2011; End of Term Report.

2011 seemed a little like living in some sort of  'time warp'. Paranoia reigned, mainly about 'benefit scroungers' and immigrants and the need to ensure those that are financially supported by the state 'get a job'. A bit bloody difficult that if there aren't any! But of course such policies appeal to the baser instincts of the people who are (generally) misled into the view that all on the 'dole are shiftless, workshy leeches. They may of course change their mind about that, when the redundancy notice drops on the mat.  And of course we had that elaborate fireworks 'jamboree' at the Thames Embankment, at the turn of the year. 'Circus' (without the bread)  would be my summation of that. They'll be plenty of the circus element to take out our minds off the the 'crisis' in 2012 with the Olympics (which has just had an extra £270m added to the bill for security to pay for an additional 13,700 personnel from G4S. That works out at £20,000 for six weeks work yet the 'going rate' is about £10 an hour. Could it be that we are being 'screwed', by the Governments favourite 'Security' Co? ) and the Jubilee celebrations being the most prominent, but still, we get a day off work to pay homage to the Royals, so that's alright then!

Delving into the 'nitty gritty', this was the first full year of the Toffs Academy's rule and Edd and, err Edd's reign on the opposition benches. What a triumph it all was, with the competition for the middle ground of mediocrity almost reaching fever pitch. The cut and thrust was painful to watch, with minutiae of each of the party's doctrine being dissected and found to be - the same! The Headmaster shone through it all with aplomb, and that was just his face. But seriously, where is the difference, the defining policy, the moment of inertia that could lift us from this politically imposed state of misery in which we are living; I'm still waiting.

'Hacking' came to prominence, with News International holding up it's hands to the offence of listening to peoples voice mail messages. Well sorry, I simply cannot get worked up about a a bunch of idiots who are so stupid as to actually leave any significant personal information on a mobile phone voice mail system, which is designed to ensure that you know someone called when you were on the 'phone or off the air! Nor am I impressed by the state expending my money on an enquiry that is designed to 'up the ante' on the damages that will be paid to a bunch of self serving, publicity seeking third rate celebrities like Prezzer and 'Huge' Grant. If NI had actually listened in, to a 'phone conversation, that would be different, but they didn't. That privilege is reserved for the security services and the US Government. So get over it, go home and stop filling the media with your contrived and silly outrage; it's your own fault!

Meanwhile, back on Earth or the planet Zog, as it seems to me (or maybe 'Life on Mars' as Francis Wheen says) much more important things were happening.

The NHS was transformed from being a dangerous organisation, entrenched in mediocrity, mendacity and self interest, to a 'shining light' of health care for the people. Privatisation and Marketisation was the route being taken by the Government, but that was a step too far for the pressure groups that sprang from the woodwork. Many of these comprised of Doctors and other Health care providers complicit, even actively involved in the reforms of  Tony Blair. Well wake up and smell the coffee, it's already happened! What do you think ISTC's, Foundation Trust's and Primary Care by GP's is! The last 'lot' (Labour) were already well on the way to that goal before Cameron et al came on the scene. GP's have always been private contractors to the NHS, either as partnerships, individuals or limited companies. If you want to criticise a system that allows this, then start with them. They've always stood on the outside, looking in, and however you want to cut it, GP's are not state employee's, which only makes me wonder why we are contributing to their pension's, but that's another story. And, all of the hand wringing of the 'Guardian' readers seemed to be out of step with the fact the Nu Labour had been the architects of most of the changes in the NHS, and Lansley is only continuing a process commenced by Tony Blair and Gordon Brown. So everything is different, but stays the same.

The 'bandwagon' of Pharma continued, although in somewhat abated form now that the so called 'blockbuster' drugs have gone off patent, and some of the seedier advances elicited huge payouts for the harms they had caused ($3 billion from GSK for fraud and mis-selling), but that didn't stop Andrew Witty getting a knighthood. Who says crime doesn't pay! Cameron decided that they (Pharma) were so poverty stricken that we needed to give them some of our money and a lot of our patient information, to get them to cause some more carnage by helping them develop some new drugs. We need some more 'lifestyle' drugs like a hole in the head, and the hand full of very expensive drugs thus far developed to treat relatively rare conditions have only had modest or even no benefit to society, except of course to Pharma's coffers.

The NHS remains 'broken' and all the rhetoric about 'saving it' is counterproductive. More 'marketisation' will not make one iota of difference to current appalling status of the patient in all of this. 2011 saw the exposure of terrible standards of care that have prevailed, and been tolerated for years. Winterbourne View, failure to provide adequate nursing, dignity and nutrition to the elderly and those with mental health issues and learning problems. The 'Stafford Hospital' enquiry, the appalling problems in A&E at weekends and nights, and substandard care in Trauma and Surgery; the list is almost endless. A new paradigm needs forging to bring the NHS up to a standard that is in accord with the vast sums expended, most of which has been allocated to the payment of the management, consultants and temporary staff at exorbitant rates. And of course PFI, PPP and ISTC's. Despite the fact that the ConDems criticised the finance model, they have still seen fit to go ahead with the £450m Liverpool Hospital PFI contract with a consortia of Laing, Interserve and FCC. There is also some evidence that Trusts are retaining patients on wards, to enable payment of treatment tariffs simply to 'grab the cash', when many could be discharged to home (much safer than hospital) and treated by their GP's.

All of the privatisation and commercialisation models will do nothing to advance patient care. To proffer the view that excellence will be intrinsic to allowing further private companys' to undertake treatment at Primary or Secondary level is littered with pitfalls. Thus far it certainly has not been proven, in fact costs have escalated out of proportion to the outcome. Time and time again it has been demonstrated that the private sector is only interested in 'cherry picking' those areas of treatment that are simple and straightforward and with little to no need for the 'back up' of an emergency department, and when things have 'gone wrong', which they have, patients have been rapidly handed over to NHS Hospitals to try and salvage something from the situation. 

Competition has long been viewed as being the spur to excellence within capitalism by successive governments since the Thatcher days, but the proof has been sadly lacking, with greed and mendacity demonstrated just as readily as in the public sector, in fact the paradigm has been so corrosive as to be valueless. Numerous companies have been earmarked by Government as 'preffered providers' in many sectors and proven to be incompetent, target driven, purveyors of substandard products and services. The simple model of capitalism is 'buy cheap and sell dear'. There are better ways of producing a better outcome for patients than that. We only have look to Winterbourne View and to the NHS IT programme to see the failings of the unbridled pursuit of money.

The organisations too, that oversee the NHS and Social Care also continue to give concern, with the CQC failing miserably in its raison detre to protect the vulnerable and curb dangerous practise because it spent too much time on the registration of the myriad components of Health care (which yields its funding) than on the protection of patients from harm. It does seem to have raised it's game a little now but like most things in Health care it's too little and too late.

And what of the Medicines and Health care products Regulatory Agency (MHRA)? Well, they seem to have gone to sleep on job, because they were warned back in 2006 about PIP's toxic breast implants after approving them without demur years previously. Could it be anything to do with alleged opinion of many that they are a bit 'cosy' with 'Pharma'. As is usual, I could not possibly comment on such a salacious view! Perhaps if anyone had checked the content the penny might have dropped because most comprised the sort of silicone used for sealing around baths and showers (Rhodorsil) or for oils seals and 'O' rings in automotive products (Silopren). As even the (fairly lax) FDA in the US banned this device in 2000,  what happened to the continuous assessment process that should have been in place?

Too often the bodies we pay with our hard earned taxes to safeguard us from harm are found wanting. and the NHS which is now consuming approaching 10% of GDP is found to be toxic for patients. When will lessons be learned?  Approximately when Doctors accept a 'duty of candour', or hell freezes over (not necessarily in that order).

You Want To 'Save' The NHS. Why?

As Thursdays report from the Care Quality Commission reverberates around the media, and adds to the mountain of evidence of misery, that is perpetrated upon that most 'captive' of all audiences, the Hospital Patient, is it any wonder that I question the motives or naivete of those who campaign to save our NHS?

This follows on from the  Royal College of Surgeons Report of only last week highlighting the appalling care meted out to patients who submit to emergency surgery, who or are admitted to A & E Departments at nights and weekends. The NHS is patently sick and cannot provide even the most basic standards of care, despite the vast sums of money extracted from the public to pay for it. 

It seems that the usually 'piss poor' CQC has followed Lansley's diktat and undertaken a number of unannounced 'spot' checks on Hospitals to formulate the report and found many Hospitals sadly wanting in the care of the elderly. Well once more I say 'no shit sherlock'. I could have told you that! Well more power to them, but I have to ponder as to whether they are an adequate provider of vigilance when they continue to be the 'licenser' of Health care Providers as well as it's invigilating body. They are funded by the very organisations they presume to police, which is a clear and present danger of potential bias and lack of independence. They have hardly covered themselves with any 'glory' in the past and the body itself is peopled by many 'refugees' from the PCT's and Hospital Trusts. It is highly likely that without the Health Secretary's urging that this report would have even been compiled. So I have to thank Andrew for that, although little else.

The NHS costs the taxpayer just shy of 8% of GDP in 2009/2010 (just over £100 billion) up from its initial cost in 1949/50 of less than £500 million (£11 billion at today's prices). The greatest volume increase being some £46 billion in the 'Blair' years (1997-2008). Yet we have seen very little improvement (er.. none) in the standards of care or the safety of patients despite this vast increase in expenditure. Under staffing and 'dumbing down', yes we have seen much of that. Vast increases in the apparatchiks and their enforcers and huge increases in pay for GP's and Consultants. Intensive 'marketisation' including PFI and the ISTC's, which even though some patients have been happy with (in the main due to short stays and hotel style accommodation) , does not detract from the view that a properly organised and adequately funded public health service, should be able to do better than the 'private sector', because there is no profit margin to factor into the equation. Hip replacement in the NHS, say £6000. In the 'private sector' £6000 + profit of 25% = £7500. And of course no 'backstop' in event of an adverse incident except to rush the inconsiderate sick patient to the nearest A & E of the NHS.

'Marketisation' then is likely to do little more than bankrupt many Hospital Trusts in the 'brave new world' of the HSCB with the large cohort of  'privateers' extracting ever more from an already creaking budget. But more; the growth of 'disease mongering' in the Primary Care sector will grow at an even faster pace, driven to new heights by the involvement of  'Big Pharma' in the provision of service as well as drugs. There is an already unhealthy relationship between the drug industry and many Doctors and Clinicians as Fiona Godlee stated in her recent BMJ Editorial, citing this study from the US and Canada as evidence of  'less than honest' dealings. I would cite more but the BMJ will not dispense with the 'paywall' on many occasions, thus actually adding to the censorship of that which goes on in the world of medicine, without the knowledge of those who are ultimately paying for it!

I actually find the original NHS model of universal health care as being a fine and principled concept that I supported for many years. I do not do so now, not from any perverse hatred of that concept but that it no longer ticks any of the boxes of its founders. Since 1979 it has been guided by the politics of greed and stupidity, most largely imported from USA. It has received huge increases in funding that have been 'squandered' on flights of fancy that did nothing to improve or even alter patient outcomes. The NeoLiberals gave most of it away to private sector companies who frankly would have no more idea about 'competition' than flying to the moon! Most would not survive at all but for the largess of the taxpayer, they have no other clients! Like the Banks, they have grown fat and lazy on our money, often without having to tender for anything. Like the Banks they have given us little in return, except another bill for our offspring's to pay.

What I would like to see is a new NHS. One that fulfils its original criteria without all the bureaucracy, hypocrisy and reverence afforded to Doctors and Clinicians as if they are some sort of superhero's. There are plenty of good guys out there, they just seem to have lost the ability of shouting louder than the bad one's. Instead of talking 'ball's' they need to find some.