Happy New Year

Best wishes to all our readers for a happy new year.

Akmal Shaikh

I am appalled by drug smugglers, and in general I think that they deserve what they get if they are caught. The case of Akmal Shaikh is clearly quite different; he was a man with a major psychiatric illness who plainly had no idea what he was doing, and he was executed by the Chinese government.

The Chinese clearly have their own rules, and will not listen to our feeble protests. So if you really take objection to what they have done, perhaps you could stop buying cheap (and often second rate) Chinese goods, which you probably didn't need inthe first place; now that is something the Chinese would notice.

How to waste money

It might seem like a minor tweak but when ministers added the number 60 to the NHS logo for its anniversary, they employed two designers, took ten days — and sent taxpayers a bill for £12,000.

The disclosure comes as part of an investigation by The Times exposing how ministers across Whitehall routinely pay top commercial design firms to “conceptualise” and “update” simple logos, often for failing schemes and minor agencies. Projects cost tens of thousands of pounds — yet one department admitted that it could produce logos in-house for £648.

Spending revealed under the Freedom of Information (FoI) Act includes £153,522 on branding and logos to launch FERA, an agency that inspects plants and bees, and a £21,090 rebrand that changed the colours of the HomeBuy programme’s logo only months before one of its key schemes ran out of money.

Many departments refused to respond to FoI requests for branding and logo design costs over the past five years or withheld details relating to subsidiary agencies. But even with full disclosure from only three departments, the bill is more than £1 million, a fraction of the true total. Thousands more were spent on printing updated stationery.


The revelations come weeks after Alistair Darling, the Chancellor, promised to “drive through efficiency, cut waste and cut lower priority budgets”.

The NHS60 logo was commissioned by the Department of Health through the Central Office of Information (COI) “to raise awareness of the 60th anniversary of the NHS” last year. A creative director and senior designer took ten days designing the number 60 next to the usual NHS emblem, charging £6,000 a digit.

The Department of Health said that the work was cost-efficient as it “avoided local NHS organisations creating their own designs for the 60th anniversary — preventing duplication and reducing costs”.

The Tory MP Greg Hands said: “Surely adding two digits doesn’t need to be outsourced at all. Civil servants can do this themselves. Modern graphic design packages surely allow anyone with an average brain to design something as good as, or better than, what we see in front of us here.”

When the Department for Communities and Local Government was founded in May 2006, it paid The Team, a leading design firm, £3,830 for branding work including a logo. Five months later it paid Bell Design £24,764.99 to develop the brand — including a new logo.

The department paid the advertising agency Chick Smith Trott £21,090 to “update the HomeBuy identity” in January this year. The logo was changed from a yellow-and-blue to a pink-and-purple version to match the colours of the Government’s Real Help Now campaign. By May a HomeBuy scheme to help first-time buyers had exhausted its funds. The department said that the redesign came from the existing communications budget.

Happy Christmas

This site is exactly three years old.

I wish you all a happy Christmas; I shall be having a few days off, and will be returning with renewed enthusiasm in 2010. If you are a politician, an NHS manager, a non-executive director,or an official from the Department of Health, remember that I have spies everywhere!

A GP writes...

Barry, your blog on your skin cancer service says everything that is wrong with the NHS today. The government believes that because management consultants and accountancy firms have come up with schemes THEY SAY which cut the cost and increase profits for big companies, that these people can cut the cost of the NHS by making it more efficient.

Management consists of looking at any subject, breaking it down into component parts, then getting less able, and cheaper people , to do the component parts - thus saving money. It just doesn't work with the NHS though, unless you actually do want to give the whole thing to private companies to see what profit they can make of it. As I have said often before, just see what private companies do for health care in America. My sister there, now on medicare pays $2500 per year, and has to pay for her drugs. Because of the lack of regulation there she has to pay $200 for a Seretide 500 for example of drug company profits

How can a manager with a commercial interest see that the the NHS is about patient care. That is getting the best possible person to see the patient in the first place, get that person to see the patient as long as possible and do as much of the treatment as possible. Just ask any patient at all and they will tell you that this is what they want. So the more efficient the NHS gets in terms of accountancy, the less will patients like their treatment.

AND apart from having long waiting lists and poor equipment and no ancilliary staff, the NHS in 1970 compared almost as well as today with other advanced nations of the world at a third the cost of today. The extra money, as I have said elsewhere has gone on systems, useless political schemes and accountancy which has contributed nothing to patient care, yet cost tens of billions of pounds which could have been spent better on patient care.

The answer to a better non-profit making NHS is to give doctors what they want to do their work and let them do it. The more doctors are monitored, the more they tick the boxes required which is a considerably lower standard than they would do for their own professional satisfaction. Why the BMA has not been in the media shouting this out loud and clear for all this time astonishes me. Instead they merely try to be reasonable, desperately looking for something in all the changes which is not too terrible and saying that this is a step forward, thus giving credance to all the crap we now have.

Liam Donaldson

The Chief Medical Officer, Liam Donaldson, announced his retirement this week.

This is how the news was greeted by one reader of the Doctors Net UK website:

"Well, you were CMO during MMC/MTAS, possibly the biggest ***-up in medical training ever. You were also CMO during the spell that hospitals turned into dirt-ridden cess-pits, and when hospitals started killing off all their patients with bugs like C diff. And you were the CMO that blundered through the 'flu crisis', with management that made most GPs shake their head slowly, wondering quite what was going on.

And so you choose to stand down, just because you chums in government are going to lose an election.

Any chance you could *** off earlier?"

Growing like topsy

I read today, that since 1970 the number of hospital administrators has grown by 2753%; the number of doctors has grown by 156%. It is like trying to fight the hydra.

Meanwhile in Copenhagen...

Today’s conference speakers include Gordon Brown, the Venezuelan tyrant Hugo Chavez; and Zimbabwe’s Robert Mugabe.

Our Prime Minister appears to be in fine company...none of them were elected

Just fancy that

“One thing puzzles me: The new Chinooks are due to come into service in 2012 and 2013 – but didn’t President Obama tell us only the other day that NATO will begin withdrawing from Afghanistan in 2011?”

It's alright for some

Lord Paul, the multi-millionaire ally of Gordon Brown, was made a privy counsellor by the prime minister after pledging to donate “as much as he could afford” to Labour’s election campaign.

Brown’s decision to grant the honour to the Indian-born industrialist, who faces a possible police investigation over second-home expenses, has provoked a backlash among Labour peers.

The peer, who is non-domiciled in the UK for tax purposes, gave £45,000 to Brown’s leadership campaign in 2007 and has promised to make a significant donation to Labour before the general election.

Am I too late?

I used to think that I was quite good at managing skin cancer; I have certainly seen enough of it over the years. I have always consulted next door to my plastic surgeon, and we have had an excellent system of asking each others’ opinions on difficult cases. Until very recently when the lab was moved, our histopathologist worked just round the corner, so we could easily get his opinion as well, and occasionally we even brought him round to see a case before we biopsied it.

Now of course, that isn’t good enough, and we have to sit down while an administrator dutifully ticks off on a list whether each lesion has been excised with the margin prescribed by some unnamed higher authority. We then have to report in to a so called centre of excellence, where someone with rather less experience checks over our work, and our pathology (reported by someone who has been at it for decades) is reviewed by a registrar (no, I am not joking). And then we are castigated if we have used common sense rather than slavishly followed the “official guidelines”. Recently a man was admitted under the physicians whose initial presentation with melanoma was with disseminated metastatic disease; he knew the diagnosis, and his dearest wish was to be allowed to go home to die in peace. I committed the hideous sin of failing to refer him to the oncologists, not that there was anything that they could have offered but because that is what the guidelines demand.

Now our skin cancer service has been scored against some formal criteria. Never mind that we produce a service where patients receive high quality care from experienced and capable consultants, my colleagues and I received 19%. I’ve never had 19% for anything, not even French at school. So what were we doing wrong?

Apparently we lost quite a few marks because our skin cancer Multidisciplinary Team meets twice a month rather than the prescribed once a fortnight. I did a quick check on the maths; twice a month means 24 meetings a year, once a fortnight means having 26. I didn’t appreciate that those two extra meetings a year to tick the boxes could so enhance patient care, and I am so grateful to those anonymous people who clearly know so much better for putting me right. We also lost quite a few marks because we don’t have a designated skin cancer nurse. The fact that we have sensible capable nurses who do everything to support our patients doesn’t count, because they are not called skin cancer nurses, and unless they are we lose marks.

So I have failed, and failure really hurts, no, not because I have been given a humiliating 19%, but because I have been part of a profession that has given in to this pathetic nonsense. It’s time for all of us to just say “enough is enough” before this disease of political correctness has fatally metastasized. But it may already be too late.

Dr Neil Cox

This post will not mean much unless, like me, you are a dermatologist.

Dr Neil Cox, consultant dermatologist at Carlisle, and one of the greatest clinical dermatologists of this or any other era, has died at the age of 53.

Neil could have sought fame or fortune at a major teaching hospital, but he chose to serve his NHS patients in rural Cumbria with skill and devotion. He was an excellent clinical researcher and wrote extensively, but more than anything else he was a lovely guy.

He will be sorely missed

Well done, Mr Darling

So there you are. We are in the worst financial mess in living memory. The chancellor rises to his feet. The world awaits.

And what does he announce? The tax on bingo is to be cut.

I'm back

People keep telling me that they miss my blog. So I'm pleased to announce that I'm back!!

I'll be posting on all sorts of issues, but especially on the NHS.

And by the way, I've missed you.