Dr Rays focal spot

Into the sunset

2008-02-17T20:04:00.004Z

It's been a while since I wrote anything on this blog and I owe an apology to the small circle of readers who visit regularly.
Some of you will have read about the huge public demonstrations against school closures in Herefordshire which were provoked by Nulabour attempting to do to local schools what it is currently doing to local hospitals. I'm proud to say that Dr Ray will be able to look his grandchildren in the eye and say that he played his part in the Great Herefordshire Revolt. Although I have now taken a back seat, the campaign was draining and I now need a rest from blogging and political rabble-rousing.
I do have other excuses.
I originally set up this blog to help publicise UK-radiology, our profit-sharing private scanning and radiology setup in Herefordshire. Along the way the blog exposed the poor value the taxpayers were getting from the Mercury Healthcare (now Care UK) 2nd wave diagnostic contract and soon after the contract was canceled. The blog also documented the experiences of what seems to be the only hospital consultant to attend one of the early Darzi rallies and revealed the scam that was passing for consultation. The Department of Health was forced to admit to offering "expenses" to only some groups of participants and, having attended a meeting myself since, I sense the blatant vote-rigging has been reined in.
The original aim of website promotion has achieved its purpose, with UK-radiology, or one of its many variants, on the first page of Google for all the relevant search terms. In fact this has led to its own problems because I now get a large number of emails which, either have to be deleted (penis enlargement and money making scams mostly-poor targeting I say, being well provided for in both departments!) or individually answered.
Many of the genuine enquirers fall into two groups. One group are unhappy with the medical care they received locally and are really after a second opinion. When I get the details, the advice they had received seems to me, in fact, usually quite reasonable. The problem is that expectations are often unrealistically high. The other group of enquiries are from people wanting total body scans just to check things out. I made a conscious decision not to offer this type of scan when we started out because I am not satisfied that these scans are ethical. The problem is that explaining all this is very time consuming and I still have my full-time NHS job to do.
As any consultants reading this will know this is also a busy time in hospitals. The annual mutual arse-sniffing exercise, more commonly referred to as "Appraisal" has come around again and everyone suddenly realises they don't have enough Continuous Medical Education points (because reading the textbooks and journals doesn't count, whereas attending a meeting to listen to a manufacturer's sales pitch does) and that they haven't done the requisite annual audit (because discussing a diagnosis with the surgeon and pathologist doesn't count whereas documenting the number of toilets in the department with jammed paper hand towels does).
The other thing that has come around again is the so-called Clinical Excellence Awards which link consultants' pay to ability to exaggerate and fill in forms. I don't think an anonymous blog counts towards such awards though I am so desperate for material I might try it this year.
Finally, one of our number is on maternity leave and we decided to do her work between us rather than employ a locum. Radiologists suffer a credibility problem in hospitals and a bad locum can undo, in a few weeks, what has taken years to build up. Fortunately it is working quite well but its another chunk out of my evenings.
What I am getting at is that the blog has to go, at least for the present. I will return when I have more time or if I need to get something off my chest but for now I will stick to reading other blogs and posting the occasional comment.
As a football manager might say: "At the end of the day, the sun will rise again"
Xavier

Trust me. I'm a doctor.

2008-01-25T21:33:00.000Z

There was a time when the expression "Trust me. I'm a doctor" would not have had everyone falling over in laughter. Unlike politicians, who have always had a reputation for being dishonest and never waste an opportunity to confirm this reputation, doctors place great emphasis on professionalism and trust. This is as it should be if patients are to divulge their most intimate details and expect an opinion not influenced by anything but clinical considerations.

The present UK government, currently under investigation by the Metropolitan police for breaching their own regulations on electoral fraud, have always judged the professions by their own standards and imposed increasingly onerous regulation. At the same time there has been a move to replace professionals by untrained or minimally trained personnel with the mistaken belief that clinical judgment and professionalism can be replaced by strict protocols and close regulation.

Telemedicine, and in particular teleradiology, distances the doctor from the patient and the radiologist from the clinician and would seemingly demand extremely high levels of professionalism and trust or alternatively cast-iron regulation for the system to work. In the USA, physicians and radiologists offering out-of State consultation are required to be licensed to practice in that State. The UK seems less concerned with protecting standards. Before Mercuryhealthcare had their MRI contract withdrawn, their business plan involved sending the scans to Hungary for reporting. The reports were supposedly to be done by GMC registered radiologists but almost none had qualified or trained in the UK or sat any UK examinations. It is questionable whether, a few years ago, many of these people would have been recognised as doctors let alone as radiologists. At the time the GMC was so desperate to maintain its position in charge of medical regulation that they acceded to Government demands that European qualifications be recognised as of equal value and offered GMC registration to these overseas doctors.

Last week I received an invitation from a company in India offering teleradiology which I reproduce in full (emphasis mine- name deleted):

"Hello Doctor !

We provide teleradiology pre reading & reporting services from India by the name of XXXX XXXX Ltd.

XXXX XXXX Ltd.offers complete, round-the-clock, fast & 98.9% accurate teleradiology services for hospitals, clinics and physicians.

We have a panel of 30 dedicated & experienced Indian radiologists interpreting MRI, CT Scans & ultrasounds. All radiologists are MD & FRCR
some of them having more than 7 years of experience in the field. We have a setup at the city of Delhi in India. We use the most
advanced technology /RIS /PACS/ Synapse/Emed that enables a rapid transmission and interpretation of diagnostic medical images.

Since in US, You need license for each state , so we can not operate directly by the name of our esteemed radiologists .So, we cater to few

US based radiologists and teleradiology who operates by their name but outsource the work to us.So less overheads and more
quality productivity for them with 98.9% accuracy level.

Our 30 MD radiologists each can read and report 16 cases a day at 12 hrs TAT (turn around time) and yet excel in terms of quality of reports. We

usually, start with a pilot service which comprises of few 4-5 test cases and then do some back log cases with 1-2 days TAT. As we get

comfortable working with each other we go live with 12 hrs TAT cases. We suggest a test sample/pilot Project to know our quality and competency level.

To ensure customer satisfaction and quality, our Quality Measurement processes document your radiologists evaluation of each PreReads accuracy. Our
Medical Quality Improvement Board reviews aggregate statistics and individual studies in an effort to help your radiologists guarantee the highest degree of clinical quality. The Board also conducts random evaluations of completed PreReads from our personnel.

We are currently looking forward to foray into the UK and EU markets for which we already have FRCR radiologists in our pannel.We shall be highly privileged to forge any alliance /collaboration with such an eminent company like you. We look forward to a long term mutually beneficial relationship with you .Hope to hear from you real soon with more of your kind suggestions.

Thanks & Regards"

So even the strict US regulations have been bypassed. It just goes to show; where money is involved the dishonest will always outwit the regulators. As Nu Labour and Societe General have found out and UK patients will soon find out.

Nu Labour, Nu Tactics

2008-01-20T11:54:00.000Z

Nu Labour's Nu battleplan

I am finding it increasingly difficult to blog about what I know well. Other medical bloggers seem to be having similar problems and dropping out or posting infrequently. I think I know why. The targets are becoming less obvious.

My broad-brush understanding of what Nu labour has always wanted to achieve is the wholesale destruction of the network of DGHs which provide the majority of secondary care (and NHS hospital doctor and nurse employment) in the UK. Once DGHs have gone, the vast army of NHS staff could be re-employed by the private sector at locally negotiated rates with disregard for the complex and expensive banding structure.

When Nu labour started their micromanagement of the NHS they chose a very direct, in your face, approach to dealing with the profession. This came to grief when Dr Richard Taylor successfully stood for Parliament and overturned a Labour majority in Kidderminster over the downgrading of the local DGH.

There followed a more subtle approach of "divide and rule" by which they hoped to drive a wedge between Hospital Doctors and General Practice. Separately negotiated contracts made both groups suspicious of each other and more easily manipulated by government. For example, in hospitals, the basic wage was set on a downward path relative to living costs with the additional remuneration through additional sessions and CEA awards being increasingly at the whim of managers. Similar mechanisms for political interference were set up in the GP contract. Plans were then put in place to "encourage" GPs to shaft their local NHS hospitals. An example is the provision of NHS MRI scanning by the private sector, which, had it succeeded, would have closed down DGH x-ray departments over the next few years and thus made DGHs non-viable.

It surprised me, and I think it surprised Nu Labour, that GPs put their patients' long term interests first and failed to support the 2nd wave diagnostics program and over the last few months many of these schemes have been quietly dropped.

I don't think Nu Labour have changed their ambitions but they have clearly changed their plan of attack. Alan Johnson (remember him?) has been remarkably quiet and non-confrontational, unlike his predecessors. In the meantime the focus has drifted to a direct attack on GPs. Wave after wave of bad-mouthing and spin have been used to soften them up and now the private sector (such as Boots and Virgin) are being encouraged to provide direct competition to them by providing a parallel system of primary care clinics run by the "iffy for the iffy".

These clinics will be providing some diagnostic services "in the community" and will presumably have a financial interest in referring to their own facilities rather than the consultant staffed local hospital. They are also unencumbered by notions of "professionalism" and "patients best interests" and will opt for using the service which provides the biggest profits. Thus our system of general practice, widely acknowleged to be a well performing part of the NHS, is to be sacrificed to get at the DGHs.

These are the classical tactics of a long term siege. First try an open direct attack on the walls of the castle. If that doesn't work bring in some high tech mobile equipment to undermine or scale the walls. If the high tech equipment only proves as good as the morons operating it, settle down for a long process of attrition and starve the besieged out. If supplies continue to be smuggled in, destroy the surrounding countryside too and bring in your own food supplies from a secure source elsewhere.

There are similar moves to destroy state education in rural areas. Under the guise of Building Schools for the Future local authorities in metropolitan areas are more generously funded than rural areas and in rural areas funds for new schools are only provided if widespread closures ("modernisation" in the Nu labour sense) of rural schools takes place. This is currently occurring in Herefordshire and is bringing the population close to mass civil disobedience. Public meetings are being attended by a full third of the population (almost the whole adult population once children and babysitters are accounted for) in some market towns and plans for street marches are being drawn up. Head teachers, local councillors, local MPs and even the Church have denounced the proposals.

I have been involved in my own little way which explains the drop off in postings on this blog. I haven't gone away. Nu Labour seems to have shifted its attention to destroying State Education and this is now the more important battle to be fought.

Staunton-on-Wye Part II

2008-01-11T19:59:00.000Z

Many years ago I worked on a specialist medical unit where mortality was approximately 50% per admission. I managed to stick it out for longer than most but one day a patient complained to my consultant that he didn't like me because I didn't smile. A few weeks later my consultant suggested radiology might be a good career choice for me. It's like being told I had the looks for a career as a radio presenter.

I read somewhere once that you should want your pathologist to be a pessimist. The same applies to radiologists so I am well suited to my work. I know radiologists who are nice jolly people and they don't make very good radiologists. I, on the other hand, start off with the assumption that each scan I look at harbours a tumour which is going to cut short a life and destroy a family. All I have to do is keep looking until I find it. I think it makes me a good radiologist but a miserable person to know.

I awaited the results of our Local Authority Review on Education suitably pessimistic. In fact I was planning the next stage of the campaign to save the school and was looking into the cost of banners to drape across one of the main route from Mid and West Wales into England which passes through Staunton-on-Wye and wondering if I could cut templates out of X-ray film so that a crack squad of villagers could go out at night and spray paint our slogans on public buildings.

When the result was published today there was no mention of our school but an axe had been taken to primary and secondary education in Herefordshire. Some of our best schools were to close or be incorporated into unpopular ones. Some parents who had recently moved to the area and bought a house near a good school saw their plans ruined. The cuts were more savage than anyone had expected and most people in Herefordshire had no idea that such cuts were even being considered. Parents in Herefordshire are in a state of shock tonight as they begin to plan for transporting their children across the county to the surviving schools or figuring out if they can afford to educate their children privately. In one move, and without consultation, a small unelected group of officials have hatched a plan to deprive the population of a high quality local education for their children. Without warning, headmasters and mistresses at 37 schools were told they are to be made redundant and will have to apply for any remaining jobs.

I don't know a great deal about political interference in local education but there is the "Stalinist Central Control's" fingerprints all over this. The local education department claimed the closures were necessary to access central government funds for new buildings. This looks very much like the privatisation of education. The plan goes like this. Close the existing locally managed schools or else be starved of funds. In return for closures and staff redundancies Central Government will provide a shiny new school (preferably in a Labour voting inner city area) built with PFI money and owned and run by a NuLabour supporting private company. Employ staff under locally negotiated (imposed) T&C of service and make sure the person in charge of the school is a Believer and "on message". Far fetched? Well I always look on the dark side but isn't this what is happening in health care?

My children have not been completely spared. The state school we chose is to lose its 6th form requiring them to go to a ghastly "sink school" on the rough side of town which, instead of being closed down, has been increased in size and given a new name and fancy website. I don't know if they removed the razor wire and security cameras when they changed the name; its not a part of town I ever venture into.

Staunton-on-Wye School

2008-01-08T21:27:00.000Z

With political interference and social engineering in state education and with my own children of primary school age, it was inevitable that I would be drawn into campaigning not only for the local district general hospital but also for the local village school.

The school at Staunton-on-Wye, a village close to the Welsh border in Herefordshire, was opened in 1860 and is in a Grade II listed building on three floors. It was originally built with money given to the region by George Jarvis, a local boy who made his fortune in London in the 18th century. The charity still owns the building although the school is now run by the local authority.
The historic buildings and generous surrounding land have served the local children well but are poorly suited to modern safety regulations and inclusion of adults and children with disabilities. Plans were made to move the school to a new building. Land was bought and funds for the new school were secured.
Late last year the local authority announced that it was reconsidering whether to allow the new school to be built because making this excellent school even more attractive to prospective pupils would threaten the viability of less popular schools. Furthermore the local authority argued that demand for school places was generally in decline and wanted to reduce school places by shutting schools.
The logic that a lower standard of state education was preferable to allowing the parents any choice struck me as typical Soviet-style government of the type which gave the lucky folk of East Germany the Trabant car (if they could bribe an official or were in the political ruling class, that is - otherwise they had to wait 15 years). The population trends were based on the 2001 census and have recently been shown to be highly inaccurate and underestimated immigration and the effect of increased birthrate in the indigenous population. We are currently seeing the chaos of this underestimate on midwifery services and we shall see the effect on schools in a few years just as school places are cut.
Deaf to our reasoned arguments the education department is due to announce school closures on the 10th January and we fear the worst.

On the radiology front things have been more positive.
On Monday Gordon Brown announced that the NHS was going to set up screening programs for stroke, heart disease, renal disease, diabetes and aortic aneurysm. Obviously the medical readers will recognise that this is basically meaningless waffle. Screening for stroke, diabetes, heart disease and renal disease presumably means having blood pressure and bloods taken, which I see from a flyer I got with my Clubcard statement this week, is being offered by Tesco for £10 (with a pedometer thrown in) and is already available for nothing from your friendly GP.
Aortic aneurysm screening is more interesting and Gordon was suitably vague. Very large studies published in the last few years have shown screening for AAA is both cost effective (by NHS criteria - less than £36000 per year of life saved) and offers benefit to men in the 65-75 age group. This is only true however if operative mortality is less than 5%. Ultrasound screening of the at risk group is relatively easy - even Mercury Health might be able to manage this with a few hundred imported Eastern European sonographers and it would go some way to compensating them for the loss of the MRI scanning contracts. The treatment of aneurysms however has to be done at a specialist centre with ITU facilities and the extra work would completely overwhelm the system. When I set up Aortascan, our private aortic aneurysm screening service in Hereford, I anticipated that NHS screening would be hyped up and publicised and then inevitably rationed, creating a demand for private scans. This is exactly what seems to be planned. The scans are going to be phased in for 65 year old men some time before 2011. What are the 66-75 year olds going to think about this; after all they are at even higher risk? What about women? The studies are in favour of screening for men but women die of aneurysms too. How is the government going to refuse screening for women without running foul of sex discrimination law and, more importantly for Nulabour, losing popularity?
The Conservative Party website called the announcement "chasing headlines" and allows reader comments on the issue. I am eternally grateful for someone who has posted the information that, instead of waiting for Gordon's largess, private scans are available for £50 at http://www.aortascan.co.uk/
I now have Gordon Brown pumping up demand for our aortic aneurysm screening service and David Cameron carrying an advert for our service on his website! You would have thought, with a team like this behind me, I would be inundated but the only call I had today was a Sun reporter who wanted to interview me. Our hospital corporate affairs director told me to steer clear and despite the lost publicity for our service I thought it was probably good advice. I really don't want any "Hospital Consultants Cash in on Patient Misery" headlines with my photo underneath.

Anyone know what Dr Grumble is up to? He has made his blog private and I don't have permission to view it. Was it something I said?

MRI scan price war.

2007-12-30T20:29:00.000Z

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).

More good news

2007-12-19T20:59:00.001Z

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.

Happy Days

2007-12-13T21:48:00.001Z

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.

Mercury Health's second failed venture

2007-11-25T14:19:00.000Z

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....

and

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.

DoH pulls plug on MercuryHealth mobile scanners

2007-11-21T20:35:00.000Z

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!!

China gets recycling bug

2007-11-17T22:13:00.000Z

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.

Darzi exposed

2007-10-31T20:55:00.000Z

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
*70% of all GPs WITH THE PLAN THAT OVER TIME ALL INDEPENDENT GPS WILL GO INTO THEM.
*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.

OBLITERATION OF DGHS- THE DECIMATION OF ACUTE CARE.
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.

DISINTEGRATION OF CARE
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;-
Home,
Polyclinics,
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.

THE POWER OF COMMISSIONING.
“ 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.

On yer bike

2007-10-28T20:27:00.000Z

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

"The days of the DGH are numbered"

2007-10-20T18:19:00.000Z

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."

"Speaking."

"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
husband's."

"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."

"Helping the nation spend wisely" Sir John Bourn

2007-10-14T18:59:00.000Z

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

The spin and the reality

2007-10-11T10:40:00.000Z

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.

We're loving it.

2007-10-07T18:59:00.001Z

"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?

More NuLabour deceit

2007-10-06T14:07:00.000Z

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.

2007-10-06T09:00:00.000Z

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

Spending your money wisely

2007-10-02T18:21:00.000Z

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.

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

2007-09-28T17:32:00.000Z

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.

Cyberwarfare: The Clash of the Computer Nerds

2007-09-27T19:25:00.000Z

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 www.netmums .com or www.nhsreview.

The "Brown" Economy

2007-09-25T19:15:00.000Z

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".

Dr Ray's 15 minutes of fame

2007-09-24T22:11:00.000Z

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 doctors.net.uk 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 doctors.net 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 doctors.net 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.

Nulabour's hospital closure consultation

2007-09-21T13:46:00.001Z

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.

3000 year wait for CT scan

2007-09-05T21:22:00.001Z

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 www.herefordradiology.co.uk. 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.

Of mice and Milburn

2007-07-30T21:50:00.000Z

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.

Quackwatch

2007-07-27T20:38:00.000Z

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.

Black-balled by The Motley Fool

2007-07-24T20:27:00.000Z

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;)

The Great Escape

2007-07-18T10:22:00.000Z

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 ....):

"PURPOSE OF REPORT: TO SUBMIT, FOR DISCUSSION, AN OUTLINE APPROACH TO THE DEVELOPMENT OF A MEDIUM TERM STRATEGY IN LINE WITH THE LOGIC OF THE ‘GREAT ESCAPE’.

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.

Scanning charlatans to be brought to order.

2007-07-16T12:16:00.000Z

While the GMC has taken its eye off the ball in order to apologise on behalf of all doctors for the actions of a mass murderer it has forgotten its original role in protecting the public from quacks and charletans. This has allowed patient-for-profit companies such as Prescan to offer private screening scans with unfounded claims of the benefits and no regard to the risks.
It now looks like the Government may be stepping in to make up for the GMC and the Royal College of Radiologists inaction and are set to introduce legislation to curb the excesses of private screening. Here is an article I found on Medicexchange

Private medical screening faces regulation in UK
by Tim Castle

Companies selling private medical screening face government controls over concerns the tests make patients anxious and put pressure on the National Health Service, a senior medical advisor said on Thursday.

Muir Gray of the government's National Screening Committee (NSC) told medical magazine Pulse that the private health sector needed regulating over the tests.

Medical screening on offer from private firms ranges from cheap cholesterol checks to whole body scans costing thousands of pounds.

"We are thinking of how we control private testing because it's an example of low value activity which generates work for the health service, may cause harm and does not benefit the individual," said Gray, the NSC's programme director.

"Lots of GPs I know are very concerned about people who go to a private clinic for a blood test and then the people who run the private clinic say 'Oh your kidney results look a bit funny -- just go and see your GP'," he added.

Since 1996 the health service has had to submit all new screening programmes to the NSC to ensure they are effective and beneficial to patients.

Gray said private sector screening also needed to be controlled.

"We'll look at different forms of regulation -- some from the Healthcare Commission, some through the Advertising Standards Authority, some through the Office of Fair Trading. It will be an evidence-based regime," Gray said.

"I don't think we've got a proper system of regulation at all for the independent sector," he said.

The Royal College of GPs backed the concerns. "Screening is becoming increasingly popular and is not without hazard if done in an unprepared way," said RCGP chair Mayur Lakhani.

"Working to national standards would bring added peace of mind," he added.

But leading providers of private testing vigorously defended their services.

Private medical group BUPA said more than 80 per cent of its customers had health insurance and so any follow-up tests or treatments were usually covered with little or no impact on the NHS.

"BUPA health assessments provide early detection of many serious and life-threatening diseases from high blood pressure and diabetes to cancers and stroke," said BUPA Wellness Assistant Medical Director Peter Mace.

"They also save NHS resources by dealing with minor problems during the assessment or at subsequent follow-up appointments," he added.

Simply Health, which includes medical insurance company HSA and testing firm Your Health Screening, said it did not offer tests of "dubious value".

"Our screens are based around mainly heart and lung disease, which are widely recognised to have a significant impact on the health of the nation," said Simply Health Chief Medical Officer Malcolm Stone.

The Department of Health said it had yet to receive the NSC's advice on private medical screening, but would consider its recommendations carefully.

Source: Reuters

Dr Ray has dipped his toe into the screening business with private aortic aneurysm scanning. Increased regulation will be unwelcome but the case for screening for aortic aneurysm has already been accepted in the UK and USA and it's just a matter of the government deciding who should be doing it and how they can cope with the entire cohort of 65-75 year old men all arriving for a scan on day one. For £50 quid I would not hang around while they decide how to "manage demand".

Private vs State Healthcare

2007-07-13T19:48:00.000Z

Readers of medical blogs will know that the most heated debates revolve around the best way to provide health care. Unfortunately, for all the heat there is little light and the protagonists remain entrenched in their positions.

The right wing, free market supporters argue that health care would be better, and even possibly cheaper, if patients could take their custom where they choose while the supporters of socialized health care argue that a comprehensive, fair and truly national provision can only be provided by the state run N.H.S.

I think that the problem is that we are not arguing about the same thing. It has long been a Nulabour ambition to abolish private medicine in the UK and it is also a Nulabour ambition to destroy ("modernize") the network of District General Hospitals which form the backbone of the N.H.S. Abolishing private practice at a time when the government were pledging to cut waiting lists would have been suicide and this was put on the back burner. Dr Richard Taylor gave Nulabour a drubbing over the "modernization" of the D.G.H. at Kidderminster and continues to be a thorn in their side as an MP, so more subtle means had to be employed.

The Nulabour plan, and it seems it will be continued under the I-had-nothing-to-do-with-Nulabour Brown Party, is to pay private companies to take over the role of the N.H.S. This is not the same as private medicine and it is this involvement of the private sector that I, and many doctors object to. This untried experiment in health care will combine the worst aspects of profit hungry, short term interest, Venture Capitalists with the take-it-or-leave-it attitude of a monopoly provider and employer. It will do nothing to improve patient care, safeguard employee conditions or provide for training and future development of services. The potential for chaos and disaster is huge and unknown.

We have seen Mercury Diagnostics win a contract to provide scanning in the W.Midlands on such generous terms (all set up costs and 80% of income guaranteed for 5 years) that it immediately sold the contract on for £77 million, without ever providing one scan. This was taxpayers money essentially given away. Contrast this to when telecom operators bid for 3G licenses about 10 years ago which brought in £billions to the state at the expense of private companies. We see the same process with PFI, where private companies are paid so handsomely that some building companies (eg Laing) now find that there is more money to be made from winning contracts from the Government and selling them on than in actually doing any building. The government is essentially subsidizing private companies to compete against the N.H.S. and then arguing that the private sector can do it better and cheaper. There is some evidence that this policy is beginning to collapse and even Nulabour are unable to continue to claim it has been a success.

Readers may know that I work in the NHS and I have also worked in a private, not-for-profit hospital in the U.S.A. I also work in a private, not-for-profit hospital in the UK and I am also trying to provide a private service within an NHS hospital via UK-radiology.

My experiment with UK-radiology continues to succeed and, to me, represents the way forward. Whereas before, the managers got a bonus if the consultants worked harder, I have been able to align the consultants interests with that of the Trust by providing reward for private work consultants do in the Trust. This means that the consultants can use their ability, ingenuity and capacity for hard work to attract income to the trust. The income is used to fund improvements to the NHS service and protect NHS jobs so that capacity is not lost. This, in turn, will allow us to compete with the private sector NHS providers and maintain a real choice for both NHS and private patients.

Control needs to pass back to the doctors as we have a long term interest in health care provision, as employees, entrepreneurs and potential patients. Venture Capitalists, Chief Executives and politicians move on when they see there is money or votes to be had elsewhere and can afford private health care for themselves when required. When all the political interference is over we will still be there sorting out the mess.

No change in the NHS-the destruction to continue.

2007-07-11T20:47:00.000Z

It is becoming clear now what Gordon Brown meant when he said that there would be changes in the way politicians deal with the NHS.

The more gullible of us thought he was going to end the micromanagement, doctor bashing and confrontational stance taken by Patricia Hewitt and the previous Government, but those of us who saw how Gordon worked while he was in opposition knew that what he says is seldom what he means. It now seems that the only change is to be an acceleration of the disastrous policies started by Milburn and taken up so incompetently by Patsy Halfwit
The Grauniad has an interview with Ara Darzi who, it seems, has been chosen so as to suggest that the medical profession actually agrees with the transfer of healthcare to the patients-for-profit sector and loss of local NHS facilities.

This looks like it might be quite bloody and I think Gordo's honeymoon might be short lived unless Ara is told to shut up and go back to his White Elephant of an underutilized* ambulatory care and diagnostic centre at the Central Middlesex Hospital.

When Ara recommended that the good folk of South Teeside might like to manage without a local hospital it caused a storm of protest. Now he is suggesting selling off the land that the London local hospitals stand on and (presumably) giving the money to the private sector to run shiny walk-in clinics for people with "nice" diseases. He doesn't say what will happen to those too old or sick to walk in.

* What is the current unfunded spare capacity in NHS treatment centres, including NHS Elect? (Dr Taylor, Q74)

In the financial year 2003-04, for the four treatment centres which are members of the NHS Elect network (Central Middlesex ACAD; Ravenscourt Park; Kidderminster; Weston-super-Mare) management information shows that they were working at 81% of their planned activity. So far in this financial year (to August), management information shows that they have working at 78% of their planned activity.

Modernisation out; change in.

2007-07-08T20:24:00.000Z

One of the most irritating things about Nulabour and the NHS was the way it commandeered the word "modernise" to hide its intention to dismantle the NHS and hand over health care to the private sector. Nulabour has made an art out of euphemisms and modernise (used in the sense that the Luftwaffe modernised Coventry) is a particularly clever one because anyone who objects to "modernisation" is, by definition, a backward looking dinosaur who is stuck in the past and not to be taken seriously. Unsurprisingly, not many people want to be thought of like this so find it best to say nothing, which gives the modernisers a free hand to do whatever they want. In fact the use of the word "modern" was so successful that they named the department tasked with destroying the NHS the "modernisation agency".
It never really worked for me. I suppose the strategy was devised and aimed at people a little younger than me, but for baby-boomers "modern" conjures up images of streaked concrete council flats (a product of the Modern movement and modern materials) and exquisite antique furniture being painted white so that it looked like something from Habitat - the iconic modern furniture shop of the late 60's
Gordon Brown doesn't seem to do "modern" but he does seem to want "change". I am not quite sure what he means. Is he admitting his Party has been wrong for the last 10 years and is going to try something else or does he mean he wants to continue the change where modernisation left off. Appointing Ari Darzi as health minister and asking him to review the NHS was clever. In one move he has silenced the doctors that want clinicians to decide health priorities and, at the same time, appointed the very same person whose ideas have driven the changes in the NHS that they dislike (ISTC, closing DGHs) to a position where he will essentially be reviewing his own ideas. I suspect that, at the end of his review, he will not be handing back his knighthood in disgust over the "modernisation" of the NHS.

++++++++++++

While on the subject of "modern" I was treated to an amazing aerial display yesterday evening. There was an airshow featuring a Spitfire locally but, I think the pilot must have found it a bit tame so, in the early evening, flew out to the rural area where I live and for about 45 minutes put the Spitfire through its paces with a series of stunts I am sure would not be allowed at an airshow. He flew at tree height and did loops and spirals. He flew low and fast and climbed almost vertically. All the time the engine kept its same throaty rumble without any evidence of stalling or strain. I could not believe a piece of machinery approaching 70 years of age could work so sweetly.
Today I decided to cut the grass and got my modern ride-on mower out. I have had it since November but I have only used it 4 or 5 times because the front axle broke the second time I used it and it was out of action for a few weeks. Half way through doing the lawn it just putt-putted and stopped. No obvious reason. I will be lucky if this mower outlives its first oil change.

Sir Liam vindicated

2007-07-02T08:30:00.000Z

The revealation, in the papers today (Doctors of Death-The Sun), that one of the people linked to the terrorist attack on the departure lounge at Glasgow Airport is a doctor entirely vindicates Sir Liam's belief that doctors need much closer and more onerous monitoring. Had recertification been in place for all UK doctors, it seems very unlikely that this terrorist would have taken the trouble to complete all the paperwork required and would have carried out his terrorist act somewhere else.
I would go further than Sir Liam over this. Our medical schools have now trained one mass murderer (Shipman) and one failed mass murderer. It doesn't need a brain surgeon to reach the obvious conclusion here. The more doctors we have, the more potential mass murderers. Therefore introduce systems to ensure that the lazy, greedy, murdering barstewards f**k off to Australia and we will have less mass murderers to deal with. Replace these murdering scum with nice cuddly nurses and mass murder will be a thing of the past.
Furthermore, I firmly believe that the standards of proof in legal cases involving doctors should be lowered on the assumption that they are all terrorists or capable of terrorist actions or, indeed, capable of terrorist thoughts (be afraid Dr Rant, be very afraid). This would allow the authorities to detain them without trial rather than just vilify them without trial as at present. In cases where any proof might be difficult to obtain it would allow for summary execution or, at least, a jolly good shooting.

hasta la vista baby

2007-06-22T21:09:00.000Z

I mentioned Vistadiagnostics previously on this blog. They are a bit of a mysterious company. They don't mention who owns the company or who the reporting radiologists are, except to say they are super special specialist radiologists or some such rubbish to impress the gullible. I adopted the attitude that all is fair in love, war and business and I was prepared to accept it as a compliment that their web designer (who I think is called Joe Lawrence) has copied the tag line (Affordable Accurate Accessible) off my uk-radiology website. He did make one change: he replaced "accurate" with "assured". I suppose he can't really vouch for the accuracy of the radiologists' reports, even if they are super special, so this is a wise move, although it betrays a lack of confidence. Anyway, "assured" sounds good even though it's meaningless.
What is getting me irritated is that he continues to shadow me. It's like being adopted by a mangy stray dog or having a stalker. What he must do is google uk-radiology and find out if the website is mentioned on a forum or chat room and then spams the forum with adverts for his company. This is really below contempt so I have done something similar to him.
I find he is getting links to his site by posting thinly veiled adverts on various article sites like amazines so I did one of my own. I don't know whether it will be accepted - it should be looking at all the rubbish on this site but I reproduce it below. I think I might have gone a bit far with this. I don't think Vistadiagnostics will be offering me any work.

When New Labour, the ruling political party in the UK, pledged to save the N.H.S. - the state-funded national health service, it invested a huge amount of taxpayers' money with little visible gain.
In an effort to reduce staff costs, which accounts for 70% of N.H.S. spending, untried systems were introduced into the area of diagnostics with some interesting unintended consequences.
A vast amount of extra imaging capacity has been purchased from privately owned providers who have been guaranteed profits and set-up costs but forbidden from employing N.H.S. staff. Dumbing down in radiology has resulted in many tasks previously undertaken by radiologists in the UK, such as ultrasound and film reporting, being done by radiographers and, at the same time, much larger numbers of radiologists are coming off the expanded training schemes and are unable to find work because hospital departments have frozen recruitment, partially to balance the books as required by the Secretary of State for Health (Patricia Hewitt at time of writing), and partially to see what effect the new providers would have on hospital radiology departments.
As costs of medical equipment have decreased and radiology reporting costs have plummeted, entrepreneurs have entered the private health-care market and set up patients-for-profit orientated companies. They have particularly promoted private MRI scanning, which is often advertised as a method of screening for cancer by the less scrupulous private companies. Since the method uses no radiation, regulation is lax and scans are widely advertised for dubious medical indications particularly to the wealthy worried well.
An example of this new breed of "health care-for-profit" providers is Vista Diagnostics who have installed a scanner in a London railway station and carry out scans seven days a week for the price of a meal for two in a fashionable restaurant.
A group of Consultant Radiologists working for the N.H.S. in Hereford, a small city on the England-Wales border, have shown that it is possible provide an ethical, high quality, low cost private service while benefiting the local N.H.S. patients. The partners have set up the Hereford Radiology Group and take private referrals from throughout the UK. They have a full range of diagnostic equipment available so are able to carry out CT scanning, ultrasound, isotope scans, plain X-ray and MRI - unlike most other private providers who can only offer a single modality. The consultants are also happy to discuss the most appropriate investigations for a particular problem and, because they are able put ethics before profit, may advise that imaging is not appropriate. In return for use of N.H.S. equipment the consultants share income with the N.H.S. hospital. This income is being used to provide extra N.H.S. scanning on Saturdays and they are now advertising for staff to provide a new N.H.S. scanning service in the evenings.
This is a win-win response to the changes in UK radiology. Private patients benefit from ethical and unbiased expert advice and the lowest scan prices in the UK. N.H.S. patients benefit from increased scan provision and the local X-ray department benefits from a secure future. There are losers of course. The entrepreneurs who see an opportunity for profits out of patients' health worries and illnesses will have to look elsewhere. I, for one, could live with that.
Hereford Radiology Group can be contacted on their website at:
www.uk-radiology.co.uk
UK lowest cost private scans

I'm particularly proud of "patients-for-profit .... companies" and "health care-for-profit providers". It has a good ring to it and fits in with the not-for-profit description of some companies wishing to make virtue out of incompetence like the nationalized railways.

God hates bloggers

2007-06-21T13:12:00.000Z

Just when it was getting interesting on my favorite blog reads at Devils Kitchen, Dr Rant and Dr Crippen a combination of NHS censorship and divine intervention put me out of action over the last week.
I have commented before that Dr Rant cannot be accessed from many work computers because it is "Tasteless". This is something of an own goal for a medical blog as many people who are interested would want to access it at work. Our NHS Trust in England blocks this site and more recently the private Nuffield Hospital has also started to block it. I could access it in a Welsh NHS hospital. Either they haven't got round to banning it yet or the Welsh are less easily offended!
Last week I found Devils Kitchen blocked because of the use of a certain 4-letter word which, interestingly, was displayed prominently on the screen explaining why the site was blocked.
When I tried to access the sites from home I found that a lighning strike had disabled my computer. I managed to fix this myself but there have been lightning storms every evening this week so I have had to leave my computer unplugged.
One of the blogs I wanted to leave a comment on was the Dr Rant assertion that radiographers and nurses don't do routine work outside the hours of 9-5. The team have seriously misjudged this and show themselves up as being out of touch.
The arguement that patients receiving nursing care in hospital after 5 must be emergencies just makes no sense and our radiographers provide a routine service on Saturdays and would do more if the funding was available. We bend over backwards to provide a service to suit patient demands, whatever our personal views on the sense in this, because the GPs can send patients to whoever provides the most accessible service. It is odd therefore that providing an accessible service shouldn't apply to GPs.

Private MRI scanning. Best year ever.

2007-06-08T08:31:00.000Z

Now that we are coming to the end of Patsy Hewitt's "best year ever" for the NHS it is interesting to ask why, in my region of the W.Midlands and Wales, record numbers of patients are paying for their own CT and MRI scans and other radiology at UK-radiology and at our local Nuffield private hospital.

Many private patients are covered by medical insurance provided by their employers and I am sure in areas such as London, where the economy is booming, many people will "go private" because of this but in my area, which has missed out on the economic boom, patients are mostly paying out of their own pockets and doing so in increasing numbers.

We are also seeing a number of private companies risking their own money setting up private scanning services, even though Nulabour has already negotiated and paid for a vast increase in scanning provision from their friends in the independent sector.

To me, this doesn't indicate improving satisfaction with the NHS. Why is this?

I haven't done a scientific survey or brought in management consultants to look into this but I can think of a number of reasons.

The "improvements" in the NHS have been targeted at the sexier aspects of healthcare and for someone with, say, M.S., sciatica or dementia, access to scanning has not really improved. In fact, because of the pressure to do cancer patients urgently, these patients often wait longer now. Waiting times figures for facet injections, which I do for back pain, are not even collected by the DOH and these patients can still wait indefinitely without breaching any target.

I don't think the process of "NHS dumbing down" is driving radiology patients to the private sector yet. Most patients don't even realise that a Radiologist is a medical consultant and have been blissfully unaware that their ultrasound scans or barium enemas have been done by advanced practitioners for the last few years (if a nurse practitioner is called a "Numpy" should I call a radiology practitioner a "Rumpy"?). Now scans are being reported abroad and the UK medical establishment has lost control over standards but the general public is still unaware of this.

I think the real reason is unmet rising public expectations. When my medical colleagues or their families suffer say, back or neck pain, we tend to give them priority and scan them within a few days. However, like other departments, we also issue "evidence based" recommendations to our GPs regarding who should and shouldn't be scanned and therefore ration access to scanning for the general public. Wanting the reassurance of a normal scan is not considered adequate reason for a scan but it is the reason my doctor friends and, indeed myself, would want a scan. I suppose the distinction is between need and want and, as Dr Crippen points out on his blog, the government has quietly been changing the provision of NHS care from "free and the point of use" to "free at the point of need". So far they haven't specified who will define "need" but I predict this will be a moveable hurdle imposed by a system of incentives like the GP QoF points system.

Nulabour wanted to abolish private practice and private schools and, after 10 years, they are both flourishing. "Vote Nulabour - things can only get better"

Top Gun Quacktitioner

2007-06-05T16:19:00.000Z

The ultimate in quacktitioners?

News from the Armenian Medical Network

Responding to actor Tom Cruise’s purchase of an ultrasound machine to monitor his fiance’e’s fetus, California lawmakers voted on Thursday to restrict sales of the machines.

The California Assembly voted 55-7 for a bill by Democratic Assemblyman Ted Lieu that would only allow sales of the machines to professionals and medical facilities licensed to use them.

In an interview with ABC’s Barbara Walters last year, Cruise said he bought a sonogram machine for then-pregnant fiance’e Katie Holmes. Concerned lawmakers feared other private citizens might do the same and possibly misuse the machines.

"Having an ultrasound once, twice during the course of a pregnancy, there is no danger,” Lieu spokesman David Ford said. “But too much or too often could cause the liquids in the womb to heat up, which could cause damage to the mother and fetus.”

Lieu’s bill now goes to the state Senate.

Bad start to June

2007-06-01T19:09:00.000Z

Arrived at my Welsh moonlighting job this morning to find an envelope on my desk marked urgent. Inside was a complaint from a patient. Among the ways I had abused her she complained that I asked her to hold her breath and that I had pressed the probe against her abdomen while doing an ultrasound. She also claimed that her appointment was at 5.05 but that I had not scanned her until 5.55 even though she had turned up with an empty bladder and I had to waste almost an hour of my evening while she filled up. I just didn't know what to say and ended up replying that I didn't treat her any different to the previous 5000 patients so I suppost she will escalate it to a formal complaint now and I will never work in Wales again.
Still seething I went to start my morning list and the first patient was someone who shouldn't have been referred for a scan at all. After scanning the abdo. as asked and finding nothing I had a look at the pelvis. All the time the patient was asking what I had found and trying to get up to look at the screen (as if she would see anything on it). Finally she demanded to know why I was scanning her pelvis when her doctor had asked me to scan the kidneys. I told her it was because I was a holistic radiologist and she shut up for long enough for me to finish the scan, presumably not wanting to admit she had never heard of a holistic radiologist. But then it started again when I told her that there was nothing wrong as far as I can see. She asked why I couldn't be more definite and I told her ultrasound was an Art not a Science. Silly really and unnecessary. Patients behave strangely under stress and I should have kept my head. Now there will be two complaints on the same day. Using the legal principle of "there's no smoke without fire" I shall now be branded a callous patient abuser.

Talking of patient abuse I am getting progressively irritated by the sheer number of criminal record checks I am asked to do at around £35 a shot. Its not something people tend to complain about because "if you haven't done anything wrong you have nothing to fear". When they came in I thought it was a bit odd that a mass murderer could become NI education minister while someone with a collection of grimy photos, who perhaps worked in a non-clinical area, would be denied a job in the NHS for life but I accepted it as necessary to protect children in hospital from pedophiles.
Over the years the emphasis changed to asking for a CRB check to protect NHS property so this applied to everyone, even those with no contact with children. The result is that if you had done a bit of thieving in the past you would never work in the NHS. A bit harsh since many young men fall foul of the law in their youth but I suppose it leaves a few people free to follow a career in business or politics.
Now I am asked to get a CRB check for each locum agency I register with every 6 months. They are not allowed to just use the same one! My local private hospital also asks for a CRB check every 3 years even though they don't see kids. The last straw was trying to register to do teleradiology reporting from my own home. The companies are still obliged by HMG to get CRB checks. I suppose there might be someone who gets a thrill out of looking at a child's X-ray but I suspect it's a way of diverting huge amounts of money from the health sector to Nulabours political donors at Capita (Crapita according to Private Eye). Anyone for a peerage?

Old Philosopher

2007-05-31T20:13:00.000Z

I was reading another blog this afternoon and came across a quote from Karl Popper - considered to be one of the most important philosophers of the last century.
Karl Popper "philosophed" about scientific reasoning and also about the nature of politics. Considering we have so much in common (I am joking of course) it is surprising then, that when I briefly looked after a close relative as a medical registrar we did not hit it off. Professor Popper died in 1994 and it saddens me that, now I am more mature and deep thinking, I will never get the chance to chew the cud with him.
He did teach me one thing I have not forgotten and that is not to treat myself or my family. Professor Popper's relative had cancer and had developed abnormal liver tests. When I went through the treatments she had been receiving it turned out that the good Professor, at the pinnacle of human intellect and reasoning, had dragged this poor lady all over the world and procured for her whatever treatment was the fashion in each place he visited on his lecture tours. So the lady had the odd dose of this and that chemotherapy, a bit of alternative therapy, the occasional blast of radiation and various other pills and potions. He was obviously trying to do the best for her but even this man could not see the folly in this. What hope for lesser mortals?
Anyway, a good friend of Karl Popper was my old boss Professor Neil McIntyre so I ended up Googleing him to see where he was now and to my dismay I found out he had just given a lecture for the BBC in Brecon - just a few miles from me and I had missed it. He has retired now and I suspect he lives nearby because he was always going on about his Welsh background so I shall try and trace him. If anyone can help I would appreciate it. He was Prof of Medicine at the Royal Free in the late 80s.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

On a lighter note I was pleased with the number of hits on the www.uk-radiology.co.uk website this month. I started the website last December with no prior experience, a very basic hosting package and a couple of quid for the domain name. I built the site myself and then set about learning how to optimize it for the search engines. This was all new to me and I needed to do it on a shoestring because I didn't know if it was going to work and I was spending other peoples money. I certainly wasn't going to pay several hundred pounds for a site.
I am not particularly pleased with my first attempt but it does the job and cost me almost nothing. I have also resisted paying for advertising or pay-per-click like my competitors. This is only partly because I am so tightfisted. Pay-per-click gives you hits while you continue to pay but does nothing for long-term ranking. I also did not want inquiries from all over which would have overwhelmed me so I took the long term route of getting a high Google rating. The most successful way has been to mention the site on other peoples web or forum. This blog was started for the same reason but has taken on a life of its own.
Hits on the site (and inquiries) have gone up month on month just at the rate I could cope with and yesterday broke through the 1000 hit/month barrier:

This may not sound like much compared to say eBay or Amazon but how many people need an MRI scan? If 1000 a month are reaching my site that must be a big proportion of them. However a few days ago it didn't look like I was going to beat last months figure but a quick look at Martin Lewis'moneysavingexpert revealed a new tread on medical tourism so I mentioned on it that uk-radiology was cheaper than going abroad. This brought in about 60 extra hits within 12 hours and comfortably beat my previous record. Who needs Pay-per-Click? Would it be too cheeky to mention this as a tip on moneysavingexpert?

Road to Damascus experience

2007-05-23T08:07:00.000Z

While listening to "Today" on the road to work I had my own Damascus experience this morning.
A judge was being interviewed about the imposition of the Ministry of Justice on the unsuspecting legal profession - that other dark force of conservatism. Apparently, true to form for Nulabour, the judges only found out about it from the Sunday papers.
The judge was worried that the Ministry of Justice would seek to influence judges’ actions. The good judge stated " We are not Civil Servants. We are not here to carry out Government Policy".
That was it. In a sudden flash of light I saw why we, as doctors, are having such difficulties with this Government. Are we civil servants? Are we employed to carry out government policies? Well, the government does pay our wages but it pays the judges too so that is not the criteria. I think most doctors of my generation thought we were autonomous and our responsibility was to our patients, our profession and, if we are self employed, to our business and staff. At some stage in the last 25 years or so this belief has been eroded and many modern doctors (including almost all those in influential positions, in the Colleges, Deaneries, BMA and Hospital Trust Management) are happy to carry out government policy and, indeed, enable the government to pursue its policies regardless of how mistaken -civil servants in fact. Doctors like me were never asked if they were happy with this and, belatedly, we are now saying that we are not.
Unfortunately, I don't think the general public understand our relationship with government. Although doctors are still, on the whole, trusted over clinical matters they cannot understand why, as employees paid for out of their taxes, we are so political and cynical of government diktats.
In short, politicians and the general public think we are civil servants but doctors think they should be like judges and be free to act without government interference. What do you think Dr Crippen and Sam Everington? - unlike myself you both have the advantage of a legal training.

HTAS

2007-05-20T19:53:00.000Z

Margaret Hodge, MP (barking) and Industry Minister, has today proposed that native Britons should be given preference over Johnny Foreigner in the allocation of social housing. She proposed that applicants would be given points depending on how long they have contributed to the UK economy.
Now, I have been mulling over some thoughts for a blog for a few days and when I heard this I instantly recognized where this was heading.
We have a housing crisis in the UK. It's not only that there aren't enough houses but that they are in the wrong place. Demand pushes up prices in some areas while, in Northern towns, perfectly good homes are demolished or stay empty. What we have is failure to match sellers with buyers.
Computers are good at doing this sort of thing and it just happens there is a perfectly good £6.3m computer system sitting idle at the Department of Health.
What I, and the barking MP, are proposing is a Modernisation of the Moving House process (MMH). Instead of the current Old Boys Network, which favors people with money, jobs or rich parents, home providers will be required to submit a home information pack (HIP) to HTAS (Homes Transfer Allocation System). Prospective home seekers would apply online to the secure HTAS computer system and submit details of age, race, sexual preference, religion, social class, parents social class, schools attended, schools parents attended, previous home ownership and income. Points will be allocated on a series of short essays on a range of everyday topics, such as the care of garden water features and how to deal with the situation of a neighbour who wishes to replace his period sash windows with uPVC.
Applications will be graded by a panel of celebrity TV house makeover program presenters and applicants will be allocated properties in order of merit so that, for example, a high scoring home seeker will be allocated a house in leafy Surrey and a lower scoring applicant would be allocated a high-rise council flat in Grimethorpe or indeed become homeless. Anyone becoming homeless will be encouraged to use the services of Shelter, until the next round of applications. All home relocations would take place on a specified single day each year.
It is appreciated that many applicants may have a preference regarding the location of their homes but this is considered socially divisive and HTAS will work with stakeholders to encourage a culture change in location prejudice.
It is self evident that HTAS will be an improvement on the current flawed system and that it should be rolled out without delay. I expect it to be whole-heartedly supported by the Royal Institute of Chartered Surveyors and any failings in the system can therefore be blamed on them.

Overpaid doctors

2007-05-19T20:33:00.000Z

Dr Rant and Dr Grumble both pick up on an article in the Telegraph today quoting a GP comparing the annual cost of providing GP care and insuring a hamster (£50 vs £65).
Vets are skilled, dedicated professionals, who have been selected for university degrees from among the brightest of our school leavers and undergone rigorous and demanding training. In a free market, they deserve whatever they are paid. So would doctors in a free market. Looking at the USA, it would probably be more than they are currently paid. The truth is that having the same monopoly acting as employer, provider of facilities, regulator of trainee and job numbers and regulator of income has actually held back doctors wages. Perhaps the USA is not typical one might argue. After all UK doctors are the best paid in Europe. They may well be but there is also government interference in healthcare in Europe and perhaps a more valid comparison would be with those other bright and hardworking individuals working at the pinnacle of free markets - the City, where a fund manager with say 15-20 years experience, if he still needed to be at work, would consider a GPs or Consultants annual wage no more than lunch money.
I was made aware of how much we stood to benefit from free markets when I started contacting osteopaths about our MRI service. I really knew nothing about osteopaths until recently but the ones I have spoken to have been gracious, well mannered and personable. Then again they are all self employed and these same qualities are their stock in trade. And what a trade it seems to be. Having phoned up many dozens of practices it seems many work from about 8am until 8pm and some even do OOH home visits. They book patients back-to-back at 20 minute intervals and the going rate around here seems to be about £35. I have never managed to phone and find an osteopath free between patients. Some employ a receptionist but some just have an answering machine and a few even work out of their own homes so expenses are low. When I did call in to one practice to deliver leaflets I noticed a patient paying in cash so even paperwork is minimal.
Well, by my calculations that is around £100/hour, lets say 10 hours/day, 5days/week, for 40 weeks a year (they all seem to take a long holiday between Xmas and the skiing season). That makes £200,000 pa before expenses.
Recently I have had 6th form students, interested in a career in Medicine, spending part of the day with me at work and I have mentioned that they could be earning this sort of money after only a three year course and should reconsider their options.
My other conclusion from my observations is that patients are willing to pay hard-earned cash to someone who is nice to them and devotes 20 minutes personal attention. The same message in the magazine from the Medical Protection Society today - patients rarely sue doctors who are nice to them. Whether the treatment is correct, safe, evidence-based or effective doesn't even register on the scale. Doctors ought to remember this.

Hot Bath

2007-05-18T17:42:00.001Z

Nice email from a radiologist working in Bath who has found out about uk-radiology. The radiologists there have set up a partnership just like uk-radiology. They are near enough to be competitors but the real competition are the parasitic independent 2nd wave providers whom the Government have brought in to smash DGH radiology departments. The Department of Health know that if routine work and funding is diverted to these people, the local district general hospital radiology departments would be starved of resources and in a few years would become obsolete and unable to attract staff. This would spell the end of the hospital itself, which is, after all, the point of the whole devious exercise. Remember, Nulabour set out to boldly "reconfigure" district general hospitals and got a good drubbing when retired surgeon Richard Taylor stood as a "Keep Kidderminster Hospital Open" candidate and overturned a safe Labour majority in 2001- they weren't going to try that again and Alan Milburn had to think up a more devious plan to offload the troublesome and inconvenient network of autonomous DGHs.
The evil plan was to lumber hospitals with debts (PFI), make them financially independent and then divert away their income stream and watch them go under. To avoid any public outcry the DOH feeds a steady supply of stories to the media about how common conditions like heart attacks and strokes can't be properly cared for in local hospitals, and that consultants in DGHs (where most are employed) don't work hard enough for the huge incomes they are paid.
So far its not quite working to plan. Nulabour thought GPs would do anything providing they were paid enough but they have, unexpectedly, decided to support their DGH and local consultants. The general public no longer believe Nulabour spin (for example, many preferred the Iranian version of events surrounding the capture of Royal Navy personnel, hence the extraordinary decision to let the sailors sell "their" version to the press) and now treat any government announcements on Health with healthy skepticism. Finally the independent sector providers have only been able to recruit piss-poor radiologists for what they want to pay and are facing competition from NHS departments who have upped their game to compete. Some, like BUPA, have already pulled out, others have delayed their launch and ATOS Origin had it's service suspended because of worries about its quality.

International joke (not the NHS)

2007-05-16T22:18:00.000Z

This is a joke from Johan - a S.African Radiologist. I don't think they know much about PC there:

On a group of beautiful deserted islands in the middle of nowhere, the following people are suddenly stranded by, as you might expect, a shipwreck:

2 Italian men and 1 Italian woman
2 French men and 1 French woman
2 German men and 1 German woman
2 Greek men and 1 Greek woman
2 English men and 1 English woman
2 Bulgarian men and 1 Bulgarian woman
2 Japanese men and 1 Japanese woman
2 Chinese men and 1 Chinese woman
2 American men and 1 American woman
2 Irish men and 1 Irish woman

One month later on these same absolutely stunning deserted islands in the middle of nowhere, the following things have occurred:

One Italian man killed the other Italian man for the Italian woman.

The two French men and the French woman are living happily together in a menage-a-trois.

The two German men have a strict weekly schedule of alternating visits with the German woman.

The two Greek men are sleeping with each other and the Greek woman is cleaning and cooking for them.

The two English men are waiting for someone to introduce them to the English woman.

The two Bulgarian men took one long look at the endless ocean, and another long look at the Bulgarian woman, and started swimming.

The two Japanese men have faxed Tokyo and are awaiting instructions.

The two Chinese men have set up a pharmacy, a liquor store, a restaurant and a laundry, and have got the woman pregnant in order to supply employees for their stores.

The two American men are contemplating the virtues of suicide because the American woman keeps endlessly complaining about her body; the true nature of feminism; how she can do everything they can do; the necessity of fulfillment; the equal division of household chores; how sand and palm trees make her look fat; how her last boy-friend respected her opinion and treated her nicer than they do; how her relationship with her mother is improving and how at least the taxes are low and it isn't raining.

The two Irish men have divided the island into North and South and set up a distillery. They do not remember if sex is in the picture because it gets sort of foggy after the first few litres of coconut whisky. But they're satisfied because at least the English aren't having any fun.

Patricia Hewitts Boobs

2007-05-15T20:54:00.000Z

Poor Patsy Hewitt just lurches from disaster to disaster.
She made her name in British politics as press secretary to Neil Kinnock, helping snatch defeat from the jaws of victory in the 1992 General Election. From 1994-1997 she was head of research at Andersen Consulting

Rebranded "Accenture", one of its subsidiaries - Accenture Technology Solutions is dedicated to providing technology solutions to the client. The solutions work is mainly outsourced to low-wage developing countries like India and The Philippines.

Her next career milestone was the destruction of the remnants of the British car industry as Secretary of State for Trade and Industry. She claimed that the receivers had been called in to the firm before the event had taken place and then, in order to avoid embarrassing redundancies during an election campaign, she gave a further £6m of taxpayers money to the company to keep it solvent for the few days prior to polling day. Almost all this money was paid by the Receivers to themselves for a few weeks work.

Flushed with this success she took over at the helm of the NHS and steered it "to its best year ever in 2006". Putting her faith in technology she ploughed ahead with MTAS - a computer based system of selecting trainees for jobs in the face of expert advice that it would be a disaster and then blamed the experts when it was.

Not content with one computer disaster she has continued to support the misguided and widely ridiculed Connecting for Health computer system at a cost estimated to eventually reach £12b. When asked to justify this expense she always quotes the success of PACS - the picture archiving and communication system now widely used by x-ray departments. While PACS has indeed been a success she has as much justification in seeking credit for this as for the replacement of film photography by digital cameras - the technology is analogous and the transition to PACS was occurring without Government involvement; the driving force actually being lower costs. PACS does bring together two things which are close to Patricia's heart (yes, we might be talking about boobs here): outsourcing work to low wage economies and the impossibility of ensuring computer security.

It would be interesting to see if Patricia has her mammograms stored digitally on an NHS hospital PACS. I doubt it because the security is so poor that it would only a matter of time before they appear on the internet. I did hear that politicians would be able to opt out of having their medical details on-line because of national security; celebs too, but I can't remember the reason they gave for opting out. In our Hospital Trust, until recently, the password for nurses (or indeed anyone) wishing to access patient data and images was "nurse". This was not considered much of a security risk because we don't have many Labour politicians or celebs where I work.

Time was when anyone with a vibrator up their rectum would have their x-rays shown around the doctors mess - with the marvels of PACS and the NHS IT system the images can be shared with the whole world. Let all hope it's not Patricia's biggest boob.

Another life saved

2007-05-14T20:59:00.000Z

One of the paradoxes of working in hospital medicine is that my actions becomes less relevant to patients the more experience I gain. More than 25 years ago, even as a medical student, I could make a difference to the outcome of a patients illness. Now I just seem to investigate patients where, either the diagnosis is already known or, if not known, the knowledge would not benefit the patient in any way.
A typical example today in a baby. Now I admit to not knowing much about babies. I really can't remember anything about my paediatric attachment as a student except that the childrens' hospital staff restaurant was rather good. I also seemed to have missed the nappy years of my own children-lost in a mist of sleep deprivation and long days at work but I was surprised at the referral I received today.
I suppose the referrer was following the recently rediscovered ancient Hippocratic principles of one investigation good; two investigations better and no one has ever been sued for asking for too many investigations but when a child came down for an ultrasound scan of its nappy rash I did wonder whether it needed a Consultant Radiologist to make this diagnosis. Of course the parents expectations had been raised by the prospect of the scan revealing all and, rather than ending up with disgruntled parents, it was easier to pretend to do the scan and announce that I did not think it was anything serious. At least it has saved the baby from an MRI scan (well I hope it has but I might be surprised tomorrow).
From my point of view it is easier to agree to do a scan, however pointless, than argue with the referrer or patient. In most cases even the unnecessary radiation is hardly a consideration as the life expectancy of most of the patients we investigate is weeks rather than years.
Contrary to popular belief there is no shortage of radiologists or scanners but the number of ridiculous requests just keeps increasing at a faster rate than we can clear them. And the more we try to improve access the more silly requests we get.

Tasteless Rant brings on backlash

2007-05-13T15:03:00.000Z

From Doctors.net.uk:

Regulation of Medical Blogs ( paul.grech) 13/05/2007, 15:42
I know many medical bloggers lurk on DNUK looking for material so I was hoping to get some views on a letter I was planning to write to Patricia Hewitt pointing out the need for regulation of this burgeoning area of medical activity.

Dear Ms Hewitt,

I wish to bring to your attention the activities of certain medical practitioners, known as "Medical Bloggers" who, acting in a completely unregulated way, are undermining the morale of NHS staff, particularly managers and nurse practitioners, and damaging the confidence patients have in the government stewardship of medical services.

Some of the more notorious sites such as the tasteless Dr Rant (http://www.drrant.net) have, I regret to inform you, been less than generous in their assessment of yourself and your predecessors in the Department of Health. By pointing out deficiencies in the NHS I believe these sites are subversive and serve to increase patient anxiety. It may be that these sites seek to drive patients to the private sector by circulating tales of patients being treated by unqualified quacktitioners on MRSA infested NHS wards and in support of this I would point you to the large number of advertisements for private care on the disgraceful Dr Crippen Blogsite. (http://nhsblogdoc.blogspot.com)

I propose that the interests of patients and the overwhelming majority of hardworking nurses, managers and doctors be protected by a system of compulsory regulation of medical bloggers overseen by a new department within the Department of Health called Modernizing Medical Blogging(MMB). This department would be equipped with the most comprehensive and advanced computer systems sourced from the the market leading IT supplier, Joe's Komputer Korner@Kilburn and headed by a blogger Tzar at a rate of renumeration set to attract an international high-flier (such as, I hesitate to suggest, myself).

MMB would be revenue neutral by requiring all bloggers to pay a nominal annual fee of say £350 linked to x3 the annual increasea in doctors pay in return for a licence for medical blogging(LfMB). Compulsory indemnity cover will be provided by the reputable financial institution, Sue Uras & Runn, for a modest additional fee.

I further propose that standards of medical blogging be set and monitored by an independent committee of your choosing, later to acquire a Royal Charter and to be known as the Royal College of Medical Bloggers. Membership of the RCOMB will be voluntary and anyone wishing to blog without paying the modest membership fee will be permitted to do so provided they do not use the internet.

Overseeing conformity to standards will be the Medical Blogging Council (MBC) who will have powers to levy unlimited fines, instigate GMC and Inland Revenue investigations and suspend doctors on no other evidence than a malicious tip off.

Applications for Medical Blogging licences will be online using a secure computer network and require details of sexual orientation, religion, political affiliation, income, parents income, schools attended and types of property owned. This will ensure that licences are issued on an equitable
basis and keep out those Tory Voting GPs and Hospital Consultants and other dark forces of conservatism.

In order to redress the imbalance caused by the current wave of cynical unregulated medical bloggers, highly trained allied health professionals such as nurse practitioners should be sent on a course and empowered to spend more time blogging. Hospital Trusts and NHS GP Practices should be incentivised to employ such experts in newly created full-time paid Medical Blogging posts.

I remain Madam, your most faithful servant and hope that this letter finds you still in your present cabinet post.

New kid on the block

2007-05-12T20:07:00.000Z

Noticed a new outfit offering private MRI scans in Waterloo station. Call themselves Vistadiagnostics and they have an interesting pricing structure varying the charge depending on how busy they are. They work 7 days a week and their charges start at £250 + 50% per additional area which will be a shock for the other providers in London used to much higher charges. The reason I was interested is that they have obviously copied much of what I am doing with uk-radiology and even used my tag line "Affordable Accurate Accessible" with minor variation. I am flattered as this was my first attempt at a commercial website. It will be interesting to see if they can turn a profit with London expenses. I would be worried if I ran a scanner in London but we are sufficiently far away and our prices at £200 + 50% per additional area are still lower. It might damage the Cobalt Appeal in Cheltenham though as there is nothing in it on price and no-one from London will bother traveling up. It would be interesting to know who is behind them-I don't think it is a radiologist because there are a couple of silly errors on their website which they will have to find themselves.

Tasteless Rant

2007-05-10T21:47:00.000Z

Tried to get onto the Dr Rant website from work today but access was blocked by "websense" a web filter which our hospital has installed to prevent staff accessing porn and online casinos. You may be interested in the reason it gave: "Tasteless"
I thought it was a rather odd phrase.
I shall try accessing some other blogs over the next few days to see if the web filter's critical appraisals include "shite", "waste of bandwidth", "subversive" and "too Tory"

I have to say that the computer has a point. The Dr Rant blog is well informed, well presented and funny but when I pointed out that the use of foul language did his cause no good at all I was subjected to a torrent of abuse more typical of a group of drunken chavs at throwing out time rather than a group of GPs.

Cost of the middlemen

2007-05-10T20:08:00.000Z

Our local commissioning group (aka GP fundholders) have agreed on an contract for our local NHS X-ray department to do MRI scans at £330 each. In fact its quite an achievement to get them to agree to anything but that's another matter. What is interesting is that uk-radiology do private MRI scans for £200 and both the radiologists and the Trust can turn a modest profit at this price using the very same machine, radiographers, clerical staff and radiologists. It is not however at all clear that the Trust will make a profit at £330. How can this be? The difference is that we have cut the middlemen out of the equation for private patients: that vast army of people who shuffle paper, collect statistics, analyze waiting times, go to meetings and attend courses on staff motivation and capacity and demand management. This is one of the clearest illustrations I have seen of the cost of all this dead wood; not just cost in terms of money, it is the reason front line staff posts are frozen and vital pieces of equipment are not purchased to the ultimate detriment of the service we can provide.

Another medical blogger

2007-05-09T20:31:00.000Z

I have noticed more medical blogs recently and some, like Dr Rant and Dr Crippen, are now regularly featured in the print media. Might have something to do with the increased militancy of junior doctors in the UK (or maybe they just have more free time).
I don't know if there is another radiologist blog but as a group we sit next to a computer all day and are pretty verbose so blogging would seem to be an ideal time-waster for work, alongside contributing to medical forums (or is it fora) on doctors.net.uk and the specific illness websites such as the usually excellent kneegeeks.
The Dr Rant and Crippen type blogs serve a purpose and counter some of the Nulabour spin against doctors while protecting the bloggers from the attentions of the DOH Stasi. I have seen the same vindictive political interference with the medical profession as these other commentators but I am responding differently and hoping to show that we don't need to learn how to run an x-ray department from the independent sector. This blog is going to follow the progress of uk-radiology as I try to attract private income to support a vulnerable DGH radiology department.