Into the sunset

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.

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 radiologist’s evaluation of each PreRead’s 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

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

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

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.

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

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

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

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

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

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

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

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"

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

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

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.

"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

Guido Fawkes thinks Yvette was faking it.

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

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

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

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

Dr Ray gets all heated up.

The, unfortunately named, "Becton Bunny Boiler"

Dr Ray has been drawing admiring glances from Dr Rita Pal, the author of NHSexposedblog. This has all been very welcome and part of me is pleased that someone has finally recognised my stunning good looks, cutting wit and lofty intellect. The image she has of me is a sort of cross between Oscar Wilde and Pierce Brosnan.

I have two problems with this.

Firstly I am a bit concerned about what she might do if our relationship were to turn sour and I prove to be a disappointment to her. Looking through her website, NHSexposed, Dr Pal is not the sort of lady I would like to cross. I don't know the full details of her problems with the GMC but from reading NHSexposed it seems she has taken on the might of the Medical and Legal establishment virtually single-handedly and won.

The second problem, faced by many men of my age, is a pressure to perform adequately. While I am generally happy to tootle along being mediocre with the occasional earthmoving performance, the expectation that I can satisfy Rita on a regular basis is a bit daunting. The Dr Rant team tackle the problem by organising themselves into a sort of shift system so that the pressure is off each individual member. Meanwhile, Dr Crippen, has indeed been the envy of every medical blogger by rising to the challenge on daily basis with enough output left over to fill a couple of pages of a newspaper, but even he has recently had to rest. We hope to see him back with his towering organ in the near future.

If I don't succeed in lowering Rita's expectations gently at least our pet rabbit already died of myxomatosis this summer and our dog is too big to get into a pot