Bob Bury

Bob Bury recently retired as a consultant radiologist in the NHS

How the brave new NHS world will look …

By Bob Bury - 11th May 2012 9:33 am

A little snapshot for you this week. It will give you a foretaste of how life will be in the new improved NHS, following the forthcoming injection of expertise and altruism from the private sector.

I’m sitting at a radiology PACS workstation, doing my locum session of plain film reporting which, post retirement, provides my pocket money - just enough to cover the odd pint of stout and my class A drugs. This is in the nuclear medicine department and in the background I can hear a colleague quietly tearing his hair out.

The PET/CT scanner has broken down for the umpteenth time in the past couple of months, and he’s trying to get someone to take the recurrent problem seriously. They are frantically trying to get it going again, while at the same time dealing with the anxieties of patients who have already been injected with radiopharmaceutical and who will probably not now get their scan. One of those patients has already been re-booked once, because his blood sugar was too high the first time round. Another patient has informed my colleague that he is a close acquaintance of the editor of one of the national broadsheets, and will be contacting his chum concerning his experiences at the trust’s hands.

He, the patient, will not have appreciated the background to the PET/CT service. Although the scanner is located in an NHS department, it is a cuckoo in the nest. The national PET/CT procurement programme was instituted by the previous government, and, as good socialists, they insisted that the new nationwide service must be provided by the private sector. So, contracts were awarded, and our chosen provider asked the radiologists to assess the equipment available and decide which was the best scanner. They did this, and the company concerned then purchased a cheaper one which, needless to say had not been at, or near, the top of the radiologists’ list.

The contract has now been running for three years or so, and an enormous amount of NHS staff time has been spent trouble-shooting the service in various ways, not least in picking up the pieces when the scanner breaks down and dealing with issues around the booking of scans. The apparent belief of both major parties that the private sector is more efficient than the public would not survive long if they spent some time in NHS departments like this one.

Of course, I can’t say with any certainty that if the radiologists had been provided with the scanner they wanted, it would have broken down less frequently. I would simply observe that with expensive medical equipment, as with most things, you get what you pay for. What I do know is that if the Labour government had just given us the money to buy the scanner and run it ourselves instead of throwing cash into a contract which appears to contain no enforceable quality criteria, we could have had a better service. But of course, the capital outlay for equipment would have impacted on Gordon Brown’s bottom line, whereas the eventually much larger revenue costs of buying the service from the private sector can be hidden. Just like PF bloody I.

And if our disgruntled patient goes to the press, as promised, it will be the trust and the NHS in general which is pilloried in the headlines, with tales of cancer patients denied a timely diagnosis and treatment. I wouldn’t even be surprised if the story used the perceived shortcomings of the PET/CT service to reinforce the case for NHS ‘reform’.

But of course, all that Andrew Lansley’s Health Act will do is to potentially reproduce this unhappy scenario by increasing the number of private concerns taking on NHS work. Providers with an eye to the main chance will be queuing up with the cheapest kit and the smallest number of staff with the minimum qualifications necessary to run their service, and no doubt relying on the NHS to cover up for their corner-cutting.

But perhaps this department has just been unlucky, and everywhere else in the NHS these private/public partnerships are working just fine.

Well?… Examples please?

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“NHS commissars are out of touch with reality”

By Bob Bury - 13th April 2012 5:24 pm

Did your heart sink, as mine did, when you read this? Just what we need - an NHS Academy to teach ‘leadership’. We’ve been here before: do you remember the University of the NHS? In case, like me, you had forgotten all about this, it was proposed by New Labour in 2001; there was then the inevitable consultation exercise, but they went ahead with it anyway, and it was launched in 2003 before John Reid promptly ‘dissolved’ it in 2005. A two-year campaign under the Freedom of Information Act resulted in a report detailing the cost of the aborted NHSU, and the associated management failures.

And anyway, academy my arse, as Jerry Nelson would no doubt say. HMG are clearly realising the huge risk they have taken by pushing through their misbegotten Health and Social Care Bill (HSCB), and feel the need to have an indoctrination centre to impose Right Thinking on the workforce. Who would have thought that it would take a Tory government to lead the country down the Maoist route? In this echo of the Great Leap Forward, I can foresee early morning exercise sessions on hospital car parks around the country, as loyal workers chant their ‘clinical commissioning group good, PCT bad’ mantras, in the shadow of huge advertising hoardings carrying Andrew Lansley’s beaming image (or, more likely, his successor’s).

Still, it will provide an employment opportunity for all those men in sharp suits and over-promoted nurses who spend their lives cocooned in training centres and converted schools of nursing, apparently joined at the hip to their flip charts. I sometimes think we should update that old aphorism: those who can, do; those who can’t, teach, and those whose sad fate is to serve no useful purpose in life whatsoever … facilitate.

But perhaps I’m being unfair. Perhaps these chair bound administrators (yes Sir David Nicholson, that’s you) really do believe that you can teach leadership in workshops, breakout sessions and on awaydays in shabby hotels on suburban ring roads, but most of us rumbled you a long time ago. Although I try to avoid clichés, sometimes a cliché is just what you need, so I make no apologies for saying that leaders are born, not made. I came across a number of them in my service career, and even a few since I rejoined the NHS 24 years ago. None of them owed their leadership qualities to hours spent in a seminar room being addressed by people who had long since forgotten what it was like to do actual work at the sharp end, if indeed they ever knew.

This is not the only recent example of senior NHS commissars being out of touch with reality. The Times believes it has unearthed yet another health scandal - this time it’s the discharge of patients during the night due to the pressure on beds (abridged version here, the full though behind a pay wall version here). There are certainly large numbers of overnight discharges, but even the journalist admitted that a large and unknown number of these are at the patient’s own request, and it is by no means certain how often old people are precipitated back into their unheated homes with no provision for relatives or friends to care for them (the type of unacceptable occurrence being touted as the reason for the paper’s outrage). However, it was all news to Sir Bruce Keogh, the Medical Director of the NHS, who promised an investigation into why it happens.

Well Sir Bruce, I suspect that most readers of this blog could give you one reason why it happens. It happens because there are admissions queuing up in the A&E corridors (sorry - in the Clinical Decision Unit), and beds are needed to accommodate them. Those beds are not available because successive governments have slashed bed numbers to cut costs. You would think the Medical Director of the NHS would at least have raised that possibility rather than rushing to reinforce the impression the The Times has unearthed a real and sizeable problem, but presumably his is a political post (is it? - I genuinely don’t know. I hadn’t even realised there was a Medical Director of the whole NHS).

The Times have clearly tired of their campaigns for simplified adoption procedures and safer cycling, issues which seem to have relegated any proper news to the inside pages for the past few months, and now have their teeth into this new ‘scandal’. In a leader, they told us that the overnight discharges indicated how badly the NHS needed Lansley’s ‘reforms’. On the contrary, I suspect they indicate how badly we need more beds and the staff to service them. The HSCB, with its push for more private sector involvement, will only increase the tendency to close beds and cut costs, thus making matters worse.

OK, I expect it’s more complicated than that, and no doubt changes in the way we work might be able to mitigate the need for overnight bed recycling. It’s also clearly wrong to send patients home precipitately if the conditions don’t exist for their proper care. However, despite the anecdotes, there are no figures for how often this happens, and in the meantime it’s irritating to say the least to hear our leaders jumping on the press bandwagon rather than counseling caution pending the acquisition of some real data, rather than raw numbers.

And … relax, Bob.

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Doctors are ideal candidates for becoming MPs

By Bob Bury - 22nd March 2012 10:39 am

So, the Bill passed through the Lords, despite a last-ditch effort to frighten peers into rediscovering their principles - an effort which attracted criticism from a fellow blogger for reasons which I respect, but with which I disagree. Although the headline writers used the word ‘revenge’, I think that most of us who signed the letter were motivated by the outside possibility that we could still change the outcome of the Lords’ vote on David Owen’s delaying amendment. Sadly, the merest hint that there might be a LibDem replacement for Andrew Lansley when he gets the boot was enough to get the LibDem peers to roll over - even Dame Shirley.

But that’s water under the bridge now, and all we can do is engage constructively and try to mitigate the worst effects of this misbegotten piece of unnecessary legislation. And we have learned a lot. For many of us, it was the first time we had been involved in this sort of fight, and we have seen how easy it is to mobilise support and have an influence at national level. If we had managed to get the colleges on board at an earlier stage, who knows?

But I don’t want to talk about that now. I’ve been considering the prospect of a number of medics standing as independent candidates in 2015 on a save the NHS ticket. If that happens, one thing we can be sure of is that they will be criticised for being ‘single issue’ candidates, and I’ve had a few thoughts about that accusation.

Firstly, if they take into the campaign one issue which fires them up more than any other, and upon which they are determined to have some influence for the better, that’s one more than most of the party political candidates. Without being unduly cynical about our elected representatives, it does seem that most new MPs arrive at Westminster with the intention of voting the way their party tells them, and furthering their own career. Frankly, if it’s a choice between a one issue and a no issue candidate, I know where my vote goes.

Secondly, let’s forget about this specific issue, and think about doctors as independent MPs. If we accept (as I do) that it would be good to have more independent voices at Westminster to counteract the sheep-like tendencies of the party political lobby fodder, then who better than doctors? We have a pretty good general education. More to the point we experience close contact with members of the public from all walks of life, including the most deprived members of society. This is particularly true of GPs, but all doctors meet with people at their most vulnerable, when they are ill, distressed, bereaved or generally in trouble, and we have to work with the agencies which exist to deal with those problems. It’s hard to imagine a career which would better prepare an MP to represent constituents in Parliament.

So there you have it: medical candidates in 2015 may have been impelled to seek election by a single issue - the HSCB - but that doesn’t mean it’s the only issue which interests them. On the contrary, they are likely to be well-rounded individuals, with good interpersonal skills, and wide experience of the problems which beset their constituents. And no - I won’t be standing myself. At nearly 67, I’ll be too old, but I will be happy to support local candidates in any way I can.

And at least we’ll have a ready-made and easily recognisable slogan. Doctor in The House, anyone?

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The Health Bill has taught me about democracy

By Bob Bury - 6th March 2012 11:26 am

I’m not what you’d call an activist, and although I did a lot of work with my college (RCR) during my career, it was mostly committee stuff and editing - I never really got involved with anything you could call politics. Then along came the Health and Social Care Bill, and in my dotage I suddenly found myself caught up in political campaigning. It was an interesting experience.

The issues around the college’s response to the Bill have been covered elsewhere, including here, and I won’t re-hash them now. After the official poll of the membership produced a majority of 76% in favour of calling for the withdrawal of the Bill, the council of the college met urgently in cyberspace to discuss the result, and agreed to make it college policy.

This whole experience did make me think a bit about democracy, and it also made me think about how people behave when they take up a cause and try to get others to share their views. Now I’m generally a pretty easy-going sort of chap - I seem to get on with most people - and although I’d like to think that’s because I’m basically a Good Person, I suspect it has more to do with my need to be liked. In the middle of this debate, though, I found myself getting pretty abrasive and forthright in my condemnation of what I saw as the college’s intransigence. I began not to like myself very much (I’m usually one of my greatest fans), and I’m pretty sure that I and the other members of the awkward squad became a pain in the arse as far as the college officers were concerned.

The problem, of course, is that when a particular issue assumes this level of importance, and particularly when you share your concern with a group of like-minded individuals, you rapidly develop a bunker mentality, and begin to lose your sense of perspective. I suspect the same thing happened with the college officers, and that what some of us saw as a failure to listen to members (i.e. us) was more a reflection of the self-reinforcing nature of the discussions within a group of individuals who share the same view, and who consequently lose sight of the bigger picture. Somewhere in the middle of all this are the members of the college, who may well be concerned about the Bill, but haven’t allowed it to become the central focus of their lives.

Which brings us to the democracy thing. When we ran our own unoffical electronic poll, just over 600 members voted, and 88% favoured a call for withdrawal. In the college’s offical poll, 37% of the membership voted, and 76% called for withdrawal. Is 37% enough? When you take into account the fact that a large number of members work abroad, and presumably would have been unlikely to vote, it’s actually not a bad turn out. And in any case, as Winston C  once said, democracy is the worst form of government, except for all the others, and if you can’t be bothered to vote, you really can’t complain about the outcome.

More interesting are the implications of electronic polling. Until fairly recently, it would have been difficult to arrange a vote of the membership in time to have any influence on events. Now, though, we managed to run two national surveys in a couple of weeks. Which raises the question in my mind of whether it is getting too easy to poll large numbers of people. Like me, you probably receive numerous emails from the 38 Degrees organisation, which campaigns on a whole range of issues. They now claim nearly a million members. That’s a heck of a mailing list, and I suspect that this contains the seeds of its own destruction. Once it becomes possible to mobilise 100,000 votes on any issue in a matter of days, the results are increasingly likely to be ignored by the target  group (usually politicians) the organisation seeks to influence. It’s certainly a tool that needs to be used sparingly.

One final thought on democracy arising from this episode. It was pointed out that, according to the college’s constitution, strategy is determined by council, and that while it will take account of the opinions of members as expressed in polls or at Extraordinary General Meetings, it will not necessarily be bound by them. This led to suggestions that we needed another EGM to call for a change in the bye-laws so that Council would be forced to reflect the democratically-expressed opinions of members (you may have spotted a Catch 22 flaw in that suggestion, but we’ll ignore it for now). I think that would be a really bad idea.

Having seen how easily a small group of committed members can call an EGM at short notice and achieve a majority from the small number of attendees, I believe that making the results of EGMs binding would be no way to run a college, or any other institution that wants to be taken seriously. OK, on this occasion, the right decision (i.e. the one that I favoured) was reached, but that would not necessarily always be the case, and it’s difficult to argue that a meeting involving 50 or so members out of a total of several thousand can reliably reflect the majority view (or that it would necessarily indicate the most sensible way for the college to act, even if it did). The democratic step in the process has to be in the election of council members, as it is now.

But then, of course, only a small minority of members bothers to vote in college elections, and not enough  people are willing to stand, with the result that many candidates are elected unopposed. Presumably that’s what is meant by the democratic deficit?

For myself, I’m going to take some time off from giving a toss, it’s easier on my coronaries.

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Radiologists call for withdrawal of Health Bill

By Bob Bury - 19th February 2012 1:16 pm

I’ve been to quite a few meetings of the Royal College of Radiologists during my thirty-odd years in the specialty, but never one like the Extraordinary General Meeting (EGM) earlier this week. The EGM was called by the council of the RCR, following a request signed by more than the requisite number of fellows. They were unhappy that the college’s current policy of opposition to aspects of the Health and Social Care Bill had clearly failed to influence its content. They wanted officers to join with the RCGP, RCN and BMA and others in calling for the withdrawal of the Bill.

There was never going to be a large attendance for a meeting called at a couple of week’s notice in the middle of half-term, but it was impressive just how many members had made it, at their own (often considerable) expense. Fears that the attendees would be outnumbered by the platform party were unfounded, and there were 40-50 of us on the floor, so to speak, including a gratifyingly large number of trainees.

There were two motions to be debated. The awkward squad presented a multi-part motion including the key demand that the college should call for withdrawal of the Bill. This was preceded by a ‘mom and apple pie’ proposal from the RCR council, giving them carte blanche to do what seemed best for the college, patients and the quality of the services provided by members.

The first motion was proposed and seconded by Peter Cavanagh and Adrian Crellin, the deans of clinical radiology and clinical oncology. No-one could reasonably vote against it, but equally, it would have been difficult to support this motion and also vote for the second one. As a consequence, the motion was carried by 20 votes in favour, none against, and 24 abstentions.

The second motion started with three sections which welcomed the RCR’s opposition to the Bill; stated that the passage of the legislation would damage the NHS, and that the Bill could not be supported without seeing the Risk Register. Then came the key demand, that the college should call for withdrawal of the Bill, followed by two related clauses calling for the RCR to seek an alliance with the BMA, RCN et al in calling for withdrawal, and that there should be a press conference with those same organisations, making the call for withdrawal public. It was proposed by Clive Peedell, a clinical oncologist, and seconded by Jacky Davis, a clinical radiologist, both of whom have been active, through the BMA and elsewhere, in seeking to get the Bill stopped.

There was then a good debate of the issues. Quite a bit of this spelt out the likely dire effects of the Bill for the NHS and for members of the RCR, most of which was non-contentious. When it came to justifying their current position, the officers really only advanced one argument; namely that a call for withdrawal would result in a loss of political influence which would be damaging to the effectiveness of the college both now and in the future, with Dick Fowler, the warden for clinical radiology, pointing out that there were important debates looming concerning the current under-staffing situation in the specialty.

Those speaking for the motion dealt with this single argument by pointing out that the college clearly had no influence in any case. Successive college bulletins over recent months had outlined the same list of serious concerns over the Bill, none of which had been addressed despite the RCR’s continuing engagement in the ‘listening’ process. One telling contribution came from Professor Peter Armstrong, a former RCR president. He stated that in his experience, influence has to be based on respect, and that, even in Whitehall, you earned more respect by taking a principled stance than by yielding to political pressure to conform. It was interesting that the trainees who spoke, who potentially have more interest in the outcome than old retired types like me, were equally keen for the college to take a firmer line.

When it came to voting, the first three, rather anodyne, clauses were carried unanimously, with the exception of one abstention. The key item, asking the college to call for withdrawal of the Bill was carried by 36 votes to 10, with 3 abstentions. The final two clauses, calling for an alliance against the Bill, backed up by a press conference, were each carried by 32 votes to 15, with one abstention. In other words, a fairly unequivocal result.

So now what? The president, Jane Barrett, had made it clear from the start that council was the body determining College strategy, and while it would be influenced by the outcome of the EGM, it would not be bound by it. Whether it will also be influenced by the electronic poll organised by the proposers of the second motion in the run-up to the EGM is less clear. That had demonstrated an 88% majority of over 600 respondents in favour of calling for the withdrawal of the Bill.

Latest news is that the college will be organising their own electronic poll-frequent calls for which had previously fallen on deaf ears. I shall take the charitable view that they simply wish to be sure of the wishes of members before changing course. Less well-disposed Fellows have suggested that officers will just keep asking the question in different ways until they get the answer they want.

Wording of the question will clearly be every bit as vital as it is for the Scottish independence vote, for example, and initial indications are that the college intend to accompany it with material explaining their position (although it might be thought that the barrage of official bulletins issued since the college was made to take the subject of the Bill seriously had already achieved that end). It is less clear what explanatory material will be included to back up the calls for a change in policy, although there is a suggestion that the minutes of the EGM will be circulated. We would have to hope that those minutes will be a true reflection of a debate which was overwhelmingly in favour of a change of direction-but then, how many people would read them anyway?

I would suggest that we should be presented with a simple choice between the status quo and a call for withdrawal, on the basis that the electorate are grown-ups who are familiar with the arguments. If they insist on including additional material, it should be limited to a Twitter-length contribution from each camp.

Whatever happens, the genie is now out of the bottle. Members have discovered that they can make their views known, and the magic of instant communication means that the outcome of the EGM is already widely disseminated, with both the BBC and Sky news stating-inaccurately but gratifyingly, for some of us at least-that the college has already called for withdrawal of the Bill.

Interesting times, as they say. One thing’s for sure. A group of college officers have never been under closer scrutiny by their members. So, no pressure, then.

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Forget the Bill, death is this week’s big subject

By Bob Bury - 3rd February 2012 1:21 pm

I bet you thought I wouldn’t be able to resist my pledge not to write about THE BILL any more, given the fact that Lansley is on the run, and that our College has ignored the craven capitulation of the Academy of Medical Royal Colleges, and stuck to the original stongly-worded statement of opposition that the AMRC retracted after late night phone calls from the increasingly desperate politicos. You did, didn’t you - especially after today’s call by the RCGP for withdrawal of the Bill?

Well, you’d be wrong - I’m not going to mention any of that. I’m not even going to lambast the surgeons for their self-serving toadying up to HMG - Jerry Nelson says all that needs to be said about their motivation. No, I thought I’d talk about death.

I’ve been thinking about it quite a lot recently. Not just because I’m getting older, and have recently acquired a proper illness for the first time in my life (yes, much better now - thanks for asking), but because during the past year I trained with the British humanist Association (BHA) to become a humanist celebrant, officiating at non-religious funerals. It may seem like an odd thing to take up in retirement, but it actually turns out to be very challenging and rewarding job.

And when you think about it, it’s a natural extension of a medical career. We deal with patients and their relatives at a very fraught time in their lives, and some of the patients die (although not all, hopefully, even in my hands). This means that we are used to talking to relatives and helping them to cope with worry and distress. When I did the training course, I realised that this gave me quite an advantage over some of the other trainees, who were coming from backgrounds that didn’t bring them into contact with people in the same way (one exception, I suppose, being the young metropolitan policeman on the course).

That’s not to say that the training was easy. I had naively assumed that the public speaking aspects of the job would be a bit of a doddle. After all, I had spoken at numerous medical meetings and conferences, and had also done quite a bit of after-dinner speaking. When, early on in the training, it became clear that the trainers were assuming that we would all prepare written scripts for our ceremonies, I was quietly contemptuous.

What did I need with a script? I had never read from a script in my life - I’d just wing it, like I always did. But of course, they were right. You can’t afford to make mistakes; you only have a short time to meet the family, get all the information about the deceased and produce a eulogy. I suddenly realised that this was much more important than any other speaking engagement I had undertaken. If I made a mess of a presentation at UKRC, it didn’t really matter - no one died, as they say. Well, here someone had died; this was the only funeral the family would have, and I had to get it right.

I actually almost gave up the training at that point. I’m glad I didn’t, but it’s a fact that I get much more nervous before a funeral than I ever did before the biggest conference presentation. It has been a privilege, though, to go into people’s homes and hopefully to be able to help them through a very difficult few days. I’ve been impressed by the dignity and courage of the bereaved relatives and friends, not least in a recent case of the sudden death of a 56-year-old man from a sub-arachnoid heamorrhage.

In an odd way, it makes me more sanguine about the possibility (or I suppose that should be certainty) of my own demise - I think I can see my own kids behaving like that relatively young man’s sons - not being afraid to shed tears on the day, but still producing an affectionate yet witty eulogy, and then getting on with their lives.

As for why I became a humanist after forty plus years as a card-carrying member of the C of E, well I didn’t. Like most humanists, I just suddenly discovered that I already was one.  And yes - I am planning my own funeral. It’s going to be a cracker, but I hope to keep you all waiting for a while yet.

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Why the ridiculous deadline on additional funding?

By Bob Bury - 12th January 2012 10:53 am

OK, now listen to this because you couldn’t, as they say, make it up.

You know how much pressure we are under to cut costs and rationalise services in light of the current austerity programme, don’t you? And you will have noticed that your pension contributions are increasing at an eye-watering rate, and that your money is being poured into the black hole of NHS finances rather than salted away to fund future pensions, as has been the (mal)practice of successive governments?

Knowing all that, you will be as delighted as I was to learn that Andrew Lansley is indulging in one of those old end-of-year mindless spending binges that we hoped had become a thing of the past.

As I discovered when I dropped in to work today for one of my twice-weekly locum sessions, and as reported in the Health Service Journal a few days ago, trusts (well, a few of them) have been told that there is a capital sum of £300m available - that’s 6.7% of the total available for the year - and that the DoH is inviting bids against it. The closing date for those bids - which must be for at least £5m? The 12th of January. That’s right - today. Although NHS London sent a letter announcing the bonanza on 23 December, many others have still not been informed about the end of year (?closing down) sale.

A colleague in Leeds first heard about it from a representative of one of the leading manufacturers of radiology equipment, who was asking if we would be directing any of the largesse their way. Well, we could easily spend four or five million on a PET/MR scanner, or a cyclotron for our existing PET/CT scanners, and even justify it to ourselves, but is this any way to allocate scarce resources in the middle of a funding drought?

This is just another example of crass incompetence at the highest level in Whitehall. How can they seriously expect trusts to produce fully-costed business cases for expenditure of this magnitude in a few days? Also, of course, many PCTs and trusts seem to know nothing about it even now, and so any distribution which does occur will be seriously skewed. It’s a recipe for waste on a grand scale in a department of state that has already set records for profligacy with its failed connecting for health programme.

As one of the PCT directors interviewed by the HSJ put it: “Get your bids in by 6 January for schemes that must be over £5m, preferably spent by end of March?…We haven’t seen this kind of thing in about 10 years. The ‘use it or lose it’ at short notice mentality went away for a long time. Seems it’s back.” Back indeed, and with a vengeance.

If you wonder how Lansley will explain this lunatic behaviour, wonder no longer. A DoH spokesperson said: “Thanks to good management of central capital budgets, we have identified capital funding which could be made available to the NHS. We are now in discussions with the NHS to see how it could best be spent“. So there you have it - contrary to what you had been thinking, this is an example of good management. As, presumably, was Liverpool’s purchase of Andy Carroll for £35m and £80K a week (and at least he has put the ball in the back of the opponent’s net on four occasions, whereas Lansley only seems capable of scoring own goals).

It’s difficult to know if the delayed and ‘hole-in-the-corner’ way in which the information concerning this fund was released is a deliberate attempt to keep bids against it to a minimum, or just another example of administrative incompetence. However, the fact that one half of the DoH apparently didn’t know what the other half was doing would tend to favour cock-up over conspiracy - in the early afternoon of 5 January the DoH spokesman denied that any such fund existed; later that same day they confirmed that Lansley had indeed authorised the release of the cash. Presumably at some point he will blame Nick Clegg.

What a bunch of wasters (no - literally).

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Don’t mention the Bill, I think I mentioned it once…

By Bob Bury - 22nd December 2011 4:13 pm

I have to start by apologising to any of you who haven’t received the goods you ordered from Amazon (or FedEx or any of the other delivery services). That will be because all of their operatives have been diverted to Leeds to deliver the Christmas gifts ordered by my wife. This is the first Christmas where pretty much all of our (her) gift shopping has been done online, and it’s also the first one since my retirement, so I’ve been around to witness the steady stream of parcels arriving at my front door (or dumped near the back door or in the grandchildren’s Wendy house when we are out).

I realise that all the women reading this will be nodding to themselves and saying, “at last he appreciates all the work his wife puts into making Christmas happen”, and they’d be right. I mean, I knew all about the food preparation and cooking that goes on in the lead-up to the 25th, and on the day itself, but the presents for the kids and grandchildren gradually accumulated in the spare bedroom almost without me noticing.

It’s not that I don’t appreciate it, and I do my bit to contribute, as a New Man, by getting the wine up from the cellar and opening it as required. I even help out with drinking it if my sons look like flagging (not that they ever do). I have found myself getting a bit Grinch-like though, as the doorbell rings yet again, and I ask myself just how many toys a five year old can be expected to play with at any one time. I’m also concerned that on Christmas Day even our large family house will struggle to accommodate two tricycles, one child-sized police car, a little girl’s pink car of similar size (she wanted pink - we’re not imposing a gender stereotype), all the other presents, me and the wife, one mother-in-law, four children, four grandchildren and two dogs.

But it will all be lovely, and I’m looking forward to it as much as ever. The commercialisation thing is actually less of a problem for me, as a Humanist, than it is for the believers - I’m just celebrating the passing of the shortest day and the approach of Spring - although I’m now at an age where I get justifiably nervous about seeming to wish my dwindling amount of time away. You do have to wonder just how much the move to online buying will change the face of our towns and cities though.

Despite that first paragraph, I did get dragged in to the present buying from time to time in the old days, and there’s no doubt that browsing online then having purchases delivered to the door is vastly preferable (at least for me) to trailing around cold, damp streets and failing to find what you were looking for. It’s alright Mary Portas going on about re-designing our High Streets, but you almost begin to wonder if shops as we know them will survive at all - and that includes the out-of-town malls that she sees as the destroyers of our town centres.

I could go on to draw an analogy with changes in healthcare, quoting increased patient choice, plurality of provision and the increasing role of the internet, but frankly, it would all be a bit laboured, and I can’t be bothered to make the effort when there is still a turkey to be stuffed (that’s my other contribution to the Christmas effort - using my surgical skills to define a plane of cleavage between skin and muscle, and fill the space with sausage meat…mmmmmm).

Anyway, I think I’ll save my “stocking and one main present” suggestion for another time, and just enjoy watching the little ones having more fun with the wrapping paper than they do with the mountain of discarded toys. In fact, I suspect that raising this issue with the family might produce much the same response as if I took this advice from the National Obesity Forum and cautioned austerity during Christmas lunch. So here’s wishing you all a Happy Christmas (or Winterval or Hanukkah or whatever). And although none of this is humorous, I have at least kept my promise of last time not to mention Andrew Lansley and his bloody Bill…whoops.

And batteries. Must remember to buy lots of batteries.

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The last word on the Health and Social Care Bill

By Bob Bury - 5th December 2011 12:06 pm

Remember the Darzi centres (or khazi centres, as they rapidly became known to the Unbelievers)? These were the walk-in surgeries championed by Lord Darzi in his much-trumpeted review of the NHS. They were designed to give patients, particularly commuters, easier access to GP services - patient choice being, of course, the paramount concern.

Now, you may recall that a lot of people, well, pretty much everyone really, pointed out that duplicating provision in this way by insisting on setting up these centres even in areas which were already well-provided for by GPs, ‘nice’ though it might be, wasn’t perhaps the most sensible way to use resources which were already overstretched. But New Labour had the bit between their teeth, and clinics mushroomed across the country, including my home patch of Leeds.

Now they are closing them down.

I would pose the rhetorical question ‘why’, but it hardly needs asking. When walk-in clinics in the South were being closed earlier this year, the associate director of communications and engagement (sic!) at the relevant PCT explained the issue very simply: “The majority of patients who have been using the centres could quite easily have used another service…they created a demand which wasn’t there before.” In other words, exactly the problem which was predicted when the centres were first mooted.

The story was the same in Leeds - only 20% of the people passing through the doors of the new centres were the commuters for whom the service was designed, and most patients were already registered with GPs in the area.

You could, of course, make exactly the same point about NHS Direct. This too was the result of focus group politics and blind acceptance of patient choice as the appropriate parameter for determining resource allocation (and if you ask people whether they would ‘like’ to be able to ring someone up to ask if they needed to see the doctor or not, they’ll naturally say “yes”). No matter that anyone with significant symptoms will be told to go to the GP or nearest emergency department anyway, and that providing the service will take hundreds of highly-trained nurses away from the front line of healthcare provision, where they are sorely needed.

The patients have what they want, and their votes are assured. That’s the important thing.

And of course, we now have the Health and Social Care Bill, which will open up healthcare provision to ‘any qualified provider’, and ensure a free-for-all which will fragment the service and result in yet more wasteful duplication, making the essential coordination between services much more difficult or non-existent. Just as the last government were warned what would happen if they set up their new clinics, Andrew Lansley has been told what will happen if his Bill comes into effect. They didn’t listen, and nor will he.

Still, never mind. The patients will have chosen, and Mr Darzi has his peerage, and has retired (I assume) back into the relative obscurity of his surgical career. So all’s well with the world.

As Mr Jerry Nelson would say - arse! And I promise you, that’s (probably) my last word on the subject of The Bill, and it’s the appropriate word.

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Reveal the risks of implementing the Health Bill

By Bob Bury - 17th November 2011 11:18 am

Well, here we go again. As Circle come riding to the rescue of the struggling Hinchingbrooke Hospital, we learn that their risk exposure is to be limited to £7m, which equates to approximately 0.7% of the NHS funds it will be responsible for over the term of the contract. Any surpluses they make will be split between Circle and the NHS.

Sound familiar? It should, because it was the estimate of ‘risk’ that was used to make the now discredited PFI initiative of the previous government look so attractive. By artificially inflating the level of risk to which the companies tendering for contracts would be exposed, the politicians made the business cases for PFI stack up. Of course, it turned out that these contracts were not actually very risky at all, which is why companies were able to make profits from building the new hospitals and then make another load of dosh by milking the NHS for the next 30 years as they maintain the buildings.

In fact, the risk was actually so low that a secondary market in PFI contracts sprang up, with quite a few firms taking the profit from putting the buildings up, then selling the contracts on for another fat profit to other providers who still felt able to get a good return on their investment from managing the PFI estate.

I suppose we should be grateful that this time the politicians are at least being up front about the way they are skewing the rules to the advantage of the private sector, but it does indicate that in their rush to involve new providers, the playing field will be far from level.

Still, no-one could accuse Andrew Lansley of being ‘up front’ in his attempts to get his pernicious Health and Social Care Bill through the Lords. Despite being ordered by the Information Commissioner to reveal the contents of the strategic risk register relating to the Bill, he is still stonewalling, on the grounds that publication of the report would ‘jeopardise the success of the policy’.

Well, quite. In other words, Lansley knows that the report, which details the risks for the NHS of implementing his changes, will confirm that the fears many of us have are well-founded, and might just lead the Peers to vote it down, or insist on root and branch amendments. Actually, now I think about it I’m wrong. He is not just being up front, he is being frankly shameless by effectively admitting that he can only get the Bill through if he stifles any debate on its likely adverse effects.

I hope readers will join me and many others in emailing their MP and asking them to tell Lansley to comply with the commissioners demands to release the report. It’s easy - just click here.

And to think it was only 18 months ago that we were hugging ourselves in relief that we’d got shot of New Labour. They really are all the same, aren’t they?

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