Sunday, 28 June 2009

NHS Dentistry a report

A while back we did a post about the fact that the Party thought there might just be a tad of a problem with NHS dentistry as after their new Party NHS dentistry contract came in at least a 1 million fewer people were registered with NHS dentists. This isn’t usually a problem if you are a caring Party (as it costs less and is therefore prudent) until pictures of people queuing to register with newly imported (from the EU) NHS dentists were a little embarrassing given their successful dentistry policy and a certain Mr Blair’s pledge of NHS dentistry for all within 2 years in 1999. We are still waiting 8 years later.

Unusually for the Party we noted that rather than employ an Armenian born Irish trained surgeon to reform NHS General Practice they would employ a UK born and trained dentist (albeit Scottish trained?) to tell them what they had done wrong. Professor Jimmy Steele has now published his report.

We are sure that like most GPs who used to see a couple of dental emergencies a year pre Party reforms but now we see anything between 2 a month to 2 a week all saying they cannot get to see a (free) NHS dentist or asking us to refer them to the hospital for (free) NHS dentistry because they cannot see a (free) NHS dentist.

If patients are to be believed no NHS dentists are taking patients on and there is even a waiting list to see private dentists. If you get on a private dentists’ list you have to take out a monthly private dental insurance to stay registered so local golf club car parks here in Northern shire are now filled by NHS and private dentists rather than industrialists.

(An aside dear reader. If the same happened in general practice and we kept our current list size and you were charged £100 a year for registration we would earn as much as we do now without doing any work. Charge for treatment on top and we would be doing a dentist and earn more than we do now! It has worked so well in dentistry why not do it for general practice? Then we could join a golf club and find out where all the missing dentists are!).

However the Party has provided a new free accessible NHS Dentistry service called NHS General Practice. In the same way that they can replace real doctors with nurses at NHS (re)Direct they can replace real dentists with GPs.

This is done in the same way that witches were condemned to death in the Middle Ages using the sink or swim principle.

If you chuck a witch into a pond and she sinks she is innocent. If she floats to the surface she is guilty and is therefore burnt at the stake for surviving. Either way she is dead.

The Party applies the same principle to NHS dentists. If you cannot see a dentist you approach your local PCT who are responsible for providing NHS dentists which they don’t. They cannot do so and so they send you to NHS (re)Direct who will tell you to see your GP.

If your GP fails to treat you then they can be penalized for failing to give immediate emergency treatment even though GPs are not qualified dentists. If they decide to treat you, based on their lack of a 5 year dental course and dental qualification, and something goes wrong they can be sued. Either way you are stuffed as a GP like the medieval witches were.

Let us look at some bits of the report as heard on the BBC while we drove home through the now pleasantly warm but thundery Northernshire.

The main thrust of the report seems to be a move away from a payment for completed treatments towards a payment based on registered patients. One of the big flaws of the current contract was that payment was made only when a treatment was finished. A filling is quick to do but corrective orthodontics for children may take years before it is finished and you get paid. So a lot of dentists doing this treatment had no choice but to go private. A lot of dentists did corrective and cosmetic dentistry which took time and so went private as for some reason people like white teeth.

Hence quick and many = money. Long and slow = waiting ages for money.

Furthermore the number of treatments was fixed by the Party and it managers who are so good at predicting illness while they work 09.00-17.00 Mon-Fri and 11.00-13.00 Fri so once you had done your Politburo quota no more money which meant some dentists stopped working for a few weeks/months in a year when they had done all the treatment they were going to be paid for. If you are doing nothing for the NHS you may as well go and do a little private work in that down time and get paid for it. Central planning at work again?

The report suggests piloting change before implementing it. Now that sounds sensible as long as the pilots are real dentists and not heavily subsidised Party stooges. Not entirely in keeping with current NHS top down Soviet centrally managed one idea suits all. Of course the report is accepted in principle by the current health secretary which means it may not be turned into practice or ignored by any future Government which actually started the rot of NHS dentistry.

More worrying is the fact that administration may get more complicated as instead of 3 bands of payment there would now be 10. No prizes for guessing what that means in practice? More administrators to manage a more complex payment system?

Interestingly there is a guarantee that any dental work that fails within 3 years would be replaced for free. It would appear that the current system encouraged second rate workmanship presumably because failures could be charged to repair the “fault”.

Praise be the Party for succeeding in increasing NHS dental provision for all those who can afford it and for its report which shows how well it has succeeded and the way forward?

We shall see but meantime we will continue with NHS GP Dental care = antibiotics and painkillers, try and see a dentist and we’ll keep our fingers crossed nothing bad happens to you.

Saturday, 27 June 2009

A new form of stimulator?

While reading one of the GP rags we noticed a very small article about the development of a Practice Based Commissioning (PBC) simulator. Now some of us here on Northernshire enjoy using flight simulators to help maintain and hone certain skills (mostly long distance navigational ones) and there are even simulators that enable you to design and fly aircraft which have been used to develop real aircraft which got us thinking about what (flight?) model this PBC simulator would use.

After a hard symposium of work at the Café Michelle on the “model” we present an artistic summary of our thoughts above.

No doubt desperate and incapable NHS managers will see the word “simulator” and think that a “simulator” will do a "Jim’ll Fix It for them" and be booking in droves seminars for them and local GPs hoping that something that sounds like a “flight simulator” will encourage their ideas to fly above the plummeting failure that is called PBC.

Some quotes from a more detailed article:

The Practice Based Commissioning Simulator has been developed in conjunction with the primary care body the NHS Alliance and Swedish-based BTS, a provider of customised business simulations.”


Humana Europe said the PBC Simulator combines hand-on learning, including role play and business simulation, with predictive technology in which the conditions and variables of PBC are replicated through a computer simulation.”

Most of our medical students are so peed off with role play that this is a guarenteed turnoff with doctors to start with. They like to see and help REAL PATIENTS and despise role play which is in contrast to managers who constantly pretend they are doing something useful on a daily basis.

The company, a subsidiary of the American health benefits giant Humana Inc, said the simulator was designed to inspire primary care clinicians and practice managers to improve health and cost outcomes through advanced PBC techniques.”

See above image. Which is the more inspiring? What are “advanced” PBC techniques and do they work any better than the failed “basic” techniques?

Dr Peter Reader, head of the PBC programme at Humana Europe, said the simulator was designed with the particular skill sets of GPs and practice managers in mind. He added: “Over the course of the simulator programme participants get to see the impact and outcomes of the decisions they make whilst building a greater understanding of the implications that practice based commissioning has on improving health outcomes.”

We are out to make a fast buck out of the suckers using this pile of horse manure.

By using the resources available to them wisely GPs can empower their patients to live healthily and reduce their susceptibility to disease and in turn ensure that services reach those people with real need.”

Hmmm. So if I spend 4 hours on a simulator we will stop our patients smoking, using heroin, getting fatter and drinking themselves to death? And we still can’t get an urgent MRI scan for a patient with a life threatening condition despite PBC?

Dr Michael Dixon, chair of the NHS Alliance and a Devon GP, said the onus was increasingly on GPs and practice managers to commission services in an intelligent way to meet the health needs of their patients.”

We could do that but the power is with the idiots called commisioners, sorry World Class idiots, that you are clearly pimping this “simulator” to?

Praise be to the Party who continue to flog a long dead horse in the hope it might get up and win the Grand National for them. The horse is dead let us hope no other fools attempt to revive it in the near future.

Thursday, 25 June 2009

Choice gets better in “World Class Northernshire”

ND being a grunt periodically patrols the perimeters of our Practice and talks to fellow grunts and asks how things are going (or hanging). An essential part of maintaining a lean mean fighting machine is identifying weak points in contrast to top down PCT managers which are the major weak point in UK healthcare getting better as they never engage the enemy called illness and never talk to patients or staff. Hence they are all wise (and therefore powerful) as they know not for they see not or hear not.

Today we spoke to our two loyal secretaries who were trying to do their best for one of our patients but were being countered by the “World Class” idiots in a “World Class Commissioning PCT” which boasts that it offers “Choice”. (Not).

The words world class and choice have meaning elsewhere in the world as per the Oxford English Dictionary but in the NHS they are meaningless sound bites which are mutually exclusive and equate to crap health care anywhere else in the world other than on planet NHS. Planet NHS is currently like Moon Base Alpha in the 1970s Space 1999 TV series moving uncontrollably out of any solar system known as rational and good healthcare due to years of huge uncontrollable gravitational forces mismanaging it called politicians and NHS Managers.

Enough of our childhoods for now. Those of you who remember David Hasselhoff, and his part in the fall of the Berlin wall, may know what we are talking about how a once great “Party” gave its people “choice”. The wall came down and these people who were detained behind it now have choice as opposed to “choice” which is that now offered to NHS patients by the current Soviet style NHS management structure.

This is the problem our secretaries encounter when true patient choice is controlled by the Party’s NHS “choice”.

Our secretaries’ problem was that they wanted to do the best for a patient as do we as doctors. Our patient is currently working with an increasingly worsening shoulder problem that if, they can see the right surgeon can be cured, and so return them to being an economically productive person at work and also, as a minor side effect, give them better health. Surely an ideal in a National “Health” Service? One would hope and think so.

The patient had seen their GP who knew what the medical problem was and what the correct treatment was and had discussed NHS “choice” and said Mr X can fix this for you but you need to go to hospital Y which you allegedly can do because you have NHS “choice”.

You see now that we are really good little comrades here at ND Central honest. In fact we offered choice before there was ZaNu Labour “choice” since at least the 70s. But we digress.

The patient has a problem with their arm that might be fixed by an upper arm joint replacement or corrective surgery it is so severe. They can’t lift their arm and so cannot work.

Simple problem you might think, use “Choose” and Book to find a local upper limb surgeon and send the patient to see the local upper arm joint replacement specialist.

Our secretaries tried seeking real choice to look for the locally respected upper arm specialist surgeon suggested by their GP and can find that this local specialist only does hip or knee problems on the “Choose” and Book NHS computer system where “Choice” is determined by local idiots working for the local Thickerazzi.

The specialist is a well qualified and very experienced orthopaedic surgeon whom we know can deal with most orthopaedic problems especially upper limb problems.

So our secretaries refer our patient to see this named consultant and book the patient into a “hip” or “knee” clinic the only ones available for this consultant on the “Choose” and Book computer system knowing that the patient will see the same consultant as these clinics are all that is offered for this expert consultant under the “Choice” agenda even thought the consultant’s main interest is upper limb work.

The referral is rejected because the local Politburo managers want the money to go locally to the local idiot hip surgeon who thinks he can operate on a shoulder but only if you want your feet facing in opposite directions after your shoulder surgery.

The idiot managers also see the word “shoulder” which is a much bigger word than “hip” or “knee” (more than one syllable in fact) and so they don’t understand why the word “shoul” is not the same as “hip” (or knee) and so the referral must be wrong. Instant rejection.

This is acceptable if you are a “World Class Commissioner” but not if you are a patient who would after surgery like to go back to work able to use his shoulder again rather than split his pants every time he takes a step after his shoulder surgery at the local Tractor plant.

Praise be to the Party. Less and less choice with each day that passes as the increased use of “Choose” and Book is used by the idiot managers to manage costs and waiting lists not patients.

How can we correctly treat patients when there is no choice?

The only way we can access this surgeon is to send a paper referral to his secretary or the patient pays to see him privately and then transfers to his upper limb NHS list.

We are not allowed to send paper referrals as these are intercepted by the local referral management center and the patient cannot afford to go private.

Looks like the return of the dead letter drop for referrals will be coming soon to Northernshire. Where are our Harry Palmer specs we feel a return to Berlin is coming . . . ?

Monday, 22 June 2009

ND and team are old - we just did a hundred posts.

Using the wondrous technology that is Blogger, yesterday we at ND Central realised that we have made our 100th post. When we started we never thought we would make 30 but the healthcare issues and misrepresentation of them by the Party and the mainstream media means that what started as a rant has been grown by a group of doctors thwarted by the Thickerrazi that is the current NHS management into the Northern Doc Blog.

(An aside dear reader, there is also a United Kingdom Northern Doctor blog which we did not realize until we had been up and running for a while. We did consider using that name but discovered someone in Canada was using that so we abandoned it only to later find out we were wrong. There was no intention to steal anyone’s thunder by using a similar name it was just chance.)

Try to do your best for a patient. What stops you? A Soviet style NHS manager. We thought we had won the Cold War here in Northernshire. ZaNu Labour and its commissar NHS mangers have corrected us here on this otherwise well known fact.

We are incredibly grateful to the many experienced bloggers whom we read for a long time before we started who have commented on our posts and encouraged us further.
When you start you feel you are on your own but the Bloggoshere is out there watching you and then supporting you.

We wish to thank what we believe to be the granddaddy of UK medical blogs Dr Rant for initially inspiring us although we do not agree with his fruity language at times, the Jobbing Doctor who has past his 1000th post much respect JD, Dr Crippen, Dr Grumble, the Ferret Fancier, the Witch Doctor, Ward 87 and not forgetting the Militant Medical Nurse. All excellent reads with different styles some easier to follow than the Witch Doctor’s unique, but informative, style once you get into it.

All at the frontline, all seeing and living NHS medical (and nursing) care on a daily basis and commenting on its many deficiencies and nuances as they see it.

If you as a doctor have issues that you feel you should raise that have been sidelined by local NHS managers then you do have, at the moment, a chance to voice your opinion although some of our European masters may be trying to erode free speech via the Internet.

Praise be to the Party for inventing blogging. Someone has to tell them what they are doing to the National Health Service is sometimes wrong. At least they can ignore blogs and the public but the public reads . . .

They cannot control that, can they?

Sunday, 21 June 2009

We was Googled

While out doing our rounds in the leafy shires and moors of Northernshire far away from the nearby large coastal industrial conurbations we did drive though a small hamlet and did espy a strange vehicle pictured above (albeit the estate version of this vehicle).

It surreptitiously pulled into a lay-by for a few seconds as we approached before driving off quickly. On its side was the word Google.

Have we been Googled while out at work?

Will one of our Practices’ many Ferraris, which General Practitioners in the United Kingdom supply free of charge to their staff, as they earn less than their local shire MPs claim in their expenses, now appear on a road in a small Northernshire hamlet on Google street view?

We will have to see in the coming weeks.

Praise be to the Party who invented the computer and have published a digital plan for the United Kingdom. 2Mb broadband for all by 2012 link here

We will be a laughing stock with such low ambition but we suppose if you think that NHS National Programme for IT (NPfIT), N3 Connection and Choose and Book are gold standards of National Digital prowess then you will aim lower than several Far Eastern and European countries have already achieved with speeds some 50X faster than ZaNu Labour’s lofty ambition.

Some of the above is true, some is a bit of artistic licence some is government policy. Decide, dear reader, which is which.

We are just waiting for the photos. Will we look good in our Ferraris?

Tuesday, 16 June 2009

Big Brother is Watching You the Flu Pandemic

Comrades, this evening we here at ND Central were asked to prescribe Tamiflu for a very important person who was venturing forth to shores foreign and had read the BNF, the British National Formulary, the prescriber’s bible, about how it was prescribable on the NHS.

Now most of us at ND do not read the NHS Spamalot email service because it is pure management spam, and so full of sh*t* that the local sewage farm, that does so much better at protecting public health than do we, would not cope if all the NHS email spam was funnelled there instead of into NHS doctors’ email boxes.

We rely on an old grunt trick called listening to people. If the media shows queues of people outside schools with confirmed cases of swine flu getting Tamiflu and online and local pharmacies tell you can’t get it then what do you conclude?

That the Party and all their wonderful managers have control of it for the benefit of the People? No one has told us this we drew our own conclusions but then there is a “Flu Plan” which we are not privy to as we haven’t bothered to read it.

So enter stage right our illustrious important person. We duly explained all of our current limited understanding of this and explained that we were happy to issue them with a prescription but they might not get it.

5 minutes later the local idiot PCT comrade pharmaceutical commissar advisor was on the line telling us what naughty boys and girls we had been.

Which bit of the NHS Tamiflu Con had we missed?

Of course fellow resistance fighters if there is to be a campaign of passive resistance following the unfortunate first death from swine flu and every GP started issuing Tamiflu prescriptions “just in case” would the comrade commissar pharmaceutical advisers be able to cope with the first influx of real work they have ever had to deal with? Life or death decisions after a 3 year degree course and failure to make it in retail pharmacy?

If swine flu does take a hold this winter and this behaviour is repeated what will be the consequences? Remember this was a highly educated “just in case” going to a high risk area as opposed to a “I am going on holiday and I might catch something can I have . . .”?

Praise be to the Party for it is truly Big Brother if you dare to prescribe Tamiflu.

No doubt every member of the Party has been issued with their own personal numbered pack of Tamiflu carried with them at all times together with their gas mask and ID cards in the bunkers just in case. What would happen in a real flu pandemic if the Five a Day co-ordinator went down with a cold, sorry flu? Anarchy on the streets?

We haven’t been issued with such packs and according to the British National Formulary it is still prescribable on the NHS except in Northernshire. You have been warned comrades. Wait ‘til the brown stuff hits the fan to see who the chosen few will be . . .

Tuesday, 9 June 2009

D-Day 65 years on some thoughts and observations

65 years ago this weekend just gone, the United Kingdom, the USA and Allied nations launched the largest maritime invasion in history.

It had profound implications on the European nations and only in the last couple of decades has the freedom that was hoped for by so many of different nations been achieved from both Nazi and subsequent Communist rule been achieved (unless you work in the NHS where both political schemes - mostly the later - are still present via NHS Management).

The generation that invaded the Normandy beaches here in the UK and all their back up workers in the ammunition factories, railways etc all hoped for a better future. Here in the UK rationing continued for years after the war until 1954 and memories of our grandparents telling of how children used to say “Give us some gum chum!” to American soldiers in the hope of getting some chocolate or chewing gum or, how our grandfathers used to go round the sergeants’ mess after food to collect the scraps of sugar and butter to get enough to make our parents a birthday cake, still ring in our ears when we walk round supermarkets and the glut of food that is there now.

One of our observations over the years has been that some of the biggest abusers of healthcare are the generation that fought in the Second World War. You would have thought that those for whom medicine was only available at a price would value and not abuse the NHS. But for some reason some of them do not value it. Admittedly they are older than they were when they fought but that does not excuse all of them.

Examples we can think of are a former soldier who had been forced to march hundreds of miles as a German POW demanding a home visit for that most urgent of medical conditions a scalp condition. When we arrived he was getting out of a car. When asked where he had been “He said to the club for a game of snooker as I do every lunchtime.” He was in remarkably good health.

Another couple we recall were Polish. The wife had survived Auschwitz. Her husband was captured by the Germans, escaped to England and joined the Parachute regiment and survived both D-Day and Arnhem. You would have thought that given their collective survivability they would have avoided doctors like the plague. They did not. They were weekly visitors with mind numbing trivia that could never be cured.

We at ND cannot understand how people who have survived so much and lived so long abuse the NHS that was not there when they fought a far more immediate cause of death than a sore throat or a worry re things that are not there.

We also recall the dignity of a World War 1 veteran who we saw when doing locum work whom we subsequently saw again after the French were awarding Legion d’Honneur medals to surviving UK First World War veterans. We remember asking him if he had had his? He said “Thank you for asking doctor but I received it from the French ambassador” and were amazed at how many people had asked him the same question.

A veteran, to whom the doctor was the pain, as opposed to the veterans who are sometimes pains to the doctor.

If is always difficult to relate to others’ experience and most of us rely on our own kin to tell us their experiences of the past unless one is an avid reader of history which is usually written by the victors.

This weekend just gone was 65 years after D-Day. Anyone can debate its merits or demerits. The ones we remember are the quiet veterans who will tell their tales if prompted or discovered by accident.

One example was when we went and told someone he had a lung cancer replied mysteriously "It don't mean a thing, Doc, if you don't pull the string."

We asked him what he meant. He had been in bomber command throughout the war and had flown every mission without a parachute and decided he would face his cancer in the same way. He had nothing to lose in either case other than his life. Unfortunately his last battle was alot shorter than his wartime service.

Another example being, when someone mentioned being a patient in a certain military hospital for 6 months. What are the chances of 2 people being in the same hospital for the same length of time separated by 2 generations and in the same service?

Praise be to the Party for allowing us all to be represented at such an important event. The Party too remembers the Gurkhas but only with some difficulty.

Curious how the Public remember history differently?

Perhaps, because some of them were there? Unlike the politicians.

Monday, 8 June 2009

Tales from the Gulag or visiting or being a patient in ZaNu Labour’s NHS 004 nursing care

There are more managers, sorry nurses, than ever before looking after patients if you believe the Party.

Nurse bloggers have pointed out how bad care is and they are right re intelligence and common sense being lacking in some of the alleged care professions. Our relative’s surgery means that they cannot use one arm and turning is difficult so reaching for things is hard.

Nonetheless domestics, who now wear scrubs and no ID, so look like the doctors on Scrubs, put things on tables out of reach and walk away. And you wonder why people starve in hospitals?

Mixed sex wards.

New Labour said it would abandon them. Our relative has already had an uninvited male visitor (Cyril) in the middle of the night.

There is always at least one Cyril, or Elsie, on a ward who gets up frequently at night to wonder or go to the loo, or scream out for no apparent reason and then plays musical beds until after waking all the patients near them up, who then shout at Cyril, or Elsie, to go to the right bed, succeed in waking more people up several times a night.

This is while our relative arms were compromised and immobile a frightening experience against a backdrop of being confined in a single room next to the nurses station and hearing loads of verbal abuse towards the nurses and doctors while they, the patient, was defenceless and trying to recover from surgery.

When our relative finally was just able to get to the loo unaided they had another uninvited male visitor in their toilet. Granted the toilet concerned was labelled as “for use by males and females” but if your personal security is compromised and you are only just out of bed you do feel incredibly vulnerable and embarrassed by such Party sponsored intrusions and equalitarianism.

It was one of the Party’s promises 12 years ago to do away with mixed wards but as it costs money and involves effort why bother? They won’t be asking our relative or any other patient why they should bother as they might not get the answer they want.

Sleep was difficult for our relative partly because of the disturbance by nurses for frequent and necessary observations throughout the night but also because they are opposite the nurses’ station on a busy ward taking regular admissions day and night.

Our relative, who is of a nursing background, has commented on the lack of confidentiality and the frequent abuse of the nursing staff by patients. All of this was heard, but not seen, (apart from Cyril) as they lay in bed after several bouts of major surgery. They thought the standard of nursing care had generally gone down but nonetheless when they were sick they did single out a few really good individual nurses.

However they did not get their hair washed for 5 days until a friend, a fellow nurse, came in and did this for them. They bought a hair dryer and hair washing kit. A couple of days earlier the same nurse friend came with another nurse friend and gave our relative a good wash. They were 2 RGNs something that militant medical nurse can only dream of. And they were there for one patient.

On one day a busy ward which was taking acute admissions for orthopaedics, head injuries and elective surgery was short of 3 nurses. On one evening our relative had 2 dedicated nurses not provided by the Party, who is technically responsible for patient care, or the multitude of nurse managers and their clip boards who should have been caring for our relative, but by 2 caring friends and co-workers of our relative.

We have no complaints against the nurses who by and large do try to do their best for the individual patient. Unfortunately it is against a back drop of the NHS ethos of "care on the cheap" and if there is a shortage of staff employ more managers to find out why rather than employ more nurses on the ground.

Praise be to the Party, and its managers and its ministers for caring for our relative so well.

We thank those nurses who were there for their dedication in caring for our relative and their other patients on an understaffed busy ward. They are the unsung heroines (and heroes) who are daily abused for the failings of every nurse manger who never works on a ward.

Patients want and appreciate nurses on the ground – not clipboard carrying invisible nurse managers or modern matrons which is what they are increasingly getting. Hint.

Sunday, 7 June 2009

NHS Security. Your personal medical records in their hands.

Our glorious leaders want everyone in the UK to have their medical records on a central computerized database with a few limited exceptions using the Orwellian principle that all pigs are equal although some are more equal than others (especially at the trough but then they were not keen to share this fact with you the Public).

Equally you the public might be a little unhappy to share certain parts of your medical history with the greater world that exists outside of your doctors (hopefully still) confidential consulting room.

One of the team recently chatted with an emeritus professor of medicine who told a saga of how long it took them to get a NHS laptop. The professor said if he had gone to a local computer store he could have walked out of the store and been using the laptop in minutes. Use the NHS to procure a laptop and it took months (of bureaucracy).

The professor still lectures and takes presentations with them on a memory stick. The professor’s new NHS laptop does not let him transfer any data from his laptop to any other device. This was especially annoying as he transferred some files from an old computer to his new one and then found he could not do the reverse after editing them. So hours of work were lost on a presentation.

Is it there to protect patient or is it there to protect Party sensitive data reaching the outside world?

However, our professor being a professor, was curious and found that there was a flaw in the NHS computer security system. Not rocket science, you could email files to the world wide web with no restriction! Might be a little slow but breakdown any problem into small pieces, transfer it and you can eventually get the whole picture! Just like a jigsaw. Takes time but it is possible.

This is like the NHS Spine a collection of everyone’s personal data and the proposed Summary Care Record that boasts that it is secure despite having over a million holes called humans. The US Department of Defence thought it was safe but a bored teenager got in despite all the layers of protection.

You can get into the NHS Spine easily as a how to do so guide was published a few years back in one of the GP rags (you do need a bit of lateral thinking here). You only have to guess a password and bingo you are in. (For any Stasi boys or girls reading, this is already well known locally to the local Stasi as they told us the next bit). What is worse that the mechanism involves the use of two third party servers located overseas in another nation. This use of third party servers overseas was allowed then under the NHS IT system.

The Stasi responded by putting in another annoying password screen using the same password we had guessed. Remember this is Northernshire which invented the computer, put a man on the moon, cracked DNA and has calculated Pi to the last decimal place and delivers “World Class Commissioning” in the top of the league table and where every Politburo commissar manager has at least one degree from Harvard or Yale.

Dream on it isn’t quite that good some of them might even share an O level but we digress.

Today our practice manager asked us to sign for a “secure” memory stick. We are allowed to “import” or transfer data from computers outside the NHS but are not allowed to “export” data to our own without one of these memory sticks.

This new security has already been a huge success as an educational meeting last week was scuppered by this policy. No one told the consultant who wanted to transfer his research data held on a NHS Super Secure Computer to a laptop that he could not do so using his own memory stick.

Result a large chunk of our practice who had arranged to attend an educational meeting was disabled by a delta grade IT manager who introduced this policy but didn’t tell anyone and was trying to do what they could never do. Think, and improve security.

If you are concerned about your data then please have a glance at this website.

This is being introduced by stealth and at present there is only one possible way of opting out so we would urge you to read. Most of our staff and families have already done so as they know how secure the system is.

Our political masters have been concerned that their finances have suddenly become available to the Public. If, for example, you had an abortion as a teenager that you did not want your intended husband to know about this would you want this known outside of your doctor’s consulting room? Especially if you had not told your mother and she was best mates with your intended husband’s mum? Using the NHS record anyone working in the NHS with a Smartcard could access that.

You may have had a temporary addiction to drugs or alcohol that you overcame and has not been a problem for years. You apply for an important well paid job and rather than ask your GP who knows you if there is any current problem your employer might access your medical file and bang goes the job.

How could they do that? Easy a few quid to a disgruntled receptionist at any local surgery, or any other of the million “Smart” cardholders, if there is a national summary care record. Cheaper than asking a GP who knows the patient for a medical report.

A key corner stone of medical practice is confidentiality. The move towards a NHS Summary Care Record is fraught with hazard and especially inequality. Should any elected politicians be able to hide the fact that they are a paranoid, homicidal schizophrenic with intent on world destruction? Of course they should but you CANNOT.

NHS IT is a joke that all of the world can see. However it is a very frightening and expensive joke if it is not stopped.

The sharing of information is vital for good healthcare especially in the protection of the vulnerable for example children.

Computers do not enable this as they do not talk to human beings. The sharing of information is vital and the easiest way to do so is to talk to people. This is why the Party have taken away our district nurses and more importantly our health visitors
convinced that using a crap computer system called System One will mean there will never be another Baby P. Right.

A simple conversation or an observation passed on by a one grunt in the field to another will protect more people than endless billions of computers. They only talk to each other depending on those who program them. In the NHS IT service, it is the thick who do this and they can barely read or write let alone indulge in any meaningful communication as we never see them.

We only receive their edicts of which the “secure” memory stick is one. No consultation, no consideration of the downside just another top down edict from the dummkopfs.

The biggest risk to patient data is the human being. Memory sticks, CD-ROMs and laptops cannot walk on their own so if they go missing there is only one person to blame and it is not technology. Using technology will never solve this weak link. This is why so much time is spent teaching grunts the impotence of confidentiality.

The idiots in NHS IT care not for confidentiality they just want data. Your data for knowledge is power. If it were a level playing field that might seem reasonable. Until our politicians are prepared to share their medical records on line as freely as they have shared their expense details the NHS Summary Care Record will be a gross example of the haves and have nots.

Secure memory sticks are a joke as they will not prevent data loss and we will not have them. After all what is on them? We respect confidentiality and if we take data home it is protected to the best of our ability and returned as soon as it has been used. Only secure human beings will protect data. The solution to this is not technology it is training and trust. The NHS does neither of these well in IT.

Praise be to the Party for telling us why confidentiality is king. Another expenses leak anyone? Hard cases make bad law. If we jot a memo on a NHS computer we cannot take it home on a memory stick but we can send to everyone on the worldwide web. Security? We love amateurs.

Thursday, 4 June 2009

Choice in Northernshire

Choice” is a ZaNu Labour buzz word. Before the current Party was in power there was no choice ever in healthcare if you believe the Party. They did after all found the NHS and were never responsible for the lack of "choice".

Those of us on the front line know that this is complete bull as there has always been choice if you know how to exercise it and if a NHS manager does not block it. However, under the free internal “market”, there is less “choice” as “choice” is now controlled by “Choose” and Book.

For some specialities your “choice”, as a patient, is to ring a call center. Here in the UK everyone knows that call centers are staffed by those of the highest intellectual ability. Any referral letters sent by GPs to consultants are screened by people only slightly more qualified than those in the call center and when you ring for your appointment you are told your “choice”.

Your “choice” is decided for you by what we shall term “referral screeners” who work in a new creation of the Party that never existed before called Referral Management Centers. Some of these are not even medically qualified and are complimentary therapists well versed in reading letters sent from one doctor to another the consultant and understanding them as they practise such advanced medical skills as voodoo.

Now, you may be unhappy when the highly trained and qualified call centre operative tells you that the comrade “referral screener” thinks you need physiotherapy. Your GP told you that you need to see an orthopaedic surgeon because they think you need a joint replacement. You may kick off especially as you have already had physiotherapy and this fact was in the referral letter your GP sent along with the fact that it had not worked.

Of course because of the high intellect of call centre staff and unqualified “referral screeners” who think that physio is big juju medicine you then be given another “choice” which is go and see your GP and ask for another “appointment” (to ring a call center).

NHS managers, many of whom would be unemployable in any other organisation due to their overqualified ignorance, are making “choices” for you because they are so much less able than you in order to “regulate” the “market” and keep funds for the local tractor plant in which they have a vested interest. No tractor plant, no job.

Thus under the current Party there is less choice in the NHS than there has ever been. “Choice”, according to the local commissar managers in Northernshire, is limited to “your” choice of hospital only. You cannot choose which surgeon you see as they control what appointments anyone using “Choose” and Book can see. If there are no appointments for a particular surgeon – which may be because the managers choose not to let you go to a particular hospital or surgeon - you can make a “request” for an appointment to be created for you.

This is meant to be done by the local tractor plant but usually they do nothing and bounce it back to your GP’s secretary who made the “request”.

This usually results in the patient being sent back to see the GP to request another appointment until finally patients, who want to see a doctor because they are getting worse not talk to a call center operative, eventually opt for the right or Party or their “choice”. Either that or they keep you waiting and the circle repeats itself or you go private and then ask to be transferred onto an NHS waiting list after finally seeing your choice of doctor.

This is the reality of 12 years of ZaNu Labours “choice” agenda here in Northernshire. Our medical secretaries have long since had enough of using Choose and Book as it has increased their workload no end and more people are involved in the referral process than under the old paper system when we actually did have real choice. We sent our letter direct to the person we wanted our patients to see. Not via a centrally controlled Party run computer system to be read by a non medically qualified idiot sometimes called a "consultant".

Choose and Book has been an expensive failure, created more work, offering less choice and is a disaster. Joseph Stalin would have loved it as it is being used to regulate choice on a scale he could never have dreamt of. Our political leaders love it for the same reason and hail it a success. All it is is a glorified bean counter.

Today in Northernshire as in the rest of the UK we actually do have a choice. It is called an election albeit just for local councils and the European Parliament. The creation of universal suffrage has been a long struggle in the UK and it is something that enables a degree of democracy in this country. We here at ND will be voting although many feel there is not much worth voting for. Nonetheless our politicians do not listen to us as individuals or to organizations that represent us.

However, unless the tanks appear on the streets overnight, they cannot ignore an election or do so at their peril. You have little “choice” in your healthcare but thanks to the struggles of our forebears you do still have a choice at the ballot box. It will take only a few minutes of your time but it is the only thing our leaders will listen to (unless they follow the example of other democracies like Zimbabwe).

Go on exercise real choice not NHS “choice”. It may not be a general election, which many here in the UK feel is long overdue, but it may be the start of one.

Praise be to the Party’s and its choice commissars’ success in healthcare “Choices”. Thank goodness we still have a democracy - for now- use it. It is your choice not theirs.

Tuesday, 2 June 2009

Summer in Northernshire

A yellow field in Northshire of buttercups in a fallow field not the usual oil seed rape.

We believe here at ND Central that it is now officially summer in the UK. Like all of the landed gentry we here in Northernshire have had the combined harvesters out to hack our humble 40,000 acre spreads at our own expense while watching our MPs struggle to employ people to hack their 200,000 acre spreads at our expense too.

The other great joy we have had is our weekly trip to the local pathology museum called the Supermarket. Here, just like with the seasons, the colours of our world changes. Gone now has the dour winter this seasons Northern “parka” look as it has been replaced by the “new” season of summer look.

Lots and lots of manky white flesh, bingo wings, pot bellies and wally shorts and sandals and flip flops of various guises topped off with hideous tattoos that may have looked good in the Falkland’s War but on a background of old wrinkled obese white flesh look positively awful now. Très cool? Non!

And that’s just the women in their summer finery the men are even worse. Sandels and socks anyone?

This season’s looks are reflected in these museums as are the different stages of the evolution of diseases soon to be seen by local doctors.

The initial white wrinkly flesh on limbs rarely used for anything athletic are followed by the lobster red wrinkly flesh that is associated with doing nothing for hours to get “healthy” and then the slightly brown bits with inflamed red are all on display illustrating how little work (or exercise) most people here in the ever, over affluent, Northernshire do out of doors.

Outdoor workers are easy to spot. Their tans are more even.

Furthermore disease spotters will see future disease coming in our local Pathology museums.

The stream of supermarket trolleys laden with a mere 8, or 9, 24 tin packs of lager and nothing else struggle on their way to large 4X4s some of whose owners will land up in A&E as a result of their hugely educated status as emergencies a few hours and boxes of lager later.

The trolleys being loaded up with ice cream and barbeque packs by mothers on mobiles shouting to their 6 year olds “Chantelle, gerrus another 20 packs of pork scratchings and some of them Sensations crisps as they rite nice and yer uncle Paul is coming to the barby so get us 200 Rothmans as well.”

Clearly public school education in Northernshire has resulted in a huge health promotion epidemic regarding summer excess.

We know what is coming this week.

Sunburn, food poisoning, infected insect bites and indigestion.

The great British summer in GP and A&E land.

We did say the local Pathology museum as another of Northern Doc’s laws is that:

“It is impossible for a GP to walk round a supermarket in the UK without hearing a conversation about someone’s health or how bad the health service is by the end of any supermarket trip”.

Tales of how people were “rushed” to hospital or they “Had to call a 999 paramedic for little Wayne’s cold but he were alrite”. Try it. You may have to listen while you are trying to be invisible in GP stealth mode going round a local supermarket.

It is always there every week at least once.

We, however, did not dress up to go to the supermarket in our shorts, or put our pot belly on we were there in our greens. No one questions this dress sense in Northernshire. We went out later to play which is where the photo came from. Anyone spot the ambush? We didn’t but we survived it due to training and got a tan with a hard earned sweat. It might save our lives and those of others later. Somewhere.

Some of our patients in the local Pathology museum will not. Alcohol indulgence, smoking, over exposure to sun and food will kill them.

Praise be to the Party for inventing summer. Roll on the “something for after the weekend” surgery. It will all be self inflicted. Just as we can’t cope well with winter we don’t do summer well either.

Especially in supermarkets.