Andrew Lansley is on iTunes!

The totally rude, disrespectful and scatological rap regarding our great Health Leader is now on iTunes here. I've just posted the link so that you can avoid it.

Suggested uses for upload;

1. Put on a loop in your surgery/hospital ward/PCT headquarters;

2. Set it as your ringtone and arrange for a friend to phone during BMA/GMC/Monitor/Health Committee meetings;

3. Get a loudspeaker and wire it to play outside Millbank;

4. Hack Andrew Lansley's phone and reset his ringtone.

Any other ideas? All purely hypothetical of course. At no time should you endanger yourself or others, take any unnecessary risks or infringe any laws, as Auntie would say..

Interested in Healthcare Training for the Future? You've Got Four Days to Tell the Government what You Think!

I came across this via Witchdoctor's blog. I suspect she was being slightly sarky about its consultation status. Nonetheless, it is important to fill these things in and create a paper trail. It means that when everything hits the fan, the government cannot pretend that it didn't know and that noone told them. So if you are a medical teacher, now is the time to get your blow in, if you don't want your college reliant on a levy from private health companies. Yes, you read that correctly. That is what the government is planning to do in future. So fill in that form. You've got until this Friday to submit it; April 1st. Apt..

Andrew Langsley Gets the Rap

I've just come across this video via Dr Grumble and ABetterNHS. I am totally shocked, scandalised and flabbermagasted at the rude, disrespectful and scatologial content. And that's only the White Paper I'm talking about. On no account should you listen to this denigration of our great Health Leader and his wonderful plans for the NHS. Do you hear me?

A Glimmer of Hope?

Something interesting is going on at the Daily Mail just now. Not just the fact that one reader made a sensible comment on nurse staffing levels, but I have been reading this article re Rachael Woollaston's opposition to the Health and Social Care Bill. (Rachel Woollaston is a Tory MP and also a GP. What's very interesting is the comments below the article. Here's a selection. (warning; put hot drinks down and make sure you are not within reaching distance of a half brick.)


"What a dangerous precedent giving GP the power to wheel and deal with our lives. The main focus should be on provide healthcare to their patients and not with the financial cost of this care. If GPs start controlling the budget then they will fundamentally try to preserve it by outsourcing to the cheapest providers, which may not be the best, efficient or closest to your local area."

"In recent years GPs have changed from, mainly, dedicated family doctors to group practices whose principal aim appears to be financial profit rather than care of the patient. They are subcontracters to the NHS and are therefore autonomous, hence their refusal to implement the NHS requirement of giving patients access to a GP within 48 hours. Given control of vast sums of money it is probable that much will be diverted into their own pet schemes rather than in improvement of patient care and treatment. Just note how much the practice nurses now do compared with their GP bosses! Andrew Lansley is riding headlong into trouble!"

"Whilst I strongly support getting rid of layers and layers of bureaucracy in RHAs, PCTs and even in the Dept of Health, Dr Wollaston is correct and Lansley's proposed changes to the NHS are likely to end in more tears simply because GPs are in the business of practicing medicine and dealing with illnesses by dishing out pills and potions and not spending much of their time fiddling budgets. Giving GPs £80bn a year to pay for consultant appointments, tests, procedures and operations is a bit like putting Dracula in charge of a blood bank."

"I would not allow my Bank Manager to decide if I had appendicitis or IBS and I'd rather my GP wasn't responsible for massive amounts of NHS budgets as she has no qualifications to suggest that she is any more competent to spend the money than I am. To say Cameron is out of his depth is the understatement of all time."

Ok, ok. Now calm down. These people are against Andrew Lansley's reforms. They are not against them for the reasons that you would like them to be against them (the idea that GPs are all greedy mercenary profiteers who only care about profits), but they are against them. In fact, out of 42 comments only six were in favour and they were the worst rated comments on the board.

For the past couple of years, Daily Mail readers have been fed a diet of anti -doctor stories and the Mail has pandered to natural Conservative instincts. They get paid too much. There's too much bureaucracy. They're incompetent and don't know what they're doing. They are autonomous and are not in touch with local needs. Now, suddenly, those same people that have been so denigrated are to be handed £80 billion of public money to do with as they like and naturally DM readers don't like it. Because these doctors are greedy, wasteful, uncaring, autonomous operators, aren't they?

I think the propagandists have made a booboo. One the one hand they want to kid on that commissioning is being handed over to nice fluffy GPs, not private companies. On the other hand, they wanted to reduce the reputation of GPs to soften up the ground for the reforms when GPs protested against it. They've been caught between two stools.

There is another element here and it's a point I made in this post. Being a Conservative pre -Thatcher, didn't mean being in favour of profiteering. The characteristics of old Conservatism are thrift, value for money and small government. This bill goes against these instincts. Rachel Woollaston has pointed that out and with Cameron trying to make capital out of condemning PFI as wasteful, he is going to find it very difficult to justify the White Paper.

Things are taking a new turn. I think saving the NHS is not going to be a battle between different political parties, but it is going to be grass roots versus leaders. The Conservatives are now joining in and in that, I can see a glimmer of hope.

Back to the Victorians

I received a press release from Leicester University today and I reproduce it in full;


"The UK coalition government's planned NHS and welfare reforms, and their use of 'nudge' theory, hark back to ideas on welfare and recession from the end of the nineteenth century, according to studies by a University of Leicester historian whose research paper has recently been published in the Lancet.



Dr Kim Price’s article entitled, ‘The crusade against out-relief: a nudge from history’ is his second in the Lancet within a year drawing parallels between past and present medical negligence.



Dr Price, a Wellcome Trust Research Fellow in the School of Historical Studies, commented: “Broadly speaking, I am interested in medical negligence under state medicine and I have focused on the pre-NHS (pre-1948) welfare system in the UK.



“The instability of doctor-patient relations has led to a fragile balance of power that is by no means set for the foreseeable future.

“The welfare debate has been divided for centuries by ideologically-driven attitudes to philanthropically, privately or publicly funded medicine.



“I see medical negligence as a complex relationship between time and place and, to varying degrees, society, law, ethics, medical practice, health professionals, and patients.”



In his paper in the Lancet, Dr Price argues that the UK’s Coalition Government has begun to tackle the annual deficit with the language and policy aims from the recession of 1870.



In the late 19th century the Conservatives instigated a policy to cut back welfare expenditure and lessen reliance on poor law out-relief. This included cutting medical extras and payments to lone mothers, widows, the elderly, the chronically sick, and people who were disabled or had mental illness.



The result, Dr Price believes, lowered the health of many families and increased the number of people who could no longer be supported at home.



Dependency was criticised by both government and ratepayers, until by the 1880s the Victorian obsession with thrift and self-help had taken hold throughout the voting classes. Philanthropy and charity, however, could not compensate for government aid, and institutional care drove up national expenditure.



Dr Price argues that, under current UK Coalition government proposals for GP consortia, and its potential conflicts of interest, the doctor-patient relationship is in peril of shifting too far in favour of doctors and undermining the trust of patients.



This too harks back to 19th century Poor Law doctors who had to choose between their private and public patients, resulting in widespread neglect of the poor. As a result relations between doctors and poor patients suffered.



At the turn of the 19th and 20th centuries the drive to cut welfare backfired and fuelled change. Liberal (and later, Labour) reformers raged against the “false economy” of a nation without welfare so that by the start of the 20th century, the tide had begun to turn.



The people’s health took centre stage when working class people as a whole were allowed to vote, resulting in a series of Acts which led towards the creation of the National Health Service in 1948."





Dr Price is funded by the Wellcome Trust as a postdoctoral fellow. His project is: Wellcome Trust funded research project [ref: 084965/Z/08/Z] – ‘Voices of the sick poor: the patient’s experience of medical negligence under the new poor law’.



Dr Kim Price’s paper, 'The crusade against out-relief: a nudge from history' was published in the Lancet Vol 377, March 19 2011: 988-9.

Fighting Talk - Allyson Pollock

Right, now that I've calmed down a bit from the last post, I thought I'd post a link to the latest from Allyson Pollock. This can be found at 'Big Society NHS' which I've just discovered. They seem a jolly bunch and quite organised as well. I strongly recommend that you visit it. They think that the White Paper stinks and so does Allyson Pollock, although she puts it in a more refined, subordinate clause kind of way. Article and blog is here.

Don't Just Stand and Moan, Do Something

Lots of negative vibes today on the Health and Social Care Bill. There were two votes lost; one at the BMA yesterday and the vote on the Opposition Day debate today. Much moaning and ochoning about Hamish Meldrum and people feeling sorry for themselves is going on. One poster is even going round putting up 'NHS 1948 - 2011'. You could be forgiven for giving up, couldn't you?

Well, maybe you could, but it's not me that's going to do the forgiving. And I'm not down. I'm angry. At you. Yes, you in the white coats. Let me tell you why.


Things are tough just now. Sure, we'd all like to throw in the towel. That's how government works. They move fast to convince you that there is no point in attempting to counter them. Well, tell me this. Where the hell was everyone at the BMA's meeting yesterday? I've seen more people turn up at a meeting of the Tunbridge Wells Socialist Workers Association. Where were the rest of you to vote down Hamish Meldrum's appeasement policy? And if you couldn't get in, why were you not crowded outside the doors waving banners and shouting for the cameras? Do you think that it doesn't matter? Well, it damn well does. You lost one of the most important votes in the history of the NHS yesterday, because you didn't turn up.

Don't moan to me about Hamish Meldrum. Or Andrew Lansley. Or Nick Clegg. You have no one except yourselves to blame for the vote yesterday. And if you sit around moaning about how its all fixed and it's all going the one way, well, I've got news for you. It's always been like that. People only win against government when they do the one thing that they don't expect - they keep going.

This fight isn't over.The bill is still at committee stage in the Commons. It's got a third debate coming up and then it has to go through three debates and a committee stage in the Lords. There is still a lot to play for. And you've already given up, have you? You know,last week several thousand people died in a tsunami in Japan and they are facing nuclear meltdown. Whatever you are facing just now, it's not that. Get a perspective on the situation for God's sake.

What everyone has to do right now, is to do what they can.Get off your bums. Write those letters. Sack Hamish Meldrum. March on Parliament.Send a submission into the Parliamentary Committee here. Go and see your Lib Dem MP and threaten to disembowel them if they don't vote the right way in the next debate.Play the percentages and the cards you have, even if you think they're crap. If you think you're not going to win, then that means you've got nothing to lose by playing. Just do it.

This is the biggest fight in the history of the NHS. Are you really going to duck out of it? Are you going to go down without a fight? If it does go, in years to come, when your children asked what you did to save it, are you going to say, 'I gave up?' Are you going to sit and moan in a corner with your hands over your eyes waiting for the big bad privateers to come, or are you going to come out all guns blazing and fight them to the last bullet?

Let us go out and meet them. And the next person to moan about the BMA vote is going to get a copy of the White Paper shoved up where the sun don't shine..

Could This Be True?

A sweet grandmother telephoned St. Joseph 's Hospital. She timidly asked, "Is it
possible to speak to someone who can tell me how a patient is doing?"

The operator said, "I'll be glad to help, dear. What's the name and room
number of the patient?"

The grandmother in her weak, tremulous voice said, "Norma Findlay, Room
302."

The operator replied, "Let me put you on hold while I check with
the nurse's station for that room."


After a few minutes, the operator returned to the phone and said, "I have
good news. Her nurse just told me that Norma is doing well.
Her blood pressure is fine; her bloodwork just came back normal and her
physician, Dr. Cohen, has scheduled her to be discharged tomorrow."

The grandmother said, "Thank you.
That's wonderful. I was so worried. God bless you for the good news."

The operator replied, "You're more than welcome. Is Norma your daughter?"

The grandmother said, "No, I'm Norma Findlay in Room 302. No one tells me shit."

All Things in Moderation - Greg Parston and the BBC

A couple of weeks ago, the BBC published this article under 'Scrubbing Up'. This is a column on health and each week someone gives their perspective. It's generally quite good, but this article had a whiff of management about it. The contributor was one Dr Greg Parston, who belonged to a group called the Public Management Foundation. I decided that whatever they were, that they couldn't be innocent, so I put 'Greg Parston' into Google to find out what his hobbies were and who were his associates. To my surprise, the same article came up on News Sniffer with a comment that had been deleted from the original Beeb article and it ran as follows;

Maybe we don't need so many hospitals Greg. However the NHS could have done with the £1billion that Accenture escaped being fined when it walked away from the 'Connecting for Health' IT NHS project and whom you work for. I note you also work for the Priory Group, who stand to gain a great deal from GP commissioning. Any reason why you didn't mention this at the start of the article?

Apparently this broke the Beeb's House Rules and the moderator removed it. So what was wrong with the comment?

A quick check of Greg Parston's activities reveals that yes, indeed, he works for Accenture and up until recently he worked for the Priory Group. He also works for the King's Fund College, whom he praised as 'well respected' in his article. Nothing wrong with sticking up for your own, but should he not have declared his interest? Self praise and all that. He also appears to be a Dr of the PhD kind, rather than the MBChB, as one commenter pointed out.

So why did the Beeb remove this comment? There's nothing inaccurate about it and puts a completely different perspective on the article. And comments like this crop up regularly on 'Have Your Say'; the only difference is that they're usually lost in a snowstorm of remarks from the masses, which this one wasn't. It was obvious and embarrassing. Was that why? And is this proof positive that the Beeb are being leaned on to adopt a specific editorial policy on changes to the health service? Go figure..

Both Sides the Tweed

Sometimes your subconscious utters what you cannot. For some days now I have had a tune in my head and it seems to have stuck there. It’s called ‘Both Sides the Tweed’ and it was written by Dick Gaughan just after the 1979 devolution vote. Like all good songs there’s complete disagreement about its meaning. Ardent unionists don’t like it because they see it as closet nationalist and ardent nationalists don’t like it because they see it as closet unionist. The chorus of the song goes;

Let the love of our land’s sacred right,
To the love of our people succeed,
Let friendship and honour unite,
And flourish on both sides the Tweed.

So why is it in my head? There’s two reasons. Firstly, I was with some friends of mine last week who were talking about student fees and the cuts going on in education. In Scotland, we are not charging £9000 a year to students. However, we have made the stipulation that any student who is not a Scottish resident will be charged fees. Some of those in the company who were English felt this was unfair.

Now, I can see this from a logical point of view. Obviously if England charged fees and we didn’t, a flood of students would cross the border to study here. We’re a small country and we don’t have the resources to cope with that. And yet, argue it as I might, a part of me was in agreement. I don’t like it either. It feels mean.

The second reason this tune will not go away, is because I was preparing a brief on the possible knock on effects of the White Paper in Scotland. As I went through it, I realised that we were going to be facing a similar situation. The chronically ill, disabled and elderly in England are going to be abandoned by the private consortia coming in. Naturally they will try to find help where they can, which means crossing the border to where there is still an NHS. And Scotland will find itself in the dilemma where it is faced with large numbers of very sick and dependent people whom we will be unable to fund. What do we do then? Are we really going to legislate to keep them out? And if we don’t, will it be possible to continue an already overstretched NHS?

I am troubled by this. The SNP and Nicola Sturgeon in particular have played a blinder on health and other issues and I will be voting for them in the Holyrood elections. I want Scotland to be able to decide on its own affairs far away from the toxic mire that Westminster has become, and I want to escape the meltdown that is coming in the English NHS. But I do not want to abandon those affected by these proposals, especially those who are the sickest and most vulnerable. And I don’t, because we are kin. Whatever the future may hold for our governments, whatever the rivalry between us and however many times the English mention the 1966 World Cup, there is a tie between us that binds. And it is the pull of that bond that I have been feeling.

So what is to be done? Well, I think it’s time to revive the good old Scottish tradition of reiving; that is, a border raid. The SNP and Plaid Cymru have taken the attitude that the White Paper is a reserved matter for England and have not voted on it or taken part in the debate (apart from one Plaid member). Well, there’s a time for the West Lothian question and there’s a time for a good bit of murder, looting, pillage, cursing,ranting and general rioting. This is not a time for reason or parliamentary niceties. This bill, the Health and Social Care Bill, represents all that is meanest, lowest and most venal in our society. It has to be treated like the enemy it is. This is a time of war; a war of ideals between the best and the worst in us. And in this instance, the Scots, the Welsh and the Irish need to take the lead. We are holding the torch for the NHS as a public service; we need to march to the front of the column and show the way, not pull up the drawbridge and retreat behind Hadrian’s Wall, Offa’s Dkye or the Irish Sea. And we are kidding ourselves if we think that if we do that, that the bill will not creep. This needs to be killed at its source in Westminster or else it will only be a matter of time before it comes to us as well.

What's the spring-breathing jasmine and rose ?
What's the summer with all its gay train
Or the splendour of autumn to those
Who've bartered their freedom for gain?

No sweetness the senses can cheer
Which corruption and bribery bind
No brightness that gloom can e'er clear
For honour's the sum of the mind.

Let virtue distinguish the brave
Place riches in lowest degree
Think them poorest who can be a slave
Them richest who dare to be free.

Let the love of our lands's sacred rights,
To the love of our peoples succeed,
Let friendship and honour unite
And flourish on both sides the Tweed.

Keep Our NHS Public - Must Watch Video

Wake Up Call Episode 1 "No decision About Me Without Me" from Health Emergency on Vimeo.

Left Out in the Cold

Do take time to read this excellent article on the Welfare Reform Bill at Benefit Scrounging Scum. The picture above is one Kaliya Franklin, who is a campaigner against the bill. Powerful stuff.

Any Willing Provider? Health and Social Care Bill Committee Sitting

Q 77 Nick de Bois: One final question, if I may. It is brief. Dr Meldrum, in respect of the BMA, I am slightly confused about something. The BMA wants hospital specialists to be involved in GP consortia. I understand that; you want that written into the Bill. What I do not understand is why you want it written into the Bill when the Bill allows it in the first place.

Dr Meldrum: It is one of those difficult areas. The Bill is very unclear. It does not even say that you have to have a GP on your consortium, which is a little strange considering that it is a GP consortium. The message that we are getting loud and clear is that hospital colleagues feel pretty alienated by this whole business. Therefore we feel that unless there is something in the Bill giving consortia a duty to consult with both their public health colleagues and their secondary care colleagues, there will not be the reassurance for them that we would seek.
Nick de Bois: Okay. Thank you.

(The Committee sitting can be found here.)

First Committee Meeting of the Health and Social Care Bill - Quote

Q 73 Liz Kendall: This is a question for Dr Meldrum. In the evidence that you provided for this session, there is quite a lot about your concerns about introducing competition, including on price. There are two quotes in particular that I want to ask you to expand on. In the first, you say that it could make it impossible for commissioners and providers to operate in the best interests of their patient population and in the confidence that they will not be exposed to frequent and potentially costly challenge. The second point that you raise is that FTs will become private entities rather than NHS entities, and as such will be subject to the same rules and regulations that apply to other private companies, including UK and EU competition law. Have you received any legal advice about how the Bill subjects the NHS to the competition law of this country and of the EU?

Dr Meldrum: We have, obviously, taken legal advice. On the first point about price competition, we hear the rhetoric that the Government do not want price competition—and quite rightly so, because all the evidence shows that that tends to lead to a downward spiral in quality. Yet it seems absolutely obvious that if a maximum price can be stipulated, you can go below that. It would seem to us to be much better to say that a price should be set.
There may be circumstances in which a consortium, because of local circumstances, will have to argue that it needs a price above that level. That would be a constant
price, and there would not then be competition there. Or there might be circumstances in which the price could be below the level. That would be consortium-wide, and you would have people tendering on not price, but quality.
In terms of taking legal advice, it is quite difficult to get legal advice about the things that might or might not happen to bodies when we do not quite know what they are going to look like, but the legal advice that we have is that the more the body looks like, behaves like and is governed like a private enterprise body, the more it will be open to the Europe-wide competition laws.

As somebody said, if a foundation trust looks like a duck and quacks like a duck, it will be a duck, and it will be treated as a private duck. If we want to avoid that sort of destabilisation and interminable challenge, and the uncertainty that it would give those in consortia, I think that there is a very good argument for making sure that NHS bodies such as foundation trusts are clearly distinct from private enterprise bodies.

Q 74 Liz Kendall: May I confirm this? You think that the Bill raises at least the possibility that foundation trusts could be treated as private companies under EU competition law?

Dr Meldrum: There are certain measures to allow them to compete, in a way, with private bodies—giving them greater autonomy, getting rid of the private income cap and various other things—that would, by their very nature, mean that you would be moving them much further in that direction. Therefore, the uncertainty about how they would be treated is that much greater—even to the extent that many lawyers might say that they should be treated as private bodies.

(The Committee sitting can be found here.)

Dementia Map

This comes into the category of 'this-is-very-interesting-info-but-what-is-it-telling-me? kind of thing.The Alzheimer's Society with the help of Tesco(?) have compiled a study showing rates of dementia compared with rates of diagnosis and comes to the conclusion that dementia is under-diagnosed. Scotland does well; Belfast does better and Wales has done badly in this respect. England varies. I'm not sure what to make of it all.

When my mum was diagnosed with dementia, we didn't tell her that she had it. There was absolutely no benefit to be had by doing this, apart from upsetting her. The diagnosis opened the door to things like Aricept, Attendance Allowance, disabled aids and a place at a local day centre that specialised in patients with early dementia. There is definitely a value in having a diagnosis; there is also an expense in it for the local authority which is maybe what these figures indicate. But there are a lot of people who don't go to the doctor when they suspect dementia, because they know there's no cure and they are afraid to have their fears confirmed. It's also an issue of independence. Not everyone has relatives who are friendly towards them and a diagnosis of dementia can mean an early curtailing of freedoms. Not to mention that a third of people with dementia live alone and never get down to the doctor in the first place.

I think this map is telling us that dementia is under-diagnosed, but not why, and that is something that we really need to know.