Medical hypocrisy

I have a few questions about this story, in which MPs lay into professional idiot, Sir Liam Donaldson, over MTAS and MMC.

And Dr Hamish Meldrum, chairman of the British Medical Association, added: "This is a damning indictment of the government's failure to listen.

"We completely endorse the basic analysis that there was a massive systems failure and a complete lack of clear and effective leadership within the Department of Health."

Well, thank you for that, Dr Meldrum; however, is it not the case that you are now head of the BMA only because your predecessor had to resign?

And is it not true that the main reason for said resignation was because of the BMA's unquestioning support for the government's position?

And is it not also true that, so egregious was your support for government policy on MTAS and MMC, doctors set up a new organisation—Remedy UK—to represent their interests?

Further, is it not true that the BMA supported the government to such an extent that it even testified on behalf of the government against Remedy UK?

And, finally, do you think that—just maybe—all of this might fairly be described as "a damning indictment" of the BMA's "failure to listen" and, as such, that you should shut your fucking face, you fucking hypocrite?

Midwives, MTAS and the NHS

Continuing in the medical theme, as we seem to be, here at The Kitchen, there was yet another very telling comment left on Katy's Midwives post.

Apalling but not surprising, unfortunately. When I was a medical student, every single midwife I came across (in three different hospitals in SE England/London) had a shocking attitude towards epidurals. The woman would ask for one early on in labour, to which the midwife would either reply, 'It's too early, you may not even need one, wait a while', or 'The anaesthetist is busy in theatre' (without even checking to see if that was indeed the case). A few hours in, the woman would be screaming for an epidural. She would be told by the midwife that an anaesthetist was on his way, before the midwife would take me aside to say, triumphantly, 'by the time he gets here she'll have delivered'.

I never saw a single epidural given. The midwives used tactics including blatant lies, bullying and delay in order to deny women pain relief (other than 'gas and air', which the majority of my friends who have sprogged tell me is next to useless). I found the general attitude towards women who cried out in pain was, 'Oh don't make such a fuss. It's natural.'. Women who wanted epidurals were viewed as being weak and whingy. The overall atmosphere was one of 'midwife knows best'.

It's enough to put you off having children. Luckily for me, I suppose, I am a pushy middle class doctor and I will damn well have an epidural if I want one.

The comment was by a doctor who writes (although not for a while) at Layla's Space. Having a scan through the posts, another interesting aspect, which I had not seen raised before, of the now-defunct MTAS system was brought to light. [Emphasis mine.]

I assume [my old job] will be filled by a shiny new 'ST3' person at the end of August. I have my one guaranteed MMC interview on Tuesday, also in London. Yet another ridiculous consequence of the new system is that, because I applied to MTAS prior to taking my final MRCP exam, I had to apply at ST2, ie SHO level. The fact that I now have MRCP, and am indeed about to start working as a registrar, doesn't matter. I can't change what level I have applied to, so if I get the MTAS job, I will effectively be resigning my registrar job a month early in order to take up a medical SHO job for another year. Resigning my registrar job to go back to doing what I have already been doing for two years.

How fucking stupid is that?! Every single doctor who passed PACES at the same time as I did will be in the same position - forced to remain at SHO grade for an extra year. And 'they' said MTAS would help to 'streamline' training, ensuring that nobody spent too long stuck at the same level. Priceless.

Surely it is some kind of enfringement of employment law, only being able to apply to four jobs per year? Surely everyone should be able to apply for as many jobs as they like, as many times a year as they want to, at the most appropriate level of seniority? There are so many stupid, probably illegal, foolish fuckwittish elements to the whole system, I don't know whether to laugh or cry.

The state runs things badly; therefore the state should not run them at all. And the NHS is something special; one of the largest state organisations in the world and subject to its very own inefficiences.

Patricia Hewitt is right on this one...

I never thought that I'd ever see that sentence written or said...

... the NHS is simply too big to be manageable.
...

There are economies of scale, but there are also diseconomies of scale as the hierarchies of bureaucracy grow, and so efficiency against size forms a curve[2]. This happens in all organisations whether public or private. Any organisation as big as the NHS would be inefficient and there is absolutely nothing going to change that unless they also do something about dividing it up into more manageable sized chunks. Maybe still as a state run system, but run by local government as in Sweden. Perhaps a multi-payer/multi-provider system as in France[4] where the hospitals are all independent organisations and the state just provides a basic universal insurance. Or if you want to be radical get the state out entirely and just have it recognise that because some things are important they should not be taxed as in the Singapore system for healthcare. It is the NHS's obesity that is killing it. The crisises might individually be dealt with, but unless the root cause is too then they will just come back.

Chris is, of course, quite correct and the NHS does need to be pulled down; as does the system of funding solely through tax. Matthew Sinclair explains why.

Two factors drive an increased demand for healthcare. First, older people require more healthcare and the population is ageing. Second, technology is vastly increasing the potential of medical science. There is huge demand for new treatments which promise incredible results but are very expensive. This effect is massively outweighing technological advances that cut costs.

The same is true in education. Rising demand for education is driven partly by people wanting to be on the right side of a growing skilled-unskilled divide created by the entry to the world market of cheap labour, particularly from India and China. Another major factor is the growth of a ‘knowledge economy’ where the kinds of analytical skills taught in higher level education are becoming increasingly important.

Healthcare and education are representative of a broad trend. Services which are currently largely the responsibility of the State are seeing increased demand across the developed world. In healthcare, Britain has doubled spending, to roughly the EU average, and health costs in America are also rising. Germany’s social insurance based healthcare system has been under huge financial strain.

The prospect of this new demand being satisfied solely with taxpayers’ money should horrify the Right. Such an expansion of government would require a massive increase in taxation which would cripple our economy and take more money from hard up taxpayers.
...

If the sacred cow of healthcare, education and other services being funded purely from taxation cannot be challenged, a crucial battle with the Left will have been lost and the struggle to stop the State expanding will become increasingly hopeless.

Do go and read the whole thing; but there is one element in which I disagree with Matt. If the NHS is not reformed, it will not just be the Right who will suffer—everybody will. Increasingly poor people will be asked to pay more and more for the treatment of those who do not look after themselves.

In some ways, I have been unfair on Dr Rant and the other medicos; heavy drinking, for instance, does, undoubtedly, damage the body. The only way in which you are going to make people take responsibility for that, though, is to make them pay for it. Right now, everyone is forced to fund the NHS and they do not do so according to need but by ability to pay. The more you earn, the more you pay in, irrespective of whether you look after your body or not.

Legislating street-drinking bans will not help: making people pay, even partly, for their medical treatment is the only way to ensure that they do actually take responsibility for their actions. As long as people perceive health treatment as being free (even though it is not) or as being "their right" no matter how much they continue to damage themselves (which they will as long as they are forced to pay no matter how healthily or otherwise they live), they will continue to make choices that distress doctors.

It is ironic, therefore, that those who fight most fiercely for the retention of our current system, the medical profession, are precisely those who simultaneously rail against the actions that the system's perverse incentives engender.

Are these people insane? Or just really, really stupid?

A little while ago, Timmy posted about MTAS and included an assessment which points out that, really, security in web systems should be thought about at every stage of implementation; in fact, it should be absolutely integral to the operating of the system. It isn't something that should be bolted on at the last minute if security is paramount; and surely, when you are storing everyone's medical histories, you really should be thinking about security at every, single second.

Which makes this question and answer, highlighted by Dizzy, so absolutely confounding.

Yesterday, Oliver Helad MP asked the Secretary of State for Health, "whether a privacy impact assessment (a) has been produced and (b) is planned for the NHS spine project." In an amazing moment of honesty, Carline Flint said, "No. We do not believe that such an assessment would serve any useful purpose at this stage of the project".

What.

The.

Fuck.

Are these people completely mental? Hello! Any politicians reading these ramblings? Are you completely fucking mental or what? (Answers in the comments, please.)

Oh, and while we are about it, can I remind everyone—again—that NHS Scotland already has a working system that cost a mere £24 million over four years. Being browser-based, it has no need for computer upgrades and no proprietory terminal-based software. So why have NHS England and Wales gone with that totally fucking stupid route solution?

Might I also remind you that your details will automatically be stored on the NHS Spine unless you request, in writing, that your GP withhold your details.

Given that the Spine, should it actually ever work, is obviously going to be a security fucking nightmare, I foresee record profits for the Royal Mail this year...

MTAS – as powerful as a ZX Spectrum?

This year every single junior doctor in the country has been forced by the government to apply for their August job via a centralised computerized system called MTAS aka Medical Training Application Service. The old system of local applications was not perfect but it is starting to look like a veritable utopia compared to MTAS.

MTAS is the side arm of MMC (Modernising Medical Careers), the rushed corrupt reform of medical training that aims to enslave the medical profession by creating a super size cohort of demoralized disempowered non consultant grade doctors; in reality MMC will simply force a lot of talented folk abroad or into the city, while rogering patient care.

The MTAS process started with incessant computer crashing, lost applications and the leaking of marking schemes; several consultant groups even withdrew from the interviews because they had no faith in the selection process; this led angry junior doctors to march on the streets of London to protest against this shambolic reform.

The under pressure Patricia Hewitt was forced to launch an ‘independent review’ into the shambles, this sham review panel was made up of the same malingering cronies who had dreamt up the festering MTAS/MMC initially; even they had to agree to abandon the tree hugging short listing process, but bizarrely the amended system is even more unfair than the original as the admittedly failed short listing is still relied upon. Political pressure from No10 prevented a complete scrapping of the system and a return to the standard tried and tested local process. Various ministers, Patricia Hewitt and Lord Hunt in particular, have been caught telling porkies with their sweaty pants down around their ankles.

Remedy UK is a grass roots organization that has sprung up in response to these incoherent reforms, and they have amassed a small rain forest worth of evidence in order to try to force the process to stop with a judicial review, which was applied for on the 29^th of April; this is while the limp BMA have stood idly by and done fuck all worthwhile. There was even a parliamentary debate on MTAS/MMC in which there were yet more government lies. The heads of MMC have now resigned and many highly respected consultants are up in arms, but the process is rolled on.

It gets much worse. In recent days it has been shown that anyone with a computer could freely access extremely personal data of all the applicants on MTAS (including sexual preference, criminal records, phone numbers, addresses and more). This headlined the Channel 4 news and the DoH then claimed that the site was secure. However on the very next day it was shown that all the emails that had been sent via MTAS could be viewed and replied to by any old punter, the emails and enclosed personal data was not even protected via passwords. The scandal is still unfolding and bizarrely the latest twist involves Hewitt lying about important details and trying to pin the blame of her department's failings on Channel 4; while it is revealed that the system delays will lead to NHS chaos in August with operations already being cancelled.

HMG and the DoH have yet again proven that they are incompetent cretinous fuckwits of the most malignant order. I wouldn’t trust them with my email address, let alone my confidential medical records on the NHS SPINE or yet more personal data on the national ID database. This affair is symptomatic of a quite contemptible Blairite regime that I wouldn’t even waste my most festering saliva on. Corrupt ideological reform hides behind their allegedly ‘noble’ motives as they railroad their through policy that benefits only themselves.

Conflict of interest: I am a doctor and I fucking hate this government.


[Garth normally blogs as The Ferret Fancier and has now been added to the DK writers rostrum—DK]