Dr No started his medical career in a surgical specialty (O&G), and in many ways, he still thinks like a surgeon. Physicians, with their pills and potions, and frock coats and baffling cardiac murmurs, were and still are quite beyond him. So he naturally expected that he would understand the Royal College of Surgeons stance on the Health and Social Care Bill. But instead he finds today it is the RCS’s position that is baffling him. If ever surgery was called for, it is a for a wide resection of the malignant tumour that is the Health and Social Care Bill. Yet the RCS wants to not just leave the tumour in place, it wants to encourage its growth. Dr No is indeed baffled.
Many surgical mistakes follow from making the wrong diagnosis. Could it be that Dr No’s former colleagues, now installed the top drawers of the RCS, have made the wrong diagnosis? Could the surgeons believe – or perhaps their pathologists have reported – that the tumour was benign? This seems hardly credible. The cardinal features of malignancy, of invasiveness, metastasis and destructiveness, and of rapid unregulated growth and poor differentiation to function, are already, even before the Bill has been enacted, plain for all to see. There can be no doubt about the malignant nature of the tumour, except to perhaps the most blinded eye, and surgeons are not blind.
So the surgeons must know the true nature of the diagnosis, and that makes their refusal to operate, to excise the tumour, even more baffling. Could it be that they believe the tumour has spread so far that we are now beyond any hope of curative excision; that ‘heroic surgery’ might harm, or even kill, the patient?
There is evidence this might be part of their thinking. In his latest President’s Newsletter, Professor Norman Williams writes: ‘to stop the bill at this late stage, even if that were possible, would create chaos. Structural changes have already been implemented on the presumption that the bill will pass; to stop now would result in uncertainty and a severe disruption in services.’ The argument, it appears, is that the tumour has got such a hold that to excise it now would do more harm than good.
That is as may be. But, even if true, it begs the question: what were the surgeons doing when the tumour was at an earlier stage, that is, when it was still operable? The answer – it appears – is first looking the other way, and so allowing the tumour to grow, and then actively encouraging its growth.
A year ago, at the time of the Bill’s publication, the College demurred on the broad question of implementation, and called instead for detailed amendments. One might suppose the policy was one of jaw-jaw rather than war-war, even if that policy, a year later, has borne but the feeblest of fruit.
By last October, however, the College position had shifted to one of rapid implementation. A briefing to parliament said: ‘The College has recommended that the plans laid out in the Health and Social Care Bill should now be implemented without any unnecessary delays, otherwise we believe that delays to this process will ultimately be to the detriment of patients.’
So – the College demurred, and then urged rapid implementation of the Bill, with only tinkering amendments. This does seem extraordinary, given that an early survey, albeit with an embarrassingly low (9%) response rate, suggested that the majority of the profession – and presumably that includes a good number of jobbing surgeons – are opposed to the Bill.
It seems even more extraordinary given that the weight of considered professional opinion is that the malignant tumour that is the Bill will, if not halted, lead to untold harm. And no right-thinking surgeon could possibly want the patient – the NHS – to get iller still – could they?
Dr No remains as baffled as ever.
In 2010 pulse magazine found that more doctors were planning to vote conservative than any other party. There are plenty of doctors who are Conservative in sympathy, usually conservative also in being against change.
I do not think the HSCB is poorly drafted and will fail under its own contradictions. It will pass the house of commons, and would have passed without amendment were the scots not to stick their noses where they do not belong. The Lords both spiritual and temporal do not stand for election, the Commons do.
There is sweet irony in watching the Guardian reading middle class praise the residual aristocrats, party donors, friends of Tony and fancy dressed church apparatchiks. I expect that they will love them just as much when they are gutting the next socialist governments legislation.
The Colleges are constituted as medical charities and cannot maintain that status if they want to be political. Nothing is more political than government legislation. They are right to neither support or oppose it. The BMA, Remedy and HCSA can be as scathing as they like, they are our trade unions.
Can’t let that comment about the Scots pass, Dr Phil. The HSCB is going to affect Scotland in many respects. First up training and T&Cs which we share with the English. Then there’s the abolition of GP boundaries which means that doctors will not be obliged to treat someone in their geographical area. If said practice is owned by companies trying to make a profit, then chances are that they will turn away those who are not profitable, ie the chronically ill and disabled. They may then decide to come to Scotland to seek the treatment they cannot get in England. Again, the raising of the private cap to 49% in hospitals and hospital closures in London will ramp up waiting lists for operations. In these circumstances, English patients may well invoke the new European Cross Border Healthcare Directive which states that an EU citizen can seek treatment in another EU country, if they are waiting in their own country. This does affect us and we have every right to stick our noses into it, as do the Welsh.
It has always been clear to me that like removing children from parents that were later proved to be totally innocent of abusing them, some judge would say that to return them to the natural parents would be disruptive (me, child psychiatrist to you, surgeon).
So, looks like the genius is going to have his way. We have to realise the thing called democracy is a joke.
Great post as usual.
Is there a personal interest benefit for surgeons if the privatisation of the NHS goes under way? 49% of all NHS hospitals with private patients in them sounds lucrative.
There aren’t enough bad words in English to describe how I feel towards the medical colleges after their disgraceful climbdown on the HSCB. Seriously, you guys need to go and picket the colleges about this and hit the papers with letters to counter this.
My Black Cat has a view as Black Cats always have. Her views are often on the bizarre side, if not on the dark side and they should often be taken with a pinch of salt, but not before giving them due consideration.
Not long after we started blogging in 2007, she persuaded WD to write a peculiar post titled “China is the Reason for MMC”
http://witchdoctor.wordpress.com/2007/12/09/china-is-the-reason-for-mmc/
MBC thinks the HSCB is an extension of the same force that drove MMC – politicians who are fearful of the effects of the bright sun rising in the east as it darkens in the west. They are afraid of the effect of globalisation and demographic change on UK economies. The fear has been there for years but is exacerbated by the sudden financial crisis a few years ago and now the precarious state of the Euro. The fact we don’t manufacture much in the UK nowadays and have few tangible goods to sell will seem very scary to a career politician. Will China, India, Brazil have the appetite to buy into our image consultants, PR agencies, or toolkits for 360 degree appraisal? Or will they think these activities are just plain daft?
Perhaps they will indeed buy our “soft” services, but The Oldest Sage Witch’s Highland Granny is of the opinion they would be better off exporting things you can touch and hold, like kilts and tartan plaids and sporrans.
My Black Cat thinks the colleges have been frantically “got at” and had lots of informal and desperate tutorials on the wobbling economy from those in the highest levels of government. Now, like the politicians, the colleges are also afraid, and feel guilty and obliged to do their bit for the country by turning illness into a commodity that might somehow help generate a healthier economy.
Remember, this government is into nudging minds. They even have a “Nudge Unit.” Surgeons and other doctors are not immune from gentlemanly nudging. Black Cats call it “reframing.”
MBC does not think gongs and pecuniary rewards are the main driving force of the colleges, and she will be surprised if the HSCB is ditched. However, it is now in the lap of the Lords.
Boots – the Colleges’ ‘charity defence’ is both devious and wrong. A charity can pursue political aims, so long as those aims are in line with the charity’s aims. Without even reading all the Colleges’ governing documents, we can be sure most will contain clauses about advancing the cause of good medicine; and so it is quite legitimate to oppose legislation that will harm both the provision of care, and the training of those who deliver that care.
What charities cannot do is be party political. Those who suggest that opposing the Bill is party political have got it wrong: those who oppose the Bill oppose it (and similar changes and legislation), whichever party introduces it/them. As it happens, it the the Tories and Lib-Dems doing it at the moment; a few years back it was Labour; before that it was Hacksaw and BATman.
It is quite possible to oppose the Bill and the market-fest it will bring about simply because it is a bad idea, contrary to the charitable purposes of the Colleges. Party politics doesn’t need to come into it at all.
Further and better particulars available at the Charity Commission’s website here.
Dear Julie,
The West Lothian question is not answered. No doubt English Health policy will impact on Scotland, but so does Scottish Health policy on England, and Scottish University policy, yet English voters have no say in these. Sauce for the goose is sauce for the gander. Alex Salmond and the SNP do show some integrity and consistency in not voting in Westminster, would that the other Scottish MPs (and incidentally Welsh and Irish) would show the same integrity.
Scottish interference in matters that only affect England stokes anti-Scottish sentiment here. In a poll on January 15th more English than Scottish voters wanted Scottish independence, desire for divorce is not one-sided. The quid pro-quo for devolution is English votes for English laws.
Dr No,
The Colleges are constituted in law as medical charities and cannot change this without privy council consent. You agree that charities cannot interfere in party political matters, and the HCSB is certainly a party political matter!
There organisations such as Amnesty International that do not register as charities so that they can intervene in issues that are party political. Perhaps the colleges should do this, but if they were to become party political they would most likely break into schismatic colleges very quickly.
The House of Lords is an offensive anachronism in this day and age and has no place in a democratic country, no other country gives the permanent power to legislate to people like Lord Mandelson or Lord Ashcroft. The House of Commons will have a general election in a little over three years. If the people do not like it then they can look at what the other parties propose in its place. The Conservatives know this, and will ensure that it is not the disaster that you forecast. As most of the changes have already been undertaken, it does seem as if very little primary legislation was required.
I do not think the HCSB will be a disaster, but I do not think it addresses the real issues. These will become manifest in time.
In view of your Caledonian roots I have a little Burns:
Fareweel to a’ our Scottish fame,
Fareweel our ancient glory,
Fareweel ev’n to the Scottish name,
Sae fam’d in martial story.
Now Sark rins o’er the Solway sands,
And Tweed rins to the ocean,
To mark where England’s province stands –
Such a parcel of rogues in a nation.
What force or guile could not subdue,
Thro’ many warlike ages,
Is wrought now by a coward few
For hireling traitor’s wages.
The English steel we could disdain;
Secure in valour’s station;
But English gold has been our bane –
Such a parcel of rogues in a nation.
O would, or I had seen the day
That treason thus could sell us,
My auld gray head had lien in clay,
Wi’ Bruce and loyal Wallace!
But pith and power, till my last hour,
I’ll mak’ this declaration;
We’re bought and sold for English gold –
Such a parcel of rogues in a nation.
The act of Union followed the financial collapse of Scotland following the Darien scheme, how ironic that 300 years later English gold was once again required to bale out RBS and HBOS. Burns would spin in his grave. Such a parcel of Rogues in a nation!
Best Wishes
Boots
Over the centuries since Burns time, there has been an awful lot of Scots blood running through English veins and vice versa. And there’s an awful lot of Scots running backwards and forwards to England to work and study and vice versa. In a witch’s view, independence nowadays would be an odd phenomenon to pursue, but then The Humankind themselves are odd phenomena.
In view of the proximity to Burn’s night, here is another poem that is very close to The Oldest Sage Witch’s Highland Granny’s heart, but she won’t for love nor money tell anyone why. Witch gossip has it that the OSWH granny’s great-granny was The Bonnie Lass o’ Albany. Nevertheless, The Oldest Sage Witch’s Highland Granny will NOT be voting for Scottish independence.
Or so she says……
The Bonnie Lass Of Albany
By Robert Burns
“My heart is wae, and unco wae,
To think upon the raging sea
That roars between her gardens green,
An’ the bonnie Lass of Albany.
This lovely maid’s of royal blood,
That ruled Albion’s kingdoms three,
But oh, alas! for her bonnie face,
They’ve wrang’d the Lass of Albany.
In the rolling tide of spreading Clyde,
There sits an isle of high degree,
And a town of fame whose princely name,
Should grace the Lass of Albany.
But there’s a youth, a witless youth,
That fills the place where she should be;
We’ll send him o’er his native shore,
And bring our ain sweet Albany.
Alas the day, and woe the day,
A false usurper wan the gree,
Who now commands the towers and lands –
The royal right of Albany.
We’ll daily pray, we’ll nightly pray,
On bended knees most fervently,
That the time may come, with pipe an’ drum,
We’ll welcome hame fair Albany.”
Dr Phil,
You haven’t really addressed any of the points that I’ve made re how the HSCB affects Scotland; you’ve simply reiterated your statement that we’re interfering. And the only way that Scottish Health policy is affecting England at the mo is in terms of a reproach; we have steered our policy away from the rocks that the English NHS is heading towards and our counterparts in England are wondering why they can’t do the same there.
But there’s a bigger issue here and it’s do with disenfranchisement. Westminster has got to a peak where it is completely, utterly ruled by lobbyists for international companies. It is not representative of the people who elected them. It is not representing their interests, their opinions or views; it is only represent the interests and views of the companies that sponsor them. The heads of the medical colleges are not representing the views of their members. They are doing exactly as they want. And what you are getting is a displacement effect. That is why you have the TUC writing to the House of Lords. That is why you have Occupy camped outside St Pauls Cathedral, instead of Westminster. That is why you have people banding together on Avaaz and 38 Degrees, instead of going to the newspapers. All the conventional channels of democracy in this country have been subverted and people are looking for someone, somewhere to articulate their views and act on them. My country did it by setting up Holyrood, because we had been ignored for years by Westminster. And yet the truth is that we did not leave England; it was rather that England left us. If anything, we are ‘interfering’ out of a sense of kinship because we don’t want the NHS destroyed. We don’t want the BBC emasculated. We don’t want these things to happen becuase we helped to set them up. As it stands, Scotland and Wales are going to end up as time capsules of what Britain was once like, when it was truly great. That time is now passing and God knows what the future holds for England, but I predict that it is heading towards poverty and political extremism. I can’t see it going any other way and there is probably nothing more that we can do for England except to try and stop it from happening here.
Great post, Julie – I will be quoting large chunks of it across the internet, verbatim, especially this bit – “But there’s a bigger issue here and it’s do with disenfranchisement. Westminster has got to a peak where it is completely, utterly ruled by lobbyists for international companies. It is not representative of the people who elected them. It is not representing their interests, their opinions or views; it is only represent the interests and views of the companies that sponsor them. The heads of the medical colleges are not representing the views of their members. They are doing exactly as they want. And what you are getting is a displacement effect. That is why you have the TUC writing to the House of Lords. That is why you have Occupy camped outside St Pauls Cathedral, instead of Westminster. That is why you have people banding together on Avaaz and 38 Degrees, instead of going to the newspapers. All the conventional channels of democracy in this country have been subverted and people are looking for someone, somewhere to articulate their views and act on them” – that made the hairs on my neck stand up!!
The scope for talk of Boots being on the other foot, and serious dents in toecaps, is clear; but as the A&E CN says, J has hit the hob-nail on the head. Superb writing, Julie.
C
Thanks, A&E CN and Dr No. And thank God we have the internet. Without it we would have no voice at all.
I worked for Medcins Sans Frontiers in Afghanistan in 2003-4. When I was interviewed I made it clear that I was very interested in the politics of humanitarianism and conflict and they offered me posts in Gaza or Afghanistan. Central to their work is ‘temoinage’, bearing witness and speaking out. They are neutral, but highly political. And they are a charity. Temoinage is cental to what I believe to be my role as a GP working in a deprived community and I expect the same morality from my college. GPs are uniquely placed to bear witness to the suffering of the vulnerable and voiceless and if we wish to care for them and advocate for them, we need to think of medicine as Virchow did, of medicine as a social science.