World Class Commissioning League Tables

The team at ND are struggling to cope with world class commissioning (WCC) to use the jargon initials as we thought it meant something useful in medicine called the white cell count. We still do not know what commissioning is other than a means of increasing unnecessary employment of managers to do something but we do not know what.

We have been told by the local Politburo’s commissars that they are overjoyed by the fact that they are in the top ten of “World Class Commissioning” Politburos.

No doubt they will be having a street party, a Soviet style parade, a Politburo wide extra holiday for being so efficient washed down by lashings of vodka and caviar to mark their collective achievement. But hang on, what have they achieved? Well we have reported that they can commission 60+ day waits for cancer care so they must be good or “world class” commissioners but we have also seen how countries do better without WCC.

Let us go to the heart of the league table which here in Northernshire will be followed more avidly by the population than the football league tables, the two codes of rugby, ferret and greyhound racing such is the pride locally at now being in the top 10 WCCers. As our patients never ceased to be amazed at the fact that “world class” treatment is only available if they go private rather than via the local NHS you can see that WCC is a “hot topic” in the bars and coffee shops of Northernshire at this moment in time.

Here is a link to the league table. (Takes a while to load all those pretty graphics that comrade graph and table commissars like so much). We are sure that you will all want to race and see how well your local Politburo is doing.

If you have time and want a laugh have a read of the HSJ from which it was taken here.

HSJ gives you lots of ideas where NHS money goes.

You can read the scientific scoring system used to compile the table here on the PCT competency score link.

Surely we are misreading this “Incompetency Score Tables”?

Those of us that work in Northernshire think that the legend on the left should read:

Locally destroy the NHS

Work not with community partners

Disengage with public and patients

Ignore clinicians

Mismanage knowledge and access needs

Ignore investment

Market?

Discourage any improvement or innovation

Destroy procurement skills

Mismanage the local health system.

You can marvel at the fact that the three areas added up to decide the “world class” rankings (did we miss a w?) are none other than:

Strategy
Finance

Board.

SFB Virgil?

All the things that our patients consider while they are on a trolley with a burst appendix. You hear them say to each other as they wait hours for treatment because there are no beds:

“Never mind the pain comrade, our Politburo’s got a top Board.”

“But mine tops trumps yours as it is better with Strategy and Finance.”

There is no mention of medical or nursing care or provision in these league tables. We wonder why?

Now a little more critical analysis shows a few interesting things.

If you look at the first twenty Politburos in the rankings you will see that 17 of them are North of Watford Gap an area we know is bathed in undreamt of affluence.

That of these top 20 Politburos no less than 14 are “Spearhead” PCTs.

Not heard of “Spearhead” PCTs? We like the word “Spearhead”. It sounds so well tough.

Surely these will be good ones given that name “Spearhead” and at the cutting edge as would any elite military unit given the “spearhead” prefix? They would be elite troops leading any offensive from the front, right?

Well no.

"Spearhead" PCTs are those PCTs with the “worst health and deprivation indicators” including least numbers of doctors per head of population. In terms of health and deprivation they are in the bottom fifth of PCTs.

A link to a list of these is here with a nice letter explaining how good these “world class” “Spearhead” institutions are. We particularly liked the comment re life expectancies: “so the gap continues to widen, and it is widening more for women than men, in Spearheads”. Starting to see some patterns?

PCTs whose managers cannot “commission” enough GPs or adequate health care to meet their patients’ needs are now being called “world class”.

Look carefully at the list and see where your PCT is.

This is probably the best guide to save your life and give you good health care as the closer to the bottom of the list your PCT is the more likely your are to live longer. We would like to have spent more time analysing life expectancy and cancer survival rates to compare with this league table but local knowledge tells us most of the answers.

World class commissioning = world class bull =destroy/dumb down the NHS to the level of the new under class in quality healthcare provision the NHS manager who at best is 30 years of date with 2 less CSEs than one of us at ND Central has.

WCC= New Labour dumb down to the lowest and worst common denominator when it comes to health care. The World Class Commissioner.

Praise be to the Party for giving us WCC. You have been warned.

A few more funnies from the HSJ can be found here, here and here.

The Cancer Clock ticks past 60, Lithuania does better and the events near the Potteries

You will, as taxpayers and patients, be pleased to know that there has been no major recent input of cash into the GBH (Gordon Brown Harm) bank fund as far as we are aware.

We at ND Central have now finally seen a Professor regarding our relative’s recurrence of cancer at T+51 days. The news was generally upbeat apart from the fact that another 28 days has been added to the NHS Wait Tariff for exercising the wrong “NHS Choice”.

You do the crime (exercise NHS “Choice”) and managers make you do the time.

Comrade Alan “Postman Pratt” Johnson was telling us this week that there is a 2 week cancer target but no doubt our relative’s experience will be subject to a degree of “quantitative easing” in that by “printing targets” no-one will be waiting any time at all.

The clock is still ticking Mr Brown and Mr Johnson.

This sounds like reports we remember reading in the quality newspapers from twenty plus years ago regarding the failed Soviet experiment that you have inflicted on all of us now via the New Labour Health Service.

Everything there in Communist Utopia was working unless you had to use it. Some of the biggest critics of our health service are from former Communist countries and compare our current health service critically with their health services which have improved year on year while ours declines ever downwards.

A patient from overseas told of how they went to their home country on a holiday after having a normal x-ray on the NHS and had a MRI, arthroscopy and surgery all on a short holiday. They did pay for this themselves and were highly critical of NHS care as they are now unemployed in this country due to the failure of the local NHS Politburo to sort out a simple back problem using the well known surgical technique of physiotherapy (cheap therefore good) rather than the right treatment (surgery expensive therefore bad).

Back now in NHS land, the home of the Free (treatment), they want the same for the other joint but will have to wait a lot longer than their holiday (and treatment) was.

They did however get a MRI scan and an operation in Lithuania while on holiday and unemployed quicker than a NHS patient, our relative, gets cancer treatment in this country while they were working and paying taxes Mr Brown and Mr Johnson.

There was a minor problem at a Staffordshire hospital allegedly due to the staff trying to meet targets (imposed on them by a fully accountable Government) that resulted in a mere 400 deaths.

Harold Shipman must be turning in his grave as to how few he managed to pop off in all of his years. He at least did the honourable thing but he was a rank amateur compared with poor management aided and abetted by Government targets in the killing fields stakes.

We suspect that those in charge in the Stafford case will move onto to higher things once the breeze has blown over and earn more as a result but continue to have a better kill ratio than old Harold.

(We wrote this few days ago and this appears to be confirmed by a post in Dr Crippen’s blog post 23/03/09. Barely has the stink cleared and failure seems to be rewarded with the chief poacher(s) being promoted to chief gamekeeper(s) so it won’t happen again will it?)

And they will (continue to) get away with it.

To paraphrase a famous Party humanitarian from the past “one breach of confidentiality is a sackable offence, 400 deaths is a statistic and to be rewarded”.

We are sure Alan is happy with our relative’s PCT as it is now in the top ten “world class” commissioning PCTS. We are so pleased with this we think?

Top 10 “world class commissioners” = crap managers = bottom class medical care.

Praise be to the Party. The cancer clock ticks on . . .

Home visits a rant

“Course we are easy to find Doctor it is 2 miles past the Red Ferret, everyone knows the Red Ferret and then 100 yards past the Witch’s Coven the large white building in the middle of nowhere then past Crippen the Butcher on the High Grumble Street you know the one just past the Ward 87 boutique and turn left at the Ben Bradsham health spa we are right next to it.

I enclose a photo of the house from me mobile but can you be quick as I have to remove a load of copper wiring from a railway to pay me kids fees at school and the kid is really ill as she came home from horse riding this morning in the Range Rover . . . "

The team at ND hate home visiting. It is not first world medicine and is widely abused. What really pees us off is that while patients know where to find and ring us we often do not know how to find them.

We are, as far as the ND team knows, the only country in the world stupid enough to provide this useless service for free. You only have to listen to a pathetic parent of a child who insisted on a home visit from a doctor in America for a sore throat and listen to their bemoaning the $150 call out fee and $ 50 medicine fee for a self limiting illness to realize how essential this service is.

“And can you sign my insurance claim form while I am here . . .”

“Yes but there is a fee for wasting doctor’s time overseas”.

Someone once said it is easier to get a home visit from a doctor than a takeaway pizza.

Why?

You have to pay for the pizza.

However have you ever tried to find a house at night on a Northernshire council housing estate?

In the fog?
In a powercut?
In the wilds of darkest rural Northernshire?

The town planners who design such instruments of torture called housing estates will be asleep on their various design awards (until they are demolished 40 years later) but many Northern Docs will be flummoxed by these planners’ idiot ideas on a regular basis.

Frequently roads will be blocked by barricades to stop joy riders meaning a few hundred yard detour to get to the house the other side of a barricade. All the time the frequent stop starts and torch reading of maps or house numbers alerts the local druggies and villains to the fact that there is a druggie’s “Fortnum and Masons” hamper aka a doctor’s bag in that vehicle full of drugs, blank prescriptions and sick notes for the taking as the occupant is unarmed, possibly female and on their own.

Now we are sure that the more articulate will say “get a chuffing sat nav yer rich b*stard” but does that work in these circumstances?

No it tells you where you are not how to get there. Assuming of course that tower blocks enhance transmission of GPS satellite signals to the point that in a dark unlit tower block with most of the door and floor numbers missing it will point to Doris at floor 18 flat 1100 with pin point accuracy.

The more articulate will also say we need home visits because they save lives.

So home visiting means that we are at the top of any health league table while countries without home visiting are at the bottom? Granted the odd life may be saved but if there is generally anything serious wrong with a patient they should dial 999 and get a far better equipped and faster response from a paramedic.

We rest our case for pandering to the pathetic winging well who always insist that they can’t get to the surgery even though we then see the same ill patients in the surgery car park crossing the road to get their (issued at home) prescriptions because they were too ill to park in the surgery car park for an appointment - rant partially over.

ND would respectfully suggest that on behalf of all those who need to locate houses in the UK in the dark that there be a mandatory requirement for house numbers/names to be visible from a car traveling at 20mph without the need for a torch from a distance of 30m.

Not a hugely expensive idea given street lighting but one that just might save lives.
Looking for a Swan Cottage at 70 High Street (hidden down a passage off the main road) where all the house numbers are complete and there is only pedestrian access from the main road may in daylight not seem difficult but when the speed limit on the road is 70mph and you are having to do 20mph to find the target in the dark in the rain then it is a slightly risky procedure not only to the doctor or ambulance driver but also to other motorists. Especially as Swann cottage is 70A rather than 70.

The fact that pedestrian access to Swan cottage is via the main road down a narrow passage while vehicular access is off a roundabout 800 yards from its location on the map on a track unmarked on the map off a minor road which doubles back on the main road to its map location is never ever told to the visiting doctor. Neither is the correct address.

Relatives even move ill patients to their own addresses before requesting home visits for patients and not telling doctors about the movement of the “unable to come to surgery” patients. You go to the patient's house and no one is in.

Of course after 30 minutes of valuable time to find the “emergency” sore throat at Swan cottage there will be the inevitable “did you not see the notice/number at the end of the drive”?

No because it was never there.

Praise be to the Party who created the home visit as used worldwide due to its proven effectiveness in healthcare. Good medical ideas are adopted worldwide.

The Party does not do good ideas or good medicine. Just sound bites which achieve nothing but waste everyone’s time bar the idiots that think of them and that was in 1947. Rant over.

A present from the Party through the post

Comrades, several members of the ND team of all ranks have this week received a copy of the local Politburo’s free mail shot “ Your guide to Local (Party) Health Services”.

Now a lot of the team at ND saw this as being extra cheap toilet paper and binned it as a mark of respect to the services that the local Politburo provide for its comrade Party members. It was written on cheap paper that most people would not allow anywhere near their anal regions due to its incredibly irritant nature, poor quality paper and laughable content.

The few liberals that reside at ND central did read this “intellectual” work and were amazed to discover several things about our local Politburo and even our own Practice that we did not know.

Remember that if you assume this was a mail shot to a population of 220,000 the cost to produce this propaganda would be several thousands for something that will not even be used as toilet paper then there is a huge amount of land fill and rain forest destruction going on here for no useful purpose.

What we as doctors at ND Central did not know was that the local Politburo and we are providing the following:

“a new Gold Standard that every person can expect from their GP”.

What is a new Gold Standard? More tractors and grain production targets met by the Politburo?

“an extra 20 GPs paid for in existing Northenshire practices”

More tractors and grain production for the starving people as we are still heavily under doctored?

“that our Practice was a kilometre from the nearest pharmacy”

It is across a road and therefore out of range of most remote controls as people will have to walk to get there.

Further reading (in between the laughter and disbelief) revealed a two page spread on how to get the right treatment. This is the right order to access treatment (according to the book):

A&E was the first point of contact for

“Getting the right treatment”
followed by

“Keep warm – keep well”
and

“Keeping warm advice”
then

“NHS Direct”
and

“Self care”
and oh yes

“GP Practice”
followed finally by

“At the Pharmacy”.

Clearly our attendance at medical school had given us all the wrong perspective on how to use the health service so now next time we need “the right treatment” for our acne we need to go straight to A&E.

Praise be to the Party for we know now that our acne will be cured when we attend A&E for the right treatment.

If that fails we’ll read the rest and keep warm while on the phone to NHS (re)Direct who will tell us to look after ourselves and go straight to the GP for a prescription.

Brown stuff, grunt training and central control of prescribing

Once again one of the ND team did the early morning Brown shift (silent f) on a frosty morning. After a hazardous drive because the temperature was still below zero we arrived at surgery later than we had anticipated but in one piece after several encounters with black ice on rural roads.

Aware that patients from the warmer and lower conurbation had had no such problems the team member was running late and switched on the god of modern healthcare the computer only to have a misfire as the computer would not let us log in or in grunt speak a “dead man’s click”. We could not log in to, or fire, our weapon of modern medical excellence the computer.

Everything we need to do the job in terms of medical records, prescribing information and results was frozen and there was no IT support until at least 10.00hrs (on a good day) some 2+ hours away.

This is where grunt basic training comes in.

A quick scan of the screen as a pilot or an anaesthetist would do gave some clues.

We knew that a local Politburo IT idiot (and in Northernshire they are idiots) had asked to install a prescribing control tool to help the “I have a chemistry set” prescribing advisor centrally control GP prescribing (and costs) the day before and the virus scanner that we have to disable in order to run our ever slow clinical system was now switched on when it had been off.

Just as when you get a dead man’s click the first reaction is to get your weapon working again.

Computer rebooted - virus scan disabled - re run clinical system . . .

dead man’s click again.

Patients waiting remember we arrived late.

Next move search for the newly installed software – identify - delete.

Reload - clinical system now accessible all without any IT support in 12 minutes including reboots.

This did not impress the patients who had been delayed even more.

Extra Brown shifts (f!) all without support as no politician has thought of that. Had there been a child protection issue or need for urgent NHS manager intervention it would have not been there either.

3 hours after we started we emerged from our foxhole and mentioned this to other staff members all of whom had had the same problem. Some were still not able to fire up their machines and had reported it to local IT support who had said their phones had gone ballistic and they were still working on it.

Problem still not solved by the elite Politburo IT team. Purchased software to save money disabled and unserviceable. Computers however were working in some GPs’ rooms.

Praise be to the Party for its wise prescribing advisers and IT back up. In their attempts as idiots to save money they cost more. Thank goodness for grunt basic training. At least we don’t need computers to do most of our job in extremis just ability and basic training. What is their excuse?

GMT the ticking clock continues

Amazing how those that have saved the world are unable to treat those that they expect to pay taxes to fund their saving of the world.

In the last few days an amazing £ 75, 000, 000, 000 of money is to be printed and another £ 260, 000, 000, 000 of toxic debt is to be underwritten by Gordon Brown plc (or is it GB plc?).

The total amount of this little extra money that has been found could fund 11, 166, 667 of treatments worth £ 30,000 a time. Remember those snivelling little toads of cancer patients that you could not afford to treat Gordon and Tony?

That you forced to go to Court to get treatment for a few extra years because you could not afford it?

The total the UK government has spent thus far could fund 76, 125, 768 treatments at £ 20,164 a time which we believe to be the cost of a cochlear implant the most expensive operation on the NHS Tariff. So everyone in the United Kingdom and another 16 million besides could have this expensive operation on what you have spent so far.

The clock is still ticking Mr Brown. The relative we have blogged about is still waiting for treatment. They have paid their taxes which you are happily spending with gay abandon to save yourself, sorry, the Banks. The local Politburo where they live ticks all the Party boxes and that includes cancer care waits as it is rated as “excellent”.

Praise be to the Party as when it comes to zeros after a number it knows no end. Was that after a name or number?

Gordon and Alan Zero. A suitable epitaph?

What will you write on this relative’s gravestone when they die from NHS failure? Another zero in needless premature death’s column?

The cancer clock still ticks. The NHS marks time but its managers are happy. Gordon is also happy as he has saved the world but at what cost?

A web search, the important people in the NHS and Revolution

Following a chat with a former comrade at arms ND did do a web search for a certain surgeon at a particular hospital in the south of Northernshire. We had hoped to track down a former colleague to ask their advice regarding local services in their neck of the woods for a patient who had “chosen” to go there. The web page we had found is here.

You will notice there is no reference to any named surgeon or their particular abilities which is the information we were after but only to the really important people who do all the work are listed prominently.

Clearly managers and their employing of web page designers is more important than informing patients of the abilities and qualifications of their surgeons who will after all operate on a patient. Patients always ask us as GPs “Which Manager will do my operation and are they any good? Do you know them?”

If the patient’s “chosen” manager is on an NHS corporate website they know they are in safe hands and that their GP will be reassured by this fact. The Internet is after all now the Truth. Comrade Gordon has said so today rolling out an “information revolution” according to this link from the BBC.

Praise be to the Party and all those who work so hard delivering front line patient care via the website designers and the NHS managers. Who needs good surgeons when you can have a ratings website instead?

NHS managers, cancer, compassion and “debit” days

The team at ND have posted about the problems that those of us that live in Third World countries like Northernshire have in obtaining First World medicine there due to the presence of an alien creature called the Thickerazzi.

The plot thickens as to how little the NHS look after their staff. The relative that we have discussed previously has been told they cannot have a day off to come to terms with the recurrence of their potentially terminal disease they will have to take it as “time owing” or a “debit” day to the local Party commissar manager.

Furthermore the same “manager” also said that the relative will have to work extra hours this week to make up the “debit” day. The manager then went onto say that they may have to shut the unit this relative had help set up and run if they go off sick after surgery. The “managers” will not be “able to cope” with having to run this unit and may have to shut it.

They are after all fit and well and idle.

Such compassion to think that a staff member’s illness will impact so heavily on their éclair eating and paper pile rearranging sessions. How will they cope?

The relative concerned is still waiting for an appointment. Another friend of this relative in the same unit has been diagnosed today with the same illness. This has added to the relative’s distress. No doubt there will be another “debit” day conversation going on here.

The same managers that asked this relative to set up a specialist day unit were recently visited by other NHS managers who were investigating the increased costs of this unit due to its success.

Although the unit was saving money overall by reducing the costs incurred by reducing inpatient admissions the unit was costing more and so the Thickerazzi that is NHS management needed to know why.

They left unable to understand that if you spend £2 to save £100 you save £98 each time you spend £2. Clearly there was a loss somewhere as the comrade graph manager had told them this.

They were just looking at the £2 it cost and spending God knows how many pounds to look at the £2 being spent.

But they have nothing else to do as they don’t see or treat patients and they are a growth industry of incompetence and inability like the sub prime mortgage market and so will ultimately generate huge returns in healthcare.

An interesting term in the new MHS (Management Health Service) dictionary is a “debit” day?

This must contrast with all the NHS managers who all must have at least 900 full years of “credit” time. Despite there being so much “credit” time in the MHS this must ultimately cost money and so lead to increased Party borrowing.

This must be the so called “toxic debt” that is the MHS. They spend a lifetime doing nothing and are always in credit. They do nothing to help customers (patients), deliver promises on the never ever and ultimately cock up and the system starts to implode.

Are we at ND seeing something that might have happened elsewhere under the current guardianship of those that run the NHS on our behalf? No, we can’t be seeing double? Can we?

Of course just like the banks which also deal with “credit” and “debit” issues there will be a payback period.

Will someone realize that there is so much management or “toxic debt” that is doing nothing and will ultimately threaten NHS patient care?

What will the politicians do then? Chuck money at it and import staff (debt) from overseas while overproducing doctors (printing money) here and not employing them?

Praise be to the Party and the compassion and efficiency that is the MHS and its managers. Always there to care for you in their “credit” days and kick you in the teeth when you need some help with your “debit”.

Banks and managers: burning money and caring sod all for those who pay for them to do so and then expecting their help when they cock up. Are we at ND Central seeing double?

GMT the ticking clock

The team at ND are really peed off at the moment so we will introduce a “clock” that we may periodically update and possibly refine. We will call it Gordon Moron Time or Good Manager Time (GMT), after Jeremy from Rotherham’s remarks, counter as it will continue to cost us all.

It at present will consist of two principal counters:

One is the time it takes to get cancer treatment in the UK in Northernshire from realizing there is a problem based on our own collective experience and the other will be based on how much the idiots that govern us feel they should bail out the banks. These will be updated as any further information from various sources comes in.

One is clearly important as it involves days and involves those with cancer that costs a few thousand pounds but is of no importance unless you are a NHS manager or a politician in which case that is a HUGE amount of money.

The other clock costs no-one as it is the money spent by completely unaccountable individuals whose pensions are completely safe regardless how much they screw up.

We are not referring to an individual whose hide may or may not have been saved by the larger figure here but to politicians who are quick to try and remove someone elses pension if they fail while still expecting to reward themselves if they fail. Will political failure still be rewarded? We all know the answer. An emphatic YES they will be rewarded and historically always have been rewarded for failure.

We will see what the numbers do over time. Care of the individual taxpayer over the taxpayer bailing out the idiots? You can guess who comes first.

Remember the NHS is a Soviet style target driven culture that offers “choice”. So in the same week that ND’s relative received their bad news a fellow worker had the same diagnosis at the same tractor plant.

They will be getting surgery next week as they have opted for the local comrade commissar manager’s “choice” of hospital and are a “new” diagnosis and so the comrade managers will fast track that one as it ticks a target box, results in payment and so is allowed.

However, ND’s relative wanted to exercise “choice” but this “choice” was verboten as it was not the commissar's choice and there is no income into the local Politburo. By virtue of the fact that this is a known, not a suspected, cancer and that the referral is a consultant to consultant referral it is of low priority for 2 reasons:

One:

the local idiot commissars do not allow consultant to consultant referrals as they do not attract money (under Payment by Results) and so, where possible, are redirected back to the GPs. These consultant to consultant referrals are 60% of all referrals to the local tractor plant and are therefore directly the result of the evil over referring GPs (not) and are therefore banned (unless it is an “emergency”) in order to preserve income and so ultimately delay treatment until approved by a commissar (non medical) as being “urgent”.

Two:

there is no income coming into the local Politburo “market” as the money will go into another local Politburo pot which the local NHS Thickerazzi don’t like as it makes their abacus unbalanced.

Same disease.

Same location.

Same Party “choice”.

2 different outcomes.

One NHS?

Praise be to the Party whose pensions will never be based on performance as if you fail in politics you get richer. Don’t we comrade Tony Blair?

Our relatives are still waiting . . . we don’t have Darzicare just N(ewlabour)HS care.