A small victory for common sense?

One of the team saw this news item in Pulse magazine this weekend. For reasons best known to the Party it is scrapping its target that 90% of referrals should be made via the hugely expensive and failed Choose and Book (C&B) system.

Now this does not sound like an earth shattering story but look at when this target was supposed to have been met. Look to the article to see what the latest figures for percentage of referrals being made by C&B. 53% in June of this year (2010) and in June 2009 the figure was the same and that was down from a “high” of 56% the previous October.

res ipsa loquitur?

GPs know C&B is crap, anyone who uses it, predominantly medical secretaries in GP practices, know it is crap which gets crapper with every upgrade made to it. It is nothing more than a Party sponsored bean counter and a means to control access to secondary care. It is the prime denier of choice within the NHS as we know it and is still Party sponsored.

We said it was a small victory and that it is all it is. We know of some Soviets that are still forcing GPs to use C&B using the well known Soviet principle of Hobson’s choice.

More worrying is the bit in the article which says:

“The DH has indicated that GP consortia should maintain and invest in the system as they take over from PCTs and this week backed the system despite dropping the 90% target.”

Given the choice of investing in real healthcare for an ill patient, or investing in a very expensive failed piece of Party enforced IT, we wonder what our patients would want any GP commissioners to spend their tax pounds on?

What will the free from top down interference new Party allow? Will a certain percentage use of C&B now be a NICE new “outcome” to reflect “quality” practice and thereby tick another box instead of a top down “target”?

Praise be the Party for appearing to realize the error of their ways but in practice it is business as usual.

When the Party allows choice the people decide.

A small article in the GP rag Pulse caught one of the teams eye.

Now one of Za Nu Labour’s big buzz words was that of Choice. For those of us who have worked in the NHS for years know patients have nearly always had a choice of which consultant they could see and at which hospital. The old fashioned and now verboten method of referral called the paper referral letter could be put in an envelope and sent anywhere in the UK.

However, Tony and Gordon after all their years in healthcare, felt that patients had no choice and so preached about choice and introduced the Soviet style command and control structure called Choose and Book. They thought this was good for it gave the patient any choice that their local Soviet felt they could allow to be put on their local system or what is popularly known as Hobson’s choice.

Tony and Gordon felt that all people wanted their personal medical records to be on one uber computerized records system called the Summary Care Record and again patients were given a Hobson’s choice of opt in or opt in.

Unfortunately for Tony and Gordon the people sometimes do get a choice and at the general election they chose not to choose more of Tony and Gordon’s Za Nu Labour. Unfortunately there was not much better choice and so we have a coalition government who seem not too dissimilar to their predecessors.

We digress slightly but look at the article and see what happens when 2.24 million people were invited to, not told to, open an advanced HealthSpace account. If you have not heard of it don’t worry most of us knew not of its existence but if you are snowed in and bored here is a link.

So how many people opened such an account? A million? Well Connecting for Health reckoned 5-10% and they of all people should know about matters health electronique.

So when given a free choice how many of the 2.24 million invited actually registered?

2,913 or a massive 0.13% according to Pulse. Does that tell one anything?

Praise be to the Party for sometimes allowing patients a free choice. Freedom is a wonderful to those who have it but to those who allow it, it can sometimes hit you back in the face. Ignore it at your peril especially when spending large sums of public money.

People want face to face healthcare not electronic smoke and mirrors manifesting as real healthcare.

Choice.

For the first time in at least 5 years today patients, and those who work in healthcare, are being given a real “Choice”.

It is called a General Election.

We, the United Kingdom electorate, have a choice and what a choice it is.

All politicians use the health service as a football to kick around as they please until the football is punctured, deflates and does nothing useful and then like delinquent youths they find something else to trash or have a fight over.

So for those of us in healthcare we now have a real “choice” that we can exercise and hope to influence possible “change” as those in the US have recently done.

Change is a great word but only if it is for the better. Most grunts on the ground know that subtle change (if ever allowed by politicians) can sometimes make a huge difference in healthcare. Unfortunately politicians do not do subtle they do sound bites.

The patient and their care should always be our priority and not a political football.

It is a choice to vote, or not, and it is a choice that the Party cannot determine.

We will use it and we would urge those who have a vote to use it, please. If you have never spoken to those who do not have a vote who envy those that do, you do not realize how valuable a thing it is however much you may despise politicians or feel that your vote is worthless.

Whatever the British public decides today those in healthcare will still deliver a service to the patient as an individual to the best of our ability tomorrow.

In the same way that if you handcuff a boxer’s hands behind their back that might influence the outcome of the fight the only thing that by and large will influence your healthcare is your choice of politician.

Please choose wisely but, given the recession, regardless of the outcome things in healthcare can only get worse. It is not much of a choice but it is still a free choice that we can, if we choose, exercise.

Praise be to the Party for finally giving us real choice.

Tomorrow will tell us our choice but today we shall go to work as usual with a slight detour at some point to put an X in a box.

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.

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.

More choice and respect for medical confidentiality in Northernshire

Once again it has come to the attention of the Resistance that the Party are continuing its Choice agenda by refusing to take no from patients who say they want to opt out (of the summary care record.)

According to an article in Pulse the local Politburo thickerazzi want the under comrade GPs to hand over patients who want to opt out to the local commissars so they “can be invited to the surgery (Gulag?) to discuss it further (for re-education?)”.

The idiot thickerazzi comrade commissar managers ever proud of their 5 year plans and popularity with the comrade patients are planning to put on their invites for re education the surgery details “as if from the practice”.

Now those in the Resistance quoted point out that for GPs to do so would breach patient confidentiality.

A rather more sinister quote goes on to say that under comrade GPs had been asked "to report (inform) on patients (comrades) who wanted to opt out to reduce the administrative burden on the practice” and so their “wishes could be respected" ?

Excuse us if we are thicker than the NHS thickerazzi here but does the compiling lists of patients who want to opt out and inviting them for re-education increase or decrease administration?

The end of the article goes onto to say that so proud is the Party of its Policy that good under comrade GPs who fully uploaded their records will receive payments of £2,000. We would be deeply suspicious of any practice that achieves one hundred percent in the same way if a politician got 100% in a general election.

Praise be the Party and its ever wise choice agenda giving Hobson’s choice to the masses via the Party who always knows best. Some of them may even be able to write their own names with an X in crayon.

P.S. Since we penned this it would appear that the Politburo who issued this has seen the error of its ways? Again the source is Pulse.
For the time being?