Proof of the Pudding?

About a year and a half ago, a good friend of mine introduced me to the wonderful website Cakewrecks. Cakewrecks is the kind of eccentric gem that only the blogosphere can throw up and whenever I'm feeling a bit down, I click on the site. It never fails to leave me in fits of laughter. Now we have an NHS equivalent. Step forward, Traction Man (well, metaphorically at least, cos you're in traction) of the wonderful 'Notes from a Hospital Bed'. Traction Man is - well, in traction in a hospital somewhere. He is taking pictures of his hospital food, posting them on a blog and inviting people to guess what it is. The most puzzling one so far has been the vegetable moussaka above; noone was able to guess what it was.

What I found hilariously funny about this site is that it illustrates perfectly the old unwritten British rules about cuisine. It harks back to a time when spaghetti bolognaise was completely off limits and you could only buy one kind of lettuce at the Co-op. Rules like;

1. Colour. Safe foods are yellow, green or off white in colour. Custard, peas, greasy chips are all acceptable; bolognaise and chicken chasseur are not.

2. Vegetables should either be carrots or peas. Other vegetables should not be present on a plate unless they are covered in a cheese sauce or mashed.

3. Meat should be either brown or white in colour. It should not be pink in the middle; it's not decent.

4. The only sauce that should be put on meat is gravy. Meat should be able to stand on its own two feet. If it needs a sauce, it's probably off.

5.Meat and vegetables should not be allowed to mix. They should stand politely to next other on a plate. Cooking meat and vegetables together in the continental practice of casseroles is to be frowned on and not encouraged. Potatoes can be placed on top of meat, but again not mixed through.

6. Mushrooms are permitted if they are cooked until grey. Mushrooms that are still white are not permitted.

7. Processed peas are good; garden peas are suspiciously middle class; haricot verts
is what you get when a bunch of lazy French can't be bothered shelling the peas.

8. Foods ending in 'i' or 'a' should be avoided.

9. Macaroni cheese is an exception to '8'; its yellow and gloopy status classifies it as a British dish and fulfills equality, diversity and ethnicity regulations re food.

10. Potatoes should always be present on a dish. In the unfortunate event of a dish being a pasta dish (see '8') mashed potato should be added to neutralise it.

Do have a look at this blog. And support this guy; laughs apart, he might just get something done about nutrition in the NHS. If they don't get him first..

If it was a Crime to be Conservative, would You be Convicted?

For those of you who have been living on Mars for the past year (or outside the UK) there is an election coming up. It's time for parties to polish up their policies and put their wares on display. As such, I thought it was time to examine Conservative policy and provide the following quiz; if it was a crime to be Conservative, would you be convicted?

1. You have inherited a multi million pound business from your father. On examination of the accounts, you find that the cost of administration has doubled from 6% to 12% over the past fifteen years. This can be traced back to a change your father made in bookkeeping, where he required the individual account of every customer to go through the main office instead of each office keeping its own accounts and reporting back. Your main rivals in Scotland rely on each office to keep its own accounts and its admin costs are 5%. Do you;

A)change over to the system your rival uses;
B) stick with the status quo?

2. You have a waiting list of customers that you cannot deal with alone. You decide to sub-contract work to another firm and pay them £15 million in advance for a five year contract. After you have signed the contract, the company come back and say that they can only do half of the work involved, due to health and safety issues, but the contract means that they keep the £15 million. Do you;

A) Consult your lawyers about possible breach of contract, sue the idiot who drew up the contract, and never do business with sub-contracted company again;
B) Shrug your shoulders, pay out the £15 million, and recommend this as a way of doing business?


3. You have an in-house cleaning team who are slightly more expensive than another company. You hire the new company, only to find that they will not clean the toilets, because their contract does not include cleaning up bodily fluids. Do you;

A) bring your old team back and tell the others to take a hike;
B) get some of your office staff to assume toilet cleaning duties in addition to their own work?


4. You want to build a dividing wall in one of your offices. Do you

A) Get a couple of quotes from local builders, take the lowest one and build it;
B) Take out an advert in the European journal?


5. A light switch is not working in your office and requires an electrician. You go to a local electrician, who, on hearing the location, tells you that he will have to charge you £300 for the job because it's in the contract tied to the building. Do you;

A)Accuse the business consortia that drew up the contract, of profiteering and hire another electrician;
B) shrug your shoulders and pay out?

6. You want to build a new office. You go to a group of lenders who borrow money on your behalf from the bank and they charge you a lending rate of 20% on the money. Two years later, you find that the bank has lowered its lending rate to 15% and the lenders have re-financed your deal, but they are still charging you 20% interest. Do you;

A)attempt to negotiate for some of the refinanced money;
B) sit back and let them pocket it all?

7. Some of your skilled workers have recently been unavailable for overtime. You find out that this is because they are moonlighting for another company. Do you;

A) Warn them that if they keep this up, you'll sack them;
B) Invite their company to take over part of your premises and allow your workers to prioritise their customers at the expense of your own?

8. The government decides to introduce a new tax for business that charges you 4% of the value of your land and property. This is a particular problem for your city offices where the land is much more valuable. Do you;

A)unite with other businesses to protest at this new and unnecessary tax that is forcing you to downsize;
B) close all your city offices and move into the country?

So how did you do? Well the good news is, that if you voted 'A' on all those questions you would not be convicted as a Tory. You would be handed the key to the cell and walk out the front door of the jail to a car with its engine running and a bottle of bubbly.Now I bet all you rank and file Tories are scratching your heads. Because 'A' is the answer that you would give to all these questions. Because they make good business sense. Because the market is about competition, minimum cost and minimum waste and providing a good service to customers. No one in their right mind would answer 'B' to any of those questions.

Except- that that is precisely what the Conservative Party has answered on all of those questions. The above are all true life scenarios from the NHS. They are all examples of how a small number of private companies have taken the NHS for a ride and pocketed its money. Private companies that are being supported by the Conservatives and Labour. They are not business men. They are profiteers. Normal business men understand the difference. And this is what I do not understand-why the hell is any self respecting Tory supporting this? If you are a Tory, you believe in the market. You believe that you should get good value for money, that things should be run efficiently without waste. Why do you not chuck these guys out on their neck? What sensible business man would deal with people like this and allow them to take him for a ride? Has the Tory party gone mad?

I know very little about the Conservative party, so I don't know how much of a split there is between the leaders and the rank and file. But if I were a Tory I would ask why my party was supporting policies that went against all sensible business practice. And why they were supporting the kind of cads,bounders and shocking bad hats that your old Tory grandee would not have put in charge of a farthing of the public money, let alone £75 billion.

The Tory party is meant to be the party of thrift and business. If you as a Tory believe this, truly believe this, then you must believe in getting rid of these companies. And if David Cameron wants to put some clear blue water between himself and Nu Labour he could do it by promising to get rid of all these leeches. Then a few of us who aren't Tories might vote for him. And even end up in jail for it.



PS the examples in order are;

1. The introduction of fundholding and the purchaser/provider split;
2. The independent sector treatment centre Stracathro;
3. The situation with most hospitals re cleaning; nurses have to do the cleaning of any bodily fluids, because the cleaners won't do it. Which is pretty useless in a hospital.
4. Most contracting work now has to be put out to tender in the European journal. This example comes from 'Can Gerry Robinson Save the NHS?'. They wanted to build a dividing wall to divide one operating theatre into two. They were going to have to advertise in the European journal. It was at this point Gerry Robinson decided he couldn't save the NHS..
5. Hospitals built under PFI are usually tied in to particular contractors. They charge inordinate amounts for maintenance work.
6. Again a feature of PFI. The consortia that borrow money on the NHS's behalf make millions through re-financing. The government tried to bring in a voluntary code where 30% of profits from re-financing would be given back, but it has been largely ignored.
7. This is the practice of consultants treating private patients ahead of ordinary NHS ones. In NHS hospitals..

8. This refers to the capital charge, a tax of 4% on land and property owned by the NHS. This has been a really big problem for the London hospitals, where the value of land has shot up. Hospitals are now being shut in cities and moved out to the country where the value of land is less. Which is bad news for city dwellers.

The Sick Man is Getting Better - Scotland's Health Improves

Now, I don't want to be cynical, but is it a coincidence that these figures have been released in Scotland, just a few days after the BMA called for action on alcohol advertising?

New figures published yesterday show 12,770 deaths were registered from April to June this year, a drop of 5.4 per cent compared to 2008.According to the General Register Office for Scotland, that was the lowest total recorded for “at least” 30 years, and just over 3,000 less than the same period in 1979.

And the number of Scots falling victim to the “Big Three” killers has shown a drop compared to last year.

Heart disease deaths fell by nearly 11 per cent, stroke deaths by almost seven per cent, and there was a 0.6 per cent decline in the number of people dying from cancer.


Scottish Daily Express

Well, maybe it is too much of a coincidence. But it's a very welcome one. Big government went out of favour in the eighties, but these figures would suggest the smoking ban is working and that there is a place for the 'nanny state'. Perhaps we should be less afraid of being censorious in our attitude to smoking and drinking. Break out the Schloer..

Disappearing Headlines - the Elderly Care Cover Up

Yesterday, I was going through the BBC health RSS feed. Near the top was a report that in an honesty test, 58% of people thought it was ok for a care home nurse to persuade an elderly person to change the will in the carer's favour. The story was headlined with this statistic. I was going to do a post on it and then I was distracted. Some hours later, I came back to the feed and at first I couldn't find the story. That was because it was now headed, 'Women judge, but do they convict?' Today, I went back and found that the story was 21st on the RSS list, way below older articles on swine flu and others.

It's not the first time that this has happened with the Beeb. The Stafford story disappeared off the radar after two days. This story about people with learning disabilities being starved to death, was mentioned first in a news trailer and reported on third. Now this. I note it's also well below the article on assisted suicide; wouldn't want anyone to make a connection between changing wills and helping the old dears on to inherit, would we?

I don't know what's more shocking to me. The fact that nearly two thirds of people think it's ok to swindle an old lady, or the fact that somebody very well connected seems to be leaning on the Beeb to cover it up. The older I get, the more I understand the function of the court oath,' The truth, the whole truth and nothing but the truth'. To be dishonest you don't actually have to lie. It's enough to change a headline or move a story down the RSS list. This is one honesty test that the Beeb has failed miserably.

Words of Wisdom from Allyson Pollock

Do have a look at Allyson Pollock's excellent article on the McKinsey report. I found myself nodding like a punk rocker all the way through it. Why can't everyone be like her? Reminds me of something my dad's headmaster used to say;

'As Jesus Christ said and I very much agree with him..'

How to Save Money on the NHS -Managers versus Staff

The esteemed consultants McKinsey recently held a stakeholder summit for management and staff from the NHS.Much fat,carbs and black forest gateau was consumed. The idea was to have a brainstorming session with blue sky thinking in order to effect a step change within the culture of the NHS. Or to put it another way, they wanted to know how to save money. The managers got together and made up one list. The staff got together and made up another. Yours truly was sneaked a copy of the result which I print below.

Managers list of Money Saving Ideas for the NHS

1. Sack 1.5 million staff by 2014, leading to a saving of approx £75 billion
2. Remove any patient from GP lists whose case notes are more than 1/4 inch thick.
3. Put all patients in hospitals, out into B&Bs in the community and let social work pay for them.
4. Let that nice man Richard Branson in to run GP practices with lots of nice potted plants and flip charts.
5. Pay out the £50 billion to managers for being so clever at doing all these things.

Staffs' List of Money Saving Ideas for the NHS

1. Sack anyone with the word 'facilitator' in their job title.
2. Sack anyone with the word 'Donaldson' in their name.
3. Firebomb all Darzi clinics.
4. Put a Doomsday virus into the 'Connecting for Health' supercomputer. On the other hand don't bother; it'll not be noticed amongst all the others.
5. Put in the Tower anyone who uses a beard, jumper or hot air balloon in an attempt to appear friendly and engaging.

There was also one other paper found, but nobody knows who wrote it, except that they signed it 'Cassandra'. Their list said,

1. Use the government's newly acquired control of the banks to give back the profits made on re-financing PFI deals;
2. Employ more frontline staff to improve productivity and ensure patients are not hanging about in hospitals when they don't need to;
3. Get the government to reduce the capital charge or abolish it altogether. This means that city hospitals especially are paying out an inordinate amount on the value of their property. At the very least, charge hospitals on the actual value of their equipment for the capital charge, not what it costs to buy new.
4. Provide some proper step-down beds and continuing care beds in whats left of the old day and continuing care hospitals and don't take up room in acute care.
5. Instead of trying to build a massive supercomputer that spotty faced teenagers can hack into when they're bored, build a number of smaller localised computer services in each county, like wot the Jocks are doing. And the next time Accenture breach their contract sue them for £1 billion, not £63 million.
6. Abolish the internal market in the NHS and bring back the health boards. That will get rid of the endless paper trail following every purchase, every patient, every tender and it will get rid of the accountants, lawyers, middle managers and alternative health care providers that know diddly squat about health that hang on to that system. All things being equal, you should be able to halve your admin costs from 12% to 6% by doing this.

Cassandra indeed..

Vote for Margaret Haywood -Support Our Whistleblowers

Margaret Haywood, the nurse who blew the whistle on poor standards of care for the elderly on Panorama, has been shortlisted for the Patients' Choice for the Nursing Standards Nurse
Awards. You can vote for her here. If you do nothing else this week do this; Margaret Haywood lost her job whistleblowing and it's important that we show our support. And do pass the message on..

Playing at Doctors -Big Pharma is Coming to Town

I'm a suspicious sort of soul. When choosing between cock up or conspiracy, I always go for the latter. It does mean that sometimes you are pleasantly surprised when things do not go as badly as you think; but more often it means that you're right and everyone hates you for it. So it came about that when the 'minor ailments' service was brought in in pharmacies, I began to be suspicious. On the face of it, it sounded like a good idea. GPs really don't like being phoned up every five minutes to write out prescriptions for Calpol and the like, and there's no doubt that it did take a burden off them. But it's what went with that. Consulting rooms. Prescribing powers. Hmm. Was this about convenience or was it the government's idea for further dilution of the GP service?

The answer came this week. Lloyd's the big pharmacy chain, has applied to be an 'alternative medical services provider.' It is going to set up consultation rooms where a patient can speak to a virtual doctor online. So instead of going to the doctor you can go to the pharmacist and at the same time you can buy all your lovely drugs from Lloyds instead of those boring generic ones you can get at the local dispensary. Great.

It's going to be particularly interesting how this is going to pan out in Scotland. The SNP has a policy against privatisation in the NHS and in 2007 the attempt to bring in SERCO for Harthill GP practice was closed down very quickly. This is opening up another front and is a direct challenge to the SNP's current attempts to amend the GP contract that allows this. There was always a danger that this would happen, because although the Scottish Government can change our legislation, European legislation states that any business worth more than a certain amount had to be open to tender. GP practices could get round this by being small and it was thought that the relentless march of the health centre and the resulting merging of practices would be the way big business would worm its way in. It looks like they've found a back door. Instead of having to deal with GPs and persuading them to shift to new premises they're doing the process the other way round. And we are going to lose GPs and dilute the service we have.

It was a conspiracy. I was right. And I hate that I'm right..

A Toast to the Scottish Government

There aren't a lot of bright spots in healthcare at the moment, what with Daniel Hannan slagging off the NHS on American tv and the political parties rushing to its defence while simultaneously privatising what's left of it. But today there was a good news story. The Scottish government has brought in measures to restrict the sale of alchohol to one place in supermarkets, to ban irresponsible drinks promotions and loss leaders, and is following up with proposals to price drinks according to units instead of classification. This means that sights like this are going to become a thing of the past. I'm sure there are folks out there who are disappointed not to find their regular Lambrusco beside a pair of rolling skates in Tescos, but otherwise I think it's a good day for Scotland and a gold star for Nicola Sturgeon. It looks like we have someone fit for taking on the big drinks companies at last.