"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.

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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.

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.

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

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