Save Bedford Hospital

It's election time

2010-04-05T10:46:00.000-07:00

So, the're off.

And who should you vote for, now that you won't have the chance to vote for the SAVE BEDFORD HOSPITAL PARTY?

Well it's simple really. Vote for whoever has the best chance of getting rid of this nasty, spiteful, incompetent Labour government. That may vary from place to place, so use your judgement and common sense.

Is this what you really want?

2010-03-28T09:24:00.001-07:00

Patients' groups expressed horror at the "sick experiment" in which NHS managers have agreed to pay £38 for every casualty that ambulance staff "keep out of Accident and Emergency" (A&E) departments after a 999 call has been made.

The tactic is part of an attempt to manage increasing demand for emergency care amid failings in the GP out-of-hours system.

Documents seen by The Sunday Telegraph disclose that staff at Britain's largest ambulance service have been encouraged to maximise the organisation's income, by securing payments for diverting patients to telephone helplines.

The bonuses are among dozens of schemes being tried out by ambulance trusts across the country as they attempt to improve their emergency response times and help A&E departments meet controversial targets to treat all patients within four hours of arrival.

Another plan uncovered would see thousands of 999 calls currently classed as urgent downgraded so that callers receive telephone advice instead of an ambulance response.

The changes were due to be introduced across the country this week, but the Government committee governing ambulances has delayed its decision amid safety concerns.

Last week, an investigation was launched at the ambulance trust piloting the scheme following the death on Thursday of a man whose case was referred for telephone advice when an ambulance should have been immediately dispatched.

Coming to a hospital near you

2010-03-07T02:25:00.000-08:00

The catastrophe of Stafford Hospital, where hundreds of patients needlessly died, was an entirely predictable result of this governments target driven obsessions.

Much of what happened at Stafford happened, and continues to happen, elsewhere, perhaps in diluted form (think, perhaps of Stoke mandeville and Maidstone).

It was headline news for 24 hours, but how have we allowed it to slip away. When are senior members of the SHA,, of the Department of Health and health ministers going to be held to account?

You have been warned

2010-03-01T14:27:00.001-08:00

"Transforming" & "Vertical Integration".

As in "Transforming" Community Services.

Every PCT in the land has been ordered by the DoH to complete the purchaser-provider split within the next 8 months, by divesting itself of all its community services. These must either be set up as independently-contracting cooperatives ("Social enterprises"), or handed over in their entirety to an alternative contractor.

Such organisations will inevitably be too small to be financially viable, so the preferred solution, & inevitable doom, is for "Vertical Integration" - in plain English, a hostile takeover by the local Acute Trusts.

The Trusts, of course, have perverse incentives NOT to provide community service, but to get everyting transferred to in-patient care, especially as non-elective emergencies to get the massively increased PBR tariffs.

So, in translation, "Transforming" means utterly destroying.

As a means of providing care, or saving money, it is barking mad.

But as a means of fattening up the acute trusts for eventual privatising, it is a brilliant way to give them abusable & highly desirable monopolies.

And in the meantime, as a side-effect, the eligibility of the employees of the divested services for the NHS pension is already being questioned with a view to being cancelled - potentially setting a dangerous precedent for existing GPs & future employees of privatised trusts.

So be advised, this is not going to go away, with or without a change of geovernment. It is civil service policy & not open to democratic debate.

Gordon Brown a bully?

2010-02-24T11:59:00.001-08:00

Amusing comment on Channel 4 News. The staff at No 10 said Brown had a ferocious temper but none said they would describe it as bullying. One said he didn’t have the empathy to bully!

Meanwhile at Stafford Hospital

2010-02-23T10:50:00.000-08:00

The NHS Trust running Stafford Hospital spent £628,000 boosting its image in a 3 year period when it was embroiled in a scandal over dismal standards of care.

Over the same period that Stafford Hospital is accused of causing between 400 and 1,200 avoidable deaths the parent Trust spent tens of thousands of pounds on a PR agency….advertisments and ‘marketing management costs’.”
Stafford Express and Star, Feb 23rd

and in London...

2010-02-23T10:48:00.001-08:00

Dr Anwara Ali, a Labour councillor in Tower Hamlets and the face of the NHS's East End campaign on breast cancer (see below), has switched to the Tories.

Dr Ali, who is the borough's lead Cabinet member on health, told the Evening Standard today:

“I have been a lifelong Labour supporter, but I believe the country cannot afford five more years of Gordon Brown.

“As a GP working on the frontline in the largest practice in the East End, I have become increasingly disillusioned with Labour’s failure to reform the NHS. The past decade has seen this government waste millions of pounds on bureaucracy in hospitals.”

“Gordon Brown’s obsession with top down targets and a tick box culture has ruined the moral and goodwill of the national health staff. Ill health and early death in the East End is a direct result of Labour’s failure to bring real reform to the NHS.”

The hazards of alternative medicine

2010-02-17T10:00:00.000-08:00

A practitioner of Chinese medicine has pleaded guilty to selling a banned substance to a woman who went on to develop kidney failure and cancer.

Ying "Susan" Wu, 48, of Holland-on-Sea in Essex, has been on trial at the Old Bailey for selling pills containing aristolochic acid to a civil servant.

The judge said he accepted Ms Wu had not meant to harm, and that the case highlighted the need for regulation.

Ms Wu has now been given a conditional discharge.

Patricia Booth, 58, took the pills, bought at Chelmsford's Chinese Herbal Medical Centre, for over five years. She was in her mid-40s when she first sought help from the centre in 1997 for stubborn patches of spots on her face.

The Old Bailey heard the products had been advertised as "safe and natural".

But they contained a substance - aristolochic acid - which when she was first sold them, should only have been given under prescription, and which was later banned.

Traditionally this would be used maybe once or twice by a doctor who would know about its toxicity, but sometimes it might get into a formulation which is then used by somebody who doesn't have this wealth of experience
Professor Monique Simmonds

The court heard Mrs Booth became ill months after she stopped taking the pills. She was diagnosed with kidney failure, and later with cancer of the urinary tract - both allegedly caused by the pills.

The grandmother, who used to manage a government office of up to 60 people, currently goes to hospital three times each week for dialysis.

She had told the court that she had been advised to take about 30 tiny brown tablets three times each day, returning to the shop every two weeks to buy up to three bottles at a time. She became friendly with Ms Wu, who was employed at the shop as a "Chinese doctor" until it closed in 2003.

Ms Wu, who had initially denied the charges, pleaded guilty to selling prescription only medicines without authorisation and to selling a banned substance.

How can this happen in the 21st century?

2010-02-11T11:16:00.000-08:00

An independent inquiry into Stafford Hospital – where patients were starved, dehydrated, left in agony, and told to lie in their own faeces – has heard how:

* The hospital's emergency assessment unit was so unsafe that staff branded it "Beirut";

* Job cuts left nurses so overstretched they became "immune to the sound of pain";

* Receptionists decided which casualty arrivals should be seen first, based on a "gut feeling" of who looked the most unwell;

* When hospital bosses were given notice of a damning inspection report, published last year, they responded by hiring a public relations team and promised to "get MPs on side";

The inquiry, led by Robert Francis QC, was ordered following last year's damning Healthcare Commission report in which regulators described care of patients at Mid Staffordshire Hospital trust as the most appalling scandal they had ever encountered.

More than 900 patients and families, and scores of staff, have given evidence to the inquiry, which is examining the care of thousands of patients treated between 2005 and 2009.

Findings of the inquiry, which were handed to ministers on Friday, are expected to focus on how a culture of "fear and bullying" prevented failings from being exposed.

Mortality rates suggested that there were at least 400 more deaths than might have been expected in a three-year period, while relatives told how their desperate loved ones had been left to drink from flower vases.

In the wake of the scandal The Sunday Telegraph launched the Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care, and which has been backed by more than 5,000 people.

Closed sessions of the inquiry heard how patients were left in agony, screaming for pain relief, while others were left without medication, food and drink, and left on commodes for long periods.

Basic hygiene was neglected, with one female patient left unwashed for the last four weeks of her life, the inquiry heard.

Nurses told how pressure to hit a Government target for all patients to be treated within four hours of arrival at A&E meant that patients were moved when they were soaking wet, or were left in an assessment unit for hours, or even days, without proper care.

In evidence, staff were highly critical of senior managers who enforced 160 job cuts to cut costs as the trust applied for coveted "foundation status".

When the status was awarded, staff were rewarded with £25 Marks and Spencers vouchers, to the disgust of many, the inquiry heard.

An obsession about the project blinded the board to the problems being suffered by patients, doctors said.

A former hospital worker described how in a conversation about hygiene, Martin Yeates, chief executive until he resigned last May, said the hospital "could not possibly" keep its lavatories as clean as those in the local Asda supermarket.

Staff giving oral evidence to the inquiry reserved much of their strongest criticism for Jan Harry, the trust's director of nursing from 1998 to 2006, when disastrous changes to the organisation of wards were introduced, and plans for swingeing job cuts agreed.

Mrs Harry, who was chief nurse when the trust decided to axe 52 nursing posts told the inquiry that she could not recall the decision, and was "not aware" of plans to drastically alter the ratio of trained to untrained staff.

She also said she had not been involved in separate discussions about 20 job cuts - a situation she admitted was "extraordinary".

Mrs Harry said it was not her job to monitor standards on the wards – a claim later described as "absurd" by Dr Peter Carter, general secretary of the Royal College of Nursing.

Toni Brisby, a former trust chairman, said the evidence provided by Mrs Harry was "at odds" with her recollection that the head nurse had been a strong advocate of proposals to change the way nursing was provided, and had assured the chairman that the loss of 52 posts would not harm patient care.

During the inquiry, Mrs Harry said she had no major concerns about the care provided at Stafford Hospital.

Mrs Harry left the trust "by mutual agreement" in June 2006. She told the inquiry that savings from the ward reorganisation had been "fortuitous" and that changes had been intended to improve patient care.

She said she wanted no part of the trust's financial recovery plan.

In previous evidence to the Healthcare Commission, she said resulting cuts to the number of qualified staff had not been her intention, and occurred after she left the trust.

A year after her departure, she was hired by Dudley Group of Hospitals trust to run a cost-cutting programme as it prepared a bid for foundation status.

After the trust won the status in 2008, its inspection rating dropped from good to weak, and last autumn it failed a basic hygiene inspection, though it has since improved.

Mrs Harry went on to work at Salisbury Foundation trust as interim director of operations between December 2008 and May 2009.

Her replacement at Mid Staffordshire Hospitals, Dr Helen Moss, who left in December to take up a training role across the East Midlands, was criticised by some staff for not acting quickly enough to tackle problems uncovered, but others praised her attempts to make changes.

Helen Morrey, director of operations at Mid Staffordshire trust from 2006 until last year, admitted "risk assessments" about the impact of job cuts were inadequate and accepted responsibility for a failure to thoroughly investigate complaints by patients.

Ms Morrey was put on paid leave last July, before leaving the trust in November.

Kate Levy, the trust's head of legal services, is currently suspended over allegations that she asked for a rewrite of a damning report into a patient's death because she did not want the trust to receive "adverse publicity".

Antony Sumara, who replaced Mr Yeates as chief executive of the trust, said the organisation was committed to work "openly and transparently and will tolerate nothing less from our staff".

Julie Bailey set up the campaign group Cure The NHS after the death of her mother Bella at Stafford Hospital in 2007.

The campaigner said the hospital's treatment of patients had been "absolutely horrific," while those who tried to speak out had been silenced. The group is calling for a public inquiry into the supervision of all hospitals.

"Our biggest concern is that this could happen again, elsewhere, unless an inquiry looks at how this was allowed to happen; the system of regulation, the role of the Department of Health, and its ministers. Nothing else will do," she said.

Spending like there's no tomorrow

2010-01-19T04:32:00.000-08:00

This morning’s Independent contains an almost incredible splash that £26bn has been wasted on IT projects over the last decade. It's a litany of binary bungles - the incompetence: staggering; the forecasting: inept; and the planning (or lack of it): simply shocking. Contending with such absurdity whilst staring down the barrel of a £175bn deficit, you don’t know whether to laugh or cry.

Let me take you on a whistle stop tour of dud investments made on our behalf. The major culprits are the NHS’ national IT programme (over budget and late at £12.7bn and used by only 160 health organisations out of 9,000), the MoD’s defence information infrastructure (over budget and late at £7.15bn and which was commissioned without a pilot) and the ID cards scheme (£2bn over budget and virtually scrapped at any rate). The government enjoys an impeccable reputation for throwing good money after bad bureaucracy; all three examples are evidence of the blinkered approach Labour still takes and the system that facilitates that approach.

In many ways, the modest examples of waste are more indicative of what is wrong with our bureaucracy and why it needs reform. In 2006 the DWP introduced the benefit processing replacement scheme, the aim of which was unclear; three months later it emerged that the scheme had been dropped, having already cost £106m. Money was spent for the sake of it on a gimmick that was quietly dropped after initial applause had subsided. Indicative of the Civil Service’s inability to cost anything, GCHQ decided to move its computer systems at an estimated cost of £41m; the final reckoning exceeded £300m. But the cream of the jest is the Department of Transport’s shared services centre. Bright and breezy analysts opined that rationalisation would save £51m; eventually the scheme cost £81m, but it was not without its benefits. After a little application, the unfulfilled vehicle licensers of Swansea came to enjoy Goethe in the original: the programme communicated in German.

The hazards of over eating

2010-01-15T08:06:00.001-08:00

A floor collapsed beneath a group of about 20 members of Weight Watchers as they gathered to compare how many pounds they had shed over Christmas.

Members of the weight-loss club were lining up to compare readings on the scales when they heard a bang as the floor came away from the walls of their meeting room in Växjö in southern Sweden.

“We suddenly heard a huge thud – we almost thought it was an earthquake and everything flew up in the air. The floor collapsed in one corner of the room and along the walls,” one of the those present told the Smålandsposten newspaper.

They abandoned the room as the floor started to give way in other areas.

Sign of the times

2010-01-12T10:55:00.000-08:00

I was driving to work in Bedford this morning when I found myself behind a Group 4 security vehicle taking prisoners to Bedford prison. Someone had written in the dirt on the back of the vehicle "Caution, may contain nuts".

Watch out, the taxman's about

2010-01-12T01:49:00.000-08:00

HMRC, desperate to make up for lost tax revenue from the recession are launch9ing a new blitz, initially to target doctors and dentists.

Doctors and dentists were identified yesterday as the first groups that HM Revenue and Customs inspectors would target.

Other white-collar workers including solicitors, barristers and accountants were expected to be targeted in coming months in what inspectors have named the “professionals campaign”.

Previously the revenue has focused on people in blue collar occupations, such as publicans and taxi drivers, when fighting tax evasion.

It was disclosed yesterday that attention would switch to the accounts of professionals earning more than £100,000.

Tens of thousands of individuals were expected to be audited.

Experts accused the Government of unfairly seeking “easy pickings”.

They suggested that the decision to chase high-earning professionals for unpaid taxes had been forced on the revenue by the Treasury, in an attempt to raise funds to reduce the national debt.

The revenue said a “significant” minority of medical professionals were engaged in tax evasion.

Examples cited included not declaring fees for private work done for medical care providers, payments for private consultation work or cash sums for drafting medical reports. Under a three-month amnesty, hospital consultants, GPs and dentists have until March 31 to make a voluntary disclosure about any income they have not declared.

In exchange, they will have to pay the outstanding tax. They will also face a fine of 10 per cent of the amount owed — but the action will stop there.

However, anyone who refuses to disclose their unpaid tax, and is caught after the deadline, faces criminal prosecution and up to seven years’ jail. They could also find themselves “named and shamed” on the revenue’s website.

Tax inspectors can issue formal notices asking people to hand over bank statements and business records if they believe they have grounds for suspicions. They can also legally inspect business premises using their civil powers. Tax evaders could also be identified through their previous tax returns.

Mike Wells, the revenue’s director of risk and intelligence, said: “I strongly urge any in this group [the medical profession] who think they may have outstanding tax liabilities on their income to get in touch with HMRC and get their tax affairs in order simply and on the best available terms.

“The message is clear: contact us before we contact you.”

Phil Berwick, the director of tax investigations at the law firm McGrigors, said targeting the medical profession alone was “without precedent”. “It is people who are going to be averse to naming and shaming and probably in a position to make a payment to the revenue,” he said.

“By offering an amnesty, HMRC is hoping to get a significant amount of tax into the Treasury’s coffers very quickly and at a reduced cost to itself. The parlous state of the public finances and the pressing need to reduce the deficit has probably forced HMRC’s hand to an extent.”

The middle-class initiative follows a previous revenue amnesty scheme to allow people with offshore bank accounts to declare how much tax they owed and pay a small fine. About 10,000 people made use of the scheme.

Richard Limburg, from Vantis Medical Group, the accountancy firm, added: “It is likely that HMRC sees the medical profession, especially consultants, as easy pickings and this could raise substantial amounts.”

A British Medical Association spokesman said doctors with concerns should consult a financial adviser. A spokesman for the British Dental Association said: “This plan serves as a useful reminder of the importance of ensuring everything is up to date.”

Poetry corner

2010-01-10T13:53:00.001-08:00

Proof that Gordon Brown cannot do anything right. Brown, fresh from surviving the Hoon-Hewitt assassination attempt, tells us that the poem Invictus by William Ernest Henley is his inspiration.

"Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find, me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul".

Who else was inspired by that poem? Not just Nelson Mandela, it transpires.

Psychopath Timothy McVeigh, who chose it as his final statement before he was executed in 2001 after killing 168 people in Oklahoma.

You'd have thought Downing Street might have thought this one through a little bit better, rather than choosing the convicted terrorist's poem of choice.

Go for it

2010-01-07T10:59:00.001-08:00

Prof Tim Briggs, medical director of the Royal National Orthopaedic Hospital (RNOH) in north London, will challenge the former minister Tony McNulty as an independent candidate for Harrow East with the aim of securing the future of the institution.

The RNOH, which treats 60,000 patients a year, is in a state of disrepair and costs millions of pounds to maintain every year.

Prof Briggs has campaigned for nearly 15 years to secure money to rebuild the hospital on its current site in Stanmore.

But his lobbying has failed to secure the £60m needed from the strategic health authority, NHS London.

Mr McNulty holds the seat with a 4,700 majority.

Professor Briggs said he was giving the Government “one last chance”. If the Health Secretary Andy Burnham did not give him a firm commitment at a meeting this week, he would stand against Mr McNulty, he told the Independent on Sunday.

NHS London said: “It is clear that the RNOH NHS Trust provides a high-quality service but from an inadequate site. NHS London and Department of Health colleagues are currently reviewing the business case and the trust is responding to a number of points that we have raised for clarification."

An invitation

2010-01-05T23:37:00.000-08:00

Would you like to write a piece for this website (anonymously if you wish). Please e-mail me on barrymonk@doctors.org.uk with your ideas.

A moneyspinner for 2010

2010-01-01T08:35:00.000-08:00

Secretary of State,
Department for Environment, Food and Rural Affairs (DEFRA),
Nobel House
17 Smith Square
London SW1P 3JR

16 May 2007

Dear Secretary of State,

My friend, who is in farming at the moment, recently received a cheque for £3,000 from the Rural Payments Agency for not rearing pigs. I would now like to join the “not rearing pigs” business.

In your opinion, what is the best kind of farm not to rear pigs on, and which is the best breed of pigs not to rear? I want to be sure I approach this endeavour in keeping with all government policies, as dictated by the EU under the Common Agricultural Policy.

I would prefer not to rear bacon pigs, but if this is not the type you want not rearing, I will just as gladly not rear porkers. Are there any advantages in not rearing rare breeds such as Saddlebacks or Gloucester Old Spots, or are there too many people already not rearing these?

As I see it, the hardest part of this programme will be keeping an accurate record of how many pigs I haven’t reared. Are there any Government or Local Authority courses on this?

My friend is very satisfied with this business. He has been rearing pigs for forty years or so, and the best he ever made on them was £1,422 in 1968. That is – until this year, when he received a cheque for not rearing any.

If I get £3,000 for not rearing 50 pigs, will I get £6,000 for not rearing 100?

I plan to operate on a small scale at first, holding myself down to about 4,000 pigs not raised, which will mean about £240,000 for the first year. As I become more expert in not rearing pigs, I plan to be more ambitious, perhaps increasing to, say, 40,000 pigs not reared in my second year, for which I should expect about £2.4 million from your department. Incidentally, I wonder if I would be eligible to receive tradable carbon credits for all these pigs not producing harmful and polluting methane gases?

Another point: These pigs that I plan not to rear will not eat 2,000 tonnes of cereals. I understand that you also pay farmers for not growing crops. Will I qualify for payments for not growing cereals to not feed the pigs I don’t rear?

I am also considering the “not milking cows” business, so please send any information you have on that too. Please could you also include the current Defra advice on set aside fields? Can this be done on an e-commerce basis with virtual fields (of which I seem to have several thousand hectares)?

In view of the above you will realise that I will be totally unemployed, and will therefore qualify for unemployment benefits.

I shall of course be voting for your party at the next general election.

Yours faithfully,

This originally appeared in the Guido Fawkes blog

Happy New Year

2009-12-31T06:43:00.000-08:00

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

Akmal Shaikh

2009-12-29T04:33:00.000-08:00

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

2009-12-26T06:09:00.000-08:00

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

2009-12-24T03:11:00.000-08:00

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...

2009-12-20T03:18:00.001-08:00

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

2009-12-19T04:50:00.000-08:00

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

2009-12-18T12:03:00.000-08:00

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...

2009-12-17T04:39:00.000-08:00

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

2009-12-16T11:34:00.000-08:00

“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

2009-12-13T13:40:00.000-08:00

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?

2009-12-12T08:44:00.000-08:00

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

2009-12-10T10:28:00.000-08:00

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

2009-12-09T14:19:00.000-08:00

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

2009-12-09T14:13:00.001-08:00

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.

New directions

2008-08-27T13:41:00.000-07:00

This blog has been running for nearly two years. In that time it has had some real successes - stories have been taken up by Sunday Times, Sunday Telegraph, Daily Mail, Private Eye (twice) to name just a few. Other stories have moved onto major political websites such as Guido Fawkes.

We have certainly exposed some of the nonsense of a target obsessed NHS.

But times change. The message has been put centre stage. At the same time, a few people have taken things rather personally, which has never been our intention; in any case, blogs are getting a bit "old hat".

For that reason, we are going to post much less frequently. There are other, perhaps better, and certainly more subtle means of getting the message across. We shall use them.

To paraphrase George Orwell "Big brother, we are watching you". The campaign is moving to a new and better level. We have never been more confident of success.

Ho, Ho!

2008-08-06T13:24:00.001-07:00

I've just re-read this Q&A that the Independent conducted with Gordon Brown on 27 June, 2007. One of our Dear Leader's responses jumped out at me. Here it is, with the question that prompted it:

How will life be different under a Brown government?
JOHN BROOKS, by email
I will let you answer that question in a year's time. I hope you'll say you feel safer on the streets and more prosperous, more confident in your local schools and hospitals, and you'll have a bit more trust in the political system.

More choose and book nonsense

2008-08-04T14:28:00.001-07:00

Despite Choose and Book becoming available to most GP-referred patients to choose a hospital appointment, two thirds of patients surveyed by University College London were given no choice of date or time. Just under a third had no choice of hospital, and 86 percent had a selection of fewer than four hospitals.

Choose and Book started to go live in January 2006, and allows patients referred to hospital by their GPs to choose the location and time they visit, while at the GP surgery, online or on the phone.

It is part of the much-delayed £12.7 billion NHS National Programme for IT, which will replace paper patient data with centrally stored Summary Care Records, provide an electronic prescriptions service, and allow online booking of hospital appointments.

UCL surveyed 104 patients who had used the system for referral to Hillingdon hospital in London, for its report, ‘Does Choose & Book fail to deliver the expected choice to patients?’. Only one patient was offered the four options promised by the scheme.

Patients trying to book online also experienced some technical problems, UCL said. As a result a number of patients were unable to book online, and ended up ringing the booking line or going back to their GP to book the appointment.

The report also warned that there has been “considerable bad feeling associated with Choose and Book with criticism about risks to patient confidentiality, reliability and speed”.

Dr Henry Potts at the UCL Centre for Health Informatics and Multiprofessional Education, who oversaw the study, said Choose and Book was a vital system because patient choice has regularly been touted by the government as central to NHS transformation.

But he added: “It is clear from these results that these patients were not experiencing the degree of choice that Choose and Book was designed to deliver.” This “could be typical” of the system around the country, he said.

The NHS had not even attempted to find out whether patients liked the system, Potts warned. “It is striking that nobody, up until to this point, has actually asked patients about their experience of the system,” he added.

There are also concerns over patients’ understanding of the system, UCL said in its report. Nearly two thirds were not aware they could choose the hospital they visited. Potts said: “This study also raises many wider questions such as what patients understand by choice and, indeed, whether they actually want choice.”

An NHS spokesperson said he recognised the results in the survey, but preferred to point to another a more recent report, which said 67 percent of Choose and Book users were able to go to the hospital they chose.

Polyclinics, what's really going on?

2008-08-02T14:12:00.000-07:00

Ministers have repeatedly insisted that government plans for 300 super-surgeries, housing up to 25 GPs, will not be imposed, but agreed through consultations with local communities.

However, information gathered from primary care trusts (PCTs) leaves those pledges in tatters.

Half of the PCTs that responded said they would not consult on plans to build centres and some cited advice from the Department of Health as the reason for their decision.

The disclosures, from 100 of England’s 152 PCTs, appear to render meaningless recent promises by Alan Johnson, the Health Secretary, who said last month he would “insist” that all decisions on the centres be “taken in consultation with local people”, later adding that there was “no argument for imposing” the plans.

Andrew Lansley, the shadow health secretary, said the new information, gathered by the Conservatives under the Freedom of Information Act, demonstrated the Health Secretary’s pledges to be “no more than spin”.

Mr Lansley said: “Labour has claimed that they are not imposing polyclinics on local people, but these figures expose that lie for what it is.”

The BMA said this confirmed its fears that a policy that could push smaller practices out of business was being forced through, regardless of opposition.

The disclosures show that just 44 of the 100 PCTs that responded intend to subject their plans to formal consultation. Six have yet to decide, while 50 said they would not be consulting the public.

Several mentioned DoH advice, quietly issued in January, that there is no legal obligation to carry out a formal consultation, and that it is a matter for local discretion. Others said they could not consult on something which was a Government directive, or that they had not been given the time to seek the views of the public.

The Government is spending £250million introducing polyclinics, which will bring groups of GPs together in large centres offering services such as minor surgery and diagnostic tests. Each PCT is expected to create at least one in its area.

So far, the plans have encountered opposition from doctors and patients. More than one million people signed a petition opposing the policy.

The Conservatives claim as many as 1,700 practices across England could be forced to close as a result of the move.

Ministers have repeatedly said that while the plan to introduce 300 new practices across the country, including 150 in London, is government policy, proposals about where they are sited, and what each scheme involves, should be subject to local consultation.

England’s 152 PCTs have until the end of next month to draw up a shortlist of bidders to run the new services. Big businesses such as Sir Richard Branson’s Virgin Healthcare are expected to enter the market, while others will be run by groups of GPs.

Mr Lansley said: “Rather than attempt to debate polyclinics with local people and win them over with the facts, Labour has instead resorted to spin and obfuscation. They know how unpopular their plans to shut down local GP services are, and are simply running scared.”

Dr Beth McCarron-Nash, of the BMA’s GP committee, said they had repeatedly warned that much of the consultation had been patchy and that without proper debate, centres would be built in the wrong parts of the country.

The Department of Health said all PCTs had been told it was their legal duty to “involve” patients in the planning of services, and those who had not done so formally had used focus groups and road shows to involve the public.

331 dead...no one to blame

2008-07-30T09:31:00.000-07:00

The hospital trust at the centre of Britain's worst recorded hospital superbug outbreak which led to the death of 331 patients has escaped prosecution.

Clostridium difficile contributed to the deaths of the patients over two-and-a-half years at three Kent hospitals a health watchdog report found.

Appalling standards of care, crowded wards, financial problems, a shortage of nurses and poor hygiene all led to the outbreak the Healthcare Commission found in a highly critical report in October.

However after studying that report, Kent Police and the Health and Safety Executive said there would be no charges over the deaths at hospitals run by the Maidstone and Tunbridge Wells NHS Hospital Trust.

Assistant Chief Constable Allyn Thomas said: "Whilst the report makes for grim and at times distressing reading, our review has not identified any information that would indicate a need or duty to conduct a criminal investigation into the Trust at this time."

Relatives of those who died in the outbreak reacted angrily to the announcement.

Steve Stroud, whose 77-year-old stepmother Doreen Ford died in Maidstone Hospital said he was "disgusted" by the decision.

Mr Stroud, husband of former Bucks Fizz singer Cheryl Baker, said: "This is disgusting. Someone has got to be held to account over all these deaths and if it is not the hospital trust, then who the hell can it be?

A bunch of chimpanzees

2008-07-29T12:30:00.001-07:00

It is of course with a sense of enormous irony that we view a situation where the NewLabour party members are as undecided as their dithering leader.

We have reached a pretty passe when a party so far behind in the opinion polls can't even pluck up the courage to ask Gordon Brown to go.

There are some clear reasons for this dithering by his underlings; first they have no clear idea what they want to say that is different to Gordon Brown. Second there is no public appetite for any of them more than there is for Gordon Brown. Third nobody would actually believe in anyhting being delivered by this NewLabour NewBoy as they have failed to deliver on so much else.

So for all those calling for what David Cameron and the tories stand for the answer is simple - not a bunch of failed promises to the poor, a wholesale wasting of public resources and multiple quangos.

I'd sooner a chimpanzee ran the country than NewLabour; it would be more sincere, it wouldn't need to be told to eat its leftovers and they don't chew their fingernails.

Revalidation

2008-07-27T13:06:00.000-07:00

Sir Liam Donaldson has announced, with considerable fanfare, his proposals for revalidation of doctors.

This is how one consultant (a radiologist) has responded:

I am a hospital consultant who, in common with other consultants, has been undergoing annual 'assessment' in the form of appraisal since 1993. The overwhelming majority of doctors will have nothing to fear from this but let us not delude ourselves that this, or any other, system of assessment would have stopped Shipman. Shipman was a murderer who simply happened to be a doctor.

On a different note, the medical profession will not take kindly to Donaldson lecturing them on accountability. He is the senior doctor in the country and so far has demonstrated no accountability for his key role in the fiasco that saw hundreds of young doctors lose out on getting jobs last year. Nor has he demonstrated any accountability to those senior members of the medical profession who passed not one, but two, votes of no confidence in him as CMO last year. It appears that accountability only applies to those doctors who have not decided to become career politicians

Cheers

2008-07-22T13:03:00.001-07:00

This is from the Guido Fawkes website:

As they slip off this afternoon to face a tough 12-weeks holiday in the real world without subsidised drink, Guido wonders how will MPs cope?

The House of Commons Refreshment Department operated on a subsidy of £5.5 million of taxpayers’ money in the 2007/08 financial year, which is equivalent to the total annual tax receipts from 35 pubs. The subsidy is equivalent to £8,500 per MP - that is approximately £50 per diem on top of the £30 per diem they voted to award themselves every working day in cash.

The subsidy, which for some inexplicable reason was not published in the House of Commons’ Annual Accounts, was £693,000 higher than in 2006/07 - a 15% increase. No belt tightening for MPs despite the Chancellor's warnings.

It accounted for 43% of the operating costs, meaning that the taxpayer coughs up £4.30 for every £10 spent refreshing our politicians: even before they claim back their outgoings without receipts through the expenses system. These figures don't include the multi-million pound re-fit of the wine cellar

How stupid can they get?

2008-07-20T15:01:00.000-07:00

Thousands of people undergoing laser treatment could be left with burns and scars as a result of government plans to end inspections of clinics, the Department of Health has admitted.

Up to 3,400 more patients could be harmed by cosmetic procedures to remove a mole, tattoo or unwanted hair, according to a consultation paper on the move drawn up by Whitehall officials themselves. The change, which critics claim will allow cowboy operators to open premises that have poor safety standards because they would no longer need to apply for a licence, comes into effect on 1 October.

A two-page appendix to the paper, headed 'Deregulation of lasers and lights - possible effect on the number of adverse incidents', said that harmful outcomes may double. It reads: 'Laser and light treatments ... are potentially harmful and they will generate adverse incidents ... Deregulation would generate an extra 1,700-3,400 adverse incidents per year.' There are already an estimated 3,400 each year.

'It's shocking that the government is prepared to countenance thousands more people being injured as a result of this deregulation - and it's an astonishing thing to admit,' said David Gault, a consultant plastic surgeon who specialises in laser treatments. 'While some of these "adverse incidents" involve only minor scarring or pigmentation, people's sight can also be damaged by a powerful laser being shone into their eyes. The psychological harm from these things happening is, in my view, harsher than the physical damage people suffer,' added Gault, the British Associ

Now there's a surprise

2008-07-20T14:33:00.000-07:00

People labelled "idiots" and "lunatics" under archaic mental health laws could soon be allowed to stand for Parliament.

Ministers are considering scrapping ancient rules after complaints from mental health campaigners that they are discriminatory.

Laws created in Elizabethan times define idiots as "incapable of gaining reason" and lunatics as capable of only periods of lucidity.

They are banned from becoming MPs "in their non lucid intervals".

Some of us had assumed that the House of Commons was stuffed full of lunatics and idiots already.

Putting the knife in

2008-07-13T14:25:00.000-07:00

The stories of lethal stabbings of young people have been ghastly. No doubt their underlying causes are complex, deep-rooted, and long-standing.

Now Gordon Brown is going to "take action". If he does take measures which end a sub-culture of alienation, then he is to be congratulated. But please don't let him just produce the usual meaningless politician's waffle. The public deserve better.

This is Britain under Gordon Brown

2008-06-26T11:32:00.000-07:00

A Gurkha awarded the highest military award for gallantry in the face of the enemy was at the forefront of a demonstration today to promote the rights of more than 2,000 of the soldiers to stay in Britain.

Tul Bahadur Pun VC, 87, a Second World War veteran who is now in a wheelchair, delivered a boardful of medals, including an MBE, to Downing Street in protest over the treatment of Gurkha soldiers.

A London hospital refused to treat him for his heart condition, claiming he owed thousands of pounds in unpaid medical bills.

Disgust: Gurkha Regimental Sergeant Major Pun Tulbahadur returns his medals to Downing Street

He was told he had no right to free care by a revenue enforcer at West Middlesex University Hospital.

Mr Pun, one of just 10 living VC holders in the UK, was close to tears and forced to leave after being told he also owed thousands of pounds because he had 'misled' the hospital over his immigration status.

The Gurkha, who lives on just £135 a week, was ejected this week on the anniversary of winning his VC in Burma on June 23 1944.

He had attended the Isleworth hospital's cardiology department for an urgent follow-up appointment and has been on lifesaving heart drugs for 10 months.

Choose and Lose

2008-06-17T14:57:00.000-07:00

So Choose and Book, the massively expensive and hopelessly cumbersome booking system Widely called Choose and lose by GPs) is now recognized as a failure.

This is what the Chief Executive of the NHS David Nicholson said today:

NHS chief executive David Nicholson last night said that use of Choose and Book remains disappointingly low but has become a fact of life in the NHS.

Answering MPs' questions about Choose and Book use at the House of Commons Public Accounts Committee hearing on the NHS IT programme, Nicholson said: “Utilisation of the system is not as great as we would have imagined at this stage.”

Originally the DH anticipated 39m appointments via Choose and Book by 2008, the actual figure is closer to 6m. A number of targets have been missed, including for 90% of referrals for first outpatient appointments to be made through Choose and Book by March 2007.

And these are our masters!

2008-06-05T13:15:00.000-07:00

What sort of democracy do we have when politicians behave like this?

A Labour MP has been cautioned for causing criminal damage to a van as he dashed to board a bus.

Rob Marris, the MP for Wolverhampton South West, caused £350 damage when he climbed over the bonnet of the parked white van.

Initially he denied the offence, but admitted his guilt to police before he was due to appear at Coventry magistrates' court. The 53-year-old, a trained solicitor and son of a magistrate, accepted a conditional caution, which does not count as a criminal conviction.

Mr Marris has also been ordered to write a letter of apology to the van's owner, and to pay for repairs to the vehicle's bon

Gordon Brown and Huxley Pig

2008-06-01T11:47:00.000-07:00

Gordon Brown is a great reader, and with a young family I hope that he finds time to read to them.

If he does, he may seek find some useful advice in his present political predicament.

I quote from that hero of children's literature Huxley Pig"

When in trouble,
When in doubt,
Run in circles,
Scream and shout.

I am sure Huxley's advice will stand him in good stead.

Gordon and the donkey

2008-05-29T11:31:00.001-07:00

A young man named Gordon bought a donkey from an old farmer for £100.00.

The farmer agreed to deliver the donkey the next day, but when the farmer drove up he said, "Sorry son, but I have some bad news... the donkey is on my truck, but unfortunately he's dead.

Gordon replied, "Well then, just give me my money back."

The farmer said, "I can't do that, because I've spent it already.

Gordon said, "OK then, well just unload the donkey anyway.

The farmer asked, "What are you going to do with him?"

Gordon answered, "I'm going to raffle him off."

To which the farmer exclaimed, "Surely you can't raffle off a dead donkey!"

But Gordon, with a wicked smile on his face said, "Of course I can, I just won't bother to tell anybody that he's dead."

A month later the farmer met up with Gordon and asked, "What happened with that dead donkey?"

Gordon said, "I raffled him off, sold 500 tickets at two pounds a piece and made a huge, fat profit!!"

Totally amazed, the farmer asked, "Didn't anyone complain that you had stolen their money because you lied about the donkey being dead?"

To which Gordon replied, "The only guy who found out about the donkey being dead was the raffle winner when he came to claim his prize. So I gave him his £2 raffle ticket money back plus an extra £200, which as you know is double the going rate for a donkey, so he thought I was great guy!!

Gordon grew up and eventually became the Chancellor of the Exchequer and then Prime Minister as and no matter how many times he lied, or how much money he stole from the British voters, as long as he gave them back some of the stolen money, most of them, unfortunately, still thought he was a great guy.

The moral of this story is that, if you think Gordon is about to play fair and do something for the everyday people of the country for once in his miserable, lying life, think again my friend, because you'll be better off flogging a dead donkey.

Polyclinic, what polyclinic?

2008-05-28T07:37:00.000-07:00

As troubles rain down upon the government, officials are feeling bemused. "It's headless chicken territory for ministers," said one insider. "Gordon rushed out his Queen's Speech plans, which was a mistake because it means we're now stuck with a load of legislation that nobody really wants." Officials are seeking relief from the gloom in gossip. "Civil servants love the kind of fun and frenzy that's going on now - wondering whether ministers like David Miliband or James Purnell will stay loyal or throw their hats in the ring - though both are really too young and raw."
Alan Johnson, the health secretary, has ruled himself out of being PM - he has said publicly he does not think he is up to it. Yet some say he is doing an excellent job at health - which is puzzling as not much seems to be happening there. "Exactly," said one senior figure. "He's charming, well liked and he has the ability to put a blanket of assurance over everything. Yet he's also extremely secretive - no U-turns from Alan - and he doesn't actually do much." Well, not in public. Apparently Mr Johnson has been backpedalling furiously over plans for polyclinics, which he is now calling health centres. Back in 1956, amid fears about National Health Service waste, the idea of health centres was mooted. An official report found they created as many problems as they solved.

Come on, Patrick

2008-05-25T13:11:00.000-07:00

"Cometh the hour, cometh the man"

So Labour MPs want a new leader, but can't decide which of them will step forward. Well, Patrick Hall (Bedford), could this be your moment?

Alternatively, if even Labour doesn't know, could we try asking the British Public and have an election

Bravo, Gordon

2008-05-25T13:08:00.000-07:00

We have adapted this piece from the excellent "Burning Our Money" website:

We feel strongly that Gordon Brown is the right man to lead Labour into the next election, and he's dismayed that not everyone agrees. Post the Crazy Result of the Crewe By-election, all kinds of Labour MPs Tyler's never heard of are trawling around the TV pundits saying Gordon should step aside. That's so wrong. Brown is doing more than anyone to ensure A Better Future For Britain.

Consider the Five Facts:

1. Gordon abolished the Economic Cycle!

His far-sighted stewardship of the economy has eliminated the recessions we used to suffer under those hopeless boomandbust Tories. Never again will unemployment stalk the land. (Technical note: the recent uptick in "worklessness" is a statistical aberration that will soon be eliminated).

2. Gordon abolished poverty!

Thanks to Him, eight year old children no longer have to slave 20 hour days in the cotton mills and up chimneys. Fact.

3. Gordon saved Africa!

Well, except for Sudan. And Zimbabwe. And a couple of other places. But come on - he was the one who got Bonio to give that epoch defining press conference in the Four Seasons Hotel.

3. Gordon legalised gay marriage!

Fine, Bliar was PM at the time. But it was definitely Gordon who pushed it home.

4. Gordon gave us great summers!

He was Chancellor during the hottest summers on record. All except for 1976, anyway. And 1757.

5. Gordon made the trains run on time!

Or he would have done, if he hadn't been so badly let down by others.

All in all, that's one helluva record. And those backstabbing Labour MPs should be ashamed of themselves.

Pigs at the trough....once again

2008-05-24T14:39:00.000-07:00

The health minister Ann Keen is this weekend revealed to have insured her 70-year-old husband’s life for £430,000 – and to have claimed the premiums on parliamentary expenses.

Keen took out a joint HSBC “first death” policy with her husband Alan, also a Labour MP, which meant if one of them died the other would get the payout.

The £867 monthly premiums were submitted as part of their parliamentary expenses. The couple are already entitled to generous payouts if one of them dies under the Commons pension scheme.

Details of the policy have been released after a three-year freedom of information battle by The Sunday Times. Michael Martin, the Speaker, was forced to publish the expenses of 14 MPs after spending more than £200,000 of taxpayers’ money trying to block their release.

This is the NHS

2008-05-15T03:33:00.000-07:00

Here is the text of a message sent to GPs in Southampton yesterday:

Dear Colleagues,

I have been asked to inform you urgently that Southampton University Hopital Trust is currently on ‘Black Alert’ with Ambulances queuing outside A/E and the Ambulance Service [SCAST] indicating that there is a 1.5 hour wait for even urgent requests for ambulances to be dealt with.

Clearly in this difficult situation we would request wherever possible that if measures can be taken by you to avoid hospital admission or A/E attendance for patients we would be most grateful.

I am conscious that communications of this nature are often deemed unhelpful, but I hope that you will take this circumstance into consideration, in consultation with patients and carers, in informing your clinical decisions this afternoon

Many thanks

Bye-bye, or at least Cheerio

2008-05-15T02:26:00.000-07:00

Stephen Carter, Gordon Brown's chief advisor, cut his teeth advertising breakfast cereal : so I presume he knows all about Cheerios.

This is the NHS in 2008

2008-05-14T14:36:00.000-07:00

ThIs piece was written by a hospital consultant (not at Bedford, and not about Bedford): it describes the shameful state of the NHS today.

My Uncle, 87 years old, previously completely with it, RAF retired, veteran of the Battle of Britain, The Western Desert and The Italian Campaign has a Squamous Cell Carcinoma of the scalp for which he has received excellent treatment. Unfortunately, he fell recently whilst attempting to find a seat on a bus, he was rendered unconscious and taken to his local hospital. A CT scan revealed a large subdural haematoma, treatment for which was apparently "not indicated". In spite of this he recovered consciousness. Within a week, OT even decided that he was fit to go home to his flat, which has 17 steps to the front door, he was expected to manage these with a Zimmer frame. My Mother (his sister) thought differently and arranged convalescence for him in a local nursing home (at her own expense) following consultation with his GP. Despite this, his discharge was arranged (without consultation with his family or GP, my Mother lives less than 1 hour away) hospital transport delivered him to his flat......and left him there. He was found the following morning by a "carer", who could see him through the letterbox, lying in the hallway in his own excrement. An ambulance was called, the door broken down, and he was taken back to the local DGH. He is now in the Nursing Home, thankfully. I have just had to try and explain to my Mum why this has happened, including the message to her that there was an awful mess in the flat that SHE would have to clean up (she has and it WAS awful!) This has happened in the last 48 hours and I am spitting nails. Have tried to contact the medical team and CE this evening, strange as it may seem no one can help. Thanks Gordon.

Hello, Ed

2008-05-14T14:31:00.000-07:00

Mr Ed Neale, Medical Director of Bedford Hospital, is an assiduous reader of this website; perhaps it is how he likes to be kept informed, in which case we are pleased to be of assistance.

So, from all of us in the Save Bedford Hospital party, we say "Hello,Ed".

Action stations

2008-05-11T14:28:00.000-07:00

Did anyone listen to Frank Field on "Any Questions" this week. If you didn't, go on-line on the BBC website and listen to it; if you did hear it, go on-line and listen again.

Whatever your political affiliations, Frank Field is always worth listening to, on live on air he signed Gordon Brown's death warrant.

It is our view that Brown may well be gone by July; if that is the case, then there would be enormous clamour for a general election (could we really have two unelected PMs in a row??).

So here at the Save Bedford Hospital party we are gearing up to the possibility of a general election in July 2008. Make no mistake, we want to win, and with your help we can win.

Off target (again)

2008-04-29T03:43:00.000-07:00

Patients are frequently bundled out of NHS hospitals' emergency units before their medical condition has been properly assessed, the Royal College of Nursing heard yesterday at its annual conference.

Peter Carter, the RCN's general secretary, said a poll of more than 500 frontline nurses in accident and emergency departments showed 93% felt under undue pressure from a government target to discharge or admit patients within four hours.

Three-quarters of those polled said patients were regularly admitted to inappropriate wards to meet the target. Carter told the conference in Bournemouth that women needing careful observation after an accident were wheeled off into gynaecological wards and men needing emergency surgery were transferred under sedation into orthopaedic wards.

Although nurses in these other departments did their best to care for patients until the correct facilities became available, they lacked specialist expertise.

The poll found 78% of A&E nurses believed the target led to some patients with multiple and complex needs having their care "rushed and compromised".

Sixty years of the NHS

2008-04-29T03:37:00.000-07:00

It's amazing isn't it: in sixty years the Labour party created the NHS as a unique ocial experiment and then destroyed it.

The pity is that building a service takes a long time; wrecking it can be done rather quickly, as Hewitt, Gordon Brown and Darzi have just proved.

What would Sir Alan Sugar have said?

2008-04-22T12:37:00.000-07:00

Last week this web site revealed the catastrophic news that Bedfordshire PCT were trying to withhold £4million that it owed to Bedford Hospital; this is a sum of money which will make a major impact on the hospital's financial situation.

The story had been an open secret for some time, but had only been made "official" by the medical director Ed Neale's e-mail to consultant staff. Not long afterwards, the Chief Executive released the matter to all staff in her weekly newsletter (although she gave the figure as £3.9 million).

Thanks to the action of the Save Bedford Hospital party the story was picked up by Bedfordshire on Sunday. The PCT, embarrassed by some searching questions immediately reduced the disputed amount to £2million.

So thanks to the Save Bedford Hospital party the hospital found itself £2million better off.

But how did they react? I suspect that if Sir Alan Sugar had found that one of his apprentices had saved £2million he would have expressed his gratitude. That doesn't seem to be Bedford Hospital's way : on Monday morning the Save Bedford Hospital party's prospective parlaimentary candidate Dr Barry Monk received a letter from Mr Neale threatening him with disciplinary action.

One can only speculate what Sir Alan Sugar might have said to Mr Neale : "You're fired" perhaps.

Make your mind up time

2008-04-22T12:32:00.000-07:00

Labour MPs, such as our own Patrick Hall, face a challenging dilemma.

Do they do the right thing by the very poorest in society and vote against the abolition of the 10% tax rate, and thereby imperil their own jobs, or do cynically support Gordon Brown, and penalize the most disadvantaged in the land.

We shall watch Patrick with interest.

Poverty and health

2008-04-20T11:34:00.000-07:00

The connection between poverty and ill-health is self-evident. The poor suffer more from chronic disease, and die younger.

So it seems extraordinary that a Labour government lead by Gordon Brown have decided to increase the taxes paid by the poorest, by abolishing the 10% starting rate of income tax; and they always pretend to have the interests of the weakest in society at heart.

Bombshell

2008-04-16T13:20:00.000-07:00

Mr Ed Neale, medical director of Bedford Hospital NHS Trust, today made a bombshell announcement by e-mail to consultant staff at the hospital. He advised that the Bedfordshire PCT are currently refusing to pay for £4million of work done for their patients by the hospital over the past year.

Dr Barry Monk, the Save Bedford Hospital party prospective candidate for the Bedford parliamentary constituency said "This has the potential to be a financial catastrophe for the Trust, and could not have come at a worse time. The recent independent staff attitude survey has shown how poor staff morale already is. The underlying problem is that year after year clinical staff - doctors and nurses - have not been sufficiently involved in drawing up the Service Level Agreement between the hospital and the PCT; this has caused difficulties year after year."

Things can only get better

2008-04-09T14:57:00.000-07:00

Dr Barry Monk has written this piece about his recent experiences:

Politicians keep telling us how wonderful the reforms to the NHS have been, but how do they affect real patients.

Let me tell you three illustrative tales, all from the same recent outpatient clinic, and then you can judge for yourself.

Firstly, a small child with eczema, brought along by a distraught mum. It certainly wasn’t the worst case of eczema that I’ve ever seen; it should have been entirely manageable within primary care, but Mum had found it impossible to get an appointment with any individual GP more than once, so she ended up having seen five different doctors in five weeks, and had become totally confused by the conflicting advice. Yes, you can be seen at the GPs without undue delay, but you can’t get an appointment with the doctor of your choice.

Then I saw a lady with an infected sebaceous cyst on the neck, referred as an emergency. In fact she had been referred six months earlier, but sebaceous cyst is a PCT exclusion, so the referral had been “rejected” (not by me, I never even got to see the referral letter). So, months later, she is referred up urgently when the cyst had become infected and the patient was in severe pain. By this stage, treatment would inevitably be more complicated and expensive, and the whole scenario was totally avoidable.

Finally, a somewhat more complicated story, but one with potentially catastrophic consequences. A lady is referred to me with a story of an unusual lesion on the leg; she tells me that she is also attending a rheumatologist at a hospital 50 miles away because that is the nearest option that came up on Choose and Book (we have an excellent rheumatologist, but if her waiting list reaches five weeks, her name disappears from the C and B menu); the rheumatologist has diagnosed a non-specific arthritis. She has also been sent to a hand surgeon, at a third hospital twenty miles in a different direction who has diagnosed “tight tendons” in her hand, but who was unaware of the skin or rheumatology referrals. On examination of her skin it is apparent that she has a rare, and potentially very serious skin disorder, scleroderma, which accounts also for the tight tendons and the joint symptoms. Yet having made the diagnosis I have no access to the investigations that have been done elsewhere. What she actually needs is to be seen jointly by a dermatologist and a rheumatologist, but our PCT rules prevent me from referring her to my colleague who consults just 10 metres away.

Patients may indeed be being seen quicker, but I leave to you to judge whether they are being offered a better quality of care.

A culture of bullying

2008-04-09T09:42:00.000-07:00

The Healthcare Commission has just published its independent review of the annual staff attitudes survey in the NHS.

At Bedford Hospital, based on a 58% return of questionnaires (which were sent to all staff) 17% said that in the previous year they had been abused, harrassed or bullied by a manager or other member of staff. However, apparently Bedford Hospital rated as "average" within the NHS on this criterion.

So there you are, there is an endemic culture of abuse, harassment and bullying within the NHS. What a way to run a public service.

Hurting the poor

2008-04-09T06:26:00.000-07:00

This article is, amazingly, from Socialist Worker:

Gordon Brown has declared war on many of his own voters by abolishing the 10p starting rate of tax.
While some of the poorest workers in Britain are now forced to pay hundreds of pounds more in tax, in the London boardrooms of the world's richest companies there was joy as corporation tax was slashed.
This is Labour's third cut to the tax on profits since 1997. Under Margaret Thatcher's Tory government, corporation tax was 52 percent. This week Brown reduced it from 30 percent to 28 percent – the lowest of the G7 leading industrialised countries.
New Labour's double standards make a mockery of its claim to be "lifting people out of poverty" and has sent a wave of anger among Labour supporters, even those who think of themselves as loyal to the party.
Millions of Labour voters rightly believe that the tax system should be used to help the poorest by redistributing wealth from the rich to the poor.
They think that those at the bottom end of the income scale should be paying a lower rate of tax, while those at the top should be paying the highest. This week's changes reveal that Brown's government is determined to do the opposite.
The abolition of the starting rate will hit young workers without families particularly hard. Those earning less than £18,500 a year stand to lose up to £232 a year – a lot of money when you are scrimping to put food on the table while paying the rent.
But it is not just the young and single who will be out of pocket. Around 1.2 million double income couples with no children and 700,000 double income couples with children will also be paying more. As will 300,000 women aged between 60 and 64.
Brown's startled response to the political furore over tax has been to claim that his regime of tax credits and child tax credits will make up for the shortfall. But he knows this is a lie.
Lack of information and a cumbersome application process means that only 40 percent of those entitled to tax credits claim them – dropping to just a quarter of single people on low incomes. Those under 25 without children are not even eligible.
Those who do manage to obtain tax credits often find that they become caught in a trap where any extra money they earn can be wiped out by taxes.
The Treasury's own figures show that 1.9 million people – including about half of all pensioners – whose income exceeds £6,500 a year are allowed to keep just less than 40p of every extra £1 they earn.
When the total of all deductions, including national insurance, are taken into account those people are paying rates of tax on extra earnings of between 60 and 90 percent.
This week's tax changes will mean a million more people are caught in this trap. The number affected is equivalent to more than the population of Birmingham and Manchester combined.
However Gordon Brown's world is full of stark contrasts. Multi-millionaire Labour donor Lord Sainsbury showed how New Labour is working for the rich. Last week he transferred most of his 8 percent stake in the Sainsbury's supermarket to a company he controls, in the process avoiding a £27 million tax bill.

How to waste money

2008-04-02T14:11:00.001-07:00

MORE than eight out of 10 operations which NHS bosses paid a private health company to carry out never happened.

Tameside health bosses paid the Greater Manchester Surgical Centre to carry out 777 operations last year but sent only 101 patients to the unit.

New figures, obtained under the Freedom of Information Act, show health bosses across Greater Manchester have forked out around £10m to South African company Netcare for operations which haven't been carried out since it opened in May 2005.

Three years ago regional health bosses signed a five-year £70m deal with the company on behalf of the 10 local trusts.

But as waiting times have fallen at the region's hospitals fewer people have opted to go to the Trafford private unit - in 2007 less than two thirds of the operations paid for were actually carried out.

More political sleaze

2008-03-31T15:15:00.000-07:00

No wonder that the public is rejectingconventional politics (and embracing the Save Bedford Hospital party) when you read stuff like this:

Crisis meetings are to take place in the House of Lords today over a series of sleaze allegations against peers, the Guardian can disclose. These include accusations that cash has been taken from lobbyists, passes handed out to commercial interests and expenses improperly claimed.

A special meeting has been called of the full Lords privileges committee, on which all the peers' party leaders sit. It is due to discuss whether an official inquiry can go ahead into Doug Hoyle's alleged receipt of cash from an arms company lobbyist.

A subcommittee led by Lord Woolf, the former lord chief justice, was originally scheduled to meet on Tuesday to try to question Lord Hoyle about a complaint suggesting he could have breached the peers' code of conduct.

The Guardian revealed last year that Hoyle, a former Warrington MP and Labour frontbencher, secured a personal introduction for the lobbyist to Paul Drayson, then the arms procurement minister.

But sources close to the privileges committee, whose members include Lady Ashton, Labour leader of the Lords, say there are doubts about whether the subcommittee is capable of conducting the unprecedented inquiry without support.

The increase in allegations is also causing resentment among some peers, who are unaccustomed to being in the firing-line. Unlike the Commons, which has a professional standards commissioner, the Lords does not have an effective means of dealing with ethics complaints.

We've been busy

2008-03-29T05:27:00.000-07:00

Sorry for the lack of recent postings, but we have been busy behind the scenes.

In partiular we are awaiting some interesting Freedom of Information requests, which should make interesting reading.

Nero fiddled....

2008-03-21T03:16:00.001-07:00

Derek Conway, the disgraced former Conservative MP, will escape a police investigation into his conduct after the Crown Prosecution Service ruled that gaping holes in the records of MPs' expenses would make bringing charges impossible.

In a move that will intensify the pressure on MPs to tighten their system of expenses and office allowances, Scotland Yard announced last night it would not be "appropriate" to launch an investigation into Conway after being advised by the CPS that "the lack of systems in this case to account for MPs' expenses would severely undermine the viability of any criminal investigation leading to a prosecution".

The Metropolitan police statement added: "In these circumstances we do not believe that it is appropriate for a police investigation to be instigated."

The gaps in the parliamentary scrutiny drew immediate criticism and calls for wholesale reform. Martin Bell, the former BBC journalist who was elected to parliament on an anti-sleaze ticket in 1997, told the Guardian: "This shows the need for external regulation. This has happened again and again and again.

"Anyone who has tried to make MPs more accountable - from Elizabeth Filkin to Alistair Graham [both former Commons sleaze watchdogs] - has been removed. We are in a state of constitutional crisis. MPs are supposed to set an example to the rest of us and yet they think there is one rule for them and another for the rest of us."

Banana republic

2008-03-19T13:36:00.000-07:00

Concerns about our voting system, and in particular the possibility of fraudulent use of postal votes has led to this country being likened to a banana republic.

So Communities minister, Hazel Blears, was faced with big dilemma when she appeared on BBC2’s Daily Politics this morning. How could the government go on resisting the individual voter registration in view of this week’s report from the Electoral Commission saying that “safeguards introduced to combat electoral fraud “are easily bypassed” because of weaknesses in the system?

The head of standards, Sir Christopher Kelly, said that the current arrangement of one registration per household “could not stop bogus names being registered and used as fraudulent postal votes.

The Blears response, when pressed on the programme, was that such a change could lead to fewer people voting and she implicitly suggested that this was worse then the possibility of fraud.

In other words, Labour feel that their only chance of winning is by allowing widespread cheating. So now we know.

Wide of the mark

2008-03-16T13:58:00.000-07:00

Once again, in today's Bedfordshire on Sunday Patrick Hall MP has got things wrong.

Patrick attempts to justify the budget's increase in alcohol duty on the need to fund extra winter fuel payments for our pensioners. But he could not have been paying attention to Mr Darling's budget. The increase in winter fuel payments are for one year only, whilst tax on alcohol is going to rise progressively each year.

The real reason for the tax rises is that Patrick's Labour government has made a total mess of public finance.

Getting worse under Labour

2008-03-13T10:44:00.000-07:00

Health inequality as measured by life expectancy and infant mortality has got worse since Labour came to power, a government report said today.

Babies born to poor families now have a 17% higher than average chance of dying, compared to a 13% higher than average chance 10 years ago.

And the life expectancy of people living in poverty has fallen further behind the average, particularly for women, than it was around the time of Tony Blair's election.

In absolute terms health is getting better. Life expectancy for all social groups is going up, and infant mortality figures are going down.

But, according to a report published by the Department of Health called Tackling Health Inequalities, the gap between the wealthy and the poor has widened over the last decade.

The figures are embarrassing for the government because cutting health inequalities has been one of its priorities. In 2003 it committed itself to reducing inequalities in health outcomes by 10% by 2010, as measured by infant mortality and life expectancy at birth.

Today's figures show that those targets are not being met.

In 2004-06 infant mortality among manual workers was 5.6 deaths per 1,000 live births. That was 17% higher than the national average of 4.8 deaths per 1,000 live births.

In the baseline period, 1997-99, the infant mortality rate was only 13% higher among manual workers.

On life expectancy, today's figures show the life expectancy gap between men living in the poorest areas of England and the average male is 2% wider than it was 10 years ago.

But, for women, the gap is 11% wider than it was.

Snouts in the trough

2008-03-06T10:05:00.000-08:00

A friend of this website was at the House of Commons yesterday, checking things out for when we are in parliament. He was at a reception and talking to the man in charge of the wine. Apparently the House of Commons wine cellars have had a £7million upgrade (not the wines, just the facilities for storing the wine).

Who pays for it all? Need we ask.

Ruth Harrison

2008-03-03T12:57:00.001-08:00

Many of you may remember Ruth Harrison, one-time deputy chief executive of Bedford Hospital. She is back in the news. This is from today's Daily Telegraph:

A former hospital chief executive who was at the centre of a superbug outbreak which left 33 people dead is working for the NHS again, despite receiving a £140,000 pay-off just over a year ago.

Ruth Harrison is being paid £52,000 on a short-term contract to head a review into maternity and children's services at Epsom and St Helier Hospital in Surrey, which could lead to the closure of wards.

&lt;A HREF="http://ads.telegraph.co.uk/event.ng/Type=click&amp;FlightID=26268&amp;AdID=31646&amp;TargetID=7654&amp;ASeg=&amp;AMod=&amp;Redirect=http://www.telegraph.co.uk/auris" target="_top"&gt;&lt;IMG SRC="http://adc.telegraph.co.uk/t/toyota/auris/liverpool/mpu_Toyota_Auris_Liverpool_300X250.gif" WIDTH=300 HEIGHT=250 BORDER=0&gt;&lt;/A&gt; She left her £130,000 chief executive job at Stoke Mandeville Hospital, Bucks, in 2006 with a £140,000 "golden goodbye" the day before a damning report was published, citing serious faults in her leadership.

Under her tenure 33 patients died and 334 became seriously ill with the highly infectious stomach bug Clostridium difficile.

The Healthcare Commission, which carried out the investigation into the outbreak between October 2003 and June 2005, said the trust "compromised the safety of patients by failing to make the right decisions" and that it "rejected the proper advice of their own experts".

Its report said: "The Healthcare Commission considers there were significant failings on the part of the leadership at the trust and has recommended that the leadership change."

The appointment of Ms Harrison at Epsom and St Helier Hospital has caused outrage among patients' rights campaigners, who believe it is tantamount to rewarding poor performance.

Vote for Rawlins

2008-03-03T12:53:00.000-08:00

Richard Rawlins, consultant orthopoedic surgeon and longstanding supporter of the Save Bedford Hospital party is standing for election to the BMA council.

Do please support him: he will be an eloquent advocate traditional professional standards in medical practice.

Number crunching

2008-03-01T03:51:00.000-08:00

GPs pay has been in the news, so here are some facts:

Typical cost of health insurance for a pet hamster for one year £60
Average payment to a GP for one year's care for each patient on his list £59

By contrast, each telephone call to NHS Direct costs £18, and one third of those calls result in the caller being told to go to A and E or to their GP!!

Which is the best value? We leave it to you to think about.

Depressing news

2008-02-28T10:33:00.000-08:00

This is how my friend Dr Rant views the recent media reports on antidepressants:

Researchers from Hull University are claiming that antidepressants only work for patients who are severely depressed.

Whilst Dr Rant is perfectly willing to believe that placebo is just as good as antidepressants for mild to moderate depression, I think we do need to point out a glaring problem with this research. It's from Hull. I mean, have you been to Hull? ****, if I lived in Hull I'd be depressed and I don't think antidepressants would help. The 1960s didn't happen in Hull until about 1985.

Here's a suggestion: next time compare the effects on depression of taking placebo against simply moving to somewhere that isn't Hull.

Spilling the beans

2008-02-27T11:39:00.000-08:00

From The Guardian:

NHS hospitals across England are systematically rigging their waiting lists to make it look as if they are hitting key government targets, the Department of Health acknowledged yesterday.

It said GPs were right to complain that it was becoming harder to make bookings for patients to get hospital treatment.

Many NHS trusts are telling GPs that their lists are full over the next few weeks and refusing to make advance bookings for later in the year. By keeping the queues short, the hospitals hope to hit the government's target for reducing waiting times.

The main health pledge in Labour's 2005 election manifesto was to reduce the maximum wait to 18 weeks from referral by a GP to being wheeled into the operating theatre, with no extra time added for patients needing complex diagnostic tests. An inquiry by Pulse, a newspaper for GPs, found 90% of hospitals were restricting advance bookings. "The practice can mean patients are barred from going to the hospital of their choice, since popular hospitals may have no appointment slots available in the short term," it said.

Ministers told GPs it would be easier to make hospital appointments for patients using an electronic system known as Choose and Book. But the inquiry found hospitals are keeping up to a third of their appointment slots off the electronic register in an attempt to reduce demand. The British Medical Association said: "We have heard of similar reports from doctors across the country. We would be very concerned if trusts were putting targets ahead of patient care.

"It is ironic that when government has put great emphasis on patient choice, their own targets on waiting times are stopping some patients from choosing their preferred hospital for treatment."

The association said it had evidence of trusts refusing referrals from GPs to avoid breaching the 18-week target. "All additional referrals are returned to the GP and not passed to an alternative provider. Such a situation could be repeated, by various providers, and further delay the patient's treatment," the association said. In some cases, hospitals were refusing to treat patients until the GP had dealt with problems such as high blood pressure or excessive weight.

A Department of Health spokesman said: "Hospitals should not be doing this. They are required to accept all referrals if clinically appropriate, and should not be manipulating Choose and Book to help them meet other targets." He added: "It is right for patients that they now have more choice, allowing them to arrange appointments at times and at hospitals that suit them - however this should not be at the detriment of being seen quickly ...

"The department has taken direct action by putting in place a national system to ensure that where patients are told that there are no appointments available on Choose and Book for their chosen hospital, they are still referred on to the provider of their choice."

Freedom of Information

2008-02-26T13:37:00.000-08:00

The Save Bedford Hospital party has been asking some questions on your behalf under the Freedom of Information Act. We will let you know the outcome : keep checking out this site, because the answers could be interesting (or painful if you are a taxpayer)

Who is telling the truth?

2008-02-26T13:35:00.000-08:00

Gordon Brown has promised a "more personalized" NHS

Lord Darzi wants GPs to work in mega-clinics of 20 or more doctors.

Both ideas may have merit, but are they not mutually exclusive?

Jack's Eye - latest news

2008-02-23T09:00:00.001-08:00

I reckon Jack and his wife Gay deserves a pat on the back from us all.

They were up at 0500 getting ready for the Today programme, and BBC Radio Devon, and BBC Spotlight for all of these people Gay made coffee and provided bacon and egg (sadly I had eaten before leaving for their house which proved a mistake).

They "threw me" on the the Today programme when they said that NICE were planning to issue their guidance today - I spent an hour working on a speech to deliver in case we arrive dat Downing Street to the news tat Mr Brown had seen sense.

Jack's treated eye has worsened and he almost tripped over a trailed suitcase in the busy station at Paddington - his cat like reflexes saved the day. He put on a brave face but I could see he was shocked.

We arrived at Downing Street courtesy of The Mail on Sunday (buy a copy please) and were inundated with attention.

The police have a search room and we were welcomed so warmly it felt like they were old friends. They were actually queing up to shake hands with us! I guess the coppers are in the same boat as the docs and we all admire war veterans.

We felt like filmstars with a scrum of photographers fighting to get the best shots of your cheques and Number 10 in the background.

We then swaggered up to the famous door - we were expected - and a photographer shouted out to knock.

At this point I saw it. It was huge. It was Victorian. It was cast iron. It must have weighed five pounds. I could not help myself - I reached up and banged the doorknob so hard the fillings must have been shaken from Gordons teeth (lets hope he has an NHS dentist).

A dazed car park attendant (they must get the uniforms from the same supplier) staggered from inside and asked if I was "The Doctor" Jack replied in the affirmative and said we had something for Gordon.

I was prepared to come in - afterall Gordon knows that it is impossible to get an NHS GP to make a housecall - I even had my gloves (in case he wanted to shake my hand). It was obvious that the doctor was no longer required and we were politely thanked.

We handed over the cheques and the door closed gently behind us. As we walked away I heard a distant low pitched rumble coming from the cabinet room and even Jack's ancient olfactory nerve could detect the powerful smell of flatus.

We turned to the waiting pack of reporters and gave out interviews.

The local BBC and ITV TV news were following us, Radio Devon, and the Mail on Sunday, the Express, The Herald Express, the press association - all out for a soundbite.

A few minutes of fighting talk in Whitehall (Jack was filmed with the cenotauph as a backdrop) and we were in a Taxi.

When we got on the train at Paddington my mobile did not stop ringing until the battery gave out. By this time we had a group of fascinated passengers were politely pretending to read books - the bloke in front of me must have a reading age of 8 because he did not turn a page before Reading.

When the batter packe dup a fellow passenger offered us a charger and another one her phone. We carried on interviewing. The lady with the phone texted her mum who watched the news. "mum says the doctor is going to kick down Browns's door - she says it was brilliant!!!!"...

We will see what comes up on the BBC spotlight (sky 987) and ITV Westcoutry. The crews there thought it would be on national news at 2200.

We know there will be more in the press.

The story is not over though. Now Gordon has got our cheques. And he knows that if he does not send them on to Jack the doctor will be back - which is not the sort of housecall Gordon really wanted.

Open all hours

2008-02-23T01:19:00.000-08:00

MPs' working hours

Sir - I recently wrote to my MP about the Government's plans for GPs' extended hours. I was dissatisfied with her response.

I contacted her secretary to make an appointment and was told that her next available surgery appointment was six weeks away. I was even more surprised to learn that she does not offer appointments in the evening or at weekends. I was told she sees constituents between 3pm and 4.30pm on a Friday once a month, take it or leave it.

I had heard that MPs had abandoned evening and weekend parliamentary sittings for more family-friendly hours. However, I was taken aback by how unfriendly their hours are to working constituents. It would appear that the Government does not practise what it preaches.

Dr Steven Nimmo, Plymstock, Devon

No wonder

2008-02-20T13:08:00.001-08:00

No wonder so much public money is wasted:

A report has revealed that not one single Permanent Secretary (the senior civil servants in charge of Whitehall departments) has a professional finance qualification and so, according to the National Audit Office, government departments lack the financial expertise to manage their multi-billion pound budgets efficiently.

Government spending will reach £678 billion by 2010-11, yet six government departments don't even have a qualified finance director in their senior management team, despite a Treasury requirement to do so.

I wonder what this tells us about how our money is being spent?

On the Rocks

2008-02-20T08:21:00.000-08:00

Storm clouds are gathering over a highly technical -- but potentially very important -- aspect of Northern Rock's nationalisation which could throw Alistair Darling's plan seriously off course.

Shortly before midnight in the Commons chamber, it emerged that the legislation to nationalise the stricken bank excluded the offshore company, Granite, which controls £40 billion of the bank's mortgages. Opposition parties say these are some of the bank's most secure assets. This has allowed Vince Cable to say that Northern Rock has been left with "rubbish" assets and he is now threatening to withdraw his support for the bill pending further clarifications from the Treasury.

This could be problematic politically: any alliance between the Lib Dems and Tories in the Lords has the potential to delay the bill and force big amendments. It is also a possible financial problem: Granite, which repackages mortgages into bonds and sells them on, relies on millions of pounds a year from Northern Rock to service them. What happens if Northern Rock is run down and unable to supply this money, however?

Even basic facts are murky. My eagle-eyed colleague Peter Riddell has pointed out seemingly basic contradictions: Yvette Cooper last night in the Commons said Granite is not covered by government guarantees. "It is not being taken into public ownership and it is not, in fact, owned by Northern Rock, so it is not part of the taxpayer's exposure and he has never been so." Yet a Treasury press release from December said the government guarantees were extended to "all obligations of Northern Rock plc to make payments on the repurchase of mortgages under the documentation for the "Granite" securitisation programme." There may be answeres to these questions, but they need to come quickly.

In plain English, this may mean the public is exposed to even greater liability, and could delay the government's timetable

Courtesy of the excellent "Red Box" in the Times

Jack's Eye update

2008-02-18T12:48:00.000-08:00

From Martin:

Very exciting day - GMTV interviewed Jack, then we had the Spotlight BBC Team and Westcountryt ITV News, both will be running big stories tonight.

I have checked and the latest info from the NICE website (link below) is that NICE state they don't consider this to be their remit "This is because intravitreal injection for age related macular degeneration is considered standard clinical practice with risks and benefits that are sufficiently well-known. "

http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11370

If we then quote Patricia Hewitt I think the case is wrappoed up and there is noway out for Brown.

We have been covered on front page of Western Morning News, a whole page in Mail on Sunday and a large article in London Today and Express.

The local paper will be running the story tommorow.

We are having live interview on BBC Spotlight this evening (report tells me I will be against a very unimpressive spokeslady for the PCT).

I was not planning to even send the letters off until morning!

If you watch Sky channel 987 for SW local news this evening you will see the story.

I have promised Jack that I willpersonally make up the first treatment if he does not get it on the NHS and would be very grateful if every one does send teir cheques in.

Well done all.

Northern Wreck

2008-02-17T10:18:00.000-08:00

The future of the NHS depends upon a healthy economy and a competent government.

Now Gordon Brown has decided to start nationalizing the banks. God help us all.

This comment comes from Iain Dale:

Even the most devout Labour spinner cannot disagree that the nationalisation of Northern Rock represents a total humiliation for the government. Alistair Darling's dithering and uncertainty have made even Gordon Brown look like a man of decision. I do not trust the government to run a whelk stall, let alone a bank. And they will be doing it with our - my (!) - money. God knows what hit the taxpayer will take now. And it will get even murkier when the government is sued for mismanaging the whole process, as it surely will be. The whole tri-partite regulatory system, which the Tories warned Gordon Brown would fail when he set it up, has been a disaster. And we're the ones picking up the bill. Plus ca change...

Jack'sEye (update)

2008-02-17T10:17:00.000-08:00

This story features in today's Mail on Sunday...you read it first here

Jack's Eye

2008-02-13T02:10:00.000-08:00

This is a posting from Dr Martin Rankin,a GP in Devon; he is trying to get some media coverage for the story, so do pass it on to any journalists who might be interested:

Below is an open letter that I propose to put in the public domain

Dear Mr Brown,

We need your help to save the vision of an old man.The case of Mr Herbert "Jack" Tagg * a Pit Boy turned WW2 Sergeant Pilot typifies the incompetence of your labour government in managing the NHS."Jack" has developed Wet Macular Degeneration - a condition which will mean he will almost certainly become blind within a couple of years. The good news is that there is a treatment for this. The bad news is that he has to go blind in one eye before the NHS will pay for treatment in the remaining eye. "Jack" is not a wealthy man but his wife has, without any hesitation, decided that they must sell their house to pay for the treatment. You have never met Jack or his lovely wife but I can tell you they are a wonderful couple. He risked his life for us, you are in charge of the NHS, we believe that our patients would prefer you to spend a few thousand pounds on Jack in his hour of need than bailing out an incompetent bank. The doctors who have added their names to this list will all post on a cheque for £5 payable to Mr Gordon Brown. Of course we don't expect you to get Jack his treatment on the NHS - we already know you are not up to the job of running the NHS, we simply would simply ask you to cash our cheques and then forward on the lump sum to Mr Tagg.
Yours sincerely

The Doctors of Great Britain.

*I have Jack's consent to use his name. Please sign your name below and send your cheque for £5 to Mr Gordon Brown (his address is 10 Downing Street, LONDON).
Let's see Brown spin this.

edit:
Please send the cheque payable to Mr Gordon Brown to me at Plym River Practice, Plympton, Devon PL7 1AD. I will get a photo and supply it with a photo of myself and Jack and the bundle of cheques next to a post box.

Pigs at the trough...again

2008-02-10T09:11:00.001-08:00

Peers were last night facing demands for an inquiry into their expenses after it emerged that members of the House of Lords with second homes in London were claiming tens of thousands of pounds a year in overnight allowances .

No proof is required to claim the subsistence allowance, worth up to £165.50 a night, which is designed to help peers who live in the country to attend late-night votes and debates in Parliament.

Peers who live full-time in London are not entitled to the perk, but those who have two homes and declare their country residence as their main home can claim, even if it is only used at weekends. They do not have to provide any evidence that their main residence is where they spend most of their time.

The furore over MPs' expenses triggered by Derek Conway, the Tory MP who employed his sons as researchers, has prompted an inquiry into Commons allowances. So far peers have escaped such scrutiny.

Among those who claimed last year was the Labour peer Baroness Billingham, who has a flat in Hampstead and a country house in Suffolk to which she normally returns on Thursday nights. Billingham claimed £26,983 in 2006-07, the last year for which figures are available, and said she had not been asked to provide any proof to support her claim. 'I think a lot of things are based on trust, to be absolutely honest with you,' she said.

Others with property in London who claim the expenses include the Labour peer and former senior trade unionist Lord Brett, who lists his address in Who's Who as a flat in the Dolphin Square complex near Westminster, but declares his main residence as his home in Cumbria. He claimed £27,887 last year.

1984

2008-02-05T11:36:00.001-08:00

From today's BBC news:

An NHS hospital trust has denied ordering a cut in blood tests as a way to reduce its reported MRSA rates.
The comments, from London's Kingston hospital come after a senior member of staff leaked an email which was circulated to all clinical staff.

The source said that staff were being encouraged to question whether blood samples should be taken.

Kingston Hospitals NHS Trust said the aim was to cut test numbers to those carried out at comparable hospitals.

In a statement, the trust said it currently carried out more blood tests than other hospitals of a similar size, and denied the intention was to reduce the number of MRSA cases being reported.

Postman's knock

2008-02-03T02:01:00.001-08:00

ALAN JOHNSON, the health secretary, has been accused of giving special access to a National Health Service contractor owned by one of the biggest donors to his deputy leadership campaign.

Johnson held a private meeting in his officers with Dr Reg Race of Quality Health, a firm that has been paid millions of pounds to conduct surveys for the NHS. A long-term Labour donor and former MP, Race had earlier given £5,000 to Johnson’s deputy leadership campaign.

Details of the meeting have raised concerns about “cash for access”. They emerged a week after it was disclosed that another of Johnson’s donors had given money to his campaign through his brother-in-law.

Johnson met Race at the Department for Health on November 12, according to questions answered under the Freedom of Information Act. No civil servants were at the meeting and no minutes were kept.

What was said at the meeting has not been made public, but it is known that Race and Johnson discussed Quality Health’s NHS contracts as well as Labour party politics.

Race’s company is one of a select group of “approved contractors” that health trusts must hire to conduct staff and patient surveys. The company, which Race owns with his wife Amanda Moore, has contracts with 320 of the 487 NHS trusts to conduct annual surveys introduced by Labour ministers in 2003.

Race’s £5,000 donation accounted for more than 10% of Johnson’s campaign spending. Nobody gave more to the campaign, in which Johnson came second. Race has also given more than £23,000 to Labour over the past three years.

Johnson’s aides last night denied Race was given preferential treatment and said the donation was given months before Johnson moved to the Department of Health last summer.

However, businesses competing with Quality Health for contracts said they had never had the opportunity to meet a health secretary.

“It is unheard of,” said the chief executive of one such firm. “It just does not happen.”

The scandal of mixed sex wards

2008-02-02T10:26:00.000-08:00

Sir - Lord Darzi's assertion that our hospitals can only separate the sexes by converting or building all hospitals with separate rooms is absurd (report, January 28). Hospitals have had no difficulty in providing separate wards for men, women and children for hundreds of years.

The pressure to mix the sexes in the wards began in the 1970s when politicians mistakenly began to believe that most surgical, and many medical, illnesses could be treated with outpatient or short-stay procedures and so demanded that, in theirview "unnecessary" hospital beds, be closed to reduce costs. At the same time administrators, having been told to achieve a 100 per cent bed occupancy to become more efficient, also enforced the closure of wards. The result was a shortage of beds so that those needing admission were put into any bed available regardless of their sex or wishes.

If hospitals ran with the ideal average bed occupancy of 85 per cent, it would not only be possible to have single-sex wards, but also be able to cope with the periods of heavy demand and have the opportunity to clean and refurbish. All of which would reduce hospital-acquired infection.

Lord Darzi should stop listening to the Treasury and direct his efforts to ensuring that patients are placed in an environment that will aid their recovery not impede it. He should tell his Secretary of State to reopen the multitude of beds that his and previous governments have closed and so give space and time for all the staff of the NHS to do theirjob properly.

Prof Sir Norman Browse, Past President, Royal College of Surgeons, Alderney, Channel Islands

Greedy bastard

2008-02-02T00:45:00.000-08:00

The health chief blamed for a hospital superbug outbreak which killed 90 patients has rejected a pay-off of £75,000 and wants twice as much.

The health chief blamed for a hospital superbug outbreak which killed 90 patients has rejected a pay-off of £75,000 and wants twice as much.

Rose Gibb left her job "by mutual consent" as chief executive of Maidstone and Tunbridge Wells NHS Trust in Kent last October after a Healthcare Commission report criticised her handling of the C.difficile infection which hit 1,176 people in three hospitals between 2004 and 2006.

There was anger at the poor hygiene in the trust's hospitals - Maidstone, the Kent and Sussex and Pembury - where the superbug was found to have hastened the deaths of another 180 patients.

Last week it emerged Ms Gibb was to receive a pay-off from the trust of £75,000, despite the efforts of Alan Johnson, the Health Secretary, to block it.

Ms Gibb's representatives have revealed she is not accepting the severance package as she feels she is entitled to twice that figure, and is seeking £150,000.

Outrageous

2008-01-27T11:19:00.000-08:00

This piece appears in the excellent "Burning our money" website:

BOM readers will recall Rose Gibb (see this blog). She's the ex-CEO of Maidstone and Tunbridge Wells NHS Trust ("Kent and Snuff It") who presided over the deaths of 90 patients from C difficile. Following a damning enquiry she was exited, but not before the Trust very nearly paid her £400 grand "compensation".

It was a particularly outrageous example of the public sector rewarding failure, and there was a huge public outcry. Commissar Johnson was forced to step in, promising he'd stop it.

Predictably enough he's failed: last week we learned Rose is still getting £75K, a lot more than the C diff victims of Kent and Snuff It will see.

Even more jaw dropping, she has now set up her own company - Resolve Healthcare Consulting Services - "to tell doctors and administrators how to give a better service to the public".

Her partner in this venture is her partner in life, one Mark Rees, "who also quit a senior NHS job with an £170,000 payout amid claims of weak leadership after the trust he ran accumulated debts of £30million."

Advice on how to fail. Surely even our blinkered self-serving management consultant sucking health bureaucrats wouldn't be stupid enough to buy that.

Would they?

We need to be vigilant. Very vigilant.

Dans le Potage

2008-01-27T10:20:00.000-08:00

Alan Johnson, secretary of state for health, has joined his ex-colleague Peter Hain in the soup over donations to his deputy leadership bid.

One of Johnson's largest (legitimate and declared) donors was Reg Race (ex labour MP).
We wrote about Reg on this blog on 7th June 2007 (Nice work, Reg). Interesting how the worms keep turning.

Putting the Boot in

2008-01-24T09:59:00.000-08:00

Just six months after leaving her job as Secretary of State for Health, Patricia Hewitt, (the woman who put the "pat" into patronizing) has joined Boots as an advisor. Presumably this relates to Boots interest in helping to privatize General Practice.

The appointment does not seem to have unqualified approval, to judge from this letter in today's Daily Telegraph:

Boots boycott

Sir - Our local branch of Boots the Chemist provides a vital service to the community and I have no problem with it.

However, Boots has recruited Patricia Hewitt as an adviser. Frankly, she was the most appalling Health Secretary we have had to endure. It is a scandal that she is rewarded for her incompetence in this way.

I now refuse to shop in Boots.

Dr Mark McCartney, Liskeard, Cornwall

If other NHS employees follow Dr McCartney's excellent example, Mrs Hewitt's appointment may not have totally the desired effect.

Sign of the Times

2008-01-24T09:51:00.000-08:00

This letter, from a distinguished NHS surgeon Mr Peter Mahaffey appeared in the Times. It is worth reading:

Sir, Your report (Jan 9) on the inquest into a mother’s death associated with a hospital’s diversion of her GP’s request for a specialist opinion rings loud bells with any consultant who has watched recent governments vandalise established referral patterns.

One of the most valuable roles of the family doctor was always to know who might give his or her patient the best opinion and treatment, but successive governments have made this increasingly futile. In the “new NHS” climate where almost the entire health budget goes to primary care and hospitals get funding strictly according to referrals from the community, patients frequently have to negotiate the equivalent of an assault course.

First, there are exclusion lists for a host of conditions and any exercise of medical discretion is patrolled by expensive panels which vet cases. Next comes the diktat to GPs that they may not name specialists on referral letters. Hence such “generic” referrals become the ownership of the hospital rather than the specialist. At a stroke, the ability of the GP to find the best opinion rather than the shortest appointment time is damaged. Hospitals living in fear of DoH diktats on waiting targets can deal with these referrals as they choose, switching clinics, using nurse specialists, or even “selling on” the case to another provider hospital.

This pernicious process has nothing to do with quality and everything to do with targets. One wonders if the Southampton coroner is fully aware of the extent to which these mechanisms impinge on so many of the cases he is called to deliberate upon.

Peter Mahaffey, FRCS
Langford, Beds

Coolness under fire

2008-01-23T01:53:00.001-08:00

Guido Fawkes, on his blog, shows that Gordon Brown has changed again; no longer is he Mr Bean, he is now King Canute!

As markets plunged yesterday George Bush convened a White House summit to push an emergency $150 billion growth stimulus package through Congress in weeks. He called in heavyweight politicians for a bipartisan effort. Elsewhere in Washington an emergency meeting of the Federal Reserve slashed interests rates 75 basis points in an effort to shore up global markets fearing recession. What does Gordon do?

He takes time out to appear on Blue Peter to wish Konnie Huq good luck in her next job. Yes, the Prime Minister has his own weird sense of priorities

Brilliant

2008-01-22T10:29:00.000-08:00

This was the report in "Hansard" of Vince Cable's superb critique of the Northern Rock situation. So much for Gordon Brown's reputation for financial prudence:

Dr. Vincent Cable (Twickenham) (LD): I congratulate the Chancellor on brilliant originality. The Government, through their bond guarantees, are solemnly undertaking to repay the Government. The taxpayer is standing behind the taxpayer and we have a private sector solution without private money as well as nationalisation of liabilities and losses and privatisation of profits. It requires a special sort of genius to dream up such an idea and I hope that the Government’s financial advisers have been well rewarded.

I am tempted to recall the Danish economist, Hans Christian Andersen, who told the story of the two conmen who visited a particularly credulous king to sell him an imaginary suit of gold to cover his nakedness. We have a naked King Gordon, desperately trying to cover his embarrassment over the “n” word “nationalisation”.

It was said this morning in the City that the financial value in the insurance markets of the guarantee of the bonds was £2 billion. Since the private buyers are not providing that money, where will it come from? Are we talking about a guarantee of a guarantee? How else will it be funded?

The Chancellor said that there would be a profit-sharing arrangement between taxpayers and the private owner, but no numbers were given. Is it true, as the Financial Times reported this morning, that the proposal is likely to be for a 5 to 10 per cent. Government equity stake, with 95 to 90 per cent. of the uplift going to the private owner? If the proposal is of that order of magnitude, what is the position, if there is to be profit sharing, of the Northern Rock Foundation? The Chancellor mentioned it in the context not of profit sharing but of nationalisation.

Since we have heard from the north-east of England, the Chancellor will know that the Treasury’s private sale document made not a single, solitary reference to jobs or the future of the region, so what is its role under the proposals?

This morning, the BBC’s political correspondent described Mr. Branson as the “cat what got the cream”. I do not know what that is, but Mr. Branson appears to be the Government’s preferred bidder. Can the Chancellor tell us what Mr. Branson is going to contribute? My understanding is that he is proposing to put in £250 million in kind, not cash, to acquire a bank worth £100 billion, or 40 times that value. He has never run a bank, and I believe that the profits will be routed through a Caribbean tax haven, so what benefit does the taxpayer derive from his participation?

Finally, as the Conservative spokesman has already noted, Northern Rock shares have soared, while the British and other international stock markets have fallen. The only cheerful faces this morning were those of the two equity fund investors who made a speculative punt on Northern Rock a few months ago and have now recouped their investment. Meanwhile, the taxpayer is being taken for a very big ride. That will continue until the Government adopt the honest, transparent solution of taking the bank into public ownership.

Secure data?

2008-01-18T13:45:00.000-08:00

The government believes, despite all the evidence to the contrary, that they shpuld be entrusted to put your confidential medical data onto a huge new NHS IT system.

This (from the BBC) is the latest data loss story:

Hundreds of documents containing sensitive personal data have been found dumped on a roundabout in Devon.

Details of benefit claims, passport photocopies and mortgage payments were included in the confidential data.

The documents were found on Thursday at a roundabout near Exeter Airport by Karl-Heinz Korzenietz, from Dawlish.

At the same time the MoD said a latop containing the details of 600,000 people was stolen from a Royal Navy officer in Birmingham last week.

I was shocked and surprised that sensitive papers like this would be lost like that
Karl-Heinz Korzenietz

Mr Korzenietz said two months earlier he found similar documents to those found in Exeter. The Department of Work and Pensions said it was urgently looking into the matter.