GPs are revolting

From The Sunday Times
December 30, 2007

Doctors revolt on patient records

Eileen Fairweather

SENIOR doctors are encouraging a mass revolt against the government’s £12 billion national health database by supporting a campaign to urge patients to opt out.

Activists in the British Medical Association (BMA) have produced a pro forma letter that people can send to their GP to stop their records going onto the database.

The doctors fear that patients’ records could be misused if they are made available to health workers across the country, as is planned under the Connecting for Health system.

The campaign is modelled on the recent widespread protest against excessive bank charges, which was also coordinated through the internet. The letter can be downloaded from the website of the BigOptOut campaign, nhsconfidentiality.org.

Dr Paul Cundy, chairman of the BMA’s general practitioners IT committee, helped compose the protest letter.

He said: “Some doctors are actively encouraging their patients to rebel. This letter is an easy way for patients to express the rights that the BMA feels they ought to have by default.”

Saying sorry

As doctors, we are taught from an early stage in our training to be honest about our mistakes, and to say sorry to patients or relatives if things go wrong; it is what is expected of us.

Why is it that hospital managers and politicians seem completely incapable of ever saying sorry. It would make life so much easier.

Another fine mess

A GP friend (not in Bedford) has just sent this letter to his local MP:

I am bemused that a Government so beset by public outcry concerning withholding pay awards to the Police, economic peril concerning Northern Rock, constitutional irregularities concerning the monies of Mr Abrahams, security lapses concerning HMRC, DVLA & DSC, and the military quagmire that is Afghanistan and Iraq, should have chosen this moment to precipitate a confrontation with a group of 36,000 professionals across the nations of Britain who enjoy the respect and daily personal contact with the vast majority of the electorate.

I speak, of course, of General Practitioners.

Following the recent Government originated survey of two million people, which cost over £11 Million of tax Payers money, I might add, we have discovered that 86% of the population are quite satisfied with the opening hours and availability of GPs. Indeed, I believe that the figure is somewhat higher here in Somerset. In most sectors of industry and commerce this achievement would be warmly applauded and celebrated as an excellent service. Apparently this was not the answer that Mr Brown wished to hear.

In response to his publicly stated pledge for Extended Opening hours, the General Practitioners Committee submitted rational and well-costed proposals. These appear to have rejected out of hand, and the Government is about to impose a draconian new contract upon the profession.

This contract will remove resources from Practices for care of chronic conditions, and instead allocate them to a clinically unnecessary pandering to the desires of a very small minority of the electorate. In pursuing these marginal votes, the Government is quite content to reduce day-time access for the majority of our needing patients – the elderly, children and mothers.

This contract further threatens the very fabric of General Practice, regarded by many as the lynch-pin of the NHS, and the essential bedrock of Continuity of Care, which we know is so valued by our patients. One potential consequence of this sequence of events will inevitably be the glancing over shoulders in the direction of the dentists – the mass privatisation of medical Primary Care is a reality that no longer creeps, yet now hurtles towards us, effective April 1st 2008.

Doubtless there are numerous Labour Marginal MPs whose political future will look very uncertain if Mr Brown’s efforts to dismantle the NHS come to fruition. You may care to mention this to them.

I am most grateful for your attention to this matter. Should you require any further details, please do not hesitate to contact me.

Yours sincerely

Another IT triumph

NHS trusts lose patients` details

Press Association
Saturday December 22, 2007 10:33 PM

Nine NHS trusts have admitted losing patients' information in the aftermath of the HM Revenue and Customs (HMRC) data loss scandal, it has emerged.

Hundreds of thousands of people are thought to have been affected by the breaches of strict data protection rules by the health service.

The losses were disclosed by the Sunday Mirror as police continued to hunt for two HMRC computer discs containing the details of 25 million child benefit claimants. Since the discs went missing in the post it has also emerged that three million motorists' details have been lost in Iowa, in the American mid-west.

One of the NHS trusts involved - Maidstone and Tunbridge Wells - has reported two breaches to the Department of Health (DoH), meaning that 10 cases have occurred in total.

The DoH said it did not have details of how many patients were affected in each case as the breaches were being dealt with locally.

However, City and Hackney Primary Care Trust has reportedly lost the details of 160,000 children after a computer disc failed to arrive at its destination at St Leonard's Hospital, east London.

The other trusts involved are Bolton Royal Hospital, Sutton and Merton PCT, Sefton Merseyside PCT, Mid-Essex Care Trust, East and North Hertfordshire, Norfolk and Norwich and Gloucester Partnership Foundation Trust.

NHS chief executive David Nicholson recently wrote to NHS managers reminding them of their responsibilities with regard to data handling.

A DoH spokesperson said: "Since the recent heightened concern about data protection a small number of trusts (nine) have reported breaches of their own security rules.

"There are strict guidelines and procedures for dealing with such breaches. Trusts have an obligation to inform patients where appropriate. There is no evidence of any data falling into the wrong hands. Investigations are under way in all the trusts involved and action will be taken against anyone who has failed to fulfil their legal responsibilities."

Not for those with an anxious disposition

If you look at this page from the Office of national Statistics

www.statistics.gov.uk/CCI/nugget.asp?ID=574&Pos=1&ColRank=2&Rank=528

which shows that moderate flu years like 1998/9 have 45,000 excess winter deaths instead of 25,000

and this page from prescriber
www.prescriber.org.uk/2007/09/26/does-influenza-vaccination-reduce-mortality/

which links to the lancet saying that flu vaccination hasn't been shown to reduce mortality in the elderly

and realize that the first influenza graph on this Health Protection Agency page
www.hpa.org.uk/infections/topics_az/influenza/seasonal/flu_graphmenu.htm

could be overlaid more or less perfectly on the excess mortality graph

And realise that we normally have a moderate 'flu outbreak every three or four years (and a severe one every 20 or so, and a Bird-Flu type pandemic every century)

And remember that even the official statistics
http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=1814&Pos=1&ColRank=2&Rank=272

show bed occupancy routinely above 85%, while the reality for most (and particularly PFI schemes) the real rate is nearer 100%
www.bma.org.uk/ap.nsf/Content/HealthcareAssocInfect~strategies~infection
www.news.bbc.co.uk/1/hi/england/7106938.stm

Then you should be really worried about the health prospects of a country whose government has removed every ounce (and more) of spare capacity in the last seven years of low illness rate

With permission

The author of this piece, a consultant psychiatrist, has given me permission to reproduce it:

Over the last few years I have spent a lot of time in and around Parliament, the DoH and the political parties. I attended the 3 major party conferences for 5 years (2002 – 2006), I gave evidence to two Select Committees, I sat through all debates in both Houses during the passage of the Mental Health Bill and, whilst the Bill was in the Lords, I acted as Special Advisor to the Opposition (sitting in a box on the floor of the House, opposite the DoH officials, writing notes to advise Peers).

When I have the time and energy I may write of my experiences. In the meantime I make the following brief observations which may or may not help in your fight:
The Palace of Westminster oozes a feeling of power (even if the occupants achieve little and damage a great deal).
Journalists, in addition to MPs and Peers, feel powerful by being there. That’s why they don’t repeatedly publicise aspects of our ‘democracy’ that are a disgrace.

MPs and Peers vote when they have not listened to the debate and may have no idea what the vote is about (they only need to know which lobby to walk through – occasionally they even get this wrong). The Bells, called ‘division bells’ are not only sited throughout the parliament building and MPs and Peers offices, but also in all the nearby pubs and restaurants. Enjoy your, beer or meal, nip in to vote, then return to boozing. The number of Lords debating the Mental Health Bill rarely exceeded 10 speaking and perhaps 20 in the chamber. The numbers voting at 6 divisions were 344; 301; 255; 327; 313; 266. Voting demonstrates ones presence in the Chamber and so enables collection of the daily fee and expenses (I think it’s about £300 but can’t remember or bother to look it up – it certainly pays for the booze). I should say that some Peers work extremely hard and are astonishingly well informed (not something I would say about many MPs).

Governments, by definition, have a majority. With our current voting system the size of the majority is out of all proportion to the votes cast. Whilst the government may occasionally be defeated on the floor of the Commons it will never be defeated in Commons Committee. Let me give an example of numbers, a typical committee would have the following representation: 12 Labour, 6 Conservative, 2 Lib-Dems, 1 Other. Given that all are hand-picked, there are never any rebels. Only government MPs are permitted to be fed information during the proceedings (unlike in the Lords). MPs and ministers need the constant stream of notes, from officials, during debates because they are so ill-informed as to facts, as opposed to opinions, (they don’t even know the details of the legislative changes they are proposing). There were 17 DoH officials working full-time on the mental health bill (they were all invited for drinkies in parliament afterwards), the Opposition had 2 of us (I was trying to hold down my full-time job in Leeds at the same time).

Party conferences cost rate and tax payers a great deal of money for all the security. Organisations which wish to influence government send representatives. Of course many businesses are there. Why do organisations such as NICE and the GMC not only send representatives but host fringe meetings – at all the conferences? As with all fringe meetings, they are awash with food and alcohol, paid for by - us.

Having had dealings with the Department for Constitutional Affairs and the Department for Work and Pensions, I can report that many civil servants really value consultation. Only those working for the DoH don’t.

How does government work? I once met the then Permanent Secretary at the Home Office. During his time there the Home Office was under ‘special measures’ because its accounts were rejected by the auditors 3 years running. When he left it was to become deputy governor of the Bank of England.

Take a break

The executive of the Save Bedford Hospital party wish all our many supporters a Happy Christmas; this has been a busy and successful year of campaigning, but we also deserve a rest (and you deserve a rest from us).

If there had been an election in October, we feel that we could well have won; we would certainly have put up a big fight. But we are ready whenever it happens, and we rely on your support and good wishes.

So, for now, all the best.

Feeling generous?

The government's Northern Rock fiasco has cost us a collective £57billion and rising.
That's an awful lot of OUR money.

And why has it happened? Well a small clue lies in my posting under the title "Jellied eels".

Jellied Eels?

Another day, another data handling disaster; and still they persist with the illusion that they could safely and effectively manage ID cards. Meanwhile, billions of your money continue to be wasted on the useless NHS IT system, which when it eventually comes to fruition will be able to lose all your confidential medical data at the touch of a button.

The real problem with this government is the lack of even a hint of basic competence; and let’s face it, none of them have even run a jellied eel stall before becoming politicians.

Enough to make you sick

Patricia Hewitt was, by a country mile, the worst Secretary of State for health that we've ever had (and we have had a few disasters...anyone remember Alan Milburn).

So now I read this in today's Sunday Times: it's enough to make you reach for the sick bowl -

PATRICIA HEWITT, the former health secretary who left the government six months ago, has been offered jobs with at least five companies with links to the health sector.

The disclosure has led to renewed calls for more stringent rules to stop politicians from cashing in too quickly on their time in office.

Hewitt, who resigned in June, has been inundated with consultancy jobs since leaving the Department of Health. She is set to be the latest in a series of health ministers and senior officials to move into the private sector.

Lord Warner and Alan Milburn, both former health ministers, have also benefited, moving to healthcare jobs soon after leaving office. Liz Kendall, Hewitt’s former special adviser, is now a healthcare consultant to a number of organisations, including private sector companies.

Hewitt, who was health secretary from May 2005 but stood down when Gordon Brown took over as prime minister, is expected to take up her roles in the new year.

Warner’s jobs, revealed this month, include advisory roles for Xansa, a technology company in Reading, Berkshire, that has a partnership with the Department of Health to provide finance services to National Health Service bodies, and Byotrol, an antimicrobial company that sells products to the NHS.

Warner also has an advisory role with DLA Piper, which advised ministers on the NHS’s £12 billion IT programme. Warner was responsible for this while a health minister.

The move into consultancy will raise fresh questions about whether companies are gaining a strategic advantage by hiring ministers with recent experience of the highest levels of government.

Macavity

Gordon Brown has been likened in some quarters to T. S. Elliott's famous cat Macavity.

This extract seems rather apt:

And when the Foreign Office find a Treaty’s gone astray,

Or the Admiralty lose some plans and drawings by the way,

There may be a scrap of paper in the hall or on the stair -

But it’s useless to investigate - Macavity’s not there!

And when the loss has been disclosed, the Secret Service say:

“It must have been Macavity!” - but he’s a mile away.

You’ll be sure to find him resting, or a-licking of his thumbs,

Or engaged in doing complicated long-division sums.

Incidentallt TS Elliott was, rather improbably, a great friend of Groucho Marx

Apparently...

...we are told that Gordon Brown did not want to be seen signing the new European Constitution.

Well, for better or worse here he is...and don't forget that it's our constitution

To avoid misunderstandings

The Save Bedford Hospital party wishes to put on record the fact that this website is the party's site, and not the website of any one individual. That has always been the case.

We would have called the site "save bedford hospital.co.uk" or something along those lines, but all those website domains were pinched by another political party the day after we launched.

The opinions expressed on the site are the collective opinions of the party; sometimes postings are made in the first person singular, but that is just a matter of literary style.

If anyone thought otherwise, we hope that this posting clarifies matters.

Gone missing

There is a bit of a mystery at Bedford Hospital at the moment.

As those of you with good memories will know, I made a bit of a fuss when it was suggested that the hospital should not replace the retiring consultant in charge of the stroke unit. I personally feel that stroke is such a devastating illness that we really must do the best we can to care for patients with the condition, and there is good evidence that having a dedicated consultant in charge of the service saves lives and reduces disability.

So, eventually a new consultant was appointed; but then, just as quickly she has vanished. The management are tight lipped, and I know no more than I have written, but something has gone on, and given that this is a public service, perhaps we are entitled to know what.

Catch them young

I am delighted to have been invited by a local school to talk to their sixth formers about my campaign. I imagine that by the time of the next general election most of them will have a vote, so if any other schools in Bedford want to get in contact with me, I will be pleased to oblige.

A new morality

I found a story today that sums up the way I was left feeling after watching yesterday's debate on party political funding:

77-year-old Maurice Fox received a letter from Kirkham Street Sports and Social Club in Paignton, complaining about him breaking wind loudly in the public bar. Maurice may be a man of with a bad habit, but he is a man with a sense of decency. When Maurice received the letter did he complain? no. This is what Maurice said: "I am happy to oblige them, there is no problem. I do get a bit windy - I am an old fart now. "I think someone has complained about the noise. I am a loud farter, but there is no smell. "I do not think it [the letter] is unreasonable, you get ladies in there." Maurice now goes outside to fart.

Compare this to the Labour party's behaviour at the commons debate for political party funding yesterday: If certain members of the cabinet had received a letter complaining about their party breaking wind in the bar, this would have been Labour's reply: "We admit that one of our group has been farting loudly in the bar. "We are angry that this has happened. "We are going to instigate an immediate review into this matter, and we are determined to have transparency at all times when it comes any member breaking wind. "Our friends will carry out the review, and on completion they will provide a detailed report of their findings to the alleged farter. "We will of course report this matter to the bodily function commission."

"However, we would like to make it very clear that patrons on the other side of the bar, have in the past, farted louder and longer than any member of our drinking group. "To this end, we would like to put forward a motion to ensure that any future farting will be done in a fair manner, and on a level playing field. "Although we admit that one of our group has farted, that member will not be going outside to fart until the Landlord throws them out."

Maurice Fox is a man with a sense of decency - The Labour party do not know the meaning of the word.

Now there's a question

From Prime Minister's Questions, 5th December 2007:

Dr. Vincent Cable (Twickenham) (LD):

Now that the taxpayers’ loan to Northern Rock has almost reached the level of the annual defence budget and is increasing every week by £3 billion—the equivalent of 15 hospitals—what guarantees has the Prime Minister received that this money will be fully repaid, beyond the vague assurances offered by Mr. Branson and the assorted collection of hedge-fund sharks who are behind him and others?

The NHS today

Sub-standard care, staff shortages and higher levels of obesity are resulting in the highest death rate among new mothers for 20 years, according to a damning report to be published this Tuesday. By Jonathan Owen and Ian Griggs

Published: 02 December 2007

Record numbers of women are dying during pregnancy or shortly after childbirth, with maternal deaths in the UK at their highest for 20 years.

The findings are revealed in a new report, Saving Mothers' Lives, from the Confidential Enquiry into Maternal and Child Health (Cemach) to be released on Tuesday. Almost 300 women died in childbirth between 2003 and 2005 from conditions relating to pregnancy, leaving 520 children motherless. In a damning verdict on the substandard care that is putting women's lives at risk, the report, seen exclusively by The Independent on Sunday, cites "avoidable factors" that have contributed to the death toll.

It condemns "the number of healthcare professionals who appeared to fail to identify and manage common medical conditions or potential emergencies outside their immediate area of expertise".

It goes on to say that "resuscitation skills were also considered poor in an unacceptably high number of cases" where women died, and that the maternity system allowed "inappropriate delegation to junior staff", which hampered the medical care mothers received.

Cemach also calls for pre-conception counselling and advice for obese women, who are at higher risk of complications during pregnancy.

The report reveals that the mortality rate among mothers giving birth is up to almost 14 per 100,000 people – an increase of more than 50 per cent since 1985-87. Repeated reports highlighting fundamental failings in maternity care have failed to reduce the rate of maternal mortality – and women continue to die from common and curable infections. The number of women dying from heart disease has more than doubled since Cemach's last report on deaths from 2000-02. It has overtaken thrombosis as the most common cause of maternal death, in what the latest report says "reflects the growing incidence of acquired heart disease in younger women related to poor diets, smoking, alcohol and the growing epidemic of obesity".

Political funding

When the Save Bedford Hospital party registered with the Electoral Commission, it was made absolutely clear to us what the rules are, and what the penalties are for not following them. I (as party treasurer) get a letter every three months reminding me to update our declaration on both donations and loans, and another reminder if we don't respond to the first one.

The Electoral Commission has a web site which explains all the rules very clearly. The staff, if you phone them, cannot be more helpful.

In summary, it is not possible to get things wrong "by mistake".

Our party is run by a small bunch of amateurs, and we can get things right without too much bother. If they can't run the Labour party, can they actually be trusted to run the country?

Apologies

I haven't updated the website for a few days, not because there is no news (there is plenty), but simply because I have been very busy.

Rest assured that I'll keep you all informed.

Meanwhile thanks to Riseley Cricket Club for having me as their guest speaker last Thursday. It was amost enjoyable evening.

Terracotta army

I have recently been to the excellent exhibition at the Britsih Museum. You do wonder what sort of mad despot surrounded himself with fake supporters; but then I started wondering about Gordon Brown, and how he feels when he looks at his cabinet.

Perhaps he would do better if he found a team who were actually able to think for themselves and to speak up when things are going wrong.

Just so...

This is from SJ Howard's web site: I think he sums things up perfectly

They’ve lost half the country’s bank details, can’t keep track of our cars, publish doctors’ intimate personal details online, drop customs documents in the street, misplace laptops with personal data on them, and don’t even bother with passwords on their computers.

They lost this most recent data by sending it on couriered CD-Roms, which is certainly against policy, and possibly illegal. It’s also the way they lost Standard Life and another banks’ customer details earlier this month, and UBS’s customer details in 2005.

Of course, we already know that Government can’t learn from mistakes, since they rehired the company behind the ‘not fit for purpose’ MTAS computer system.

Now they want us to trust them with our health records and even our identities.

Is this Government serious?

And so to bed

Hospitals across the east of England have been placed on "black alert" as staff and wards are overwhelmed by high patient numbers.

Non-urgent cases have been sent home after up to 10 ambulances were left queuing outside one hospital.

Few or no beds are free at Queen Elizabeth Hospital, King's Lynn, and the James Paget Hospital in Gorleston, both in Norfolk.

People with minor injuries have been urged not to attend A&E.

Beds blocked

The alert status means plans designed to enable staff to cope with major incidents, such as terrorist attacks and train crashes, are put into action.

At the Norfolk and Norwich University Hospital (NNUH), which announced it had reached the emergency status on Wednesday afternoon, managers worked with other agencies to discharge non-urgent patients from the 1,000-bed hospital to create space.

However, the hospital said that between 60 and 70 beds were still being blocked because patients who were medically fit to leave had no where to go.

Paramedics treated patients in ambulances outside the NNUH on Wednesday evening.

'Diarrhoea and vomiting'

A spokesman for the East of England Ambulance Service said: "Most things we can manage - it only becomes critical to get someone out of the ambulance and into the hospital if someone is bleeding to death or in full cardiac arrest needing resuscitation.

"There were serious condition patients but they were being treated at the NNUH by hospital staff."

NNUH spokesman Andrew Stronach said there was no single incident that brought on the beds crisis.

HOSPITAL ALERTS Amber alert: Early warning of pressure increase in the normal activity. Red alert: Escalating pressure in one or more part of the system continuing to increase. Black alert: Contingency measures are exhausted and pressures are not sustainable.

"It's just general run of the mill problems, like chest pains, collapses, diarrhoea and vomiting."

The James Paget hospital and the Queen Elizabeth in Kings Lynn said there were sufficient beds, but a sudden change in the weather was putting extra pressure on them.

Norman Lamb, MP for North Norfolk, said the hospital was regularly well above the safe occupancy level of 85%.

He said: "If there was to be a flu epidemic this winter then we've got a major crisis.

"Across the country we're seeing occupancy rates increasing. There's also evidence that you run an increased risk of hospital acquired infections if you've got a hospital that's literally full.

"This is a serious problem and yet there appears to be nothing being done to increase the capacity to ensure that there's enough beds to treat patients."

Lack of staff

Milton Keynes and Hertfordshire health officials have said they are not on alert, but Bedford Hospital has been on red alert since Friday.

In Suffolk, Ipswich Hospital said it had very few beds but was managing the situation and a spokesman for the West Suffolk Hospital said its alert had been caused by sickness bugs.

In a statement Addenbrooke's Hospital said it had been on black alert, but by Thursday morning it was no longer on high alert, and a bed managing scheme had been implemented.

For sale

On E-bay

Open Government

Gordon Brown promised us more open government; I had not appreciated that that extended to everyone's bank details being available.

Well I suppose it is the pantomime season.

This is worth reading...

...From today's parliamentary debate on Northern Rock

Dr. Vincent Cable (Twickenham) (LD): I do not know whether the Chancellor has been singing in the bath, but he does bear an increasing resemblance to the former Conservative Chancellor, Norman Lamont, who presided over a comparable financial disaster.

I want to focus on the £24 billion loan—£900 for every taxpayer—which is over and above the £18 billion deposit guarantee, which is less controversial and which we all support. The former Prime Minister, Tony Blair, was widely criticised for advancing £800 million for the millennium dome. In the past few weeks, the Government have provided the equivalent of 30 millennium domes to this bank, without even the prospect of a decent pop concert at the end of it.

The key question, which I put to the Prime Minister last week, is this: is the lending secured? He said that it was. Will the Chancellor confirm, however, that that is not the case? Of the loan, £13 billion has a first charge security, although at a more relaxed standard than is normal; £11 billion, however, is wholly unsecured. Half the assets of the bank have been packaged up by a company called Granite, which is registered in the Channel Islands and has the first claim on the assets. The remainder is a collection of mortgages, many of which were advanced at the peak of the property market and are now of declining value. I therefore return to the question that I put to the Prime Minister, and that has been partially put to the Chancellor already. Will he stand up and give an absolute guarantee that the loan will be repaid in full, with full interest, within the lifetime of this Parliament?

Will the Chancellor also comment on the management of the company? Does not Mr. Adam Applegarth, who has just been dismissed, now have a pension pot of £2 million and various bonuses, which are underwritten by the taxpayer? Will the Government explain how they got into a position in which they have entrusted £24 billion to a management team that was discredited, that led the bank into its present crisis, and whose chief executive showed such contempt for his own bank that he sold his own shares to invest in a country estate and a Ferrari for his wife?

That is not the only conflict of interest. An attempt is being made to sell the bank, led by the company. The company has a clear conflict of interest. It is in the interests of the directors and the management to maximise the taxpayer’s contribution. The taxpayer’s money is being used to prop up the bank, and to provide a profit opportunity for spivs in the City.

Jinxed

Asked if the Prime Minister was going to be at the England v Croatia game on Wednesday, the Prime Minister's Spokesman said that there were no current plans.

Asked why that was, as he had gone to the Scotland game at the weekend, the PMS said that the Prime Minister could not go to every match but obviously these things were kept under review. The PMS went on to say that some people had argued that the Prime Minister had not necessarily been the best of omens so far but he would let others make that judgement.

Nice work if you can get it

Adam Applegarth, Chief Executive of Northern Rock did pretty well out of Northern Rock shares in the year before it collapsed. He has trousered many millions over the years, allowing him to enjoy an Aston Martin with a Ferrari for his missus parked in the driveway of his mansion. His confidence in his bank's business model long term is demonstrated by his selling of £1.5 m of shares in two days. (25 Jan 2006 sold 52,253 at 957p for £500,061.21 and the next day he sold another 111,426 at 957p for £1,066,346.82).

His faith in the business was shown by his purchase last April of just 262 shares worth a little under £3,000. Not a lot of faith in the business from the boss was there?

Enron's crooks were massive financial supporters of the Republican party. Northern Rock gave half-a-million to Labour's favourite think-tank, the IPPR. It also employed Gordon's personal pollster, Deborah Mattinson, as an adviser. Of all the pollsters to seek advice from, why her? Why give money to that think-tank? Nowadays it is very rare for publicly quoted companies to make politically partisan donations.

Gosh

From today's Guardian:

The NHS chief executive yesterday said he was "scandalised" by the £250,000 awarded to the manager of the hospital trust responsible for Britain's deadliest superbug outbreak.

David Nicholson also warned that health bosses risked losing touch with the real world. He told NHS leaders yesterday that he had been "scandalised" by the episode and said it created a powerful impression in the public mind of health service managers feathering their own nests after 90 people were killed by Clostridium difficile bacteria linked to failings in infection control at the Maidstone and Tunbridge Wells trust in Kent. Nicholson told the boards and senior managements of health trusts to reconnect with popular opinion: "One of the things that came out of [the Kent case] for me was that sometimes we lose perspective in the NHS about what our public really think about us."

Just like that

With thanks to my friend Dr Rant

If I suddenly disappear

Gordon Brown makes much of his Presbyterian upbringing, but what happens in his brave new world to non-believers? I think that I have just found out.

I make no secret of the fact that I have been critical of some aspects of the implementation of the new Labour project for the NHS. I have, for example, criticized the rather reckless way that the extra funding for the service has been squandered (although here my views have recently been endorsed by Sir Derek Wanless and the King’s Fund); I have criticized the massively overspent NHS IT programme (where my views have been endorsed by the House of Commons Select Committee on health, and by the National Audit Office); I have criticized the relentless pursuit of targets as an end to themselves, and have pointed out some of the incidental casualties that this policy has produced. I have also pointed out the destabilizing effect on a hospital such as Bedford of putting all the medical secretaries on redundancy notices.

What I have said has never been less than the truth, even if at times it has been a harsh truth for some officials of the Department of Health and for government politicians. My intention has never been anything other than to open up public debate on the conduct of a vital public service.

A few weeks ago (5^th September to be precise), I was summoned by the chairman of Bedford Hospital NHS Trust, Ray Rankmore, to his office. Mr Rankmore has a reputation for speaking frankly so I was interested to hear what he had to say. “In business” he told me “ if management think there is someone who isn’t 100% behind them, they get rid of them; they call them in and they get rid of them, just like that”. He repeated the “just like that” for added emphasis. “In the NHS, we can’t do things quite like that, so we have to do things somewhat differently.”

So there you; make up your own mind. But if I mysteriously disappear you might just ask Mr Rankmore where I’ve gone.

Yesterday...

Yesterday the price of gold went even higher (Gordon Brown sold our reserves off at a rock bottom price), and the Northern Rock share price went down by another 7%

So much for financial prudence; if this is prudence, give me a touch of recklessness any time

Cameron's bullseye

This was David Cameron in today's debate on the Queen's speech:

It is all short-term tricks instead of long-term problem solving. Let me take just one example: the Prime Minister’s pledge to “deep clean” our hospitals. Here is the headline from one newspaper—it is just what he wanted:

“I’ll wipe the wards clean—PM’s amazing pledge on MRSA”.

When we look at it more closely, it certainly is amazing. The Prime Minister said that “deep cleaning” would happen in “every hospital”, but listen to what the Department of Health said:

“There are no plans to centrally monitor the deep cleaning of hospitals. Arrangements for the programme are entirely a matter for local determination”.

[Interruption.] Wait. The Department of Health went on:

“Undertaking deep-clean is just one of a number of approaches trusts may take in tackling healthcare infections.”

It gets worse. The Prime Minister said that deep cleaning would happen “over the next year”, but the Department of Health said that

“no specific date has been set for either the commencement or completion of the deep-clean programme.”

The Prime Minister said deep cleaning would be repeated “every 18 months”, but the Department of Health said:

“The success of the first programme of deep cleaning will be fully evaluated before a decision is made about whether to repeat.”

Then it said:

“There are also no plans to assess the effectiveness of deep-cleaning.”

Therefore, all the things that the Prime Minister told us—that it would happen in every hospital, start immediately and be repeated every 18 months—turned out not to be true.

What a complete shambles. People are worried about going to hospital and catching a disease that might kill them, and all they get from the Government are short-term tricks. I will tell you, Mr Speaker, what needs a deep clean: the culture of spin, deceit and half-truth that we get from the Government.

Prudence?

We are constantly told how prudent Gordon Brown has been with our finances.

Yet it was Gordon who sold 60% of our gold reserves at $260 an ounce, when today's price is $800
and it was Gordon who wrecked the pension industry, not to mention the Northern Rock sage.

If that is prudence, let's have a touch of recklessness.

Feeling sick

Look at the purple line on the graph; it shows the number of people of working age who are on long term incapacity benefit.

In 1984 it was about 1million, now it is 2,700,000.

So thanks to all the medical advances we have made, an additional 1,700,000 adults of working age are too ill to work.

We may be hitting the performance targets, but it doesn't say much for our ability to restore people to functionality.

And for those of us bearing the enormous tax burden, well it's enough to make us feel ill.

Off Target

As a medical student in the early seventies, I spent a happy day in Kent exploring two long abandoned institutions – the Joyce Green Smallpox Hospital (closed in 1948) and Long Reach ; the latter was so called because it was the furthest point up the Thames Estuary that a ship showing a fever flag had been permitted to travel. It appeared to us that in an era of immunization and of antibiotics, infectious disease was as much part of medical history as leeches and chloroform.

It seems quite remarkable that in thirty years we have seen advent of AIDS, SARS, and bird flu; even syphilis, a disease that was close to extinction has re-entered the dermatologists differential diagnosis. Those, of course, have been conditions which have been largely out of the control of doctors and health planners, but the same cannot be said of the most recent scourge – Hospital Acquired Infection, a phenomenon that many of us thought had disappeared with Lister, Semmelweis , and Florence Nightingale. Nowadays it is hard to turn on the TV or open the newspaper without hearing the latest horror story about MRSA and Clostridium difficile ; when you talk to patients you realize how very afraid many of them are, and any of you who have ever seen a patient with C diff will know just what a truly horrible condition it is.

According to the Health Protection Agency (www.hpa.co.uk) there were over 50,000 cases of C diff infection in England in 2006, and given that it has a mortality of some 10% , that is far more deaths than occur through road traffic accidents, or malignant melanoma, or AIDS; it’s a Harold Shipman every fortnight. Attention has been drawn to the catastrophic events at Maidstone and Tonbridge, and at Stoke Mandeville, which were investigated by the Healthcare Commission, but twenty other hospitals (including my own) had infection rates higher than those in Maidstone. Politicians have been quick to blame doctors for not washing their hands and for being profligate with antibiotics, but is this the real answer? I suspect not. Remarkably, the C diff epidemic sweeping through the English NHS has not been seen in Wales; this is not, as far as I know because Offa’s Dyke or the River Severn have any magical antimicrobial properties, nor that Welsh doctors make freer use of soap and water, or make less use of antibiotics.

The only difference in practice that would explain the phenomenon is that the Welsh NHS has not become such a slave to politically driven access targets. In my own hospital, as in many others, the eagerness of managers to avoid “waiting list breeches” is that patients, usually ones awaiting non-urgent elective surgery are admitted to wards that are already bursting at the seems. Bed occupancy rates of close to, or even exceeding 100% are commonplace, yet the evidence of an association between high occupancy rates, short bed vacancy intervals and high rates of hospital acquired infection are well known. Patients are, all too frequently admitted to inappropriate wards and are moved all too readily from ward to ward. Only recently I saw a nice lady who was on her fourth different ward in 48 hours, and who, although she was quite lucid in every other way, no longer knew where she was. The whole situation is just an accident waiting to happen.

The government’s failure to tackle the problem is a disgrace; they talk vaguely about “deep cleaning” wards (whatever that means) without evidence that it is an effective remedy.

It is time for the medical profession to insist that achieving political targets cannot be allowed to endanger patients lives; if that upsets a few politicians, then so be it.

What hope is there...?

What hope is there for probity in public life when you read stuff like this:

The government's chief spending watchdog, Sir John Bourn, yesterday announced he would retire, two weeks after coming under fire for running up hundreds of thousands of pounds in expenses.

Ministers expect to tighten up the rules for his successor as comptroller and auditor general when an inquiry into the governance of the National Audit Office reports. The NAO said his decision was unconnected to the expenses row.

Sir John is the chief investigator into Whitehall waste and extravagance. But his travel and entertainment records - published in the Guardian earlier this month - revealed he spent £365,000 on foreign visits in three years, in some cases flying first class with his wife. Over the same period he ran up a meal account approaching £27,000 including lunches and dinners at the Ritz, Savoy and Dorchester.

Lies, fantasy and rubbish

I quote the following verbatim from Hansard, the official record of parliament. This was a question and answer in Prime Minister's questions today:

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

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

What is the evidence for Mr Brown's bold assertion? In fact it is complete nonsense. I am not aware of a 17% reduction of cancer, and I doubt that there is any evidence that cancer incidence has changed because of government targets.

Prudence?

Primary Care Trusts were set up in 2002 or thereabouts,in a blaze of euphoric management-speak,by Alan Milburn.Within four years they are deemed too small to be viable,and are yet again re-reorganised into larger units.
Redundancy costs alone are said to be £38,000000.The average payout to board members of PCTs is in excess of £300,000,many of whom have taken immediate re-employment with the NHS.
Yet another example of prudent government stewardship of the NHS and the nation's finances?

And don't forget whose money it is!

From today's Guardian

Trusts raided public health cash in panic over funding

John Carvel, social affairs editor
Friday October 19, 2007
The Guardian

NHS trusts across England syphoned off almost £100m from government funds intended to combat obesity, alcohol abuse and sexually transmitted infections as a panic measure to escape financial crisis, public health chiefs revealed yesterday.

The money was earmarked for primary care trusts to help them promote healthier lifestyles, improve sexual health services and appoint more school nurses. But a survey by the Association of Directors of Public Health has established that most of last year's allocation was raided to compensate for overspending on trust budgets for hospitals and GPs.

---

Data provided by 103 PCTs showed that half axed almost all the projects promised by the government in the Choosing Health white paper in 2004. Less that 10% of PCTs used the full public health allocation for the intended purpose.

The association said the 103 PCTs, covering more than two-thirds of England, were supposed to spend £141m on projects which should have included alcohol treatment services and action to combat obesity by promoting better diets and exercise. In the year to March the PCTs ended up spending only £46m, saving almost £100m for other purposes.

In spite of increasing alarm about obesity and rising rates of chlamydia infection, finance directors found it easier to cut public health programmes than make economies in hospital services and GP practices with big overheads and rising wage costs.

The public health allocation for England increased to £341m in the current financial year, but the survey forecast that only 28% of this money would be spent as the government intended.

The PCTs have complete discretion on how to spend their allocation.

Tim Crayford, the association's president, said: "Three years after the white paper, funding intended to tackle preventative health problems is still being used to pay for financial deficits in some parts of the NHS." Instead of preventing the dangers, the health service was spending a fortune on treating the medical consequences. "With funding [available] at grassroots level, the government should make sure it is ring-fenced so that it can be used for its intended purpose."

This week the government abandoned its 1997 election manifesto pledge to halt childhood obesity by 2010; the Foresight report said tackling obesity could cost £45bn a year and take 30 years to turn round.

The Choosing Health white paper included plans to spend £20m in 2006-07 to provide a full-time school nurse for every cluster of primary schools. "This commitment will be crucial to the...delivery of the obesity target and targets on health inequalities," it stated.

Other government priorities included £56.5m to modernise sexual health services, £35m for chlamydia screening, and £21m for action on diet, activity and obesity. The association's survey found little of this money had got through.

But a Department of Health spokesman said: "We do not agree with ring fencing [which would mean that] the amount of money spent on individual programmes in each area of the country would be determined centrally from Whitehall." The government had delivered 135 of the 190 public health commitments, he added.

Clostridium difficile - whose fault?

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

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

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

I quote these hospitals just because they are local, but it is clear that there is a huge national problem in the English NHS. I say English, because curiously Wales has not been similarly affected. Why is this? As far as I am aware Offa’s Dyke and the River Severn have no magical antibacterial properties, and indeed in parts of the West Midlands it is routine for English patients to be admitted to Welsh hospitals and vice versa.

There is only one obvious difference between hospital medical practice in England and in Wales, and that is that in England there has been a rigid application by hospital managers of waiting list targets.The impact of this obsession with targets is that there has been an insistence on admitting non urgent patients even when there is a bed shortage, and even when wards are contaminated by infected patients. Wards were not designed for occupancy rates close to 100%, and the reason for this is that when occupancy rates rise, so does the risk of hospital acquired infection.

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

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

Tip of the iceberg

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

This suggests to me that there is some more generalized problem; the details of infection rate are available from www.hpa.org.uk

Here are the numbers...

...of deaths from C difficile in England and Wales, year by year. This is not a problem restricted to a few hospitals.

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

At a hospital near you

If you have ever seen a patient with Clostridium difficile diarrhoea lying in their own excrement it is not something you will ever forget, or ever wish on your worst enemy.

This startling comment from the Healthcare Commission's report into events in kent makes it clear that this could easily be happening all over the place. Bedford Hospital (where I must say the cleaning staff are very hard working) is certainly not immune to the problem.

“The investigation into the outbreaks at Maidstone and Tunbridge Wells NHS Trust has thrown up a number of similarities with the findings of our previous investigation into outbreaks of C. difficile at Stoke Mandeville Hospital, part of Buckinghamshire Hospitals NHS Trust. Both trusts had undergone difficult mergers, were preoccupied with finances, and had a demanding agenda for reconfiguration and private finance initiative (PFI), all of which consumed much management time and effort. They also had poor environments, with many dormitory style wards and few single rooms which could be used for isolating patients with infections. In both we observed unacceptable examples of contamination and unhygienic practice. Additionally, the impact of financial pressures was to reduce further already low numbers of nurses and to put a cap on the use of nurses from agencies and nursing banks. There was unrelenting pressure to reduce the number of beds. Thus, both trusts had very high occupancy levels, could not manage with fewer beds, and so had to open ‘escalation’ beds, often at short notice and in unsuitable environments, without proper support services and equipment in place and, by definition, without permanent staff. The effect of all this was to compromise seriously the control of infection and the quality of clinical care. While it should be noted that improvements have subsequently been made at Stoke Mandeville, it seems unlikely that these similarities are coincidental. We are concerned that where trusts are struggling with a number of problems that consume senior managers’ time, and are under severe pressure to meet targets relating to finance and access, concern for infection control may be undermined.”

Keeping busy

In the last week, in addition to regular postings on this site I have:

Featured on Chiltern FM
Featured (twice) on BBC Three Counties radio
Held a public meeting for the Save Bedford Hospital party
Delivered several hundred election leaflets explaining about our campaign.

Now that Gordon has chickened out of having an election, I am going to keep campaigning.

I have been invited to be guest speaker for a local cricket club dinner, next month, have been invited to speak to a national GPs meeting in January, and to a medical society in London in February.

Please keep contributing your comments, and please tell your friends about this site

Chicken

So Gordon Brown has chickened out of an election.

Let me remind you that Gordon Brown is an unelected Prime Minister: that's the sort of thing they have in North Korea, not a major democratic nation. Indeed he wasn't even elected by his own party.

Gordon Brown said that he wanted the election to be held on the NHS: well, we were ready to tell the public what a shambles he has made of the NHS. When we do have an election, we will still be ready.

A journalist' s view

Nick Robinson, the BBC political correspondent has just posted this on his website:

Key to today's NHS review is giving patients access to services when they need them. Funnily enough I've just been putting that to the test in Blackpool, so here's my input to the Darzi review.

Finding myself without my asthma inhaler when I needed it in the middle of the night I ring NHS Direct for advice on how to get another. Having answered a dozen form-filling questions (none of which include the basic "what do you think you need?") I am then advised to call another number for an out-of-hours doctors service.

Not wishing to waste a doctor's time in the middle of night I decide to wait till the morning. I go to the local chemist and wave my empty inhaler and wheeze loudly. You need a prescription they say. So I go to the doctor's surgery who say they can get me a prescription if I can wait till three o'clock, or I can go the NHS walk-in centre. Off I go only to be told they don't issue prescriptions there and I need to go somewhere else. Everyone I've spoken to has been pleasant but yet ultimately not helpful.

I've given up and am wheezing my way home.

So a young, intelligent, articulate journalist can't get the system to work; what hope is there for those who are poor, sick, inarticulate, or immobile?

THIS IS WHY WE NEED TO CHANGE THE POLITICS OF THE NHS

Open for business

In an effort to create a good photo opportunity, the Prime Minister today cut the ribbon to ‘open’ the Essex Cardiothoracic Centre at Basildon Hospital. But the Hospital had in fact been opened three months earlier. Gordon Brown even dragged back a patient from the first opening in July to help him cut the ribbon.

But...

* In June, the Hospital Trust published a newsletter announcing that the keys of the building had been handed over in a photo shoot
* On 1 July, the Centre announced it had official opened and began treating patients. Government websites confirmed the opening.
* On 2 July, the Trust put out a press release welcoming the first patients
* On 4 July, the local paper – The Brentwood Gazette – announced the opening to readers
* On 11 July, the NHS Trust put out a press release announcing a successful ‘first week’ of operations
* On 30 July, the Trust published another newsletter showing Heath Secretary Alan Johnson had officially visited the new Centre
* In August, the Trust announced that health dignitaries ‘officially opened’ the Education Suite at the Centre


Commenting, Shadow Chancellor George Osborne said:

“In the last ten days alone, we’ve had fake announcements; fake photo shoots; and fake troop withdrawals. Now, after a hundred days of spin, Gordon Brown has set a new low by faking a hospital opening.”

“Gordon Brown’s big health launch is rapidly falling apart. How can you trust a Prime Minister who even fiddles a photo shoot?”

A patient's view

A patient copied us in on a letter to the head honcho at the Choose & Book HQ.

Here are a few 'choice' excerpts:

After several phone calls I successfully arranged an appointment at Hospital X

A week later I received an undated letter stating that this appointment had been cancelled "due to unforeseen circumstances" and that "a new appointment will be posted". The explanation is pure bureaucratic gobbledegook which tells the patient nothing - which is, one assumes, the intention.

I then received a letter offering me an appointment at Hospital Y. No mention was made of Hospital X, my preferred 'choice'. When I phoned for an explanation I was told that Hospital X does not offer the service I need.

Why give me an appointment at Hospital X if they don't provide the service? And when the error was spotted why not offer me an explanation?

I then received another appointment, this time for Hospital X which, as you'll see above, does not offer the service. Which of my two appointments should I attend?

I have a lifetime's experience of dealing with mindless bureaucracies and this one takes the biscuit. My complaint is not about your very courteous staff, but about your system which, I invite you to agree, seems to be completely defective. How do seriously ill or confused patients cope with this?

To cap it all, several weeks after this started, I have now received another letter, signed by you, berating me for not having booked my appointment yet!

This letter is being copied only to my GP. Before advising a wider audience of the major shortcomings in the way the 'Choose & Book' system operates I would welcome your comments.

Election fever

So Gordon Brown is promising us a 'More Personal NHS' is he? Needless to say he didn't go into specifics, but if you extrapolate what his party has done in the past 10 years you get a pretty clear idea of what he's on about:Evidently, a personal NHS is an NHS where flexibility and motivation are completely removed from the careers of its workers.It's an NHS where targets are based on politics and finances, and where patient care doesn't matter a jot - the figures can be tweaked to make it look as though patients are getting a good deal when they're actually being used as pawns in a political game.It's an NHS where the public's hard-earned taxes are wasted on PFI deals and management consultancies instead of on healthcare.It's an NHS where billions of pounds of public money is wasted on failed IT projects.It's an NHS where talented doctors are forced into posts they don't want, or chucked out of the system if they don't strike it lucky.It's an NHS where nurses and physios can perform doctors' roles, but only if the patient fits the rigid protocol.It's an NHS where the top-class service used to be based on the motivation of juniors keen to achieve, and the goodwill of seniors keen to provide an excellent service... but such activities are no longer permitted.It's an NHS which tried to get a better deal from GPs by grossly underestimating the work they do, then launching a hate campaign against them because they achieved above and beyond the government's expectations.It's an NHS which pushes patients from pillar to post, wasting money, time and resources instead of providing the professional care and input which is required.

This article first featured on Dr Rant

Keep listening

I have just done an interview with Chiltern FM, which I hope will be broadcast tomorrow morning; and don't forget the meeting tomorrow night.

PS Dr Rant seems to be very cross this morning (or should I say even more cross than usual)

Between a Rock and a hard place

I have been catching up on my reading, and have only just realized that Sir Derek Wanless, who advised Gordon Brown five years ago how to spend all that extra money on the NHS (our money, may I remind you) and who recently (in a King's Fund report) told us that most of it has been wasted, is also, in his spare time a non-executive director of the Northern Rock bank.

Northern Rock is a salutory reminder that much of NuLabour's reputation for financial prudence is a fig leaf; indeed the party itself is hardly an example of financial prudence. Perhaps we should start calling it NuLabourLite.

Comments please

Our shrinking economy

I am grateful to Iain Dale for the following:

There was one bit of the Brown speech on Monday that caught my eye, but which no one seems to have remarked upon, and it was this sentence:

We should take pride that, under a Labour government, Britain - this small number of people on this small island - is the fifth largest economy in the world.

Didn't we always use to say we were the fourth largest? This happened, of course, under Brown's watch -- in Dec 2005. I think it's strange no one's pointed that particular line out -- seems a strange thing to boast about. 'Under this Labour government, we’ve lost our position as the fourth largest economy in the world…'.

Waiting for Gordon

The Prime Minister says that he wants the NHS to be his battleground for the next election : good.

Then he can start explaining the wasted billions (as cited by the King's Fund and Sir Derek Wanless), the disaster of PFI, the useless management consultants charging hundreds of millions for very little, the £20billion NHS IT fiasco (for a system that doesn't work).

He can also explain why Choose and Book prevents patients being seen in the hospital of their choice or by the consultant of their choice; he can explain the perverse effect of waiting list targets and the "4 hour rule" which actually costs lives, and the spectacular increase in hospital acquired infections, largely attributable to running hospitals at capacity levels for which they were not designed.

Yes, we are ready for an election; the leaflets are ready for the printers, the badges have been ordered, and the canvassers are ready.

Name the day, Mr Brown.

Don't forget

Tuesday 2nd October, Biddenham Village Hall, 8 p.m

Getting personal

So Gordon Brown tells Andrew Marr on TV today that he wants NHS care to be "more personal" (his words not mine)

So how can that be achieved when our hospital tells GPs that it wants them to no longer refer to consultants by name ( Dear Mr Smith, Dear Dr Spratt, etc) even if that is their, or their patients wish; indeed for some departments such as ENT and orthopoedics it isn't allowed at all anymore.

Meanwhile Brown's health minister Lord Darzi thinks that local hospitals should be shut and replaced by regional superhospitals, where he plans that operations should be done by robots.

More fatuous nonsense from the supreme leader, it seems.

Public opinion

A medical friend has just sent me this:

Yesterday evening I had an insight into the workings of Nulabours "consultation" process on the planned closure of NHS District General Hospitals and replacement with dumbed down polyclinics.

A few weeks ago invitations to attend a public consultation were sent to consultants at our Trust. We were only given one day to reply for the meeting a few days later even though we have to give 6 weeks notice of leave because of "choose and book".

Obviously this meant that most of us could not attend but one consultant did take up the invitation.

The location of the meeting was kept secret until three days before the event and when this consultant was eventually told the location and turned up in Birmingham it turned out that medical staff were outnumbered 2:1 by laypeople specifically chosen by an agency to attend the event. The media were present and had obviously been invited to publicise the event.

The delegates were split up into groups and each allocated an electronic voting device. A "minder" was allocated to each group.

Then the stars of the show arrived: Gordon Brown, Alan Johnson and Ara Darzi.

There followed a rapid succession of questions from the podium on which the delegates were asked to vote. The minder was available to suggest the best answer if there was any doubt.

Strangely, almost all the votes were 2:1 in favour of Nulabour's policy. Even the question: "Would you prefer gynaecological surgery to be carried out in your GP practice even if it meant the closure of your DGH facility?" was answered with 2:1 in favour.

Following the "consultation" the medical delegates were told to leave but the other 2/3 of the audience were kept back and each given an envelope. My colleague was intrigued by this and managed to catch one of the "chosen ones" and ask about the contents. Each envelope contained £75 in cash!

So now the consultation is over and the results indicate there is overwhelming public and doctor support for closing down the DGHs. I can only say that the way the voting was done makes the "Blue Peter" voting fraud seem like, well, "Blue Peter".

So now you know how it works

Tuesday October 2nd

Don't forget to put this date in your diary; the Save Bedford Hospital party is having a public meeting at Biddenham Village Hall, Nodders Way, Biddenham at 8 p.m

Admission free, all welcome

Come and hear the real story of what is going on.

Where's the money gone?

www.order-order.com is a website that is not for the fainhearted (see under Guido Fawkes in the "links" column), but today they have produced this masterpiece. I commend it to you:

Boom to Bust : A Political Bail-Out

On 12 September 2007 in a paper submitted to the Treasury Committee by Mervyn King, Governor of the Bank of England, he warned the City: “…the moral hazard inherent in the provision of ex post insurance to institutions that have engaged in risky or reckless lending is no abstract concept”. On September 13, 2007, the Bank of England, pushed by HM Treasury and with the acquiescence of the Financial Services Authority, bailed out mortgage lender Northern Rock. What caused this about turn?

Nobody in the City was surprised by Northern Rock's difficulties, but many were surprised by Mervyn King's overnight U-turn. His stated policy of avoiding moral hazard was prudent and generally accepted in the Square Mile as wise and right. Foolish risk takers should suffer when they get it wrong.

In 1995 Barings collapsed. The Bank of England did not bail it out. Imagine the outrage if a Tory government bailed out the Queen's bankers, "Tory toffs looking after their own pin-striped aristocrats" would have been the charge. Central Banks should only intervene when their is systemic risk to the financial system, not to bail out shareholders when things go wrong. Northern Rock put too many eggs in the mortgage securitisation basket and offered mortgages at slim margins. That strategy is now shown to be risky and unsustainable. So why bail it out?

Northern Rock is not merely the victim of illiquidity in the money markets as Alastair Darling spins, investors knew something was wrong months ago, the share price tumbled long before the sub-prime crisis made the headlines. Nor can you argue that the collapse of the Northern Rock would cause systemic crisis. The mortgages would be administered, the householders would barely notice a change in ownership and it is inconceivable that other banks would suffer contagion.

The economic arguments against a bail out such as this have been impressively made by Mervyn King himself, the special circumstances argument is patently political spin. So isn't it more likely that this is a political decision forced on the Bank of England by Gordon Brown and Alastair Darling to spare their blushes?
Northern Rock is a regional bank from Labour's North-Eastern electoral heartlands. Labour supporting figures are on the board. Sir Derek Wanless, Gordon's favourite banker, chairs the Risk and Audit committee. Sir Iain Gibson sits on both those committees and was appointed by Gordon to the Court of the Bank of England. As far back as the miners strike it has been seen as a "Labour" bank. In the eighties Conservative ministers were furious when striking miners were told not to worry about their mortgages by Northern Rock - removing a pressure on them to return to work. The Labour movement lauded them for it and for their giving of 5% of profits to North Eastern charitable projects.

Guido suspects that the Treasury pressurised Mervyn King, against his better judgement, to bail out Northern Rock for political reasons. Brown's Britain is a bigger version of Northern Rock. Gordon's macro-economic policies are Northern Rock's borrowing policies writ large. Gordon has mortgaged spending through PFI, government debt has ballooned and the consumer economy is floating on debt secured against over-stretched property prices. It can't go on

Where's Patricia Hewitt?

Former health secretary Patricia Hewitt is an MP for Leicester:

Campaigners are fighting to save the job of health chief Peter Reading who they fear is being made a scapegoat over the collapse of a massive revamp of Leicester's hospitals.

Peter Reading, chief executive of the University Hospitals of Leicester NHS Trust, is said to be on "unavoidable annual leave" and the trust did not know when he was due to return.

Mr Reading failed to appear at a public meeting at the Walkers Stadium on Monday despite it being publicly advertised that he would be there.

He did not attend a trust board meeting on Thursday, September 6 and the board was told he was ill.

Although no-one for the trust will comment further on the current position, patient watchdogs believe he is being forced out because of the collapse of the £711 million Pathway scheme to rebuild Leicester's three hospitals.

The scheme was scrapped in July when costs spiralled to more than £921 million and the trust said it could not afford to go ahead.

Rumours concerning Mr Reading's future have been circulating since the scrapping of Pathway project.

About 500 people are now planning to picket the meeting of the East Midlands Strategic Health Authority, in Nottingham, on October 18.

They will lobby the authority - responsible for overseeing health services in the region - to keep Mr Reading in the job.

Zuffar Haq, chairman of Leicester Patients' Group, is leading the protest.

He said: "I am very concerned that Mr Reading will be made a political scapegoat. It would be a total disaster if, through the interference of Government and strategic health authority, we were to lose one of the best chief executives in the country.

"In the time I have dealt with him, he has been open and honest and does listen to people.

"It will also jeopardise the future development of Leicester's hospitals, which people have been promised for so long."

When asked by the Mercury if Mr Reading had left, a trust spokesman said: "He is on unavoidable annual leave. I don't know when he will be back. He is still chief executive."

The Department of Health said that it has asked the Strategic Health Authority to carry out a review into what went wrong with the Pathway project, a private finance scheme to transform the three sites.

Mr Haq fears hospital development will be further delayed if a new boss is brought in to run Leicester Royal Infirmary, the General and Glenfield hospitals.

Mr Haq said: "The future of Pathway began to look vulnerable when the Treasury called for a review of schemes and put a ceiling on costs.

2nd October

The Save Bedford Hospital party has organized a public meeting to explain our views on what is going on in the NHS.

Do please come along; it's at Biddenham Village Hall, Nodders Way, Biddenham at 8p.m (Nodders Way is just opposite the Three Tuns pub.

(oh, and by the way, bring your friends)

Pouring money down the drain.

How much money is Bedford Hospital spending on its bid to become a Foundation Trust? Newspaper ads ( a four page spread in the Times and Citizen), radio ads, brochures, consultancy fees.

I think that we should be told. Let's face it, it's your money.

I feel a Freedom of Information request coming on.

Wakey wakey

A key plank of the £6.8bn NHS IT upgrade project in England has come under attack from MPs.

The Health Committee said there was a "worrying lack of progress" and raised concerns about the security of patients' electronic records.

...but why has it taken so long to wake up to what we have been saying for a number of years?

The King's Fund

Yesterday, the King's Fund, in the form of Sir Derek Wanless, reported on the state of the NHS.

In 300 pages he said what I have been saying for over a year - that all the extra money that has been spent on the NHS has largely been wasted.

Go back over my posts and you will see exactly how - management consultants, IT projects that don't work, targets that have nothing to do with patient care, PFI projects; this list just goes on.

This is exactly why my campaign is so important.

At a hospital near you

If you asked a hundred random employees in the NHS what they thought that the NHS needed, I suspect few of them would suggest yet another managerial reorganization. But that is just what we are in the thoes of. Our hospital managers are hell bent on us applying for "Foundation Status"; from their point of view it will no doubt be an opportunity for new job titles and pay rises. From the Department of Health's point of view it is a great opportunity to devolve problems ("not our fault, the're an independent foundation"). From the point of view of us poor foot soldiers the benefits are far from clear.

One of the hoops that they have to go though is to prove that they have local support and to sign up 4000 locals as "Foundation Trust Members". This is a bit tricky, so the way that our managers have done this is to announce that all employees (even if, as in the case of my clinical assistant you only work for the hospital three hours a week) are automatically deemed to be in favour of the applcation and to be "members". If you want to opt out of this you have to give the management your name and details of where in the hospital you work - which few are hardly likely to do when only a few months ago one in seven of the hospital's employees were on redundancy warnings. No such thing as a secret ballot.

So there you have the new democracy: you're automatically in favour, whether you vote for Foundation Trust status or now, unless you give then your name and put your head on the chopping block. Even the Iraqis had something closer to a democratic election.

Dr Rant is upset

The BBC seem to have upset Dr Rant!

Apparently, Whatsisface, you know the new Secretary of State for Health was on Radio 4's 'Today' program this morning. He agreed with John Humphrey's contention that:"GPs have too much of a 9 to 5 mentality."Sorry Humph, but I missed your incisive questioning because I was at work before 8am. I'll also still be at work after Radio 4's other paroxysm of half-arsed, sanctimonious pomposity, 'PM' has finished, and I do this 5 times a week.Well, in Dr Rant's opinion, John Humphreys has got too much of a '6am to 9am every other day' mentality. It appears that he only works 9 hours a week, yet still earns more than what he considers to be an outrageous amount for a mere GP to earn.The lazy, workshy, money-grabbing, sheep-shagging twat!

Is the worm turning?

Patients' needs have been ignored under Labour's reform of the NHS, the man who was tasked with protecting their rights believes.

Harry Cayton: 'We have taken a real step backwards' GP care has taken a "step backwards", while endlessly reorganising the health service has been a "waste of time and money", according to Harry Cayton, until last month the NHS "patients' tsar". He also accuses the British Medical Association of being against patient choice and says that GPs will change only if they are paid to. Mr Cayton revealed that he resisted pressure from ministers to produce a report supporting plans to reorganise and close hospitals because he could find no evidence that the proposals were driven by the needs of the public. He also said the job, which he held for five years, was hindered by a slew of policies that worsened the quality of care.

MMC again

A terrible way to treat our doctors
By Martin Wolf
Published: September 7 2007 03:00 Last updated: September 7 2007 03:00
"Modernising Medical Careers" is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service.
The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if
not a reactionary. Yet, like all systems of centralised planning,
this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.
Like most outsiders (and many insiders), I find it impossible to understand precisely what has happened, but having a daughter-in-law at the sharp end
has helped. The outlines at least are clear. They also offer a classic example of how a government-run monopoly behaves.
What, then, lay behind the fiasco that Modernising Medical Careers
has become? There appear to be
three causes.
First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.
Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.
Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.
As always, reasons existed for the shift to central planning: critics complained that the traditional apprentice system was riddled with favouritism; and the European Union's working time directive sharply cut hours for junior doctors, which not only necessitated a greater number of them, but also reduced the experience each would gain from a given period of training.
Some reform was presumably necessary. But this one is an object lesson in what happens when the government introduces a "big bang" shift to a centralised, computer-driven system. A bureaucratic monster replaced what had been a moderately flexible, albeit imperfect, system.
In the old system hospitals hired senior house officers; now they are sent them like a parcel of slaves. In the old system, if doctors did not get a job first time they could keep on applying; in the new system, they were to be given just one chance a year. In the old system, if they made a wrong choice it was relatively easy to change; in the new system, doctors must decide early and are then stuck with the consequences. In the old system, hospitals could change the mix of junior doctors relatively easily; in the new system, nobody knows what flexibility will exist.
Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must really
be joking.
To put the point bluntly, these highly trained professionals, on
whom you may depend for your
lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone
so treated?
To make the computerisation manageable, the doctors were allowed only very limited choices - far too few to eliminate random factors. As the chaos mounted, people were offered just one interview each.
The result was that those most likely to fail to get a job were the best, because they made the most desirable options their first choice. To make the computerised system "fair", much of the detail of people's careers and the detailed knowledge of those they worked for were also eliminated.
Centrally planned systems always eliminate latent knowledge, ignore human motivation and destroy flexibility. It was predictable that this Gosplan for the training of doctors would end up just as it has. It could not do anything else. This is a superb example of how the combination of centralisation of power with a belief in rationalistic planning works in the real world.
No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer. But bureaucrats are far too grand to be held accountable. It is doctors whose lives are disposable. Who cares that they have devoted up to a decade to the acquisition of knowledge and experience? Who cares that patients will be worse served? What matters is that the Department of Health is firmly in charge.
So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed.
Copyright The Financial Times Limited 2007

Thank you

Thanks to Boleyn Press for the excellent campaign leaflets which they have printed for me.

Financial prudence?

The government frequently crows about financial prudence: so how does it explain this?

The handling of a £1.5bn computerised farm payments scheme by two senior civil servants is condemned by MPs today as "a masterclass in bad decision-making" which could land taxpayers with a £500m extra bill. A highly critical report from the Commons public accounts committee accuses Sir Brian Bender, then permanent secretary at the Department for Environment, Food and Rural Affairs, of being "largely responsible" for the fiasco, which left tens of thousands of farmers without any cash from the European Union.

The fact is that that the government is totally profligate with your money. And don't forget it is your money (government's don't actually have any money of their own).

Is this fair?

A British member of the European parliament will continue to get £75,000 a year in salary and expenses despite being jailed yesterday for swindling £65,500 from the taxpayer in a five-year benefits fraud.

Ashley Mote was elected in 2004 as an MEP for the UK Independence party, but was thrown out of Ukip after the fraud charges. He sat as an independent and joined a far-right bloc. Mote, who represented south-east England, was jailed for nine months. He would have been expelled from the European parliament had he been jailed for 12 months or more.

No wonder politicians are held is such contempt

Public debate

I believe that politicians (and intending politicians) should be able and willing to answer challenging questions. But this is clearly not the prime Minister's view.

This conversation took place at today's Prime Ministerial press briefing:

David Grossman (Newsnight) : Prime Minister, on Breakfast News in 1987 you said that Margaret Thatcher should accept the then Leader of the Opposition's invitation to debate him live on television. You said it was only right for the British people to see the two protaginists debate each other. However, today you ruled out such a debate. What has changed in the intervening period?

Gordon Brown: Well, er, you know, er... blah....blah...not a presidential system....blah... play for time...plenty of opportunity to question me in the House of Commons...blah...not a presidential system....blah...ok?

management beanfeast

As far as many of us can work out, PFI is a system designed by politicians to make their friends lots of money, and to make the rest of us pay.

This is an example (from the Guardian) of how it works in Coventry:

In Coventry it had been planned to refurbish two hospitals at a cost of £30m. But analysts realised that business would not be interested. The scheme was too small, and there was no scope for the financial innovation that could produce serious profits. As a confidential report by the local health authority showed in 1998, the health service redesigned its scheme to make it more attractive to private capital. Instead of refurbishing the two existing hospitals, it would ask private business to knock them down and build a new one - the University hospital. This would cost not £30m but £174m. The health experts who wrote the confidential report predicted that in order to find this money, the hospital trust would have to cut both beds and services. They have just been proved right.
Did I say £174m? I beg your pardon. By January 2002 the price had risen to £290m. A month later it reached £311m. By the end of that year it had grown to £330m. In 2003 it was estimated at £370m. In March 2007, the Birmingham Post reported that the final cost was £410m. This year the hospital trust must find £56m, covering repayments and service fees, to hand to the private consortium. The annual cost will rise in line with the retail price index for 30 years.
It is now pretty obvious that this fee is unpayable, if the hospital is to maintain a proper standard of care. Over the past few days the hospital trust has announced a £30m hole in its budget. Around £10m of the necessary cuts could be found by making staff redundant: it will lose perhaps 200 people, possibly 375. It will also rely on "revenue generating activities". These include charging people £3 for dropping their sick relatives outside the hospital, and £10 for parking there, while cancelling the free parking scheme for disabled people. As the new hospital is on the edge of the city (against the wishes of 160,000 people who signed the Socialist party's petition to have it built in the centre), which means that it is hard to reach without a car, this is an effective way of raising money. But it casts doubt on the government's claim that the NHS remains free at the point of use.
The hospital trust's press officer told me that this cost-cutting is a unique event: "We have always balanced our books up to this year." But in 2005 - the year in which the PFI payments began - a leaked memo revealed that the trust was anticipating a deficit of £13m by the end of the financial year, and "drastic measures" were required to plug the gap. These included the closure of one ward, the removal of eight beds from another, limiting the opening hours of the surgical assessment unit and the "rationalisation of certain posts": which meant, eventually, cutting 116 jobs.
In 2006 the local newspaper reported a shortfall of £29m. This was met partly by freezing the recruitment of district nurses. In January this year, the hospital announced that it was closing another ward, just six months after it had opened. Yet another ward - where people with acute conditions such as pneumonia and strokes were treated - was closed in June. The impact of these cuts is already being felt: three months ago the new hospital found itself in the bottom 10 in the national league table for waiting times. Where will the money come from over the rest of the 30-year PFI contract?
There is one set of costs the hospital cannot cut: the money it must pay every year to the private financiers. In September 1997 the government declared that these payments would be legally guaranteed: beds, doctors, nurses and managers could be sacrificed, but not the annual donation to the Fat Cats Protection League. The great free market experiment looks more like a corporate welfare scheme.