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"The NHS Centre for Involvement supports and encourages the NHS and other organisations to involve patients and the public in health and social care decision-making. We engage with organisations in order to create, encourage and support a healthcare culture that involves individuals and communities on many levels."   

A happy, smiling photogenic little girl eating cake. A young boy playing a video game. Both threatened with death. This advert makes me so angry I am lost for words. It is a reflection of the top-down, micro-managed, intrusive climate in which we now live. Are there no boundaries? Must we threaten our children in this way in order to improve their health?

Full details here

I want you to imagine this. Your mother is about to have a knee replacement. Mother can have the operation done by that charming consultant orthopaedic surgeon, Mr Green. Or she can have it done by that charming consultant orthopaedic surgeon, Mr Grey. Mr Grey has nearly five times more experience that Mr Green. Mr Grey has done nearly forty such operations in the past. Mr Green has done seven operations.  Who is your mother going to choose? Silly question. The answer is obvious. Actually, the question is even sillier than you think. There is no choice. Mr Grey does not exist. Mr Grey is naught but a distant memory. Mr Grey no longer exists because of the EWTD.

 An eminent consultant surgeon writes:

The sad thing about this, as indeed about many European Directives, is that most other European Countries are ignoring it and put the lives of their citizens before a crass misplaced desire to please the EU/unions etc.  I wish the Tories could run with it.

Will the Tories run with it? Full details here.

Some light relief for Christmas. The results of the NHS BLOG DOCTOR competition to chose the recent video that best demonstrates why the prime minister should go are now in. My favorite was the one above featuring William Hague, surely our best current Parliamentarian, but the readers only put it at number seven. For the full top ten results see: Ten Reasons why Gordon Brown must go.

The single most effective way of improving the care of hospitalised patients is the provision of good nursing care. Sadly, inexorably, over the last ten years there has been an exodus of trained nurses from the wards. The modern nurse-specialists do not “do” patient care. They are the “too posh to wash” brigade. They prefer to walk round with clipboards telling others to "wash their hands" whilst the real nursing care is delegated to auxiliaries, who call themselves nurses, but who do not have any real training. And there are not enough of them. So patients in UK hospitals are lying in their own excrement. The elderly ones become malnourished for there is no one to feed them. In this environment, MRSA and clostridium difficile thrive.

Now, a nurse-specialist writes in to NHS BLOG DOCTOR to reveal all.

[I am] …getting angry about the state of nursing, the lack of care, the prevalence of specialist and consultant nurses (God help me I am one). How did this happen to the NHS?
Please start a campaign to rid the NHS of specialist nurses...please save us from ourselves...
The nurse-specialist’s tale is here

Get our nurses back to nursing

Whilst Gordon Brown attempts to bathe in the reflected glory of sixty years of the NHS, on the front line we have run out of the vaccines needed for routine childhood immunistations. We have ordered and re-ordered. We have emailed, faxed and written to the suppliers and to the Department of Health, all to no avail. We no longer have enough vaccines to provide routine immunisations for our children. And the government? They are refusing to admit that there is a crisis. They are telling lies. Flagrant, brazen lies.

“we are currently distributing more (vaccine) than is needed to vaccinate all infants…”

“…in order to maintain stability in matching deliveries to supplies, we will introduce ‘allocation’ of the above vaccines…” (full details here)

For the first time in my practice life, I am having to turn away small children who need routine immunisations. I cannot offer them protection against diphtheria. This is the reality of Gordon Brown's health service.

God knows what David Davis’ personal agenda is for this extraordinary resignation. It has unsettled the Conservative leadership and put them between a rock and a hard place. They cannot not support the Davis by-election campaign but David Cameron is not best pleased. We all know the meaning of “courageous” and “personal” in this context. Was it just gesture politics by David Davis? What is in it for him? Difficult to see any personal gain whatever the outcome. Or are we all too cynical about politicians? Could it have been genuine conviction politics without consideration of personal gain?  A resignation designed to put civil liberty back on the agenda. Whatever the motivation, and however annoyed the Tory leadership may be, there is a real political opportunity here. When David Davis arrives back in the commons, as he surely will, he is not going to be back in the Home Office post. And yet he is too talented not to be in the Cabinet. But in what position? I suggest a new, roving portfolio as the first (shadow) Minister for Civil Liberty. A wide ranging brief to cover imprisonment without trial, the erosion of juries, CCTV, the uploading of personal medical records to central government computers, Oyster Card monitoring, DNA records, finger printing… the list is sadly endless. The Conservative Party needs to eschew lowest common denominator populism and show its real libertarian credentials. And David Davis is the man to do that.

Paediatricians and family doctors all over the country have been worried that there is a desperate shortage of vaccine for routine childhood immunisations. Following a leaked email sent to NHS BLOG DOCTOR I can reveal that there is no problem. The Department of Truth has confirmed that there is no shortage of Pediacel and all comrade children will be immunised on schedule. The email is from Dr Raj Nagaraj, a Consultant in Public Health medicine

Hi All

We have a slight  twist (good news)  to the event now. When I contacted the DH this morning I am told there is no shortage but only a rationing of supply because of the high demand ….

…Meanwhile could you all keep me and members updated on developments. I am told this shortage is going run for sometimeand it is important that the message Pediacel is  only for infant vaccination and not pre-school vaccination is communicated to GPs  and more importantly to PNs who usually vaccinate.

regards

Dr Raj Nagaraj
Consultant Public Health Medicine

"No shortage but only a rationing of supply because of the high demand."

Brilliant!

The emails may be read in full here.

William Kelly, the do-it-yourself-dentist who extracted part of his own tooth, leaving a black stump.

***
"I’ve got a dental abscess", said my patient, opening a mouth that looked like the Black Hole of Calcutta. He asked me to prescribe antibiotics. Like every other GP in the country faced with this increasingly common presentation, I sighed, and suggested he went to see his dentist.

"I tried to get an appointment with my dentist this morning but he is very busy so he cannot see me until next Tuesday. And anyway, NHS Direct says you have got to treat it".

NHS Direct is indeed telling them to take their dental problems to their GP. (full report here) No wonder the government is constantly pressurising me to be available at all times of the day and night.

I do not blame the dentists for leaving Gordon Brown’s micromanaged NHS. They have been treated appallingly. I even understand the government’s cynical dishonesty about dentistry. Gordon Brown will continue to pretend that NHS dental treatment is widely available until the last dentist has left the service. The financial savings will be enormous. The only thing I do not understand is how the government has been allowed to get away with the abolition of NHS dentistry.

Why has there not been a public outcry?

Following media reports of patients unable to access NHS dentistry and even treating themselves, the health minister said on the Radio 4 Today programme that this should not be happening. There was now a duty on primary care trusts to provide urgent dental treatment. Mr Bradshaw said: "If people are in pain or need urgent treatment, they should go either to their GP or to their primary care trust and demand what is now their right." (Medical News Today)

My father in law lives in London. He is into his eighties now but still fit and active. He has a bus pass which he uses frequently. Occasionally, when he wants to get somewhere specific in a hurry, he takes a taxi. He has just received a letter from the Mayor of London telling him that as he has paid to use a taxi, he can no longer use the buses.

Too silly for words. Equally silly are the cases highlighted in this morning’s papers of NHS patients who have decided to pay for drugs not available on the NHS and, as a result, have been thrown out of the NHS. This is classic old Labour “what’s yours in mine, what’s mine is my own” pseudo-socialism. Take your pick, comrades. Second rate care from the NHS or first rate care from the private sector. But you cannot “pick and mix”.

Few people can afford full private care; a much larger number may be able to afford to pay for an occasional upgrade. And the private medical insurance industry will easily be able to design products that underwrite occasional upgrades.

Into the moral maze we go. Hell, none of this is perfect. I don’t like the idea of people having to “top up” their medical care either. But we live in an imperfect world. All this stubborn, blinkered refusal to allow “pick and mix” does is ensure that first rate medicine remains available only to the super rich. How dare the government deprive a UK citizen of his right to NHS health care because he has chosen to take an occasional medical "taxi"?

Family doctors were furious with both the Government (Dawn Primarolo) and the BBC PM programme (Eddie Mair) suggesting that the main cause of the rising alcohol problems in UK is the failure of GPs to recognise such problems. Too silly for words. Alcohol problems are easy to recognise. And we are not just talking about the clichéd alcoholic, lying semi-comatose in the alleyway clutching a bottle of strong cider. We are talking of the housewife who drinks two bottles of supermarket plonk every night, the lawyer, the accountant and, yes, the politician even who starts the evening with two stiff gin and tonics (8 units), demolishes a bottle of claret over dinner (12 units) and finishes the evening with a couple of whiskey night-caps (8 units). That’s 28 units a day, and about 200 units a week. No one can drink that much and still stand up, you may say. They can. They do. And, during the working day, no one notices. Until one day, they turn yellow.

Labour’s attempt to blame the medical profession is absurd. We need to change the drinking culture. We need to start with children. It can be done. Drinking is “cool”, and tough and macho. Smoking used to be like that but, slowly and surely, there has been a change. It can be done with alcohol too.

Where would I start if I were a politician? I would declare war on Alcopops.

It was worrying that Stanley Johnson revealed that Boris had agreed to stop drinking for the duration of the mayoral campaign. This may well make him what doctors call a sick quitter. (Full details of sick quitters in Boris : the Boozer, the Fool and the Archbishop of Montevideo.) Orders from George Osbourne to reduce the risk of gaffes or a personal decision? Who knows? Either way, this behaviour suggests there may be an underlying problem. Boris is now off the wagon. How soon before the gaffes start?

There was one of those silly five-minute fillers on Any Questions last night. Peter Hall was on the panel and the question was, “Which Shakespearian characters most resemble Ken Livingstone and Boris Johnson?” My answer for Ken Livingstone was immediate. He is Iago. Honest Iago. It was gratifying that Peter Hall made the same suggestion. I found I had to give more thought to casting Boris. Peter Hall’s suggestion was Sir Andrew Aguecheek. I think we can do better. I would cast Boris as the Fool in King Lear. Lovers of King Lear are not deceived by the Fool’s antics. Full of wit and insight, he is the most intellectually talented character in the play. Boris Johnson may well be the most intellectually talented member of the Conservative hierarchy. Whether or not you agree with that, he is now without doubt the most powerful Conservative in the country. He is David Cameron’s Fool.

King Lear could not control his Fool. We shall see whether Cameron can control his.

Gordon Brown’s mendacity on the Today programme was breathtaking. I will leave others to comment on his deception about the tax burden. But then he said that he had increased GP's hours and made them “more available” to patients. I can comment on that. Weasel words. The new programme has not yet started. PCTs are only now sending out details of the government’s proposals; a set of complex rules and regulations issued in the normal top-down way which will force us to work in a protocol driven, inflexible and inefficient manner. It is a complex issue but basically GPs wil be compelled to offer out of hours appointments to those who need them least and at the same time be prevented from offering them to patients who need them most (full explanation here). This is for polyclinics, not for professionals.

If GPs meet the letter of the law (there is no spirit behind it) then we may be notionally more available but in reality we will see fewer patients. Whilst the patients and the taxpayer suffers, the government will continue to say that they have improved the service. It beggars belief.

Sitting here watching the Panorama programme on C. Diff I am getting angrier and angrier. Please do not not crucify Rose Gibb again. She is not personally responsible for C. Difficile. What happened in Maidstone is not exceptional. But Maidstone is to be the scapegoat and Rose Gibb is to be held responsible.

Don't get me wrong. There is a problem. And all doctors know there is problem. And we know how to solve the problem. There are not enough nurses. The government targets have increased the throughput of patients to unmanageable proportions. Beds are too close. Sheets are not changed. The bed occupancy rate is unsustainable. The truth is that it is not Rose Gibb who needs to be dismissed. It is not her fault. The fault lies at the feet of Gordon Brown, Tony Blair, Alan Johnson, and Patricia Hewitt. And do not be fooled by the deep cleaning initiative. It was a con. An expensive con.

Don't believe a word of it (full report here).

It is not easy at the moment to say anything positive about family doctors. Any suggestion that they may be providing a valuable service is nowadays met with a tirade of jealousy from nurses (see the comments here), particularly the oxymoronic “consultant nurses”, who cannot get through the day without asserting that they can do any job a doctor can do, and do it better. Then the right-wing Taxpayers’ Alliance wades in with one of their tabloid headline grabbing ad hominen attacks on public sector salaries.

This is a perfect starting point for the government to introduce the polyclinics.

On 1st April 2008, the Countess of Chester Hospital proudly announced successful completion of their “deep cleaning” initiative. Two days later, the local paper reported that part of the hospital was being closed due to an outbreak of Clostridium Difficile.

Doctors have always known that the government’s hospital “deep cleaning” initiative was an expensive scam foisted on a credulous general public in the run up to a general election that never happened because Gordon Brown lost his nerve.

Full details, including the hospital propaganda video, here.

Since Barack Obama’s “A more perfect union” speech I have thought a great deal about the question of political sincerity. Shortly after his retirement the well-liked John Cole, BBC political correspondent, said that most politicians were decent people with honourable objectives. And yet in our modern political age, dominated by spin and focus groups, any politician attempting to speak from the heart, to speak with conviction, to speak inspirationally, is greeted with cynicism and disbelief.

Tony “Im a pretty straight sort of guy” Blair has much for which to answer. I cannot listen to a word he says without thinking of calculating hypocrisy. I reached the stage with Patricia Hewitt that I had to turn the sound of when she appeared on television. Barack Obama’s speech was different. A speech born of necessity, certainly, but a speech that was both intelligent and inspirational. And, God knows, we need an inspirational American President.

I have been discussing this with Iain Dale. Is it possible for a modern politician to make a sincere and genuinely inspirational speech? I issued a challenge. Give me an example of such a speech made by a British or American politician since 1950, the start of the television age. The commonest suggestion has been...

The statistics are beyond dispute, and are published by the government:

For the latest three-year average period, 2001–03, the infant mortality rate (for all babies with father’s occupation stated) was 5.0 deaths per 1,000 live births, and the rate for those in ‘routine and manual’ groups was 6.0 per 1,000. This was higher than the rates for those in the ‘managerial and professional’ (3.5 per 1,000) and ‘intermediate’ (4.7 per 1,000) groups.

The infant mortality rate among the ‘routine and manual’ group was 19% higher than for the total population in 2001–03, compared with 13% higher in the baseline period of 1997–99.

Dawn Primarolo says it is difficult to change health inequalities. Indeed it is. But they have changed. They are getting worse. See Killing Babies

The government is offering a free I-Pod to any man with one child who will volunteer to have a state sponsored vasectomy. Well, probably not, or not yet at any rate. As the budget approaches, rumours abound, and there is speculation that there will be a huge purchase tax hike on large family cars, maybe as much as £2000. Tax the Chelsea tractors, the Porches and Ferraris by all means. But not this. This is a tax on children.

It really does not matter anymore if civil servants leave confidential database records in coffee shops. Despite numerous promises to the contrary, Computer Weekly reveals:

"A new national database of confidential patient records is being opened to access by NHS staff who need no professional qualifications - despite official assurances that records will only be accessed by specialists who are providing care or treatment. A document obtained by Computer Weekly under the Freedom of Information Act also provides evidence that NHS Connecting for Health - which runs part of the £12.4bn National Programme for IT [NPfIT] - has quietly decided to weaken assurances given to patients about the confidentiality of records."  (Computer Weekly)

Doctors have been warning about this danger for some years. And it is worse in America.

Good news, comrades.

Commissar Burnham has been awarded the Order of Lenin for his achievements in introducing our children to the best of British kulture.

Meanwhile, school teachers throughout the country are fulminating with anger as the government tries to tell them how to do their job. As a doctor, I cannot but indulge in a little schadenfreude.  Perhaps people will begin to understand now what the government has been doing to doctors and the NHS over the last ten years. Teachers are underpaid, desperate for resources and struggling to achieve better literacy and numeracy rates. They do not need the government to tell them about the benefits of creative writing.

Currently, after ten years of NuLabour "around 16 per cent, or 5.2 million adults in England, can be described as "functionally illiterate". They would not pass an English GCSE and have literacy levels at or below those expected of an 11-year-old."  (National Literacy Trust)

But do not worry. Five hours of compulsory, government defined kulture will soon solve the illiteracy problems. "Heavens," said Commissar Burnham. "Five hours is nearly enough time to sit through the Ring cycle."

Problem solved then, Andy.

(and see "I am not a number, I am a free man")

I see Ken Livingstone is at it again. He is going to charge the owners of Chelsea Tractors £25 a day for taking their gas guzzlers into “town”.

If respiratory physicians at the Brompton Hospital wanted to spend taxpayers’ money on a healthcare initiative to improve the environment for asthma and bronchitis sufferers they would have to produce a strong evidence base to justify the expenditure. Let us reduce pollution by all means, but will charging stockbrokers’ wives another £25 a day for doing the school run in central London have any impact?

Foul emissions? It's just another stealth tax

A degree from Oxford, five years at medical school, four years of hospital jobs, a year as a GP trainee, supervised by an experienced family doctor and then, finally, at last, I was deemed well-enough trained to be safe to see, assess, diagnose and treat patients on my own. And, even then, I was nervous. I was of course an expensive commodity. You would not pay Gordon Ramsay to put ketchup on your burger, would you? Why pay me to see your sick child?

Feeling ill? You don’t need to wait to see a doctor.

"Our prescribing Nurse Practitioners are highly trained and are able to deal with the vast majority of medical issues that you present us with. They are able to diagnose and prescribe medication and work closely with our GPs on any cases about which they want a second opinion. As we have a growing team of nurse practitioners, you could save you time if you want to get in and see us as quickly as possible. You don’t need to wait to see a doctor!"

At the moment, this is an option offered by government-favoured beacon general practices. (Full details here). Soon, the way things are going, for patients without private health insurance, it will not be an option. It will be compulsory.  The art of family medicine is sifting the chuff from the chaff. It took me twelve years to acquire the requisite skills. I must be stupid. It seems nurses can do it in three years with a top up seven day course on “diagnostic skills.”

You have to ask yourself, if your child is ill, do you want him assessed by doctor or a nurse? And don’t think it is any better if you take him to a hospital. Hospital paediatricians are being replaced by “health care practitioners” and... er... traffic lights. Really!

The office of Coroner has existed since just after the Norman Conquest, longer than the office of Lord Chancellor. Tony and his flat mate, Charlie, decided to abolish the latter office without consultation and without warning. Worse is now in store for Coroners. They are to be “replaced” or emasculated by Harriet-Harman-lite, the Home Secretary. Coroners were traditionally medically qualified with some legal training. Nowadays they tend to be lawyers. Sir Monty Levine, Jim Callaghan’s family doctor, was one of the best known and well-respected of the doctor-coroners, and dealt with the Stephen Lawrence case.

Coroners have always been a thorn in the side of the establishment. And, when they sit with a jury, they are nigh-on uncontrollable. That is always the trouble when you let independent professionals loose in a democratic country. Two years into World War Two, the case of Liversidge v Anderson was fought in open court. We must never forget Lord Atkin's dissenting judgment, in which he told the Home Secretary, in no uncertain terms, that notwithstanding the Nazi threat, notwithstanding the Battle of Britain, he could not lock-up British citizens without giving reason.

Now the Home Secretary is taking statutory powers not only to suspend habeus corpus but to stop coroners’ courts sitting with juries. She is likely to exercise these powers in the case of terrorist deaths.

Why would the government not want a jury to decide the Jean Charles de Menezes case?

*Posted by Tim on behalf of Dr Crippen*

As an experienced father of four teenagers I no longer enter into the “will you tidy your bedroom” conversation. I never win.  Experienced parents know that the key to managing teenagers is not about winning the battles. It is about choosing which battles to fight. I look with amazement at the current battles that the government is fighting. It is a rare day now not to hear Jacqui Smith, our increasingly beleaguered home secretary, defending the extraordinary decision to cut the police pay rise from 2.5% to 1.9%.  And, if you are half asleep listening to the Today programme, doesn’t she sound like Harriet Harman? One of those is quite enough.

Alan Johnson meanwhile is on a collision course with the BMA about three hours extra work a week for GPs. Whatever the problems may be with “modern General Practice” (I feel an oxymoron coming on) an additional three hours will solve none of them. In any case, the BMA is not complaining about the extra time, it is complaining about the centralised micromanaging approach that tells doctors how the time is to be worked.

The strings are being pulled from Number 10. Tony Blair had outstanding “people skills” and would not have been fighting either of these battles. The police are marching. GPs are threatening to strike. Morale throughout the NHS continues to slip-slide away. I am relieved that none of my four children is going into medicine. I should not feel like that.