And The Winner Is!

Dr Irvine Stuart. This is what he wrote. Read it, and see that which is of real value.

Mandate, What Mandate?

The current ConDems have launched the Health and Social Care Bill, onto a largely unsuspecting public, who did not vote for them, and did not vote for almost any of the elements of this tawdry piece of 'Privatisation'. During the election, Cameron promised to ring fence the NHS, "I'll cut the deficit, not the NHS", was the clarion cry. He was going to stop "top-down reorganisation". He also promised to not raise VAT, and not to raise tuition fees, but that's another story (lying b*****d), but it displays the treachery, of an unholy alliance, of politicians, without any mandate from the people, to attempt to invoke such policies, completely contrary to their hollow promises.

This Bill takes an axe to the NHS, where a surgeons scalpel was needed. It gives the responsibility for Primary Care into the hands of a somewhat bewildered bunch of Doctors, who have little experience of Commissioning health care, and will be placed in the position of both poacher and gamekeeper. Under the requirement to allow 'any willing provider', to provide services, it will become illegal, not to allow the likes of Tribal, Circle, Virgin, Serco et al, to tender for services, which will be decided on price, at the expense of quality, due to the ability they have, to provide care, at less than 'tariff prices'. They will manage this, by 'dumbing down' the staff cohort with, nurse practitioners, salaried GP's and the Health Services versions, of the 'Polish plumber'.

We do need some perspective on this, I think, because I am not one who holds the NHS in reverence, in fact I have often treated it  with contempt ( which it deserved), and described many aspects of it with unguarded venom. But this was because of the many within it, who have meekly accepted substandard levels of care, turned a blind eye to their colleague's incompetence, and worse lied, to protect them, and thus, deny legitimate complainants, justice and candour. But was it ever the same? Doctors have been hiding behind the protection of the 'Bolam Test' for generations, on the simple principle that they are above the laws, that us mere mortals have to abide by. This is the unacceptable face of health care, both in the past and in the 21st century. As the paymaster of physicians, we deserve better.

But, the concept of 'free' health care for all (which is far from free), remains steadfastly my abiding belief. I spent a good part of my youth, and indeed my life, fighting for this goal, both for myself and for others. I became jaded by the actuality, many years ago (politics that is), after years of smoke filled rooms, far from the public eye, where the real decisions were made. The chamber was just the 'window dressing', for public view. 'Real Politic' was conducted always, behind closed doors. I gave it up, to wield my talents, for what they are worth, as someone in the 'real world', where you are judged by your peers, as competent, or having integrity and is the abiding tenet, I live by.

The NHS is important. But it has been flawed. A concept, conceived in the aftermath, of a war that was to change everything, was taken over by the self aggrandising, elite Doctor cohort, who began to manipulate the 'system' for their own ends. This was a construct, that within a few years, became a self perpetuating 'gravy train' for senior Doctors, Surgeons, and Consultants who had a foot in both the Public and Private camps. Manipulating the system, to enhance their income by 'cherry picking' the patients who could pay. Government stood by without demur, simply to keep them 'on side'. Thatcher ended some of that, probably, with an even worse system, that typified the excesses of the USA, where the concept of 'invoicing' everyone, for well, everything, was born. Another 'top down' re-organisation'  conceived in an era, that was to provide a legacy for the future, we have yet to shed; Neo-Thatcherism.

Blair et al, pursued this ideal, with PFI, PPI, Darzi and all the rest of the 'slieght of hand' that attempted to hoodwink, the populace, that 'World Class Commissioning' was the legacy we were to enjoy, by gist of the huge additional funding deployed, to bring the NHS to a 21st century health care standard. De-regulation, privatisation and draconian social policy, was continued with renewed vigour.  Like many before him, he bought off the GP's with new contracts, that they could only have dreamed of. The private sector boomed and management blossomed, together with the 'new era' of measuring everything, except care. NICE was born, the Quality Outcome Framework, was born, and we became gripped by surrogacy in our designs for measuring outcomes, instead of preventing disease or death. We believed the rhetoric peddled by 'Big Pharma', spurred on by that benign presence, in many of our lives, since childhood, our GP, who also bought into this, or retired (many did).

But what a betrayal! That same GP was being paid, quite considerable sums, to achieve these dubious, and often unrelated goals of lower LDL, increased HDL, lower BP, lower fasting plasma glucose, all founded in a flawed, even 'barmy' concept, with little or no scientific evidence to back it's goals. My masked hero has complained about this himself, here and here.

The public bestow, far too much benevolence, on those employed in Healthcare generally, and 'the hard pressed GP' in particular. Yet we are treated, with these appalling protocols, that are costing the earth, to no real effect, except of course the lovely money that accrues to GP's practise, and 'Big Pharma'. This is where real and meaningful cuts, should be made. And I do believe that QOF,s, ISTC contracts,  and PFI's that are eating up the NHS budgets to a far distant horizon, and 'rubbish', protocols that do nothing to advance the health of the Nation, is a folly we will live to regret, and will bring us closer to the 'NHS' plc of nightmare proportion.

Well Don't Say I Didn't Warn You!

Under the Blair and Brown Governments 'watch', over the NHS, more services both for Health care and for Government generally, were outsourced. A revolving door, between the DofH and many of the 'Big Four' accountants and consultants, was established with ex NHS Commissioning czar, Mark Britnell, becoming a KPMG Partner in October 2009.

We now hear, that KMPG Health  has won a contract with NHS London, worth.... well who knows? You see, even though, some of that cash, is mine (and yours), it is now a commercial 'secret', between the new 'pathfinder' consortia, and those with whom they contract, for services. If I believed for one moment that this would be a helpful development, or one that would yield cost savings, or efficiencies, I would be applauding. But I am not.

The involvement of management accountants, in Health care (or anything, if it comes to that)  has done little or nothing, to make it better, or save money. The converse is true. The expansion of 'the management', in the NHS, was almost always preceded, by some Consultant report, demonstrating it's need. Then of course, offering to recruit the needed 'management', or often providing it, as a service. A very large proportion of the ever burgeoning budget in the NHS, was consumed by these pariahs.They were responsible, in the main, for the stupid and expensive, PFI and PPI Projects, that delivered, less. Less beds, nurses, care (fill the rest in yourselves); all for more than it cost before.

The concept, that involving 'any willing provider' and invoking the profit motive, will drive down costs is highly flawed. Witness the view from 2006 of Allyson Pollock of the huge cost of PFI projects in the NHS, which has driven up costs for Trusts out of all proportion to the benefits involved. Or indeed the £12.4 billion squandered on the NHS IT project that never worked, and likely will be entirely cancelled. The 'big four' were heavily involved in the design and execution of all of these failed policies, reaping enormous fees for them and 'bugger all' for the NHS and the taxpayer. Only last June, Gary Belfield, Mark Britnells successor at the DofH also left to join KPMG, no doubt rubbing his hands with anticipation of Lansleys plans and how he might ' turn a dollar' from the opportunities that were now available to commercial providers, in the 'new dawn' of GP Commissioning.

This is just one of the 'buzzards' circling, to see that which they can pick off from the, dying carcase of the NHS, to their own advantage of course. Serco, the company that provides services for Government and the Military, formed a partnership only last year, with Guys and St Thomas' Hospital, to undertake pathology work for itself and other Hospitals. A year down the line, concerns are being voiced about governance, security, and other problems, especially one of cost increases, that had to be paid to the new body as a result of increased demand, amounting to some £2 million (as reported by Private Eye). Increased demand, is endemic in hospital laboratory testing, simply due to the nature of the beast. So long as the NHS, continues to treat for prevention, with surrogate end points and markers, it's patient cohort, it will have to test to prove they are being achieved. It's the climate that surrounds QOF protocols, that drives this. A sort of convoluted, payment by results system, that eats money and will continue to do so, for as long as health care is tied to this barmy concept.

Only yesterday, it was revealed that the estimated cost of overhauling the NHS, to favour GP Commissioning, over that which exists, will be £1.5 billion. This vast sum, will no doubt go to largely to the 'big four' because it always seems to. They will be heavily involved, without doubt. The revolving door between Government and them will see to that. Oh, and of course, we should not lose sight of the fact, that the 'big four' were complicit in the Banking crash, we are all paying for. They helped to design some of the models of profligate lending, and audited the results without demur.

Polypill Trials- Oh My Gawd!

Law and Wald, strike again! Not content with inventing a pill to treat the 'worried well' after their famously flawed 'teleoanalysis', these pair of opportunistic 'researchers', who are obviously gifted with great integrity, because they patented this pill as their own, have now persuaded the Wolfson Institute to begin a small trial to test a modified version of the original. The results will no doubt be promoted as being proven, despite the fact that such a small trial of 12 weeks duration is unlikely to reveal any result that could be viewed as conclusive. It is not being helped either by the next step, which is then to treat all the cohort after 12 weeks, as well as the control group, with the 'polypill' for some two years.

This is junk science, in my book and in the eyes of the esteemed Malcolm Kendrick, who posits that teleoanalysis is (and I paraphrase) trying to prove my aunt is actually my uncle without the benefit of a sex test, or even sight of the wedding tackle! This is the original study from 2003, and it's 'wibble'! Do we really want commence to treat people on a 'just in case' principle, especially when the foundation of the of the hypothesis is so flawed. This is just about as bad as a previous idea to hand out statins with Big Mac's.  The BMJ paper, Kendrick, amusingly derides, is here.

This pair, I believe, typify those in health care, who are prepared to compromise integrity for the sake of  turning a fast buck. It shows us the bright new tomorrow that we can look forward to, going forward with the ConDems. This will be a new shiny world of spin, hype and the delivery of surrogate end points, instead of  real health. The markers laid down, are unlikely to bring about a sea change in the Nation's health. But we will be told they will. And of course, being told, by those with letters after their name in abundance, that it will revolutionise, all of our lives, and make them a lot of lovely money, as well, will only be tested by history, some generations later. If that inheritance, mirrors the results, of the surrogate end points, promised when we started down the road of Statins, then we will, as always, be waiting in vain.

Orthopedics vs Anesthesia

Hot on the heels of Dr.Zorro, my masked hero, comes another but similar YouTube offering. My reason for sharing is because it pretty much mirrors life (well for me anyway). This really did happen, with a few slight differences, the first one being it was a real trauma emergency and the patient did not know she was Diabetic.

Sadly neither did the Surgeon. Obviously he did not understand long words, of a medical nature, but also on this occasion neither did the Anaesthetist. Makes you wonder why they keep a Lab Technician available, day and night and even weekends. Obviously DKA and 19.5 mmo/L (351mg/dl) does not compute, so we'll ignore it.

The Great Swapathon (Change4Life Strikes Again).

More drivel from Government, only this time with support from the 'food cartels'. Yes, under Cameron et al, we now have to endure Government's insane advice, about diet and health, funded largely now, by the Architects of our society's current ills! Nestle, Mars, Kellogg's etc will pay for, along with others, including some of the worst purveyors of fast food, a campaign, to provide vouchers for so-called 'healthy food'. These vouchers will be for £50 to enable participants to purchase, from Asda (Walmart), food that has little to no fat, cereals, and other  healthy options (so called) that will galvanise them into a process of being active (nudge,nudge) and eating in a healthy manner.

As well as being condescending, and patriarchal, this is an opportunity for the sponsors to gain new customers at very low cost; £250m is pretty cheap for a national, Government backed campaign, but the slug in the salad, is obvious to any, that have a background of science, or an understanding of nutritional needs; it's puerile nonsense! Five a day continues as one the mainstays of the apparatchiks, who wrote this nonsense despite the fact that it has been categorically denounced, as ineffectual for protection from Cancer, Heart Disease or Diabetes, see here and here and my previous post. Worst, it provides the opportunity for the the food 'giants' to place themselves in a position of advantage over others, who may actually be producing the components of a healthy diet, without much of the kudos attached to one with a Government 'stamp of approval'.

Cornflakes for instance, are processed maize, patented by that Seventh Day Adventist, John Harvey Kellogg as a palatable source of carbohydrates for a vegetarian, along of course with other 'barmy' protocols such as yogurt enemas (yes really). His flakes of corn, not immediately a popular breakfast choice, became popular in the 1950's and 1960's and infiltrated the UK eventually as almost the sole source of an easy breakfast, for the modern humanoid.. In modern times this, was built upon with numerous variants, generally, laced with sugar and today, my pet hate High Fructose Corn Syrup.

That one example, of the diet, symbolised by the Change4Life protocols, does in my book epitomise the stupid and dangerous view expounded by most of the Government Agencies and Health Charities, that we should consume very high intakes of carbohydrates, especially wheat and other grain based products. But all of these promote high insulin reactions to every meal with this composition. This can and often does lead, after a time, to insulin resistance, the precursor to Diabetes in Homosapiens. With certain exceptions, we are not adapted to heavy intakes of carbohydrates, especially, dwarf wheat and other grain products as William Davis will attest (endlessly, but he has a point) as he does again here. I don't agree with everything he says, any more than I would adapt completely, to a 'paleo', 'ketogenic', or carb free diet. I have however adopted a low carb diet, because it is overall, somewhat more healthy, than the stupid alternative propounded by the successors to the Food Standards Agency (the DofH). I would however, embrace it completely if I was Diabetic.

Since we have adapted to a diet of mainly carbohydrates, laced with seed oils, small quantities of very low fat dairy products and fructose, it is patently obvious that, society's health has declined. In fact, the rise of industrialised food manufacture has almost exactly coincided with this decline. We have much higher rates of  Diabetes, Heart Disease and Cancer, than 50 years ago when this transformation commenced. For Government to enjoin with manufacturers, in an endeavour, to 'nudge' us into a better horizon, based upon the poorly documented and unscientific premis that it is 'healthy', is founded in spin and hype at the expense of truth.

Are these 'suit and tie chic' politicians so blinded by the 'hype' of their co-conspirators, in this cabal they have formed as to not understand, simple biology, or is it a purely cynical exercise in marketing, founded in the need once more to save money? I do not know the answer. None of our current masters, and I include in this NuLabour, who would have done little different, seem to have much in the way of brain cells. They have 'bought' the sales pitch of the 'food giants' and 'Big Pharma' without demur. This is despite the view of the great (late) Albert, who is said to have coined the phrase 'doing the same thing, over and over again, and expecting a different result'. This is, once again, a prime example of futility, laced with danger.

Little Black Cat.

A while back, in another time and place, Blackdog fell in love, in love with Little Black Cat. Maybe now, it's time, for me to tell her story.

"Small and black with belly so rotund and swollen, it almost dragged on the ground, she came to me; crept into my life. Willful and sleek, but most of all tiny, she let me share in the birth of her kittens, with a trust that was almost conspiratorial. She purred, mewed and growled herself into my life and affections, and then left me when she felt the call of the wild. Bringing back to me on her return, gifts of birds, mice and worse; parts of them. Sometimes still alive, I tried to rescue these unfortunate victims of her hunting, without offending her; not always succeeding, I must add. But she came back, squirmed onto my knee, digging into my thigh, with razor sharp claws, and then my chest, until I stroked her shiny, course coat. She often looked into my face, as if to say, 'why so miserable, so serious', I guess she knew.

She left me often, sometimes for long periods, and I fretted, searched for her, questioned neighbours and made sorties into derelict allotments. She always came back, looking askance at my effusive welcome, but devouring the 'fatted calf ' with relish, that caused my tear filled eyes to dry, and contentment, of a sort to be re-engaged. I was pleased that something so wild, so free could like me, even need me sometimes. It was a love affair; I worshiped her and she, well tolerated me. Her absences were painful; like those of an indifferent lover, but sometimes in the depths of my personal despair, she was a shining light of freedom.

Myriah was brave almost to the point of foolishness. With little regard for her own safety, she would take on opponents, so large as to dwarf her. Like a mongoose with a snake, she usually was victorious, due mainly to the ferocity of her attack, and swiftness of movement. When she became ill, I instinctively knew, though others chided me that little was wrong. It seemed to me she was dying; I could not let that occur.

I rushed to the Vet, and it soon became apparent that she had succumbed to that scourge of many cats; hyperthyroidism, making her heart race, and kidneys to flaunt their imminent failure. Fruzemide together with Carbimozole, brought her back from the brink, and after a short stay for intensive care, I brought her home. A regime of medication to keep her thyroid in check, then became the daily battle. Those tiny Carbimozole pills lent themselves to concealment within a small prawn, so I was OK mostly, but sometimes I did have to force them into her tiny throat, feeling awful at the need. Until the establishment of the regime, I had to keep her indoors and she hated it, constantly fighting against her incarceration, then disaster, she escaped!

I searched, the sun drenched summer streets, the byways and woodland nearby, for days, knowing that without medication, the hyperactivity would re-establish and she could die of heart failure. She was a hunter so I knew she would not starve, so I went out in the cool summer night to try and entice her to me. Once I almost succeeded, only for her elude me again. Then one day in late summer, word reached me that she had been seen in the nearby allotment gardens. So through the day, I searched long and hard. Through the nettles and weeds, of abandoned dreams of self sufficiency, I looked, calling her name. As the rain started to fall, that growly mew, so familiar to me, came back. At the base of an overgrown thorn bush, she lay, looking wild and unkempt.

It took many tries, but I caught her up in my arms finally. I held her tight and made for home, in fear of the squirming black bundle escaping again. With blood streaming from my arms and chest, I made it home. Capture complete! Imprisoned once more and with medication in place she calmed at last and ceased attempts to escape. The weeks turned to months and my shame at the incarceration grew; I had curbed this free spirit, but loved that she was safe.She often cried at the door to be freed, and one day, heart beating fast, mouth dry, I let her out, into the outside world again.

She ran out, and then stopped, just a few feet away, and commenced grooming herself. She seemed bewildered to be outside once more, and sat in the early summer sun, then wandered off to inspect her domain, without urgency. I watched her, pleased that she was calmer, less frantic, but slightly sorry that what I had done, was to tame her wild spirit. Freedom had been her essence and I had taken that away, but I had done it, to save her life. That did not sit too well with me. I knew that in humans, this protocol, was slightly resented, by recipients, because it robs them of their tendency to high activity. Many preferring to feel as they did before.

Myriah seemed to thrive, but one sunny Saturday morning, on arising I could not find her, and then heard her plaintive cries from the bathroom. She lay on the cold tiles, in a pool of her urine, her back legs unresponsive to her efforts of movement. A stroke! Holding back tears I dressed and rushed her to the Vet, in the vain hope that it may be temporary or curable. It was not to be; I should have known.

Almost in a trance, I listened to my voice, agreeing to end her life, to avoid the misery she was in, and then held her as the life slipped from her, as the drug infused into her tiny black body. I had loved her so much, but it was over. I dug the grave, beneath the oak my children had planted, from an acorn, years before. I let no-one else touch the spade, this was my duty, my penance, my tribute. Wrapping her gently in a clean towel, I laid her in a hole deep enough, lest she ever be disturbed, and stood back. It was a long time before I eventually filled the hole, wracked with sobs, misery uncontained, unashamed of my tears.

It was a long time, before the sobs subsided, and months before my grief was controlled. Tears would sting my eyes, whenever I thought of her for months even years later. She was just a cat, but had touched something in my soul. She had seemed to have sensed my misery, the depression that had stalked my life at that time. Tried, I mused, to show me  a better way to live; freedom. I had loved her so much because she had been such a free spirit, unburdened by guilt or doubt, as I had been for so many years. Perhaps all these years later it would be fitting epitaph, for me to be free and to live life to the full. And so I did. Or at least I try to, every day for those that are left. I will never forget her."

I wrote these words, five years ago, as a tribute  to my cat who died two years before. I have had nine cats and three dogs in my life and loved every one, and stayed with all to the very end. But none was quite the same as Myriah. I will have no more, lest they outlive me.

Broken Promises Cost The NHS An Extra £250 Million

It was trumpeted widely by both arms of the ConDems at the recent election, that VAT would not rise. That was a lie, because today it has. The vacuous Osborne, has increased it to 20%. It is also significant to remember that only Tory Chancellors have done so, Geoffrey Howe in 1979 raised it from 8% to 15% and Norman Lamont then increased it to 17.5%. It has been the 'milche cow' of successive Tory Governments since it's inception, who in general, and quite wrongly view it as 'progressive'. As the poorest will be hit hardest, it is difficult to see it as anything other than regressive.

Osborne has stated, that he views this increase as "unavoidable", so as to raise £13.5bn towards the deficit, but this is due to the reluctance of this and the previous Government, to increase Corporation Tax or a levy on the Banks who caused the deficit (largely) in the first place. This increase will cost the average household in the UK some £425 per year and likely cost an additional 47,000 jobs in the retail industry. As we have been hit hard by recent increases in the cost of energy, just at the time of the worst winter since records began, together with ever rising cost for motor fuel, partly due to the rise in duty, which in turn then has Vat applied to it (a tax on a tax?), which will now rise again with this increase, it is somewhat hard to see any economic logic, in the increase.

This rise will also add an estimated £250m to the costs of the NHS at a time when they are supposed to be looking for a saving of some £20bn over the next few years. In addition the issue of VAT in general, is going to figure quite highly in the proposal to allow GP's to commission all NHS services in the future. Most GP's are not VAT registered because their Practises are exempt, unless they are dispensing practises (with a pharmacy attached) and even then, most of their output is exempt. This will change however when then they become commissioners of services and providers of that same service, because they will have to bill it somewhere and be billed for many aspects of it themselves. This of course creates an opening for the need for more 'bean counters', to assist in this endeavour and the 'big four' accountants, who already have a stranglehold on both NHS and Government accounting and audit, will no doubt be ready to fill this gap (despite their piss poor record). NHS Trusts and PCT's seem to find it impossible to account for their money, especially VAT, so they employ outside bodies such as these to do it for them and pay the exorbitant fees for the privilege.

So then, the 'law of unintended consequences' comes into play. Costs will rise in the form of VAT that cannot be reclaimed, and the 'big four' will flourish as a result, GP's will flounder in a welter of bureaucracy and the Government will reap the consequent tax benefit. And, of course the poor old taxpayer will be caught in the middle, paying for it all, at a time when they can ill afford it. Cameron and his millionaire cabinet will not even notice.  Maybe that was the plan?