It is a truth universally acknowledged that a regulator in possession of a dodgy report must be in want of a cover-up.
–Attr: Austen, Miss J.
Yesterday on Newsnight, the Chief Stoat was worrying another victim, on this occasion the Chief Pongo for the time being at Can’t Quite Cope, the body charged for the time being with keeping an eye on the quality of health and social care in England. The story is that CQC had given a certain NHS Trust a green light when it should have flashed a red. On finding the error, senior staff at CQC ordered all lights off, all shredders on, and folk who should have known better started wall-papering their arses. But wall-paper is no match for the brown stuff. As the skid marks appeared, the CQC leadership panicked, turned to its lawyers, and received the extraordinary advice to hide behind the Data Protection Act. It was the absurdity of this advice, not to mention that it was followed, that caused Paxo’s eyes to enlarge in visible increments. Mr Behan, the Chief Pongo for the time being at CQC, responded for the time being by talking up his leadership, but the vigour his assertion was compromised by the fact he spent most of the interview looking like a goldfish about to lead the escape from a wet paper bag.
Dr No’s mother has been admitted to hospital – at home. This NHS wheeze is a worthy idea, which Dr No supports. On paper, it is win-win: patients stay in their beloved homes, and the NHS saves money. In practice, it has one minor but fatal flaw. The hospital has a matron, kit in abundance, OTs, you name it, but no ward nurses. It is a hospital without nurses on its wards, and like all hospitals without nurses on the wards, it doesn’t work. Ironically, the money saved by not admitting patients to real hospitals could fund these nurses, but no one in the NHS has spotted this, and so the idea remains worthy, but doomed to fail. One supposes that were Crippen still blogging, he would have done hospital at home full justice, as he once did for another NHS corker, the hospital at night, a hospital whose defining characteristic was not an absence of nurses – rather the opposite in fact – but an absence of doctors.
In his zeal to declare the NHS open for business, David Cameron 
Hot Burning Coales, the enigmatic London GP who has for a time been a thorn in the side of the Royal College of GPs, is showing signs that she is about to start hammering at them like a pneumatic drill. She is alarmed by the absurd pattern of results from the College’s Clinical Skills Assessment, the ‘exit’ exam for trainee GPs. Her concern is that white British candidates go through on the nod, while Asian International (non-UK medical school - IMG) graduate candidates are systematically failed, on the grounds that they are not ‘one of us’. Certainly the raw figures appear to back up the suggestion that there is a case to be answered. The College’s own statistics (page 28 
Over the years Dr No has encountered a number of single handed general practices. His first encounter was on a Scottish island, as a student, in a practice made memorable by two things: the sweet malt smell from the oil drum sized barrel of beer that brewed beside the kitchen range, and the loan of the practice Land Rover, with a licence to roam the island. Later, as a locum, he found single-handed GPs on leave a reliable source of work: he could be transported, as if by a revolving door, to the seat of a single handed GP. For a week or two, he had eyes-only access to almost every aspect of the practice. He saw the intimate details first hand, not as a squinting sociologist might, but as a living participant. And living practices they certainly were, but pretty rum many of them were too. Too often for comfort, opening a drawer in search of a prescription pad, Dr No was greeted not with a jumble of papers, tongue depressors and broken tape measures, but with the clink-chink of bottles of high proof but non-surgical spirit.
The title for this post arises because Dr No has idly been playing Shorter Titles, the I’m Sorry I haven’t A Clue game in which panellists are invited to submit film (or song) titles where a single letter omission changes the meaning – Oldfinger, The King’s Peech, Rear Widow, The Godfarter, The Tird Man, that sort of thing – but as Jack Dee would say, they don’t work in print - the original title here being Left Shift, the hypothetical statistical fancy much beloved of the medical Islingtonistas who favour alcohol minimum unit pricing. Left shift is the notion that in populations the body wags the tail: the mean determines the extremes. Applied to alcohol minimum pricing, left shift has it that if average consumption falls because of raised minimum unit prices, then so too will heavy consumption fall. Populations, according to this hypothesis, behave like a blancmange made with excess gelatine: a nudge in the middle, and the whole pud moves across. 
Just as there is gold for drug companies in them thar pills, so there is gold for GPs in them thar patients. Historically, GPs were paid chiefly on a patient head-count basis, topped up with item of service fees for ‘extras’ such as vaccinations and contraception. The simplest way for GPs to boost income under this system was to increase list size, sometimes to absurd levels where the GP could not hope to provide adequate care for all the patients on the list. Some even gamed the system, by sneaking ghost patients on their lists. Governments disliked crude head-count based pay, not least because it offered no scope to influence GP activity. Item of service payments were an attempt to change that, but the capitation fee was still paid whatever the doctor did, or didn’t, do. The below par golfing GP trousered the fee in equal measure to his more conscientious colleague on the other side of town. 
The idea the there is gold in them thar pills is, one might say, as old as the hills: the 
The doctors' strike, or ‘industrial action’, as the strikers prefer to call it, has happened. On the day after the longest day (2012 is a leap year), a smaller than expected number of striking doctors turned up for work sporting ARP style armbands declaring ‘I’m caring for patients’, which was a bit rich if you happened to be a non-urgent patient, and smugged their way through their day. As own goals go, it was a corker, more Rear Admiral Hamish McMayhem taking his entire fleet the wrong way up the Windward Passage, than a solitary cocoa bean going the wrong way up Bournville Boulevard. On the radio, you could hear Langho rubbing his hands with glee at the gift of anti-doctor propaganda, while the media at large took turns to shy coconut after coconut at the ‘my pension or your life’ protesters. If proof was needed that Dr No’s former colleagues had lost the plot, then this was that proof.
Today’s announcement by Scotland’s Minister for Emesis, Nicola Stugeron, that the Scottish government intends to set a 50p minimum unit price for alcohol reminds Dr No that a similar bell is set to toll South of the Border. Forty-eight hours after Porgie’s boomerang budget, the one that keeps on coming back to tap the Tories where it hurts, Theresa May was pushed on to the floor of the Commons, in a reckless bigger-the-pushed’un-the-better-the-cushion move, to zap hostile media coverage of the budget, by announcing the Westminster government’s own Alcohol Strategy. Needless to say, that strategy also contains proposals for minimum unit pricing, and, needless to say, both governments are equally deluded in their expectations that this daft policy will do any good. In fact, Dr No predicts it may even do harm.