Saturday, 31 January 2009

NHS Rangers lead the Way Confidentiality #1

ND has for as long as ND can remember been aware of the duty of confidentiality with regard to patients’ medical information. It was drummed into ND from basic training onwards. Indeed ND and the team have often been accosted by a patient’s friends/family/employers’ when they find out from the patient that ND or the team have been giving the patient sick notes sometimes for years which the patient’s friends/family/employers’ have not appreciated.

NDs’ team did not tell their patients’ friends of this relationship the patient did. The Team knows what confidentiality is, how valued it is by patients and that it is a keystone of good ethical medical practice.

However, NHS managers and the Party have a different view on this issue.

They want all of the population to give their medical data, without consent to the Party, but as a responsible Party they are not prepared to do the same with their medical information. Certain senior Party comrades will not have their medical details on the system as they enjoy the Blair option (for they are Holy and divine) unlike the people that they serve and enjoy the all Pigs are equal option of opt in or else but some Pigs, as they are Holy, may opt out.

Many, many light years ago in a galaxy far, far away ND was a junior grunt. While toiling in the small hours mindlessly but conscientiously labeling small bottles with patients’ names, ranks and serial numbers ND noticed in the faint light provided by the hurricane lights that there was a computer and a printer by the side of ND that could print labels faster than ND could write them. To label all the samples required for a sick patient with meningitis would take ND 20 minutes but, if labels were printed, this labeling process would take less than 5 minutes so speeding up the diagnostic and treatment process.

So ND did ask of the seniors why, during daylight hours, were labels printed off by the ward clerks, but at night this did not happen?

(Hint: clerks work 9-5 grunts work all hours). They did not know and suggested several people that ND could speak to about having access to printing labels at night a seemingly simple task.

ND, feeling supported in this matter, did follow the leads for 2 months rising higher and higher into the intellectual black hole known as Management with each level saying “I don’t know sounds like a good idea I will ask the next level” up until he eventually reached the high point the Manager person dude who could explain the inefficient use of resources (capital purchase of expensive technology used only one third of daylight hours but available for 24 hours with a limited life expectancy, use of lowly paid junior staff to write labels, delays in patient diagnosis due to inefficient use of doctors time and skills, ward clerks employed for a mere 8 hours a day).

ND had reached the summit and hoped that ND would see into the chosen land and be able in matter of seconds to print off enough labels to avoid nights of 20 minutes of handwriting while dealing with seriously ill patients.

Did ND achieve this simple task of access to a hospital’s computer system out of hours?

No.

ND did not.

The reason?

“You cannot print sticky labels at night because it is a breach of patient confidentiality.” (Crawl back into your hole worm and use your pen).

“So clerks can print labels with the same information on them as grunts can write and that does not endanger ‘confidentiality’ ”. (Yes worm)

NHS Rangers protecting your confidentiality from doctors but not from managers and the Party (and speeding up your child’s treatment by delaying prompt diagnostic tests while a junior grunt handwrites labels next to an idle printer).

Remember, where were the managers and ward clerks when grunts were handwriting labels next to idle printers and your child was ill?

In bed, thinking, and protecting patient confidentiality as they always do 24/7.

Rangers lead the way.

Praise be to the Party.

Thursday, 29 January 2009

Odds and Sods

Following on from the last post (we do not mean the military one played at acts of remembrance) the team at ND would like to recommend a few fellow bloggers’ posts that have caught our collective eyes in the last week.

The excellent and well established Dr Crippen’s blog drew our attention to an interesting graph on a website of political disrespect called Guido Fawkes . We particularly liked the first comment and the graph both of which could easily be modified for many things in the NHS.

Another post of note came from the Ferret Fancier about the mushrooming of the MHS. Lots and lots of titles but very little healthcare we suspect is being delivered by those on that list.

How did we as junior grunts ever manage to send patients home without such new things as a “discharge co-ordinator”? Oh yes we do vaguely remember when nurses used to look after patients and do this job rather than input information into computers to write care plans and get payments by results rather than deliver care to patients.

Finally can I recommend a post by the Jobbing Doctor Jan 22 Unacceptable who has been kind enough to mention us. We showed it to one of our bright young and enthusiastic medical students who could not believe how the system in which they are training is working. We only have them for a few weeks to try to show them how Primary care works but will hopefully introduce them to good sources of education!

Much respect to these bloggers who keep us informed and entertained in the long, centrally imposed waits that make up almost half of the working day at present.

Praise be to the Party and fellow Bloggers keep the faith and posting for truth will out.

QOF and the insidious creep of graphs and managers into medical practice.

For most members of the general public seeing a GP has not changed much in the last 60 years. You make an appointment go along and hopefully are treated.

We at ND wish we could say the same of medicine in the NHS but every politician who has seen his GP knows that the system is crap (after all they designed it) and regularly change it based on their 5 minutes at the doctors without asking anyone in their constant attempts to make it worse.

We here in Northernshire wonder if any other doctors have noticed how NHS managers are using QOF (Quality and Outcomes Framework) to direct medical practice? Or could it be that we are silently moving towards centrally controlled and regulated health care that works in a similar way to former communist states?

One of the concepts of the new contract was that it should be a “high trust contract”. We know from surveys that doctors are generally regarded as the most trust worthy members of society but ND’s team do not think anyone has asked about NHS managers trust, or even ability, ratings.

In Northernshire we have noticed that managers have discovered that certain spreadsheet programs can draw graphs.

For those that have used computers since the 1960s this is nothing new. We used to write the software ourselves to solve a particular problem and print graphs off using Xs to create the lines on the graph.

However in the 21st century there are now ready written software packages that do the same job. For the thick that are NHS mangers this is a godsend because they think they can now identify fraud or deviation from Party Policy by looking at a picture, sorry graph. For every QOF indicator they now draw, or more likely employ consultants to draw for them (we jest not on this one), lots and lots of graphs. They then look at the pictures, don’t understand them and point to anything that looks different.

The local commissars then send enforcers out to try to understand why some practices are different. They have no idea about this as they cannot work out why people have different heights but height is not standardised as per QOF so they don’t have to worry about height - just their graphs.

The thickerazzi then have little words in peoples’ ears and tell them they should do something different or else there will be sanctions.

And so the thickerazzi managers massage their figures to come into line with everyone else’s. Thus they show to Party Central that they are good comrade commissar managers as their graphs are the same as everyone else’s and so the local Soviet’s tractor production is on target. All is then well in the world of the MHS (Management Health Service).

Good idea unless you are a patient with a disease who needs treatment in the NHS. This massaging of figures by morons will lead only to one thing. Increased political and management interference with patient treatment and care. Patients are individuals and are different not collections of figures drawn on a graph.

Given that NHS managers are in the bottom third of your school in terms of ability you can see what this will do to your medical care? GP thinks you need this treatment but manager decides otherwise. Your treatment is not in line with the graphs and graphs must not be out with the Party’s targets.

This is already happening. ND stumbled across members of the team being told by the local commissar manager for an important disease that now needs treating (having been ignored for years by the same manager) that the Practice did not have enough people with the disease and so they would not get paid unless they found a few more patients with the disease. So we know have to find or invent patients with this particular disease in order to meet a local Politburo target and then subject them to unnecessary intervention so that the idiot managers can tick a few more boxes. And draw graphs to show they have met targets.

So dear patients when you cannot access a particular treatment that your doctor thinks you should have please do not blame us. Our hands are well and truly tied by all the thick people in your class at school who never went to medical school. They probably struggled in their maths lessons to draw graphs but with the advent of computers they don’t have to. The graphs are even in colour and have lines that aren’t made up of Xs. Isn’t progress great?

Praise be to the Party and NHS managers for keeping communist working practices alive in the democracy that is the NHS. And for drawing graphs that are so essential for good patient care.

Sunday, 25 January 2009

Dob in a Doc


So certain members of the Party a few weeks ago thought that having a website is a good way to improve GPs performance? Clearly the party think that this will “empower” patients to “improve” their GPs. How?

You are a druggie that needs 50 Diazepam to pay his dealer that he owes for his next fix and your GP won’t give you them?

Clearly a crap GP.

I’ll go on the website and dob in a Doc.

That will improve “service”.

My GP did not give me a letter for rehousing because they know the council will ignore any such letter.

Clearly a crap GP.

I’ll go on the website and dob in a Doc.

That will improve “service”.

I could not get an urgent appointment for my athlete’s foot. I was told to wait a day.

Clearly a crap GP.

I will dob in a Doc.

That will improve “service”.

And so on. Don’t get what you want so you will now be able to complain like a child having a temper tantrum in a supermarket. Now you can use a Party “moderated” (or is it “monitored”?) website to slate your doctor completely anonymously. Because it is anonymous you won’t be penalised and your doctor can never improve service because he may not recognize what you are moaning about.

Any politician who thinks that rating your GP will improve them have forgotten that they introduced patient satisfaction surveys for GPs. They thought this would do this until GPs discovered that the cost outweighed any benefits.

Where ND worked we have found that over the years ratings in these surveys fell for all GPs (nice and nasty alike) year on year yet our QOF performance went up? There was even competition to see who got the lowest ratings! But the rankings stayed the same year on year only the numbers went down. Bit like the Party’s opinion poll ratings.

But wait?

Are not opinion polls a measure of “performance” on a par with a rate or slate your GP website?

If GPs ratings (opinion polls) go down surely the performance (of Government) must improve? Recent history should tell those how this system works especially with politicians who value falling opinion polls above the care they give to their electorate.

Ratings sink to rock bottom so what do they do? Improve performance of Government? Hell no they have a credit crunch.

The one thing that has never been analysed by the Party in general practice is death rates. Death rates are the only thing that rate health care systems and outcomes world wide as death is a certainty (along with taxes).

Have politicians missed the point for a sound bite?

Did any politician measure Harold Shipman’s death rates?

No they did not. Ever.

So lets have an objective dob in your Doc’s Death Rate website?

Clearly the trick now will be to increase death rates until someone notices and then decrease them so that the Rate your Doc’s Death Rate site shows a huge improvement. Hence a “good” GP will notice his ratings go down i.e. their death rates go up and so they might think about doing a bit of medicine off the golf course. We see where the politicians are coming from now, ratings down so lets improve things. A bit like screw up the economy and your poll ratings go up?

Anyone ready to dob in a politician? Sorry we have to wait 5 years to get rid of incompetence. More money to be wasted on a political whim that will be of no objective use to anyone other than the software designers who will no doubt cream off loads of wad for a totally useless website.

The best rater of GPs and restaurants is, and always has been, word of mouth. Politicians rarely indulge in the art of talking to people as this means listening to them. Politicians listen to so many of their electorate that they can clearly see more at their once weekly surgery of a couple of hours than any doctor can see in a whole week of surgeries. Hence they can represent their constituents. But those in the Party know better.

Praise be to the Party and its wise ministers. A dob in a Doc website is far cheaper than ever improving healthcare.

Saturday, 24 January 2009

ND went to the Barber . . .



ND went to get their hair cut today. As ND was not working, ND indulged in a bit of conversation not having to think about every word that was being said. During the course of the conversation we talked of matters medical among many other subjects and of the hairdresser’s experience of medicine in this country and abroad.

The barber made a very interesting personal observation that he sees his GP perhaps once a year. He says he is peed off by the number of old people sitting in the waiting room that look so well and keep him waiting and obviously from working and earning money. “They are retired and could go any time” he remarked.

They do go any time, ND replied, and come into the extra Brown shifts (remember the f in shift is silent) that GPs here have to work to cater for the busy commuting pensioners and children. ND made the point that this happens in the USA too where pensioners are known as “frequent flyers” as they don’t pay and so go round and land in various physician’s waiting rooms there.

The barber then contrasted his own experience while in the USA when involved in a car crash in the middle of nowhere. He was conveyed to a hospital the like of which he had never seen in the UK. His observations were there were 7 CT/MRI scanners all waiting and he just went straight in. He could not believe the service compared with that at his GPs or when he last went to A&E. Granted he had to sort out the insurance but he was impressed and highly critical of the UK.

That same afternoon ND went with a relative to an oncology clinic. There was the possibility of a recurrence of a malignant tumour and the relative was assured that they needed an urgent CT scan and MRI scan which the doctor said would be done in less than 2 weeks.

ND walked with the relative to the CT booking department where we were told it is 6-8 weeks for CT or MRI scans by a clerk you could just see above the desk whose disinterest was only overshadowed by her poorly bleached blonde hair. On our way out the only CT/MRI scanner we saw was a portable CT scanner in the car park hired from a private company lying idle.

ND was reminded at that point of a patient who recounted their experiences in South Africa where the patient had a car crash. He went to see a local GP who referred him to an orthopaedic surgeon who arranged a MRI scan of their neck and then sent him to see a physiotherapist. This was all within 3 hours of the accident and, as the patient was so proud of, for £200 which he was to claim back from his holiday insurance. Anyone in this country able to beat this in terms of a) cost and b) time to see so many healthcare professionals and get a MRI scan?

What a contrast of first world medicine (USA and South Africa) and that in the United Kingdom. ND’s relative still has not got their “urgent” CT and MRI scans but they do still have a cancer that may or may not be growing.

The same day while between the barber and the oncology clinic ND listened to the radio where patients and doctors were saying that, because of the 18 week wait rule, in order to get quick follow up treatment (and improve hospital finances) patients were being re referred at the behest of their consultants in order to get follow up treatment quicker. There is an 18 week target from being referred as a “new” referral until treatment. If they are already a patient then there is no target and so they are a low priority for treatment as there is no target for follow up treatments and so new referrals get priority.

While there may be a 2 week wait target for patients with suspected cancer whereby they should be seen within 2 weeks of being referred this clearly does not apply once the diagnosis is made.

So ND’s trip to the barber, listening to the radio and the oncology clinic had showed how bad the current NHS system is. As targets and attracting money for hospitals are high priorities the patient isn’t in the UK. And yet money is a priority for doctors and hospitals abroad but somehow the market there leads to a better service for the patient in contrast to the NHS “market”.

ND was (and is) confused but at least ND now had short hair and feels better for that. ND did not have to wait for the hair cut but ND’s relative is still waiting for their “urgent” follow up scans.

Perhaps if ND takes the relative to see their GP then the income that a new referral will bring to a hospital will speed up the scan in the same way as going private would? Now ND understands how the NHS works. Profit not patient.

Meet the target and don’t treat the patient unless the target is met and income is made.

Praise be to the Party for creating the market that is the NHS. It works so well for patients, sorry managers.

Sunday, 18 January 2009

Surgical Checklist Saves Lives? So does a decent medical training.


The BBC reported this week that a simple checklist has reduced deaths by more than 40% and complications by a third. A lot of us at ND have worked in various surgical specialities and some of us have been anaesthetists at various stages in our careers. We went to the BBC website in search of more enlightenment as to what we were doing wrong all those years ago and the checklist can be found here .

We read it, analysed it and all of us came to the same conclusion. This is exactly what we did when we did surgery and anaesthetics as junior doctors many years ago. The places where this was piloted are Seattle, Toronto, London, Auckland, Amman, New Delhi, Manila and Ifakara, Tanzania.

Given our collective experiences in various locations and theatres is this headline actually telling us something we already know?

That if you have proper training and discipline in all branches of medicine and nursing then you should have good results?

Talk about telling your grandmother how to suck eggs.

Researcher Dr Atul Gawande, from Harvard School of Public Health said:

“The checklist could become as essential in daily medicine as the stethoscope.”

We hope he knows that the correct orifice in which to put a stethoscope if one is using it is in your ears.

Dr Kevin Cleary, NPSA medical director, said:

"The results of the study give clear evidence that a simple intervention leads to dramatic improvement in outcome for patients undergoing surgery."

So does training but that costs and interferes with waiting list initiatives.

Health Minister Lord Darzi, who played a role in developing the checklist, said:

"The beauty of the surgical safety checklist is its simplicity and - as a practising surgeon - I would urge surgical teams across the country to use it.”

That way you won’t remove the wrong organ.

Northern Doc says:

“There is clear evidence that proper training and supervision leads to a dramatic improvement for patients undergoing surgery. Checklists are helpful but they do not replace training. Airline pilots use checklists but the NHS forgets that most airline pilots are also trained but not usually at public expense. You cannot fly an aircraft using a checklist alone experience helps too. Did the pilot who landed the A320 in the Hudson river just do it with a checklist?"

Praise be to the Party for we all know that checklists and protocols are cheaper than training people to do the job right in the first place.

Friday, 16 January 2009

Golden Globes or is it Golden Balls and General Practice?



A certain British actress has scooped a couple of minor gongs in the land of the free. Her speech must surely have been an ├╝burlovey overacting experience to most people watching but not to your average UK frontline healthcare professional.

Clearly the Press have not spent a Monday morning in UK General Practice where the number of patients doing a Winslet is a daily experience. Examples of their acceptance speeches into alleged emergency surgeries include:

“I have had a really, really, sore throat for 2 hours” (Not just a sore throat for that long?)

“I am so dizzy” (but you have driven 20 miles in a Range Rover and stink of alcohol at 09.00hrs after an argument with your spouse and it is an emergency?)

“I am an emergency I have to be at work in 5 minutes” (but you claim to be ill with no symptoms and are fit enough to go to work?)

I am PREGNANT and have toothache. (Pregnancy is ALWAYS an emergency and we are not dentists.)

I am sure that you have seen loads of this (you are quite right we have) and you can do nothing for this (you are quite right we can’t. It is a virus so why are you wasting our time when everyone you know has exactly the same thing and we have not given them any treatment and they got better on their own?).

I have been like this for weeks (but it is an emergency).

I need my blood pressure medication it is an emergency (and you did not notice the fact that you were running out of pills for the last 4 weeks until you had none left?).

I need my blood pressure medication it is an emergency (I am going on holiday in 2 hours time and need to catch my flight. Got your passport and ticket? Of course you have wouldn’t want to miss your holiday you’ve paid for that).

I am really, really ill but you sound just like me. Have you got the same? (Yes and I have what you have but am still at work).

I have just flown back from Spain this morning, at 05.00hrs, and have been really ill for the last two weeks of my holiday . . .(but now healthcare is free it is an emergency despite the fact that you are well tanned rested and reeking of aircraft booze after the taxi dropped you off).

I am having a panic attack! (Well I will sit here and do nothing as you caused it and you will get it better. Call me when you finished your Winslet moment. and then we will resume the consultation).

The team at ND Central have been overwhelmed by theatricals this winter but not by much illness. If you think Kate Winslet was bad look at patients clutching their gongs, sorry props, called tissues, multiple layers of clothing, exaggerated facial grimacing, not being able to move limbs at all until asked to undress, faint pathetic voices, overbreathing, insisting their relatives talk for them they are “so ill”, swooning, saying they are having panic attacks, limping intermittently on different limbs, bursting into tears as they talk and over act for England in order to try to convince health care professionals there is something wrong.

Listen up dudes if you can walk into surgery and whine on uninterrupted for several minutes there is rarely anything seriously wrong with you. Seriously ill people are usually the very, very, very quiet ones not the really, really, really ill ones. They need urgent treatment but the Winslets among you delay that treatment.

This is NHS general practice and A&E everyday.

Lots of Winslets but very, very rarely genuine illness.

Praise be to the Party and all of the billions they provide to support amateur thespians in this country each year.

A thought, what if Kate gets an Oscar? Will she go into histrionics overdrive? We wouldn’t want to do the emergency surgery after that performance. Perhaps she should see her GP when she gets back . . . .

Heaven help that GP - a real actress doing a Winslet? They might get confused.

Thursday, 15 January 2009

A Recent Symposium


ND and fellow Resistance Fighters were recently at a true symposium (the Greek meaning of the word) at the Caf├ę Michelle. As they indulged in a bit of symposing inevitably the conversation turned to the increasing top down dumping of useless work on doctors by non medically qualified managers. As by now a lot of symposium “work” had been done there was a lot of irreverent humour floating about.

During this period someone jokingly said:

“I think therefore I am. You think therefore you aren’t!”

This was met by one of those stone cold silences that stop laughter dead when all realize that something profound has been said.

Someone had encapsulated the current state of the relationship between NHS managers and medical staff in Northernshire. It is called “clinical engagement”.

Praise be to the symposium for sometimes in vino veritas.

Postscript: a few days after that remark was made a story broke regarding child protection issues in a town in the south of Northernshire. The issue that gave rise to the above comment was proposed changes to local child protection procedures and the model proposed by the local Politburo commissars was that used in the same town in the news story.

Praise be to the Party and its local Politburo commissar managers for they always know better especially regarding child protection.

Sunday, 11 January 2009

Dementia


We woke up this morning and were told that GPs are to get extra training in something but we cannot remember what it was?

We used to know but we forget that we had lots of lectures on it at medical school and how we should investigate it to rule out serious, but incredibly rare causes of it, but then we forget. When we were junior grunts we saw lots of patients with this disease and spent hours seeing patients we admitted with this disease in A&E, on medical and surgical wards but we have forgotten all of this.

We did then do GP training and forgot all we learnt about this disease but fortunately the politicians did remind us that we have forgotten and about how hard it is to diagnose and how it can take months or even years to come to a diagnosis but with “re education” we will be able to spot it in seconds as politicians can do.

They however know better as they see this forgotten disease on a daily basis in their once weekly “surgeries” for they say “yes, Granny is a problem, go and see your GP” and do nothing about Granny for they control the money.

Reading this we must be suffering from something but we cannot remember all those years of training and what we are suffering from. Do we all need an urgent consult with a politician?

Unfortunately while the Party has just discovered “dementia” many families have discovered how lacking the NHS is in its provision for this disease.

The caring ones struggle against the progressive loss of function that dementia brings and even fight the local Politburos who regard it as an expensive inconvenience to treat someone who will die and never get better but in living will cost more with each painful year of functional decline. The less caring dump and run at A&E.

ND and the team have seen the same disease process year after year despite the fact that we know nothing about it. The desperate call “you have to do something about this” almost always for a home visit when Granny wanders the street at night in sub zero temperatures in her nightdress or Granddad starts thinking that petrol and vinegar will sort his bowels out as he has a fag on the toilet are not too uncommon scenarios to frontline NHS staff. But not for the politicians for they know what Northern Docs do not.

Dementia is like childhood but in reverse. Children start as completely dependant but with nurturing and education gradually become fully independent. Dementia patients start as fully independent people who regardless of how much nurturing or help is given become progressively more dependant until finally, and often mercifully, they are released by Death.

The human brain is a very subtle, delicate organ, which if we can quote from medical school “in life has the consistency of yoghurt”. It is easily damaged for example by a baseball bat that can change a Nobel prize winning scientist to an incontinent rambling idiot in seconds. Unfortunately age too can destroy an intelligent self functioning, caring individual into a dement but the process can take years.

Whilst we can potentially prevent the Nobel prize winner’s argument with a baseball bat we can do sod all against aging. If you live long enough it may happen to you and you won’t care because you may not know but fortunately the politicians will. They will be there to care for you as they are now “re educating” doctors in all they have forgotten or rather did not know (if you believe the Party).

The dementia process is irreversible, we do not as yet understand it, but nonetheless re education at the Gulags will make us better able to “treat” it.

Extra funding and resources will off course be of no help to the families who struggle with dementia as it will not be provided. Ticking a few “re education” boxes is so cheap compared with providing adequate care in the community (or anywhere) for a dementia sufferer.

Praise be to the Party and can they tell us what we are all suffering from and how to treat it as we have forgotten? Clearly GPs need “collective re education” (sound familiar comrades?) and the Party clearly feels GPs should be sent to the Gulags for this.

(This piece is respectfully dedicated to a family in Northernshire who have fought the Party and its local Politburo for years to look after their parents and got nothing from the Party without a huge fight despite the patient, their spouse and children all having worked and paid taxes for all of their working lives. ND’s team have huge respect for these fellow Resistance Fighters. This is dementia in the real world. A war against the uncaring NHS management.

We will see if St. Fiona Phillips has the same problems as those outside of celeb la la land do. There is a programme on channel 4 tonight on this subject. We hope it is better than the aforementioned Sts coverage of MMR over the years) .

A few Odds and Sods Techno corner

So the use of mobile ‘phones is to be allowed after many years of being banned in NHS hospitals. The well established Dr Crippen (much respect) have their own thoughts on this momentous day for the appliance of science overcoming management ignorance.

A personal observation over the years has always been that the more senior the person wielding the mobile phone the less interference it has always caused even if it was exactly the same model as the one you owned. So consultants and nurse managers’ mobile phones have never ever had any problem with interference as these are shielded by the invisible cloak of importance as are senior managers’ phones which always have double shielding to everything especially to knowledge and common sense.

Due to technological progress this shield it would appear is now fitted as standard on all mobiles not just the top “end” of the spectrum.

Bit like the huge problems that microwave cookers caused to air traffic control and internal organs in the Seventies?

Had a computer problem at work they didn’t work. Problem was apparently a power cut to a certain part of a Northernshire conurbation. According to the company’s blurb this should not cause a problem to the maintainace of a seamless service they provide at huge expense to the taxpayer as there is a second back up server that should kick in Ninja like at another location.

Given that this didn’t happen we can only presume that the back up was in the same segment that lost power possibly the computer next door?

This needs investigating we thinks as if this is the case the centralization of data will make it very vulnerable to sabotage.

Given the Governments urge for centralization of patient records had one been a patient at one of the several Northernshire practices affected who had need urgent treatment presumeably the patient would have died as there was no central record?

No-one did die. Amazing.

Praise as always be to the Party as it is all wise.

Friday, 9 January 2009

NHS Rangers lead the way - the War on MRSA #4



Another great idea that the NHS Rangers have come up with is that if MRSA cannot see patients it cannot fly through the air to infect them (all NHS Rangers know about the stealth flying mode of NHS MRSA transmission as it guides all their policies). The NHS Rangers corps has therefore copied another tactic from the military to prevent MRSA being able to see patients called the smoke screen.

This simple technique is being employed at the front line of all NHS hospitals nationwide. Furthermore it is a free service and a credit to the British people as any foreigner who enters a NHS hospital has to cross this defensive line before gaining access (to free healthcare) and to the MRSA free ward area that lurk behind this NHS smokescreen.

As well as the defensive smoke screen the NHS Rangers, mindful of the environment impact of discarded smoke grenades, utilize the dog ends that are so full of carcinogens that the MRSA on the hands of smokers will never be trampled into the hospital on their feet and so the “smoke screen” tactic helps defeat MRSA in a pincer manoeuvre so beloved of NHS modern matrons while eating chocolate eclairs.

Furthermore in addition to adopting an outside in approach to defeating MRSA the Party also utilize an inside out approach and engage, at no cost to themselves, the patients who are free of MRSA to contribute to this hugely successful smoke screen.

NHS Rangers lead the way.

Monday, 5 January 2009

NHS General Practice, vets and Darzi centres too

There is a popular myth that if the NHS did not exist and if it were not free at the point of service then the whole population would die a hideous death from undiagnosed and treated illness.

We know this is true as every other nation in the world is swamped with death due to a lack of free healthcare but amazingly “suffers” with better health care systems than the NHS which is dropping year on year in the international rankings.

One of the ND team did have need to consult with a veterinary surgeon this weekend and despite this nation being a nation of dog lovers were amazed to discover that you had to pay to see a vet. Surely not?

Now ND does not disrespect vets as some of the team trained with them and by enlarge they are slightly more intelligent than Drs. What really p**d ND of was the fact that the cost of the consultation was cheaper than an NHS Direct phone call.

Granted the person to whom we spoke was a qualified vet, who took the trouble to listen to us, to examine the dog, the patient, and even more amazingly, we were not sent to A&E or our GP and a computer was not consulted to make the diagnosis.

The appointment system ran at 10 minute intervals throughout the day, a Saturday, and we only had to wait an hour and twenty minutes to get an appointment. In the 20 minutes we were there in the waiting room they took £200 from the paying punters who by and large were happy to part with their cash.

This was a well organized practice who had managed to provide a 10 minute appointment system without a government diktat. It is also a teaching practice.

Whilst the idea of paying for healthcare is heresy in the UK if you want to reduce waits to see a doctor then the idea of a charge for A&E attendance or to see a GP we suspect would reduce waits of weeks down to days or even hours. The thought of having to part with some cash to be told you have a cold or a sore throat, that will get better on its own would, we suspect, put most of the punters off wasting Drs time after a few attendances with life threatening or “emergency” consultations that are not treated but do cost (the taxpayer at present).

Whilst doctors cannot treat animals we believe that vets are able to treat humans. So if you want to be seen quickly by a qualified person you might consider seeing a vet rather than a phone call to NHS Direct. It will be cheaper and you will probably get more out of it although you will have to pay out of your own pocket rather than out of your taxes.

The Party thinks that the private sector (the vets, rather than the GPs) can do things better and they can but, and, there is always a but, in this case a huge but, the public will have to pay for it some how. The apparent move to Darzi centres being provided (possibly and mostly) by private providers will cost us all but not at the point of use which is OK to Joe “the plumber who charges for their service (and it will cost) but expects his health care for free” Public.

Some figures seen by the team on their travels suggest that the cost of a “Darzi” centre could be between £ 900,000 to £ 2 million a year to provide a 3 doctor practice as against a £ 1.2 million a year to provide a “normal” current NHS 8 doctor practice in the same area.

Of course like the vets the Darzi centres will be privately run and like some veterinary practices these are staffed by salaried vets in training who do not earn as much as their owners who will cream off the profits. So if there is a fixed pot to run a Darzi centre you can see what will happen. Staffed by cheap salaried doctors with happy rich owners.

Quality is said to cost. Crap also costs. Will Darzi centres provide the same quality as good vets do?

These are being applied equally across the country regardless of need so may provide a degree of catch up in providing extra doctors in areas of need (if they can be recreated to work in these areas) while providing more doctors in already well doctored (popular areas for GPs to work in) regions. Some may be of use but others will be hugely expensive white elephants unless you are the owner of a Darzi practice. These white elephants will be funded for 5 years and properly earn their owners millions in the process.

Of course there may be large capital start up costs for premises etc but we at ND do wonder if the move towards privatization is actually going to cost more than it can ever save. The team at ND know that if we were greedy then providing less than half the service we do at the moment at twice the costs would mean we could each earn more than the £250,000 that all Northern Docs’ do already (not) earn. And we would have to do none of the medical work to earn these sums the salaried vets would do it all for us!

Praise be to Lord Darzi for helping “improve” primary care and to the Party but at what cost to Joe “the Plumber who charges for their service (and it will cost) but expects his health care for free” Public?

Time will tell if it will be as successful as the Independent Sector Treatment Centers have been.

Saturday, 3 January 2009

NHS Management and how it pays GPs not to do work


(This piece was inspired by the stories towards the end of last year of GPs being paid not to refer patients and is provided as an example of how this stupidity comes about in one part of Northernshire).

ND and the team are constantly frustrated by the ability of NHS managers not to use what they have already got and waste NHS money in doing so. If they were standing in the middle of the Kielder forest, an area of 250 square miles of forest in Northumberland, you can bet your bottom dollar that they would be holding meetings to increase the number of trees planted around them as their reports show them there are none. There would also be a sub committee reporting on the lack of water in that area as well.

This is the same with minor surgery provision in one part of Northernshire. For individual surgeries there is a fixed local Politburo or PCT pot of money to pay local GPs to do a fixed number of minor surgical procedures per year. This lasts about 3 months per practice before it runs out.

In today’s modern NHS everything has a cost so GPs have essentially 3 choices when the money runs out. They could:

1) Stop doing minor surgery
2) Continue to do minor surgery by funding it themselves
3) Refer all minor surgery to the local hospital.

Given that most GPs run businesses then to a rational businessman option 3 is the only viable option.

After a few months the local Politburo managers notice that referrals for minor surgical procedures go up. They wonder why and have lots of meetings to figure this out. Of course the root cause must be the GPs so they devise a Practice Based Commissioning (PBC) plan that will reward GPs if they cut the number of referrals for minor surgery.

In other words if GPs don’t treat their patients, by not referring them to a hospital for minor surgery, they get paid to do so because the PCT saves money as it does not pay the hospital for the minor surgery which costs the PCT more than if the GP were to be paid directly to do the surgery themselves.

So the solution to too many patients needing minor surgery is not to use the redundant capacity in general practice to do the minor surgery, by paying them to do it, the solution is to pay the same people who could do the surgery to not refer the patients for the surgery.

Logical is it not?

You have a redundant solution to a problem available so you pay the solution not to solve the problem.

This is how local Politburos reward their GPs for not referring patients. It is a bit like the EEC paying farmers not to farm. This may seem daft but if there is over capacity there may be some sense in it. However, when there is a shortage of the product, then this is daft.

Excess grain can be easily stored but unfortunately excess illness does not go away so quickly. It has a habit of moaning to GPs who will usually refer in order to sort the problem out (that is after all what we are trained and paid to do). In this case the GP gets paid to do the referral under his normal contract but does not earn extra from the local PBC plan because admission rates go up.

In this case the patient gets their treatment albeit at a wait. The Politburo thinks it has won (because it hasn’t paid the GPs to do minor surgery and it hasn’t paid them for reducing admissions) but dear readers there is another way of looking at it.

The Politburo has in fact lost because it is paying over the odds for it to get the surgery done at the hospital and it has failed to meet its own PBC plan. It has also spent lots of new money building new health centers with specially equipped operating theatres to do the minor surgery that it won’t then pay for.

So NHS managers often stand in the middle of a forest not seeing the trees but planning on ways to increase tree capacity and paying people not to make trees.

If you read this last sentence and think this is stupid then you are normal. If however you read it and think it is all common sense then please apply at once for NHS management. They need you.

Praise be to the Party and its ever wise managers who achieve so little by doing so much at our expense. They also can’t see the trees around them or the solutions to the problems they engineer.