How the NHS failed me and mine.
What it did, to the most important person
in my life and how it could happen to you unless
we do something about it!

Tuesday, 27 September 2011

The Road to Perdition.

So as the Greek storm threatens the destruction of what is left of it's fragile democracy, and the two Ed's join together in a trip to Knotty Ash, in an attempt to rival Ken Dodd's stage presence, I look to our leaders for guidance and comfort. Cameron's not for turning; I vaguely remember that from my past. No, it's gone. Ball's will not promise any change. And Angus is pissed off with Tesco.

So, as the sun slowly sinks over the UK economy I am left to my own devices to ponder the solution for our ills, and I am reminded of something that one of my few hero's said. "The world cannot get out of the current crisis with the same thinking, that got it there in the first place." Yes it's from the wondrous Albert (Einstein that is). As is usual, that which he said about the crisis of capitalism applies equally now, as it did way back in 1949.

The British political classes, irrespective of whichever party to whom they belong, have one priority; the repayment of the 'deficit' by those who can ill afford it, and didn't cause it, rather than those that did and can. The Financial sector, basking in the sunlight of handouts and bonuses, is completely unperturbed, safe in the knowledge that Governments all, are held in thrall by their pronouncements about whole economies, and remain hostage to the fortune of diktats honed by wankers bankers in boardrooms throughout the Western World, despite their implication in the very crisis to which they profess to have the solution. All whilst we continue to wage wars in lands afar, support the 'Arab Spring' with strong (ish) words to the dictatorships to which we still peddle arms, and rain down Brimstone missiles on the opposing side, and the innocents, in a Libyan 'proxy' war, fueled more by the prospect of oil, than any righteous hope of the rise of Democracy. I have no time for Gadaffi, but frankly none for the self styled rebel leader Mustafa Abdel Jalil either, who is staging little more than 'coup' than any revolution, and has slaughtered thousands both in the past, and now in his pursuit of power. Not of course forgetting the Napoleonic ambitions of one Nicolas Sarkozy.

This moral bankruptcy is redolent of the paradigm in politics of the past thirty years, the Neoliberal agenda. That which espouses the 'market' as the most efficient tool of Administration and accepts, on behalf of those who vote for them, that a large proportion of the people will be condemned to both poverty and/or inequalities that spring from it's policies. It's democracy usurped by the rich for the impoverishment of the remainder. Forged by the 'Iron Lady' in concert with an aging film star who ruled the USA in the early eighty's, it has predominated Western politics ever since. This is why politics is bankrupt of any new ideas that can extricate us from the hole in which we now reside, but which nonetheless pursues the same one's anyway, as it has for the past thirty years. The word 'Socialist' has been eliminated from all the parties of power in the Western World just like 'nuclear' was expunged from the names of the power generators, and who now hold out their hands for subsidy from the people, to build a new generation of reactors, so they can charge even more for the product we can none of us live without.

Neoliberalism is the reason why the NHS is what it is now and more, what it is to become. The Paymaster once more becomes the supplicant, hoping for some crumbs that may be scattered from the 'top table' of Serco, Carillon, Crapita, and all the myriad facilities managers, management accountants, hedge funds, merchants bankers who 'leech' off the funder of their profligacy, the people. This agenda is not openly touted, so the 'paranoid indifference' of the masses is largely a myth, invented at the dinner parties of the chattering classes, and the pages of the 'Indy' or the 'New Statesman'. It is in fact a hidden agenda, an open secret that is almost the 'elephant in the room'.

It's the movers and shakers, who 'flit' through the revolving door of public service, and back again with the ease of those who know power and relish in it who have shaped this model. Heavily subsidised from the taxpayer, they feign resolute independence and ardent if not passionate belief in the 'market' to sort out all of economy's ills whilst enjoying the hypocrisy of their six figure comfort of taxpayer gold. The rest of us look on in startled incredulity that such a belief system can be sustained, but that is the supreme tenet of politicians; perverse and single minded confidence in their own stupidity, as being wisdom. It is the MP's who have never known what it is to work for a living in a 'real' job, who came straight from University, to research assistant, to PPS, or the 'Parliamentary Silk' from a lowly place in 'chambers'; all of these are responsible for the paucity of 'real people' in the corridors of power, and for the rise and rise of the Neoliberal agenda.

So then Ed and err...Ed. Try to remember you are in the Labour Party, an organisation formed from the blood, sweat and tears, all spilt on its foundations, in a world that was different from today's. We can return there if you continue with the cowardice and hypocrisy of Blair and Brown. But I cannot forget the men of my youth who recounted tales of fighting in the Spanish Civil War, of battles with mine owners, and of blood spilt to provide the children with enough food to sustain life. If you want us to return to those days then just go as before. You and your ilk will not feel the sting of poverty, wrought in the name of the 'deficit', your deficit will be in the integrity that you fail to display. Less 'bollocks' and more balls is what we need!

Friday, 23 September 2011

Lying Bastards!

Writing this post on my shiny new computer, after the old one gave up the ghost and left me bereft of data, that I still have to retrieve, and of course the means to post anything. Should have gone to 'laptop savers' ie; Angus Dei's Kitchen but took it to my local poxy computer shop, where it still resides.

Andrew Lansley has been bemoaning the dreadful position  of NHS Trusts who have been burdened by huge debt born of the Private Finance Initiative 'foisted' upon them by the 'previous lot' ( Blair and Brown). In the process conveniently forgetting that, for all their faults, which were legion, it was an inheritance of Conservatism of the Neo-Thatcher era, who actually 'spawned' the beast. Politics has a dreadfully short memory.

PFI was the invention of a certain Norman Lamont (with others) upon the relaxation of the Ryrie Rules in 1992. In fact a number of major projects were well under way or had even been completed prior to the victory of the Blair Administration in 1997.

The M6 Toll Road (1992)
The Second Severn Crossing (1990)
Croyden Tram link (1996)
Northern Line Trains (1995)
And many others, including the Channel Tunnel.

Blair of course embraced PFI with almost evangelistic zeal and built further upon it, to the extent that almost every public project on his 'watch' was financed in this way. Graham Allen's paper from 2003 details the position taken by 'NuLabour' in its flawed construct to sell off our childrens' futures, to finance grandiose plans, that would make them look good, but conceal the real cost. Even to the extent of selling the Army's estate along with that of HMRC, then leasing it back at guaranteed rates. The company involved was of course based off-shore so we don't even get any tax back for that which we pay. Which is that which all parties involved in PFI actually factored into the cost, so as to represent the deals as 'better', than less complex vehicles for funding that were cheaper, and at least left the taxpayer with an asset at the end.

What has happened, is that the Governments Advisers, both now and then, (KPMG) factored in the taxation element into the cost analysis for public consumption, then were retained by the PFI outfits to advise on how then, to avoid the tax. Some might call them treacherous bastards, but I could not possibly comment. What is sure is that Government, both central and local were queueing up to get deals brokered and operated by the 'usual suspects' ( Carrilion, Serco, Interserve, Capita et al) which were then often sold to offshore equity' finance outfits and they then 'pocketed' the difference, or simply refinanced once the rates got lower. After all, the new owners were looking at profit stream of the order of 15% to 17% per annum and the operators were able to charge £200 to change a light bulb, or £500 to hang a picture, (I've just hung 12 in 1.5 hours for £6 in hooks) as well as exorbitant service charges.

As all these participants were and are contributors to the Tory party 'coffers' and a number of the cabinet have either worked for them directly or indirectly, and they objected little about the use of PFI during Nu-Labours years, it seems a little hypocritical to 'cry wolf' about at this stage. And of course Gove has just sold the Governments share of the 'Building Schools for the Future'  LLP, (as reported in Private Eye) which owns the 700 schools already built under the PFI scheme, he recently closed on the grounds of "massive overspends". And to whom were they sold? Yet another 'offshore' investment outfit called International Public Partnerships, based in Guernsey. So no tax there then!

This Government, despite all the rhetoric they spout about about PFI, seem to be just as hell bent on utilising this highly flawed model of financing, as the 'last lot', and they did after all both invent it and facilitated the legislation needed to allow its rise. So I would posit that Lansley's complaints are really for 'public consumption' only, with  a whole different agenda, being planned behind the scenes. So is anything safe in the ConDems hands? Well probably not; they are politicians after all. A treacherous breed at best!

Thursday, 8 September 2011

The Point of Departure.

As the Leviathan that is the Health and Social Care Bill, lumbers inexorably to a vote, shrugging off the attacks on its content, like a Tank does small arms fire, I have pondered as to what I would like to see the NHS become. Certainly not that which it is now, so I do not want to 'save it'. And 'curing it' does not appear in any agenda for Health that I can conceive of, because the cancer within has all but consumed the host. Spectacles of a rosy hue, seem to have been donned by the 'liberals', now that their precious NHS is under threat. All the transgressions of the past seem to have been forgotten and it is now to seen  as a beneficent, almost angelic body that we should strive to save from the evil machinations of the Tory's. In reality, nothing could be further from the truth.

At it's inception, the NHS was a construct based upon universal health care for all. Sadly that did not compute with Doctors of the day, so it was 'hijacked' by the Consultants and whilst the 'proles' got their boils lanced and their teeth pulled for free (well almost), there still existed a 'cabal', a 'mafia' of senior Doctors and Surgeons who dispensed their largess very much on a part-time basis, but nonetheless held sway at the BMA and called most of the shots. Several incarnations later (there were many), once a few of the miners son's had made it to Medical School and infiltrated into Hospitals it became it little less elitist, but the 'firms' still held sway, with the 'rugger playing' registrar being more the norm than a lad from the terraces of an Allan Sillitoe novel, even more unlikely a girl! So we move forward through time and seventeen major reports and reorganisations later we arrive to today, or rather the white paper of the Coalition of July 2010 Liberating the NHS (didn't realise it had been imprisoned) from which sprang the Health and Social Care Bill. But, long before then the NHS had lost it's way.

The Thatcher years saw the invention of 'fundholding' and of course the bureaucracy attached to that hugely expensive and pointless accounting system that it was, causing mountains of paper invoices to be generated and mailed to each component of the system. The invention too of the Hospital Trusts, and of course the 'internal market', providing an entry for Private Health care to the NHS, and a proliferation of 'for profit' organisations and Hospitals. Tony Blair, not wishing to be seen in any way as 'socialist' perpetuated and embellished many of these policies including privatising the 'out of hours' provision of Primary Care, Foundation Trusts, incentivisation of GP's and of course the spectacularly useless and costly IT projects, together with the expansion of the Private Finance Initiative. In fact the only good thing he did was to eliminate the internal market, only sadly to decide to reinvent it just before he left office.

In all of this we have seen the 'legacy' of the Thatcher years become the Neo-Thatcherite agenda of today which sprang from the Neo-Liberals of yesterday, all completely oblivious to the vast sums of money they were spending, to achieve little other than the enrichment of an 'elite' cartel of Accountants, Facilities Management Companies, and Consultants, not forgetting 'Big Pharma' of course and to the detriment of the 'end user', the patient, who had no input to all of this, except of course to become a 'victim'. I say victim without any hesitation, because the joint efforts of the politicians, GP's, Consultants, and all the retinue of Nurses, Bureaucrats and hangers on have done virtually nothing to improve the lot of the patient but simply improved their own. I have no desire to save anything for any of them, they are completely undeserving even of the the little patience that I have left.  The GP's are more concerned about their pensions than patients, the Hospitals more interested in the preservation of their empires, even if it's at the expense of patient safety, than adopting better and less invasive protocols, or the concentration of specialist services in regional centres and thus improving mortality (childrens heart surgery?). The health care charities have been 'hi-jacked' by Pharma as patient advocates, to peddle drugs like Avastin which may prolong very slightly, the lives of terminal cancer patients, at enormous expense (and their profit) and with a whole host of side effects that can be terminal in their own right. All in the NHS and those outside it who will be 'willing providers', have an agenda that has nothing to do with patient care and everything to do with profit, with preserving power, extending control and personal gain.

Why for instance do we continue with Angeograms when we can utilise Electron Beam Computerised Tomography which is non-invasive, less dangerous and considerably less unpleasant. Because it's cheap and a lot of people will lose their jobs, power and influence if we 'can' it. Why do we continue with the 'sham' treatment of healthy people for heart disease they haven't actually got, because they have fulfilled some test criteria for a 'surrogate marker' evidenced by one of (several) computer 'risk scores' that are frankly useless and have been proven so. We also 'treat' perfectly healthy pregnant women, simply because 'we can', to ultra-sound scans, hospital births, inductions and other invasive procedures that for most are not needed, when we should be saving them for those that are 'at risk'. Why do we allow 'Pharma' to 'bribe' physicians and Surgeons with nice little 'jamborees' in exotic locations, 'free lunches', financial support for 'pet' projects and studies, all in the interest of promoting their dubious and often dangerous drugs and devices. Of course no Doctor would be influenced by such largess (and Genghis Khan was a really nice guy).

That is where I depart from the 'curers' and the 'savers'. I have seen my best friend die from stupidity and misdiagnosis. My father from neglect of his chronic illness. Almost lost my sight in one eye and watched the woman I love treated with appalling callousness, have her life endangered and her future blighted forever, for the want of diligence in simple protocols that are the foundation of medicine. Many of my friends have lost everything in their lives at the hands of those who swear to 'do no harm' and I have seen them rage at the impotence they have felt in their pursuit of justice and candour.

Denial of their incompetence seems to be the only thing at which Doctors are actually any good. So I want not to save the NHS, I wish it to be demolished like a fire gutted, dangerous building. Let the ConDems do their worst and destroy what is left whilst the Labour dissemblers snipe at the minutiae of the Bill, sure in the knowledge that they would have done little differently. Perhaps then, when we see yet again the differences and inequalities that will have been forged in England's NHS and we look North to Salmond's fiefdom where a new social democratic model is being invented, we can rebuild it as it should have been. I truly hope so, before I'm saddled with the DNAR.

Thursday, 1 September 2011

Screening for Cancer Fails to Prove its Worth.

I have talked at some length about Breast Cancer Screening  before, and accused those involved to be more interested in perpetuating the myth that 'screening saves lives' than in providing facts for women to make an informed decision. Well, the clamour is getting louder for 'real information' to be available for this and other screening protocols and what are the advocates doing to quell the disquiet? Closing their eyes, ears and more importantly their mouths.

The recent study in the BMJ showed clearly that screening (mammography) is not responsible for the reduction in Breast Cancer mortality seen in six Eurpoean populations. In fact, in a few of these countries, mortality was reducing prior to any screening protocols being in place. The response of the screening lobby   ( a powerful vested interest), has been resounding silence, to these obvious negative inputs to the argument. Displaying the trait it seems of the 'three wise monkeys', as Richard Smith  explained on his BMJ blog.

Screening for Bowel Cancer too has been having some bad press as the relative risks are presented as absolute in the leaflet provided to the prospective cohort (including me). In truth the risks are quite small and the relatively 'crude' methods involved in screening lead to many false positives, waits for confirmation, and much unneccessary treatments, investigations and, the attached risks of harm involved in colonoscopy are actually higher than the likelihood of Colerectal Cancer (much higher at 1 in 150) and the risks of  procedure causing perforation and the consequent risk of pertonitis is 1 in 1500. Risk of death is pretty low at 1 in 10,000, but that is close to the absolute risk anyway, which is less than 1 per 1000 in ten years of screening.

Mitzi Blennerhassett, wrote in Macmillan blogs about the dearth of information, and indeed the bias of that available and she is (thus far) a survivor of colerectal and breast cancer, so she talks from the frontline. The replies to the BMJ about the study also make fascinating reading, with much criticism of the lack of evidence and indeed the arrogance portrayed by most in the 'business' (for that is what is) when questioned as to the efficacy of mammography or indeed most forms of cancer screening.

The NHS spends vast amounts on these protocols, allegedly to save us from 'harm' and an untimely end, but fails consumately in simple areas of diagnosis of illness in so many patients, treats the elderly with appalling disdain, even cruelty. Is lacking in 'adequate out of hours' trauma provision. Trains Doctors to be patently less good at the job than in the past, then 'throws' them into the maelstrom of A&E with little or no mentoring or backup. When scientific evidence is presented that indicates that a drug or procedure is harmful, especially Primary interventions for prevention using 'surrogate markers' or end points, rather than a patient actually being ill, they ignore it!

Prof. Michael Baum with others, ( 3 pages of them) wrote to the Sunday Times about this lack of information and the virtual conspiracy of silence that exists around the harms, way back in 2009. He was ignored. He wrote again recently but that's behind a paywall now so I can't post that link. The signatories are seeking  a judicial review of the screening programme because they are so incensed by the lack of information and potential harms it causes. The conspiracy of silence continues with evidence stacking up in the aisles that we do little to end the tyranny of Cancer but much to find it, where it doesn't exist and even more to treat it with questionable drugs and procedures that may in fact add to it's virulence. A scientifically informed choice is what is needed and an NHS dedicated to curing the sick and the lame, and giving comfort to the dying, not that which we have now.