Healthcare systems....

This is David Asman, an anchor on Foxnews in the US. In 2005 his wife had a stroke whilst on a visit to london. I just saw http://www.opinionjournal.com/extra/?id=110006785 over on the BBC website and was interested in some bits.

The Good:

As I was to discover time and again in the British health system, despite the often deplorable conditions of a bankrupt infrastructure, British caregivers--whether nurses, doctors, or ambulance drivers--are extraordinarily kind and hardworking. Since there's no real money to be made in the system, those who get into public medicine do so as a pure vocation. And they show it.

There is also much less of a tendency in British medicine to make decisions on the basis of whether one will be sued for that decision. This can lead to a much healthier period of recuperation.

British doctors, nurses and physical therapists also seem to put much more stock in the spiritual side of healing. Put simply, they invest a lot of effort at keeping one's spirits up. Sometimes it's a bit over the top, such as when the physical or occupational therapists compliment any tiny achievement with a "Brilliant!" or "Fantastic!" But better that than taking a chance of planting a negative suggestion that can grow quickly and dampen spirits for a long time.

The Bad:

As it happened, the best such hospital in England, Queen's Square Hospital for Neurology, was a short distance away, but it had no beds available. That's when I started dialing furiously again, tracking down contacts and calling in chits with any influential contact around the world for whom I'd ever done a favor. I also got my employer, News Corp., involved, and a team of extremely helpful folks I'd never met worked overtime helping me out.

Based on my Latin American scale, Queen's Square would rate somewhere in the middle. It certainly wasn't as bad as public hospitals in El Salvador, where patients often share beds. But it wasn't as nice as some of the hospitals I've seen in Buenos Aires or southern Brazil. And compared with virtually any hospital ward in the U.S., Queen's Square would fall short by a mile.

The equipment wasn't ancient, but it was often quite old. On occasion my wife and I would giggle at heart and blood-pressure monitors that were literally taped together and would come apart as they were being moved into place. The nurses and hospital technicians had become expert at jerry-rigging temporary fixes for a lot of the damaged equipment. I pitched in as best as I could with simple things, like fixing the wiring for the one TV in the ward. And I'd make frequent trips to the local pharmacies to buy extra tissues and cleaning wipes, which were always in short supply.

In fact, cleaning was my main occupation for the month we were at Queen's Square. Infections in hospitals are, of course, a problem everywhere. But in Britain, hospital-borne infections are getting out of control. At least 100,000 British patients a year are hit by hospital-acquired infections, including the penicillin-resistant "superbug" MRSA.

As I mentioned, the cleanliness of U.S. hospitals is immediately apparent to all the senses. But Cornell and New York University hospitals (both of which my wife has been using since we returned) have ready access to technical equipment that is either hard to find or nonexistent in Britain. This includes both diagnostic equipment and state-of-the-art equipment used for physical therapy.

The thoughtprovoking:

But what of the bottom line? When I received the bill for my wife's one-month stay at Queen's Square, I thought there was a mistake. The bill included all doctors' costs, two MRI scans, more than a dozen physical therapy sessions, numerous blood and pathology tests, and of course room and board in the hospital for a month. And perhaps most important, it included the loving care of the finest nurses we'd encountered anywhere. The total cost: $25,752. That ain't chump change. But to put this in context, the cost of just 10 physical therapy sessions at New York's Cornell University Hospital came to $27,000--greater than the entire bill from British Health Service!

"Free health care" is a mantra that one hears all the time from advocates of the British system. But British health care is not "free." I mentioned the cost of living in London, which is twice as high for almost any good or service as prices in Manhattan. Folks like to blame an overvalued pound (or undervalued dollar). But that only explains about 30% of the extra cost. A far larger part of those extra costs come in the hidden value-added taxes--which can add up to 40% when you combine costs to consumers and producers. And with salaries tending to be about 20% lower in England than they are here, the purchasing power of Brits must be close to what we would define as the poverty level. The enormous costs of socialized medicine explain at least some of this disparity in the standard of living.

So a country of hard-working, patient centred staff struggling in an underfunded, unclean hospital with poor equipment. Yeah, I guess that sums up the NHS.....

Procrastination on b3ta

From b3ta:

National Health Shennanigans!
When I were but a lad, my Mother worked in Personnel for the NHS. And, as such, when I wanted a holiday or weekend job, she'd put out some feelers to find out if there was anyone in the hospital who needed help.

And thus it came to pass that I held several positions within the trust. Everything from filing monkey in Medical Records to Helpdesk Support (which I actually stayed at for a year).

During the course of my few years there, I came across the following people:

1) The Catering Manager who looked as if he drank the grease out of the fryers. He smoked in the kitchen too, and never flushed the loo after he had done a poo.

2) A few times I did a night shift cooking simple food for the on call doctors. The other guy I worked with had little or no idea how to cook. 'Rare' chicken was his specialty. Thankfully, I think I always caught him before he killed someone.

3) The hospital porter who, after I had just walked in to their cabin, asked the dazzlingly insightful interview question "Do you wank or what?"

4) The poison dwarf who managed the helpdesk who had never seen a computer, let alone fixed one. She bollocked me for resetting a senior consultants password (when he had asked me to), and made me go and apologise to him. He called her a 'stupid bitch', which I thought was an understatement.

5) Dr. De'Ath (seriously) told me off in a corridor for having my mobile on. I know that was wrong, in fact I was turning it off, but the killer was that he was having a conversation on his at the time.

6) The porter who was caught having relations with a sheep. I don't know if that's true or not, but you could believe it of him.

7) Finally, there was Graham the Sweep. Graham was a porter too, but all he ever did was sweep floors. He actually had been an eminent professor whose wife had left him, and he had a complete and catastrophic breakdown. He used to ballroom dance with his broom. He had a brilliant mind - he would talk with me about Shakespeare and Theatre and Science and Education and Politics and Philosophy and Physics and all kinds of things. Some morning's he'd be on top of the world, whereas some mornings he would actually growl at you like a wild dog. He wasn't a bastard, he was fascinating. He lived with cats in a caravan, but due to his state of mind couldn't look after them properly, and the RSPCA had to take them away. I've never seen a man look so broken as he did after that.

He once told my mother she had all the grace and subtlety of a prima ballerina. My mother has all the grace and subtlety of a brick through a window.

Ah, the NHS. Best in the world for weirdos and bastards.

I feel the last sentence sums it up......

The joys of dentists

For the past 3 months I have been trying to find an NHS dentist near where I live, or near Uni.

Due to living in the middle of town there are few NHS dentists (if any) around the place, and the nearest ones are in some of the less nice areas surrounding the city centre, or in the opposite direction from uni with poor transport links.

There are lots who have websites saying they do take on NHS patients, but upon phoning you discover that they only do that in March for one week.

So this week I tried phoning further afield, and still found that most of those I could get numbers for are taking on private patients only. This leaves me in a quandry:
1) Bite the bullet and pay up for a monthly dental plan
2) Risk not having a dentist and having to go to the dental hospital if it goes wrong.
3) Go to a dentist miles away, who takes on NHS patients.
4) Keep looking - this one kinda links with number 2!

Open wide

I need to see a dentist.

Why?
I've not seen one in over 3 years, because I used to go to my childhood one, but then he wet private and Mum & dad only registered themselves. Also, being 250 miles from your dentist isn't good. More immediately I need one as I have worn down one of my fillings so now very hot or cold food result in pain.

What is the issue?
I can't afford private dental care, so I need to find a dentist with an NHS list. Call me snobby, but more NHS dentists tend to be in less nice areas of town, and miles from home and/or Uni. The ones near Uni are expensive private ones. And the ones near home in the city centre are mostly also expensive and private.
What's wrong with the free NHS dental hospital?
Firstly i should let you know that I hate injections in my mouth - I smashed my front 2 teeth as a wee kid, and had 3 years of root canal treatment and caps so I had hundreds of injection in my upper gums and hate it.
Secondly I like dentists who a) know what they are doing and b) have only ever had one dentist from the age of 2-22, so i feel nervous about finding a new one. Also i know what state Med students are in in the morning, and I worry that dental students will be the same.

Ok, so why be picky?
I acted as hand-holder to the blu one when she needed dental treatment last year (she is scared of dentists beyond belief) and saw that some dentists are friendly, let you watch TV etc, and all on the NHS. In fact if I thought having a dentist in Edinburgh was a good idea, i would have gone along with her choice of dentist.
So have you any hopefuls?
Well after a google search and consulting the NHS lists from the health board I have found a possible dentists on the Southside, in Burnside. So I;m gonna phone them in the morning.

Latest health crisis to hit the NHS

I'm Spinning Around

I was interested in this blog post from Nick Robinson:

Finding myself without my asthma inhaler when I needed it in the middle of the night I ring NHS Direct for advice on how to get another. Having answered a dozen form-filling questions (none of which include the basic "what do you think you need?") I am then advised to call another number for an out-of-hours doctors service.

Not wishing to waste a doctor's time in the middle of night I decide to wait till the morning. I go to the local chemist and wave my empty inhaler and wheeze loudly. You need a prescription they say. So I go to the doctor's surgery who say they can get me a prescription if I can wait till three o'clock, or I can go the NHS walk-in centre. Off I go only to be told they don't issue prescriptions there and I need to go somewhere else. Everyone I've spoken to has been pleasant but yet ultimately not helpful.

It is interesting how Journalists think that the world works in the way that the Government says it does. Most of the world would assume that a Walk-in centre would be for precisely this kind of service.......ah well. Serves them right for believing Government spin.

MMR & Autism

Does MMR cause Autism?

• There is no doubt Autism exists.
• There is no doubt that Autism diagnoses have increase in the past 10-15 years.
• There is no doubt that MMr was introduced in the mid 1990's.

The connection between children receiving the MMR jab and developing Autism was a temporal one and these are notoriously complex, and often link two unlinked things.

The medical community investigated Dr Wakefield's results very carefully, to double check and see whether a horrendous mistake had been made in the introduction of MMR. However numerous studies, some covering over 30,000 children each, have shown that MMR is not linked to higher incidence of Autism.

Autism diagnoses have increased - possibly due to an increase in the number of cases, but also due to improved diagnostic criteria, more child psychiatry / psychology staff and a different approach to managing children with attention / behaviour disorders.

The Lancet and the GMC inquiry
This week sees the start of a GMC hearing into Dr Wakefield and two of his colleagues behaviour.

The Lancet who published his work have already issued a retraction and apology, as have 10 of the 12 authors of the paper.
The Lancet apology is interesting:

We do not accept Andrew Wakefield and colleagues' interpretation of the letter published in The Lancet on May 2, 1998, which was, in any event, only published 3 months after the original 1998 Lancet paper. This letter was written in response to a letter from Dr A Rouse, published in the same issue. Dr Rouse's letter raised concerns about whether children investigated in the 1998 paper had been referred to the authors by the Society for the Autistically Handicapped, and simply mentioned that his concerns arose out of a fact sheet produced by a firm of solicitors.

Although the letter made it clear that Dr Wakefield “has agreed to help evaluate” some children for the Legal Aid Board, it does not indicate that in fact such work had been commissioned and was being undertaken well before the 1998 paper was published. The natural and ordinary meaning to be drawn from Dr Wakefield's letter at the time was that following the publication of the 1998 paper he had agreed to complete evaluations of children reported in the 1998 paper for the Legal Aid Board. We understood the letter to mean that, although Dr Wakefield agreed to undertake an evaluation for the Legal Aid Board, the evaluation had not taken place before the 1998 paper's publication.

In the light of this, and Dr Wakefield's express statement that no conflict of interest existed, we had no reason to investigate the position further, until the editors were notified for the first time that Dr Wakefield's relationship with the Legal Aid Board predated the publication of the 1998 paper by some considerable time.

Some journalist have done a lot of digging around this issue - see briandeer.com if you want to see the full set of allegations. These might ordinarily be dismissed, except these allegations and investigations seem to be very similar to the charges being placed before the team from the Royal free hospital, led by Dr Wakefield, next Monday at the GMC in London.

The losers
The main losers in this case all along have been two groups of children and parents.

1. Those who developed Autism and were told that there was a causal link. These parents were told that through giving consent for an immunisation, they had harmed their child for life. the associated guilt and depression has influenced the care that their children received, with an understandable suspicion of medical intervention and treatment.
   
2. The children whose parents decided not to give them MMR, and then the child developed measles, mumps or Rubella, and subsequently was injured and developed long-term consequences.

As someone born prior to the MMR introduction, I had both measles and mumps as a small child. I survived. many children did not., the introduction of the immunisation cut the death rate from these childhood disease down to less than 1 in 1,000. With the removal of herd immunity, with less children having MMR, these levels are once again rising.

The other big loser will be public confidence in the medical profession. Dr Wakefield and colleagues have spun the issue as being them sticking up for the truth, and the Medical community covering up. Thus it rings true because it has happened before. However this does not mean it is the case this time.

Pick a job, any job....

Apparently the NHS needs more staff. So they have created a website so schoolkids think the NHS is cool to work for - Step into the NHS.

There are lots of videos, on caring, benefits of working for the NHS, and breaking your wrist.

I decided to do the test which decides what job in the NHS would suit you from the hundreds available. My list of 5 was A+E Doctor, Paediatrician, Paediatric nurse, midwife, Biomedical scientist. So I guess after my course I might be qualified for 40% of the jobs it thinks I suit.
Butcher Boy came out as :

• Director of finance
• Information Analyst
• Medical secretary
• Chief executive
• Accountant

The full list is:
Accident and emergency doctor · Accountant · Adult nurse ·· Anatomical pathology technologist · Audiologist Biomedical scientist
Cardiac physiologist · Chef · Chief executive · Children's nurse · Clinical audit assistant · Clinical audit facilitator · Clinical coder · Clinical psychologist · Clinical scientist · Clinical technologist · Communications/PR executive · Community pharmacist Dietitian · Director of finance · Director of operations · District nurse · Dramatherapist Electrician · Emergency care practitioner · Emergency medical dispatcher · Emergency services call handler · Estates officer Forensic psychologist Gardener · General practice doctor Housekeeper · Human resources professional
Information analyst · IT help desk advisor · IT support officer Laundry assistant Maternity support worker · Maxillofacial prosthetist · Medical laboratory assistant · Medical physicist · Medical records clerk · Medical secretary · Midwife Network manager · Non-clinical (counselling) psychologist Occupational therapist · Occupational therapy assistant · Operating department practitioner Paediatrician · Paramedic · Pathologist · Pathology links officer · Personal assistant · Phlebotomist · Physiotherapist · Play worker · Porter · Psychiatrist · Psychotherapist
Radiographer (diagnostic) · Respiratory physiologist Speech and language therapist · Sterile services technician · Surgeon · Systems analyst

I don't know how much this website costs, but ifs clear how the increased NHS funding is not resulting in improvements at hospitals and GP surgeries, when so much is topsliced for this website, MTAS and the NHS Jobs website which seems to be unable to fulfil its function, and which many Trusts do not even use. Will Alan Johnston stop the NHS Corporate Service function using all the budget increases?

New PM, New NHS?

BBC Five Live are having an NHSS day and asking people to fill in their experiences of the NHS today - be it as a patient - GP, Dentist, optician, A&E or outpatient; or staff member - consultant, staff grade doctor, foundation year doctor, medical student, nurse, physio, OT, SLT, cleaner, ambulance-person, manager clerk etc.

Five Live then plan to send these collected experiences in a dossier to Alan Johnson, the new English health secretary, to help inform his decisions.

Many of the contributions are the classic stories of the NHS being there in times of emergency:

I was taken ill on a Sunday a few weeks ago. I rang my Doctor’s number and was put through to an emergency number. The person on the end of the line took all details and told me a nurse would ring me back. The nurse advised me to go to Southmead Primary Care Unit, where I was examined by a doctor. He told me to go to C Ward in Southmead Hospital. I was immediately seen by a nurse who took my blood pressure etc. I then saw a doctor who gave me a thorough examination. She sent me for an X-Ray. Eventually I saw a Consultant who told me I had pneumonia. I was allowed to go home with antibiotics.

or failing in out of hours cases.

My mother suffered abdominal severe pain on Christmas Eve 2004 and through a misdiagnosis at her GP out of hours surgery in Cheshire and a failure to manage her properly she was sent home and later passed away in pain on Christmas Day. All three triage nurses we spoke to on the phone over a 24 hour period were later criticised for having weak skills while several medical staff visited her but left her in pain not taking responsibility for her

The stories from staff of long hours,

We can run a 24 hour service, but there is no 24 hour support - no CT scans, physio, OT, Echocardiograms etc out of hours unless we are talking a dire emergency. Clearly these things shouldn't be done at 2am, but I don't see 7pm as a problem. So we enter a game of negotiation with these clinical areas, trying to get our patients through quicker, while the departments have to prioritise the requests. It takes up an awful lot of time which doesn't truly contribute to patient care.

Everyday I'll stay till about 7pm, and there is always something still not done. Handover is tough as Working Time laws mean people are available and unavailable at random times - I fear for next year with the 48 hour working week because it may be that patients rarely have the same team looking after them. That can't help a sick and scared patient.

I like my job - because I know my patients, because I feel involved, because it is interesting and challenging & I am privileged to play a part in peoples lives. But I am increasingly fatigued, by the moaning in the press, by the moaning on the wards, by the governmental attacks on the profession. I do this job to be a doctor - and know for cetain politicians cannot tell me how to do this.

and the relentless demand for change:

PLease stop CHANGING things. GB said this word 8 times in his first speech. We are sick of changes all the time, moving goalposts and targets. How can we hope to build a stble forward thinking service for our patients with this constant meddling. Leave doctoring to us doctors and stop criticising consultants. We work bloody hard, above our paid hours to serve our patients. Considering it took 13 years of hard work working through nights, doing untold exams, self funding my own training for the essential courses and neglecting family life to get to where I am, I think you are getting us at a bargain price. Especially when you consider the incredibly stressful and skilled work that we do on a daily basis. Leave us alone to get on with it..

The laundry gets a mention as well:

Much has been said and written about infection control in hospitals and much importance has been put on good practice such as hand-washing. However, one vital aspect of infection control is virtually overlooked. This is infected laundry. Hospital laundries are very much 'out of sight, out of mind' and a common misconception is that everything that comes out of a washing machine is clean. Nothing could be further from the truth - infected laundry must be thoroughly disinfected. A long-standing official NHS guideline advises hospitals to disinfect infected laundry by washing at high temperatures.

and the cleaning;

A sufferer of Bowel and Liver Cancer and now very sadly died, he made an unfortunate mess of the toilet bowl and seat which I cleaned up as best as I was able with tissue.
Once I had him back in bed I reported the state of the toilet to a Staff Nurse and advised that it required disinfecting.
In the two and a half hours that my sister and I were present, no attempt was made to clean the toilet despite the assurances that it would be done.

So basically the answer seems to be that the NHS is great in life-threatening emergencies but fiddling around with the staffing structure (MTAS, MMC, Working time Directive), management (more managers, privatised hospitals and ancillary services), and targets seems to have caused the system to once again appear on the brink of collapse.

We should remember however that Alan Johnson is no fool -

...then on to the Education department as higher education minister. He proved a cunning, persuasive and, above all, successful campaigner in the battle to get the back benches to support "top up" university tuition fees. The measure was carried by just five votes, and beforehand the whips were so unsure of victory that Blair discussed the terms of the motion of confidence that would have followed such a major defeat. The orphaned grammar school boy without an O-level to his name cut a more convincing figure among old Labour stalwarts than Charles Clarke, his hectoring, public-school-educated boss. "I was part of the charm offensive with Charles Clarke," Johnson said recently. "I did the charming and he was offensive."

Of course, up here in devolved Scotland things are very different, with only some of the NHS decisions from London actually affecting us.

The NHS up here is now run by Nicola Sturgeon, who has already made an interesting start to the new Executive / Government's programme by reversing hospital re-organisations in Lanarkshire and Ayr, but supporting the previous executive's decisions elsewhere.

The SNP minority government are also opposed to PFI, so we shall have to see if the rate of investment up here is maintained, or whether the NHS is allowed to settle before more upheaval is foisted upon it.

Media induced waiting lists

This nice BBC article http://news.bbc.co.uk/1/hi/scotland/6714955.stm ends with the paragraph:

If you suspect that you've a problem even though you're already wearing glasses, or even if you're given the all clear in a routine eye test, ask your GP to refer you to the orthoptics department of your local hospital where you can be properly assessed and given treatment if necessary.

Thus inundating GP's across the country with the need to refer hundreds of people, and read up on the condition. In turn, waiting lists for Hospital Orthoptics will increase, and thus another Government target is missed, and the Media get a second story!

Surgery (2)

WOW!!!!!
It was a great day!

I loved my day in theatre. It was an early start to get there on time, but we arrived a wee bit early and watched te two cases prior to the one we were supposed to be seeing as part of the SSM. The surgeon, and thhe registrar were both very helpful and epxlained a lot about what they were doing, and even turned the microscope and TV on for the earlier cases which were adenoidectomy and grommet insertion and draining of glue ear.

Implant
We then got to watch the Cochlear implant, and it was great to see the things that everyone else viewed as normal, such as the care taken to make the incision as small as possible, and the neat and detailed drilling so that the implant would sit comfortably under the skin and slightly recessed into the skull. It was not like surgery is reputed o be and was in fact very gentle and the staff didn't seem arrogant at all - maybe ENT surgeons are different?

Wearing blue scrubs was in fact kind of cool, and got me some interesting looks when I went for lunch - all 8 minutes of it.

Scans and Anaesthesia
We were offered the opportunity, in the afternoon, to watch a child having an MRI & CT Scan as well as evoked Auditory Brainstem Responses (ABR) to assess their candidature for a Cochlear implant.

The little girl (M) needed to be anaesthetised for the scans, and it was amazing to see how she went from being happy (if deaf) 18 month old, to being a floppy mass of wires and tubes, with her life entirely in the anaesthetists hands. Because of the big paedatric hospital, little DGH like the one we were at don't do much paediatric anaesthesia, s there was an hour wait before M was sedated, allowing the registrar to pick my brain in a one hour tutorial on ENT, hearing impairment and my course. It turned out that he was friends with a Doctor who had done an MD and been Mr Tiddlywink's (a friend of mine) supervisor for his BMedSci project in my Honours Year.

The scans were successful in demonstrating that M had an intact auditory nerve. The EBR results were a mass of lines on a graph, and I couldn't even get a handle on them, but the Clinical scientists seemed happy that they had a result.

DIME
Of course me being me, a long uni day was not enough! I got the Bus to Train to Bus combination to be at DIME for 8pm, 110 miles away, since they were 2 Leaders short for DIME 3. Thus I got home 19 hours after I left!

SSM Week 2 (1)

Tuesday
We spent the day with a Speech and Language Therapist, who was telling us about deaf children, and deafness in childhood.

Neonatal screening
One of the interesting bits was the new "Neonatal hearing test" which measures the brainstem response to sound. It does this using small electrodes stuck onto the baby, and by playing a sound into the ear. this basically tells you if the pathway from the ear to the brain is working. If the child does not pass the test, they do not 'FAIL' but the test is repeated, and if the same result appears, they are referred to the audiometrists who assess them further.

Multidisciplinary team
This seems to be an MDT that works, involving, SLT, audiometry, teachers, social workers, psychologists and Doctors. It is quite a community based specialty, and a lot of the consultations and work goes on in the child's home or school environment.

We also got to see some videos of deaf children and noticed that the ones who had had their hearing aids for the longest had the better spoken language skills. In the afternoon, we had a visit to a grou for parents and their deaf babies which was being addressed by a health visitor about baby behaviour and their developmental milestones. The babies were lots of fun, although one toddler did whack me in the face with a toy. I think it was an accident.

Wednesday
We were away at the Cochlear Implant centre getting an introduction to cochlear implants from a medical physicist, then watching the programming of a cochlear implant and finally the ENT Surgeon explained the surgery to us and explained what we would be seeing at the Implant operation on Thursday.

SSM Week 1 (2)

Ear volume and pressure chart

Yesterday we visited the Hearing Aid clinic and sat in on a session with the Audiologist. Since he had two Audiometry students in, who have clinical exams coming up, he let them practice their examination techniques on us to give us an idea of the procedures and how they feel for a patient.

Audiogram of Right ear

Shown here are my charts for my right ear audiometry, both ear volumes and pressures (indicating that my hearing is normal and that I have un-perforated ear drums). They also took a mould from which a hearing aid ear mould could be made. This is done by injecting blue silicon into the ear canal them leaving it to harden. The picture does not do this wonderful toy any justice.

Mould of the inside of my right ear.

As we left, the Audiologist told me I looked too happy to have these exciting toys and souvenirs of my visit, but did tell me that the world needed people who got excited that easily. We are back next week, when we get to sit in on a session on programming a new type of hearing aid. I think I;m starting to like Medicine again.

Life of Brian

Sorry to return to a theme again, but my favourite political commentator, Brian Taylor of BBC Scotland has a fantastic piece on his blog about NHS Auditing (financial, not medical) - see Blether with Brian.

My favourite section has to be where he says

Howat agrees with Audit Scotland that “it remains difficult to assess whether the NHS in Scotland is delivering value for money”. Is it perhaps beyond difficult? Is it philosophically impossible?

Further, is it possible that improving the audit capacity may actually hinder or distort the small matter of catering for patients? Has this already happened through the obsession with targets? Did this oblige clinicians to pursue objectives which departed from medical decisions they would otherwise have taken?

Election Day

Well I voted.

Not going to say who for, but suffice to say it was a different party in each of the 3 ballots, and in one case I did base it on their NHS policies. I doubt my constituency one will win, but the regional stands a good chance and no idea about the council.
I did wonder why it needed 8 council staff to staff one polling station. 7 people (plus 2 police)
x 15 hours is a lot of money......still they have a computer or scanner to count the votes this time, so the results will be later than before (go figure). Ah well I have this afternoon off timetable, so back to my flat looking out the window at the half-dressed peely-wally ones getting their UV rays. I am actually very very very very very jealous - normally its raining!

Elective update (2)

At last, after firing off lots of emails, I have an offer of an elective, working with an anaesthesia team - it is nearby, and I have met the supervisor when he was a PBL facilitator, The one fly in the drink is that he is on holiday the first 3 weeks of the elective block, so my summer holiday will be split into 3 weeks between SSM and elective, and 2 weeks after, This also means that the Year 3 exam resits are in the last week of my elective!

Political balance.,....

And lest anyone thinks that my post the other day was designed to stop you voting SNP, look at this video. Its by the SNP but it neatly sums up why I would love to see either a rainbow coalition of smaller parties or, at least a definite change in the direction that the Scottish Executive pursues on health, social justice and community cohesion.



As one of the party politicians has said on TV this week, I have two slogans for the public:

"No Vote, no Voice"
"Vote. Vote for me, vote against me, just vote"

and in this, the 200th anniversary of the end of slavery, and the first steps to all people in the UK being treated equally, and allowed to vote, I'd like to add my voice - think about it, and whether your election is for a parish councilor, an elected mayor, an MSP or a Welsh Assembly Member, go and vote.

For Scotland or Wales, check out the party's health policies - what kind of NHS do you want, centralised, de-centralised, clinician led, management led, community hospitals, or specialist centres?

So come Friday, will I live in a Nationalist utopia, half way to Independence? I doubt it.

MTAS and protests

Following the MTAS Chaos this year, some Academics are trying to make the Review Group set up by the Department of Health see sense, but their latest email update indicates they are having problems.

Following our letter to the Times, 4th April, the deputy CMO in charge now of MMC/MTAS requested a meeting, brokered by the PRCP, which seven of us attended together with the Director of NHS Workforce. We reiterated our absolute opposition to the principle of appointments by one-strike-and-your-out interviews. We expressed amazement at the perpetuation of an appointments system after its short-listing stage had been accepted as flawed. We questioned the rigour of medical representation on the Review Body when two College presidents obtained separate arrangements for their UoAs or Specialties, and the other two declared themselves happy with the MTAS appointments within their specialty.

We were told that the apparent intransigence of the Review Body reflected both their desire not to waste interview time already conducted, and feedback from Focus Groups, Deans and SHA Chiefs that the widespread discontent with MTAS evident in the media, marches and polls was incorrect. Surprisingly, it was conceded that neither a staggering of the 1^st August start date, nor a selective return to Deanery-specific appointments in a first or second round had been absolutely excluded from consideration by the Review Body.

We explained to the deputy CMO our view that most grief from the one-strike proposal would be felt at ST3/4 level, because of the considerable investment to date in a branch of Medicine, and lack of realistic future in hospital practice if unsuccessful. Whereas a lottery in ST1/2 appointments might only be replacing the previous lottery of SHO appointments, this argument was untenable at ST3/4. The risk of failure is particularly severe in high-competition ratio specialties. We therefore proposed an immediate reversion to Deanery-specific appointment for ST3/4 appointments in those specialties not content with MTAS, with a proportion of posts held back for the top 20% or so already interviewed (to avoid unnecessary repeat interviewing). Subsequently, we have also requested that applicants to high-competition-ratio specialties in England are given partial equivalence to applicants in the devolved nations, being permitted a backup choice. Before and after our meeting at the RCP we have asked several bodies – Royal Colleges, their Academy, the Review Body – to ballot on this (or other) proposal. The responses, uniformly negative, have been that the questions are too complex to ballot, that the Review Body already has feedback, and that complainers on blogs and marches are unrepresentative.

A complete suspension of MTAS is no longer likely or feasible – not least because Deans report plenty of Consultants willing to continue as MTAS executioners in the one-strike process. Since our meeting at the RCP, we have allowed breathing space for the interest professed in our proposal to be taken further. So far, all that has been offered is of more FTSTAs at a second round. This is not acceptable. All the time, August 1^st approaches. It is still possible – some might think probable – that MTAS will implode, perhaps because PMETB discovers its responsibilities, or the meaning under English law of the balance of probabilities. Even if everything in the garden had been rosy so far, it is inconceivable that there will be a level playing field for applicants interviewed in rounds 1a vs. 1b.

I keep thinking of the experience of the European constitution as an example of a huge monolith devised by bureaucrats, promoted as unstoppable because of the amount of time spent erecting the monolith, but finally demolished by the late arousal of democratic opposition. Two years later even the bureaucrats can probably not remember why the constitution was so important. MMC seems the same. The new ballot provides the slumbering mass of doctors one last chance. Please visit http://www.cai.cam.ac.uk/people/mjb14/ to answer the yes/no questions regarding alternatives to the Review Body proposal, and register your approval score for the various bodies/persons involved with the MTAS fiasco. Please forward this message (minus the first paragraph) or website address to as many other doctors as possible, of all grades, in your region and specialty.

I have heard the marchers in March dismissed by an influential medic as unrepresentative complainers about anything and everything. This is preposterous. The ballot will irrefutably document views of MTAS and preferred alternatives according to doctors’ location, grade and specialty. In March a single letter to the BMJ led 2250 to our poll. A similar number this time may be enough to shame the Review Body. A poll of 10,000, with results published widely in the lay and medical press, would be impossible for our inglorious masters to ignore.

Morris Brown

Cambridge

The campaign group Remedy-UK, set up to fight MTAS, is also now appealing for donations to its' "War Chest" to fight the government in court. See here or donate here.

Blood Donor

I got my nice card through today reminding me it is ow 12 weeks* since I last donated, so time for another trip across to give blood. I think I might go tomorrow morning and get my juice and biscuits afterwards for morning coffee.

* For those of you south of the border, although the time interval between donations is 16 weeks in England, it is only 12 weeks in Scotland (and was so even before Devoution in 1999) -so much for the National Health Service.