There has arisen, it seems to Dr No, a certain class of doctor, typically female and in their thirties or forties, maybe a GP, but not in full time clinical practice, perhaps instead involved in medical education in some guise or other, or perhaps not, who number, amongst their many duties, that of patrolling the internet. They patrol other, often male, members of their profession for what they consider to be misdemeanours, great and small, and when they find such misdemeanours, they feel driven to act, in the name of decency, correctness, and the final eradication of all victimisation, bullying and harassment; and for the greater good of the name of a modern caring profession. Dr No calls them The Furies, after the Roman version of the Greek Ερινύες, the avenging goddesses of wrath, who arose, fittingly enough, from drops of blood spilt at the castration of Uranus.
Stilton, the Chief Pongo at the General Medical Council, is pleased. In 2010, his Gestapo took on more cases, and spiked more doctors than ever before. His network of field spies, the Herr Medical Directors soon to be mantled Responsible Officers, are reporting ever greater numbers of medical dissidents to GMC-HQ. Only two years ago, a mass spiking event took place, with the introduction of medical licences to practice. But that mass spike will pale into trivial insignificance next year, when the greatest spike-fest of them all starts. Revalidation is, as they say in managerial and political circles, due to be rolled out, in 2012. Those doctors who manage to escape acute spiking will be rolled over repeatedly by the heavy steam-roller of revalidation. Doctors, once real life and 3D, will find themselves flattened two dimensional cartoon characters, with not even a shadow of their former selves left to relieve the barren new landscape of 360 degree multi-source blowback. Small wonder, then, that Stilton is so pleased.
This post is not, as it happens, about the misadventures of a trench soldier in the First World War, but is instead about the perils of language: for, if there is one word that fogs today’s NHS reform debate, it is surely privatisation. Unions, the media – only yesterday, Channel 4 reported on ‘proof’ that the ‘government plans to privatise the NHS’ (only to fog matters further by adding a terminal question mark) – and bloggers may all declare loudly that the Tories are privatising the health service. At the same time, the Tories and the DoH (and, of course, our very own Sam) say they are not. Clearly, both sides can’t be right. Or can they? It all depends on what we mean by privatisation, and that is where privatisation fog, like the recent weather, can bring progress to a grinding halt.
Those who follow the UK medical blogosphere will already be well aware of the curious case of Dr Una Coales, the Korean Missile currently disguised as a locum GP. A prolific, out-spoken, self-promoting and self-publishing writer, with ambitions to become the RCGP’s next president (small fry, given that she is already, according to her twitter page, ‘Conservative Health Secretary’), she has brought a world of fury upon her shoulders for – allegedly – shopping the identity of a person or persons unknown as the real Dr Rant, late of the blogosphere, to the police – or perhaps the GMC, or even both. Within hours, other bloggers started going out, like bulbs on a set of Christmas tree lights. A better known Heat Seeking Missile has weighed in heavily, and told us in no uncertain terms that it is our own stupid, indolent fault that our lights are going out. Her comments as of now lie, steaming like elephant dung roadblocks, at the bitter end of more than one post on the matter. No doubt a similar steamer will be dumped here before too long.
The BMA are at it again. By leveraging (Dr No has been reading too many financial reports of late) proper indignation at unspeakable parents who use their cars as smoke-houses to kipper their kids, they now propose a ban on all smoking in any car – even when the smoker is the only occupant. Perhaps they even want to ban smoking in cars when there is no one in the car. Bloggers and commenters too numerous to mention have pointed out the libertarian and practical legal objections to a total ban – but what about the science behind their proposal? Their briefing paper carries the mark of the BMA Board of Science on its front cover – so the science had better be good. But is it?
Dr No observes Remembrance. Last Friday, the day before yesterday, at the eleventh hour on the eleventh day of the eleventh month, and this time as it happens of the eleventh year of the century, he fell silent and still for two minutes, and remembered those who have given their lives for the freedom we enjoy today. It is a moment of solemn awe for the sacrifice made, and of great humility in the face of such selflessness.
Remembrance was made that bit more poignant this year by the breaking news that Circle Health had signed the long foretold contract to run Hinchingbrooke Hospital. This contract is a clear challenge to the authority, competence and perhaps most of all to the values of the NHS; a challenge which, if not seen off, will in short order threaten the very life of the NHS.
So – the Iranian Hospitalier, Mr Anti Pasta, the ex-Goldman Sachs banker who likes to make the money go a long way (viz. to off-shore tax havens), has finally bagged Hinchingbrooke. His Circle group have been given the contract to take over running the ailing hospital. Radio 4’s Today programme put a curious too-small-to-matter slant on the story, perhaps as relief to too many too-big-to-fail bank/government/country stories. TweedleWebb, however, and to his credit, did manage to slip Mr Pasta the three-in-a-bed question: what happens to the money when you add commercial investors to the provider-patient marriage? Mr Pasta replied in the high tones of a man in a state of preternatural excitement – either that, or someone had recently grabbed him where they had no right to do so.
Dr No is fed up with the Health and Social Care Bill, and the interminable waffle that surrounds it. To him, it is clearly the death warrant to the National Health Service. Once enacted, it will allow any willing cowboy – and that includes the unscrupulous doctors amongst us – to ride into town, and hawk their wares. Britain’s greatest post-war achievement, healthcare on need not ability to pay, will be dynamited, and Wild West law will prevail. Many, far too many, will perish.
Faced with this threat, what do we have? Walls of argument as penetrable as fog. Touching faith in democratic and parliamentary process. But as Dr No wades through Hansard, he finds no cause for celebration. The worthy but windy briefings swirl away as an autumn mist. The Noble Lords, when not bemoaning the declining standard of Westminster biscuits, cast their breath on the looking glass of truth, and see not the angled knife at our health service’s throat, but instead their own wondrous learning, so wonderful to behold.