Betty here again

Thank you all for commenting on my post. I had no idea there were so many of you out there. John seems to have more virtual friends than real friends. Quite a few more actually.

I have learnt a lot from you all. It seems that this blogging ban for NHS staff comes from the very top. Anonymous (who seems to comment rather a lot) has pointed out that the ban originates from from David Nicholson himself. Somebody else has posted a link from which you can find out that Alan Milburn "committed himself and the new Labour Government to protecting the freedom of speech in the national health service". It's a powerful medium this blogging malarkey. I am beginning to like it.

Tell me something. If you work for Virgin Healthcare are you allowed to blog when there is a election in the offing? Presumably you are. So why can't you blog if you work for the NHS? Is this fair? It doesn't seem so to me.

What are the authorities afraid of?

Betty says hello

Hello, everybody. My name is Betty. You know me here as Mrs Grumble. You may also know that I don't read this blog. That used to be true anyway but John left his laptop lying around and I clicked on the Dr G bookmark and have read the odd post. But that is all. I also found a picture of Belle de Jour on the desktop. For anybody who doesn't know, Belle de Jour is a trollop and what John is doing with a picture of her on his desktop I have no idea.

Anyway you may be wondering why I am posting here. It is actually the first time I have written anything on a blog. I do have a blog (can't do links yet) but John writes it for me. This time it is me writing for him. You see he has a problem. His Trust has told him that he cannot blog during the run up to the election. Perhaps this is tantamount to telling him that he can blog when there isn't an election. I really don't know. John doesn't quite know if they know who he is. Probably they do. He has been careful now for quite some time. There are many things that he does not tell you. They are all local things about which he knows most but can publish least. Perhaps that is OK. On the other hand perhaps in the interests of free speech it is not such a good thing. People should be free to criticise. Like Simon Singh. As I say, I can't do links but if you look at the shared items you will find John has put up quite a good article on this by a scientist called Brooke Magnanti. Weird name that. John says that he has read a lot of her work. He probably doesn't tell you here but at heart he is a scientist as well as a doctor.

Look I'm digressing. The point of this post is to tell you that John is not allowed to blog until after the election. Although I take little interest in blogging I actually think this is outrageous. Why shouldn't a doctor working in the health service keep a blog in the run up to an election? John tells me that some of his fellow bloggers are even putting up for parliament and they are still blogging.

Anyway I want John to keep his job. He tells me that things are getting very tough at work and he thinks a lot of people are going to lose their jobs. It won't be very soon. It takes time to work out how to shed staff. But he says it will happen whoever wins the election.

Crass, cruel and craven

Trenchant critic though he is, Dr Grumble thinks Labour has much to be proud of. They have made mistakes, rather too many. But if you examine what these were you have to conclude that the Conservatives were mostly egging them on. Not that that absolves Labour. But it gives no credit to the Tories either. It has always disappointed Dr Grumble that in recent years there has been so little real questioning from the opposition on the important policies of the day. Prime Minister's questions have become a knock-about routine unworthy of the legislature of even a banana republic. Thorough parliamentary debate is a thing of the past. Could that be why so many mistakes have been made?

Just think of New Labour's most major blunders: Iraq, the NHS internal market, deregulation of the financial sector. Why weren't these madnesses questioned? Where were the Devil's advocates? Had the Tories been in power, what would they have done? Dr Grumble can only conclude that it would have been much the same only worse. Their parliamentary record speaks for itself.

It's too early for the silly season and with an election nearing you might think we might at last be able to glimpse at least a semblance of sense from the major parties. Sadly it seems not to be. Following the charade of the Tories three quid a week to support marriage, a ludicrous proposal if ever there was one, we now have this from New Labour. Just how incompetent can they get?

There's nothing new about this. Does anybody remember the War of Jennifer's Ear?

£3 per week drivel

Dr Grumble did imply that as an election neared this blog would become more political. It has not really been the case so far. For those of us concerned with the NHS the battle between the parties is something of a phoney war. As Dr Aust has pointed out, it is hard to get a cigarette paper between New Labour and the Tories on their attitude towards the NHS. Yet the way forward can seem clear to MPs of all persuasions who examine problems of the NHS dispassionately in committee. But the major parties remain oblivious to the problems and New Labour and old Tory blunder on with their misguided markets. Read the Health Committee's report (pdf) and you will see that there are obvious better ways forward. Publicity about the findings of the Health Committee has been scant. Despite the potential to save enormous sums of money, vital issues are not being discussed. Few of Dr Grumble's colleagues, though they share the views of the Health Committee, are even aware of their latest findings. With an election imminent the mainstream media content themselves with peddling political drivel. There is no focus on the key issues which matter. Journalists and politicians seem in cahoots. Trivia is what they like. The electorate deserves better. And if the public feel the same way as Dr Grumble it is the Tories who will pay the price. They are the ones banging on about change. When it comes to the NHS they are the ones offering more of the same - but worse.

In lieu of policies that matter we are now being fed silly policies that don't matter. The Tories, as we know, are a party in favour of marriage. Being an old fart Dr Grumble does understand the point. He can see the follies of these feckless young people with serial partners instead of a life-long spouse but what has the proposed payment of £3 per week got to do with this? Is it really the job of the state to pay people to stayed married? And will £3 per week do it? How much ironing can you get done for £3 per week?

Where have all the bloggers gone?

Since the retirement of Dr Crippen, medical blogger extraordinaire, there has been concern about the health of the medical blogosphere.

In the early days there were some good bloggers out there but they appear to have run out of steam recently and some, probably worried about being exposed, are no longer publicly viewable. Others suddenly disappeared after being revealed. Quite a few never really got off the starting blocks.

Below is a list of what Dr Grumble has loosely labelled British Medical Blogs in his Google Reader. If you know of others than should be listed put them in the comments and if Grumble has time he will add them in. It is only in compiling this list that Dr Grumble has come to realise how many good bloggers have disappeared into the ether.

A beginner's guide to being a junior doctor

A fortunate man

A GrumpyRN

A Life in the Day of A Basics Doc

An English Physician

A New Kind of GP

Antifroth

Aphra Behn -danger of eclectic shock

Bad Medicine

Campaigning for Health

Chez Sam's

Crossing over to the Darkside (invited readers only)

Doctor Bloggs

Doctors from the Future

Dr Aust's Spleen

Dr Da Vinci

Dr Informed

Dr Jest's Caseblog

Dr Phil Yerboots's Consulting Room

Dr Rant

Dr Rachel Joyce's Blogspot

Dr Rays focal spot

frontier psychiatrist

FrontPoint Systems Ltd (now defunct it seems)

geepeemum

GP Informed

GP Lite: The New NHS

Green the Health Service

Health Blog

HospitalPhoenix (once glorious, now defunct)

Inside Surgery

Lake Cocytus

Life in the NHS

Margaret McCartney's blog

Militant Medical Nurse

Mousethinks (invited readers only)

Musings Of A Disheartened Doctor

NHS Secretary

Nice Lady Doctor

Non Timeo Sed Caveo

Northern Doc

Northern Doctor

Nurse Ratchet

On-Call Blog (invited readers only)

Our NHS

Pathologists Anonymous

Pondering Practitioner

Quasi Serendipita

Ramblings on Fruit and Chocolate (mostly about fruit and chocolate but Grumble gets a mention)

Sandman's progress

Save Bedford Hospital

Secret Doctor's Diary

The Angry Medic

The Brown Stuff

The Cockroach Catcher

The Ferret Fancier

The Fuddled Medic

The Hippocratic Oaf

The Jobbing Doctor

The Junior Doctor

The KnifeMan

The Little Medic

The Lowly Worm

THE NHS EXPOSED BLOG

The Psychiatrist Blog

The Student Doctor Diaries

The Witch Doctor

Trick-cycling For Beginners (invited readers only)

Two Weeks on a Trolley

Ward 87

Wishful thinking in medical education

Medical blogs form an important, perhaps the only, record of how grass roots doctors and others were thinking at a particular time. A glance at the list above will show how the problems related to MMC and MTAS motivated some medical bloggers. The impact of Darzi is another recurring theme. Perhaps this quiet period in the medical blogosphere is a lull before the storm of a new government. We shall see.

Concern has been expressed at the loss of Dr Crippen's past posts which many consider to have the status of an important historical record. Fortunately Crippen's blog was selected to be archived for posterity. Whether or not all of his posts were captured Dr Grumble is unsure but at least some of them are available at the UK Web Archive where presumably they will be available for ever.


STOP PRESS:
Just two days after this list was posted Julie McAnulty kindly volunteered to take on the task of producing a better list which will in due course will have separate pages for patient blogs, student blogs etc. It is called MediBlogUK.

Everybody knows

Everybody may know but still not everybody stops smoking. Dr Grumble was always taught that to persuade people to stop smoking you need to highlight the positive aspects of quitting.

Do you think this video will work?

Change

The Conservative Party promises change but as far as the NHS is concerned their policy seems much the same as that of the present incumbents. This is despite an all party committee of MPs drawing attention to the unknown costs of a failed NHS internal market and suggesting that the the purchaser/provider spilt "may need to be abolished". You might think that the Select Committee's tentative conclusions about the costs and waste of the internal market would be worthy of banner headlines. Even more worthy of a headline is that the Department of Health actually has no reliable measure of how much the commissioning process costs. But you won't find many headlines. The reality is that there seems to be no public discussion on the way forward and both Conservatives and New Labour seem intent on blundering on.

Are there any new ideas out there? There are rumours of one. Many years ago when fundholding was in vogue an effort was made to give GPs some control over hospitals. The idea essentially was for GPs to purchase care on behalf of their patients. It looked as if it might be working but New Labour then decided to do in another direction. The two tier approach was unacceptable to Labour and their replacement system never worked.

So what is the new idea? Rumours are that the next big plan is to put hospitals in charge of GPs. It is not as daft as it may sound. What you do is give the money to a large Foundation Trust and tell that Trust to run all healthcare in their area. A Foundation Trust is able to make a profit and there will be various incentives for the organisation to run healthcare as cheaply as possible. Doctors will be in charge.

The advantage to such a system is that primary and secondary care will become closely integrated and that care will be provided either in hospital or in the community according to where that care can be provided most cheaply and effectively. There will be no purchaser/provider split but private organisations may be hired by the Foundation Trust as necessary to deliver care.

Now what do you think of that?