Monday, 30 November 2009

More Education, Education, Education? Medicine and Education a few parallels.

While driving home earlier this month a few us “customers” of state funded education heard that the Party feel that parents who “cheat” should be penalised for advancing their children. When we say cheat we mean trying to get their children into the best schools. Not too long ago the Party felt that co-payment should be verboten and so we here at ND Central started to note a few parallels between education and healthcare.

No surprise here given that one of us at ND Central was a victim of the “Old” Labour Party educational policy which dictated that all comrade serfs’ children, regardless of their ability, should be downgraded to a Party sponsored education, called comprehensive schools.

At the same time that the Old Labour Party elite, sorry they were called MPs then, who were the “true socialists” in those dim and distant days, felt it was totally acceptable for their children to be sent to Public schools (no doubt on MPs’ expenses). At that same time they, as parents, sorry political commissars, insisted that other parents’, their serfs’, children should be given the same “choice” that they had and given a true Soviet equalitarian comprehensive based education as opposed to a State funded (via MPs expenses) private or Public school education.

Such disadvantage is continued in this country in the course of “socialised medicine” and “socialised education” so that any black, inner city child with the intellectual ability to be a doctor will be denied a chance of a decent education, not because of race sex gender etc for these forms of discrimination are now outlawed, but because they live in the wrong street and because their parents cannot afford it.

This is fundamentally wrong.

Ability should be fostered, rewarded, encouraged and not penalised. A poor child who becomes a doctor will more than pay for their education via taxes (we estimate about 70% of their income per year will go to the State if that child becomes a GP) and the admission of people from various backgrounds will help enrich medicine by providing a rich vein of social experience as well as intellectual excellence and ability.

It was the same 30 years ago that one of us experienced “socialized education” but manage to rise above it even though it meant leaving the shores of Northernshire to experience true world-class education. Things are worse now due to the numerous reforms denying advancement via education to those gifted and the need for a large financial input in order to afford education. And that is if you have to live in the right area with access to good schools to start with.

Remember that everyone in the UK pays for state sponsored education and medicine via their taxes but not everyone gets a decent education (or healthcare) despite paying for it.

Given the “market” economy so beloved by the current Party Commissars in healthcare surely the fact that schools that are popular should mean that the money follows the patient, sorry pupil?

Oops we think there may be a cock up there. We think there may even be a slight “market” cock up here? The ZaNu Labour “market” theory would dictates that the consumer, the taxpayer, would have choice. We pay our taxes (our money as customers of the State) we want to go to school X or hospital Y.

Doesn’t work fellow comrade workers as the Party, all powerful, dictates your “choice” of healthcare (via “Choose” and Book run by the local commissars at the PCT), and your education (via local commissars at local Councils), in the same way it denies your children Blair care and Blair education using the well known Socialist Principle of all Gordons and Tonys are equal but some are more equal than others.

So No Joe the Plumber care here in the UK. No Joe the Plumber education here either. But Joe the Plumber (UK) works in a real market and charges what the hell he likes and gets his healthcare for free and knows his rights. You dear patient, or parent, operate in a true Soviet, or “socialized” market called the health service or school system. You can have any “choice” of school or healthcare as long as the Party approves.

Dissent, try to use your nouse, money or private healthcare and the Party disapproves and you will be penalized. Try to get your child into a good school and the Party will get you. Try to get your patient to see the right consultant and the Party will get you.

Old and Za Nu Labour are the same Party separated by a few decades but some of the names and most of the ideas are the same bar some mild tinkering with words and ideas and suits replacing donkey jackets.

Anyone see a headmaster refusing a Prime Minister’s child education based on his address? Doubt it but it is not the same for you or I comrade? We don’t get Darzi care when we are ill we get whatever cheap crap the people in the lower streams of a Northern comprehensive think is right for you based on their huge inability.

For some of the people running local healthcare now weren’t bright enough to hack it in the private sector or get into a University or medical school. They went into NHS management after failing several times in other jobs first.

Clearly in this respect Old and New Labour have succeeded. Don’t foster and encourage ability penalize it. You get what the Party provides and it is presided over by the least able of all, the NHS manager. The ones we know of were in the bottom third of a mixed ability comprehensive school in a large Northern industrial town.

Try to do better and you are penalised either financially by having to pay for better healthcare and education, or by the State denying you better care or education, that you have paid for by taxes and taking you to Court if you try to better your child.

So much for the every child matters agenda and the Children’s Act putting the child’s interests at the centre of any decision making process. So much for the mantra of “education, education, education” so often quoted from a former Party leader.

Education is the current way to advance oneself in our society and it should be provided on the basis of merit. If a child from an inner city school has the potential to be the next Einstein is recognized he or she should be sent to the best schools locally based on ability not location. If that child’s parents recognise this fact they should be encouraged in the same way that if they wanted to see a better surgeon at another hospital for a particular condition rather than a less good one locally they should be given real choice to do so.

Praise be to the Party who provide “choice” as a word but not as an option. Thirty years ago choice was limited in education locally but in healthcare it wasn’t. Now both are limited more than every before and more “choice” is in fact less.

No wonder the Americans are worried. More management means less progress and choice. Pay more get less. More Choice anyone?

Regardless of the politics who loses? The patient and their kids.

Thursday, 26 November 2009

Some thoughts while driving in Northernshire in Autumn . . .

Now that we are back on Zulu time or GMT the nights draw in quicker here in the more Northern parts of Northenshire and the change in light makes the drive into work literally appear in a different light. May sound like a bit of bull but any photographers will know what we mean.

One thing that has struck us is how many pubs (Public Houses or bars) have shut in the last 2 years along our drives to our various surgeries and visits. In the last 2 years we have counted 10.

Now this being one of the more intellectual and affluent areas of Northernshire the average working man after a hard days graft at the coal face that is the office will usually be off for a quick gallon at the local gentlemen’s club called the Working Men’s club in the Northern shires.

But the lights are no longer on and the windows are boarded up. We know not why as liver disease is on the increase and, coupled with the increasing number of signs on buildings reading “Licence to let”, or “Building for sale”, or “Can you run this pub”?, we wonder why these are appearing rapidly on once prosperous and booming businesses?

The dark nights have also unleashed a new hidden menace onto Northernshire’s already hazardous roads.

In addition to the odd deer, pheasant, uncontrolled horse, farm tractor, combine harvester, wet leaves, black ice and floods, we have here in Northernshire noted an increasingly common new hazard preventing our normal Mach 5 journey home in our state funded Ferrari (if you, or anyone, believes our current Party as to how much the evil under worked over paid GPs earn).

This may reflect the increasing aging of our population but it is an insidious problem, possibly a mission creep, which will result in more harm as it is an unregulated problem at present.

What is it?

None other that the nocturnal pensioner on an electrically powered mobility scooter.

Surely not? Yes not.

These demented “infirmed” users of these devices with cataracts are using them on Northernshire roads with passing places on hills and in the dark as well. Some will use lights or wear fluorescent jackets but others will not as using lights will diminish their battery power which is severely challenged by them going up the local 1 in 5 hills on their way back from the local tavern (still open) in a valley bottom.

Coupled with diminished hearing and eye sight these scooters have caused both Northern Docs, and local bus drivers, some scary moments on single track roads with passing places as they pull out without warning onto the unlit roads to avoid a steeper climb up a hill on the footpath parallel to the road which runs up a different contour from the road causing traffic to screech to a halt and crawl behind an almost invisible pensioner on an electric scooter up a 1 in 5 hill until the next passing place a mere 500 yards away at 4mph.

No insurance, no minimum standard, no licence but still a hazard particularly in the dark.

Now one is bad enough but there are now packs of them. Could this be the Marlon Brando Wild Ones generation of bikers making a final come back? A new Hell’s Angels chapter in the making the Mobility Scooter Granddaddy Hells Angels Drinkers Chapter?

We jest not this is all true not in a Northernshire Granny ghetto conurbations but in country lanes and villages. It may be related to the closure of a local pub that was on the flat but now the nearest pub is in a valley bottom we know not but there is a new hazard on the dark roads that hunts in packs.

Although not fans of over regulation there must come a point when there will need to be regulated. 8 deaths and a thousand injuries are quoted by the BBC in 2004 and it would appear that some (patchy) bits of law might apply already.

Praise be to the Party whose zeal to legislate and regulate is sometimes conspicuous by its absence especially for the protection of the individual as opposed to the corporate entity that is Government especially on dark nights in Northernshire’s dimly lit roads.

We would hate to dent the Ferrari on a mobility scooter oops we meant to say cause injury to an unlit pensioner. Could this also be an income generation measure to reduce the National Debt? Mobility Scooter Road Tax? Compulsory insurance? M(S)OT certificates?

Monday, 23 November 2009

Useless jobs in the NHS

If you have not read the most excellent Ferret Fancier’s blog and their post of how many useless managers (we would have liked to use a five letter grunt word that starts with s that had hi in it and ending with e but we thought better) are employed in the NHS in this country wasting tax payers’ money to achieve more management as opposed to the aspiration of Joe Public for decent, or even better, healthcare then we would urge you do so.

See also our photograph of this list on a wall and then think of the great new term that we love at ND Central from across the Pond called “socialised medicine” and you can see why the Americans are worried.

One of us here at ND Central went to sleep, sorry, to a local Party meeting to tell us something important (we think).

As far as we were concerned it was another example of NHS management (in)action namely creating people to do a job which does nothing useful but they (the NHS managers) will happily pay for it as if their box is ticked they get promoted. You get the idea more boxes ticked = more money wasted on more management expenditure = ultimately less patient care and therefore promotion.

A self sustaining spiral of ever increasing expense and incompetence the essence of NHS management.

Let us go back a while to a former time where there was a job called a navigator. This used to be a highly skilled and important job based on knowledge, science, mathematics and a degree of experience.

In the Royal Air Force you used to get half a wing or a brevet as a navigator the idea being you can tell a pilot, who flies a plane, how to get from A to B. Although navigation is not an exact science especially in war time when it is reckoned that only 1% of bombs hit their intended targets (WW2) having a good navigator meant that at least you could get home to fly (and die) another day.

So the local Thickerazi have rolled out a totally new and useless job called the “care navigator” which they say will help the demented patient “navigate” the “complexities” of the “patient centred” NHS to “facilitate” them accessing “world-class” care.

This will be delivered locally via 6 nurses on the frontline of health delivering one to one, “personalized” care by sitting beside a phone. Similar in a way to the couple of people employed locally to sit at a local Poliburo sponsored Swine flu help line (we jest not).

Can anyone see the problems here? “Care navigation” versus real healthcare and help? 6 nurses sitting by a phone as opposed to 6 nurses delivering one to one patient care, or boots on the ground to use the current expression.

Did the RAF use navigators based in a call centre in World War 2? No they were real human beings in real aircraft whose lives depended on many things especially the ability to find an airfield to land on always useful if you are in an aircraft just like getting the right healthcare. It might even save your life.

Remember dear reader that the answer to any problem from the Party is to create a call centre (and lots of managers to run them).

Successes include:

NHS (re)Direct
the National Swine Flu Pan(dem)ic line and of course

BT (India). Yes months on BT (India) are still delivering dial up service at home and after 5+ years a dial up service via N3 at work the later service at your expense.

So bums on seats in call centres top trumps boots on the ground every time for NHS managers with a “problem”

Given these “successes” and please bear in mind for whom the “care navigator” service is for the demented patients of the United Kingdom let us think how this might work.

A concerned relative consults a doctor, or a real nurse, who gives “the care navigator” contact details to the dement’s relative.

Dement’s relative then puts contact details, no doubt on the NHS corporately produced card, on the side of the kitchen along with messages to “shut the door”, “take your tablets” and “do not ring your doctor unless it is an emergency”, “do not reorder your prescription you already have enough drugs” and “poo in the toilet”.

So want does the average dement do?

Come on stupid they completely forget to take their tablets, leave doors open and ring the doctors every 5 minutes to re order their medication and request a visit as they feel “dizzy”. And did we mention the toilet?

However, they suddenly see the “CARE NAVIGATOR” card, and to a stirring rendition of the Dam Busters’ March from a long time ago in their minds they suddenly remember the War and the Blitz spirit.

Let us not pee and crap on our beds and wander naked in the streets at night there is a war on we must all pull together. We, the dements, of Britain, shall dig for victory and ring the Care Navigator.

That we teach the Hun and damned Bosch a lesson! (Quite right their pensioners get better healthcare than we do and they lost the War).

The relatives will of course be thinking, thank God we rang the care navigator, it was the only way we will get this bird down and into a nursing home. If only.

So lets run through this idea again.

A nurse sits at a phone, a highly skilled “care navigator” no doubt wearing a badge as per the Service, for demented patients who are meant to ring them to get help from the “care navigator”. How much of the conversation do you think the dement will remember?

Anybody brighter than your average NHS manager, or a work avoiding nurse doing “care navigation”, able to see a slight problem with this idea?

Like who tells the demented patient about this service? Perhaps a “care navigator facilitator" when it does not work? Another nurse off the front line? Cue another level of “service” provision?

We have already seen this with Community Matrons who have failed spectacularly at reducing hospital admissions that they now have created a Community Matron “support worker” formerly called a district nurse to help them look after their six patients.

More and more chiefs, less and less Indians but at more and more cost to deliver less.

Given the current state of public funds and the inevitable needs for cuts a few of us at ND Central can see one place where the axe should fall with no harm to patient care.

Useless job number 2: "the discharge co-ordinator".

When we were grunts if a patient was fit for discharge this was arranged by the ward staff. Usually staff nurses, sometimes with ward clerks involved, under the supervision of a ward sister who would between them arrange all the bits and pieces needed to allow a patient to go home.

This was in the days when wards had real nurses in adequate numbers and with enough beds to treat patients. MRSA was there then but easily manageable as there were enough isolation facilities, nurses and beds to contain it.
These days are long since gone as despite an increase in ill patients and a population increase of 10 million the number of hospital beds per head of population has decreased. No rocket science here comrades less fuel in a rocket leads via “efficiency savings” to get more bangs for your buck. Or was that deaths for your dollar?

So what used to be a simple procedure called a discharge is now made more complicated as someone now has a job to be a “discharge co-ordinator”.

Rocket scientist or an auxiliary nurse promoted? Have a guess.

Such is the success of these highly paid professionals that if you have ever been on an NHS ward as a patient (and two of us have been in the recent past) and been discharged at 08.00hrs by a consultant can you guess when you actually are allowed to leave a ward?

Try 15.00hrs.


Because the pharmacist who dispenses your discharge drugs was on a ward round.

A pharmacist on a ward round? Bit like a chocolate frying pan but they are important para medics and no doubt the "discharge co-ordinator" had vectored in this 7 hour wait into their incredibly complex NHS navigational equations to improve patient care on the frontline.

Sit on your (ar*e) when well doing nothing waiting for almost a whole working day for an incredibly important pharmacist to dispense drugs that they could do in 15 minutes or less. But the ward round was important so up yours you are only a patient. A 7 hour wait is perfectly acceptable and it is being “co-ordinated” as well.

Gone are the days when Sister would have noticed that a patient discharged by a consultant at 08.00hrs was still on a ward at 10.00hrs and dispatched an auxiliary nurse to get the TTOs (abbreviation for take home drugs) and got them within the hour.

Praise be to the Party for creating “care navigators” and “discharge co-ordinators”. What will be next illness “observers” or nurse “co-pilots”?

Whatever happened to trained nurses in adequate numbers to do the job? We know they are replaced by managers and call centres. Progress.

Wednesday, 18 November 2009

The NHS Brand or Ronald McBrown on corporate identity.

Fellow bloggers and readers while doing some research for a post one of us stumbled across the NHS Brand Guidelines website.

Being good scientists and scholars we did study this website and if you have no surgeries or anything else constructive to do for the next week then we respectfully suggest that you trawl this website to see where tax payers’ money is being spent (on healthcare).

Go to the Homepage. Look to see what is in the centre: a section for dentists. Are we thick up North but when did anyone in this affluent area get access to a NHS dentist especially as an emergency?

Look at the rotating images and see how clean everything in the NHS is. We all know that actors and film, or photographers’, studios rarely see the number of patients in a day that real healthcare professionals and institutions do. Notice the subtle ethnic “diversity” and images of children being cared for by the benign “NHS brand” team of website designers as opposed to real healthcare professionals. Don’t the patients look so well and the staff so relaxed and rested?

Check out the About the NHS brand to learn that “this website is a central resource for all those involved in developing NHS communications”. Hmmh clearly no-one there talks to patients or to us on the frontline.

It finishes with the sentence “whether you are a communications professional working within the NHS, or an external supplier providing design or print services, our guidelines will show you how to use the NHS brand properly and effectively”.

Nice to know that the frontline staff in the NHS are being provided with all this vital information to help them treat patients. Next time we access an NHS print service as part of our families healthcare we will be greatly reassured.

Back to the Home page. There are 21 options in the drop down menu in the blue Welcome box. Being thick enough to be GPs we went straight to the last one “unsure?”
Reading this we found the following sentence:

If you're not sure where to fing the information you're looking for, . . .”

Clearly Vicki Pollard is now working for the NHS as a website designer and doing nothfing, whatever. But getting paid for it no doubt handsomely.

There is even a telephone number possibly a “NHS Identity Helpline” call centre? For the paranoid perhaps?

Try checking out the section we think might apply to us we think it is General Practice.

There is even a a 4.2Mb pdf document with a warning large file size (think steaming pile of cow dung) underneath it. It is 103 pages long and we suspect that a quick skip read of the first few pages will make the idea of hammering nails into your feet a more rewarding experience than reading the rest of the document. Go on give it a try. If you are not a GP there are loads of other such documents to download too some even bigger than ours!

Try reading the first page and see what it says, remember we found this site by accident:

This need has come from:

GP surgeries and primary care trusts (PCTs) asking us how to use the NHS brand within their surgeries

Of course we have been we have been banging on their doors for years asking how to use the NHS brand and we suspect that every other GP and medical blogger in the UK has been doing the same too.

Look at the bewildering array of options on the GP site which we have looked at and after an hour of research at the CafĂ© Michelle have barely scratched the surface of this hidden gem of NHS excellence in wasting tax payers’ money.

On the web page there are 3 GP categories. Unfortunately we fall into the D or Delta fraternity here at ND Central as we do not use the NHS brand on any of our Practice correspondence so no doubt there will be a visit soon from the NHS Brand Stasi for a spot of political reeducation or is that rebranding?

If you are still breathing after being underwhelmed by this marvellous website of Party speak (deep breaths, dear reader, think calming thoughts of steaming dung heap to counter any negative thoughts or emotions) then navigate to the Useful Links and click on the bottom link Tone of voice: Words and written communication.

Start reading this section and image the text being read by Telly Savalas as Ernst Stavros Blofeld in the James Bond film On Her Majesty’s Secret Service in a darkened room.

Read the section Respect, understanding and accessibility and see how communication should be. Anyone ever hear a PCT manager speak “free of jargon, free of acronyms and free of overly technical language”?

Clearly even the PCTs are not on message so we GPs have no hope but carry on listening to Mr Savalas’s dulcet tones in your imagination as you progress to bits that might just be relevant to GPs’ daily lives the “One-to-one communication with patients and the public”.

Every time you communicate with a patient or a member of the public, you are acting as an ambassador for the NHS. You are projecting the NHS identity. Remember, first impressions count, and what you say and how you say it will impact on that person’s confidence (positively or negatively) in our ability to do a good job.”

Now why were none of us told this in medical school? All those lectures, booklets and sessions on communication skills and we were not told that we were not doctors but were in fact ambassadors for the NHS constantly apologising for its inefficiences and difficiences. We did not realize we were projecting the NHS identity we thought we were being doctors.

How could we have got it all so wrong?

Praise be to the Party for enlightening our darkness as to what we are actually doing with patients – projecting the NHS identity. So much better than treating them and making them better. And this will not have cost the taxpayer a penny.

This is the polite version the grunt speak version is as follows: what a load of paired dangling male sexual organs contained in a sack. Money to burn anyone?

Thursday, 12 November 2009


The last few days have been crap days for a number of reasons for us here at ND Central but what caught our collective attention was the recent out pouring of apparent public grief in the UK.

Commentators at the annual Remembrance Day Ceremony at the Cenotaph said there were more crowds than usual. This week we watched scenes that evoked memories of the funeral of Diana, Princess of Wales when hearses with coffins inside this time with the bodies of fallen serviceman, were covered with flowers as they passed through a normally quiet English village of Wootton Bassett.

This got us thinking about grief and peoples’ reaction to death. One of our forebears lost 5 of their siblings and a father in one year. A few short years later more of their family were lost in the First World War albeit just within the last one hundred years. Infant mortality was high then and deaths in the First World War were in the tens of thousands in a day alone.

One death is a tragedy, a million is a statistic said the “great” Soviet leader Joseph Stalin well known for his humanitarian views and influence on current Party thinking especially freedom of expression.

But perhaps there may just be a point?

When infant mortality is high then losing a child is as upsetting to parents in these times as it is today. Emotions do not change but circumstances do.

If those around you lose their children to disease and in large numbers perhaps there is a degree of desensitization that sets in as a means of evolutionary self preservation?

Similarly if you lose a loved one in war, especially if you believe it to be unnecessary, this is not good but if tens of thousands do the same does it alter one’s perception of loss?

One person’s death or a few people’s deaths versus tens of thousands? Which is the greater grief?

Which is the greater absolute “loss” versus the greater Media interest?

For any human being the death of a loved one is distressing. It takes time to come to terms with and usually involves the support of one’s friends, or family although increasingly there always seems to be the all wise watcher of the UK Soap opera called Eastenders whose perception is that you always “you need to go and see your doctor.”

It devolves any responsibility for our own disquiet with death or disease and it is free in the UK. Grief then becomes an “illness” not an uncomfortable unpleasant emotional state.

So often within 24 hours of a death we will see relatives who have been sent always by someone else as an “emergency” and usually expecting the magic grief prevention pill which they have been told we have by whoever refers them to see us.

They usually get nothing other than a bit of time spent explaining that grief is a normal but unpleasant experience and what they are experiencing is normal.

Yes, you will be crying. Yes, you cannot sleep and yes, you will be thinking of him or her all the time but this is normal. Yes you may feel disbelieve, anger, guilt or any other emotion but this is normal. You will get better but it will take time.

Time is a great healer but unfortunately works slowly. Time spent explaining usually works better than the quick fix usually expected pill based alternative.

Disasters create Media induced grief. Would the tens of thousands slaughtered on the first day of the Somme have been reported in the same way that a servicemen’s death is reported today? Would Wootton Bassett have stood still for a 20,000 long cortege in the same way that the Public honoured those fallen in the last few days?

Same loss of an individual to the individuals concerned, same emotions but different circumstances and more importantly numbers.

Grief is an immensely personal thing. It is also a highly collectively hijackable thing via the Media but still, at whatever level one thinks of it, it boils down to the relationship between the individual, those around them and the deceased. It also now boils down to how we as Society, via the Media, view death.

The support provided in the UK usually also boils down to that between the individual and those they deal with. Often that is the principly the local undertaker followed by a local GP or in the military medical officer or members of whichever faith the family subscribe to. Before free healthcare the family would shoulder a lot of this as would local ministers of religion. It is a deeply personal relationship and always takes time to resolve.

While we here at ND Central do not have any qualms about public outpourings of grief we know that behind all the pomp and ceremony there will be a few individuals working locally to help bereaved individuals in all manner of different capacities.

We are relatively lucky in this day and age that the widespread losses that even 2 or 3 generations ago wiped out huge parts of families have been reduced to the point that death is a relatively rare occurrence in most peoples' lives although one that we will all with certainty experience on a very personal basis.

Thinking back just a hundred years ago to our forebears’ experience of losing several children to disease then losing several young adults a few years later to war must have been awful.

The human emotions were the same then as they are now, the circumstances were different. Grief is grief is grief but society changes and not always for the better.

Our thoughts go out to anyone who has experienced the loss of a loved one however it was caused. It is never easy whatever the circumstances.

Who knows whether one of us here at ND Central will have to break the news of a death to someone today, go out and confirm a death, or see a relative who has been bereaved. For some of us more than others it is a regular occurrence and has to be handled with sensitivity and tact.

Death always has the upper hand and always plays the game by his rules. We just follow.

It does not get any easier the more you do you just get more used to it. It is however part of the job and we will get on with it as always, however hard.

The same can be said for the military and the relatives of those killed in action for we feel war will always be with us.

Praise be to the Party for all their support for our servicemen and servicewomen.

Fortunately the Services have their own methods of support evolved over years to help those with loss. They may not be perfect but they have stood the test of time certainly longer than the NHS.

We await the centrally Party approved NICE guidelines on how to deal with grief (military personnel) but a lot of us have already learnt the hard way. We are but grunts on the ground and cope accordingly - without guidelines, on a one to one, very personal level with no cameras in sight.

Thursday, 5 November 2009

More NHS Choice, Swine Flu and Immunization.

One of the advantages of being involved in medical education is that every now and again you go to meetings and talk to different doctors at different stages of training outside of your own Practice. A few days ago one of us did just that and came back with a rather worrying story.

It would appear that one of the many local hospitals is “encouraging” their staff to have the swine flu immunization.

Obviously an excellent idea of the benevolent Party looking after its own as it says, in one of its briefings for managers, that if you are sick with the dreaded Swine flu then you cannot be allowed to work and look after patients.

How caring is the Party? It is so concerned for the well being of the comrade workers on the frontline that, in order to enable them to continue to care for their fellow comrade patients, it is offering them a free flu jab ahead of all others.

The carrot.

What is more worrying is that staff are being told that, if they do not have the Swine flu jab, and then they dare to be ill with Swine flu, they will face "disciplinary action" for not having had the “voluntary” swine flu shot. If they have the shot and get Swine flu they will not. Same illness, two different outcomes?

The doctor in training from whom we got this little gem in passing also said that managers were prowling the wards at night in the small hours to immunize their staff after these threats. Good stasi tactics there comrade managers.

The stick.

Now we may be old fashioned here at ND Central but we still, as far as we know, have the concept of informed choice in healthcare.

Unless the Law has changed as a result of us here in the UK “democratically” accepting the Lisbon Treaty after the "promised" referendum, a patient has the right, if they are compos mentis, to decline treatment even if it may harm them (assuming no other conflicting law for example the Suicide Act).

Now if any lawyers are reading perhaps we could suggest that rather than sniffing round A&E departments there may be rich pickings to be had here.

Employment Law, European Law, Human Rights Laws surely are being breached here as well as basic medical and nursing ethics and codes of conduct?

What if a patient who is coerced to have a shot gets Guillain-Barre syndrome? A lawyer’s Christmas present in one convenient bundle perchance?

And at what cost then to a local hospital or more importantly to the NHS for the incompentent local managers’ zeal in the face of basic medical ethics and human rights?

Come the New Year we may start to know the success or failure of the Swine Flu pan(dem)ic vaccination program in terms of Guillain-Barre syndrome. We are normally great advocates of vaccination when the science is there but given the fact that a few days ago the local Politburo came to immunize priority staff and less than a third of the doctors took it up does that tell you something?

Praise be the Party for we know it to be all wise.

We hope it rewards these managers with the prize that they will surely richly deserve a one way ticket to their spiritual homeland:

North Korea.