Category Archives: NHS

A talk by Aseem Malhotra to the European Parliament

15th April 2018

Last week, Aseem Malhotra addressed the European Parliament to talk about the complete nonsense of the current dietary guidelines. Also, the power of the Nutritional and pharmaceutical industries to distort those guidelines and drive the use of more and more medications. I recommend that everyone has a look.

https://www.youtube.com/watch?v=H4uVNywg848

Thank you. I think this is important to view and share.

The NHS

[A slight divergence of theme]

As an election looms in the United Kingdom of Great Britain, the National Health Service has become the usual political football. All political parties now claim to love it and want to hug it, and squeeze it, and spend eye watering sum of money on it. Because, for the next three weeks or so, they truly ‘care’. Sincerity, once you can fake that, you’ve got it made.

A UK politician, Nigel Lawson, once called the NHS “the nearest thing the English have to a religion”. This, of course, rather pissed off the Scots, Welsh and Northern Irish. Forgetting that England is not the only country in the United Kingdom is something English politicians just, unconsciously, do. They now wonder wonder why the Scots are all going to vote for the Scottish National Party in a few weeks time. ‘But how could anyone possibly dislike us?’ Oh well.

But what is the NHS? It is, to state the bleeding obvious, a National Health Service. It is paid for out of taxes which are gathered with the usual threats of punishment and fines. The Government then hands it out, well over a hundred billion pounds (~$150Bn), through a mind-bogglingly complicated bureaucratic system, losing vast chunks as it goes.

What pitiful sum finally remains is spent on the healthcare of the people of the United Kingdom (including Scotland, Northern Ireland and Wales). Although Scotland would claim it now has its own NHS, sort of. As would Wales, and Northern Ireland, sort of.

Whatever country you are in, the key underlying principle of the NHS is that it is free at the point of use. If you turn up at a GP, or accident and emergency, or hospital, whatever is wrong with you, you are charged, not a penny. Yes, it is free.

Actually this is not quite true. Dentistry used to be part of the NHS, but most people now pay for dentistry. Many people also pay for prescriptions, and it is eye-watering expensive to get a decent hearing aid. Also you cannot get medical equipment for free, e.g. a nebuliser. So the NHS is mainly free, but this concept is being sneakily eroded.

I know that many Americans believe the NHS to be some terrible ‘communist’ system where you queue forever, cannot get expensive treatments, and people wither and death in dimly lit hospital corridors whilst uncaring staff blow their noses on your sheets and cackle as they stride past in their jackboots. The NHS, at least as reported over here, seems to be held up as the poster child of an ‘evil’ system by those on the right wing of American politics.

I would just like to point out that it costs less than a half (as a percentage of GDP) of American healthcare. Yet, almost all measurable outcomes for health in the UK are better than in the US. Looking at the single most important outcome, which is overall life expectancy; people in the UK live longer than in the US. As do, it should be added, the French, Germans, Italians, Danish, Swedish, Spanish… Indeed, in virtually every way you choose to measure it, US healthcare comes last of all developed countries in the Western World. Just saying. So, the NHS may not be perfect, but please, please, let us not drift into US style healthcare provision.

However, having said all this, I still have a huge problem with the NHS. In that, it is no longer a ‘free at the point of access healthcare delivery system paid for out of taxes’. It has become ‘The NHS.’ Sounds of trumpets and a celestial choir. A kindly bearded figure sits on a throne in the clouds, beaming, surrounded by angels. Hallelujah, hallelujah.

Many years ago, the one thing that Margaret Thatcher said which, more than anything else, marked her out as an evil witch (in the eyes of many) was when she said that ‘there is no such thing as society.’ This is all that most people remember her saying, and they still hate her for it.

It marked her out as an uncaring monster, which is why they song ‘The witch is dead’, from the Wizard of Oz, got to number on in the UK charts shortly after she died. Not, perhaps, the UK’s finest hour.

In fact, the full quote was as follows:

“I think we’ve been through a period where too many people have been given to understand that if they have a problem, it’s the government’s job to cope with it. ‘I have a problem, I’ll get a grant.’ ‘I’m homeless, the government must house me.’ They’re casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It’s our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There’s no such thing as entitlement, unless someone has first met an obligation.” http://briandeer.com/social/thatcher-society.htm

As for me, I don’t really believe that there is such a thing as ‘society’ either. But not, perhaps for exactly the same reason as Margaret Thatcher. My problem is when an abstract concept becomes a real thing which is a form of ‘magical thinking.’

For example, on the left we have those who believe in ‘society’ and ‘the NHS’. On the right we have those who believe in ‘the Market.’ As in, the market won’t like this, or the market won’t like that. When the EU tries to bail out Greece, we are told that the Markets will stop this from happening. This idea, I believe, derives mainly from Adam Smith’s ‘The invisible hand of the market.’

I say. ‘Can you please introduce me to the ‘the Market’. Could I have a word with the market to understand what it thinks?’ Oops, silly me. There is no ‘market’. There are just individual bankers and financial workers and economists. These, in turn, are just individual men and women, with a high percentage of psychopaths sprinkled in.

You see, Market does not exist, it purely an abstract concept. Yet we talk about it as if it were almost a person, an entity with powers beyond mere mortal man. God like, in fact. The ‘invisible and all-powerful hand.’ Kind of like the vision of Emmet in the Lego Movie when he saw ‘The hand’.

When Nigel Lawson called the NHS the nearest thing the English have to a religion, he was right. In that many people have also raised ‘the NHS’ to a status of an entity. A super-corporeal being, infused with special powers and goodness beyond our understanding. An ‘invisible’ hand that works in mysterious ways to improve the health of the nation.

However, until we can stop thinking of the NHS as some sort of deity, and start thinking about the most equitable way to fund and provide healthcare in a rational way, all discussions about healthcare will become bogged down in cant and emotion. People will continue to wave banners about emblazoned with ‘Save the NHS.’ Politicians will gaze at television cameras with that special, coached, excruciating limpid expression on their face talking about how much they care about ‘the NHS.’ Bleurrgghh!

Guys, there is no such thing as ‘the NHS.’ There are paramedics and porters and lab technicians and nurses and managers and doctors and some buildings and equipment. What is the best way to use these resources to provide the biggest bang for your bucks? End of.

Sorry, I shall start slagging off statins again next week.

The pharmaceutical industry now controls NHS policy – hoorah.

I noticed the other day that the pharmaceutical industry have managed to achieve something they could surely once only have dreamed of. Creating policy documents. Here is the offending headline from the Guardian newspaper:

NHS hires drugmaker-funded lobbyist

As the secondary headlines say:

‘Conflict of interest concerns as Specialised Healthcare Alliance (SHCA), funded by pharmaceutical companies, advises NHS England.’

A lobbying organisation with links to some of the world’s biggest pharmaceutical companies and medical equipment firms has been asked by NHS bosses to write a report that could influence health policy, it has been reported.’

It seems lobbying is now ‘so five minutes ago.’ Who needs a lobbyist when this organisation, the Specialised Healthcare Alliance (SHCA), which is entirely bought and paid for by the pharmaceutical industry, has been commissioned to write a report on funding specialised services for the NHS.  Services worth £13,000,000,000.00p (£13Bn/$20Bn) per year.

The article does point out, though, that we are misguided to think that this could be in any way an issue. For John Murray, the director of the SHCA, a lobbyist, and author of the report, has made it clear that:

.…..there was no link between his lobbying business and the SHCA other than providing secretariat services and said the SHCA “never takes a position on particular products or treatments in any of its activities”.

John (Pinocchio) Murray’s nose is now in the Guinness Book of Records for being the longest nose ever recorded on a human being, at seven point three miles. He is a lobbyist, paid for by pharmaceutical companies, and his organisation never takes a position on particular products…..hahahahahahahahahaha. Well then, sack him immediately for being useless…. sack him for failing to do what he is handsomely paid to do.

The final part of this newspaper report, which I savoured, is the following:

‘James Palmer, clinical director of specialised services at NHS England, said he was aware of Murray’s role as a lobbyist but “there are no opportunities for lobbying in the process of forming clinical policy”.’

This, of course, is true. There are no opportunities for lobbying in this particular process of forming clinical policy. Once a lobbyist starts to write clinical policy, they have moved well past the annoying requirement to lobby anyone. For the lobbyist has now managed to become the very person that they should be paid to lobby.

Instead of trying to influence someone who may not listen to him, he can just talk to himself…. Imagine that this short section of imagined dialogue is like Smeagol talking to Gollum in Lord of the Rings (Smeagol and Gollum are, or course the same person):

John Murray: ‘We must put the following phrase into the report, my precious. A “clear commitment” to “disinvest in interventions that have lower impact for patients” in favour of “new services or innovations”.

John Murray: “But why would you like me to put this in the report, wont this harm the hobbits? Hobbits have been kind to me…yes they have.”

John Murray: ‘I needs it in the report you fool. I represent precious pharmaceutical companies that are bringing new products onto the market. We needs to ensure that there will plenty of money to pay for them. So they must stop paying for stupid old fashioned treatments…yes, they must, foolish Hobbits.’

John Murray: ‘But won’t the kind Hobbits be worried this will just look like lobbying.’

John Murray: ‘Don’t be so stupid. How can the nasty Hobbits accuse me of lobbying? I am their friend, and I am trying to help them…yes I am.. Yes John Murray likes the friendly Hobbits. John Murray want to help the Hobbits, yes he does.’

John Murray: ‘You are so clever Smeagol, our master will be pleased.’…….

Duchess: ‘You’re thinking about something, my dear, and that makes you forget to talk. I can’t tell you just now what the moral of that is, but I shall remember it in a bit.’

“Perhaps it hasn’t one,” Alice ventured to remark.

“Tut, tut, child!” said the Duchess. “Everything’s got a moral, if only you can find it.”

The state of the NHS today

It’s a beautiful thing, the destruction of words.’ 1984

I still do work for the National Health Service (NHS), although not full time. Over the years, and especially the last few years, it has become an increasingly depressing, target driven, soulless place. When I re-read 1984 recently, virtually every page resonated with the type of management nonsense that rains down upon us each day. Particularly the way that language is distorted into meaningless ‘party’ slogans.

The more we are told that our healthcare trust is ‘meeting and exceeding’ targets, the more the word ‘doubleplusgood’ springs to mind, and I also know that we are, clearly, in big trouble.  The greater the trumpet blast of triumphal news, the worse that things become. War is Peace, Failure is Success, Lies are Truth.

One thing that particularly sticks in my craw, are the pictures of happy staff members that adorn various PR brochures. The production of which seems immune from financial pressures of any kind. They are written in a distorted management language that uses thousands of words, whilst their meaning remains almost perfectly obscure.

A recent example of how dispiriting they are was encapsulated by a recent brochure I received through the post. It had a picture of two nurses on the front. They looked as if they had both won several millions pounds on the lottery.  Their faces a picture of almost uncontrollable glee.

When I opened it, I found that this was a brochure informing all nurses, and doctors, that we would have to pay considerably more money into our pensions. In addition, we were going to receive a much lower pension, at a greater age, than we had been told we were getting in the past. Oh joy, oh joy.

I would have said the picture on the front cover was ironic, but NHS management do not do irony. We are continually exhorted, in a ‘Unite workers of the Soviet Union’ sort of a way, to be smiling and happy in our glorious tractor factory. A frowning worker is a worker who clearly does not love the party with sufficient fervour. A frowning workers needs re-education.

Ah yes, each year we produce more tractors to sell all around the world, with a song in our heart, and a spring in our step. Each five years we are set a new, joyous, production targets. Each year everything, we are told, gets better. The statistics tell us so. Each year, we can see with our own eyes, things are getting worse. I suppose people who do not work in the NHS may feel a certain echo of all of this in their work place.

Whilst mulling over this seemingly unstoppable drive from relying on professionals to be professionals; towards target driven, dehumanising, wearisome micro-management and meaningless jargon. I came across a post on Doctorsnet.uk. A website for UK registered doctors. It was written by a doctor A Boyle, and I thought it should be shared more widely.  (I asked for, and got, his permission to do so).

What I wanted, and what I got?

I wanted to help old people
I got frailty assessments on incomplete information

I wanted to save lives from PEs*
I got VTE2 assessments

I wanted to diagnose the cause of acute confusional states
I got dementia screening on frightened old people at 3am

I wanted to spend my career constantly improving my knowledge
I got mandatory training

I wanted to perform cutting edge research
I got GCP3

I wanted to critically evaluate my performance
I got the audit department asking for a meaningless action plan

I wanted role models to inspire me
I got multi-source feedback forms

I wanted to teach the next generation
I got work based assessment emails

I wanted to be competent
I got competencies

I wanted to be good at difficult procedures
I got cannula care records and central access teams

I wanted to keep people alive, safe and comfortable
I got the four hour target, breach reports, and observation wards to fudge the targets

A.  Boyle

And Amen to that. And a happy Christmas to you all. Sorry if this seems a little off-beam from my normal musings, but I felt the need to get it off my chest.

*PEs = Pulmonary Emboli (clots in the lungs)
2: VTE = Venous Thromboembolism (assessment). VTs can break off and travel to the lungs.
3: GCP = Good Clinical Practice