Woefully bad...

I have commented in the past on the activities of the Department of Health, which has - over the years - developed an unenviable cachet as the worst Department in the Government.

They are a department that keeps giving......as a Jobbing Doctor, I was often aghast at their low level incompetence. The flip-flopping of advice, the lack of support for clinicians, the utter incompetence of the swine flu imbroglio.

We hear that we don't have enough doctors and nurses now to run our health service, so we are going abroad to steal qualified staff from poorer countries.

I listened to Professor Ian Cumming on the BBC radio trying to smooth things out, and saying black is white. I was not impressed by the arguments, and amazed at the inability to see we have a real problem.

What about workforce planning? Who is responsible for this mess?

What are they doing about it?

Don't hold your breath.

A bad penny....

Sometimes, someone reappears, and reminds you all over again what damage they wreaked in a former period of time.

Thus it is with 'Baroness' Julia Cumberlege.

She was asked by a previous Tory Government to produce a report on Maternity services, her committee sounded the death knell for General Practice Maternity care. All up and down the country small GP maternity units closed, despite any cogent arguments that they were dangerous. It was a sad day for General Practice when this happened.

Now, like a bad penny, she has re-emerged with her latest wheeze - personal budgets for maternity care. This is clearly designed to be an adjunct to the Health and Social Care Act of 2012, which is about the fragmentation of Maternity Services, to enable further sell-offs to the private sector.

This is, frankly, another bad idea which has been dressed up in the clothes of 'freedom of choice' for expectant mothers. Cue much 'personal midwives and continuity of care' bullshit. It is simply a tool to advance the privatisation agenda, as the personal budgets will quickly need co-payments to make them affordable.

Another nail in the coffin of the NHS by a Conservative Party placewoman. She is known to dislike the NHS, so who better to produce this kind of garbage.

It makes me so depressed......

Marmalade

It's February, so for a few weeks the Seville oranges are available to make marmalade. I've always enjoyed making marmalade. I don't save money doing it, it doesn't really save any time. For me it is therapy!

The fruit

This year's first batch is four fruit marmalade - oranges, lemons, limes and grapefruit, and here is a picture of the fruit ready to be cut, squeezed, peeled, de-pithed and generally prepared. It is hard work, but it is rather pleasant to have your hands smelling of citrus!

Here is the boiling pan, with a muslin bag containing all the pith and pips. The finely shredded skin is on the surface.

Boiling the fruit.

Hours and hours later, and boiling the mixture frenetically gives you your marmalade, which needs to be poured into jars and sealed (and labelled - I'll get around to that later!)

14 jars of heaven!

However, what it is all about is the flavour, and the freshness, and the enjoyment of making something that is properly home-made. The marmalade is a little runny (despite using the pectin from the fruit, jam sugar, and a sachet of extra pectin), so any suggestions in letting me know how to get my marmalade more solid would be gratefully received.

Mmmmmmm..........

The end of stupid....

Some ideas are just plain stupid.

It doesn't stop some idiot promoting them for all they're worth. The idea of 'Dementia Screening' fails at every level of sensible medicine.

A passing understanding of the Wilson/Jungner criteria of screening (this is not new, developed in 1968 by the World Health Organisation) would ensure that policy makers would understand that this would be a pointless and wasteful exercise.

Here are a couple of basics:

Screening picks up a condition in its pre-symptomatic form. Dementia 'screening' does not.

There has to be an acceptable treatment for the condition that works. Not so in Dementia (which is a variety of conditions, anyway).

There needs to be a clear understanding of the pathophysiology of the condition. We don't in Dementia.

News has come that the programme is to be abandoned: not before time. It has achieved nothing of value.

Surely there ought to have been someone at the Department of Health who could have said to the idiot politicians pushing it that it was a waste of time, money and effort. Politicians were told by many people at the time. They chose to ignore opinions outside of their narrow and shallow understanding. This is why the Department of Health is, by some distance, the worst department in Whitehall.

Pants on fire....

The central theme of the Government's latest argument, this time with the junior doctors, is that the lack of staff working at the weekend causes higher mortality.

This is despite many people, including Margaret McCartney, the original authors of the piece in the BMJ, the editor of the BMJ and many others saying that Jeremy Hunt's interpretation of the data was deeply flawed, and he can't make any assumptions based on this information.

Now it would seem that even the Department of Health [a.k.a the worst Department in Whitehall] have even managed to make a correct judgement.

The wheels are falling off his argument now, and what he needs to do is stop being so arrogant and naïve, and start taking advice. And stop saying things that aren't true.

Is that too much to expect?

Another day, another report

Today we have a report on problems in mental health services in the UK.

They are not good enough for a country of our size and wealth.

If you spoke to anyone who has any experience of working in mental health services, or anyone who has used them, they usually say that this is not news and has been like this for many many years. Certainly, I was keenly aware of all the problems when I was a Jobbing Doctor, so much so that we tried to treat as much in house as we could, as the opinions and back-up for our mental health patients were patchy, mostly bad.

It is being spun today as being an attitudinal problems, and there is some validity in the view that mental health is regarded as less worthwhile by many in the country. The real problem is lack of facilities, lack of resources and lack of people on the front line with the requisite skills. Reorganisation upon reorganisation, and squeeze upon squeeze (all with the support of the Department of Health) has left psychiatric services in their knees.

As an example, I used to use a treatment called Lithium to help with patients with severe bipolar disease: these I started and monitored in primary care, as I felt I had the experience and knowledge to do so. I would have preferred to have these done in secondary care, but the resources were not there to give a good service to my patients.

Who is responsible for the poor quality of mental health services? Is it the public (with their blinkered attitude to mental health)? Is it the front line workers (who are not good enough or plentiful enough)? Or is it the politicians (with their squeeze on funding, and pointless reorganisations)?

I know who I blame: but no-one will take any responsibility for this.

So I give this piece of advice: fund the front line properly, treat the professionals as professionals, and allow them to do the job they want to do.

Is that so hard?

A friend of a friend told me....

The NHS seems to be going to hell in a handcart. We have had a 13-year freeze of resources in primary care, so that General Practice is now on its knees with the lack of funding and demoralisation.

I hear (from a friend) that in a large and well-respected local practice that it is common for patients to be queuing out into the car park to get an appointment, doctors are leaving and retiring, the patients vent their anger and anxiety on the receptionists (not their fault), and what have the authorities done?

Bugger all.

The NHS is not just about doctors, but it is the doctors who are in the cross-hairs.

First they came for the Junior Doctors, but I did nothing, as I was not a junior doctor. Sound familiar?

Then they came for the nurses.

Then they came for the support and reception staff.

Then they came for the consultants.

Then when I became ill there was no NHS left, and I was asked for my Mastercard Number.

And when that ran out...........

Infamy

It is quite difficult to explain to non-medics the significance of 11th February 2016 in the status of medical care in England.

You certainly won't get a balanced view from the mainstream media, who seem incapable of analytical understanding of the issues. Soundbites provided by press offices seem to be easy to regurgitate as fact whilst ignoring the complexities.

The bald facts are that the Secretary of State for Health decided to impose a new contract on Junior Doctors (anyone who is not a consultant or a GP), in the stated belief that he is working towards a seven-day NHS (whatever that means). He uses some cherry-picked statistics to back this up (despite the authors being unhappy about his hi-jacking of their data in a selective way), and attempts to take the moral high ground.

Imposition of a contract on people who are very intelligent, highly motivated and have transferable skills is a recipe for them to leave, retire, resign or emigrate: this will happen in record numbers over the next few years. You do not treat professionals like this: if you stop treating people as professionals, they will stop behaving like professionals - they will not be minded to cover difficult shifts, they will work to their contract and no more. This is the rule of unintended consequences.

Over the next few months I shall be chronicling the unintended consequences of this rash decision, and pointing out where things can be changed for the better.

11th February 2016 was the day where the English NHS started to die.

Weep for what we are about to lose.

Nemesis

It looks to me like the Government has decided to impose a new contract of work on the Junior Hospital Doctors. An announcement is expected today from the Secretary of State for Health, Mr Jeremy Hunt MP.

If this is the case, then we are approaching the break-up of the National Health Service, chaos in hospitals, and the resultant morbidity and mortality that will result will mean that people will die.

This is a political struggle with the Government trying to rebadge Saturday as a weekday, and cut costs and expect people to work these days as a matter of routine. This is something that MPs do not do.

This is a very dangerous time for the service I spent 38 years working for.

By 2020 the end stage of the Lansley reforms and the Hunt contracts will result in a fragmented, inferior, privatised service, and the jewel of our NHS will be a distant memory. In the same way that national Education has gone, Health will follow.

The roll call of shame is, indeed, a very long one: you expect the Tories to be liars, selfish, and arrogant. This is what Tories are. But there are many fellow travellers who should be ashamed of themselves.

These two are at the head of the roll call of shame:

I wonder how they can sleep at night realising what they have done?

The Magic GP tree

General Practice is in crisis, and I see this in contacts I have with all my ex-colleagues. The last time we approached a problem of this magnitude was around the time of the 2003 GP contract. That was the time when the then Government were keen to start privatising aspects of the NHS, and out-of-hours services were seen as an obvious choice. So GPs were bribed to stop out-of-hours, and NHS Direct, commercial GP out-of-hours services and NHS 111 were all introduced.

And we all know how successful that has been!

Last year the Prime Minister promised an extra 5000 GPs by 2020. I really don't know how the Government will achieve this, when there are record numbers of GPs retiring, emigrating or leaving medicine, and applications for training are down by 5% this year alone.

Where are they going to come from?

The magic GP tree at the bottom of the garden?

A Jobbing Patient

These things eventually have to come. Having spent 38 years as a doctor, being the one doing things to other people, or listening or deciding, there comes a time when you are a patient, and stuff is done to you, and you are no longer in charge.

Following a serious rugby injury 40 years ago (collapsed scrum, trapped at the bottom, dislocated knee and torn ACLs) I was offered conservative or radical treatment: I opted for conservative therapy, which meant a Robert Jones bandage, and analgesia. No rest, as I was a junior hospital doctor. That went pretty well for around 35 years, but having the build of a rugby playing man (loose-head prop) meant that the inevitable was merely postponed.

So, I have now had 2 total knee replacements as an NHS patient. The surgery and care was excellent, and I am recuperating, but it is quite difficult not being in charge. I suppose that, as the years progress, I will have to get used to the change in relationship with my doctors (my GP now was a GP Registrar in my practice many moons ago). It isn't easy being passive, and having to rely on others' decisions.

I suppose that makes me a Jobbing patient.

A new Nadir

I thought that I would retire gracefully, and leave it to others to comment on all things medical. I have maintained this self-induced purdah through thick and thin over the last year, and resisted any temptation to comment on matters medical.

One thing has changed my mind, and that is the wondrous incompetence of our current Secretary of State for Health, a certain Mr Jeremy Hunt MP.

Jeremy is a man who takes no advice from anyone medical, for he clearly knows best what to do. You won't need GPs in 20 years time, all you need is a computer and an algorithm to diagnose anything. His tame puppets, like the ghastly Sophie Borland of the Daily Mail (see blogs passim) or Sarah Baxter in the Sunday Times (who sees no need for GPs) dutifully spout his line.

Jeremy thinks we should google skin rashes to make a diagnosis. He thinks this is feasible. This from a man who thinks the privatised NHS 111 is 'successful', and not a disaster as we all predicted - especially as it is run by Care UK (a private firm who gave Mr Hunt's predecessor £29,000 for his private office).

Have you ever seen the rash of meningococcal septicaemia, Mr Hunt? Do you know its significance?

Oh Dear.

I used to think that Patricia Hewitt was the worst Secretary of State for Health: and she was awful. But at least she didn't jeopardise people's health.

Jeremy Hunt - a new nadir.