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).

No Shit Sherlock!

The Royal College of Surgeon's (RCS) recent report on the appalling death toll of patients admitted for out of hours and emergency surgery is to be commended. It has been a long time in coming and highlights the dangers associated with being admitted to Accident and Emergency in the evening, or worse, at the weekend. It sheds light on the dangerous and often fatal, lack of care imposed upon patients who present with, often simply diagnosed conditions, who then become even sicker than on admission due to lack of manpower, facilities and very basic care that all of us hope to avail ourselves of, should we be unfortunate enough to have an accident or become ill outwith the Primary Care pathway.

The NHS is quite good at the provision of elective surgery, especially cardiac surgery. It is however significantly lacking in safety when it comes to major general and emergency surgery, with both higher mortality and complication rates than are acceptable in the setting of modern hospital care. Of 170,000 patients treated for non-cardiac surgery we manage complication rates of more than half at 100,000! And of those, we actually manage to kill 25,000! Mortality rates for emergency surgery in England and Wales is over 25%, with early discharge and subsequent re-admission being a significant factor in these statistics. The other horrifying figure is that our chances of dying is 10% greater if it's a weekend!

Well I'm no stranger to this situation, when she, with whom I have have decided to end my days, became part of these same statistics. Delays, both in pain management, diagnosis and treatment at a very basic level were missing, possibly because it was early on a Friday evening. No Consultant on duty, just a few nurses or rather 'healthcare assistants'. Of Doctors, well none until some five hours into admission. Tests, well there were plenty of those, in fact it seemed to be a goal rather than any sort of pathway to treatment, as hindsight indicated that none of the results were followed up! An X-ray was eventually carried out, but nonetheless a a treatment protocol was then pursued that was contraindicated and injurious and resulted in an outcome she still lives with to this day and which will blight her life until it's end.

Weekend surgery did take place, 'squeezed' into the list between the 'elective' private patients who had the surgical suite given over to them for some Saturday 'bunce' for the Consultants. Postoperative care was poor to non-existent with severe hypotension ignored, as was the diabetic keto-acidosis, and very low oxygen saturation that kept triggering alarms ( to my alarm).

So, this report does not surprise me in the least. The apathy and stupidity demonstrated to me by my personal involvement in this event did at the time. Up to then (2008) I had not had any chance to witness first hand the terrible position in our hospitals especially in emergency care. Any contact I did have had faded, like most bad memories do; part of that 'defence' mechanism our minds have to retain sanity. Despite my many ailments, and a minor wound in my early history with firearms, none was dependant on a hospital stay and I hope that it remains so. So dear reader, I would suggest that you plan for any emergency you may have in health care for you and yours, on a weekday between 0900 and 1700hrs. Or of course join with me and others to press for a whole new paradigm in health care and medicine, that is patient centred and based on scientific treatments. I want to tear it all down, rip it to shreds, along with many of those that perpetuate it by virtue of vested interest or hubris or worst, apathy.

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.

Do We Save It Or Cure It?

The NHS, that is, now that the Future Forum has rendered it's report, to a somewhat baffled, bored or bemused public.

Saving it seems to be the view of the liberals (not the Liberals) who not having sampled it's wares often, (they're mainly healthy and in BUPA), but fervently do believe in it, in the sort of soft, warm and cuddly world in which they live, with their Volvo's, Labradors, wholemeal bread and 2.4 brats. Slagging off the ConDems somewhat flawed paradigm, for the NHS is almost a badge of honour among them..

The Neo-Liberals on the other hand, want to reduce it to the Purchasing Department of NHS plc, because (surprisingly) the paradigm they've constructed to prevent illness, in advance of it occurring hasn't actually worked. In truth, most of the political input to Healthcare is a 'busted flush' such as mammography, which has done nothing to reduce breast cancer incidence, and has often done more harm than good, as eminent breast Surgeon Michael Baum opined back in 2008. The position has deteriorated in the intervening years with more being spent to produce worse outcomes. And QOF (The Quality and Outcomes Framework) has assumed the mantle of a policy to keep UK 'Pharma' afloat, and reward GP's for achieving dubious surrogacy of health, than making any significant inroads into heart disease or indeed any disease of civilisation, such as Cancer, Diabetes or Stroke. In April the Kings Fund condemned it (QOF) for not having "improved health outcomes or reduced health inequalities". (please forgive me quoting from them).

Even more sadly, the health care unions have not raised the game, but generally portrayed themselves as a bunch of greedy militants, undeserving of their pensions, thus playing right into the sights of the Daily Mail assassins. When in truth the average 'coalface' worker in the NHS is poorly paid, often badly treated and gets a quite low provision in pension compared of course with the management. The 'elite' seem to be little affected by the proposed changes, and seem to move seamlessly into new roles to help forge the brighter future that we are told will be the reward for NHS reform (yeah, and the cheques in the post etc, etc).

As I have previously said the debate has sunk to a level of a 'war' between opposing armies, with Steve Field's lacklustre crew attempting to treat for an armistice, but only achieving surrender, with a few crumbs for the Dem's in the Coalition of Toff's. Little to nothing has been done to assuage the inroads made by PFI into an already 'stretched' budget. Nothing said about savings that could be made by shifting the paradigm to actually care for the sick, injured or dying, rather than medicating the population with the flawed output from 'Pharma'.

Structured targeting with science based interventions into disease, needs to be based upon evidence, not dogma and flawed or even falsified trials that pervade medical journals. Always, we are presented with a polemic by both politicians and most in health care. They will have no truck with opposition to flawed and often dangerous policies or protocols. We are patronised and vilified, lectured and harangued, always to reduce this or increase that and the net result to date has been somewhat less (health) for somewhat more (money). Just take this pill and you'll live forever (but your life will be miserable). As the funders of ... well everything, we deserve better.

A Pause For Thought?

Cameron, Lansley et al, have announced their intention to have a 'natural pause' in the Bill to reform the NHS. A 'future forum' including that 'porcine' (honorary) Professor, Steve Field is being launched upon the country, to listen to the views of the NHS constituent about the changes that have been proposed (excuse me whilst I choke). Once this period, which coincides of course with the Easter Recess anyway (yes more holidays for the politicos), is over, the Bill will be sent to the Lords for perusal and possible modification.

The problem I have with the current and past reforms, is that they continue to concentrate on structure instead of quality, organisational change rather than the ethos and tenor of what universal health care should be. For far too long the NHS has stood for invasive and pernicious campaigns to to persuade us  (and now nudge us) into a new horizon of well being with moralistic and ill conceived measures about smoking, drinking, sex, and diet, indeed anything enjoyable. With social engineering at its heart, the anxieties of society are constantly addressed by campaigns to reduce cancer, heart disease and diabetes with little result other than a significant  elevation in the Nations blood pressure.

This has in turn led to poor quality health care, dispensed '9 to 5' (weekends and holidays excluded), in Hospitals and Surgeries, to a somewhat hostile patient cohort, who are now being appealed to by the NHS constituent, to 'save the NHS'. Those who have delivered this inferior and authoritarian 'we know best' standard of that which passes for Medicine, cannot really now expect the public to 'go to the barricades' and fight for them to keep their bureaucratic temples intact.

The NHS has presided over ever increasing levels of interventions into our lifestyles and behaviour, very few of which are founded upon any evidence or indeed have had any success. Doctors have become the 'health police' rather than the healer, and as they have distanced themselves from their patients they have prospered enormously in monetary terms, but lost credibility. They are now pawns in the Neo-Thatcherite construct started by Blair and continued by Cameron and his academy of 'toffs'. An NHS that has treated society with such contempt, despite its huge cost to that society deserves to founder.

I do not like the changes proposed very much. They amount to little more than a bureaucratic reshuffle; a movement of the deckchairs, because the fundamentals remain. But the opposition that has formed against it almost worries me more. If Allan Milburn, the BMA and the King's Fund  ( and David Owen for f***s sake) are against something then I'm afraid I will possibly have to review my position. In fact as the number of unprincipled and opportunistic politicians grows, who oppose this Bill, the more I become alarmed that I may have missed something! Hardly surprising in view of the number of pages it runs to (299 clauses!). Perhaps there may be some nugget of redemption in this pointless, needless and irrational Bill after all? Oh yes, the Quango's are going! But no, they are being systematically saved, if not by name then by transfer, such as the Food Standards Agency to the Dept of Health.

Doctors and the BMA never wanted an NHS, of that be certain. They wanted an elitist cohort of Physicians that dispensed wisdom and medicine to the 'proles' at a price that they set, not one set by some 'oik' in a Government Department who went to a ...Grammar School?  They persisted in this view until the Thatcher years, when Maggie offered them more power and control at the expense of a bureaucratic nightmare of invoicing procedures and budget management, when they decided that it was all too much, a bit like the 'poll tax'. Then along came Blair, all fired up to change the mindset and the BMA embraced him. All at once the BMA discovered it's desire to participate in Government sponsored (and guided) health care resulting in massive financial benefits to the membership and less hours! Well that was a surprise then?

Incentivised, at a level they could not have dreamed possible, most Doctors and Hospital Consultants doubled their pay, and reduced their involvement in patient care. 'Out of hours' was handed to private companies and A & E to trainees and locums (60% of all Hospital Doctors are locums).  The patient became the supplicant expecting little and rarely being disappointed. Many died, were maimed or at best received poor care and continue to do so. Yet the gravy train for Doctors, now irretrievably committed to peddling 'Big Pharma's' often substandard or even useless products, rolled on, with further and more intrusive protocols, even for the 'worried well', moving medicine further and further away from diagnosing and treating disease, to fruitless and dogmatic (usually wrong) prevention interventions that were founded in poor or even bad science.

At no point in this train of events was it thought necessary to involve the patient, save for 'patient, public involvement' rhetoric that only sought the views of an unrepresentative minority, of charities and professional middle class campaigners, with the time and money to be involved in the 'tea and biscuit' culture of meta-quango's, discussion forums and pointless conferences. Constantly harangued, largely ignored, the public in general wants little to do with the NHS or even their Doctor, now ensconced in expensive and shiny Health Centres, except when they are sick or fearful. Then they are treated to an endless list of questions, unrelated to the condition they have presented with, to ensure the practise fulfills the QOF protocol and a test regime more interested in their 'lipid profile' than their pain. Is it any wonder that as 'modern medicine' lurches toward wholly preventative measures, instead of treating "the poor and the lame, the sick and the dying" (1), that we are becoming more and more disenchanted with that which we are financing.

There now seems to be a further erosion of NHS principles, driven by privatisation of Primary Care that has more to do with dogma than need, the desire to furnish capitalism with further subsidy, and the utilisation of the latest 'mousetrap' from Pharma, whose greed continues to know no bounds. Older drugs, and medicines that were 'fit for purpose' before, keep falling off the end of the list, for no reason other than a desire to use the new and shiny one approved last week, irrespective of efficacy. Once in fact, all of those in the NHS have had their piece of the cake, there is little left for the actual patient, except indignity, poor care and nonsensical intrusion into their lives. And yet, are not all of these people there for one purpose and that purpose only, to pursue the practise of Medicine?

Change is in fact needed and drastic change at that. Justice for the harmed, together with Candour. Genuine scientific protocols to improve lives, not the treatment of symptoms for the enrichment of a pernicious industry that no longer is fit for purpose; 'Big Pharma'. A cessation of intrusive, patronising and ultimately fruitless endeavours to engineer social change, with fear. Medicine without the boundary of 'out of hours', peopled by real physicians, who actually know what they are doing. Yes let's have a real and vibrant 'Big Society' in the NHS that recognises its goals are set by its patients, not by its political masters and I include in these the BMA, the GMC and the bloody 'think tanks'. In fact I'd rather like to put a tank on their lawn, and see if I could get Niall Dickson, John Appleby and Penny Dash with just the one round. That would be fiscally responsible would it not?

So whilst you politicians are are all pondering, as to what cosmetic changes you can make to a Bill that is widely reviled, and the GP's squeal about how they will be able to cope with all the extra work, without some extra payment (again!), spare a thought for the poor sodding patient, because they're the reason we have an NHS. They aren't the one's that fucked it up, you are!

"Perfection of means and confusion of ends seem to characterize our age." 
(Albert Einstein) 


(1) Quotation courtesy of Morton Thompson - 'Not as a Stranger' C1954.

Curing the NHS (A Rebels View).

Of What? By whom? Well one thing is certain, it won't be by Andrew Lansley and the cabal of warlock millionaires, headed by ("call me Dave") Cameron. Their proposed acts of vandalism are likely to make the chances of a 'cure' even more remote.

One, who has a pretty good idea as to what is needed, is one Dr. Vernon Coleman. Vegan, (well you can't be right about everything), author, 'cross dresser', columnist, publisher, libertarian. Author, amongst many of "Medicine Men" and "How to Stop Your Doctor From Killing You", both of which intimated how much of a rebel, he really was. He has kindly consented to allow republication of his view of  how to cure the NHS on the website of the NHS Justice Group.

His views, almost exactly coincide with mine. We need to rid ourselves of that which is not needed; that which is not affordable, or even desirable, on the NHS. Give power to GP's, but not all Commissioning, they are neither equipped, nor are they as yet competent to fulfill such a role. Rid ourselves of the pariah's that suck the blood of patients and clinicians; the 'Management' and their lackeys. Stop 'private' medical care being provided in NHS Facilities, and oust the Consultants who control it. Provide 'proper' Nursing, with real Nurses, not the poor quality Nursing Assistants, who have no more idea about 'nursing' than they do about quantum mechanics. Not surprising really, as the qualifications to become one are, err, none! 'Peanuts, Monkeys' are the words that spring to mind.

And Doctors, well they need to realise both their importance, but also their lack of it. It is not possible to legislate for empathy or compassion, but it is possible to enshrine in statute, the 'duty of candour', in the event of harm, being done to patients. It is perverse, that Doctors are the only section of society, that can lie under oath, without any consequences being visited upon them, but they can, as my friend and tireless campaigner Will Powell will attest. Twenty one years is far too long to wait for justice, both for him, and for any society, 'Big' or otherwise. But 'Dave' would have us believe that it would be step too far.

So far as 'by whom', well there's the rub. The ConDems seem unable or unwilling to effectively change the NHS, beyond pathetic attempts to 'privatise' most aspects of it, in the blind hope of saving money. My experience of privatising public bodies and duties has been one of more bureaucracy, less transparency, considerably higher costs due to the additional layer of management required, together with the need to extract a 'profit' from every transaction. And of course, the continuous desire by all parties involved, 'to pull up the flowers to check if the roots are growing'! So then it is left to us, the people, to clamour for effective change, not the 'window dressing' of this and successive Government of the NeoThatcherite persuasion, which they have all been, of "no decision about you, without you" and other such PR platitudes, forged on the playing fields of Eton and in the slick offices, of the campaign managers.