Sunday, 30 December 2007

MRI scan price war.

Private imaging cowboys shoot it out

A couple of years ago it was quite common-place for patients to be charged £600 for a single area MRI scan. The atmosphere surrounding private medicine was very much like I imagine it is when buying a Saville Row suit: "if Sir needs to ask the price then Sir cannot afford it".
As MRI scanners became more widely available and patients began to shop around, or even go abroad, for their scans MRI providers began to compete on price.
I think the first to break ranks was the Cobalt Appeal in Cheltenham, who suddenly found themselves with vast overcapacity for their mobile service as hospitals in the West Midlands installed their own fixed scanners. As a registered charity they have financial advantages over purely commercial organisations and could also rely on charitable donations to provide working capital, rather than have to borrow money at commercial rates.
With little competition and clever marketing to potential referrers and directly to the public they established themselves fairly firmly as a low cost quality provider and drew patients from throughout the UK.
Last year Vistadiagnostics in London entered the market with a variable charging structure depending on the time of day but as low as £250 for one area and actually cheaper than the Cobalt Appeal for multiple areas and for contrast enhanced scans. Their business is based on the EasyJet model and relies on using the scanner 7 days a week for 13 hours each day with aggressive promotion of their service. I think this was quite a risk because rents and radiographers still have to be paid if the scanner is idle and costs in London are high. With such narrow margins they could only survive if they ran the scanner at full capacity.
They had the lucrative London market to themselves for about a year but just before this Christmas, Med-Tel, another private scanning centre in the City, announced a "special deal" matching Vista's prices for MRI. Not to be outdone Vista has taken the classic poker player's route and upped its stake and cut its headline price to £200.
Both companies are haemorrhaging money with Google pay-per-click advertising campaigns and, unlike the Cobalt Appeal, can't rattle tins at village fetes and shopping centres to restore their cash flow. It looks like the town ain't big enough for both of them and I foresee the one who blinks first will be eating dust before the new year is out.
Meanwhile, our private scanning enterprise, UK Radiology, which still offers scans cheaper than all of them, sailed serenely on, gradually taking business off the commercial scanning centres and Cobalt Appeal while spending virtually nothing on advertising. Irritatingly though, after my self-contented last post on this blog, it has disappeared off the first page of Google again for the search term "private MRI scan". I think getting a high Google ranking is a bit like sailing a tanker. Where you are now depends on actions taken weeks or months before and I now realise I had become complacent over the year and took my foot off the throttle (sorry about the mixed metaphor - do tankers have a throttle?). Out of interest I looked into the cost of pay-per-click. To put a company's link in the first four places for the search term "private MRI scan" costs 0.43p every time someone clicks on the link. Google accounts for around 75% of my visitors and if I were in the first four places it would be many more. Based on the number of click-throughs I get from Google, Met-Tel, Vistadiagnostics and Cobalt Appeal must each be spending hundreds of pounds every month on Google. At the margins they are working to now and with unused capacity that must be hurting.

A happy and prosperous New Year to all my fellow bloggers and readers. (Especially Dr Crippen - I hope you decide to come back next year- even if its just the occasional blog).

Wednesday, 19 December 2007

More good news

My cup brimmeth over.

When I wrote my article last week I meant to mention one other development which had cheered me up but I forgot at the time and, when I remembered, the moment had passed. What I was going to add was that the CT screening companies, the prostitutes of modern healthcare, were coming under critical examination.
Many people in the profession, and in particular Radiologists, have been alarmed by the lack of regulation of these companies and their direct marketing of CT scans to the worried well for purely profit motives.
The screening business had flourished for a time in the USA but, as the public became better educated and began to realise the lack of evidence for the claims the companies were making, there has been a tail off in demand. In the UK we are still on the upward slope of the curve with the worried well believing the claims that the scans can find your cancer and thereby allow you to be cured by timely surgery.
Considering the close regulation of industries which expose people to ionising radiation I have always been puzzled by the way these companies are allowed to irradiate the public with no proven evidence of benefit. The irradiation of someone without informed consent is technically assault. In hospitals we generally assume consent for irradiation but each investigation has to be justified such that we are satisfied that the benefits outweigh the risks. The benefits of screening CT are largely anecdotal so, by definition, the benefit/risk ratio is unknown and I cannot see how someone can give informed consent. I presume they ask the punters to sign a disclaimer rather than a consent form.
Anyway, last week there was a Jeremy Laurance article in The Independent that raised the issue of the dubious claims made for these "medical MOTs" and the risks to the unsuspecting public. This week calls for regulation have been made by COMARE, a government advisory panel on radiation. Even Liam Donaldson stuck the boot in.
Now, like many other bloggers - most notably DK, the news that an unelected, pressure group want to inflict more regulation and restrict the individuals choice does not generally cheer me up but in this case the public really does need to be protected. The very same public who worry about living close to a power line or having a mobile phone mast near their childrens' school are quite happy to part with anything up to £1300 to be subjected to radiation doses similar to those which caused excess cancers following the use of nuclear weapons in Japan.
Dr John Giles, a radiologist who runs Lifescan, one of the more aggressive and successful "radiation-for-reward" companies put a brave face on it today, claiming that he welcomes the report and, bizzarely, that Lifescan don't do screening scans but target individual organs. This might wash with the gullible public Lifescan usually deals with but as a radiologist he knows that CT scanning doesn't target individual organs; everything in the region scanned is irradiated. If he "targets" just the lungs and bowel that is a screening scan of the whole torso. Notwithstanding Dr Giles' welcoming of the report, COMARE states "...we have strongly recommended that services offering whole body CT scanning of asymptomatic individuals should discontinue to do so."
In fact its probably a distraction to focus too much on the radiation risk, which is unquantified for small doses. The main problem with the "scans-for-spondulis" companies is that they make unsupported claims of benefit, expose patients to the anxiety and physical risk of further investigations, and cost the taxpayer a large amount of money.
The scientific evidence in favour of screening is notoriously difficult to prove. There are still eminent scientists arguing whether breast screening is effective. CT screening for cancers is much less studied. Some cancers will not be reliably detected, others will be detected too late to alter outcome and others will be detected that would not have shortened the patient's life anyway. The best example of a cancer that is worth finding and is often picked up by chance is a renal tumour. You will find this mentioned in all the testimonials ( an indication of quackery) on the scanning company websites. The other abnormality worth finding is an aortic aneurysm. Both are easily picked up on a £50 ultrasound.
The anxiety, physical risk and cost to the taxpayer stem from the large number of false positive scans. These are scans that either show something which looks abnormal but isn't present or something that looks serious but is harmless. The scanning companies don't reveal how many "patients" have false positive scans but, in my experience, the majority of patients will have either a cyst or haemangioma in the liver, a cyst in the kidney or a solitary lung nodule. These patients would need a further investigation such as ultrasound, a repeat CT with contrast, a repeat CT after an interval or even a biopsy. Many of these would look to the NHS for these further investigations and some patients will suffer as a result of unnecessary biopsies.
Patients often contact me for screening scans and I find it difficult to explain why we don't offer them at UK-Radiology. The first time I was asked I wrote a long thesis on the scientific arguments; there just isn't a quick way to explain it. Now I say we don't consider it ethical and send a copy of my reasoning. I have been thanked a few times. If I were a quack I could use the comments on my testimonials page!

The other bit of good news this week is UK-radiology's return to first page of Google for the search term "private MRI scan". My colleagues simply don't appreciate how difficult and labour intensive it is to do this. Some have even criticised my methods (i.e. this blog - they haven't found out about my other methods yet). The easy way would have been to copy our competitors, charge the patients an extra £50 each and buy a pay-per-click campaign. That would have left me my last month's evenings and weekends free for me to enjoy away from my PC. Then again, we run an ethical company.

Thursday, 13 December 2007

Happy Days

Dr Ray (In my dreams!)

Apologies for neglecting my blog for the last couple of weeks.
Blogging for some of us is born out of turmoil and strife. It is a cry for help and attention. I hope I am not tempting fate by saying things have been going pretty well recently and my need for blogging has correspondingly decreased.
I started blogging in the closing months of Blair and Hewitt. Contracts were being signed with the private sector to put me and my colleagues out of work and the medical profession were generally getting a good kicking and were too timid to resist.
Now Blair and Hewitt have gone. Mercury Healthcare and a few other private sector "providers" have been told to sling their hook and, even though the medical profession has not become militant, the government is being brought to account by the police over the way they reneged on independently recommended wage rises (as they have done for doctors over many years).
Add to this the total shambles that passes for Gordon Brown's premiership and I am beginning to think the government may lose its appetite for meddling too much more with the NHS for ideological reasons.
The cherry on the cake came yesterday while watching Gerry Robinson on "saving the NHS" (or Rotherham General Hospital to be precise).
Sir Gerry wasn't very complimentary of the consultants when he did his first program last year, blaming them for the hospital's problems and failing to see the bigger picture and understand the reason for their lack of enthusiasm for the changes being foisted on them by managers. A year later he recognised that Rotherham General was just a pawn in the great game the government was playing with the NHS. Even though the Hospital was working flat out and providing a service which was obviously in demand a £12m Polyclinic was being built within walking distance which would make the General Hospital non-viable. And what sort of work would the Polyclinic do? Sir Gerry asked the CEO of the primary care trust. The Polyclinic would be a nurse-run walk in centre for people with bumps and bruises or for people who felt a bit "iffy" while at work. Sir Gerry pressed him on this but that is as specific as he could be. That is the level of planning that has gone into Polyclinics. They are going to target people who are well enough to go to work but feel a bit "iffy". In return the District General Hospital in Rotherham, which serves 250,000 people will probably end up closing. Why does this make me happy? It's because I already knew this was happening but was having trouble explaining it to anyone else. Sir Gerry has exposed the sham of Polyclinics to a much wider audience than I could ever hope for and made Lord Darzi look like a fool. I hope they repeat the program. It's a good thing Sir Gerry already has his knighthood because I don't think Gordon Brown would honour him now, not even for money.

The other reason I haven't blogged is more mundane. A couple of weeks ago I noticed that UK-Radiology, our private radiology set up in Hereford County Hospital, had dropped off the first page of Google for the search term "private MRI scan". It was still on the first page for all the other relevant search terms I could think of but the demotion riled me and I have spent all my free time trying to get back links by doing articles and "press-releases" to post on the web, going on to medical websites and forums and submitting my URL to directories. It takes some time to influence google ranking and I still have a bit more to do but I hope this all works.
My little enterprise with UK-radiology is one year old this week and despite the google set-back is continuing to grow and attract patients from throughout the UK. It has enabled our NHS department to recruit more staff while the rest of the hospital is making redundancies, we run the scanners for longer, offer open access for GPs and our department is in financial surplus. Isn't it amazing what NHS consultants can achieve if they are properly incentivised.

Sunday, 25 November 2007

Mercury Health's second failed venture

I don't normally get many comments on my blog and I don't think I have a very wide readership so I was surprised to get so many comments on my previous piece on Mercury Health having their contract withdrawn. There were two or three genuine ones from people who regularly read and comment on medical blogs but most were from employees of Mercury itself and even a couple from people claiming to be satisfied customers of the service. My first thought was that my story had been picked up by CNN or the BBC but I have found no evidence of this. The conclusion I have reached is that Mercury has ventured into news management and set up a Blog Rebuttal Unit. I presume their employees were told to get on their computers and try to rubbish my story.

To a man (or woman) they chose to make it a personal attack on me while seeking public sympathy for their individual plight, now that the grunts at the front line have lost their jobs.

It hasn't gone terrifically well for them. Unfortunately most of their employees don't seem to be able to write English and even the ones who can missed the point that my piece was about the reversal of government policy and not a personal attack on Mercury employees or the quality of their scans. Rather than delete the worst of the comments I left them on because they portray better than anything I can write the nature of the people who will be providing health care if the Nulabour reforms succeed.

I will even go as far as giving additional prominence to some of the comments:

Rubenac Beaaaverr said... I am a radiographer who came to UK to join the Mercury team . My line manager is Claire and throughout the whole induction period and competency testing she has shown me values that I have never experienced before. I have loved working as part of this team, I am proud that I have been involved. I go home with regret, a distrust of Uk politics and a firm belief that Uk radiologists are complete wankers....

Anonymous said...

Dr Ray's face in this focal spot is a true representaion of yourself ! From your method of argument which does not really centre on objectivity but selfishness and greed,it really looks like you have got no grey mater in that empty skull.No wonder you had to hide your ugly eyes inside that dark spectacle !! Ha Ha Ha ! You know wat,I am a radiographer with mercuryhealth,I have worked in several places in the UK and I can authoritatively tell you that mercury is the place to be...Stop being jeaolous ray,with or without the DOH contract,we will still be out there saving patients from people of your ilk !
Am sure you must have included mercuryhealth in the body of ur x-ray reports lately,poor patients ha ha ha....

Does anyone else have trouble understanding this? It's no wonder they were told to stop posting later in the day when the quality of these front-line staff was becoming clear for all to see.

Wednesday, 21 November 2007

DoH pulls plug on MercuryHealth mobile scanners

Tuesday was a truly horrible day in the West Midlands.
I took a day out to attend a radiologists' meeting at Heartlands Hospital in Birmingham, only 70 odd miles away, and spent a total of 5 hours on the road driving (or sitting in stationary traffic) in heavy rain and half an hour queuing for lunch for the sake of around 4 hours of lectures.
I did, however, end the day a happy man. During the meeting, Tom Goodfellow, a radiologist in Coventry, announced that the Department of Health had terminated the contract with Mercury Health to provide "2nd wave diagnostics" scans in the West Midlands. Care UK, the company which bought Mercury Health earlier this year for £77million, makes a curt announcement on their website. The news was also briefly covered in the Guardian.
I have written about the Mercury Health contract before on this blog. The second wave diagnostics program was a central pillar in support of Nulabour's plans to close down District General Hospitals (DGHs). The plan was to divert the easier scans to the private sector leaving the complex, difficult and unprofitable scans to the DGH x-ray departments. These would not support continued investment in staff and equipment and within the five year period of the contract most DGH x-ray departments would have become obsolete. Modern medicine demands on-site access to MRI and CT for a DGH to be viable so this would result in a downgrading or closure of the DGH.
The news was greeted with clapping and cheering from the 150 odd consultants and trainees at the meeting. As it happens, the radiologists at Heartlands Hospital were involved in the Mercury contract and we heard from the horse's mouth that the failed endeavor will cost the taxpayer £84 million in compensation payments. From the figures given to us by Mercury last month (see earlier blog) I would guess they have done a total of around 840 scans, costing the taxpayer £100,000 per scan compared to £200 which we charge for a private scan at uk-radiology. The reason the contact was canceled was the lack of demand. It seems that Mercury was only working at 5% of anticipated capacity.
Dr Ray is not one to gloat over Nulabour's discomfort caused by this pigheaded pursuit of political dogma against the advice of almost every radiologist in the UK, the National Audit Office and a House of Commons Select Committee on Health but I will make an exception in this case.

Ya boo sucks-- We told you so!! Ha Ha Ha!!

Saturday, 17 November 2007

China gets recycling bug

Not posted for a while due to work but here is an interesting item I nicked off the doctors-only website, Univadis:

Used condoms are being recycled into hair bands in southern China, threatening to spread sexually-transmittable diseases they were originally meant to prevent, state media reported Tuesday.

In the latest example of potentially harmful Chinese-made products, rubber hair bands have been found in local markets and beauty salons in Dongguan and Guangzhou cities in southern Guangdong province, China Daily newspaper said.

"These cheap and colourful rubber bands and hair ties sell well ... threatening the health of local people," it said.

Despite being recycled, the hair bands could still contain bacteria and viruses, it said.

"People could be infected with AIDS, (genital) warts or other diseases if they hold the rubber bands or strings in their mouths while waving their hair into plaits or buns," the paper quoted a local dermatologist who gave only his surname, Dong, as saying.

A bag of ten of the recycled bands sells for just 25 fen (three cents), much cheaper than others on the market, accounting for their popularity, the paper said.

A government official was quoted as saying recycling condoms was illegal.

China's manufacturing industry has been repeatedly tarnished this year by a string of scandals involving shoddy or dangerous goods made for both domestic and foreign markets.

China's manufacturing industry has also been tarnished by accusations of non-sustainable development and environmental pollution so I suppose we should be pleased they are trying to do something to remedy this.

Wednesday, 31 October 2007

Darzi exposed

Resistance is futile

Most medical people recognise that Darzi was brought in to give a veneer of clinician support to the wholesale transfer of healthcare to the private sector. While we recognise it, we are individually powerless to resist this and our BMA representatives are, at best, supine to the extreme, and at worst, enabling the government in its plans by suggesting that, for example, doctors' work could be done by pharmacists, nurses, paramedics and other various jumped up quacks who did not possess the intelligence and work ethic to train as real doctors.

With her permission, I have reproduced a posting on DNUK (a doctors only site) by Miss Anna Athow, a Consultant Surgeon with 35 years experience as a doctor. Although it is perhaps overlong it does dissect the truth behind Darzi's reforms and needs a broader readership.

Darzi's 'Framework of Action'=NHS privatisation in England

The “Framework for Action” plan for Londons healthcare fronted By Professor Sir Ara Darzi, proposes the destruction of a publicly provided NHS in London. It is a blue print for privatising the NHS nationally.

Lord Darzi, the National Advisor on Surgery, has been working with the Labour government for 10 years on the NHS plan and promoted the separation of elective from emergency surgery into independent sector treatment centres( ISTCs). Under Gordon Brown he has been elevated to under secretary of state for health and he is being used to pretend that doctors are in favour of dismantling the NHS.

This lengthy document, is designed to deceive the unwary, laced as it is with fine phrases about improving healthcare and ending inequality. Nothing could be further from the truth.

It claims to be about services not institutions. In fact it proposes to smash the fundamental institutions of the NHS; NHS general practices and district general hospitals (DGHs), and replace them with brand new institutions; POLYCLINICS

Though the report does not say so, these would be owned and run by private healthcare corporations and would act like American health maintenance organisations.

The essence of the destruction plan is to be found in the Technical document. Accountant have analysed all the health care procedures performed in London in 2005/6 . Using the techniques developed for payments by results ( PBR) tariffs, every healthcare procedure perfomed in London in 2005/6 has been classified by HRG ( Health Resource Group ) and the volume of each of them recorded.

London’s entire healthcare is then viewed from a commercial perspective and is laid out as a prospectus to attract private healthcare investors. It is is the complete antithesis of a medical approach to healthcare, which begins from clinical needs.
This document starts out from the financial interests of the private healthcare providers and divides the whole of medicine into arbitrary “ Service Lines” based on estimated profitability.

Elective surgery for example is divided into – complex, "high throughput", minor procedures and under 17s. “ High throughput” surgery consists of procedures such as cataracts, arthroscopies and inguinal hernia repairs. These belong to the surgical specialties of ophthalmology, orthopaedics and general surgery, but are all lumped together because they are attractive to ISTCs as short episodes of surgical care.

We are told that the small group behind the technical paper worked to basic principles the first of which, was to allocate to Polyclinics every aspect of healthcare they could. This is what they have done. Essentially every walking patient having a daytime procedures has been allocated to polyclinic care.

60% of London's healthcare would end up in them.They would contain
*50% of community care, (district nurses health visitors etc)
*50% of outpatients clinics, shifted out of hospitals
* 50% of A&E patients shifted from hospitals into walk in urgent care centres
*all ‘routine’ diagnostics such as xrays, CTscans, other tests.
Also, regular attenders, patients with Long term conditions, non emergency medical procedures such as endoscopies, patients having chemo therapy, minor operations etc.

Polyclinics would predominantly employ GPs and nurse practitioners or other practitioners. There would be few consultants and staff nurse support. There would be no junior doctors.
For 150 new polyclinics each with catchment areas of 50,000 population to be successfully launched, Londons district general hospital are to be largely destroyed.

Darzi says. “ The days of the DGH doing all services to high standard are over.”
The plan is that the 32 DGHs in London would be reduced to between 8 to 16 acute major hospitals.
The other 16 to 24 DGHs would be destroyed or turned into rumps called Local hospitals.
Local hospitals would have medical inpatients only. There would be no surgeons or anaesthetists on site. Intensive care units would be closed. The A&E department would remain open, but would be in the dangerous situation of not having surgery on site. So if a surgical emergency arrived or developed, they propose that either a surgeon would be called in from another hospital or if the patient were very ill, he would intubated and ventilated and shipped across London in an ambulance to one of the few acute major hospitals left.

Supposedly, ambulance men would be trained to decide which patient should go to the urgent care centre in the polyclinic, which to a Local Hospital and which to a major acute hospital. They would learn to “bypass” hospitals.
Those DGHs closed completely, as is planned at Chase Farm Hospital in Enfield, would become sites for polyclinics, walk in urgent care centres +/- elective surgical centres (ISTCs).

Darzi says that six clinical working groups were set up to advise him on the new models for healthcare ( mental health left to one side )
1. maternity and new born
2. staying healthy
3. acute care
4. planned care
5. longterm conditions
6. end of life care.
The division of healthcare into these apparently arbitrary divisions becomes clear on reading the recommendations. 1. 3 and 5. are to be cut to the bone. 2. 4. and 6. are to enjoy huge new investment for the private sector.
1.3.5. all comprise consultant intensive hospital specialties.
1. Consultant led obstetric units are to be reduced and replaced with midwife led birthing units and home births (to increase from 2% now to 10% target in the future.)
3. Paediatrics, emergency and elective surgery and intensive care units are to be stripped out of DGHs as described above.
5. Patients with long term conditions such as diabetes, who in their old age make up the majority of acute hospital admissions are to have their acute care massively cut. Every effort is to be made to keep them out of hospital. They are to look after themselves, and go to polyclinics.

2.4. and 6 are to be expanded. Private enterprises are to be employed keeping people healthy. Planned care like outpatients, diagnostics and elective surgery are to shifted into polyclinics and ISTCs. As for the dying, the DoH has suddenly developed great enthusiasm for helping patients to die out of hospital and in their own home. Private companies called “ End of Life service providers”are to get the lucrative contracts.

What we had in the NHS was primary care (GPs and community care ), which was local and personal, secondary care ( DGHs and teaching hospitals) embracing all aspects of care on one site and providing training for the next generation of doctors and other staff, and tertiary care ( more specialised hospitals for less prevalent conditions such as neurosurgery, burns, etc )
The Darzis plan proposed to disentegrate care into seven models;-
Local hospitals
Elective surgery centres
Major acute hospital, specialist hospitals. Academic Health Science Centres.
Polyclinics, and elective surgery centres would be owned and run by private corporations. The latter hospitals have to become foundation trusts by 2008 so these would be run as businesses. The plan for local hospitals is probably to starve them of funds and gradually run them down. There would be no NHS left.

“ Commissioning can only drive change if it has a direct impact on the income of healthcare providers. Funding flows need to be used to incentivise the best practice contained in this report. At its simplest, this means commissioners defining the best practice for a patient pathway and then ensuring that this best and only this is the best practice they pay for.”
These stark words say it all. The commissioners will dictate so called “ best practice”. If that means that a patient can only be seen by a nurse practitioner in a polyclinic and not by a consultant at a hospital, so it will be.
The commissioning role of PCTs is now being outsourced so that the private corporations will be laying down the rules of so called “ best practice ” pathways.

THE DARZI PLAN MUST BE TOTALLY REJECTED. It represents a fatal reduction in the volume and quality of healthcare for Londoners in the interests of big business. The BMA should unite with other unions in fighting to defend the NHS. The government has no mandate for privatising the NHS and must go. It must be replaced with a government which will fully fund a publicly provided NHS.

Sunday, 28 October 2007

On yer bike

An unbelievable story in the Telegraph today. If it really is true it illustrates just how bonkers this country has become.
Robert Stewart was discovered in his locked room, wearing only a T-shirt and gyrating his hips against a bike as if to simulate a sexual act.
Now, in my mind, having sex with a bike rates as some way less depraved than having anal intercourse with a stranger, which is perfectly legal, in private, and, in fact, is apparently practiced by some of our political masters.
Poor Mr Stewart, however, has been placed on the sex offenders register. This would be funny if it was not such a stark example of the Judiciary misusing it's power. While it seems Mr Stewart may be going through a bad patch (he lives in a hostel), placing him on the sex offenders list will essentially prevent him ever getting employment and will restrict the chance of him ever returning to normal society.
And what exactly was his crime? The article doesn't state the bike's age or whether it consented to the act but I was not aware the law took this into consideration. Mr Stewart had taken the trouble to lock his room so the act was in private. He was only caught because the cleaners had used a master key to enter his room. Contrast this to the firemen who were fined £1000 and demoted after a complaint that they had disturbed a quartet of homosexuals engaged in public (and therefore illegal) sex. The complainant and his partners did not face prosecution.
So essentially Mr Stewart has been criminalised for using an inanimate object as a masturbatory aid in the privacy of his own locked room. A quick look at the sort of online adult shops we are not allowed to access from work suggests that he might not be the first person to have done this and I am given to understand that such devices are on sale in Boots up and down the country.
Perhaps the story has not been accurately reported and perhaps there was someone strapped to the bike against their will at the time but, to me, the Law looks like an ass here and I hope the judgment is reversed and Mr Stewart awarded a six-figure sum in compensation for defamation and mental anguish. On the other hand he doesn't seem like the sort of person who could afford Max Clifford or, the late, George Carman QC

Saturday, 20 October 2007

"The days of the DGH are numbered"

Lord Darzi of Harlesden

This quote is from Lord Darzi before he started his consultation on the future of NHS provision.
It is quite clear that Nulabour has wanted to close down the network of district general hospitals for many years. District general hospitals provide the bulk of NHS secondary care and employ large numbers of staff. Staff are employed under rigid T&C of service and this leaves little scope for reducing costs within the NHS even with the ready availability of vast numbers of people from Eastern Europe and beyond who would be willing to work for a fraction of current NHS wages. If the service could be provided in a parallel system run by the private sector, issues such as staff wages, qualifications and training could be conveniently circumvented.
Nulabour initially tried a direct approach in Kidderminster and were shocked to lose a safe seat to Dr Richard Taylor who campaigned on keeping the hospital open. Since then more devious methods have been employed including the Darzi review with its sham consultations and predetermined outcome.
Dr Phil Hammond, the clap doctor, medical journalist and TV personality has written on this on a doctors' only medical site called Univadis. His column is like a blog but he gets paid to write it. I don't, so I don't feel too bad about copying it in full because he makes the points I want to make rather well:

"Should we have one union that represents all NHS workers? This thought struck me at a UNISON meeting I was asked to speak at m in Cambridge. The East of England SHA was £800 million in debt when it came into existence and has never quite recovered. Two district general hospitals in Hertfordshire are in the process of being ‘downsized', despite the fact that they are treating more patients than ever, to be replaced by ‘acute care centres' to be run by GPs, allegedly. Management claims that many A&E attendances are inappropriate, but 90% of acute admissions to both hospitals come via A&E. These are hardly inappropriate and if you close the front door of any hospital, what's left is very vulnerable. Job losses have started but any protest by UNISON to the SHA is answered with ‘clinicians want this.'

This is the latest Labour wheeze, to claim that the reform programme is based around what clinicians want. Lord Darzi, a very eminent clinician, is leading the charge, and doubtless in a workforce as diverse as the NHS it's possible to rustle up some pro-Labour doctors to rubber stamp reconfiguration. But the last twenty years of clinical medicine has been about abandoning the dubious opinions of experts and focusing on the best available evidence. The same approach should be applied to NHS reforms.

The best evidence so far on NHS reconfiguration comes from a comprehensive analysis by the Academy of Medical Royal Colleges. Hardly the most radical organisation, but their message was simple. There is a case for the centralisation of specialist services onto fewer sites, but only in three areas; major trauma, neurosurgery and vascular surgery. However, there is no evidence – in terms of quality and safety - to support the centralisation of the non-complex and high volume work that is the bread and butter of district general hospitals. If you've got any sort of breathing difficulty (asthma, choking, anaphylaxis), you want to get to a local A&E, and quickly.

This report was conveniently buried under all that mock election hubris, superseded by Lord Darzi's interim review which contained such gems as ‘we need to change the way we lead change.' Have you ever met a surgeon who speaks like that? What has ‘new' Labour done to the poor man? His report was largely a smokescreen for the real story, that Labour has ‘approved' 14 private forms to help PCTs with commissioning (McKinsey, UnitedHealth, KPMG, Dr Foster Intelligence (sic) etc). Given that PCT commissioning is worth £64 billion, this is clearly something that a united NHS workforce should challenge. But we're not united, and we still work in silos with ridiculous inter-professional rivalries. And without one union representing us all, from doctors to domestics, we're quietly sleepwalking towards a privatised NHS. I don't think clinicians do want this, but we're too supine to complain. Wakey, wakey. As Joni Mitchell put it; ‘We won't know what we've got till it's gone.' "

Lord Darzi was appointed as Health Minister so that Nulabour can argue that it has listened to the clinicians when they give health care to the private companies to run. If the experiment works they will take the credit; if it doesn't and the population realise they have been hoodwinked when they lose their local services they will blame us.


More plagiarism: a joke sent to me from South Africa

The phone rings and the lady of the house answers.
"Hello. Mrs. Ward, please."


"Mrs. Ward, this is Doctor Jones at the Medical Testing Laboratory.
When your doctor sent your husband's biopsy to the lab yesterday,
a biopsy from another Mr. Ward arrived as well, and we are now uncertain
which one is your husband's.
Frankly the results are either bad or terrible."

"What do you mean?" asked Mrs. Ward nervously.

"Well, one of the specimens tested positive for Alzheimer's,
and the other one tested positive for AIDS. We can't tell which is your

"That's dreadful! Can't you do the test again?" asked Mrs. Ward.

Normally we can, but Medicare will only pay for these expensive tests
one time."

"Well, what am I supposed to do now?" asked Mrs. Ward.

"The people at Medicare recommend that you drop your husband off
somewhere in the middle of town.
If he finds his way home, don't sleep with him."

Sunday, 14 October 2007

"Helping the nation spend wisely" Sir John Bourn

A visitor from Mars, looking at the way government spending and taxation have increased over the last 10 years, would surmise that we have wasteful and profligate politicians. On the contrary, our leaders approach government spending as if taxpayers' money was their own and, if they do squander it, they have the National Audit Office to answer to.
The National Audit Office is funded by the taxpayer but independent of government. Sir John Bourn, head of NAO, has, for example, congratulated NHS Direct on its success:
"NHS Direct, the national telephone healthcare advice service operated by nurses, has achieved a high level of customer satisfaction since its introduction. The service, which has been fully available throughout England and Wales since November 2000, has a good safety record. Evidence at the local level suggests that it can help reduce demand on healthcare services provided outside normal working hours, for example by GPs, and is directing callers to more appropriate forms of care during the day." This was the same NHS Direct where the operators pretended to be answering machines to avoid dealing with callers and has been widely blamed for directing patients unnecessarily to A&E departments while conversely delaying the treatment of severely ill children.
On the National Programme for IT in the NHS, Sir John commented:
"Substantial progress has been made with the National Programme for IT. The Programme promises to revolutionise the way in which the NHS uses information to improve services and patient care. But significant challenges remain for the Department and NHS Connecting for Health." This is the same NHShIT that is widely seen as unworkable, overambitious, wasteful and unwanted by the medical profession and is projected to cost more than £20 billion with no measurable benefit. In fact the most widely touted benefit of having the patients records available online in an emergency is now being offered for free by Microsoft, and PACS (digital imaging and archiving), for which the NHShIT is widely praised, owes as much to the NHShIT programme as the move from film to digital photography.
A later NAO report on the progress, (or more accurately the lack of progress) of NHShIT was, according to documents discovered by the BBC, altered by the Department of Health to remove the more critical findings.
Still, even if the NAO isn't as independent as we would like it to be, at least its head, Sir John Bourn, is an honourable man, leaving no stone unturned and enduring any personal hardship in his protection of the public purse.
It comes as a shock therefore to find he has his nose in the trough too. A BBC report of Sir John's spending for the 6 months to September 2007 revealed he had spent £16500 on five overseas trips and £1650 on business meals. This was after having previously been criticised for spending £336,000 on 45 business trips in a 3 year period. Maybe this is not an unusual level of spending for a high ranking public servant but the accounts reveal that the trips were taken as First or Business class and the taxpayer was picking up the tab for entertaining parliamentarians and senior government officials at 5* London hotels and upmarket restaurants. Even more surprising, for the person in charge of safeguarding the taxpayers money, his wife accompanied him on some of the trips and was paid for by the taxpayer. For comparison, the code of practice governing doctors and the pharmaceutical industry stipulates that the choice of venue for meetings should be no better than a doctor would normally choose for themselves and the entertainment of doctors' spouse is strictly prohibited.
One wonders why the taxpayer has been paying for Mrs Bourn to go on overseas trips. It can't be that Sir John is hopeless without her because he managed single handedly on his trips to Kazahkstan, Moldova and Belfast but was accompanied to the much more desirable tourist locations of San Francisco, Lisbon and Venice.
I think the taxpayer will be reassured that our money is being wisely spent to benefit our population and that the NAO is leading the way by example.
Update 25th October
He's resigned

Thursday, 11 October 2007

The spin and the reality

The Spin - Happy Shiny People from the DoH "A New Ambition for Stroke" document which sets a target for CT scan within 60 minutes for patients thought to have suffered a stroke.

The Reality - "Many of the buildings, especially at the Kent and Sussex Hospital, were old and in a poor state of repair. Many of the wards did not have sufficient storage, space in utility rooms, or hand basins, making the control of infection difficult. The beds on several wards were much too close together, making it difficult to clean between them and seriously compromising the privacy of patients. Although there had been improvements generally in cleanliness and hygiene since the outbreak was declared, there were still some serious concerns. When we visited, we observed levels of contamination that were unacceptable, such as bedpans that had been washed but were still visibly contaminated with faeces."

"Other medical wards such as Cornwallis and John Day also had high bed occupancy figures of over 100% for several months. Whatman ward consistently had a rate of between 85 and 94%. In April 2006, when functioning as a cohort ward, its bed occupancy rate increased to 110%."

"Many attributed much of the poor care to the shortage of nurses and talked of seeing exhausted nurses in despair, with their heads in their hands. However others talked about poor attitude of some staff, including agency nurses. They described instances of nurses shouting at patients, leaving them unattended for hours, and not providing a proper level of care."

Report of the Healthcare Commission: "Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust" which killed 90 patients.

Sunday, 7 October 2007

We're loving it.

"enhancing the client’s reputation by positioning them as open, engaging, listening and responding."

Readers of the right-wing blogs might come away with the idea that there is widespread dissatisfaction with our current political leader. Readers of medical blogs might think that the millions of pounds of taxpayers money have been wasted. This is far from the truth.

Take Opinion Leader Research for example. This company has been running the Citizens' Juries for NuLabour. OLR thinks taxpayers money has been well spent. Why does this matter? It matters because if OLR thinks it then you think it too - that is their job. They proudly claim: "Opinion Leader influences". Why do they think the money has been well spent? It has been well spent because a large amount of it has gone to them. The tag-line "enhancing the client’s reputation by positioning them as open, engaging, listening and responding." is also from their website. It tells us clearly what our money has bought. It hasn't told us anything about public opinion; it has been used to give the impression that this government cares about public opinion and thus enhances its reputation.

As an extension of the democratic process the Citizens' Juries are profoundly undemocratic. OLR gets to pick the participants and gets to chose the questions. The participants are only told selected aspects of the argument and, in the atmosphere generated during the "consultation" can be manipulated by skilled moderators (or social influencers as OLR prefers to call them). There seems to be no rigorous audit of the selection or voting process.

OLR conducted the "Your Health, Your Care, Your Say" Citizens' Jury for Patricia Hewitt in 2005. Never heard of it? Pulse magazine said:

"The Government has fixed its flagship listening exercise on the future of primary care to ensure it backs pre-stated plans for dual registration, walk-in centres and an increase in private providers."

Sounds familiar? This seems to have been a dry run for the current Darzi review and had only 89 participants.
Pulse later did a FOI Act inquiry on the event. Its conclusions were:

"The finding supports accusations by GPs and academics (Pulse, 24 September) that the consultation was a sham exercise because it focused on a restricted range of issues relating to access, but marginalised others such as continuity of care.

The documents also reveal that Opinion Leader Research was asked to write a proposal for the Your Health, Your Care, Your Say consultation before other organisations were even asked to tender."

It also found out that OLR were chosen instead of other pollsters, ICM and MORI, even though the OLR tender, at over £2,000,000, was more than 10 times higher.

OLR are also involved in "consultations" over nuclear power. An item on the Channel 4 website is eerily familiar:

"In the videos - alternative viewpoints had doom-ridden music in the background. The government's view was then given against calm, relaxing music. I feel I have been mugged."

"Not at all a consultation, merely a sleek marketing ploy."

"I went in with an open mind... myself and others felt we were being misled and manipulated."

So-much-so that Greenpeace withdrew from the consultation and made a formal complaint to the Market Research Standards Board. Unlike the recent Citizens Jury on the NHS, which I documented last month, many people have come forward to complain about the conduct of the Nuclear Energy consultation. Their description of events confirms the tactics routinely used by OLR to give the government the answer it wants while appearing to consult.

OLR's stated aim is to "enhance the client's reputation". Taxpayers are footing the bill for enhancing NuLabours reputation. Well, you can't polish a turd (not even with another turd) so this is money wasted and NuLabours reputation further damaged, if that were possible.

Here's a novel idea for the Clunking Fister. How about we give real democracy a try and let us elect our own Prime Minister?

Saturday, 6 October 2007

More NuLabour deceit

Guido Fawkes thinks Yvette was faking it.

A few days after the infamous "Citizens Jury", where selected "participants" were paid £75 cash in plain envelopes, Yvette Cooper, Minister for Housing and wife of Ed Balls held a webchat on the Downing Street website. I came across this on the thoroughly recommended Guido Fawkes blog.

Transcript of Webchat:
"Karen Doran: What is the government doing to make sure their policy on housing (regeneration and growth) is aligned to policies designed to promote economic growth. Could the Minister give practical examples of the opportunities this presents to local authorities in their place shaping role?
Yvette replies: You are right Karen that new homes need to be planned alongside new jobs -- as we are doing in the Thames Gateway, which is a major area of regeneration and housing growth. But housing and economic policies need to work closely together for existing communities too. Look at what cities like Manchester and Birmingham have done in their city centres -- creating new jobs, but bringing people back into the cities to live as well.

Guido writes:
If that patsy question reads like a planted question, it is because it is almost certainly exactly that. Now why she needed to ask the question in a "public engagement" exercise is beyond Guido. Karen Doran works on the Community Housing Task Force (formerly part of the office of the Deputy Prime Minister) where she advises on "Communications and Consultation Strategy". So it seems unnecessary for her to pose as a member of the public to ask the housing minister a question."

I do wish these revelations got better coverage in the mainstream media because the bloggers already know how deceitful NuLabour are. It needs wider coverage to stop them getting away with this.

Dr Ray gets all heated up.

The, unfortunately named, "Becton Bunny Boiler"

Dr Ray has been drawing admiring glances from Dr Rita Pal, the author of NHSexposedblog. This has all been very welcome and part of me is pleased that someone has finally recognised my stunning good looks, cutting wit and lofty intellect. The image she has of me is a sort of cross between Oscar Wilde and Pierce Brosnan.
I have two problems with this.
Firstly I am a bit concerned about what she might do if our relationship were to turn sour and I prove to be a disappointment to her. Looking through her website, NHSexposed, Dr Pal is not the sort of lady I would like to cross. I don't know the full details of her problems with the GMC but from reading NHSexposed it seems she has taken on the might of the Medical and Legal establishment virtually single-handedly and won.
The second problem, faced by many men of my age, is a pressure to perform adequately. While I am generally happy to tootle along being mediocre with the occasional earthmoving performance, the expectation that I can satisfy Rita on a regular basis is a bit daunting. The Dr Rant team tackle the problem by organising themselves into a sort of shift system so that the pressure is off each individual member. Meanwhile, Dr Crippen, has indeed been the envy of every medical blogger by rising to the challenge on daily basis with enough output left over to fill a couple of pages of a newspaper, but even he has recently had to rest. We hope to see him back with his towering organ in the near future.
If I don't succeed in lowering Rita's expectations gently at least our pet rabbit already died of myxomatosis this summer and our dog is too big to get into a pot

Tuesday, 2 October 2007

Spending your money wisely

Department of Health Spending Plans

Today I visited the Aston Villa Football Club directors suite for a bit of lunch courtesy of MercuryHealth.
I have mentioned MercuryHealth previously. This company won the contract to provide diagnostic services to the West Midlands as part of NuLabours 2nd wave independant sector contracts. The government has commissioned them to carry out up to 190,000 procedures per year including almost 70,000 MRI scans. The scans are provided by a fleet of 9 mobile MRI scanners and 1 mobile CT scanner each with 2 trailers of supporting facilities.
You might think this is an expensive service to provide, and you would be right. Fortunately, for MercuryHealth, their set up costs have been met by our generous taxpayers who have even guaranteed 80% of projected income over the next 5 years.
We are told that the introduction of the private sector shifts the financial risk away from the taxpayer. We know that has not been true for PFI hospitals and we can see it isn't true with 2nd wave diagnostic centres. We are also told that the NHS is expensive and inefficient and that the private sector would introduce efficiency savings and do the work better and at lower cost. Let us see how true this is.
MercuryHealth was due to start providing its service in April 2007 but the launch was delayed until June 2007. Today we were given the activity figures for the first 3 full months of operation. Total MRI scans for September was 154. That is 9 scanners working 12 hours per day 6 days a week. For comparison, our inefficient NHS unit does 16-20 scans per day on one scanner. Of more interest were the CT scan figures. For the last 3 full months of operation MercuryHealth has carried out 1 scan. That isn't a typo; 1 scan. That is a fully staffed mobile unit with two supporting trailers over a three month period. Our NHS unit does around 25 scans per day and provides an out of hours service. It isn't Mercury's fault. This government was warned that private sector involvement was not needed and not wanted. They were told that what was needed was adequate funding of the NHS units but they had their own agenda (para 139) and went ahead regardless.
Still, I don't think Mercury will be that upset about this because they are being paid anyway. In fact the payment-by-results tariff system means they are paid as much for every patient they do not scan as the NHS unit is paid for every patient we do scan.
To add the final insult to the assembled audience, some letters, allegedly from grateful patients and GPs, were read out. They praised Mercury for the service they provided. I'm not surprised. If we were scanning our only patient in three months at UK-radiology I would treat both the patient and the referrer to a Champagne reception and a night of debauchery at Hereford's finest lap-dancing club. And I wouldn't expect the taxpayer to pick up the tab.

Friday, 28 September 2007

Hospital Scandal: "MP did not consent to digital insertion"

Nulabour MP, James Purnell, has accused Tameside General Hospital of subjecting him to a digital insertion without his consent.
The NHS Trust has admitted that a digital insertion took place but claims that Mr Purnell asked for it. Mr Purnell, 37, is Gordon Brown's new Secretary of State for Culture, Media and Sport, a post previously held by Chris Smith, the first openly gay MP.
The alleged incident took place on the new hospital building site after Mr Purnell arrived late for a photoshot and found himself alone. His parliamentary colleagues had already been photographed and left but Mr Purnell agreed to the one-on-one session with the Trust's photographer. He has subsequently claimed that he did not, however, consent to the digital insertion and the Trust has been forced to issue an apology.
Opposition supporters have greeted the story with unrestrained glee. "Here is cast-iron proof that Labour ministers are quite happy to 'fake it' if they think they can get away with it," said Mr Hunt (shadow culture minister).
For the full story go to the BBC website.

Thursday, 27 September 2007

Cyberwarfare: The Clash of the Computer Nerds

Dr Ray at Work

A lot of fun to be had on the net today if you are that way inclined.
It started with the much anticipated Webchat by His Eminence the Lord Darzi of Park Royal.
I had been posting questions for a couple of days and encouraging others to do the same. I had a vague hope that if all the lurkers on DoctorsNet.UK all posted questions it would overwhelm the Downing Street website and crash it but, either not enough doctors did or no taxpayers expense was spared to protect the site from a denial of service cyberattack. A more tangible aim was to create a record of questions which could be disclosed under a FOI request should he choose to ignore the real issues.
As it happened he did address the issues to a degree. Jill Robson asked why he was interfering with General Practice when the Government's own surveys showed widespread satisfaction with the service. Catherine Heaton asked why payments were made to participants in the Citizens Juries (revealed on this blog last week) in return for their opinion. His Mostness had no answer for this and simply said that the idea that participants could be influenced by being offered money was absurd. I personally can't see what is absurd in this. If it wasn't true why are drug companies not allowed to offer doctors money?
There were a few less critical questions but none obviously planted to make him look good. At the end he gave a couple of links including to a Mum's website where the consultation would continue.
I had a look at the site and it seemed kosher with no obvious link to Nulabour so I registered and added my comments. I noticed that Garth of the Ferret Fancier Blog had done the same and later at least one other doctor. The comments on the site were already not that complimentary of NuLabour or Lord Haw-Haw of Harlesden but, after a few well aimed observations from the doctors, I think NuLabour must have regretted allowing free comment on this forum. I don't know if they expected a smooth ride from the grateful mums to whom they had offered 120 quids worth of vegetables but they didn't get it.
A mistake from His Darziship I think.

If you want to give your opinion of the NHS you could do worse than visit or www.nhsreview.

Tuesday, 25 September 2007

The "Brown" Economy

Tarmac your drive guv?

For a Party which gave the Inland Revenue unprecedented powers to forcibly enter homes and businesses without a warrant, force banks to divulge information on their customers' accounts and even to empty a customer's bank account without even having to inform the owner, it is odd that it has chosen to pay lay participants in the Citizens Juries in cash. The payments (which were only offered to the "public" after NHS staff were asked to leave) were described in my earlier blog and caused a bit of excitement and frank disbelief but have now been admitted and documented in this article in the GP magazine "Pulse".

The reasons given for handing out tax payers money in this way are quite frankly an insult to our intelligence. The money is claimed to be for "expenses". This may seem reasonable at first sight, but if this was the case why were "expenses" not offered to everyone who attended. My colleague had a 100 mile round trip to attend the meeting while supposed to be on leave. Then there is the irony. Blood donors in the UK receive no payment. They are expected to give blood as a public service. In fact, the argument is made that offering money would attract the wrong type of person whose blood might be tainted and impure. So, a pint of blood is worth less if it is paid for but an opinion on the future of the NHS is worth £75.

Why was the money handed out at the end of the meeting if it was "for expenses"? A cynic might suggest that the payment of expenses was contingent on a "satisfactory" outcome.

The Department of Health spokesperson said the money had to be paid in cash because not everyone would have a bank account. It was, in fact, this government which stopped pension and benefit payments in cash. This lead to the closure of thousands of Post Offices. This was done to reduce fraud. We can all work out for ourselves why payment was made in cash. The recipients will be untraceable if someone should question who they were and how they were selected. It won't be detectable if the same people turn up at every meeting. Conveniently the money will also be untaxable

There was an explanation for the sealed envelope too. The spokesman said it would have been difficult to handle the loose £50 and £20 notes. That is true enough but why were the NHS staff asked to leave before they were handed out? Did someone have something to hide?

The rules under which doctors deal with drug companies strictly control inducements and gratuities. If a drug company offered doctors £75 in an envelope at the end of a sponsored meeting it would find itself in breach of the Pharmaceutical Industries Code of Practice and the doctor may well have to face a GMC investigation. It is not unreasonable to expect the same standard of behavior from the politicians who write the rules.

Don't forget. Prof., Sir, Lord, Your Worship, Dr., Mr., His Majesty Ara Darzi is doing a webchat on Thursday. Go onto the Downing St website and ask him if he is happy with medical staff representation at the Citizens Juries bearing in mind that they were given as little as 24 hours notice to attend. They are taking questions now. Make them realize we do not believe this is "consultation".

Monday, 24 September 2007

Dr Ray's 15 minutes of fame

Andy Warhol's portrait of Dr Ray

My description of the Citizen's Jury in Birmingham on the 18th (see previous blog) caused quite a stir and propelled the normally quiet and reclusive Dr Ray into the limelight of publicity.

Events unfolded with amazing speed after the Dr Rant team picked up the story. Within 24 hours all the major medical blogs had reproduced or linked to the story and even the political bloggers and the blogging MP Iain Dale gave it extensive coverage. Three separate threads started on and by Monday one of the threads had reached the top quality postings and the person who started the thread reached the weeks top author. By Monday afternoon, Hospital Doctor had picked it up and included it as top medical blog for the day.

Journalists and politicians were emailed and the word went out to uncover Dr Ray.

Initially almost all comments were supportive. The only exception was one anonymous on Iain Dale blog who complained that Dr Ray misused an apostrophe. Then one or two people pointed out that there was no supporting evidence for the statements in the blog and the early stirrings of the rebuttal unit could be heard. Hints of legal action for defamation of Prof Darzi appeared on even though my only mention of him was to say that he was there. My work colleague answered enquiries from journalists and posted replies on on my behalf asking for some other doctors who attended the meeting to confirm or deny that the blog was truthful but by this evening only two people had come forward to confirm that the notice period was as short as 24 hours and no one who attended the Birmingham meeting had appeared. Is it possible that my colleague was the only independent doctor at the whole Birmingham rally? It was, after all, fortuitous that she was free to attend because she was already on leave.

I think the whole episode is going to be forgotten in a few days. The opportunity to embarrass Gordo at the NuLabour Love-in will pass and the next we shall hear is that "following extensive in-depth consultation with the medical profession and stakeholders we have reached a consensus that the DGH model of care must be modernised to meet the needs of the 21st century" (i.e. closed down and replaced with privately run , profit motivated clinics owned by shysters, spivs and barrow-boys and staffed by Eastern Europeans).

Ara Darzi is doing a Downing Street webchat on Thursday and they are taking questions now. Obviously they will filter out any that might cause embarrassment or need a truthful answer but if several hundred doctors all ask him about his confidence in the consultation process it will presumably be on record somewhere and might come back to haunt them whether they choose to ignore the questions or answer them untruthfully.

Here's a funny thing. The consultant who attended the meeting and started the whole thing is on holiday and not a fan of blogs or the internet so is probably unaware of all the excitement.

Friday, 21 September 2007

Nulabour's hospital closure consultation

Gordon Brown.....Alan Johnson.....Ara Darzi

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

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

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

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

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

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

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

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

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

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

According to the Downing Street website there are nine more of these "consultations" due around the county. Thats an awful lot of people to bribe with taxpayers money, but once they're done the business of closing the DGHs can start in earnest.

Wednesday, 5 September 2007

3000 year wait for CT scan

Egyptian CT scanner.

Quite a lot happening on the UK-radiology front which is one of the reasons I have not been blogging recently.

I set up a new website called It's nothing special - just a single page that directs visitors to the main website and I wouldn't have bothered had not a mysterious shyster been buying up all the specialty names in almost every town in the UK. So now they own aberdeencardiology, aberdeenradiology etc. Hundreds of sites, but I managed to buy ours before them. Presumably they will be approaching each group and offering the domain name for sale or threaten to sell it to their competitors. Anyway, I put it to good use and used the website and search engine optimisation to get visitors from the Birmingham and West Midlands and this has now started to work with first page google ranking already.

One of the Birmingham visitors today was the Museum and Art Gallery. They wanted us to scan their Egyptian Mummies. I would have loved to do this. It would have been really fascinating and would have given us national publicity, but, thanks to being ripped off by Toshiba when they sold us the scanner, our image processing software isn't up to the job of producing those 3D reconstructions of the whole skeleton. Also I was wary of the press. You can't really predict what sort of spin they would choose to put on it. It could be something corney but harmless like "Birmingham Mummy waits 3000 years for a scan" or maybe more damaging like "NHS scanner used on 3000 year old corpse but cancer patients denied scans" Anyway, with great sadness I had to direct them elsewhere. Just wait till I buy my own scanner!

The other landmark recently was our first international referral. I was contacted from Thailand by someone who found me on the internet and I carried out a scan when they visited the UK, faxing the report back to a consultant in Thailand.

The income from our venture has been put to good use. The collapse of Atos Origin as a 2nd wave diagnostics provider not only cheered me up a great deal but provided us with an MRI radiographer looking for work. We have been able to employ him to extend the working day for our NHS patients and we now run 8 to 6.30 weekdays and alternate Saturday mornings whereas previously we only ran 9 to 5 weekdays. Oddly, the success of our low cost private service and increased NHS provision has not reduced our private referrals to the local Nuffield Hospital who pay the full rate. What seems to be happening is that, as we become better known as serious players, we are attracting insured private patients on the basis of reputation and quality rather than just price.

So far it really does seem like a virtuous circle.

Monday, 30 July 2007

Of mice and Milburn

2nd wave diagnostics was a scheme originally promoted by former Health Secretary Alan Milburn as a way of transferring diagnostics from the NHS to the private sector where it could be done more "efficiently" by lower skilled and lower paid folk from Eastern Europe. He was a paid advisor to Alliance Medical, a company that expected to benefit from such work.
Alan Milburn was one of the more disliked of our recent Health Secretaries, especially by Gordon Brown who feared him as a prospective "Stop Gordon" candidate, so it is with great pleasure that I report that the whole 2nd wave diagnostics scheme is beginning to look sickly.
There have been a number of signs that things were not going to plan. BUPA pulled out of the contract on the South Coast and were replaced by a building company called Carillion, causing the start date to be delayed. The Group who won the London contract initially wanted to recruit UK radiologists at Eastern European rates of pay but they have found few takers. Now Atos Origin, a French company who had won the contract to provide diagnostics in two regions, has been sacked. They were due to start the service last April. Atos also has the contract to provide Choose and Book - the other useless and unwanted scheme burdening the NHS.
It all looks like its quietly going to go the way of Milburn and disappear into the dustbin of failed Nulabour hopes. Good riddance.

Friday, 27 July 2007


Its all gone to plan and I am registered with The Motley Fool again (see previous post).

Yesterday I went to post something on the back pain forum but, instead, I found a really good link to a site devoted to exposing health fraud and quackery written by American doctors. As I mentioned before, this was the original role of the GMC but they are now too busy using our money persecuting doctors and sticking their heads up politicians backsides to do this and it seems the whole country is now wasting its money on faith healers, fad diets and food supplements with no-one interested in protecting the gullible, vulnerable or stupid from being fleeced.

There is a touch of Emperors New Clothes about it too and anyone who is prepared to say what most scientifically literate people know is the truth about food supplements or homeopathy is denounced as narrow minded or protecting their own status and interests.

This sort of quackery does blend into the sort of quackery that we see in the NHS where opinion and bullshit count for more than hard work, intelligence and experience. If you have time to read some of the articles on Quackwatch you will see that the snake-oil salesmen use much the same terminology and selective quoting of dodgy research to justify their existance. Embarrassingly, the author quotes the use of the word "holistic" as one of the giveaway signs of quackery. I used this on my uk-radiology website and have been known to describe myself as a "holistic radiologist". Obviously this is a meaningless term and I originally used it as a joke but it seems to tick all the right boxes and no-one has queried it. Somehow it conjures up a softer, gentler image of radiology than the use of Hiroshima levels of radiation justifies.

Tuesday, 24 July 2007

Black-balled by The Motley Fool

People have different reasons for writing blogs and I was surprised to hear on Radio 4, this evening, that blog writing popularity had actually decreased from 15% to 12% of internet users. Personally I find it difficult to believe it is anywhere as high as 12%.

Anyway, some write a blog because it helps them set out their thoughts, others lead a sad and lonely life and want to leave their mark and others do it for financial gain. I am happy to admit that I started this blog as a way of driving traffic to UK-radiology and maintaining its first page Google listing. Once I started writing it I found myself making political statements on it, which, from the business point of view, might seem a mistake, but no-one is going to read a blog which has nothing of interest on it (I assume someone does read this but as I don't get stats I might be wrong).

One of the other ways I seek to drive relevant traffic to UK-radiology is by contributing medical information to health discussion boards. I don't spam them of course but I look out for discussions where my radiology knowledge is helpful. It should be obvious that a doctor can't do this under their real name or give specific medical advice so I use one of a number of nicknames. If permitted I give my website URL in my signature or on my profile but if not permitted I usually tell readers to look on the internet and not pay more than £200 which just about narrows it down to our group without actually naming it.

Last week, the moderator on The Motley Fool, a financial website with a very small health discussion board, deleted my posting because I had, in truth, gone over the mark and put my URL on it. As a site which depends on advertising income they certainly don't want to offend BUPA or one of their other sponsors. Fair enough, so I posted again and this time just indicated that readers don't need to pay more than £200 for an MRI scan. Instead of deleting this post the moderator posted a public reply accusing me of posting under a nickname to mislead the readers and listing other examples on other websites where I had also posted under the same nickname. Now that looked bad though, in fact, it was quite proper; the moderator was posting under a nickname too. Funny thing was that the idiot went further than I dared and provided a valuable hyperlink to my website from the Motley Fool. I was thinking that "any publicity is good publicity" and was going to leave it there but it didn't fit with our image of a sincere and ethical company so yesterday I emailed The Motley Fool and asked to be voluntarily struck off their register and have my postings deleted, which they have now done. Obviously they had to delete their allegations too.

I'll give it a couple of days and register again under a different name;)

Wednesday, 18 July 2007

The Great Escape

Many people, who do not work in the NHS, must think doctors are an ungrateful lot. Largely educated at public expense, paid huge amounts of money and doing a job most admit they enjoy doing, and yet they complain; usually about politicians or hospital managers.
Just to give an idea of what we put up with and what is p!ss!ng us off I have reproduced an email sent out this week to all the consultants at a Trust somewhere in the UK (I have taken out the initials which identify the Trust and replaced them with ....):


1. Introduction

This paper sets out for discussion a (high level) outline approach to the development of a medium term strategy in line with the logic of ‘The Great Escape’.

2. Some context

‘Strategy’ is defined as follows

• Strategy is about role and direction
• A strategy should be based on an analysis of the external forces and drivers for change impacting on the health care system and/or individual services
• This environmental analysis should in turn drive a definition of organisational purpose (mission) and the development of a set of organisational values or decision making criteria; mission and values in turn should shape stakeholders thinking about service development, service design and service delivery together with the nature of the relationship between partner agencies.
• A strategic plan needs to cover a minimum of five years and specify key milestones.
• A strategic plan must be explicit about both income assumptions and the balance between costs, volumes and quality.
• A strategy should be sufficiently succinct for service staff to carry it ‘in their heads’

The key force or driver for change in an NHS which is moving towards a competitive market-driven regime is the aspirations of ....’s customers: PCTs/ LHBs, GPs and individual patients.

It also needs to be recognised that strategy formulation and execution is as much a micro – political process as a technical one.

3. A suggested approach

A three stage approach based on a modified version of the ‘top down, bottom up, top down’ model is suggested. It also suggested that the process is overseen by a reference panel made up of representatives of the PCT/PBC groups and .... LHB, local politicians, members of the public and senior clinical staff (possibly based around the existing FT Project Board?). The development of the strategy will need to be supported by a managed communications plan.

STAGE 1: Production of an .... strategic framework

The objective of this stage is to agree a Trust level strategic framework to provide the parameters for more detailed directorate and care group level clinical strategies

The strategic framework will be based primarily on the IBP and outputs to date from ‘The Great Escape’.

STAGE 2: Production of directorate level clinical strategies

The objective of this stage is to develop draft directorate and care group level clinical strategies.

This more detailed work would involve workshops focused on answering the following questions:

1. What are the forces and drivers for change impacting on and shaping the future of .... and the services provided by the directorate?
2. What gaps or weaknesses are there in the services provided by the .... and the directorate?
3. What are the outputs of any benchmarking exercise?
4. What issues (relating to capacity and efficiency in particular) do ... and the directorate face in delivering access targets and other S4BH core standards?
5. What ‘fixed points’ are there in ...’s strategic ‘trajectory’ over the next 5 – 10 years?
6. What values or deign principles should underpin the development and delivery of ...’s services (including expectations of partners within the local health and social care community)?
7. What are the options for service delivery and what is ...’s and the directorate’s preferred direction of travel?
8. What are the corollaries of this direction of travel in terms of location, site usage and accommodation?
9. What are the critical success factors in realising the preferred direction of travel?
10. Of these critical success factors, what is the top priority?

Debate at the workshops will be supported by where possible by ‘hard’ analysis of demand/workloads, changes in clinical practice, policy and comparative performance. Critically, the resulting draft strategies will be need to be ‘owned’ by the relevant clinical teams and ‘signed off’ by commissioners and patient groups. The Medical Director will have a particular role in challenging and supporting the work of the clinical teams.

It is suggested that a consensus development conference is run to secure the ownership and sign off required. The conference consensus (which would need to run for between one and three days) would be divided into two parts:

• Part one: An internal ... event in the course of which the Medical Director and Care Group Clinical Directors take the lead in ‘cross referencing’ the draft clinical strategies to ensure consistency with the strategic framework and with each other and in ensuring that their contents represent a robust and ambitious set of proposals.

• Part two: An ‘external’ event to which .... customers (commissioners, GPs and patient/ public representatives) are invited to review and comment on the emerging clinical strategies.
Each strategy will need to be tested for affordability in advance of its submission to the Board for approval in principle.

STAGE 3: Production of the Trust strategy

The objective of this stage is to review/refine the clinical strategies and incorporate them into an overall Trust strategy for approval for the Board.

This will involve the Board and Executive Team ‘reading across’ the clinical strategies to ensure that they complement each other and testing them against the strategic framework for consistency. The resulting Trust service strategy can then be amplified to incorporate a capital and financial strategy. The role of the reference panel will be to ‘referee’ the development of the overall Trust strategy. The Trust strategy will be tested in a second consensus development conference for stakeholder groups before formal adoption by the Board.

4. Timelines

The key determinant of the timetable for delivery of a formally adopted/ Board approved strategy is the FT application process.

5. Communications

Although the primary focus is on the engagement of clinical staff, workshops for non – clinical staff and support organisations employing the format set out in section 3 will also be organised.

A week long interactive exhibition to attract patients/ visitors sited at a suitably prominent part of the hospital will be organised.

Invitations to the Consensus Development Conferences could be extended to members of existing patient groups. Certainly the opportunity to participate in dedicated workshops would be provided.

Finally (in support of increasing FT membership) a suitably amended version of the attached would be widely distributed.

6. Recommendation

The management team is asked to discuss the above."

I don't blame anyone for giving up after the first couple of lines and if you did read it all I don't blame you for not understanding it. No-one does understand it but the "logic of The Great Escape" is intriguing. Several senior managers at the Trust where this email was circulated have already made their Great Escape and some now work for the private sector so perhaps they are suggesting the managers plan their exit before the DGH is closed down. Here is an email reply sent by one of the Consultants which I thought was funny:

"I've worked it out I think!! In the classic film a huge effort was put into the planning and execution of the escape involving extensive team working and coordination. Unfortunately, although the escape went ahead, the end result was unsuccessful; all the escapees except one (Charles Bronson) were recaptured and if I remember correctly rounded up and summarily executed. Thus the take home message was that despite all the careful planning and teamwork and effort, the plan was ultimately comprehensively thwarted. So what's new about "The Great Escape" thinking in NHS strategy??"

This report was written by a highly paid director while the Trust is making front line staff redundant. And you all wonder why we complain.