09-May-2011 – NHS REFORMS From An Informed Opinion

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Hi,

challenged by this comment in red below a friend of mine married to an NHS Doctor checked and ammended his opinions in the light of both his and her opinion and experience.

The NHS needs a good shake up. Problem is, I suspect its as much about money and targets as it is about ‘don’t care

If the public knew how true that is, politicians would ALL be swinging from lamp posts.

I know one GP extremely well (have done for nigh on 31 years). Her practice is inner-city, predominantly immigrant, and very high on the deprivation index of same. Targets are the bane of her life, as is a meddlesome, politically-driven Primary Care Trust (PCT).

She has the ‘wrong’ sort of patients, so for three years prior to this one she’s had a pay freeze. This time it’s a pay cut (can’t do that to the staff, as they have NHS-determined rates). She’s also doing substantially more hours (nominally 3/4 time, actual hours about 40/week over 4 or 5 days depending on clinic patterns).

This is because they can’t afford another salaried GP, and, when one partner recently retired, they had no applications for the salaried (i.e. income-protected) job. Yup, that’s zero, zilch, nada, none at all. Nor can they recruit a Nurse Practitioner, and at least one other local health centre has had similar problems. Neither can recruit additional GPs, as apparently nobody wants to work there.

If you think that’s surprising, in view of the megabucks GPs are paid, read on…

Many simple things about the NHS are stupidly broken: discharge letters from hospitals, containing the details of treatment and instructions for follow-up care, arrive as physical paper letters: my daughter has a Saturday job scanning them into the practice system! The doctors still can’t get at all the test results from all the local hospitals on-line: most of them sometimes, some not at all. The systems linking the NHS together are terrible, and hospitals’ own records are inconsistent, and often chaotic (they don’t tell you that in the clinics or the X-ray departments!).

The ‘choose and book’ system for arranging appointments is a disaster. Hospitals block-out large amounts of clinic time, and the metrics are such that, once you’re on a waiting list, you are already counted as ‘dealt with’ (or something like that), and actually not on any waiting list for statistical not-meeting-our-targets measurement purposes. Bizzarre, dishonest, and wholly true.

I’m in IT (sort-of). All the GPs in this area have their IT provided under ‘contract’ from their PCT. The service standard is truly pitiful. In the past few years they have gone for days at a time without working computer systems in the practice. Given earlier NHS campaigns for ‘paperless’ surgeries, imagine the ‘fun’ that causes.

Patients could be forgiven for not understanding the reasons and being cross (hell, the doctors don’t understand the reasons!), but that does nothing to help GP’s stress levels, nor fix the problems. If my company served our commercial clients the same way, we wouldn’t be in business any more. The contract is effectively a monopoly – GPs pay, but have no real say in the service level provided. For those in the know, XML and PGP encryption (which would probably sort out the hospital connection in short order) might as well be the Enigma codes.

Whoever runs the NHS’ IT departments certainly doesn’t do so in the patients’ interest.

[Personal disclosure: we’d like to bid for local IT support contracts. We already have several in private healthcare and our customers are, generally speaking, delighted with us. We can’t get a foot in the general practice door though, as the PCT IT structure is incestuous, defensive, and behind the ‘firewall’ of public sector commissioning, meaning in practice small businesses can’t get anywhere near it.]

Regarding the PCT’s other management gaffes, there are endless anecdotes about their meddlesome ways. The most recent spectacular example of waste locally was replacing all the health centre carpets (the place is only about 5 years old!) with lino, as carpets are ‘unhygenic’ in consulting rooms. The facts that, 

(a) it cost a fortune, 
(b) the patients feel much less stressed in a room with carpets (wot, really?), 
(c) the carpets didn’t need replacing, and
(d) the GPs protested (in writing) and were ignored, tells you everything you need to know about the PCT’s priorities.

Now the coalition, in essence, wants to add financial responsibility for hospitals (through ‘commissioning’) to GPs’ already overloaded job description. Why? Follow the money trail:

GPs have already been a convenient ‘aunt Sally’ for politicians. They got a half-decent income settlement from Blair’s last administration that went some way towards stopping the brain-drain. Ever since, successive governments have tried to claw it back, labelling GPs as ‘greedy’ and money-grabbing.

Chance would be a fine thing! There must be greedy, very wealthy GPs somewhere, but I’ve never met one. Her accountant takes home far more than she does, as do the lawyers they so often have to employ these days (employment tribunals, patient complaints and so on. They’ll need one on the staff eventually!). Don’t even ask about management in the local PCT (there’s a surprise!) — oddly, they don’t have any trouble recruiting.

If you don’t want clever, effective doctors, don’t pay ’em. The existing ones are obviously greedy and a bit thick, but don’t worry, they’re beginning to take the hint…

She already has to manage her imposed and artificial drug ‘budget’ (need an expensive drug? Fergeddit!), and will shortly also be funding some care delivery such as the treatment room staff. The budget transfer from the PCT for that function is estimated at 40% less than the PCT spends on it now. Go figure that one!

Nominally, the practice operates commercially as contractors to the NHS. In reality it’s a fantasy world of statistical targets (with financial penalties, etc.), ‘funny money’ (part-subsidised, no-choice services from the PCT, such as the dreadful IT), ordinary partnership accounts (for the Revenue), odd things like NHS pensions provision and staffing rules, pay grades, and so on.

It’s contract service provision, but not as we humans know it, Jim. The commercial world of TAC (total absorption costing), cost centres, budgeting and so on, doesn’t apply. It’s so muddled, I doubt anyone could measure efficiency in any meaningful way, nor say where money is being wasted (except perhaps the carpet suppliers!).

She’s already beginning to talk wistfully about early retirement, or a career change.

Given that reform of the NHS is obviously a priority. The question, for me, is this: Do you want your GP worrying about their nominal hospital budget when they should be finding your tumour, or would you rather the system was run properly in the first place?

Don’t blame the doctors for being human. They’re struggling to be professional in the face of a bl**dy huge, overbearing, expensive and self-serving bureaucracy, that sits like a fat leech on the back of the NHS where it can’t be touched. “No cuts to front-line services” is code for “We’ll dump the blame on the one group of professionals who can’t/won’t fight back”.

The person I know very well prides herself on spotting odd, life-threatening and difficult to diagnose things. She has twice had people drop dead in front of her whilst at work (and actually saved them through CPR – don’t think it’s like ‘Casualty’). She spends hours listening to people’s problems, and visits patients in her free time, presumably because she cares. But she shops at Asda and can’t afford to replace the 9-year-old car.

She tells me she didn’t qualify as a doctor to fight bureaucrats about the carpet in her room, nor to have to log onto the PCT system from home to stay on top of bureaucratic emails (no time in the surgery).

But she’s not superwoman either.

If you want it fixed, go deal with the politicians that caused the mess in the first place. Someone actually voted for Andrew Lansley, but I wonder how many of his constituents actually checked him out first, to find out what he was competent at, and how good he’d be in government.

The one thing about the present generation of politicians is that it’s their job. They do care if they lose it, because they’re otherwise largely unemployable. So we do have leverage, if we use it properly.

Other countries view MRI scans as cost-effective (i.e. cheap) diagnosis tools. Here, although we actually invented the things, we ration MRI time, and rely on charities to supply the machines. It’s beyond ridicule.

You can’t blame GPs for this, but you might, just, fix the people causing the problem in the first place, namely the incompetent and self-serving politicians.

Rant over. Sorry for taking up your time.
 
I am happy to publish my friend’s opinion as it is a considered view point that needs airing, that does not however mean I endorse his comments and some I profoundly disagree with.
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I Have Been Fighting Cancer since 1997 & I’M STILL HERE!
I Have Cancer, Cancer Does NOT Have Me
I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
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Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
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YOU are welcome to call me if you believe I can help in ANY way.
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Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62
on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW  
Health/Cancer Blog: http://GregLW.blogspot.com  
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12-Apr-2011 – DEATH by MANAGEMENT?

12-Apr-2011 – DEATH by MANAGEMENT?

Hi,

early screening is a great idea, as one of the great keys to Cancer survival is early diagnosis and prompt treatment.

It does make me wonder that although I have now had cancer for 13 years this latest TCC (Transitional Cell Carcinoma) was obvious during my bladder op. in December – just look at the Cancer Diary and consider the dates!

For more details on TCC CLICK HERE

Having discovered the tumour in the bladder and aware that it MIGHT be through the bladder wall I can only call the 4.1/2 months of delay utter incompetence on the part of management at some level in the idiotic multi level QUANGOcracy that is Britain’s NHS of today, as a result of the 13 years of obscene misrule and economic illiteracy of our Government.

Had my surgeon in December been able to carry on and do the obvious by removing a cuff or coin around the site and re-establish the integrity of the bladder at the time would I now be facing a potential death sentence? Would cancer have ever had the chance to spread to the lymph glands?

Would I need chemo. with its consequences and far from wonderfull side effects and poor prognosis?

To what extent can it now be argued that due to the incompetence of the multi layered QUANGOcracy that is the modern NHS and the childish doctrinal weenie waggling of NHS Wales, desperately wasting public money on reforms and rebadging etc. – not because it provides a better service but purely because they can to hide their over staffing and inadequacies as managers or even politicians they end up killing patients.

Just what is the value of spending a small fortune on rebadging The NHS Health Care in Monmouthshire after Aneurin Bevan when he was clearly utterly useless, was arguably one of the first champagne socialists – neglected his constituents in The Valleys and although married to an outspoken Communist used his Ministerial income to buy a farm in Surrey or was it Sussex.

Just what did Aneurin Bevan ever do for Health Care in Britain let alone wales – it was he who was charged to implement the decision made by the previous Government and agreed to by Labour and The Liberals to impliment Lord Beverridge’s Plan for a National Health Service and almost all of todays problems in The NHS can be attributed to Aneurin Bevin who seemingly was too stupid to understand The Beverridge Plan and could not resist tampering with it – resulting in it becoming a political football with a massive overstaffing of managers relative to medical staff and medical management – we lack even the ability to train adequate staff hence the huge number of aliens imported from third world countries who can ill afford to loose their most valuable assets!

Surely the cost of rebadging in Monmouthshire would have been far better spent on another CT Scanner and better management of MEDICAL resources – who cares what uniform nurses have or what fatuous badges are on NHS vehicles.

I believe a more available scanner would stand far more chance of having saved my life and ensured that the cancer had not spread than any amount of ego trips for inadequates with what can only be described as non jobs!

Many will find this article of interest CLICK HERE
Which together with this CLICK HERE
indicates it is not just The NHS going off the rails!

We seem not only to have moved into a ‘Post democratic Era’ where Politicians are an entity in their own right but where we have little or no meaningful say as all too much of our lives is clearly founded on NON Science, NON Logic, NON Entities and NON Jobs functioning for their own personal gain at the expense of the society they are paid to serve yet seemingly believe are merely there to ensure their incomes!

When will a death due to this level of self serving indifference be found to be at least manslaughter if not murder by a Coroners’ Court or is that as hopelessly unlikely as a Police Officer being charged with murder when they gun down yet another innocent victim!

I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62

11-Apr-2011 – Bowel Screening!!

11-Apr-2011 – Bowel Screening!!

Hi,

Black Humour to the fore:
I was amused today to receive an intriguing envelope in the post today which when opened contained a self help kit for Bowel Screening.

DIY Bowel Cancer Kits are a regular mailing in Wales & Monmouthshire!

You can find full details of the service at CLICK HERE

I was surprised to find that not only is this folder of, quite literally, bumf (spelt thus as it was an acronym emanating originally from Oxford, as I recall, for ‘Bum Fodder’) entirely bi lingual English and Welsh but the entire back page is dedicated to offering to mail out the entire ‘thingee’ in 15 other languages:
Information leaflets now available in Arabic, Bengali, Chinese, Chinese (Traditional), Gujarati, Hindu, Italian, Japanese, Nepali, Polish, Portugese, Punjabi, Somalian, Turkish and Urdu.

I presume that those speaking Eirean or The Gallic – both languages spoken on these islands by the indiginous peoples do not count – it is however all too understandable that Greeks, French, German, Spanish, Dutch and various other Continental EUropeans are of no significance relative to including SELECTED Indian languages when we leave out so many that are relatively common such as Tamil or the languages of the Philipines and Thai – I was surprised to note Spaniards are excluded also!

This early screening is a great idea as one of the great keys to Cancer survival is early diagnosis and prompt treatment.

It does make me wonder that although I have now had cancer for 13 years this latest TCC (Transient Cell Carcinoma) was obvious during my bladder op in December – just look at the Cancer Diary and consider the dates!

I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help. . YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62
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25-Aug-2008 – A CYNICAL LOOK AT The NHS

25-Aug-2008 – A CYNICAL LOOK AT The NHS

2008 August 25 01:13:35 BST
Posted By: Greg_L-W.
Discussion
Greg_L-W.’s Blog

Hi,

I’ve just put this on the Cancer Research comments section on their web site:
http://scienceblog.cancerresearchuk.org … comment-537

Quote: I HAVE THE ANSWER

May I suggest that if you are worried that you have or may get Kidney Cancer and need to claim on your Health Service:-
Make sure you are on a Government QUANGO the beauty of the job is that the Government doesn’t believe in the Health Service and provides all its senior staff with PRIVATE HEALTH INSURANCE!

Also the Government doesn’t believe in the Public Pension Service so it gives all its Staff prefferential INFLATION LINKED PENSIONS to compensate for the c*ck up they know they will make in Government.

Also Government staff on QUANGOs are not held accountable for mistakes just put all the data you can find on your provided Lap Top and lose it like the MoD do having lost over 700 to date!
If you want more expenses just loose your CD with all the records on them and claim for a larger sum.
Perhaps you have been away for the last month in Beijing with the other QUANGO members and 650 people funded from the public purse who had NO relevance to performing in the tedious and obscenely costly farce.

Join N.I.C.E. or a P.C.T. where you can be sure of no meaningful work, regular long holidays, inflation linked pensions, early retirement, stress related compensation, staff car schemes and of course PRIVATE HEALTH INSURANCE as of course you can’t relly on or trust the old NHS which is so badly managed it is obviously broken.

Don’t worry your job will be safe N.I.C.E. alone has a budget of £30,000,000 and if you need a pay rise you can take it out of the drug budget and kill off a few more Cancer Patients – they’re a nuisance anyway they just won’t die quietly they are just selfish – next they will start demonstrating but never mind the Government is on your side on a QHANGO so the State Police will be called in under the terrorism laws we can just murder them – woops sorry Mr. Menenez can we have those 8 bullets back!

Cover your risk – join a QUANGO.

The other beauty of a QUANGO or Government job is you get promoted for lies – look at Blair and his lies about Iraq which used so much of the money we could have used for health. Why do soldiers get health care? They knew the risks they should be like smokers or the obese and denied care!

Mandelson lied so often he is now an EU commissioner WITH PRIVATE HEALTH CARE!

On a £2.4Billion Budget I note incompetency and waste has already run that to £9.3Billion and it is rumoured the Olympics will cost Britain over £18,000,000,000 – Howmany people will the Government have to kill to pay for their tedious sport? Already they CLAIM that due to their incompetence they are going to have to kill Kidney Cancer patients!

Quick join a QUANGO and be safe for life.

Join me at http://www.KidneyCancerResource.com where we can fight this clearly non political issue!

First they came for the Jews but I was not a Jew so I did nothing….’

Regards and Warm Hands,
Greg L-W.

Have YOU commented? There are loads of ideas there!
Regards,
Greg L-W.

I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62

17-Aug-2008 – PCT Policy – OBFUSSCATED by TORTALOGOUS LANGUAGE!

17-Aug-2008 – PCT Policy – OBFUSSCATED by TORTALOGOUS LANGUAGE!

2008 August 17 18:44:32 BST
Posted By: Greg_L-W.
Discussion
Greg_L-W.’s Blog

Hi,
I note with some interest the lengthy tortalogous definition of PCT Policy which has been tracked down which follows:
[QUOTE]
This is a typical attempt of a PCT to explain why they are refusing to fund cancer treatments. This is from their policy document.
Guidance for considering exceptionality¡¦ in individual cases
Oxfordshire Commissioning Board decision – Policy Statement 80a

The Oxfordshire Case Review Committees consider requests to fund individuals for treatments which currently fall outside commissioning policies and agreements. A patient will not normally be funded, unless exceptional circumstances apply. The purpose of the Case Review Committees is to carefully consider, within the Ethical Framework, whether such circumstances exist. The key question is: On what grounds can this patient be funded when others will not be?¨ The Oxfordshire Priorities Forum gives guidance for decision making about ¡§exceptional cases¡¨. It is not appropriate to give specific examples of exceptionality. Definition of exception: A particular case which falls within the application of a rule, but to which the rule is not applicable. Definition of exceptional¨: of the nature of or forming an exception; unusual or special.
General guidelines: 1. It is stated on the Priorities Forum low priority¡¨ policies Potentially exceptionalcircumstances may be considered by the patient¡¦s PCT where there is evidence of significant health status impairment (e.g. inability to perform activities of daily living)¡¨. 2. By definition, ‘exceptional’ may not necessarily be predicted or spelt out in advance. 3. The fact that a patient¡¦s clinical picture matches ¡¥accepted indications¡¦ for a treatment which is not normally provided is not, in itself, exceptional. 4. The fact that the treatment is (or is likely to be) efficacious for a particular patient is not, in itself, exceptional. 5. Consideration will be given to evidence that shows that the benefit from the treatment for the patient would be significantly greater than would be expected for an average patient. 6. It is for the requesting clinician (or the patient) to demonstrate why they should be considered as an exception.

===========================

Individual Patient Requests
Exceptional Status (what makes the individual sufficiently different from the usual in policy terms)

Central to consideration of individual requests for funding is the concept of the case being exceptional.
In order for funding to be agreed there must be some unusual or unique clinical factor about the patient that suggests that they are:
„« Significantly different to the general population of patients with the condition in question
And
„« likely to gain significantly more benefit from the intervention than might be expected from the average patient with the condition.
However:
„« The fact that a treatment is likely to be efficacious for a patient is not, in itself, a basis for an exception.
„« If a patient‘s clinical condition matches the ‘accepted indications’ for a treatment that is not funded, their circumstances are not, by definition, exceptional.
„« Social value judgements (the ‘worth¡¦ of patients) are not relevant to the consideration of exceptional status but there may rarely be exceptional circumstances where benefits may go beyond the patient (e.g. as a carer) in respect of social or health related benefits for others.

This guide is in addition to the Oxfordshire Priorities Forum Lavender policy on ¡§Guidance for considering exceptionality in individual cases¡¨, policy number 80a.
Oxfordshire Treatment Request Panel and Case Review Committee June 2007
[/QUOTE]
Why we go to such lengths to track this sort of stuff down one has to wonder when we could so much more readily have obtained the original training manual for PCT Diktat Obfuscation when required to hide dishonesty and corruption in regulation documents.
Here is the relevant passage in the Drafting Officer’s Manual:
[QUOTE] “The fact that the Patient needed to know was not known at the time that the now known need to know was known, and therefore those of us who needed to advise and inform felt that the information that we needed as to whether or not to inform the highest authority of the known information was not yet known, and therefore there was no authority for the authority to be informed because the need to know was not yet known, or needed.” [/QUOTE]
I must admit that I have cheated a little as I substituted the word patient for prime minister in this section of speech by Sir Humphry in ‘Yes Minister‘.
For EU Regulations it may interest you to know that the Official drafting of ALL EU drivel is drawn up by French ENARCHS, who are, whilst at L’ Ecole National, it seems trained in the black arts of perfidy to write any sentence in a manner where that which is the diametric opposite of that which it would seem to indicate!
No one has yet managed to answer the simple question under Law – by which Act of Parliament are The State authorised to practice EUthenasia on selected groups? The fact that the Government shelter behind their appointed cronies in N.I.C.E., P.C.Ts. etc. makes it no less a State decision to EUthenase selected Kidney Cancer patients.
In a civilised society it is possible to judge its standards by the way it treats its weakest citizens. To administer a poison in order to kill someone is an act of MURDER – perhaps someone wiser than I in authority can explain how it is Morally any different witholding a needed and proven drug.
Be aware that – the self same Government which is advocating the deliberate Muder of certain selected Kidney Cancer patients on the grounds of cost efficacy of certain drugs has I understand sent over 600 people, besides athletes & trainers, to Beijing to watch people running around in circles or whatever – I understand the cost of an MP in terms of expenses runs to about £24K. This is the same Government that authorises the John Lewis List scam and the funding of London second homes for MPs.
More specifically this is the Government which Baroness Gardiner assured us in The House of Lords ‘spends upto £300,000,000 on tattoo removal’.
Just how can the deliberate Murder of Kidney Cancer Patients be justified?
Any ideas?
Regards, Greg L-W.

I just want to say sorry for copping out at times and leaving Lee and friends to cope!
Any help and support YOU can give her will be hugely welcome.
I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins
tel: 01291 – 62 65 62