Thursday, 31 May 2007
Well this is a true story:
An 84year old lady in Burnley needed to see a dermatologist. "Where would you like to go?" asked the GP."Well Burnley Hospital is just down the road, I'd like to go there please".
A few clicks on the computer, and the answer came back - no appointments available at Burnley, or anywhere else nearby. The nearest appointment was at Blackpool - fifty miles away and with no direct public transport connection.
And why were there no appointments at her local hospital? Well it was full with patients from Blackpool who couldn't be seen at their local hospital because it was full of people from Burnley.
Another triumph for Nu labour.
Tuesday, 29 May 2007
I am writing to invite you to help take up a case where the Home Office immigration minister Liam Byrne has been responsible for a monumental injustice.
Rifleman Tul Bahadur Pun VC is now aged 84. In 1944 he won a VC fighting for the British army with the Gurkha regiment in Burma. You can find the VC citation on the web, and even by the standards of winners of VCs, his selfless actions when already severely wounded were utterly amazing. In 1953 he was invited to Britain for the coronation, and invited to have tea with the Queen Mother. His actual medal is in the Gurkha museum in Winchester to whom he donated it.
He is now quite old and frail and unable to walk each month across the mountain valley from his home to collect his £130 a month army pension. He would like to move England. His application has been refused by the Home Office on the grounds that he can show no connection to the United Kingdom.
I am sure that you wish to make representations to ensure that this injustice is reversed.
I have been in Barbados and Trinidad, visiting hospitals there.
It was impressive to see what high standards of medical care were being provided there with very limited financial resources. Perhaps the secret is that they seem to leave the professionals to get on without managerial influence; indeed they seem to manage very well without Choose and Book, NHS direct, management consultants, or Connecting for Health. I have a feeling that we can learn something.
Sunday, 20 May 2007
Saturday, 19 May 2007
Patricia Hewitt, the Health Secretary, was accused last night of misleading Parliament by concealing the true scale of the problems that have crippled the online recruitment system for junior doctors.
In an emergency statement to the Commons this week, Miss Hewitt said she had jettisoned the system in response to the concerns of junior doctors and recent security breaches.
But legal documents drawn up by the Department of Health disclose that fundamental flaws with the system's software means it does not work properly and is not allocating jobs to the best candidates as expected - an issue she failed to mention in the Commons on Wednesday.
In a document submitted to the High Court on the same day as her statement, Nicholas Greenfield, the Department of Health's director of workforce, spelt out the system's failings and even described the software used to allocate posts as a "work in progress".
He said Beverley Bryant, the Department's head of information services, warned last month that any attempt to overhaul the system could prove "fatal to the programme".
The revelations will damage Miss Hewitt's already battered credibility. They will also intensify pressure on Gordon Brown to sack the Health Secretary when he moves into No 10 next month.
Last night, Norman Lamb, the Liberal Democrat health spokesman, called for Miss Hewitt to be summoned to the Commons to explain why she misled Parliament. "I'm amazed that on top of everything else that has happened, she failed to mentioned the highly embarrassing fact that the system could not deliver what was needed," he said.
A Department of Health spokesman said: "It is incorrect to suggest that the Health Secretary has in any way misled Parliament." He said Miss Hewitt's statement referred to the concerns of junior doctors.
Friday, 18 May 2007
Wednesday, 16 May 2007
This week is set to be a historic one for both Junior Doctors and NHS patients throughout the country. Remedy UK, a grassroots doctors' organization was set up in response to a growing loss of confidence in the implementation of medical training reform and in employment strategy within the medical profession. Accumulating an astounding 10,000 members in the 5 months since it launched, and in unprecedented and historic action tomorrow, Remedy UK are taking the Department of Health (DoH) to court. Although Patricia Hewitt today announced the scrapping of the disasterous online application system, she remains intent on seeing through round one of the system, which has been plagued by astounding incompetence.
The DoH have recently taken command of hospital doctors' recruitment with the aims of a central computerised process replacing a local, regionally based system. Despite repeated warnings from the medical profession, the Medical Training Application Service (MTAS) was rushed through untested and the devastation it has left is unspeakable. It has spat in the faces not only of doctors but also of patients.
The incompetence is multi-fold. Selection criteria was so flawed it forced a change of interview scoring half-way through, resulting in the first half of applicants being interviewed without any consideration of their curriculum vitae, previous experience or recognized awards of excellence. Applications were lost in cyberspace, or were sent to the wrong jobs and some NHS consultants were given 4 hours to assess 600 applications.
Hewitt was forced to set up a review group that spat out weekly proposals that were rejected as the inadequacies of each were highlighted. And each DoH rescue suggestion sent waves of despair through doctors as they were effectively told they would have to move house and separate from their partners or families or their careers were effectively over.
Everyone in the country, whatever their profession, can and should be able to apply for as many jobs, as many times as they desire. We all have mortgages to pay, families to care for, established lives to live. The DoH's final attempt to correct these profound and fundamental errors proposes that all doctors be offered a "rescue" interview. Fair enough, you say. Not fair enough, I say. Ten years training at £250,000 each - we are granted one shot each to get on a one-point-of-entry conveyor belt that blocks all future attempts to re-enter. And previous interviews will still count - including those not accounting for CV's, experience or awards.
If the best doctors are out there, patients should be treated by them. The recent unprecedented displays of public protest by doctors are because the medical profession has no confidence that this will be the case. It is suggested that these spoilt doctors are all fighting over prized training posts - well, yes, we are. Because we want to be trained, we want to be competent. We want you, our patients to be looked after properly. If we can't be the best possible doctors in this country, we'll be forced to leave, and some already have.
Medicine has always been a highly competitive field right from entry to medical school. Competition has become a part of our lives - indeed, we encourage it. Competition pushes us to strive for the best and it provides you, the patients, with the best possible doctors. We don't feel we deserve jobs or employment security for life, we just want to be considered fairly within a competitive system.
So wish us luck tomorrow, for you and for us. Let's hope justice prevails and your doctors of tomorrow will be the best you deserve. We'll see you in court.
Is this a resignation issue? It is getting perilously close.
When ministers are forced to backtrack not once but twice or three times, finally conceding the very points made from the start by their critics, their position is fatally weakened. Had Lord Warner, the minister who could most plausibly be blamed for the junior doctor appointment system, not chosen to retire at the end of last year, he would be on his way any day now. His absence leaves Patricia Hewitt, the Health Secretary, rather exposed.
She may not be directly culpable for the failings of the application system, but she is culpable for the political error of not seeing early enough that this was an issue that could not be finessed. At every stage she has been a yard off the pace. Today’s court action by RemedyUK is the key. If the court rules that doctors’ reasonable expectations of fairness were not met, then she will face another retreat. If, on the other hand, it finds for her, she will be home clear – winged but still defiantly flapping.
Scotland, Northern Ireland and Wales can offer doctors four interviews, but apparently England cannot. After ten years’ training, their futures are to hang on a banal application form, dodgy computer software and a single interview. Small wonder they are angry.
And what will happen if, through the misguided workings of the application system, thousands of overseas doctors are appointed to posts while thousands of expensively trained British doctors are not? The political consequences would be huge.
Law firms would never tolerate their trainees being selected in such a way: nor would newspapers, or any properly run business. Will hospitals really put up with the wrong doctors being imposed on them for the next five years?
It is symptomatic of the arrogance of NHS management that such a “Year Zero” approach was ever adopted. In the attempt to undermine the old boy network that, it claims, characterised the old interview system, the department came up with something infinitely more sinister. And where were the defenders of medical professionalism? The royal colleges were silent, the Postgraduate Medical Education Training Board denied responsibility, and the British Medical Association equivocated. Not my problem, guv.
It is no surprise that so many doctors despair of their profession when there are so few prepared to defend it.
Mr Hague said Mr Prescott would be "missed" by the Tories and "wished him well in his retirement" after 37 yeas in the Commons. He asked if the government would apologise for mistakes made over the computer system for junior doctors' jobs.
Mr Prescott said he was not leaving the Commons and said it was nice to hear he would be missed. He said he would not be "whingeing on the backbenches" when he retired from the frontbench "as I hear some of my colleagues doing from time to time".
Mr Prescott hailed Labour's record on employment and help for pensioners, compared with the previous Tory government, adding "can I say I am the longest serving deputy prime minister" and had seen off five Tory counterparts.
Mr Hague said his question had been about junior doctors. He asked who was responsible in government for the "fiasco" of the online recruitment system.
After a pause, Mr Prescott said: "Tories".
So that's reassuring - it's nothing to do with Mrs Hewitt.
Monday, 14 May 2007
Nigel Hawkes, Health Editor
An emergency review of the appointments system for junior doctors is being dominated by government apparatchiks, leading doctors claim in a letter to The Times today.
The system and attempts to rescue it are a fiasco, write Morris Brown, Professor of Clinical Pharmacology at Cambridge, and more than a dozen leading specialists, as doctors prepare to challenge the outcome of the review in court.
The hearing, which begins on Wednesday, will seek to have the computer-based Medical Training Application System (MTAS) declared so unfair as to be an abuse of power. It is expected to take two days.
Victory for the doctors would leave the Department of Health, which has apologised for the debacle, in confusion.
In their letter to The Times, Professor Brown and colleagues say that MTAS has so far failed every task, and the review set up to rescue it “has become top-heavy with DoH apparatchiks”.
The issue, in the Times letter and later today in court, is whether it is fair to allow doctors in England, who have already spent ten years training, a single interview to determine their futures.
There are about 32,000 junior doctors applying for about 20,000 posts, which they will take up in August. Nobody knows the exact figures, nor how many of the applicants come from outside the UK. The doctors are mostly in their mid to late20s, and are applying for “run-through” training posts lasting five years, which would end with them ready to apply for jobs as consultants. Hospitals that pick the wrong applicants will be stuck with them for five years, so finding the right ones is crucial.
Applicants who fail to get a run-through post will not necessarily be unemployed but their careers will stall.
To get a doctor to this stage costs the state £250,000 in education and training costs. The potential losses would easily exceed £1 billion if, say, 5,000 UK-trained applicants gave up medicine or decided to go abroad.
One official, who did wish to be named, blamed the department for a failure to match the expansion of medical schools to an equivalent growth in training posts.
This year, the difficulties are compounded by a failed attempt by the department to exclude foreign graduates. Under European law it cannot exclude EU graduates, but relatively few of them apply. The key is graduates from outside the EU, traditionally one of the mainstays of the NHS.
The department attempted to cut off these applicants by saying they would need work permits. A challenge in court by the British Association of Physicians of Indian Origin (BAPIO) was rejected, but leave to appeal was granted. Pending the result of that appeal, the department was forced to allow nonEU doctors to apply in the first round of selection.
Thousands more found another way round, by joining the “highly skilled migrant” programme. They qualified for that by virtue of already working in the NHS as, for example, senior house officers. As a result, it is estimated that between 10,000 and 11,000 of the applicants for the 20,000 posts originate from outside the UK and Europe, maybe half of them through the highly skilled migrants programme. Nobody knows quite how many, nor do the application forms enable hospitals to distinguish home from foreign applicants.
So who is in charge? “Nobody is,” said the official who spoke to The Times. “The system was developed in isolation from workforce planning. So it was impossible to find any one person who would ask: ‘Will this work?’ .”
RemedyUK, the pressure group bringing the action, hopes the court will say the process is unlawful, but expects a solution to require negotiation.
Saturday, 12 May 2007
He has said that he wants to listen to health professionals ; good.
He then says that he wants to extend NHS Direct, which any health professional will tell him is useless, wants to expand drop-in centres, which are both useless and dangerous (since they eliminate continuity of care) and wants GPs available in the evening and at weekends ( which may be good, but has only just been ended by the government with the new GP contract).
If Gordon really wants to listen, I am available to talk. I look forward to it, and I promise not to charge as much as the management gurus who have been wreaking so much havoc on the NHS.
I am standing by for the phone call.
Friday, 11 May 2007
Now, even more alarmingly, the whole of the SHA (the organization which funds and overseas the whole of the NHS in the East of England) seems to be in hiding.
The SHA has public board meetings (which I imagine very few of the public actually attend) and publishes on its website the agenda and papers for these meetings; these papers are a gold mine of information, particularly in relation to how badly the SHA is missing its targets on Choose and Book, and how it is doing conjuring tricks with the money. It is, after all, public information, and our money.
But now they have gone all bashful. The next public meeting of the board is on 17th May, but there is still (despite two reminders from me) no agenda, no papers, and no minutes of the last meeting in March.
What have they got to hide?
Thursday, 10 May 2007
Dr Rob Oakley, one of my campaign team, is currently on a charity cycle ride (in aid of the Bedford Sports Foundation and the Bedford Hospital Charity) from Land's End to John O'Groats, so our message is being spread far and wide.
Wednesday, 9 May 2007
Jack and Jill went up the hill to fetch a pail of water
Jack fell down and broke his crown and Jill came tumbling after
Both subsequently died in the ambulance and the PCT set up an enquiry, which came
to the following conclusions:
The 50 mile journey to the nearest casualty department was in the couples' best Interests. The fact that there was no local bed in which Jack could mend his head was
unfortunate but no targets had been breached and he had been offered a Choice.
The lack of vinegar and brown paper was not material to the man’s death as NICE had not yet decided whether it was cost-effective and in any case both the brown
paper nurse and the vinegar nurse were away on courses
The GP was most to blame and should be suspended and referred to the GMC as he had:
1 Not reported Jack and Jill's lack of water to social services
2 Failed to recognise that anyone going UP the hill to fetch a pail of water must be
(Thanks to the person who sent me this)
Monday, 7 May 2007
It is remarkable to think just how quickly the Internet has become an apparently essential part of our lives. One area where I now find it indispensable is booking flights. If you fancy a weekend away, you just click on your favourite web site, and if the flights to Barcelona seem too expensive, or at the wrong time of day, you can choose to fly from another airport or on another day. It’s all so delightfully quick and foolproof, and I can only imagine that it was after such a happy experience that some bright spark at the Department of Health dreamed up the madness that is Choose and Book.
I suppose that if you have a totally obsessional personality, and your GP has diagnosed you with, for example, a hernia, you may wish to research all the available surgeons, find out which of them has the lowest recurrence rate, and then ask to be referred to him (or her). But that, of course, is not something that Choose and Book can offer; for a start you can’t be referred to a named consultant anymore - so if you really want to be seen by Mr Spratt, that’s tough nuts, you just have to get a referral to his hospital and hope for the best. But that’s not the end of things; suppose you merely wish to be seen at a particular hospital, perhaps simply because that’s the only hospital within thirty miles of your home, or because that’s the hospital which has all your records of your previous care, well you had better hope that the hospital isn’t too popular with the rest of the general public, because if it is, you may well find that it is no longer a choice, because since nowhere is allowed to have a waiting list of more than thirteen weeks, once the appointments have been filled, your favoured hospital just vanishes from the computer screen.
This hardly seems a recipe for giving patients what they want, and if the system doesn’t work for patients with straightforward acute problems – hernia, haemorrhoids, and so on – what happens about those with chronic diseases, and especially those with chronic dermatological disorders such as eczema and psoriasis? Well, the brave new target-driven NHS designed by management consultants find this group of patients a bit of an inconvenience, and since they don’t fit neatly into their deluded plans, they take the easy way out and simply ignore them. The latest wheeze from these masters of the NHS is to penalize consultants who see more than a very minimal number of follow up cases, and follow ups, I may remind you, are those cases which by their nature are the most complex and challenging, and which cannot simply be seen once and sent on their way.
So, under totally artificial pressures from our managers, we send patients with challenging long-term problems back to their GPs, but always with the proviso that if the problem flares up or becomes more troublesome, they should ask to be referred back. And what happens when they do just that? Yes, you’ve guessed it, they fall into the Choose and Book trap. They cannot be sent back to the consultant of their choice, the consultant who knows their case with all its idiosyncrasies, the consultant who they trust, because the Department of Health cannot abide the concept of anyone providing a personal touch. Worse than that, there is no guarantee that they will even be able to get back to the hospital of their choice, with all their past notes and investigations, and the better the reputation of the department, the more unlikely they are to be able to get back there.
If Choose and Book has anything to do with patient choice, or even patient care, I seem to have missed something
Saturday, 5 May 2007
In Bedford we had electronic counting of the votes for the local council. It all went wrong and we ended up, after over 18 hours being the last council in the country to announce the results.
The local labour MP, Patrick Hall, who has been notably silent on all the computer disasters in the NHS and on MTAS was furious with the inconvenience that he had been occassioned by the failed technology!!
I hope he learns, but I fear that he won't
Friday, 4 May 2007
I am delighted to say that Adam stormed to victory. I hope this is an omen for the Save Bedford Hospital party.
Thursday, 3 May 2007
Bedfordshire PCT has only been in existence since last October, but in its first six months has managed to spend £121,000 on management consultants. Don't forget that's your money, and it should be spent on patient care. £121,000 would have pad for four more district nurses for a year.
Tuesday, 1 May 2007
But there is an even more worrying aspect to the whole sorry saga.
The MTAS system was apparently set up for the DoH (no doubt at enormous public expense) by a company called Methods Consulting Ltd. It was, we are told, the fault of this company that basic security flaws arose. The web site of Methods Consulting Ltd proudly lists their other important public sector clients, including, would you believe, the Metropolitan Police; it hardly bears thinking about.
If you have psoriasis (or if a relative or friend is affected) please do try to get to the annual conference of the Psoriasis Asociation on Saturday 12th May. I am the guest speaker.
For information : www.psoriasis-association.org.uk