politician? I would declare war on Alcopops.
It was worrying that Stanley Johnson revealed that Boris had agreed to stop drinking for the duration of the mayoral campaign. This may well make him what doctors call a sick quitter. (Full details of sick quitters in Boris : the Boozer, the Fool and the Archbishop of Montevideo.) Orders from George Osbourne to reduce the risk of gaffes or a personal decision? Who knows? Either way, this behaviour suggests there may be an underlying problem. Boris is now off the wagon. How soon before the gaffes start?
There was one of those silly five-minute fillers on Any Questions last night. Peter Hall was on the panel and the question was, “Which Shakespearian characters most resemble Ken Livingstone and Boris Johnson?” My answer for Ken Livingstone was immediate. He is Iago. Honest Iago. It was gratifying that Peter Hall made the same suggestion. I found I had to give more thought to casting Boris. Peter Hall’s suggestion was Sir Andrew Aguecheek. I think we can do better. I would cast Boris as the Fool in King Lear. Lovers of King Lear are not deceived by the Fool’s antics. Full of wit and insight, he is the most intellectually talented character in the play. Boris Johnson may well be the most intellectually talented member of the Conservative hierarchy. Whether or not you agree with that, he is now without doubt the most powerful Conservative in the country. He is David Cameron’s Fool.
King Lear could not control his Fool. We shall see whether Cameron can control his.
Gordon Brown’s mendacity on the Today programme was breathtaking. I will leave others to comment on his deception about the tax burden. But then he said that he had increased GP's hours and made them “more available” to patients. I can comment on that. Weasel words. The new programme has not yet started. PCTs are only now sending out details of the government’s proposals; a set of complex rules and regulations issued in the normal top-down way which will force us to work in a protocol driven, inflexible and inefficient manner. It is a complex issue but basically GPs wil be compelled to offer out of hours appointments to those who need them least and at the same time be prevented from offering them to patients who need them most (full explanation here). This is for polyclinics, not for professionals.
If GPs meet the letter of the law (there is no spirit behind it) then we may be notionally more available but in reality we will see fewer patients. Whilst the patients and the taxpayer suffers, the government will continue to say that they have improved the service. It beggars belief.
Sitting here watching the Panorama programme on C. Diff I am getting angrier and angrier. Please do not not crucify Rose Gibb again. She is not personally responsible for C. Difficile. What happened in Maidstone is not exceptional. But Maidstone is to be the scapegoat and Rose Gibb is to be held responsible.
Don't get me wrong. There is a problem. And all doctors know there is problem. And we know how to solve the problem. There are not enough nurses. The government targets have increased the throughput of patients to unmanageable proportions. Beds are too close. Sheets are not changed. The bed occupancy rate is unsustainable. The truth is that it is not Rose Gibb who needs to be dismissed. It is not her fault. The fault lies at the feet of Gordon Brown, Tony Blair, Alan Johnson, and Patricia Hewitt. And do not be fooled by the deep cleaning initiative. It was a con. An expensive con.
It is not easy at the moment to say anything positive about family doctors. Any suggestion that they may be providing a valuable service is nowadays met with a tirade of jealousy from nurses (see the comments here), particularly the oxymoronic “consultant nurses”, who cannot get through the day without asserting that they can do any job a doctor can do, and do it better. Then the right-wing Taxpayers’ Alliance wades in with one of their tabloid headline grabbing ad hominen attacks on public sector salaries.
This is a perfect starting point for the government to introduce the polyclinics.
On 1st April 2008, the Countess of Chester Hospital proudly announced successful completion of their “deep cleaning” initiative. Two days later, the local paper reported that part of the hospital was being closed due to an outbreak of Clostridium Difficile.
Doctors have always known that the government’s hospital “deep cleaning” initiative was an expensive scam foisted on a credulous general public in the run up to a general election that never happened because Gordon Brown lost his nerve.
Full details, including the hospital propaganda video, here.
Since Barack Obama’s “A more perfect union” speech I have thought a great deal about the question of political sincerity. Shortly after his retirement the well-liked John Cole, BBC political correspondent, said that most politicians were decent people with honourable objectives. And yet in our modern political age, dominated by spin and focus groups, any politician attempting to speak from the heart, to speak with conviction, to speak inspirationally, is greeted with cynicism and disbelief.
Tony “Im a pretty straight sort of guy” Blair has much for which to answer. I cannot listen to a word he says without thinking of calculating hypocrisy. I reached the stage with Patricia Hewitt that I had to turn the sound of when she appeared on television. Barack Obama’s speech was different. A speech born of necessity, certainly, but a speech that was both intelligent and inspirational. And, God knows, we need an inspirational American President.
I have been discussing this with Iain Dale. Is it possible for a modern politician to make a sincere and genuinely inspirational speech? I issued a challenge. Give me an example of such a speech made by a British or American politician since 1950, the start of the television age. The commonest suggestion has been...
The statistics are beyond dispute, and are published by the government:
For the latest three-year average period, 2001–03, the infant mortality rate (for all babies with father’s occupation stated) was 5.0 deaths per 1,000 live births, and the rate for those in ‘routine and manual’ groups was 6.0 per 1,000. This was higher than the rates for those in the ‘managerial and professional’ (3.5 per 1,000) and ‘intermediate’ (4.7 per 1,000) groups.
The infant mortality rate among the ‘routine and manual’ group was 19% higher than for the total population in 2001–03, compared with 13% higher in the baseline period of 1997–99.
Dawn Primarolo says it is difficult to change health inequalities. Indeed it is. But they have changed. They are getting worse. See Killing Babies
The government is offering a free I-Pod to any man with one child who will volunteer to have a state sponsored vasectomy. Well, probably not, or not yet at any rate. As the budget approaches, rumours abound, and there is speculation that there will be a huge purchase tax hike on large family cars, maybe as much as £2000. Tax the Chelsea tractors, the Porches and Ferraris by all means. But not this. This is a tax on children.
really does not matter anymore if civil servants leave confidential database
records in coffee shops. Despite numerous promises to the contrary, Computer
"A new national
database of confidential patient records is being opened to access by NHS staff
who need no professional qualifications - despite official assurances that
records will only be accessed by specialists who are providing care or
treatment. A document obtained by Computer Weekly under the Freedom of
Information Act also provides evidence thatNHS Connecting
for Health - which
runs part of the £12.4bnNational
Programme for IT [NPfIT]- has quietly decided to weaken assurances given to
patients about the confidentiality of records." (Computer Weekly)
Doctors have been
warning about this danger for some years. And it is worse
Commissar Burnham has been awarded the Order of Lenin for
his achievements in introducing our children to the best of British kulture.
Meanwhile, school teachers throughout the country are
fulminating with anger as the government tries to tell them how to do their job. As a doctor, I cannot but indulge in a little
schadenfreude. Perhaps people will begin
to understand now what the government has been doing to doctors and the
NHS over the last ten years. Teachers are underpaid, desperate
for resources and struggling to achieve better literacy and numeracy rates. They do not need the government to tell them about the benefits of creative writing.
Currently, after ten years of NuLabour "around 16 per cent, or 5.2 million adults in
England, can be described as "functionally illiterate". They would
not pass an English GCSE and have literacy levels at or below those expected of
an 11-year-old." (National Literacy Trust)
But do not worry. Five hours of compulsory, government defined kulture will soon solve the illiteracy problems. "Heavens," said Commissar Burnham. "Five hours is nearly enough time to sit through the Ring cycle."