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.

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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."