Advising on Drugs

Graham Parsons has been stopped from being a member of the government’s drug advisory panel. He’s the chief pharmacist at a leading addiction service, so it isn’t his expert qualification that’s in doubt. the problem, apparently, is that between 2010 and 2013 he posted critical tweets about Jeremy Hunt. For those who’ve forgotten that time, he wasn’t alone. Hunt’s management of the NHS was abrasive and controversial, seriously damaging morale within the service, and many people from many walks of life were seriously critical of the tactical choices that Hunt made.

The interesting question is how this connects with the quality of drugs advice seven years later. And the answer, sadly, is in the title of the panel, and the virtual death of the word “advisory.” Back in the day, governments recognised that they couldn’t be expert in everything, so it would help to have real experts, people who knew stuff, to offer them advice. Things have changed. Now, “we” know all that we need to know, and we want panels of people who think we’re right. If they think we can make mistakes, we don’t want to hear from them, because things get complicated if you have to change your mind. It’s obviously illogical, but it’s also wasteful - drugs are complicated, and complicated problems won’t get solved by simple people who are sure they’ve got the answers.

Post-Brexit doctors

I’m glad of my filing cabinets, with their endless stacks of cuttings, because it keeps me in touch with the recent past. So much news coverage is urgent, and instant, without any memory of what happened before. I watch Jeremy Hunt on Peston, talking confidently about the twenty thousand new doctors that Johnson has said he’ll supply, but acknowledging that of course in addition to that we’ll need more doctors from abroad. And Peston nods, and goes on to the net point, as if that were simply common sense.

Am I the only person in the country to remember the tory Party conference of 2016, when everyone was Brexit-mad, and excited by the vision of our exciting future, from which all foreigners would be barred? And Hunt was there, with a straight face, confident asserting that sure, we could have an all-Brit NHS. It was nonsense then and it’s nonsense now, but somebody needs to say that he was lying through his teeth.

Fear and Lies

For once, Trump's classic summary "sad" is exactly appropriate. Paul Watson, a senior NHS official, forced hospital leaders to repeatedly chant "We can do this", criticising them for not doing it loudly enough.

Watson sort of gets it. He tries to cover his tracks by saying it was meant as "light relief", but it clearly wasn't, as in his next breath he's insisting there's a serious message there: "If it seems cheesy or patronising then so be it but it does have the merit of being true."

So there. This is about power. These aren't just any hospital leaders. They're leaders of hospitals deemed to be failing, and he's just accused them of putting patients' safety at risk. Before the chanting stunt he offered them a choice - "Do you want the 40-slide version of our message or the four-word version?" Cunning, that. It means they were asking for it, that in a way it's their fault - which presumably is why none of them told him to grow up, or to get stuffed. Welcome to Jeremy Hunt's NHS. Does that sound like an atmosphere in which you'd want to do good work?    

NHS staffing

"NHS England to spend £100m recruiting GPs from overseas." Hang on a minute. Back in October, in the heady days of the Tory Party Conference, I swore I heard Jeremy Hunt promise delegates that we'd have an NHS staffed entirely with pure white Brits. It wasn't right to be taking other country's doctors away from where they were needed (even though it is actually cheaper than training them ourselves), so the new post-Brexit Britain would be treated by a medical workforce that was 100 per cent Brit. Yeah, right.

We should be used to it, but they have no shame. They will say whatever it takes, for today's headlines, to solve this week's crisis. If they have to say the opposite a month later that's fine. Nobody remembers, nobody cares. It's just a game.  

How to mismanage morale

Another scare for the NHS, and this time it's serious. Large numbers of doctors, some of them young, are looking to move abroad. now why would they want to do that? Is it possible they're just a tad weary of being treated like kids, pushed around and told they're rubbish, being re-organised yet again to serve a political agenda that has no connection with good medicine? Just possibly.

This feels so familiar from education, where there isn't the same ease of transfer to other countries - and the professionals involved have less money with which to make such a move. But the principle's the same. If you create a hostile environment, encourage ministers to attack the work that people are doing, then they don't feel so committed and they start looking for alternatives. It's not rocket science, just basic management. When did we last have a government minister that people wanted to work for?

NHS Whistleblowers

It’s to Jeremy Hunt’s credit that he says he wants to support whistleblowers in the NHS, and it’s high time somebody did. But yesterday’s proposals won’t make much difference, because they give whistleblowers an advocate – who’s paid by the people who run the hospital. Not good enough. It’s the bosses who are the problem. It’s the way they run things  – try to cover things up, take revenge on employees who say what;s going wrong – that’s the problem. so there needs to be some kind of power that can stand up to frightened management. I’d love to think this government – or any other government we’re likely to get – was going to provide that, but don’t hold your breath.

Answering back

And here comes another one. My busy local MP, Philip Dunne, sends me an email about what he’s doing and what’s going on in the world. but this time, just for once, I send him a reply. Not sure whether he’ll read it, but it makes me feel better:

Philip, hi. Thank you for your newsletter. Your own energy and commitment to the area are beyond question, but on the national issues I find your outline far from convincing. I guess it’s difficult to speak to a variety of audiences, and I understand that you have to remain loyal to party policy.

Even so, your general endorsement of Cameron’s macho posturing over terrorism is really depressing. We’re supposed to be excited by the prospect of banning jihadis from returning to this country, when security experts tell us that the return of disillusioned jihadis is the best possible (maybe the only?) way of deterring other youngsters from following their example.

You dismiss those who make noise to “defend the NHS” as though there were no threat to the NHS, but Lansley’s act has continued a process begun by New Labour which seriously threatens the whole structure. Headlines in the last week show specialists moonlighting and making false claims to boost their profits, and official assessments that the NHS’capacity to respond has been hampered by the changes over the last twelve months. Not to mention the constant drain of money which might have paid nurses and is now spent rewarding competition lawyers.

But the real problem is Scotland. You think that voters their are being tempted by an “emotional appeal to run their own affairs.” If only. I think they’re facing a very rational choice. Living under a distant, patronising government which values financial profiteering above the social fabric, would you like the chance to make sure you don’t have to suffer such a government ever again? They’re voting yes, and so would I.

Yours, with regret, Paul Francis.

Good News

At last. some hard evidence that we’re not all dummies, heading for hell in a handcart. A poll in today’s Guardian announces “Half of Britons would be happy to pay more tax to back NHS.” Me too. So if that’s how we feel, why isn’t the government giving us what we want? What is it that they know which we can’t understand? (Simple, really. Self-interest, making a profit. Sod public interest and watch the dividends rise.)

Nobody’s listening, but at least they’re still taking the polls, and we haven’t all gone along with the privatising line. all we need to do now is turn that widely shared feeling into some form of effective resistance.

Good news about the NHS

Maybe, there is a god. We’ve had this steady drip of bad news about the NHS – is it spiralling out of control, in collapse, in need of further structural reform? – when suddenly this report appears. some international body has looked at a range of health services in various countries across the world, and the NHS comes out top. Good value for money, good quality of care. If you’re sceptical about the propaganda this comes as no surprise, but it’s still a boost in the poisonous climate of privatisation, when some bright people are working very hard to spread as much bad news as possible about a system we’re really going to miss. Most big organisations have their own PR department, telling the world how good they are; only the NHS has a high powered clique whose only purpose in life is to rubish what they do.

NHS whistleblowing

Last Friday, Ian Lakin and I performed the premiere of our show condition Critical, a programme of songs and poems about the NHS. One strand of that was the pressure of management in the hospitals, to ensure that bad news is controlled, and to dissuade staff from speaking out. In today’s Guardian, a week later, There’s a graphic reinforcement of that. Raj Mattu, a heart doctor in Coventry, was sacked nine years after he first spoke out about dangerous conditions. To save money, the hospital was squeezing five beds into bays designed for four. the NHS watchdog condemned this policy, and said death rates at the hospital were higher than should have been expected. The Warwickshire NHS Trust spent more than £6 million on a campaign to vilify, bully and harass Mattu out of a job he loved. Finally, he’s been vindicated by an employment tribunal, but it’s been a long hard road. what exactly would it take for management to accept that there might be a benefit in listening to what whistleblowers are saying?

Cigarette Packaging

A lot of people are angry, but no-one’s very surprised. After a lot of work devoted to ensuring that cigarettes should be sold in plain packaging, the government has decided not to go ahead with the scheme. There’s camouflage talk about “let’s see how it works in Australia”, but Australia have only just made the change, and they’re looking for long-term benefits to health, not an instant fix. This isn’t about evidence; it’s about keeping business happy, and this government will never tell business anything it doesn’t want to hear.

Defending of the NHS

Ken Loach is at it again, and though his view of 1945 may be a bit rosy, his call for public resistance to NHS changes to me seems totally convincing. All parties have collaborated in the sell-off, the preparation for privatisation. Trade unions and professional bodies haven’t fought as hard as they might, so who is it that can secure an NHS for our grandchildren? “If ever there was a time for there to be a broadly based movement, democratic and principled, that stood for the interests of the people against the demands of business and the politicians who speak for them, that moment is now.”

Truth in the NHS

In the last five years, £2 million of our money has been spent on shutting up more than 50 NHS employees, who would otherwise have had embarrasing things to say. Not at all surprising that the Treasury advised that such payments didn’t have to be declared, but depressing that so many people are happy to be bought off. Truth in the NHS, apparently, carries a heavy premium.

Two more examples, from this week. (1) David Nicholson, forced to rsign because of mid-Staffs, can now tell us that the coalition wasted two crucial years: “We spent our time talking about reorganisation, and we didn’t talk about the really important changes that are required for the NHS.” (2) Sir Liam Donaldson, former chief medical adviser to the government, complained that “We used to lead the world in public health, but now we are becoming followers, and late followers at that.” So how could we fix things that people say what they think, while they’re actually doing the job?

The Wonderful NHS

This date has been in the diary a while – the day I go into Gobowen hospital for a double knee replacement. I’ve heard horror stories of people being refused their operations because they have a scratch on the knee or a slight head cold, and over all the preparation and packing has been the shadow of “it might not happen.”

But it has. The Robert Jones and Agnes Hunt hospital operates in favourable conditions – specialising in knee and hip replacements, with a maternity unit but without the pressures of A and E – but they make the most of it. Careful preparation, clear information in advance ( a detailed pre-op visit, an excellent booklet, and a DVD to watch). Everyone I know who’s been there gives it a rave review, and now I’m joining the gang.

Great, hardworking staff, working together, with a passionate concern for patient care – paid reduction, hygiene. Cleaners, tea ladies, physios, nursing staff, anaesthetists, surgeons; everyone seems to understand that we’re all in this together. In the present climate, that’s a miracle.

NHS whistleblower

There’s an article today about casualty departments, by Allyson Pollock. That’s a name I remember, from way back in the day, when New Labour were first getting enthusiastic about helping US health firms to take over the NHS, and she was one of the experts who was clearest about what the threat involved. There was a dirty tricks campaign involving a New Labour MP, smearing Pollock as an unreliable witness whose testimony should be disregarded. I can remember being so incensed, yet fascinated, by this process that I wrote a play about it. Never got anywhere, long forgotten, but now, maybe, is the time to dust it down and look again…

Ratchetting standards

Health minister Jeremy Hunt asked the Nuffield Trust to explore the idea of an OFSTED type assessment in health. They’ve told him “hospitals are too complex for their performance to be adequately conveyed through a single score.”  I’m not at all surprised. But I remain gobsmacked by the idea that anyone thinks that the performance of schools can be conveyed through a single score. A massive brainwashing operation has convinced the media world that teaching is actually a very simple job. Not when I did it, it wasn’t.

Mid staffs hospital

The Francis report on mid-Staffs makes grim reading, and there’s no doubting the justified anger of relatives. But it’s an interesting tension, between isolating individual incompetents to blame, and seeing what’s wrong with the overall picture. On that Francis is in no doubt: “corporate self-interest and cost control have resulted in poor quality care.”

I’m not sure Cameron read that bit. But he’s as confident as ever. The solution to one kind of bullying is another kind of bullying – peg the nurses’ pay to how much they care. Oh, right. That should be easy enough. Just a few thousand people with clipboards, wandering round the wards.

Ironic that a key part of Francis’ solution is duty of candour. Nurses have to say if conditions are wrong; hospitals have to listen if relatives complain. But we’re still meant to believe that this massive destructive reorganisation is about improving the service, rather than creating a market for private firms. By the time they’re honest about that, it will be far too late.

Prostate with terror

Only males over 60 will really understand. There’s this strange little gland halfway down the body, which so far you haven’t been aware of at all. By the time we’re 70, 80% of us will have an enlarged prostate gland, and that might mean obstruction of the urine flow. Embarrassing. Who wants to talk to the doctor about that? Especially if that might lead to a rectal examination, when they put a gloved finger in your backside, and then give you pills whose possible side effects include “prolonged and painful erection that can last from several hours up to a few days.” (To be fair, that particular one does comes under the heading Very rare). Not nice at all. So you’d be tempted to say nothing, except that this could be an early stage in prostate cancer, which can kill you. What was that about penis envy?