tag:blogger.com,1999:blog-252009612024-03-16T09:29:10.936+00:00Dr GrumbleDr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.comBlogger489125tag:blogger.com,1999:blog-25200961.post-59299073264675220912015-02-07T10:36:00.000+00:002015-04-24T18:30:57.148+01:00Clean shavenWorking where I do, I have a lot of patients who are actors or work in TV. Recently we had a TV producer who makes adverts. He had a fever so I needed to take a travel history. Why you need to travel the globe to make advertisements I have no idea but, worryingly, he had been to all sorts of exotic places. My heart sank as I struggled to remember all the weird and wonderful tropical diseases I might have to consider.<br />
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But that's not at all the point of this post though it does set the scene and explains how we got talking. It turns out that one of my patient's assignments was to make an advertisement showing men how to examine their testicles. (Perhaps I should watch this film as I've not much idea myself.) My patient found an actor who was apparently willing to demonstrate on camera. They talked about how they would get the right shots. The actor then asked, "Do you think I should shave?"<br />
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"Oh no," my patient replied. "I think we should show them au naturel."<br />
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"No, no," said the actor. "I meant my face."<br />
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<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com53tag:blogger.com,1999:blog-25200961.post-30734668402795750092013-03-28T07:53:00.000+00:002013-03-28T07:55:04.986+00:00JG speaks upHere is a comment written by an anonymous doctor in response to the GMC guidance on social media. I am grateful to Dr Anne-Marie Cunningham for drawing my attention to it. I have to say that I agree with everything this doctor, who calls himself JG, said:<br />
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There is no way I would ever write to the GMC about this but I'm happy enough (at the behest of Anne-Marie) to comment here - which, of course, shows the value of social media. <br />
My first thought is that this advice comes much too late. A quick check shows I first blogged in 2006. That's when I needed this advice. <br />
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My second thought is that this advice doesn't really facilitate anything. I learnt the hard way that it was difficult to put clinical vignettes online without risking a breach of confidentiality. At first I started changing dates/times/sex and I kept myself anonymous but if the condition is rare that doesn't help much. As a result, I concluded that using a blog as a way of teaching on real clinical cases was unwise. Yet we have been publishing such cases for centuries. The GMC provides no solution – not with this guidance anway. My guess is that most patients would not mind and might even be pleased to have their case publicised but how do I get their permission reliably without falling foul of the regulator?<br />
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As for identifying oneself when acting in a professional capacity, I am not too comfortable with that. But what is meant by a “professional capacity”? Even if I did put my real name how would anybody know that I am really a doctor and really who I say I am? There are people on Twitter who claim to be well-known people who are imposters. None of this has been addressed. And what is a “professional capacity”. Is moaning about the GMC or Mr Lansley’s policies operating in a professional capacity or do they just mean things related to patient care? And if I used my real name wouldn’t that be inviting patients to contact me in my area of special expertise (which I hope I have kept largely under wraps)? That’s not something I want to do and, it would seem, nor should I. <br />
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The GMC tells us not to give medical advice so why do we need to identify ourselves? Requests for medical advice are, in any case, surprisingly rare. Patients as well as doctors seem to know where to draw the line. But only days ago somebody asked urgently whether an overdose of a particular drug was dangerous and whether he should take action. Thinking of the GMC advice that “you must not use social media to discuss an individual patient”, I held back. Fortunately others did not and promptly gave appropriate advice. I think if they hadn’t I would have done the same. It was the GMC that deterred me. As it happens the police were called and hopefully the patient was OK – though I don’t know. <br />
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What if somebody tweets: “I have severe crushing chest pain”? Do you tell them that you cannot discuss their problem and that they should call their doctor for advice? Or should you tell them to call an ambulance? Or do you pretend, as I did, that you hadn’t seen the tweet. These issues have always been around. I was taught as a medical student how to deal with requests for medical advice at a cocktail party. Twitter is not very different really. The advice I was given then holds good for Twitter now. <br />
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I don't welcome this advice at all because it won't be long before the GMC start prowling around the social media. Doctors won't be able to be people. They will have to be professionals. The only safe thing to do will be to stay away. Doctors will become social media lepers. <br />
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JG</blockquote>
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I think this JG chap makes some good points though not everybody agreed with him. You can read the views of others <a href="http://wishfulthinkinginmedicaleducation.blogspot.co.uk/2012/04/doctors-use-of-social-media-some.html">here</a>.<br />
<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com22tag:blogger.com,1999:blog-25200961.post-64814952949696782412013-03-03T10:17:00.000+00:002013-03-03T10:17:29.392+00:00My political forayIt's gradually been dawning on me that we all need to seize control. I know some of you think I'm wasting my time and money supporting the National Health Action Party. But I don't think I am. I've never been a member of a political party before and, until Eastleigh, I had never been canvassing. It's never too late to learn.<br />
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And I have learnt a lot. The hostility shown on the doorstep was an eye-opener. The people of Eastleigh came over as utterly disenchanted with the political process. Who can blame them? I feel the same way. We are in the era of disenchantment. We don't feel we have any control. The politicians just plough on regardless. And their direction of travel is wrong.<br />
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The other thing that dismayed me was how the propaganda originating from our masters and spewed out by our complacent and compliant press is actually believed. The badmouthing of the NHS has been so widespread and sustained that the public now think that the good care they themselves may have received has been the exception rather than the rule. You can't overturn entrenched views. Evidence cuts no ice on the doorstep. Politics is about belief.<br />
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A comment on my previous post mocks the efforts of the NHA Party in Eastleigh. Mocking is easy. Doing nothing is easy. But trying to do something to improve matters is difficult - especially if you make no progress and are ridiculed. But today I feel that there are signs that the tide is turning. I awoke this morning to news that the prime minister himself is claiming that his is the party of the NHS. Later came a tweet from the Labour Chief Whip in the Lords telling me that "doctors have rumbled the Govts Trojan horse, sneaky regulations that marketise & privatise health care in the NHSby forcing CCT". I'm not sure which planet the Chief Whip's been on over the past year but it's better late than never. <br />
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So on a day when five Sunday papers have an NHS story on the front page, two about privatisation, I am heartened that the views of those with genuine concerns are at last being heard. I think the <a href="http://www.nationalhealthaction.org.uk/home/">National Health Action Party</a> is having an effect. Don't dismiss it. Maybe you should even consider given it your support.Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com12tag:blogger.com,1999:blog-25200961.post-45502344559594492072013-02-25T15:13:00.000+00:002013-02-25T15:13:23.974+00:00Calling Eastleigh Voters<iframe width="500" height="315" src="http://www.youtube.com/embed/QgtDV_IEY3Y" frameborder="0" allowfullscreen></iframe>Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com4tag:blogger.com,1999:blog-25200961.post-33389325163030987812013-02-24T08:34:00.000+00:002013-02-24T18:43:09.028+00:00The last nail in the NHS coffinWe all know that politicians lie but as I have followed the story of the unravelling of our NHS I find it quite difficult to grasp the depths of their dishonesty and duplicity. It's one thing to be economical with the truth but to deliberately mislead the public repeatedly is altogether more serious. If a doctor were to do this in the course of his work he would be struck off the register. Perhaps we deserve the honesty rating accorded to us in public polls. Certainly politicians deserve their ranking at the very bottom.<br />
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What's new, I hear you say. We all know politicians lie. We all know it's wrong. We all know this is the way of our world and we are stuck with it. Sadly you may well be right. But what is new is that in recent days yet another enormous political lie has come to light which spells the death knell of the NHS.<br />
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If this blog has had a purpose goading me to put pen to paper early on a Sunday morning, it has been to warn and warn again of the plans of successive governments to do away with the NHS as we know it. To begin with I was something of a loan voice. Colleagues I met in the hospital corridor looked at me as if I was deranged when I told them that I thought the NHS was being privatised. If they didn't know, what hope was there that the public would grasp what is happening?<br />
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By the time of the Health and Social Care Bill many of my colleagues had woken from their slumbers and were looking for reassurance that the NHS was safe from the fragmentation and privatisation that appeared might be the main intent of the bill. And they got it.<br />
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Here are some quotes:<br />
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Andrew Lansley MP: “There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector.”</blockquote>
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Andrew Lansley MP, 12.02.12, letter to Clinical Commissioning Groups: “I know many of you have read that you will be forced to fragment services, or put them out to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators – should decide when and how competition should be used to serve your patients interests.<br />
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Simon Burns MP: “...it will be for commissioners to decide which services to tender...to avoid any doubt—it is not the Government’s intention that under clause 67 [now 75] that regulations would impose compulsory competitive tendering requirements on commissioners, or for Monitor to have powers to impose such requirements.”</blockquote>
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Lord Howe: “Clinicians will be free to commission services in the way they consider best. We intend to make it clear that commissioners will have a full range of options and that they will be under no legal obligation to create new markets....”</blockquote>
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But, despite these reassurances, regulations just published break these promises. These new rules will force through privatisation whether or not the local population want it. Not only that, Monitor will have the power to force through privatisation.<br />
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But the purpose of this post is not to tell you what you already know: that politicians do not exactly tell the truth. It is to warn you, yet again, that your NHS is being sold off. It could just be that you think that's a good thing. But, even if you do, be very careful in what you wish for because, once the NHS is gone, we will never get it back.<br />
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Now you might think there is nothing you can do and all this is a fait accompli. Ordinarily you would be right as parliament does not usually even debate this sort of secondary legislation - which just shows that it was always the intent to slip this in under the public radar. But fortunately there a just a few worthy souls out there trying to do what they can to save our NHS and they have some ideas about what you can do <a href="http://abetternhs.wordpress.com/2013/02/23/urgent/">here</a>.<br />
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<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com2tag:blogger.com,1999:blog-25200961.post-13426922031800115172013-02-23T13:54:00.001+00:002013-02-23T13:54:53.997+00:00The White Rose or Weiße RoseI'm ashamed to say that I had never heard of the White Rose until the recent 70th anniversary. For those who may still not know, the White Rose was a non-violent resistance group in Nazi Germany. Four medical students, Hans Scholl, Christoph Probst, Alex Schmorell and Willi Graf formed its core. Scholl, his sister Sophie and Probst were beheaded on 22nd February 1943. Graf and Schmorell suffered the same fate some months later. Their crime was to produce leaflets criticising the Nazis. You can listen to the story <a href="http://www.bbc.co.uk/iplayer/episode/p014knxl/Witness_The_White_Rose/">here</a>.<br />
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My parents took the view that the Germans are easily led. I take the same view. But I differ in that I think we are all easily led. Humans are built to be led. It's what enables us to operate in societies instead of just squabbling with each other for scarce resources.<br />
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Since the time of Hitler, the way we are controlled has changed. We are told there's a democracy. And many of us may believe that. But the reality is that we have very limited choice at election time and the main political parties have a stranglehold on the process. In parliament your MP is told strictly how to vote. He's not his own man. Only rarely can a well-meaning independent reach the Commons.<br />
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But it's worse than this. The policies of the main parties are not really determined by the wishes of the electorate. We all know of the strong support for the NHS. But the Coalition has changed the basis of the NHS without any public support. And before them Labour was intent on heading the same way.<br />
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It might not be so bad if our masters were acting in our best interests but they are not. They are acting in the best interests of themselves and their paymasters. At least when Hitler was in charge there was a visible unequivocal villain. Now the corridors of power are controlled by a more insidious evil of which few of us are much aware. That evil takes the form of the <a href="http://www.telegraph.co.uk/news/election-2010/7189466/David-Cameron-warns-lobbying-is-next-political-scandal.html">lobbying industry</a>. Ironically this scandal-in-the-waiting was recognised by the prime minister himself. Judge for yourself whether he has met his promise to stop the lobbyists from influencing government policy.<br />
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The effects of the lobbying industry on our lives is all pervasive. Examples are legion. Here I mention only the NHS. I do not know of anybody who does not take the view that, in the NHS, we have had the most cost-effective healthcare system in the world. It may not be the best. But it has been the cheapest. Yet we are told we can no longer afford it. Labour, LibDem or Tory the message is the same. It's the same message because it originates from the same people: the lobbying industry. <br />
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The message that so many believe - that healthcare is unaffordable - has to be wrong. But few question it. You cannot, in a civilised society, just leave people to die. You have to look after them. There is no choice. That's why the British people love the NHS so much. There is something uniquely good about ensuring that all one's fellow beings get looked after. And, if you accept that people have to be looked after, it follows, if money is short, that you need to look after them as cheaply as possible. We are not talking about giving everybody everything they might wish for. But we are talking about giving everybody the key care that they really need.<br />
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So there is an unequivocal, but largely unvoiced, argument to keep the NHS as it is in order to keep the costs of healthcare down. What though have our governments been doing? They have been increasing the costs of healthcare by introducing markets into the NHS. They have, of course, duped people into thinking the NHS is inefficient - despite all the evidence to the contrary - and, on this basis, have been paying hospitals per item of service instead of en bloc. What's wrong with that, I hear you ask. The problem is that it encourages more work which costs more and not less work which costs less. You see, in health care, not all work that could be done needs to be done.<br />
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So how have we got here? We got here because of the lobbying industry. What interest do the lobbying industry have in a government service like the NHS? The answer is none while the NHS is a publicly-provided service. What the outsiders want is to profit from a slice of the money provided by the taxpayer and they want the service run down so that people have to buy health care themselves privately. And that is why the NHS is being privatised and why we are losing hospital beds.<br />
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So where does all this fit in with the White Rose? The answer is that there are still malign influences around today and we, the British people, have been duped into being led in the wrong direction just as the people of Germany were. Worst of all, the British people have largely acquiesced in all of this. There is no excuse. We won't be executed for putting the case for the NHS to the people of Eastleigh. But I bet there won't be many people there tomorrow when I plan to lend a hand to the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>. I hope I'm wrong.<br />
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<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com10tag:blogger.com,1999:blog-25200961.post-78004334842121806962013-02-18T08:17:00.000+00:002013-02-18T08:19:29.417+00:00Dr Iain Maclennan National Health Action ParyIf you live in Eastleigh, please give this man your vote.<br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/kSzOxvRlbNM" width="450"></iframe>Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com2tag:blogger.com,1999:blog-25200961.post-54095976255873738702013-02-17T16:02:00.001+00:002013-02-24T18:45:38.946+00:00NHA Party's Eastleigh Rally<div class="separator" style="clear: both; text-align: center;">
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Snaps from today's <a href="http://www.nationalhealthaction.org.uk/home/">National Health Action Party</a> Rally in Eastleigh.</div>
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<span id="goog_700078677"></span><span id="goog_700078678"></span>Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com0tag:blogger.com,1999:blog-25200961.post-75105615442215271902013-02-17T08:48:00.000+00:002013-02-17T08:52:52.686+00:00EastleighI'm off to Eastleigh this morning. I don't really want to go. One of my kids is coming for lunch but I'm hoping that Eastleigh may be something of a turning point.<br />
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You see the politics of this country are truly rotten. We are, to be blunt, governed by a bunch of toffs. It just cannot be the case that the only people with sufficient talent to run the country are from the top echelons of society. I wouldn't actually mind if they had the interests of the people at heart but they don't. They are hell bent on furthering the interests of their toffy mates. Things are very little different from the days when only the landed gentry were sent to parliament.<br />
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The battle over the NHS is a microcosm if the divide between the toffs and the ordinary British mortals. The NHS is a key feature of Britishness. It is one of the things we most admire about ourselves. It's one of the only things we are prepared to brag about. Bragging is not something we British do. It's just not British - unless you're a British toff. But we feel comfortable in bragging about the NHS because it is not about being elite, it's not about high achievement, it's about fairness.<br />
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And now I pause because I realise I have been calling myself British. I do that because I think of myself as British and the NHS is British. The values of the NHS are recognised throughout our small island. Britain and the NHS are inseparable - or they should be. But my concern is focused on the fact that I am actually English and I live in England. Because it is in England that the toffs in Downing Street and the toffs that came before them are embarking on a major change to our NHS.<br />
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For those that have not been following what has been going on, you can be forgiven. People argue about when it started because there was no starting gun but in recent history all the main political parties have been following the same policy for the NHS. Without many of you noticing and deliberately operating under the radar, politicians have put the NHS into a cut-throat market. The true purpose of this is to privatise the provision of NHS care - though they never quite say so. Since they don't actually tell you that this is what they intend, they don't actually tell you the reason either. If pressed you will hear something about the NHS being inefficient and getting private companies to get rid of all those inefficiencies that blight our healthcare. The only problem with this is that it is just not true. The NHS is not inefficient. It has been without doubt the most cost-effective healthcare system in the world.<br />
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So what is the real reason they want to privatise the NHS? One reason is that we are run by toffs and toffs want to help other toffs. The private companies that will run the NHS ensure that this happens by nefarious schemes to influence the political class.<br />
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There are other reasons. They want to move the NHS away from tax funding to insurance funding. Instead of paying your taxes and relying on the NHS to be there when you need it, they will be requiring you to insure. Nobody has yet told you this. I cannot point to a document where you can find any evidence to support my view. But trust me that this is the only thing that makes sense of what they are doing.<br />
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Now I could go on but I need to get to Eastleigh. But let me say this: when the forests were threatened, people went into their woods, tied ribbons to the trees and the woodlands were saved. When local hospitals are threatened, people do the same. When the whole NHS is threatened, people don't seem to notice.<br />
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So please wake up out there. Realise what is happening and get on down to Eastleigh and persuade those people of middle England to turn the tide by voting for the <a href="http://www.nationalhealthaction.org.uk/doctors-descending-on-eastleigh-to-support-by-election-candidate/">National Health Action Party</a>.<br />
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<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com1tag:blogger.com,1999:blog-25200961.post-37454931686942975072013-02-14T08:20:00.000+00:002013-02-14T08:26:25.536+00:00A sad old dog<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkO3h2laaqXYYKf4_uUMxCvu_QkZCkhmKvleiuNpsJEjraIufvDF121owrJ80oLU3KGL-1vjbNUf17AYCbDIczxZMhuKIS8-XLmNl6LWgX3odKAqcJurlj1bvnVSEnyowVCcMz/s1600-h/symptomsdog.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5133727289770066114" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkO3h2laaqXYYKf4_uUMxCvu_QkZCkhmKvleiuNpsJEjraIufvDF121owrJ80oLU3KGL-1vjbNUf17AYCbDIczxZMhuKIS8-XLmNl6LWgX3odKAqcJurlj1bvnVSEnyowVCcMz/s400/symptomsdog.gif" style="cursor: pointer; display: block; margin: 0px auto 10px; text-align: center;" /></a><br />
Mrs Grumble's dog is getting old. It's sad when your dog gets old. She has begun to get those sorts of terrible things old people get. One of the worst is wetting the carpet. She never used to do this. She's also been panting a lot. It's a different sort of panting from usual - almost a breathlessness. She climbed the stairs yesterday and was gasping at the top. Another curious thing is that she has been drinking a lot - vast quantities. Yes, Dr Grumble thought of diabetes. Mrs Grumble managed to catch some urine and there was no glucose. Even odder she has become ravenously hungry and has begun stealing food. She never used to do this. Not once. Now that is very odd. She's also had difficulty jumping into the car and like old people she has developed a bit of a pot belly. Old age is bad. And the dog is only 9. In her breed (she is a Newfoundland) old age comes on early. They rarely live to 13.<br />
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What you don't want to do when your dog gets decrepit is prolong the decline too much. It's really not fair on the dog. So Dr Grumble was a little concerned about where the inevitable trip to the vet (who does <a href="http://drgrumble.blogspot.com/2007/05/cost-of-medical-care-for-hamster.html">extremely well</a> from the Grumble household) might lead. He was not looking forward to an incontinent, gasping dog on heart failure pills.<br />
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If you are a vet reading this you might by now have made a diagnosis. If you are a doctor you probably won't have. Certainly Dr Grumble hadn't. But then he's not a vet. And the disease Mrs Grumble's dog has is a rare one in humans but common in dogs. Mrs Grumble's dog has <a href="http://www.canine-cushings.co.uk/whatisit.htm">Cushing's Syndrome</a>.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhV3AXVPcziGqn4c_LYEcgnBrA4NAidiXjxC0Rnd6Dd6raKU5j3AHXnZ1jrLeSEApYsL5aNPtr7AyowQviRLhMtHqylcVhDZ28WOiX8TWP5xBSNWxBmfIoYjbPzc7UadT9pdxA0/s1600-h/whatisitdog.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5133724090019430578" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhV3AXVPcziGqn4c_LYEcgnBrA4NAidiXjxC0Rnd6Dd6raKU5j3AHXnZ1jrLeSEApYsL5aNPtr7AyowQviRLhMtHqylcVhDZ28WOiX8TWP5xBSNWxBmfIoYjbPzc7UadT9pdxA0/s400/whatisitdog.gif" style="cursor: pointer; display: block; margin: 0px auto 10px; text-align: center;" /></a><br />
And Dr Grumble thought it was old age. But Dr Grumble is now becoming an expert on canine Cushing's and according to the textbooks 'the most common signs are very similar to those of the normal ageing process'. But Dr Grumble feels a bit bad because, looking back, Mrs Grumble's dog has obviously had this problem for at least a year or two - perhaps longer. This too is typical.<br />
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(This post was first published in 2007 and has been republished because I was thinking about our poor dog who eventually got weaker and weaker and died.)Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com6tag:blogger.com,1999:blog-25200961.post-27464866105157344752013-02-10T09:59:00.001+00:002013-02-10T10:00:36.709+00:00The National Health Action PartyOK, I'm back. The reason? It's because I want to give a plug to the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>. If you've never heard of them, quite honestly I'm not surprised. They are new. They have been set up by a small clique of people concerned about the way things are going with our NHS. "Clique" sounds a bit pejorative. It's not meant to be. The people at the top are very committed and their concern is for our NHS.<br />
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Despite their youth and not really being ready for an election, the National Health Action Party were the first to announce their candidate for the Eastleigh by-election. Unsurprisingly, this failed to get a mention on the BBC. Even the redoubtable Jon Snow didn't seem to know. Which shows that modern journalists don't find things out any more, they wait to be told.<br />
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So I'm now telling you all direct: The National Health Action Party is up and running and has an excellent candidate for the Eastleigh by-election. His name is Dr Iain Maclennan. It's remarkable that such a brilliant local candidate has been found so quickly. Dr Maclennan lives in the borough in Bursledon. He was a GP for some years and more recently a consultant in public health with the local Hampshire Primary Care Trust. For ten years he was a medical officer in the Royal Navy.<br />
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In brief the National Health Action Party could not have found a better candidate. If you live in Eastleigh he deserves your support. If you don't live in Eastleigh the <a href="http://www.nationalhealthaction.org.uk/news/">National Health Action Party </a>deserves your support. If you are a journalist, we need your support. Please at least give <a href="http://www.nationalhealthaction.org.uk/eastleigh-doctor-challenges-governing-parties/">Dr Maclennan</a> a mention - even though I've been a bit rude about journalists!<br />
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Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com13tag:blogger.com,1999:blog-25200961.post-52829900975848595072012-10-27T21:09:00.001+01:002012-10-27T23:41:31.617+01:00TobaccogateIt may be that you have never heard of John Dalli. I hadn't. He was, until recently, a European Commissioner. Now you know why you've never heard of him. Despite the importance of these people who make the laws that affect the lives of half a billion people we tend not to hear much about them. Nor do we plebs have any influence over who they are or what they do. I don't mean to imply that what they do is necessarily bad. In the case of John Dalli I suspect that quite the opposite is the case. Because John Dalli was European Commissioner for Health and Consumer Policy and was about to launch legislation related to tobacco control. Nothing too remarkable about that.<br />
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I used to go to school by bus. One day the bus conductor shouted, "Two more for the cancer ward." It was 1962 and the Royal College of Physicians had just published its report highlighting the link between smoking and lung cancer. The bus conductor had clearly got the message and had cheerily adopted a topical way of pointing out that there were still two seats on top where, for those readers too young to remember, the smokers were confined. I well remember having to take a seat next to the smokers upstairs. Even as a child I noticed that in the winter months the passengers on the top deck were constantly coughing and the windows were stained brown from smoke deposits. Friends at school who smoked used to do a party trick. After a deep draw on a cigarette they would inhaled deeply and then breathe out through a clean white handkerchief leaving an unsightly dark brown stain. It was no surprise to me that smoking might not be good for you.<br />
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What might have surprised me was how long it took for smoking to be controlled. Reasonable measures to protect people from the consequences of smoking have been opposed at every step by those making money from tobacco who have used every trick in the book. Now I'm older and know more and more about how the world works I'm not, of course, surprised.<br />
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Fast forward to 2012 and these battles are still going on. There's been progress but it has been slow. Children are still dying from the consequences of secondhand cigarette smoke and lung cancer, COPD and circulatory diseases continue to take their toll of adults.<br />
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Given this background, when I heard that John Dalli had resigned suddenly following an allegation from a tobacco manufacturer I couldn't help but smell a rat. So I did a bit of delving.<br />
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What are the facts? As is so often the case the facts are hard to come by. While it is said that John Dalli resigned suddenly it would seem that Dalli himself takes the view that he was ousted. Certainly he has lost his job. A second fact is that he was about to launch tough new tobacco legislation. <br />
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At this point I need to introduce you to snus. Snus is a form of tobacco which is placed between the gum and the lip. It comes in a variety of flavours: coffee, aniseed, elderflower, cranberry and mint. Nice to know if you fancy some but the important thing about snus is that it is banned in all European countries except Sweden. Which means, of course, that there is a company out there who is concerned about the future of snus and that company is Swedish Match.<br />
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It turns out that Swedish Match complained that a Maltese entrepreneur had asked for money in return for using his contacts with John Dalli - presumably with a view to ending the ban on snus sales in countries other than Sweden. Enter now Olaf. Olaf might sound like a Norseman but is actually the name of the European Commissions anti-fraud office. Olaf investigated and following the investigation John Dalli resigned or was made to resign with the consequence that progress of the long-awaited tobacco directive was frozen.<br />
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This did not escape the notice of my friend Sir Richard Thompson and my virtual friend Dr Clare Gerada who, along with Professor Lindsey Davies, wrote to the Guardian pointing out that delaying the directive would be a victory for the tobacco industry. Which does rather make me wonder if perhaps that was the point of the original complaint to the commission.<br />
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And then, to make matters even more mysterious and sinister, we learn that not two full days after the resignation of John Dalli the premises of three anti-smoking groups were burgled: the European Respiratory Society, the European Public Health Alliance and the Smoke Free Partnership.<br />
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It's a good story isn't it? Some would say it has all the makings of a Hollywood film. Why has it has so little publicity? Could it be that the lobbyists are now busy putting journalists off the scent? Or is that too fanciful? Who do you think produced <a href="http://www.ecita.org.uk/blog/?p=331">this blog post cataloguing past allegations relating to John Dalli</a> within hours of his resignation?<br />
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Are those of us who see conspiracies in these things bonkers? Draw your own conclusions. <br />
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<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com9tag:blogger.com,1999:blog-25200961.post-48533249504518233492012-10-25T13:35:00.000+01:002012-10-25T13:35:45.179+01:00Stuart Patterson Lecture 2012Dr Clare Gerada has kindly allowed me to post a link to a pdf of the full text of her recent speech to the Australian RACGP Conference: <a href="http://www.doctors.net.uk/DocStore/DSView/Document.aspx?docid=714510">What is wrong with Health Care: The 3 Ms</a><br />
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If you have any concerns about what is happening to our NHS and the way doctors are being turned into automatons doing the computer's bidding, this is a speech for you.Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com3tag:blogger.com,1999:blog-25200961.post-59743540369769297842012-10-14T07:35:00.000+01:002012-10-14T09:08:09.783+01:00DemocracyWas it here or on Twitter that I referred to Britain as the world's oldest democracy? I can't now remember and it doesn't matter. I can't even remember whether the ticking off I received was because we aren't the oldest or because we aren't a democracy. But it did set me thinking. I don't like to be wrong but I do like to be put right. That is the great strength of the wonderous new media of blogging and twitter. You can say something and be put right. There have been some interesting antics on twitter recently when people with entrenched views block those whose views differ. These people do not want to hear arguments; they just want to express their views. Banter with people like this becomes as sterile as an argument on the existence of God between Richard Dawkins and the pope. There really is no point.<br />
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One, but only one, of the reasons I had a blogging break was that I was a bit irritated by a very small number of these individuals with one-way minds making comments. They are not the sort of people who engage with arguments. They just want to sound off. And, since their arguments tend not to stack up, they bolster their ill-considered views with invective to try and give them some strength. I know that the louder they shout the more wrong they are likely to be but it does tend to render the debate somewhat sterile. <br />
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I have never really thought that I live in a true democracy. The world's oldest democracy is just a stock phrase I trotted out. It probably stems from the ruling classes intent on giving us plebs the illusion that we have some control over our lives. We don't. Not much anyway.<br />
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This point was brought home to me the other day. A group of local GPs came round to talk to the consultant body. It's an indictment that, although I knew all their names, I had scarcely ever met one of them before. Worse, for the first time, I met consultant colleagues I regularly correspond with. That's the modern hospital for you. The days of meeting people in the consultants' dining room are long gone. It been replaced with a snatched sandwich - and that's if you're lucky. It was clear that the GPs have a similar problem. Not only do they not know the consultants, they rarely meet their GP colleagues either.<br />
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The really surprising thing was the illusion these GPs had about the power of the consultants in the hospital. I have picked up this misunderstanding before from online comments from GPs. They really don't understand. GPs, you see, have very great influence over their own surgery. As many politicians like to point out, they are independent contractors.<br />
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If you are a senior GP you remember hospitals as they used to be. There was an illusion then that the consultants were in charge and ran the hospital. Perhaps there was a time when they did or, at the very least, they were listened to. But that was way back in history. They don't now. Not at all. They are scarcely listened to.<br />
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So why this extraordinary meeting with some local GPs when we all met for the first time? Well you've guessed it. It has to have been some sort of crisis. And you don't have to be very bright to guess that the Grumble hospital might be under threat of closure. <br />
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This then was what the local GPs came to discuss. They assumed that the consultants of Grumble hospital would have had in-depth discussions with the management about the hospital's future. They assumed there would have been lots of agonised discussions and hand wringing about the future of the hospital and what the consequences might be for our patients and for local GPs. It was an eyeopener for them to discover otherwise. One of Grumble's colleagues pointed out that our Chief Executive, when announcing some plan nobody much liked, announced that the hospital was not a democracy. It's not. It never has been and it never will.<br />
<br />
Like most meetings nothing much came out of it though the GPs certainly learnt just how impotent today's consultants are. The interesting point for the consultants, though it may not have been a surprise, was that the local GPs had also not been consulted by their masters on the hospital closure. They had taken part in a formal public consultation process but, as was pointed out to them, formal consultation processes are more about telling the populace what is going to happen than listening to their concerns.<br />
<br />
Does any of this matter? My own feeling is that we could do with a few benevolent dictators. But the hospital closures are not being driven by a need to improve healthcare by having fewer larger hospitals. The driver, though it is never admitted upfront, is a desperate need to save money.<br />
<br />
Towards the end of the meeting the GPs launched their bombshell. If the planned loss of 1000 hospital beds goes ahead, there is no evidence that care in the community can take up the slack. This concept is just a management consultants' pipedream with absolutely no data to support it.<br />
<br />
By then all the managers had left. <br />
<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com4tag:blogger.com,1999:blog-25200961.post-69248484149660751742012-10-13T12:42:00.000+01:002012-10-13T12:49:54.145+01:00How the NHS was lost Here is a recent editorial by Jacky Davis for the NHS Consultants' Association newsletter:<br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">We really ought to have a black border around
the latest edition of the Newsletter, to mark the
death of the UK National Health Service. After a
</span><span style="font-size: 12.000000pt;">2 year fight, the infamous Health and Social Care
Bill finally became law earlier this year. The
</span><span style="font-size: 12.000000pt;">legislation was bulldozed through parliament
with the assistance of the Liberal Democrats, a
scandalous betrayal which will not be forgotten
</span><span style="font-size: 12.000000pt;">or forgiven. In its final stages it was encumbered
</span><span style="font-size: 12.000000pt;">with over a thousand amendments and is now
even more Byzantine and dangerous than when
</span><span style="font-size: 12.000000pt;">it first saw the light of day. It was opposed by
</span><span style="font-size: 12.000000pt;">every major organization representing health
care workers and degenerated from a bill sold
as empowering doctors and patients to one
battling the vested interests of the professionals.
Its passage was a low point for democracy in this
country. It became a matter of political pride and
personal prestige, an arm wrestling match in
which the coalition leadership had invested too
much to back down. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">It’s worth recalling why it matters so much.
</span><span style="font-size: 12.000000pt;">This legislation is a bottle of snake oil, it
</span><span style="font-size: 12.000000pt;">doesn’t do anything it promises on the label.
</span><span style="font-size: 12.000000pt;">Cuts costs? No, costs will rise, with the ever
increasing financial burden of marketised
</span><span style="font-size: 12.000000pt;">care not to mention £3 billion+ for the
</span><span style="font-size: 12.000000pt;">‘reforms’ themselves. Cuts bureaucracy?
No, it replaces 3 layers with 7 and the CEO of
the NHS Confederation has recently warned
</span><span style="font-size: 12.000000pt;">of a ‘tsunami of bureaucracy’. Gives power to
</span><span style="font-size: 12.000000pt;">patients? No, patients will have less choice than
</span><span style="font-size: 12.000000pt;">ever thanks to management referral centres,
reduced treatments, and the limited choice
already present in some parts of the country
where the private sector has taken over. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">It certainly doesn’t give power to doctors and
</span><span style="font-size: 12.000000pt;">front line staff. GPs will be answering to CSUs run
</span><span style="font-size: 12.000000pt;">by private companies and in London GPs have already been forced to pay for commissioning
‘support’ from the private sector. Management
consultants like McKinsey have made millions
so far and are anticipating many more millions
to come. At the same time GPs are taking the
blame for massive cuts in budget and we are
already seeing headlines blaming doctors for
service cuts and for denying care to patients.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Finally it cannot fail to adversely affect teaching
and training, core functions of the NHS. No
</span><span style="font-size: 12.000000pt;">wonder the government defied the law and
</span><span style="font-size: 12.000000pt;">refused to release the risk register. </span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">So the H&SC Act represents a massive
</span><span style="font-size: 12.000000pt;">redisorganisation of the service, so huge that
according to the Big Beast himself, Sir David
</span><span style="font-size: 12.000000pt;">Nicholson (CEO of the NHS) it could be seen
</span><span style="font-size: 12.000000pt;">from outer space. How was it possible that
such unwanted, undemocratic and destructive
legislation could get through against the
</span><span style="font-size: 12.000000pt;">opposition of the profession? Part of the answer
</span><span style="font-size: 12.000000pt;">must be that there was a dreadful failure of
medical leadership and much of the blame lies
at the door of our representative bodies. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Many GPs were unfortunately but
understandably attracted by the idea of
commissioning while failing to notice that it came
accompanied by less attractive elements including
the drive to outsource any and all NHS services
</span><span style="font-size: 12.000000pt;">to the private sector. The BMA, with GPs in the
</span><span style="font-size: 12.000000pt;">driving seat, pronounce the bill to be a ‘curate’s
egg’, good in parts and announced that they
would have the tasty bits and manage the rest, thus
fatally missing the point of the tale of the curate’s
</span><span style="font-size: 12.000000pt;">egg. Once part of the egg is rotten the whole thing
is inedible and this is as true for the HSCB. It is
</span><span style="font-size: 12.000000pt;">woven of whole cloth, without the possibility of
taking up the attractive parts (if indeed there ever
</span><span style="font-size: 12.000000pt;">were any) while rejecting the rest. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">The BMA failed to consult its members over
the HSCB, relied too heavily on political
lobbying for ‘significant amendments’ which
</span><span style="font-size: 12.000000pt;">never materialised and resisted coming out in
opposition to the bill until forced to by repeated
</span><span style="font-size: 12.000000pt;">emergency motions at Council. By then it was
</span><span style="font-size: 12.000000pt;">too late, and on the day the bill became law
Andrew Lansley was still claiming that he had
the support of the profession. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">The Royal Colleges, with a couple of honourable
</span><span style="font-size: 12.000000pt;">exceptions, were the dog that didn’t bark in
the night. Not a sound was heard from most of
them on a matter which would massively affect
</span><span style="font-size: 12.000000pt;">their members. They kept their heads down,
discussing instead (in the case of my own college)
</span><span style="font-size: 12.000000pt;">important matters such as the move to a new
building rather than legislation which would
affect every aspect of their remit i.e. teaching,
training and standards. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Finally in desperation at their silence several
campaigners, led by David Wrigley, a GP from
</span><span style="font-size: 12.000000pt;">Cumbria, set up a website to encourage college
</span><span style="font-size: 12.000000pt;">members to formally request emergency
meetings of their college so that they could
</span><span style="font-size: 12.000000pt;">call for opposition. The resistance of college
officials to this move was a sight to behold,
</span><span style="font-size: 12.000000pt;">and many interesting conversations took place
with people to whom it had clearly never
occurred that the members might notice what
</span><span style="font-size: 12.000000pt;">was going on (or not going on ) at college HQ,
</span><span style="font-size: 12.000000pt;">and what’s more might have the temerity to
question it. I’ll forever treasure the memory of a
</span><span style="font-size: 12.000000pt;">phone call to someone at the RCS to say that we
</span><span style="font-size: 12.000000pt;">had enough members signed up to call for an
emergency meeting. ‘But I’ve never heard
of you’ was the bad tempered response. Well
you have now and what’s more we have
the requisite number of names to request
</span><span style="font-size: 12.000000pt;">a meeting. The great and the good who
</span><span style="font-size: 12.000000pt;">represent us did not appreciate being called
to account. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Once called to account almost all the colleges
</span><span style="font-size: 12.000000pt;">found themselves faced with overwhelming
demands for opposition to the bill from their
</span><span style="font-size: 12.000000pt;">members. Even then there were delaying tactics
</span><span style="font-size: 12.000000pt;">but the message had gone out to the media that
doctors were united in their opposition to the
legislation. Unfortunately by then it was too
late to stop the bill. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">A shining exception to this behaviour was the
</span><span style="font-size: 12.000000pt;">RCGP, which regularly consulted its members
and whose president, Clare Gerada spoke
</span><span style="font-size: 12.000000pt;">repeatedly about her concerns. Given the supine
position of the rest this was a heroic thing to do,
</span><span style="font-size: 12.000000pt;">and attracted a lot of press coverage. Many firmly
</span><span style="font-size: 12.000000pt;">believe that if the whole medical establishment
had had the courage to work together and speak
out against the bill it could never have survived
the joint onslaught of the profession. As it was
the complicit enablers, through silence or, even
worse, co-operation, betrayed the NHS, the
profession and our patients. Shame on them,
history will not remember them kindly. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">So are the prophets of doom right, and is
</span><span style="font-size: 12.000000pt;">the NHS in England facing extinction? Well,
</span><span style="font-size: 12.000000pt;">the news coming in is not good and already
we are seeing the vultures circling the NHS.
</span><span style="font-size: 12.000000pt;">Significant contracts have already gone to
</span><span style="font-size: 12.000000pt;">transnational corporations like Virgin and Serco,
the biggest company you have never heard
of. Virgin picked up community services in
Surrey, where presumably patient choice now
consists of Virgin or Virgin, and also ‘integrated
children’s services’ in Devon. As far as I know
they have no experience of providing the latter
but that doesn’t seem to matter in the brave
</span><span style="font-size: 12.000000pt;">new world of outsourcing public services. The
</span><span style="font-size: 12.000000pt;">core business of these transnational companies
is in winning government contracts regardless
</span><span style="font-size: 12.000000pt;">of what they are for. They have the experience,
</span><span style="font-size: 12.000000pt;">the legal expertise, and the deep pockets to
allow loss leaders if necessary and it is simply
unrealistic to think that small charities and social
enterprises can take on these huge companies
and win. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Once they have the contract they then put
</span><span style="font-size: 12.000000pt;">together the package, and the word is out that
community paediatricians are being urgently
</span><span style="font-size: 12.000000pt;">sought, presumably to fulfil Virgin’s new
</span><span style="font-size: 12.000000pt;">contract in Devon. It has been said that G4S,
</span><span style="font-size: 12.000000pt;">awarded the security contract for the Olympics,
</span><span style="font-size: 12.000000pt;">expected to take on operatives and deploy
</span><span style="font-size: 12.000000pt;">them 3 days later. This is no way to run any
</span><span style="font-size: 12.000000pt;">public service let alone the NHS and the G4S
</span><span style="font-size: 12.000000pt;">Olympic fiasco certainly seems to have alerted
</span><span style="font-size: 12.000000pt;">at least some in government to the dangers of
</span><span style="font-size: 12.000000pt;">outsourcing public services. Vital public
</span><span style="font-size: 12.000000pt;">services like the NHS can’t just simply be
allowed to disappear, and if private providers fail or walk away when profits don’t materialise
then the government has to step in. The result is
that profits are privatised while risk is socialised,
</span><span style="font-size: 12.000000pt;">a convenient scenario for the private sector but a
recipe for disaster for the tax payer, the NHS and
those who rely on it.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Elsewhere GPs are waking up to the real world
of loss of autonomy to the Commissioning Board
</span><span style="font-size: 12.000000pt;">and to commissioning support services, which
are likely to end up in the hands of – you’ve
guessed – the private sector. At what stage will
GPs decide that they can no longer ride the tiger
</span><span style="font-size: 12.000000pt;">of the HSC Act and that it would be better to show
</span><span style="font-size: 12.000000pt;">their disapproval with events by walking away
</span><span style="font-size: 12.000000pt;">from commissioning? There are still those who
</span><span style="font-size: 12.000000pt;">argue that they must remain involved otherwise
‘others will do it’ but that is the primrose path
to hell. We underestimate our strength as a
profession, but strength requires acting in unison
which requires strong leadership. We are still
waiting for it. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Meanwhile the ‘Nicholson challenge’ of ‘saving’
£20 billion makes a nonsense of promises that
there would be no cuts to NHS services, and
thousands of front line jobs have been lost already.
And as longer and longer lists of treatments are
excluded from the NHS menu as part of these
</span><span style="font-size: 12.000000pt;">McKinsey-driven “efficiency savings” fewer
</span><span style="font-size: 12.000000pt;">people will be offered an acceptable choice;
instead many will have to choose between pain
and discomfort or paying privately. Personal
</span><span style="font-size: 12.000000pt;">health budgets (PHBs) are another ideological
</span><span style="font-size: 12.000000pt;">move, designed to facilitate the path to top ups
and co-payments while allowing top slicing by
</span><span style="font-size: 12.000000pt;">20% to cope with the financial constraints. Martin
McKee’s <a href="http://nvl002.nivel.nl/postprint/PPpp4488.pdf">article</a> in the BMJ described how the
</span><span style="font-size: 12.000000pt;">Dutch are moving away from PHBs while we are
rushing to embrace them – yet another example
</span><span style="font-size: 12.000000pt;">of policy based evidence making? </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">There are too many other depressing stories
</span><span style="font-size: 12.000000pt;">related to the cuts and the ‘reforms’ to describe
them all but you might like to consider that
</span><span style="font-size: 12.000000pt;"><a href="http://www.guardian.co.uk/society/2012/jul/31/bankruptcy-criminal-record-nhs-roles">criminals can now run the NHS</a> that NHS
patients will be able to ‘self fund’, the role
of the media during the listening pause,
</span><span style="font-size: 12.000000pt;">predictions about the privatisation of hospitals</span><span style="font-size: 12.000000pt;">, how patients lost their sight at a private
centre, and the scandal of over treatment in
the USA to chose but a few. And if you want more where those came from please follow Clive
(@clivepeedell), myself (@DrJackyDavis) and
KONP (@keepnhspublic) on Twitter. People who
</span><span style="font-size: 12.000000pt;">don’t tweet often think that it is just about what
</span><span style="font-size: 12.000000pt;">Wayne Rooney did last night but if you ignore
</span><span style="font-size: 12.000000pt;">the celebrity trivia it is a wonderful campaigning
tool. Depending on who you follow you can get
all the news, articles and low down on health
and medical politics and never need know what
</span><span style="font-size: 12.000000pt;">Madonna had for breakfast. Try it, you’ll be
</span><span style="font-size: 12.000000pt;">pleasantly surprised, but - health warning – it is
dangerously addictive. </span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">On an up note the Olympics provided some great
</span><span style="font-size: 12.000000pt;">bread and circuses entertainment and Danny
Boyle became an instant NHS hero when he
featured the NHS during the opening ceremony.
</span><span style="font-size: 12.000000pt;">Needless to say Tory MPs immediately saw
</span><span style="font-size: 12.000000pt;">a conspiracy, but most recognised a genuine
wish to celebrate one of this country’s greatest
institutions, even while we are in danger of
losing it. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">Talking about great institutions and sporting
</span><span style="font-size: 12.000000pt;">achievements, the award of Hero of the Year
</span><span style="font-size: 12.000000pt;">goes to my Co Chair Clive who distinguished
</span><span style="font-size: 12.000000pt;">himself by running from Nye Bevan’s statue in
</span><span style="font-size: 12.000000pt;">Cardiff to the DoH in London, an unbelievable
</span><span style="font-size: 12.000000pt;">feat which required 6 marathons in 6 days. We
salute him and his running partner Dr David
Wilson both of whom spent a great deal of time
in ice baths, although with or without added
</span><span style="font-size: 12.000000pt;">gin and tonic is not reported. They were helped
along the way by the indefatigable Chris Burns
Cox who provided transport, logistical support
(and possibly the gin). Read about it <a href="http://bevansrun.blogspot.co.uk/p/welcome-to-%20bevans-run.html">here</a>. </span><span style="font-size: 12.000000pt;">Hypocrite of the Year award was a difficult
</span><span style="font-size: 12.000000pt;">decision as ever but probably goes to the
</span><span style="font-size: 12.000000pt;">Coalition government for rubbishing the
</span><span style="font-size: 12.000000pt;">NHS at home while selling its brand abroad.
But there were plenty of other contenders for
the title. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;">The year has been a busy one for your officers,
</span><span style="font-size: 12.000000pt;">with many public talks, articles, letters in the
paper and arm wrestling with more conservative
</span><span style="font-size: 12.000000pt;">institutions. Thanks go as ever to our equally
</span><span style="font-size: 12.000000pt;">indefatigable president Peter Fisher, without
whom the organisation would not survive let alone prosper, and to you, our members, whose
subs allow us to help our sister organisations
</span><span style="font-size: 12.000000pt;">KONP and the NHS Support Federation in their
</span><span style="font-size: 12.000000pt;">important campaigning work. More members
mean more money and perhaps if you do one
</span><span style="font-size: 12.000000pt;">thing to help the NHSCA in the next year it
</span><span style="font-size: 12.000000pt;">should be recruiting at least 2 new members.
And meanwhile be thankful you’re not running
6 marathons... </span></span><br />
<br />
<br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 12.000000pt;"><i>A pdf of this article with the references can be found <a href="http://www.nhsca.org.uk/docs/newsletters/sept2012.pdf">here</a>. </i></span></span><br />
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Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com7tag:blogger.com,1999:blog-25200961.post-79214890936309608482012-10-13T07:12:00.000+01:002012-10-13T07:14:26.363+01:00National Health Action PartyWhy I hear you ask, has Dr Grumble decided to resurrect his blog? The answer is the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party.</a> What, I hear you ask, is the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>? The answer is that it is quite difficult to find out. And that is the reason for this post.<br />
<br />
The fount of Grumble's knowledge is that eighth wonder of the world: Google. If you type "Dr Grumble" into Google you will probably find at least some reference to the pseudonymous Grumble. The likelihood is that you will be referred back to this blog. Type in "<a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>" and you might expect to be referred to the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>'s gleaming new web site. But you don't. Not, anyway, when Grumble does it.<br />
<br />
Dr Grumble doesn't pretend to understand the vagaries of the internet. He's too old. To this day he wonders who pays for the multitude of connections that enables instant communications around the globe. Nor does Grumble grasp how Google, the best of all search engines, takes him to the exact page he wants from all the trillion or so out there. But it doesn't yet do the trick for the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>.<br />
<br />
But Grumble does know what a Google bomb is. If you have ever entered into Google "Famous French victories" and got back "Did you mean famous French defeats" then you have been the victim of a Google bomb. It's done by getting a lot a people to make malicious links.<br />
<br />
So now you know the reason for this post. It is to make plenty of links to the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a> in the hope that Google's algorithms will begin to point people in the right direction when they search for the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>.<br />
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Please accept Grumble's apologies for a lot a unnecessary links to the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>. If you have a blog, please consider a few links of your own. Together we may be able to get Google to find the <a href="http://www.nationalhealthaction.org.uk/">National Health Action Party</a>.<br />
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<br />Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com1tag:blogger.com,1999:blog-25200961.post-26170993320353076962011-10-29T10:22:00.002+01:002011-10-29T10:27:59.963+01:00A postcard for the NHS<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirvESisn6X1n6t3RTUpF53JijMmrRAEd3IDFTLAEjRTaIRsFVQwiNrPXXRX6g9waJ8B6Df8bUkUqv5aO7aGpSgPcFg0KVIzUu2O-yzbpcAbDtHOaaCimXUsKJTRheT15uBE2Z5/s1600/429260476-1.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 600px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirvESisn6X1n6t3RTUpF53JijMmrRAEd3IDFTLAEjRTaIRsFVQwiNrPXXRX6g9waJ8B6Df8bUkUqv5aO7aGpSgPcFg0KVIzUu2O-yzbpcAbDtHOaaCimXUsKJTRheT15uBE2Z5/s400/429260476-1.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5668842186823454898" /></a>Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com12tag:blogger.com,1999:blog-25200961.post-76270858327415153802011-10-22T08:24:00.004+01:002011-10-26T11:07:49.050+01:00Clare Gerada's speech to the RCGP conference"Like blood, health care is too precious, intimate and corruptible to entrust to the market"<br /><br />Woolhandler & Himmelstein "When Money is the Mission –The High Cost of Investor-Owned Care," New England Journal of Medicine. 1999<br /><br />The full text of the speech in case you prefer to read it (and it is quicker to read) is below.<br /><br /><br /><embed src="http://c.brightcove.com/services/viewer/federated_f8/1485945011" bgcolor="#FFFFFF" flashVars="videoId=1237320371001&playerId=1485945011&viewerSecureGatewayURL=https://console.brightcove.com/services/amfgateway&servicesURL=http://services.brightcove.com/services&cdnURL=http://admin.brightcove.com&domain=embed&autoStart=false&" base="http://admin.brightcove.com" name="flashObj" width="486" height="412" seamlesstabbing="false" type="application/x-shockwave-flash" swLiveConnect="true" pluginspage="http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash"></embed><br /><br /><br /><br /><br />Thank you for all your support over the last year.<br /><br />I’d like to tell you a story about a GP, a radiologist, a pathologist and a psychiatrist.<br /><br />Sounds like the first line of a joke, but it isn’t.<br /><br />The GP was me.<br /><br />We were having dinner with our children at an open-air opera in Germany. The place was packed.<br /><br />Everyone was having a good time – when the dreaded happened.<br /><br />Out of the corner of my eye, I saw an elderly man fall headfirst into his plate.<br /><br />The four of us looked at each other.<br /><br />We knew our meal was over – and we swung into action.<br /><br />Each working to type.<br /><br />The psychiatrist tending to the man’s wife.<br /><br />The radiologist searching for a defibrillator.<br /><br />The pathologist pounding on the poor man’s chest.<br /><br />Me giving mouth-to-mouth.<br /><br />From the way he keeled over, it was obvious he was dead.<br /><br />But we knew there was still plenty for us to do.<br /><br />We had to comfort his distressed wife.<br /><br />And we had to keep the crowd calm for 30 minutes, till the paramedics arrived.<br /><br />When it was over my 15-year-old son turned to me and said,<br /><br />"I want to be able to do that."<br /><br />"Do what?" I asked him.<br /><br />"Care for people", he said.<br /><br />His reply surprised me.<br /><br />Not just because impressing teenage children isn’t easy.<br /><br />But because what impressed him wasn’t the glory and the drama of our public display of medical skill.<br /><br />No. What impressed him was our simple act of caring.<br /><br />Caring for a sick man. Caring for the man’s wife.<br /><br />And caring for the people in the crowd.<br /><br />That’s what inspired my son.<br /><br />And that’s how my father inspired me a generation ago.<br /><br />It wouldn’t be allowed now, but he used to take me with him on home visits in the post-war slums of Peterborough.<br /><br />I watched him treat children with measles.<br /><br />And care for the dying in their homes.<br /><br />That’s when I knew I wanted to be a doctor.<br /><br />Why did I tell you that story?<br /><br />Because I believe each of us has a story about what inspired us to become a doctor.<br /><br />A story that made us what we are today.<br /><br />A story that lights our way to the future.<br /><br />What’s yours?<br /><br />Our stories have never been more important.<br /><br />Especially now, when our profession is under pressure to replace the language of caring with the language of the market.<br /><br />This is why I told you my story.<br /><br />We need to remind ourselves why we entered this honourable profession in the first place.<br /><br />When I come home from work and my son asks me what sort of day I’ve had, on a good day I want to be able to say ‘I saved a life’, not… ‘I met a budget’.<br /><br />Of course, it’s important that GPs are mindful of resources.<br /><br />We have a responsibility to spend the public’s money carefully – and wisely. That goes without saying.<br /><br />But we must never lose sight of the patient as a person, at the heart of our practice. Patients are not "commodities" to be bought and sold in the health marketplace.<br /><br />In this brave new cost-driven<br /><br />Competitive<br /><br />managed-care world,<br /><br />I worry about the effect the language of marketing is having on our clinical relationships.<br /><br />It’s changing the precious relationship between clinician and patient into a crudely costed financial procedure.<br /><br />Turning our patients into aliquots of costed tariffs.<br /><br />And us into financial managers of care.<br /><br />We are already embracing the language of the market when we talk about: for example<br /><br />Care pathways<br />Case management<br />Demand management<br />Productivity<br />Clinical and financial alignment<br />Risk stratification<br />We’re already accused of making "inappropriate referrals" whenever we put what’s best for our patients above what’s best for saving money.<br /><br />We’re being forced to comply with referral protocols and so-called rules-based medicine, in an effort to control medical care before it’s delivered.<br /><br />Referral management systems – already widespread – places a hidden stranger in the consulting room.<br /><br />A hidden stranger who interferes with decisions that should be made by GPs in partnership with their patients.<br /><br />Insulting terms, like "frequent flyers", are being used to describe people who are sick and need our care and attention.<br /><br />The Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".<br /><br />If we don’t watch out, the deserving and undeserving poor could soon be joined by the deserving and undeserving sick.<br /><br />I worry we’re heading towards a situation where healthcare will be like a budget airline.<br /><br />There’ll be two queues. One queue for those who can afford to pay, and another for those who can’t.<br /><br />Seats will be limited to those who muscle in first.<br /><br />And the rest will be left stranded on the tarmac.<br /><br />This can’t be right. After all, no one chooses to be sick. <<br /><br />We must hold fast to the principle that good healthcare should be available to all, regardless of wealth.<br /><br />Of course, there have always been health inequalities. But my concern is that despite all the talk of reducing these inequalities, the size looks set to increase, not decrease.<br /><br />So what about GP commissioning?<br /><br />Will it help us reduce health inequalities?<br /><br />And will it enable us to deliver better care to our patients?<br /><br />People often tell me that GPs make good commissioners because of the population-focus we bring to care.<br /><br />After all as a profession we see 300 million patients per year.<br /><br />If anyone can be said to have their finger on the pulse of the nation, surely it’s us.<br /><br />It’s an argument I’ve supported for decades.<br /><br />But we must tread carefully in this brave new world.<br /><br />And do everything in our power to make sure it’s the public’s pulse we have our fingers on… not the public’s purse!<br /><br />Which is why I believe that big decisions – decisions like whether to close hospitals – should be the responsibility of governments, not GPs.<br /><br />It’s the government’s job to decide how much we invest in healthcare – and what services the NHS should provide.<br /><br />Of course we should do our bit – we already do, by sitting on NICE, SIGN and other committees.<br /><br />But governments should have ultimate responsibility for decisions about rationing healthcare, not GPs – guided and advised by us, for sure, but finally the decision must be taken by a publically accountable body, not an individual doctor or a group of doctors<br /><br />We don’t shirk our responsibilities.<br /><br />Governments shouldn’t shirk theirs either.<br /><br />Rhetoric about putting doctors in charge doesn’t convince me.<br /><br />In this brave new world it’s the market – led by CEOs, share-holders and accountants – that will be in charge, not doctors.<br /><br />We mustn’t allow ourselves to be compromised.<br /><br />Our first responsibility must be to the patient in front of us.<br /><br />Our next is to the patients in the waiting room.<br /><br />After that comes our responsibility to those on our list.<br /><br />And then to our local community, and finally the wider population.<br /><br />In that order.<br /><br />I’ve always said that Good Commissioning is about being a good GP.<br /><br />Its about understanding how we use resources fairly and effectively.<br /><br />But whatever happens we must make sure that the commissioning agenda isn’t allowed to compromise our relationship with the patient in front of us.<br /><br />We must not risk long-term benefits being sacrificed in favour of short-term savings.<br /><br />How soon will it be, for example, before we stop referring for cochlear implant? -<br /><br />An expensive intervention, but one that in the long term, saves enormous amounts of public money.<br /><br />But not a saving from our budget.<br /><br />How long will it be before we find ourselves injecting a patient’s knee joint – at Injections-R-us plc - instead of referring to an orthopaedic surgeon for a knee replacement?<br /><br />And, once referred for hospital treatment, patients must be able to trust their doctors to base care on need and not on making money for the hospital.<br /><br />If you think this is far-fetched…<br /><br />The Economist calculated that in 2009 the market-driven, corporate-dominated US health care system generated around $300 billion dollars worth of charges for unnecessary care.<br /><br />This represented 10-12% of US healthcare spending for that year.<br /><br />• This means women having unnecessary hysterectomies<br /><br />• This mean men having unnecessary angiograms<br /><br />• This means adolescents being given antidepressants for no reason<br /><br />Do we want that here?<br /><br />As doctors we risk being doubly compromised.<br /><br />We’ll have to choose between the best interests of our patients and those of the commissioning group’s purse.<br /><br />And, to make matters worse, we’ll also be rewarded for staying in budget – and not spending the money on restoring that child’s hearing.<br /><br />It goes by the quaint title of the "quality premium".<br /><br />Now that’s what I call a perverse incentive.<br /><br />What will you do when you’re presented with choices like these? Because you will be!<br /><br />We are told that one of the reasons Clinical Commissioning is being introduced is to reduce the spiralling costs of health care.<br /><br />But if the American experience is anything to go by, the opposite will be true.<br /><br />Paul Ellwood one of the founders of the American Health Maintenance System in the 1970s, had this to say in 1999 about what happened there…<br /><br />"A series of perverse economic incentives were instituted<br /><br />from top to bottom<br /><br />so as to seriously compromise the independent clinical judgments of physicians<br /><br />and other health professionals…..<br /><br />He describes Health Maintenance Organisations (which have the same function as our Clinical Commissioning Groups) as finding themselves in…<br /><br />"A deepening swamp of commercialism over service,<br /><br />of profiteering over professionalism,<br /><br />of denial or rationing of care where such care is critically needed,<br /><br />of de-personalization of intensely personal kinds of relationships"<br /><br />Is this what we want here?<br /><br />The NHS can always be improved, but we must do it very carefully, so as not to lose what we and previous generations of doctors like my father have achieved.<br /><br />As Allyson Pollock reminds us, the NHS was not an experiment.<br /><br />It wasn’t a mythical utopia either.<br /><br />The reality is that for more than 50 years it has delivered high quality care for most patients, most of the time.<br /><br />Can the market achieve similar outcomes?<br /><br />There is plenty of evidence that market driven health services lead to:<br /><br />• Limited choice<br />• Escalating costs<br />• Reduced quality<br /><br />And let’s remind ourselves – the biggest health market in the world, the US, has achieved the remarkable double whammy of having the most expensive system in the world and the greatest health inequalities.<br /><br />It comes near the bottom of the league for most health outcomes – and boasts an unnecessary death every 12 minutes.<br /><br />So what can we do?<br /><br />It would be easy to feel discouraged.<br /><br />But I know we all want the best for our patients, we always have and we always will.<br /><br />And as long as we do what we know to be right for patients, we will keep their trust.<br /><br />And we can do this by ensuring that the systems we work in continue to allow us to work ethically and always as our patients advocates.<br /><br />We must resist the encroachments of the market wherever it threatens our freedom to serve our patients and our communities. This is what those of you leading commissioning must promise us.<br /><br />We have to get the actuaries, risk-adjusters and share-holders out of the health service, and put clinicians (not just medics) back in charge of it.<br /><br />And then we need to bring in management staff to advise and assist us.<br />Staff who are truly committed to the values of our NHS.<br /><br />We all became doctors because we wanted to make a positive difference to people’s lives.<br /><br />It would be hard to devise a better and more inspiring way of achieving this than through the provision of excellent general practice care, within a universal health service.<br /><br />In times of austerity, we need to come together so that we can collaborate, cooperate and innovate… not compete against each other.<br /><br />You expected me to talk about the Health Bill in England, but this Bill, like other reorganisations across the whole of the United Kingdom will come and go.<br /><br />Instead I have chosen to talk to you about what matters to our patients, now and for ever - a doctor who cares.<br /><br />I am convinced that there are enough of us to create a revolution in health care. Not a revolution that the Government is talking about in the Bill –in structures, payments and competition.<br /><br />But a revolution in values.<br />One that will provide excellent care to our patients.<br /><br />Where in every interaction we pinch ourselves at the honour we have been given to be privy to their secrets and pain –<br /><br />and as Don Berwick says:<br /><br />"being allowed to be guests in their lives"<br /><br />My message to you is simple and clear. My son wanted to do medicine because of what he saw me and my friends do – care<br /><br />If we want to keep serving the best interests of our patients, we must reject the language of the market and embrace the language of caring.<br /><br />And – keep telling our stories…<br /><br />Thank you.Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com5tag:blogger.com,1999:blog-25200961.post-11211173341667970652011-10-13T18:57:00.003+01:002011-10-13T19:07:33.836+01:00What to do with Lansley's rotten billThe Liberal Democrats have let us all down on a grand scale but there are a few around with a great deal of common sense. Charles West is one. Read what he had to say here: <a href="http://www.charleswest.org.uk/NHSSOS/HealthBillConcerns.pdf">pdf</a>. Of course, any doctor with a modicum of nous could have written this. Not many politicians could. But then Charles West is a doctor.Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com2tag:blogger.com,1999:blog-25200961.post-23430101916710998192011-10-09T22:50:00.001+01:002011-10-09T22:53:17.057+01:00What NHS managers think of the bill97.1% of managers say withdraw the Health and Social Care Bill (<a href="http://library.constantcontact.com/download/get/file/1102665899193-712/nhsManagers+comments.pdf">pdf</a>).Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com1tag:blogger.com,1999:blog-25200961.post-56951231879565905692011-10-08T23:19:00.002+01:002011-10-08T23:25:22.703+01:00Open letter to the LordsHere is the text of a letter from doctors in England to the Lords:<br /><br /><blockquote>As doctors in England, we are writing to you to express our conviction that the Health and Social Care Bill will irreparably undermine the most important and admirable principles of the National Health Service, and to appeal for its rejection by the House of Lords.<br /><br />Because it is universal and comprehensive, and publicly accountable, and because clinical decisions are made without regard for financial gain, the NHS is rightly regarded all over the world as the benchmark for fairness and equity in healthcare provision.<br /><br />The transfer of services to private, profit-making companies will result in loss of public accountability and a damaging focus instead on low-risk areas that are financially profitable. A confused patchwork of competing providers will deliver a fragmented and inequitable service and any reliance on personal health budgets or insurance policies will further increase inequality. Because there will be a financial incentive for providing treatment patients will be over-treated, the potential costs of which are limitless. And the possibility of the commissioning role being outsourced to the private sector is also deeply concerning.<br /><br />In forcing through this ill-conceived Bill, without an electoral mandate and against the strident objections of healthcare professionals, the Government is also ignoring overwhelming evidence that healthcare markets are inefficient and expensive to administer.<br /><br />The public has been misled throughout, first by claims that no major reorganisation of the NHS would be undertaken, later by repeated denials that what is happening represents privatisation, and furthermore by suggestions that the Bill enjoys the support of the medical profession. We do not accept the argument that "things have already gone too far" - the enactment of some of the Bill's proposals has been premature and illegal, however some of its most damaging aspects may still be mitigated.<br /><br />We believe that on moral, clinical and economic grounds, the Health and Social Care Bill must be rejected.</blockquote><br /><br />If you are a doctor in England and would like to put your name to this letter please email Jonathan.folb@nhs.net with your details. Feel free to circulate this letter further. Time is now very short. Do it now.Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com0tag:blogger.com,1999:blog-25200961.post-22352278684710647622011-10-04T07:51:00.008+01:002011-10-04T23:15:56.260+01:00Lords save usHere is the text of an open letter to the Lords from nearly 400 doctors:<br /><blockquote>Dear Honourable Members of the House of Lords,<br /><br />As public health doctors and specialists from within the NHS, academia and elsewhere, we write to express our concerns about the Health and Social Care Bill.<br /><br />The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole.<br /><br />It ushers in a significantly heightened degree of commercialisation and marketisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicable disease outbreaks and other public health emergencies.<br /><br />While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms as a whole will disrupt, fragment and weaken the country’s public health capabilities.<br /><br />The government claims that the reforms have the backing of the health professions. They do not. Neither do they have the general support of the public.<br /><br />It is our professional judgement that the Health and Social Care Bill will erode the NHS’s ethical and cooperative foundations and that it will not deliver efficiency, quality, fairness or choice.<br /><br />We therefore request that you reject passage of the Health and Social Care Bill.<br /><br /><br /><br />Jo Abbott<br />Consultant in Public Health, NHS Rotherham<br /><br />Dr Sushma Acquilla<br />International Faculty Advisor, UK Faculty of Public Health and Honorary Senior Lecturer, Imperial College London<br /><br />Dr John Acres<br />Head of the School of Public Health, Wessex Deanery<br /><br />Dr Mayada Abu Affan<br />Consultant in Public Health Medicine, Dudley PCT<br /><br />Dr Nicholas Aigbogun<br />Specialty Registrar in Public Health, Health Protection Agency West Midlands<br /><br />Professor Priscilla Alderson<br />Professor Emerita of Childhood Studies, Institute of Education, University of London<br /><br />Dr Rob Aldridge<br />Academic Clinical Fellow (Public Health), University College London<br /><br />Dr Kirsty Alexander<br />Public Health Directorate, Gloucestershire PCT<br /><br />Martin Allaby<br />NHS Consultant in Public Health<br /><br />Ben Anderson MPH, MFPH<br />Acting Consultant in Public Health, NHS Sheffield<br /><br />Dr Elspeth Anwar<br />Public Health Registrar, Mersey Deanery<br /><br />Dr Ike Anya<br />Consultant in Public Health Medicine<br /><br />Charlotte Ashton<br />Public Health Specialty Registrar in London<br /><br />Professor John R Ashton, CBE<br />Director of Public Health, Cumbria<br /><br />Matthew Ashton<br />Assistant Director of Public Health, NHS Knowsley<br /><br />Dr Esther Aspinall<br />Specialist Registrar in Public Health, West of Scotland<br /><br />Dr Daphne Austin<br />Chair of the UK Commissioning Public Health Network<br /><br />Dr Ishraga Awad<br />Consultant in Public Health Medicine<br /><br />Dr Sallie Bacon<br />Associate Director of Public Health, Hampshire<br /><br />Dr M R Bahl<br />Consultant in Public Health & Communicable Disease Control (retired)<br /><br />Dr Simon Balmer<br />Consultant in Public Health Medicine<br /><br />Dr Helen Barratt<br />Research Training Fellow/ Public Health Specialist Registrar, University College London<br /><br />Prof Mel Bartley<br />Director of the ESRC International Centre for Life Course Studies, University College London<br /><br />Dr Subhashis Basu<br />Specialist Registrar in Public Health and Accident & Emergency, NHS Rotherham and Sheffield Teaching Hospitals<br /><br />Alison Bell<br />Consultant in Public Health, NHS Wiltshire<br /><br />Dr Paul Batchelor<br />Consultant in Dental Public Health, Thames Valley and Senior Lecturer, UCL<br /><br />Dr John Battersby<br />Medical Director, Eastern Region Public Health Observatory<br /><br />Jackie Beavington<br />Associate Director of Public Health<br /><br />Dr Charles R Beck<br />Specialty Registrar in Public Health<br /><br />Jane Beenstock<br />Specialty Registrar, NHS County Durham and NHS Darlington<br /><br />Dr Ruth Bell<br />Clinical Senior Lecturer/Honorary NHS Consultant in Public Health, Newcastle University<br /><br />Professor Yoav Ben-Shlomo<br />Professor in Clinical Epidemiology, University of Bristol<br /><br />Helen Bewsher<br />Public Health Intelligence Specialist, NHS Kirklees<br /><br />Dr Sohail Bhatti<br />Interim Director of Public Health Medicine, NHS East Lancashire<br /><br />Professor Raj Bhopal CBE<br />Professor of Public Health, University of Edinburgh<br /><br />Amy Bird<br />Specialty Registrar Public Health, London, Kent, Surrey and Sussex<br /><br />Dr Christopher A Birt<br />Senior Research Fellow / NHS Public Health Physician, Liverpool<br /><br />Andrew Boddy<br />Director (retired), Public Health Research Unit, University of Glasgow<br /><br />Sarah Bowman<br />Specialty Registrar Public Health, NHS Tees<br /><br />Dr Ian Brown<br />Specialty Registrar in Public Health, NHS Hertfordshire<br /><br />Dr Claire Bradford<br />NHS Consultant in Public Health Medicine<br /><br />Dr Fiona Bragg<br />Specialty Registrar Public Health<br /><br />Professor Carol Brayne<br />Professor of Public Health Medicine, University of Cambridge<br /><br />Professor John Britton<br />Professor of Epidemiology, University of Nottingham<br /><br />Dr Helen Bromley<br />Division of Public Health and Policy, University of Liverpool<br /><br />Jilla Burgess-Allen<br />Specialty Registrar in Public Health, Derbyshire County PCT<br /><br />Julia Burrows<br />Consultant in Public Health, NHS Bradford and Airedale<br /><br />Dr Jenny Bywaters<br />Senior Public Mental Health Adviser, Department of Health (retired)<br /><br />Dr Nigel Calvert<br />Associate Director of Public Health, NHS Cumbria<br /><br />Dr Corinne Camilleri-Ferrante<br />Consultant in Public Health Medicine and Head of School of Public Health<br /><br />Professor Simon Capewell<br />Professor of Clinical Epidemiology, University of Liverpool<br /><br />Professor Francesco P Cappuccio<br />Professor of Cardiovascular Medicine & Epidemiology, Warwick Medical School<br /><br />Dr Robin Carlisle<br />Consultant in Public Health, NHS Rotherham,<br /><br />Dr Marie Casey<br />Specialty Registrar in Public Health<br /><br />Dr Jacky Chambers<br />Director of Public Health, Heart of Birmingham tPCT<br /><br />Dr Jennifer Champion<br />Acting Consultant in Public Health, NHS Forth Valley<br /><br />Dr David Chappel<br />Assistant Director, North East Public Health Observatory<br /><br />Hannah Chellaswamy<br />Deputy Director of Public Health, NHS Sefton & Training Programme Director, Cheshire & Merseyside, NW School of Public Health<br /><br />Professor Aileen Clarke<br />Professor of Public Health & Health Services Research, Warwick Medical School<br /><br />Professor Stephen Clift<br />Professor of Health Education, Canterbury Christ Church University<br /><br />Dr RA Coates<br />Consultant in Public Health Medicine, Southampton City PCT<br /><br />Prof Michel P Coleman<br />Professor of Epidemiology and Vital Statistics, London School of Hygiene and Tropical Medicine<br /><br />Katherine Conlon<br />Speciality Registrar in Public Health, NHS South Gloucestershire<br /><br />David Conrad<br />Specialty Registrar in Public Health, Knowsley PCT<br /><br />Dr Joanna Copping<br />NHS Consultant in Public Health Medicine<br /><br />Dr Gary Cook<br />Consultant Epidemiologist, Stockport NHS Foundation Trust<br /><br />Professor Derek Cook<br />Professor of Epidemiology, St George's, University of London<br /><br />Dr Emer Coffey<br />Consultant in Public Health, Liverpool PCT<br /><br />Ellen Cooper<br />Public Health Specialist, NHS Stockport<br /><br />Mary Corcoran<br />Consultant in Public Health, NHS Nottinghamshire County<br /><br />Jonathan Cox<br />Specialty Registrar in Public Health, Norwich Medical School<br /><br />Maureen Crawford<br />Director of Public Health, Sunderland Teaching Primary Care Trust/Sunderland City Council<br /><br />Dr Tricia Cresswell<br />Consultant in Health Protection, Health Protection Agency/Deputy Medical Director, NHS North East<br /><br />Dr James R Crick<br />Specialty Registrar in Public Health, Yorkshire and Humber Deanery<br /><br />Denis Cronin<br />Public Health Consultant, NHS Cornwall and Isles of Scilly<br /><br />Professor Ann Crosland<br />Professor of Nursing and Public Health Lead, University of Sunderland<br /><br />Dr Elizabeth Crowe<br />Specialty Registrar in Public Health, SE Scotland<br /><br />Dr June Crown, OBE<br />Former President, United Kingdom Faculty of Public Health<br /><br />Professor Steven Cummins<br />Professor of Urban Health & NIHR Senior Fellow, Queen Mary University of London<br /><br />Sarah Cuthberson<br />Specialty Registrar in Public Health, South Yorkshire Health Protection Unit<br /><br />Dr Fiona Day<br />Consultant in Public Health Medicine, Sheffield PCT<br /><br />Valerie Delpech<br />Consultant Epidemiologist Health Protection Agency<br /><br />Prof Elaine Denny<br />Professor of Health Sociology, Birmingham City University<br /><br />Martin Dockrell<br />Fellow of the Royal Society of Public Health<br /><br />Dr Hiten Dodhia<br />NHS Public Health Consultant, Lambeth PCT<br /><br />Professor Danny Dorling<br />Professor of Human Geography, University of Sheffield<br /><br />Dr Flora Douglas<br />Lecturer in Health Promotion, University of Aberdeen/NHS Grampian<br /><br />Dr Peter Draper<br />Freelance health policy analyst<br /><br />Dr Julian Elston<br />Consultant in Public Health, Cornwall and Isles of Scilly PCT<br /><br />Barry Evans<br />Consultant Epidemiologist<br /><br />Professor David Evans<br />Professor in Health Services Research, University of the West of England<br /><br />Dr Jamie Fagg<br />Research Associate in Epidemiology and Biostatistics, UCL Institute of Child Health<br /><br />Andrea Fallon<br />Consultant in Public Health, NHS Oldham<br /><br />Dr Tracey Farragher<br />Senior Research Fellow, Academic Unit of Public Health, University of Leeds<br /><br />Dr Jill Farrington<br />Consultant in Public Health Medicine, NHS Calderdale<br /><br />Greg Fell<br />Consultant in Public Health, NHS<br /><br />Natalie Field<br />Public Health Consultant, South Gloucestershire<br /><br />Dr Richard Fielding<br />Professor of Medical Psychology in Public Health, University of Hong Kong<br /><br />Dr Tim Fielding<br />Public Health Registrar<br /><br />Dr Alastair Fischer<br />Health Economist, National Institute for Health and Clinical Excellence (NICE)<br /><br />Paul Fisher<br />Specialty Registrar in Public Health, West Midlands East Health Protection Unit<br /><br />Dr Julian Flowers<br />Director, East of England Regional Public Health Observatory<br /><br />Dr Alison Forrester<br />Clinical Advisor to NHS North Yorkshire and York<br /><br />Kirsten Foster<br />Health Improvement Practitioner Advanced, Kirklees PCT<br /><br />Dr David Foxcroft<br />Professor of Community Psychology and Public Health, Oxford Brookes University<br /><br />Sue Frossell<br />Consultant in Public Health (Health Protection and Improvement), NHS Milton Keynes<br /><br />Dr Tom Fryers<br />Hon. Professor of Public Mental Health, University of Leicester<br /><br />Dr Alison Furey<br />Independent Public Health Consultant<br /><br />John Gabbay<br />Emeritus Professor, University of Southampton<br /><br />Dr Linda Garvican<br />QA Director, Cancer Screening Programmes, NHS South East Coast<br />Dr Alexander Gatherer<br />Former Director of Public Health, Oxford<br /><br />Dr Katie Geary<br />Consultant in Communicable Disease Control, Health Protection Agency East Midlands<br /><br />Dr Ivan Gee<br />Senior Lecturer in Public Health, Liverpool John Moores University<br /><br />Dr Steve George<br />Reader in Public Health, University of Southampton<br /><br />Dr Daniel Gibbons<br />NIHR Doctoral Research Fellow, School of Public Health, Imperial College London<br /><br />Professor Ruth Gilbert<br />Professor of Clinical Epidemiology and Director of the Centre for Evidence-based Child Health, University College London - Institute of Child Health<br /><br />Professor Anna Gilmore<br />Professor of Public Health, University of Bath<br /><br />Dr Suzanne Gilman<br />Public Health Speciality Registrar, NHS Central Lancashire<br /><br />Dr Michelle Gillies<br />Specialist Registrar Public Health and Clinical Lecturer Chronic Disease Epidemiology<br /><br />Dr Jay Ginn<br />Visiting Professor, Institute of Gerontology, Kings College London<br /><br />Professor Michael Goldacre<br />Professor of Public Health, University of Oxford<br /><br />Chris Godfrey<br />Consultant in Public Health, Solihull Primary Care Trust<br /><br />Sara Godward<br />Locum Consultant in Public Health<br /><br />Dr Paula Grey<br />Joint Director of Public Health, Liverpool PCT/Liverpool City Council<br /><br />Professor Selena Grey<br />Professor of Public Health, University of the West of England<br /><br />Dr Carl Griffin<br />NHS Consultant in Public Health Medicine<br /><br />Professor Rod Griffiths CBE<br />Former President, Faculty of Public Health<br /><br />Sarah Johnson Griffiths<br />Consultant in Public Health, NHS Western Cheshire<br /><br />Professor Sian Griffiths, OBE<br />Former President of the Faculty of Public Health<br /><br />Rachael Gosling<br />Locum Consultant in Public Health, Liverpool Community Health NHS Trust<br /><br />Dr Hilary Guite<br />Director Public Health and Well-being, NHS Greenwich<br /><br />Dr Fay Haffenden<br />Consultant in Public Health Children & Health Inequalities, NHS Cambridgeshire<br /><br />Professor Sir Andy Haines<br />Professor of Public Health and Primary Care, London School of Hygiene and Tropical Medicine<br /><br />Dr Jennifer Hall<br />Public Health Specialty Registrar, London<br /><br />Tom Hall<br />Specialty Registrar in Public Health<br /><br />Mr John Hampson<br />Public Health Specialist, NHS Western Cheshire<br /><br />Wendy Hannon<br />Public Health Commissioning Manager, Plymouth PCT<br /><br />Dr Maggie Harding<br />NHS Consultant in Public Health (Medicine)<br /><br />Dr Andrew Harmer<br />Honorary Lecturer in Public Health, London School of Hygiene and Tropical Medicine<br /><br />Dr Ruth Harrell<br />Specialty Registrar in Public Health, West Midlands<br /><br />Lynda Harris<br />Director of Public Health, Wales<br /><br />Dr Shamil Haroon<br />Public Health Registrar, Sandwell PCT<br /><br />Professor Stephen Harrison<br />Honorary Professor of Social Policy, University of Manchester<br /><br />Dr Wayne Harrison<br />Consultant in Public Health<br /><br />Martin Hawkings<br />Consultant in Public Health Medicine, NHS North Yorkshire and York<br /><br />Hazel Henderson<br />Consultant in Public Health<br /><br />Alan Higgins<br />Director of Public Health, Oldham<br /><br />Dr Christine Hill<br />Consultant in Public Health Medicine, Cambridge<br /><br />Dr Christine E Hine<br />Head of School & Training Programme Director, SW Public Health Specialty Training Programme and Consultant in Public Health, NHS Bristol & NHS S Gloucs<br /><br />Julie Hirst<br />Public Health Specialist, NHS Derbyshire County<br /><br />Dr Sue Hogarth<br />Public Health Specialty Registrar, University College London<br /><br />Dr Jason Horsley<br />Specialty Registrar in Public Health Medicine / Honorary Clinical Lecturer<br /><br />Dr Anita Houghton<br />Consultant in Public Health, London<br /><br />Professor Walter W Holland, CBE<br />LSE Health and Social Care, London School of Economics<br /><br />Dr Peter Horby<br />Senior Clinical Research Fellow, University of Oxford<br /><br />Julie Hotchkiss<br />NHS Consultant in Public Health, Wigan<br /><br />Dr Rob Howard<br />NHS Public Health Specialty Registrar<br /><br />Dr Jonathan Howell<br />Consultant in Public Health, West Midlands Specialised Commissioning Team<br /><br />Clare Humphreys<br />Specialty Registrar in Public Health, NHS Yorkshire and the Humber<br /><br />Professor David Hunter<br />Professor of Health Policy and Management, Durham University<br /><br />Louise Hurst<br />Public Health Specialty Registrar, University College London<br /><br />Dr Sandra Husbands<br />NHS Consultant Public Health Medicine<br /><br />Dr Sabina Fatima Hussain<br />Specialist Registrar in Public Health<br /><br />Jan Hutchinson<br />Director of Public Health<br /><br />Paul Iggulden<br />Independent Public Health Specialist<br /><br />Dr Chikwe Ihekweazu<br />Consultant Epidemiologist, Health Protection Agency<br /><br />Kathryn Ingold<br />Public Health Speciality Registrar, Leeds<br /><br />Dr Maggie Ireland<br />North East Public Health Doctor<br /><br />Dr Helene Irvine<br />Consultant in Public Health Medicine, NHS Greater Glasgow and Clyde<br /><br />Dr Richard Jarvis<br />Consultant in communicable disease control and public health medicine, NHS Merseyside<br /><br />Charlotte Jeavons<br />Programme Leader, Public Health, University of Greenwich<br /><br />Dr Anna Jones<br />Teaching fellow at Brighton and Sussex Medical School<br /><br />Margaret Jones<br />Consultant in Public Health, NHS Sefton<br /><br />Lesley Jones<br />Deputy Director Public Health, NHS Bolton<br /><br />Professor Frank Kee<br />UKCRC Centre of Excellence, Queens University Belfast<br /><br />Dr Gifford Kerr<br />Consultant in Public Health, NHS Blackburn with Darwen<br /><br />Dr Anuj Kapilashrami<br />Lecturer Global Public, University of Edinburgh<br /><br />Dr S Vittal Katikireddi<br />Clinical Research Fellow, MRC/CSO Social and Public Health Sciences Unit & Specialty Registrar in Public Health Medicine, NHS Lothian<br /><br />Dr Marko Kerac<br />Specialty Registrar & Academic Clinical Fellow, Public Health<br /><br />Dr Mark Lambert<br />NHS Consultant in Public Health Medicine<br /><br />Professor Tim Lang<br />School of Health Sciences, City University London<br /><br />Dr Rajalakshmi Lakshman<br />Clinical Scientist and Honorary Consultant in Public Health, Addenbrooke's Hospital, Cambridge<br /><br />Dr Bruce Laurence<br />Acting Director of Public Health for Derbyshire<br /><br />David Lawrence<br />Consultant in Public Health, NHS SE London<br /><br />Mike Leaf<br />Acting Director of Public Health, NHS North Lancashire<br /><br />Ben Leaman<br />Specialist Public Health Registrar, Yorks & Humber<br /><br />Dr Conan Leavey<br />Senior Lecturer Public Health, Liverpool John Moores University<br /><br />Dr Joyce Leeson<br />Retired Senior Lecturer in Public Health, Manchester University<br /><br />Dr Nicholas Leigh-Hunt<br />Public Health Registrar, NHS Leeds<br /><br />Professor David Leon<br />Professor of Epidemiology, London School of Hygiene & Tropical Medicine<br /><br />Valerie A Little<br />Director of Public Health, Dudley<br /><br />Mary Lyons<br />Public Health Specialist, NHS Central Lancashire<br /><br />John Lucy<br />Associate Director of Public Health, Liverpool Primary Care Trust<br /><br />Dr Helen Maguire<br />Health Protection Agency, London<br /><br />Dr GJ MacArthur<br />Academic Public Health Training Fellow, University of Bristol<br /><br />Professor Alison Macfarlane<br />Professor of Perinatal Health, City University London<br /><br />Dr Frances MacGuire<br />Specialist Registrar, Public Health<br /><br />Dr Paul Madill<br />Specialty Registrar in Public Health, NHS South of Tyne and Wear<br /><br />Dr Alexis Macherianakis<br />Consultant in Public Health Medicine, Sandwell PCT<br /><br />Shepherd Masara<br />Associate member of the Faculty of Public Health<br /><br />Dr Mashbileg Maidrag<br />Consultant in Public Health, NHS Suffolk/Suffolk County Council<br /><br />Alan Maryon-Davis<br />Hon Professor of Public Health, Kings College London and Immediate Past President of the UK Faculty of Public Health<br /><br />Dr Christina Maslen<br />Clinical Effectiveness Lead, Public Health Directorate, NHS Bristol<br /><br />Dr Rebecca Mason<br />Specialty Registrar (Public Health), Mersey Deanery<br /><br />Sue Matthews<br />Public Health Specialty Registrar, Hertfordshire PCT<br /><br />Dr Eleni Maunder<br />Retired Senior Lecturer in Nutrition, Bournemouth University<br /><br />Janet Maxwell<br />Director of Public Health, NHS Berkshire West<br /><br />Dr Melanie Maxwell<br />Associate Medical Director and Public Health Specialist, Wirral University Teaching Hospital<br /><br />Dr Gerry McCartney<br />Public Health Consultant, NHS Health Scotland<br /><br />David McConalogue<br />Speciality Registrar in Public Health<br /><br />Dr David McCoy<br />Associate Director of Public Health and Consultant Public Health Medicine, Inner North West London PCT, NHS<br /><br />Amy McCullough<br />Public Health Specialty Registrar<br /><br />Professor James McEwen<br />Emeritus Professor in Public Health, University of Glasgow<br /><br />Lynne McNiven<br />Public Health Consultant, Assistant Director of Public Health, NHS Lincolnshire<br /><br />Dr Sarah McNulty<br />Assistant Director of Public Health, Quality and Health Protection, NHS Knowsley<br /><br />Professor Klim McPherson<br />Visiting Professor of Public Health Epidemiology, University of Oxford<br /><br />Dr Jeff Mecaskey<br />Fellow of the Faculty of Public Health<br /><br />Elaine Michel<br />Interim Director of Public Health, NHS Tameside & Glossop<br /><br />Professor Susan Michie<br />Professor of Health Psychology, University College London<br /><br />Dr John Middleton<br />Senior NHS Director of Public Health<br /><br />Dr May Moonan<br />Clinical Lecturer in Public Health Medicine and NICE Scholar/Specialty Registrar in Public Health, University of Liverpool<br /><br />Professor Robert Moore<br />School of Sociology, Social Policy and Criminology, University of Liverpool<br /><br />Dr Gemma Morgan<br />Academic Public Health Training Fellow, University of Bristol<br /><br />Maria Morgan<br />Lecturer in Dental Public Health, Cardiff University School of Dentistry<br /><br />Dr Andrew Mortimore<br />Director of Public Health, Southampton<br /><br />Dr Anna Morris<br />Specialty Registrar in Public Health, NHS Hampshire<br /><br />Maggi Morris<br />Director of Public Health, Central Lancashire<br /><br />Aldo Mussi<br />Senior Lecturer in Public Health, Birmingham City University<br /><br />Dr Bernadette Nazareth<br />Consultant in Communicable Disease Control, HPA Norfolk Suffolk and Cambridgeshire<br /><br />Professor Angus Nicoll, CBE<br />Former Director, Communicable Disease Surveillance Centre, Health Protection Agency<br /><br />Dr Rory O’Conor<br />Consultant in Public Health, Wakefield PCT & YHPHO<br /><br />Claire O'Donnell<br />Clinical Effectiveness Specialist in Public Health, North West Specialised Commissioning Team<br /><br />John O'Dowd<br />Consultant Public Health Physician (Child Health), NHS Scotland<br /><br />Professor Eileen O’Keefe<br />Professor of Public Health, London Metropolitan University<br /><br />Dr Donal O'Sullivan<br />Consultant in Public Health Medicine, NHS South East London<br /><br />Dr Ifeoma Onyia<br />Public Health Physician<br /><br />James Lindley Owen<br />NHS Consultant in Public Health<br /><br />Dr Kishor Padki<br />Consultant in Public Health Medicine, NHS South West Essex<br /><br />Dr Arun Patel<br />Associate Director of Public Health, South West Essex PCT<br /><br />Dr Matthieu Pegorie<br />Specialty Registrar in Public Health, NHS Trafford<br /><br />Dr David Pencheon<br />Director, NHS Sustainable Development Unit (England<br /><br />Sarah Phillips<br />Public Health Intelligence Analyst, NHS South Gloucestershire<br /><br />Professor Kate Pickett<br />Professor of Epidemiology, University of York<br /><br />Dr Mary Pierce<br />Clinical Epidemiologist, MRC Unit for Lifelong Health and Ageing<br /><br />Dr David Pitches<br />Locum Consultant in Public Health, NHS Walsall<br /><br />Professor Tanja Pless-Mulloli<br />Institute of Health and Society, Newcastle University<br /><br />Dr George Pollock<br />Honorary Senior Research Fellow, University of Birmingham<br /><br />Professor Jennie Popay<br />Professor of Sociology and Public Health, Lancaster University<br /><br />Dr Debora Price<br />Senior Lecturer, Gerontology, King's College London<br /><br />Alison Pritchard<br />Consultant in Public Health, Derbyshire County PCT<br /><br />Dr Angela E Raffle<br />Consultant in Public Health, Bristol<br /><br />Professor Rosalind Raine<br />Professor of Health Care Evaluation, University College London<br /><br />Thara Raj<br />NHS Public Health Manager<br /><br />Dr Giri Rajaratnam<br />Deputy RDPH, East Midlands NHS<br /><br />Professor Salman Rawaf<br />Director of the WHO Collaborating Centre for Public Health Education, Imperial College London<br /><br />Mr Abdul Razzaq<br />Joint Director of Public Health and Senior NHS Public Health Consultant<br /><br />Dr Arif Rajpura<br />Director of Public Health, NHS Blackpool<br /><br />Dr Boika Rechel<br />Clinical Lecturer in Public Health and Honorary Consultant in Public Health Medicine, University of East Anglia<br /><br />Dr Paul Redgrave<br />Consultant Public Health<br /><br />Professor Margaret Reid<br />Professor Emeritus, Public Health, University of Glasgow<br /><br />Dr Mark Reilly<br />Assistant Director Public Health Intelligence, NHS Tees<br /><br />Becky Reynolds<br />Speciality Registrar in Public Health, Yorkshire and Humber Deanery<br /><br />Professor Jammi Rao<br />Visiting Professor in Public Health, Staffordshire University<br /><br />Prof Jennifer Roberts<br />Prof Emeritus in Economics of Public Health, LSHTM<br /><br />Dr Heather Roberts<br />Director of Postgraduate Education, School of Community Health Sciences, City Hospital, Nottingham<br /><br />Professor Paul Roderick<br />Professor of Public Health, University of Southampton<br /><br />Helen Ross<br />Hon Member of the Faculty of Public Health<br /><br />David Ross<br />Consultant Public Health Medicine<br /><br />Dr Eleanor Rutter<br />Public Health Specialist Registrar, NHS Sheffield<br /><br />Prof Harry Rutter<br />Director, National Obesity Observatory<br /><br />Dr Alison Rylands<br />Director of Public Health, North West Specialised Commissioning Team<br /><br />Dr Vanessa Saliba<br />Public Health Specialty Registrar, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine<br /><br />Martin Schweiger<br />Consultant in Communicable Disease Control, West Yorkshire Health Protection Unit<br /><br />Dr Sonya Scott<br />Specialty Registrar in Public Health Medicine<br /><br />Dr Alex Scott-Samuel<br />Senior Clinical Lecturer in Public Health, University of Liverpool<br /><br />Dr Anjila Shah<br />Consultant in Public Health, NHS Sefton<br /><br />Professor Prakash Shetty<br />Professor of Public Health Nutrition, Southampton University<br /><br />Dr Mohit Sharma<br />Specialty Registrar in Public Health, Oxford Deanery and University of Oxford<br /><br />Dr Sally Sheard<br />Senior Lecturer in History of Medicine, University of Liverpool<br /><br />Jessica Sheringham~<br />Specialty Registrar in Public Health, North London<br /><br />Dr Khesh Sidhu<br />NHS Consultant in Public Health Medicine<br /><br />Professor Peter Sims<br />Honorary Teaching Fellow, Peninsula Medical School<br /><br />Dr Katherine Smith<br />Lecturer in Global Public Health, University of Edinburgh<br /><br />Professor Alwyn Smith CBE<br />Past President, Faculty of Public Health<br /><br />Dr Jenifer Smith<br />Director of Public Health and Chief Medical Advisor, Isle of Wight NHS PCT<br /><br />Victoria Smith<br />Health Improvement Officer, Blaby District Council<br /><br />Dr Tasmin Sommerfield<br />Consultant in Public Health, NHS Lanarkshire<br /><br />Dr Rosamund Southgate<br />Public Health Specialty Registrar, Oxford Deanery<br /><br />Dr Dan Seddon<br />NHS Public Health Consultant and Public Health Educator<br /><br />Dr Ruth Stern<br />Honorary Visiting Fellow, London Metropolitan University<br /><br />Dr Alex G Stewart<br />Consultant in Communicable Disease Control, Cheshire & Merseyside HealthProtection Unit<br /><br />Professor Tony Stewart<br />Professor in Public Health / NHS Consultant in Public Health, Staffordshire University<br /><br />Dr Alex Stirling<br />Specialty Registrar in Public Health, NHS Greater Glasgow and Clyde<br /><br />Dr Ljuba Stirzaker<br />Consultant in Public Health Medicine, NHS Buckinghamshire and Oxfordshire Cluster<br /><br />Laura Stroud<br />Lecturer in Public Health, University of Leeds<br /><br />Dr Graham Sutton<br />Consultant in Communicable Disease Control, Leeds<br /><br />Professor Stephanie Taylor<br />Professor in Public Health and Primary Care, Queen Mary University of London<br /><br />Dr David Taylor-Robinson<br />Clinical Lecturer in Public Health, University of Liverpool<br /><br />Alison Tennant<br />Specialist in Pharmaceutical Public Health, NHS Dudley<br /><br />Sarah Theaker<br />Specialty Registrar in Public Health, NHS Nottinghamshire County<br /><br />Richard Thomson<br />Professor of Epidemiology and Public Health, Newcastle University<br /><br />Martin Tobin<br />Professor of Genetic Epidemiology and Public Health, University of Leicester<br /><br />Dr Daniel Todkill<br />SpR in Public Health Medicine<br /><br />Julie Tolhurst<br />Health Improvement Practitioner, Public Health Directorate, NHS Kirklees<br /><br />Dr Caroline Tomes<br />Public Health Specialty Registrar, NHS Cambridgeshire<br /><br />Dr John Tomlinson<br />Deputy DPH, NHS Nottinghamshire and FPH East Midlands Local Board Representative<br /><br />Dr Paul S Turner<br />NHS Consultant in Public Health<br /><br />Pat Turton<br />Senior Lecturer, University of the West of England<br /><br />Linda Turner<br />Consultant in Public Health, NHS Sefton<br /><br />Paul Turner<br />Consultant in Public Health, NHS Ashton, Leigh and Wigan<br /><br />Ruth Twiggins<br />Head of Public Health: Health Inclusion Team, NHS Wakefield District<br /><br />Louise Unsworth,<br />NHS Public Health Consultant, North East Public Health Observatory<br /><br />Emily van de Venter<br />Public Health Speciality Registrar<br /><br />Professor Edwin van Teijlingen<br />Centre for Midwifery, Maternal & Perinatal Health School of Health & Social Care, Bournemouth University<br /><br />Dr Marie-Noelle Vieu<br />Fellow of the Faculty of Public Health<br /><br />Dr Rebecca Wagstaff<br />Deputy Director of Public Health, NHS Cumbria<br /><br />Dr Andy Wakeman<br />Senior NHS Public Health Consultant<br /><br />Alice Walsh<br />Deputy Director of Public Health, NHS Gloucestershire<br /><br />Sue Wardle<br />Public Health Specialist, South Staffordshire Primary Care Trust<br /><br />Professor Richard G Watt<br />Department of Epidemiology and Public Health, UCL<br /><br />Dr Joanna Watson<br />Unemployed Public Health doctor, Leicester<br /><br />Dr Helen Webster<br />Speciality Registrar in Public Health, West Midlands<br /><br />Sarah Weld<br />Public Health Specialty Registrar, NHS Wiltshire<br /><br />Dr Jane Wells<br />NHS Public Health Physician, Oxford<br /><br />Professor Robert West<br />Director of Tobacco Research, Department of Epidemiology and Public Health, University College London<br /><br />Dr Ben Wheeler<br />Research Fellow, European Centre for Environment & Human Health<br /><br />Professor Peter Whincup<br />Professor of Epidemiology, University of London<br /><br />Professor Martin White<br />Professor of Public Health, Institute of Health & Society, Newcastle University<br /><br />Professor Margaret Whitehead<br />Professor of Public Health, University of Liverpool<br /><br />Dr Lisa Wilkins<br />Consultant in Public Health Medicine, NHS Oldham<br /><br />Dr Ewan Wilkinson<br />NHS Public Health physician, Liverpool<br /><br />Professor John Wilkinson<br />Professor of Public Health, Durham University<br /><br />Professor Charles Wolfe<br />Professor of Public Health, King's College London<br /><br />Dr Ingrid Wolfe<br />Child Public Health Research Fellow and Paediatrician<br /><br />Dr Fiona Wright<br />Assistant Director of Public Health, Haringey<br /><br />Huda Yusuf<br />Specialist Registrar Dental Public Health, North West & North Central London Primary Care Trusts<br /><br />Dr Helen Zealley, OBE<br />Former Director of Public Health, NHS Lothian<br /><br />Dr Rosemary Millar<br />Specialty Trainee in Public Health, NHS Tayside<br /><br />Jay Succaram<br />Senior Lecturer, College of Nursing, Midwifery and Healthcare, University of West London<br /><br />Dr Rachel C Thorpe<br />Specialty Registrar in Public Health, NHS Lanarkshire<br /><br />Dr Celia Duff<br />Specialty Training Programme Director, East of England<br /><br />Dominic Mellon<br />Specialty Registrar - Public Health, South West Public Health Training Programme<br /><br />Helene Denness<br />Specialty Registrar in Public Health, Babington Hospital<br /><br />Dr Ayoola Oyinloye<br />Consultant in Public Health Medicine, NHS Swindon<br /><br />Dr Ardiana Gjini<br />Consultant in Public Health Medicine, NHS Bristol and NHS North Somerset<br /><br />Dr Hynek Pikhart<br />Senior Lecturer in Epidemiology, University College London<br /><br />Dr Joshna Ahir<br />Specialty Registrar in Public Health, Yorkshire and The Humber<br /><br />Dr Nora Pashayan<br />Senior Clinical Lecturer in Applied Health Research, University College London<br /><br />Shaukat Ali<br />Public Health Specialist, Sandwell Primary Care Trust<br /><br />Julie George<br />NIHR Doctoral Fellow, University College London<br /><br />Dr Andy Liggins<br />Director of Public Health, Peterborough<br /><br />Dr Tasmin Sommerfield<br />Consultant in Public Health, NHS Lanarkshire<br /><br />Dr Rosemary Millar<br />Specialty Trainee in Public Health, NHS Tayside<br /><br />Professor Eileen Kaner<br />Director of the Institute of Health and Society and Professor of Public Health Research, Newcastle University<br /><br />Dr Alison McCallum<br />Director of Public Health and Health Policy, NHS Lothian<br /><br />Dr Eleanor Hill<br />Public Health Specialist, Stockport PCT<br /><br />Kevin Elliston<br />Interim Associate Director of Public Health and Visiting Professor in Public Health, NHS Plymouth<br /><br />Dr Jo Williams<br />Specialty Registrar in Public Health, NHS Bristol<br /><br />Dr Merav Kliner<br />SpR Public Health, Yorkshire and Humber<br /><br />Jan van der Meulen<br />Professor of Clinical Epidemiology, London School of Hygiene and Tropical Medicine<br /><br />Dr Lynne Hamilton<br />SpR in Public Health Medicine, Tayside NHS Board Public Health<br /><br />Carl Mackie<br />Advanced Health Improvement Practitioner, Huddersfield<br /><br />Veronica Killen<br />Senior Lecturer in Public Health, Northumbria University<br /><br />Helen McAuslane<br />Public Health Specialty Registrar, Leeds<br /><br />Anna Middlemiss<br />Specialty Registrar in Public Health<br /><br />Elisabeth Smart<br />Consultant in Public Health, Dumfries<br /><br />Dr Jane Bethea<br />Specialty Registrar in Public Health<br /><br />Rachel Sokal<br />Public Health Specialty Registrar, NHS Derbyshire County<br /><br />Lucy Douglas-Pannett<br />Public Health Specialty Registrar, NHS Leicester City<br /><br />Dr Sakthi Karunanithi<br />Specialist Registrar in Public Health, NHS North Lancashire/NHS North West<br /><br />Dr Brijender Rana<br />Consultant Public Health, SEC Specialised Commissioning Group<br /><br />Dr Pratibha Datta<br />Consultant in Public Health, Outer North East London (ONEL)<br /><br />Dr Jennifer Mindell<br />Clinical Senior Lecturer, University College London<br /><br />Dr Amina Aitsi-Selmi<br />Specialist Registrar in Public Health, London<br /><br />Jo Peden<br />Public Health Specialty Registrar, South West (North) Health Protection Unit<br /><br />Dr Imogen Stephens<br />Consultant in Public Health Medicine, Solutions for Public Health, Oxford<br /><br />Stephen Turnbull<br />Assistant Director of Public Health, NHS Barnsley / Barnsley MBC<br /><br />Jonathan Gribbin<br />NHS Consultant in Public Health<br /><br />Dr Kate Ardern<br />NHS Senior Public Health Consultant<br /><br />Catherine Chiang<br />Consultant in Public Health Medicine, NHS Greater Glasgow and Clyde<br /><br />Dr Olusola Aruna<br />Consultant in Public Health Medicine, NHS Gloucestershire<br /><br />Professor Ian Watt<br />Professor of Primary and Community Care/Hull York Medical School<br /><br />Dr Nigel Field<br />Academic Clinical Lecturer, University College London<br /><br />Dan Seddon<br />NHS Halton and St Helens / Merseyside and Cheshire Cancer Network<br /><br />Gaynor Scholefield<br />Public Health Manager, NHS Calderdale<br /><br />Prof. Rod Thomson<br />Director of Public Health, Shropshire County PCT<br /><br />Dr Katherine Russell<br />Specialty Registrar in Public Health, NHS North Central London<br /><br />Dr Angela Bhan<br />Director of Public Health, Managing Director - Bromley BSU<br /><br />Abigail Knight<br />Specialty Registrar in Public Health, NHS Camden<br /><br />Dr Lucy Reynolds<br />Consultant Paediatrician, Maternal and Child Public Health Team, NHS Greater Glasgow and Clyde<br /><br />Dr Tim Daniel<br />Consultant in Public Health<br /><br />Dr Julian Mallinson<br />Consultant<br /><br />Dr Mike McHugh<br />Consultant in Public Health<br /><br />Glenda Augustine<br />Specialist Trainee in Public Health<br /><br />Sue Weaver<br />Public Health Manager, NHS Gloucestershire<br /><br />Dr Stephen Watkins<br />Director of Public Health, NHS Stockport<br /><br />Dr Sian Williams<br />Consultant in Occupational Medicine, London<br /></blockquote>Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com7tag:blogger.com,1999:blog-25200961.post-21958789375318501072011-10-02T06:44:00.005+01:002011-10-02T11:24:06.602+01:00Crossbench peers invited to Downing Street?Dr Grumble is beginning to move in high circles. Yesterday he learned from two independent sources that the crossbench peers are being invited to Downing Street to discuss Lansley's Health and Social Care Bill.<br /><br />The problem with parliament, the Commons particularly, is that most MPs just do what they are told. To be fair, MPs are busy. The NHS Bill is just one of very many things they have to do. Reading it, for most, is not an option and failing to follow party orders has dire consequences for an MP's career progression. Doctors in the new NHS know what this is like. Dr Grumble is anonymous because he wants to say what he believes and not what his NHS masters want him to believe.<br /><br />The Lords is very different from the Commons. While some of the people there are career politicians who have been pensioned off and given a seat in the best day centre in the land, many others have found another route there. Quite often these will have special expertise in one area or another. This, of course, is vital. Dr Grumble is actually a supporter of the House of Lords. He is even a supporter of the only elected members of the Lords, the hereditary peers. It can't be justified. All Grumble can say is that over the years he has met a few MPs and a few lords. Most of the lords he has met have been <a href="http://drgrumble.blogspot.com/2006_04_01_archive.html">patients</a> - all NHS patients (including one hereditary peer). He has been impressed by every single one.<br /><br />Grumble met another peer when he was a civil servant nearly two decades ago. Grumble had to go to a deprived part of the country to open a new facility. It doesn't matter what it was. To say exactly would identify Grumble. Few if any of Grumble's readers would ever have visited one of these places. Grumble, because of his own special expertise, has lost count of the number he has visited including some abroad. Suffice it to say that a private company had been given sweeteners to set up one of these facilities in a deprived part of Teeside. The Minister was to open it but, as ministers do, he cancelled at the very last moment and a lord was sent up from London instead. The occasion was actually exceedingly boring and Grumble and the noble got chatting over the canapes. The lord had taken the train North and he told Grumble that at one stop a whole lot of mentally impaired people got on the train with their minders and sat next to him. At the next stop the minder called them all off leaving the noble alone in the carriage. Then the minder called to Grumble's noble friend and dragged him off too. "No, no, I'm from the House of Lords!" he said.<br /><br />You can only tell that joke if you are from the House of Lords and it made Grumble chuckle. He has remembered it all those years. It's not really PC but Grumble liked it. He has liked all the lords he has met and he likes the House of Lords.<br /><br />Now what is the point of all this sycophantic rambling? It is to explain that these people in the House of Lords are nice fair-minded types who have a sense of vocation and dedication. Some of them can be relied upon to look after the NHS, which they too use. Many members of the lords are spoken for. They wear a party badge just like most of those in the Commons. And, mostly, they will do what they are told. But, in the Lords, there is a big group of crossbenchers. These are people will no overt party affiliations who will do what is right according to the evidence. <a href="http://www.u.tv/News/NHS-shakeup-poses-threat-to-political-control-Lords-committee-claims/64efb974-93a2-4d79-95b1-82a5a629d314">Already they are exerting their influence</a>.<br /><br />So, if it is true that the crossbench peers have been invited to Downing Street, you can be sure that there is a reason for this. And you can be sure that they will only hear the side of the story that Downing Street wants them to hear. So if you want them to hear what they should be hearing <a href="http://www.doctors.net.uk/DocStore/DSView/Document.aspx?docid=679748">about the NHS Bill</a>, you may need to get in touch will them. You can find out which lords are crossbenchers <a href="http://www.parliament.uk/mps-lords-and-offices/lords/">here</a> <s>along with their email addresses</s>. Get writing now.<br /><span style="font-style: italic;"><br />With thanks to Baroness Hussein-Ece (actually a Liberal Democrat), who has advised Grumble that brief emails with bullet points are appropriate, and to @UKHouseofLords with their helpful tweet. Yes, peers tweet!</span>Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com7tag:blogger.com,1999:blog-25200961.post-16185259033040763322011-09-27T18:58:00.004+01:002011-09-27T19:07:17.490+01:00Block the Bridge. Block the Bill."The National Health Service is the most important institution we have ever had in this country."<br /><br /><br /><object width="560" height="315"><param name="movie" value="http://www.youtube.com/v/j5-hi4FG-dQ?version=3&hl=en_US"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/j5-hi4FG-dQ?version=3&hl=en_US" type="application/x-shockwave-flash" width="560" height="315" allowscriptaccess="always" allowfullscreen="true"></embed></object><br /><br />"It's not theirs to sell."Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com4tag:blogger.com,1999:blog-25200961.post-15016715887606054992011-09-26T22:42:00.000+01:002011-09-26T22:43:19.301+01:00A doctor's touch<object height="374" width="526"><br /><param name="movie" value="http://video.ted.com/assets/player/swf/EmbedPlayer.swf"><br /><param name="allowFullScreen" value="true"><br /><param name="allowScriptAccess" value="always"><br /><param name="wmode" value="transparent"><br /><param name="bgColor" value="#ffffff"><br /><param name="flashvars" value="vu=http://video.ted.com/talk/stream/2011G/Blank/AbrahamVerghese_2011G-320k.mp4&su=http://images.ted.com/images/ted/tedindex/embed-posters/AbrahamVerghese_2011G-embed.jpg&vw=512&vh=288&ap=0&ti=1231&lang=&introDuration=15330&adDuration=4000&postAdDuration=830&adKeys=talk=abraham_verghese_a_doctor_s_touch;year=2011;theme=new_on_ted_com;theme=medicine_without_borders;theme=a_taste_of_tedglobal_2011;event=TEDGlobal+2011;tag=Culture;tag=Science;tag=communication;tag=health;tag=health+care;tag=medicine;&preAdTag=tconf.ted/embed;tile=1;sz=512x288;"><br /><embed src="http://video.ted.com/assets/player/swf/EmbedPlayer.swf" pluginspace="http://www.macromedia.com/go/getflashplayer" type="application/x-shockwave-flash" wmode="transparent" bgcolor="#ffffff" allowfullscreen="true" allowscriptaccess="always" flashvars="vu=http://video.ted.com/talk/stream/2011G/Blank/AbrahamVerghese_2011G-320k.mp4&su=http://images.ted.com/images/ted/tedindex/embed-posters/AbrahamVerghese_2011G-embed.jpg&vw=512&vh=288&ap=0&ti=1231&lang=&introDuration=15330&adDuration=4000&postAdDuration=830&adKeys=talk=abraham_verghese_a_doctor_s_touch;year=2011;theme=new_on_ted_com;theme=medicine_without_borders;theme=a_taste_of_tedglobal_2011;event=TEDGlobal+2011;tag=Culture;tag=Science;tag=communication;tag=health;tag=health+care;tag=medicine;&preAdTag=tconf.ted/embed;tile=1;sz=512x288;" height="374" width="526"></embed><br /></object>Dr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.com2