Good, But Could Do Better?

The King's Fund has published it's verdict on the NHS in England after 13 years of Labour's governance. It is not surprising that some criticiscms are evident, but, on the whole, it is a pretty thick coat of white emulsion with a few areas of wall showing through.. As a large number of the Funds members, are ex NHS, or participants in it's associated Quango's, it was unlikely they were ever going to administer a large dose of opiates, to the patient and pronounce it dead, despite it being 62.

There are a few adverse comments in the report, probably to convince the watching public that they are doing something, but on the whole the ex-chief's handprint seems in evidence, to cynical little me. Having only left in January, Nial Dickson's influence, is unlikely not to have been present in its compilation. Sure, there have been a number of goals achieved in thirteen long and expensive years, mainly in the reductions in waiting times and the establishment of NICE, but waiting time reductions, at the expense of quality of care, seems a pyrrhic victory to me. As for NICE; well more a defeat, snatched from the jaws of victory.

They also congratulate the establishment of the NPSA (National Patient Safety Agency), as do I. It's somewhat of a pity that most Trust's ignore its advice and fail to implement much of it's protocols  Also highlighted, is the reduction in Hospital Aquired Infection, but fail to register that it is the Trusts and the Dept. of Health's fault, that they allowed these appalling infection rates, to evolve in the first place. Dirty Hospitals and over use of antibiotics fails to get a mention as the root cause. Under reporting, is mentioned as a problem, even a major one, but it only mildly states that "there is some way to go, on creating a fully open culture of reporting (of incidents) within NHS organisations". No mention of any 'whistleblowers', note, or the need to support their courage, or future livelihoods.

In health promotion and the management of chronic illness, the best they can come up with, is the ban on smoking in public places, as being responsible, in the future, for less associated ill health. But, that progress in the reduction in the harms, caused by excessive drinking and obesity has been "elusive". Might have something to do with Government failing to kurb supermarket sales of drink, at loss leader prices, but we don't mention that. Or the rubbish science of the of the Dept. of Health and the Food Standards Agency telling us to 'eat healthy and exercise', when exercise does little to reduce wieght (although it can make you a little more healthy), and the diet suggested, rich in carbohydrates, is in fact likely to increase your wieght, not reduce it. They predict, despite the applause given to the dubious advice mentioned, a future upsurge in obesity-related ill health. Well there's a surprise then! You would think that after twenty odd years, of this type of advice, that it's obvious there might just be a flaw somewhere, in the hypothesis. But no, if it's not working, let's keep doing the same!

Applause is given to GP's for responding well, to the incentives provided for chronic care, against the 'performance indicators'. But as yet, little has been achieved in avoidable admissions to Hospitals. Which translated means; we've given out lots of money to doctors to hit targets, but it's done bugger all in keeping our diabetics, COPD and CHD patients out of A and E! More rubbish protocols no doubt, that do little, if anything to advance the health of the patient, but ticks lots of boxes and makes lots of money for the cash strapped doctors.

So far as clinical effectiveness is concerned; some progress is highlighted in the areas of CVD and Cancer. Falls in mortality for both, being credited to the huge expenditure in these areas. The truth is that CHD and CVD death rates have been falling, since the end of the 2nd World War, long before any interventions by Medicine. And Cancer rates have increased substantially, but mortality from Cancer has fallen, probably due to our ability to prolong life to the point where death is no longer counted. If you have survived five years after diagnosis you are (statistically) cured. The report does touch upon the fact that our NHS is lagging quite some way behind our European counterparts in these areas, but the level of censure is quite restrained. The same applies to their verdict on cardiac and stroke care, with variations in quality between parts of England and other comparable countries. So no bouquets there then. A curious conclusion is made about mental health services, giving the NHS an A-plus it would seem, for early intervention and crisis resolution leading to reductions in acute admissions. And here's me thinking there was a paucity of treatment possibilities other than a box a of pills and a waiting list for CBT, but I must be losing the plot. Probably because I couldn't get any treatment when I needed it (except privately of course).

Moving swiftly on to Patient Experience, we enter the realm of  la-la land, with the assertion that "public satisfaction with the way the NHS is run, has been increasing steadily for the past few years". Which NHS are they talking about, and in which country? There is little evidence, that I have seen of such a phenomena, in fact the converse is true. Gosport, Stafford, Birmingham Childrens; the list stretches to my horizon at least, but obviously not the Kings Funds researchers, who seem to live in some sort of 'bubble' insulated from the Internet, the Newspapers and Dr. Foster and probably the NPSA. There is an entreaty for Trusts to build a complete picture of their patient cohort to further the ends of patient centred care, or some such waffle, but the view they have is a somewhat more rosy one than I have encountered, or had related to me.

They do take the Trusts to task, about the high rates of infant mortality especially for deprived areas and overall life expectancy for the poor. But they could hardly sweep it under the carpet when the third world does better than us in many of these areas of concern. But they spoil it all by telling us we face few financial barriers to accessing services. Yes sure we do, if we are lucky, go private, or have an accident on a weekday between 9 and 5. Outwith that it's a lottery. So their view of Equity is that it represents a 'challenge'. One more statement of the 'bleedin obvious' (how much do you get for writing this drivel).

Efficiency also is viewed as a challenge, with productivity being difficult to measure and the increase in activity seems to be limited to devising methods to measure it more efficiently! It also seems to suggest that efficiency needs to be targeted at patient services rather than losing a few overpaid,. fat cat managers, of whom we seem to have legions. And mention is made of the rather alarming fact that half of all the additional funds given to the NHS since 2002, has been given over to higher pay. As the management has had increases in the order of 84% in the last ten years with chiefs at 101%, it seems my taxes have gone to keep the 'elite' of the NHS in sparkling wine and Volvo's. I would rather it had gone to fund real nurses to get back to nursing.

Accountability gets a big mention with praise heaped upon the Government for instituting 'independent regulation' for health care organisations. Hang on am I getting this right? They have made professional regulation more responsive to public rather than their own interests. When? How? I am not making this up; honestly! The only thing they've got right, is that the arrangements for redress are yet to be developed. Too right they are! Will Powell's been waiting for redress for twenty years!

They conclude this pile of fawning irrelevent crap, with at least a few words of censure, that I have 'cherry picked' because at least I agree with them; "unwarranted variations in access, utilisation and quality of care, even where national guidlines exist". It then drones on about government needing to  aspire to deliver quality healthcare, to all patients, all of the time.

It is without doubt, one of the most irrelevant, overblown documents I have read for some time. It plays to the Gallery of Government rhetoric, touches it's forelock to the NHS and makes a few slightly censorious comments about that which we all know to be defective. It's the sort of report I would expect from Andy Burnham's spinmeister, if of course I did not know any better?

If you wish to make your own decision about this report  read it here.

5 A Day - Not So Good After All?

Details of the EPIC study of the relationship with Cancer and the consumption of fruit and vegetables, has at last given its findings, to the World. And what do you know; there is little to no evidence, that consumption of these vaunted dietry components, has any effect on the rates of Cancer of all types.

Developed in 1991 by the World Health Organisation and adopted in the UK, with the usual mindless vigour associated with Government dictats since the beginning of time, we were told to get our 'five a day', on pain of every possible disease in the Medical Dictionary, especially Cancers. As overall we have all adopted this, to some extent or other, it is alarming, to say the least, that overall rates of all Cancers have increased by 21% in men and 45% in women between 1971 and 2007 (Office of National Statistics). Now after some nine years study of 400,000 people (not half a million as reported by the BBC) the relative risk is reduced overall by 4% or 2.5%, depending on the interpretation. That was across the board, men and women, and relative risk is not a valuable guide. Absolute risk, is the true arbiter of whether or not you are likely to fall prey to a particular ailment. If one takes behavioural variables into account, the protection afforded, is only shown to have any significance in women, drinkers and smokers. In addition, it seems that intake of fruits showed a much weaker association, with protection, than did vegetables alone. There is some possibility, as well that tomatoes confer some benefits, associated with their Lycopene content, which is a powerful anti-oxidant.

So everything changes again, much like the association of eggs, with high levels of cholesterol some years ago, now rescinded to the advice to eat as many as you like. Continual intervention by Governemnt, with 'bad science' based on unproven hypotheses, that later prove to be false, pervades all of our lives. True science is continually ignored for the sake of convenience, or political dogma. After all, it sounds good to tell everyone they are killing themselves with unhealthy lifestyles and advising them to moderate this behaviour, rather than looking to the true components of illness and disease. That might upset the food lobby, which is almost as bad as 'Big Pharma'. Why? Because food and diet are as important to our everyday health as is any drug or medicine and thus we need to choose with knowledge, not dogma.

I and many others, especially scientists, believe that high intakes of fruit, are as bad as high intakes of carbohydrates, because fructose in isolation (without glucose) elicits litle or no insulin reaction. Therefore it is highly likely that most will go to adipose tissue for storage. So yes, simply put, too much fruit, especially the highly cultivated, high fructose varieties grown today, or concentrated fruit juice (smoothies), can make you fat!. Vegetables conversely, of the green leafy type, are good for you, provided they are consumed in moderate quantities, and can confer considerable benefits.

It's going to take some time for any advice to change, if at all.. Most doctors and scientists in the employ of Government or Business do not want to relinquish their prejudices without a battle, even in the face of incontravertible evidence, that they are wrong. A lot of people died, as a result of giving heart attack patients bedrest, not so many years ago, but it was the accepted view, based again, on a faulty and unproven hypothesis. The truly brave scientists, are assiduously ignored for much of the time, despite a wealth of evidence in many areas of diet, nutrition and healthcare that what we are doing is simply wrong, even dangerous. As Mencken said, "for every complicated problem there is a solution that is simple, direct, understandable and wrong", (my italics).

Government and it's many agencies, live in a la-la land of myth, legend and poorly thought out theory. But when they propound those views in slick, expensive campaigns they go a step too far. No discernable improvement in the lot of the Western citizen has been achieved by promotion of 'healthy eating', in fact the converse is true. Diabetes, Cancer and some Vascular disorders, including hypertension have been steadily rising over the years, that this rubbish advice has been propounded. None of the interventions, which cost many billions in resources, that we can ill afford, are based on any sound principle. Protocols to lower cholesterol, blood pressure and cancer are defeated by the very measures invoked to reduce them. Yes, lifestyle measures can make a difference to all our lives and they are cheap; they could save billions and many lives as well. But they have to be the right one's, not the rubbish propoganda of the Dept. of Health (sic) or the Food Standards Agency.

Read this report yourself at;  http://jnci.oxfordjournals.org/cgi/content/abstract/djq072

"A void in my soul"-( NHS Complaints - Part 2 ).

My friend and fellow blogger Angus Dei, wrote those words yesterday. I have no monopoly on eloquence, or indeed anguish, but it sums up the effect that the loss of hope has on all that tread the route of the Complainant. Far more succinctly, than any that I have penned. Far more for he, and many others that I call friends, that stand with me in the pursuit of justice and candour, for they have lost loved one's. I have not, although it seemed a close call.

I once said, that this endeavour can be likened to wading through a swamp, with a dagger thrust in your heart, but, yes, there is a void in mine and all those hearts, that battle with a system so designed to make you fail, that it can and often does break the spirit. It is really not the system even, but those that operate it and the framework in which it sits. The Orwellian structure that the NHS has become lends itself to a system of 'them and us', with all the power and resources vested in the state run behemoth which the Complainant must battle. For you to win is virtually impossible; you are very much 'David' to their 'Goliath'.

We none of us, I believe want revenge, but we do want redress. By denying this need by the many constructs they place in our path to any sort of justice, they engender that primitive emotion within us, often to our detriment. We become obsessed, paranoid even to wreak some damage against this implacable monster that robbed us of our well-being, confidence, complacency and even sanity. We 'rage against the machine' often in self destructive and even dangerous ways. Many are wracked with guilt; the guilt of the survivor. We are reduced to automata, thinking of nothing but the events of our downfall. We shun friends and family, make new enemies, often of our friends and even, of the loved one's that are left.

If you are lucky, as was I, before you completely self destruct in a welter of pain and misery, impotent rage and all the damage these inflinct; something or someone brings you to a realisation that it is not your fault. You are neither bad nor mad, just damaged more than you would ever believe possible.  I came close to losing the very thing that made my life bearable, the love of the person for whom I was battling this implacable beast. I sat in tears for long periods, couldn't get my breath, heart pounding, reaching for that cigarette, the bottle of booze.

Taking care of her became obsessive, seeking every way possible to help, to heal, to make me hurt for the pain she was suffering. I needed to pay for the damage to her, for which I imagined I was responsible. I had let them harm her; I could have stopped this, it was all my fault. I am not cured of this, nor will I ever be completely. But victory in the battle with Authority would have helped to heal some of the wounds. Would have assuaged more of the guilt than it has so far. But it has not been so. We are still in the limbo the system leaves you with; waiting for the next episode in the saga of the Complaint.

NHS Complaints - Stage 1 - Local Resolution

A Critique from a Patient.

"The first problem encountered was the delays in obtaining Medical Notes.

Although these are supposed to be available within 20 days of request, that means 'working days'. You have also to send a fee, just register your need (£10) so they can assess the work needed and then tell you of a further fee of maximum £40 (which it always is) to provide you with the copies. Nothing will be done until your payment is recieved and processed, so we are already well beyond 20 days overall. You will in fact, in all your dealings with complaints system, find that time assumes an elasticity akin to a rubber band.You are of course at some disadvantage, because you have no idea as to what constitutes a complete set of notes or otherwise, or whether some have been witheld. 

With your notes to help, you can then formulate your complaint and forward it to the Hospital or PCT. Again the passage of time will extend to suit 'them' rather than you. Although protocols are laid down, every excuse will be made to delay, such as people off sick, on leave, left the department, abduction by aliens ? All of these calculated to allow the passage of time to obscure issues and your memory of events.

Your reply will eventually arrive; probably penned by a Complaints Manager, or worse 'A Patient Experience Officer'. It will usually be condescending, rich in terms that you may not understand unless you have medical or scientific training and littered with excuses and obfuscation. You may also recieve some possibility of an apology for the experience you have had. Or, an admission that certain things that should have been done that were not. And of course they will ensure that such problems will not re-occur because they have measures in place to ensure it will not.Pure 'bullshit' of course, and should not be countenanced by any complainant. You need to know that their measures will be put in place and be seen to be so. But of course they are unlikely to invite you inspect or check this out; you are simply expected to accept their word.

Remaining dissatisfied at this stage, you may take advantage of a meeting that may be offered to discuss your complaint. You will assume it will be with Doctors or others who had a hand in your treatment. It won't; it will be with the machinery of the official excuse and bafflement department. The specialists, whose role in the scheme of healthcare, is to navigate a safe passage for the Trust through the complaint, to achieve the best outcome for their employer. You will not be allowed to put a face or even often a name, to the Architects of your treatment. They will be hiding behind the 'stonewall' of the Medico-Legal team with whom you will be confronted. This usually fronted by a Consultant, not in the normal sense of the word but one that mainly earns a living being an Expert Witness, or Single Joint Expert in Private Practice, as well as taking taxpayer gold in the NHS. These 'mercenaries' of Medicine, make a handsome living working for anyone who can afford their extortionate fees or of course the NHS. Yes we are paying them, to deny us justice and candour, and get their cronies off the hook.

Obfuscation will be the order of the day; issues will be clouded, and finally you will be told that any negligence in your treatment is a 'matter of opinion', as to whether or not your complaint has value. This is the 'perfect storm' of medical errors defence, 'the bolam test'. They say that patriotism is the last refuge of the scoundrel, well Bolam is the final defence of Doctors who have transgressed. If a 'body of opinion' within the Physician cohort agrees with the treatment you feel to be negligent, then it is correct. It is unjust, counter intuitive, robs you of the redress that you seek, but it is the Law of this land.

Your meeting is finite. You will not be allowed to overrun, despite the fact that you may be distressed by the dissection of your experience. You will be alone or with your ICAS advisor, who may, or may not act as moderator. You also have to remember your opposition are important and busy persons, with meetings to go to, money to make, and more complainants to shaft. You will at some time be asked what you want 'them' to do about your complaint. Pretty much a 'when did you stop beating your wife' question. They will also apologise for the poor experience you feel sums up your treatment, but will give no tangible hope that anything will change. 'Smoke and Mirrors' is what you will be shown, all signifying nothing.

You will leave at the termination of the allotted time, feeling lost, distraught, drained of hope, even doubting your own veracity. Probably in tears, as was I and my J, with their weasel words of sympathy ringing in your ears. And of course with your hope of redress in tatters".

Lies, Damn Lies, and Statistics.

It has long been a suspicion that Data presented by the NHS did not compare with anecdotal evidence from the Patient cohort. More than anywhere,  the data for time spent in A&E, seemed by many, not to concur with with their personal experience. But of course the view in isolation of an individual, is subjective and often viewed by them as, the exception rather than the rule.

All Hospitals have a target time of 4 hours, from arrival in A&E, to discharge or admission. Target times are shorter still for Trauma Orthpeadic or other urgent admissions. Currently all are supposed to achieve a minimum of 98% of the target. Whether we believe in targets is irrelevent, especially to badly injured or sick patient who needs help. So the outcome does have merit.

Overall the Dataset for 2007 - 2008 shows this target is not met, failing by 2% at 96%. Curiously, 6% of these were discharged or moved elsewhere in the last ten minutes of 4 hour target. Close in fact to 147,000 patients of nearly 2.5 million. An incredible feat, one might feel, for the NHS Hospitals involved, with some having a remarkable recovery, beds being found at the eleventh hour, or perhaps just wheeled into a corridor or cupboard, as some actually relate.

Whatever the reason and jaundiced our view of this 'last orders' rush, it is quite a feat. But what has now emerged, in an independent audit of these figures, at the Nottingham Queen's Medical Centre, part of the Nottingham University Hospitals NHS Trust, is that staff 'bent' the rules to ensure targets were met, or came close to meeting the target. 1889 records were wrongly recorded, as being in target time since April 2008. A 'whistleblower' had raised the issue in 2005, but was ignored (you may have heard of this phenomena before).

Words like "enormous pressure" and "failure of systems" were trotted out by the man with the egg on his face, the Chief Executive. Dr. Peter Homa, but the Hospital already had a poor record in this area with a score of only 52 in the patient satisfaction survey on A&E waiting times. The top 20% of trusts scoring 81 with the best being 98. So they take a poor record and then 'fudge' the figures to prevent themselves from looking even worse. It makes one wonder in fact, if there is any point at all in trusting data from any Hospital or even the Dept. of  Health. The figures are in fact a meta-analyses of the data provided from the Trusts. No one usually gathers the information independently, the Trusts are simply er.... trusted. Perhaps that is the first mistake.

According to the 2008-2009 data in the DoH Hospital Episode Statistics this Trust achieved the 4 hour window in 97.3% of cases, leaving 4305 patients outwith the target time. They have admitted an error of 1889 cases; that is almost half as much again ! This puts them below the target by over 2%.

This is a Teaching Hospital; an alleged centre of excellence where young Doctors and Surgeons are trained to assume the mantle of Healer. The truth is somewhat more stark. It is a crumbling monument to 60's design in concrete, decorated in... concrete. It is short of front line staff and facilities, has an ISTC built within its own grounds, that went bust before opening and arose like a phoenix under another name months later. Its car park had to be demolished as it was dangerous to use. They haven't rebuilt it because the money for the new one went elsewhere. Yet the building is contemporary to the car park if not older and hangs by a slender thread, propped up by Messrs Screw,  Bodgit and Scarper's  tender mercies.

Worst, it is the place, that failed me and mine, in the pursuit of justice and candour, after an appalling litany of errors in treatment and aftercare. Now we have seen, how they lie to protect themselves, from any sort of censure. This is just the tip of a very large iceberg. They deserve to founder upon it.

To QOF or not to QOF ?

Quality Outcome Frameworks, that vehicle to keep the proletariat 'healthy' comes under fire once more. This time in an area dear to my heart; Diabetes.

It's always interesting to look at what NICE recommends and examine from time to time that which is ignored and that which is adopted from the voluminous output of this august body. When there's a few quid for the cash strapped GP's we find it to be adopted without question. When it's something that is valueless, in monetary terms it seems to take a back seat. What a surprise !

NICE does a lot, some of it is even useful (rarely), some of it benign and some of it positively dangerous, such as the guidance for QOF targets for Diabetes outcomes. The Lancet, last week published the outcome of a study into the application of these targets in the management of 50,000 patients in the UK showing clearly that the pursuit of HbA1c levels below 7.0 was putting patients at risk for CVD events. Dr George Kassianos, a GP and research fellow in Cardiology went further suggesting that tight glycaemic controls for Type 2 patients was in fact dangerous and should be amended to 7.5% instead of the current 6.5%.

Diabetics generally have a tough time of it in the NHS with being 'over managed'. Constantly being told to lose weight, that they should lower cholesterol, BP and keep within very strict limits for glucose control. Practices are paid by results to achieve these targets so patients become a cog in the machinery of practice income instead of a human being with individual needs and problems that need addressing with patient centred protocols. The money gets in the way and the so called research that backs up the QOF is often an ill thought out hypothesis with little or no evidence to back it save for that from the drug company that thought it up. And we know how impartial their research is !

This study highlights the dangers to the extent that mortality was 52% higher in those with HbA1c levels in the lowest tenth of the study at 6.4%. That's 2500  patients ! Yes that's correct 2500 people died because they were put on 'tight' control protocols by a QOF ! Yet I've looked for a response to this study from Diabetes UK,  the 'leading' charity and I can find stuff all !

I have long known about the piss poor protocols and treatments available to Diabetics in the NHS which eats up a huge portion of the budget, with drugs, insulin, dieticians, and so on and so on but it never seems that anyone really looks at the Science to see if the money is well spent or the patient is getting better. Because the former is a lucrative 'gravy train' of ever increasing length and the concesus on the latter is, it will never happen. It seems it is in the interests of all, except the patient of course, to maintain the 'status quo' and now we find that a major element in the treatment plan is so flawed as to be deadly ! It should have provoked an immediate rethink of policy but no doubt NICE will have to conduct a long and expensive review of the policy (QOF DM23) prior to reducing the target. In the meantime a few (hundreds ?) may actually die ! It should be urgently amended for the current year, not next !

Still, what does it matter, the cash is coming in and there's plenty more diabetics. It's not like we are a looking at a famine of people to treat. More are diagnosed every day due to the crap advice doled out by the Agencies of Government and the kindness of the soft drinks industry in feeding us High Fructose Corn Syrup. I always say if you are looking for the culprit for most events that cause harm, especially in Medicine; 'follow the money !'.

Frustration

It is without doubt, a travesty that defies logic, that Jane Barton has escaped the ultimate sanction that she rightly deserved. It is once again the destruction of an expectation of Justice, that most felt to be inevitable and desired. Ann Reeves, who fought long and hard for the opportunity to bring this profligate over subscriber of opiates to vulnerable and now dead patients, is both bitter and outraged.

At the same time 'teflon' Tony Blair was expounding his singularly individual account of how he got us into our own version of Vietnam; the Iraq War. With a confidence bordering on Evangelism he absolved himself of all blame, piling it on the head (now detached) of Saddam Hussien.

Both events are a travesty of the natural Justice that we all feel should be meted out to those that are guilty of sending people to their deaths, be it on the field of battle, or the Wards of Gosport Memorial Hospital. Not because people die in either place that is given, but because they died without need, without a purpose that their loved one's feel, they can espouse or understand.

Tony Blair continues to earn the inflated and undeserved reward that he would never have been heir to without the bodies he has clambered over. His £15 million a year income (as reported in the Sunday Mirror, so it must be true) would never have been possible without his unholy compact with Bush to invade both Iraq and Afghanistan. He would have been consigned to a different history, of Memoir and Scholarly endeavour, with a comfortable, but hardly lavish lifestyle.

Jane Barton too, continues albeit with some restriction, to continue the practise of Medicine. Probably with a lifestyle, that the victims of her particular penchant for profligacy with syringe driven morphine, would never have achieved, presupposing of course that were not already dead; which is a fairly certain curtailment of one's ability to earn a crust.

Blair seems to have stolen Barton's dubious victory from the limelight, which only the most paranoid would believe to have been a plan rather than kismet. But, in a country where basic, intuitive belief in fundamental justice, is now so eroded, we expect almost anything of the machinery of the State. One thing that does stand out as significant, is the lack of  condemnation of Jane Barton by her peers. The medical bloggers, especially the Doctors have continually highlighted the case and roundly condemned the verdict, with splenetic utterings that are both deserved and even ingenious. You can read them at the side of this blog.

One however, stands out in his silence, which as I generally admire him is almost hurtfull, but with a nom de plume, linked with another poisoner of historical fame, maybe he thought comment to be inappropriate. That's as maybe, where are the other 30,000's view of this consumate figure of evil, in the eye's of her victims loved one's. If it comes to that, where are these men and women of letters views, on the litany of disasters, nigligence, accidents and sheer stupidity perpetrated in OUR NHS almost daily. Do they think that we do not notice their silence ? Is it too much for the servants of the Taxpayer to side publicly with their constituency, or am I being too dense ?

Doctors have been known to kill as Shipman proved but their ability to evade the Law is both tragic and counter to all the tenets that we as citizens have to abide by. Have we created a cohort in Society that has the power over life and death with none of the responsibility attached ? You would almost believe they were Politicians or Policemen.