Saturday, 28 April 2007
But the Chief Executive of the East of England Strategic Health Authority, Neil McKay, seems similarly elusive. For some nine months, consultants at Bedford Hospital have been trying to arrange to meet him, but every time a date is agreed, it is then suddenly cancelled.
Rumours are now circulating at the hospital that perhaps he doesn't exist at all. So if anyone does manage to spot the elusive Neil, please let us know.
Friday, 27 April 2007
Shropshire doctors were urged to send patients 70 miles to Aberystwyth because the county’s main hospital was full, it was revealed today.
The Royal Shrewsbury reached its highest state of alert this week as it struggled to cope with a huge rise in emergency cases, mainly involving the elderly.
Calls had to be made to hospitals outside Shropshire to see if they could help.
This happened despite the hospital opening extra beds - with more being made available at Telford’s Princess Royal.
The Royal Shrewsbury was operating at what is known as Escalation Level 4, the highest state of alert, when it is under enormous pressure and beds are not available.
Some medical beds were available at Bronglais Hospital in Aberystwyth and were being offered to Shropshire GPs, particularly those with practices near the Welsh border.
One was offered to Dr Paul Mott of the Belvidere Medical Practice, Shrewsbury, when he tried to refer a patient to the Royal Shrewsbury.
But it was not possible to take up the offer because of the patient’s special care needs.
Dr Mott said today: “There is constant pressure on all hospitals, not just the Royal Shrewsbury. Next week it could be another one facing the same problem.”
He said that across the country there had been a cutback in bed numbers.
Wednesday, 25 April 2007
HEWITT ADMITS TO SMOKING POT
Health Secretary admits to smoking dope...'
Tuesday, 24 April 2007
"For much of Labour's decade in power, the constant, often ill-thought out, reorganisation of health has been destabilising and hugely expensive, wasting resources which should have been invested in the preventive strategies which can deliver real health gains, as the Government has shown"
Gosh, he's agreeing with me.
I have a couple of patients who need rare and expensive drugs. In my fantasy world, the specialist, patient, and GP could prescribe this - and, as mature responsible adults, the doctors could perhaps be trusted to agree what steps needed to be taken to protect the patient, and by whom.Sadly, life is not so simple. A whole array of people sit on committees to decide whether a drug is one that GPs should prescribe. Expensive people. People who presumably believe all GPs have identical compentencies. My patients pay for NICE (national), MTRAC (regional), and local PCT prescribing committees. These all agree I should not prescribe these drugs.All well and good, except - these drugs are expensive, so either the hospitals send patients home with a supply for all of seven days, or the patient's treatment needs to delayed for some months while all the relevant bureaucrats agree to give the hospital the money to pay for the drug (and they do always agree eventually, although sometimes the Sun pushes the Government to push the PCT to tell the committee to say yes....). In either case, the NHS deliberately leaves the patient up a money-saving creek with only a GP as a paddle.In the meantime, we poor GPs write lots of unneccessary letters - and either obey the instructions from on high (and watch the patients become ill, their transplants fail, complications ensue) , or ignore the bureacracy and prescribe it anyway (and await flak from above)
Which would you do?
Given that the structure of the NHS routinely forces clinicians to ignore the guidance from high ivory towers a long way from reality, and that most of the guidance issued is a 'motherhood and apple pie' regurgitation of existing guidance, how many of these bodies do we actually need?There were officially 849 Quangos in 2003 (plus more in Scotland, Wales, Northern Ireland)Sadly, that doesn't include 43 Non-departmental Public Bodies in the Health field, and presumably excludes hundreds of others in other fields.
Saturday, 21 April 2007
NHS computer flawsSir - Recently, I came up against the full might of our proud nation's new NHS computer system (Letters, April 19). We all, our dear leader tells us, want choice. I was offered "Choose and Book", which is supposedly a part of the system that is actually beginning to work.
I was given a password and went as instructed to nhs.healthspace.
That was the first problem. I use a browser that is chosen by all who have tried it in preference to the one that comes with the computer. But although the NHS began working on its system in the past century, it is still under construction. The first response I got was that the system could not cope with my decent browser.
So I downloaded the old-fashioned browser. Did that help? Not a lot.
"Choose and book your appointment," it said on top of the document that I was given at the local surgery. But as soon as I tried, the NHS website went into a sulk from which it never recovered.
Nothing was having any effect. So I resorted to the telephone. A surprisingly cheerful woman explained, as though to a toddler, that I could get no further because there were no appointments.
What none at all? At any of the hospitals within a day's train ride? None at all. If there is no such thing as an appointment, it was not very polite of the NHS to offer the temptation to try to get an appointment. It hardly seems like £12 billion well spent.
John Ticehurst, Chard, Somerset
Friday, 20 April 2007
after bad. Huge sums have already been sunk into the project, runs the argument, and all that - plus political credibility - will be lost unless it continues.
The fallacy weaves an astonishingly powerful spell over ministers. Only after spending £500m on a computer system upgrade and three years watching it fail did Labour ministers finally do the right thing and throttle the congenitally useless Child Support Agency.
Governments of every political hue fall prey to it. Since 1993, American taxpayers have been bankrolling the International Space Station, which has produced nothing but cost overruns, and whose final price-tag is likely to top $100bn.
About the only good news in the Commons committee's report about the NHS IT upgrade is that, so far, only around £2bn has been spent. That alone is a hefty sum - enough to pay the wage-bill of 10,000 extra nurses for a decade. But unless ministers can cure themselves of the sunk cost fallacy, it will be just a downpayment on a debacle of historic proportions.
Thursday, 19 April 2007
In her statement she denied reports that thousands of young junior doctors were to find themselves jobless in three months time.
This evening I have been advised from a very senior and reliable source that the Department of Health is drawing up contingency plans for up to 10,000 trained junior doctors who may well find themselves on the scrapheap .
Has Mrs Hewitt no shame, or is lying so much of a politician's psyche that she simply cannot tell truth from fiction.
Wednesday, 18 April 2007
Once again it was left to a rather obscure politician from a minor party from Northern Ireland to ask this pertinent question in the House of Commons today:
Dr. Alasdair McDonnell (Belfast, South) (SDLP): Is the Prime Minister aware of the major disruption that will occur in NHS hospitals in Northern Ireland and in parts of Britain, too, on 1 August next, following the introduction of the hospital doctor training programme known as modernising medical careers? Will he advise the Secretary of State for Health to postpone the programme for a year until the administrative problems are sorted out?
The Prime Minister: Yes, we are aware of those problems
For Tony Blair to actually admit that there is a problem, things must be pretty bad.
But why has it taken them so long? This was all revealed in David Craig's book "Plundering the Public Sector" last year and before that in numerous computer magazines. I have been going on about it on this web site since I first started writing.
And what will Patricia Hewitt do about it? If past form is anything to go by, NOTHING.
Tuesday, 17 April 2007
Another foot up the greasy pole
The health secretary's 'flexible' views undermine her credibility
Monday July 25, 2005
One Friday afternoon in early October 1983, Neil Kinnock and I sat, drinking beer, outside the Grand Hotel in Brighton. We were providing a "photo opportunity" to illustrate how the leader of the Labour party and his deputy - recent opponents in the leadership election - would work in perfect harmony. We had more in common than the assembled journalists realised. Neil Kinnock had just read me a letter that Patricia Hewitt had sent him earlier in the week. It expressed the devout hope and profound conviction that he would lead the party and offered her services as his press secretary. I had received an identical letter.
Ms Hewitt got the job so, during the next nine years, I had a grandstand view of her modus operandi. Not once, in good times or bad, did I doubt that she possessed outstanding ability. As she made her irresistible progress into the cabinet, my judgment about her talent was confirmed. Only one thing - apart from her patronising manner - stands in the way of her achieving even greater success. The "flexibility" that enabled her to pledge allegiance to both Kinnock and me undermines her credibility.
The quality that facilitated her journey across the whole social democratic spectrum was on display this week in an interview she gave to the New Statesman. Only an idiot - which she is not - could honestly reject "the proposition that we would have been safer if we had not done what we did in Iraq". It is possible to argue that the threat of terrorism should not have deterred Tony Blair from a war that he believed to be right. But the contention that the bombs are not the consequence of coalition membership is clearly absurd.
However, having got the officially sanctioned nonsense out of her system, Ms Hewitt produced some freelance wisdom that made me glad that she is secretary of state for health. Labour, she said, has an opportunity to "put a core proposition of policy beyond attack". The government has won the argument about public expenditure. The promised reduced taxes in return for lower investment in health and education no longer wins votes. If the money is wisely spent, "we can win again to assert the argument over the role of the state".
Ministers' unscripted comments should not be examined with the textual care that was once afforded to the Dead Sea Scrolls. And Ms Hewitt's reference to the "role of the state" - reasserted after Labour "wins again" - is far from precise. But by using a word that New Labour usually regards as pejorative, she was acknowledging that the community as a whole (which is all that the state amounts to) has duties that transcend meeting the demands of the vocal and influential middle classes.
Then the self-adjusting mechanism that keeps Ms Hewitt on message kicked in again. The state, she argued, has a duty to diminish the power of the community to meet need and replace it with the ability of individuals to compete for public services. For that is what "choice" - the mantra of all good Blairites - amounts to. It is why, as she rightly said, "social democrats have never liked choice in the public services".
It must be admitted that she set out the case against choice with great distinction. "There were fears that it would be exploited by the middle classes, that it would lead to a two-tier service." On the assumption that she holds regular advice bureaux in her Leicester constituency, she must know that to be true. Surely, for example, she meets small groups of self-confident parents who argue their children's way into "better" schools for which they were not originally destined.
Only the knowledge that she is talking nonsense can explain the fatuity of her arguments against the social democratic view. It is, she says "patronising". Perhaps. But it is also accurate. Then the secretary of state for health sank to even greater depths of absurdity. Believe me, she really said: "The more people say: 'I might go somewhere else', hospitals which aren't up to scratch will have to improve or risk losing patients." That is the argument for the market economy applied, without amendment, to the provision of public services.
Of course, it would not work. What would happen to the hospitals that "lose patients"? Would they close down like a bankrupt supermarket or stagger on half-empty, short of staff, increasingly inefficient and with continually diminishing esteem? Would it not be better for the Department of Health to bring pressure to bear for their improvement?
Perhaps even now, Ms Hewitt regrets that she talked such rubbish. She cannot believe what she said makes sense. Because of her obvious ability, it is generally assumed that her "flexibility" is a product of her ambition. Ironically, that assumption will stand in the way of her progress. Perhaps I ought to write her a letter offering my help in her attempts to climb another foot up the greasy pole.
Monday, 16 April 2007
Please sign the petition here (and enter your GMC number in the comments box)
(Please ignore the bit about a paypal donation at the end; this is NOT required)
Please also tell you colleagues about it.
I was interested to see that her apology was carried prominently on Channel Four News, but totally ignored by the BBC; it was the BBC which also tried very hard to ignore the march through London by 12,000 junior doctors on 17th March. There was a time when the BBC was regarded as being independent. Now it appears to be a mouthpiece of 10 Downing Street. Perhaps those initials really do stand for Blair Broadcasting Corporation.
Sunday, 15 April 2007
GORDON BROWN is to face questions in parliament after revelations that he disregarded advice from the Bank of England before he sold off more than half the country’s gold reserves at the bottom of the market.
Insiders involved in the decision have broken ranks after an 18-month battle in which the Treasury has blocked attempts by The Sunday Times to make public the official advice received by Brown before he sold the gold.
They have revealed that Bank of England officials had serious misgivings over the chancellor’s determination to sell 400 tons of bullion in a series of auctions between 1999 and 2002, when the price was at a 20-year low. Since then the price has almost trebled, meaning the decision cost the taxpayer an estimated £2 billion.
So much for "financial prudence". £2billion would buy a lot of health care.
Friday, 13 April 2007
I need to stress this is not a deficiency within the Trust, trauma spinal and pelvic surgery is highly specialised, it is not a service West Hertfordshire Hospitals NHS Trust provides or should provide. In fact once we are looking after one of these patients the medical staff in particular spend an inordinate amount of time on a daily basis ringing spinal units far and wide. You are our last resort, having already contacted various individuals and medical organisations. The feedback has all been the same – there is a complete failure nationwide. Presumably, if you happen to have an accident outside St Georges Hospital for instance, you will get the care you need promptly and expertly; a very select postcard lottery.
I finish with quotes that I have received from consultants in my quest on behalf of these patients.
“and actually one of the few problems that cannot be laid at this government’s door, although in the present shambles they have not done anything constructive to address it. It is morally wrong, for example, to have a patient sitting in one of our hospitals waiting for an acute transfer to RNOH with a spinal injury for which they require specialist treatment, to be told that there is no bed in a foreseeable time frame, due to nursing staffing issues, whilst the RNOH continues to admit for elective foot and joint surgery etc. The answer is that trauma needs to be put much higher up the pecking order in political priority. It is not visible on waiting list times or league tables”
(Consultant Orthopaedic Surgeon)
“Further to your email, below are the responses from members of the College Trauma Committee. As you predicted, not very encouraging. This is one of several issues that urgently need to be addressed with the NHS and DoH and also through the political agenda.
A national problem – quite frankly these services are a shambles. “Better Care” clearly states what is needed. There is no joined up system for commissioning these services, and they do have a high priority on either the political or the various College’s agendas. Until the political climate changes I don’t really have any advice that I can give other than ‘battle on’. (A & E Consultant)
This is a national problem, made worse by the historic separation of head and spinal injuries from general hospitals. It is particularly trying in London with very limited resources – at UCLH we are supposed to have access to Queen Sq but they are rarely able to accept patients because of non-availability. (General Surgeon)
National problem, funding can be secured through pt home PCT prior to transfer but they compete for access with local 4 hour A & E target patients for beds in receiving unit. Mirrored in pelvic and acetabular injuries, plastics for open fractures etc. That’s why I included them in the first RCS report, but that was poorly put to government and media. No resolution in sight. (Orthopaedic Surgeon)
This is a national problem. Access to neurosurgical services for trauma patients is patchy at best. We can only really take those patients who require surgery not the DAI patients. Specialist commissioning does not seem to have helped so far. (Neurosurgeon)”
If you need any further information, please do not hesitate to contact me.
Dr Valerie Page
Thursday, 12 April 2007
I have today received a copy of the report by Sir William Wells into the NHS university which I have been trying to obtain since 2004. It paints a damming picture of an organisation lacking in clarity of purpose, and failing to engage with stakeholders while managing to spend 72 million pounds of taxpayers money.
As readers of this blog will know, the NHS university was proposed in the labour manifesto of 2001 and established as a special health authority in 2003. It's demise was announced on November 30th 2004 by the then Health Secretary John Reid, following a report into it's progress and performance by Sir William Wells.
I asked for a copy of the report in October 2004 and my MP received a letter from John Hutton in November 2004 saying that it was the Department of Health's intention to publish their findings "shortly".
When the Freedom of Information Act came into force on 1st Jan 2005 I wrote, under the new mechanisms, requesting that the report be disclosed which the department of health refused to do. I then appealed to the Information Commissioner who ruled in Nov 2006 that the department should disclose the document. The Department of Health then appealed against that decision to the Information Tribunal. Last week, just before the hearing, they withdrew their appeal.
The covering letter, which I received with the report today, suggests that "the Department has undertaken a full review of the determination of the public interest in this case". They argue that release in early 2005 would "prejudice any future reviews which might be conducted by the Department into the economy, efficiency and effectiveness of sponsored bodies", but that two years later this has changed. There is no explanation of what has changed since they appealed against the Information Commissioners ruling in November 2006.
The report itself is in two parts, the first detailing progress and performance and the second forward to the creation of the "NHS Institute of Healthcare Innovation and Education".
It starts by setting out the original concept behind the NHSu, but even on page one criticises the lack of clarity about where the NHSu fitted into the "already crowded healthcare education and training sector" and what its role should be. It goes on to describe tensions between strategic objectives and potential roles as a provider or broker of training. The lack of understanding of the wishes of customers (eg Strategic health Authorities) , is highlighted as a reason for the lack of support and integration with the wider NHS.
The quest for University title is highlighted as a major problem which was not understood by senior staff in the NHSu or ministers and added to confusion over the NHSu's role.
A major part of the report is devoted to delivery and value for money, which deals with a range of issues including; the staff complement of 412, learning services, and academic partners. It gives some numbers of the limited take up of NHSu courses and predicts that these would not meet the projections, particularly once the courses had to be paid for. Comments from a variety of stakeholders about the lack of a clear business plan caused Sir William concern as did the processes for governance. The 30% of staff involved in corporate services "seems disproportionately large" especially when viewed in the light of comments about the "culture and style of a start-up enterprise" and the lack of focus on structure and systems. Frequent changes of structure and individual roles were seen as another barrier to the establishment of effective working.
The report concludes with some answers to crucial questions about whether the investment was appropriate and over what timescale it is likely to bear fruit. The answers are damming and relate to lack of clarity of purpose, the absence of market surveys or prices, governance, pursuit of the University title, and engagement with stakeholders.
It suggests that in the light of the £72 million investment up to March 2005 "the Department of Health is exposed to significant embarrassment if the value for money delivered by the NHSU were to be probed".
I suspect this might be the reason that the report has taken so long to see the light of day - but I hope that now it has, it will be used to inform future decisions and avoid making the same mistakes again.
Tuesday, 10 April 2007
This is an email I hope will reach as many consultants in the UK as possible: if you agree please forward to any consultants whose email address you know.
What are your views on MTAS, the recently chaotic national junior doctor appointment system and what we as consultants should do about this now?
I feel that all consultants in all specialties should immediately cease to cooperate with interviews, shortlisting or helping in any way with the process in order to make it stop entirely and, as Morris Brown and his colleagues suggested, in the their letter to the Times, http://www.timesonline.co.uk/tol/comment/debate/letters/article1610358.ece, return to a fairer regionally based system, at least until a national system fit for purpose is instituted.
In my view the royal colleges and the BMA have seriously let us all down and in particular the young doctors that are the profession's future.
It is not just academic medicine that is under threat, in any case all medicine is academic to a degree and all consultants benefit from an academic component to their postgraduate education and training.
Since the royal colleges seem to have been so useless in this matter, in my view we should organise a boycott of the MTAS process now whilst there is still time for a return to a system of fair shortilisting, interviewing and selection. I am informed that Deaneries have contingency plans for a return to the previous well tried system of appointment. The neurologists in Bristol/Southwest region have already withdrawn comletely from MTAS.
I would be grateful for your views and if you could forward this mail to all the consultants in your address book (with a copy to me), even if you do not want to put your head above the parapet.
If you agree with this proposal can I suggest you contact you local deanery and tell them that you can not participate in the MTAS process; you will be glad to have the time to do some work I expect! If you don't want to be labelled as a bolshie, then I suggest you just say you haven't the time (which is probably true).
For a boycott to work we would need a large majority of consultants to take part in as many regions and as many specialties as possible, so please forward this to all your consultant colleagues in all specialties.
Dr CMC Allen MA MD FRCP
Dept of Neurology (Box 165)
Cambridge CB2 2QQ
Tel: 01223 xxxxxxx
Fax: 01223 xxxxxxx
Email 1: email@example.com
Email 2: firstname.lastname@example.org
Monday, 9 April 2007
The transparently jealous attempt to devalue and disempower the medical profession by this Labour government has been exposed for shambolic outrage that it is. Patients can be glad that we took to the streets in opposition of the appalling sabotage of our training and education. Taxpayers can be glad we protest at the wasting of their money. But will the general public vote with their feet and demand that the government take responsibility for the mess they have created and ensure the future of the medical profession in this country?
At least in Bedford you will have an opportunity to vote for the Save Bedford Hospital party
Now the take-over of the system by management consultants seems almost complete, or at least in Bedford, where our new Trust chairman, Ray Rankmore, is himself a management consultant.
Actually I am pleased that Ray has taken up the post; he is a man who likes to talk to people, and who likes to listen, and he has a track record of success in business. I genuinely wish him well.
Sunday, 8 April 2007
The Prime Minister has allowed the NHS to plunge into crisis by becoming trapped in a "parallel universe of spin", according to the new head of the Royal College of Nursing.
In a blistering attack on the Government's running of the health service, Dr Peter Carter, the RCN general secretary, said cuts in jobs, services and training were catastrophic for the country and a "personal tragedy" for the Prime Minister.
Dr Carter, who will address his first RCN annual conference next week, said Tony Blair should admit Labour's administration of the NHS had gone "fundamentally wrong". He said Labour's track record on the health service was far worse than that of the Conservatives, even though Mr Blair had poured in record funds.
Dr Carter, a former hospital trust chief executive, told The Sunday Telegraph: "I have never seen so much money go into the health service and I have never seen so much money wasted.
Thursday, 5 April 2007
A SURGEON today announced he is standing for the Scottish Parliament in protest at NHS changes.
David Smith, who intends to stand as an Independent in the Glasgow Cathcart ward, is demanding better healthcare provision across the south of Glasgow.
His campaign will see him go head-to-head with former city council leader Charlie Gordon.
Mr Smith claimed the local health board has been reducing services in that part of the city over the past 15 years.
The consultant surgeon is particularly concerned at plans to replace the 362-bed Victoria Hospital with a new building, which he claimed, will not meet local needs as it provide only day surgery and out-patient departments.
The other services currently offered, including an A&E department, are being transferred to the Southern General Hospital.
But Mr Smith, who has worked at the Victoria Hospital for 34 years, argued that those new facilities are planned for the wrong location.
He added: “I’ve been a consultant here for 30 years and I’m saddened by the way in which the health board in the last few years have decided to strip away the services from people in Cathcart.
Tuesday, 3 April 2007
Patricia Hewitt, the Health Secretary, has apologised to junior doctors for the first time for the failure of the new recruitment process that left thousands of well qualified doctors without the prospect of a job.
Hewitt has apologised for the recruitment fiasco
Hewitt: 'We are now sorting it out'
Ms Hewitt acknowledged that the new online system had caused “terrible anxiety” and that it was “nowhere near where it should have been”.
She said: “That is exactly why junior doctors have been caused this absolutely needless anxiety and distress and I am very sorry indeed that has happened.
It must be pretty catastrophic if a politician apologizes, but that's not enough. We need a proper system of recruitment, and we need a new minister (preferably one who actually listens.)
We are pleased to support Dr Adam Pringle, a GP and medical campaigner, who is standing for his local council in Telford as a independent on health service issues; Adam has indicated that if successful at council level he intends to run a Richard Taylor style independent campaign in Telford at the next general election.
This web site will keep you updated on his progress; there will be a link to his web site as soon as that is up and running.
Sunday, 1 April 2007
Wednesday 28 March 2007 11:14
Department of Health (National)
Nicholson: NHS financial system now fit for the future
Improved NHS financial control allows an end to Resources and Accounting Budgeting 'double whammy'
The NHS is set to move to a more transparent and fair financial regime following the announcement today of the reversal of RAB deductions and the replacement of cash brokerage with a formal system of loans for NHS Trusts.
"We are moving NHS trusts out of the resource accounting and budgeting regime as this was inconsistent and unfair. "
Suffice it to say that it was this system, now officially acknowledged to be "inconsistent and unfair" that has crippled Bedford Hospital financially.