Fracture dislocation elbow

Fracture dislocation elbow
Why I hate trampolines

He Lied

He Lied
Don't think anyone's noticed my Pants are quite seriously On Fire here...

Thursday, 8 September 2011

On the Beginning of the End of the NHS

Sad day.

There is no reason why you should know, as there has been absolutely zero media coverage on the event, but yesterday, Wednesday September 7th 2011, the NHS Health and Social Care Reform Bill was passed through the Commons on its first Reading, by 65 votes.

No party had a mandate for it, nor any manifesto mention. The parties that became the Coalition Government promised us "no top-down reorganisations" at the 2010 hustings. But they all lied. All over Whitehall pants are on fire, a bonfire of the pre-election pledges.

We have taken the first step to a US-style healthcare system. A system that is based on a price for everything and where nothing has a value. Including professionalism. It will undoubtably work efficiently for the earning, worried well but for those with co-morbidities that look unattractive to Any Willing/Qualified (Private Company) Provider, things are going to get very tough.

In a market economy, many smaller NHS hospitals will close to concentrate resources in cost-efficient centres. Community based projects (cottage hospitals, rehabilitation centres) will be nonviable, more useful as real estate. Private concerns will be able to cream off the high turnover, lower risk procedures, driving the contracts down with loss leaders, leaving the NHS to deal with the elderly and those with multiple morbidities. Accountants for GPs whose budgets run out before the end of the financial year will find a plethora of creative ways to defer organising investigations and treatments. It's already started in NHS Yorkshire " Before you consider surgery ... remember there are significant risks attached ... surgery can be painful ..." NHS 'cynical' tactics are up and running.

And training, how on earth are we going to train future surgeons when the 'routine' operations are removed to the private sector where only consultants are insured to practice...

This is only the first Reading. I realise it has to get past the Lords but the staggering lack of engagement in this last vote by the media and the general publlic has left me gobsmacked. Honestly. Nothing today on any of the national papers' front pages. No discussion of any of the BBC's flagship news programmes. Liberal Democrats crowing on twitter that they showed the Tories what they're made of (really, REALLY? You abstained in protest, oo how tough were you). Dead silence from the Labour leadership.

They all want it. They all want the NHS albatross removed from around their collective neck, it's their dirty little secret.

And now it's our future. Or is it ...

Read the Bill go on, have a go. If you like what you see, well at least you are informed. If you don't, then:

Adopt a Peer and email them your thoughts. Please engage in this process: there is no doubt that the Old Girl needs reform after 63 years but this, truly, is not the way.

Saturday, 3 September 2011

On questioning the role of surgeons

Why is there so much antipathy to the Surgeon and so little value placed on the performance of Surgery?

Not for the first time the job that we do is portrayed as optional, sham, cosmetic, a luxury. Pain isn't optional. Osteoarthritis, neuralgia, tendinitis, functional incapacity, inability to be economically active through musculoskeletal insufficiency: these are not conditions to be put off to another day. A torn meniscus isn't cancer, doesn't provide the emotional photo ops of a children's ward, and yet for that patient it means pain, it means swelling, it means not driving, it means losing income, it means lack of sleep, sleep deprivation that most penetrating of all psychological abuses.

Surgeons are not charlatans. We do not exist to create a demand, a need, where there is none. We have training in a skill that maintains the human skeleton beyond its warranty: it was only designed to last for 35-40 years. After that, it loses much of its adolescent ability to repair. It starts wearing out, at the height of our economic earning potential, when our outgoings are at their lifetime peak. Mortgages, childcare, tax demands, insurance... Who will underwrite that when you take to your bed after discovering all the Nurofen in the world won't let you sleep.

Value your surgeons. If a surgeon offers an operation, it is because all reasonable non-operative options have been exhausted. It's not because we're looking for a job creation scheme. Be honest about what you are doing when you ask people to think again about surgeries to improve quality of life. You are talking about Rationing, Cost and Corner cutting. Storing up worse trouble for the future, even if it is a future government of another colour. You are talking about an NHS that can only deal with cancer, kids and crashes.

Value the current, the existing NHS. In the words of Joni Mitchell, you don't know what you've got till it's gone...