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« Delta farce | Main | Sinks and sources »
Saturday
Jan032015

Why do good intentions in the public sector lead to evil?

The tactic of demonising dissenters from the global warming orthodoxy has a long and dishonourable history now, and I'm sure that readers scarcely need me to recount the instances of bad behaviour that have made it to the public record. I was struck by the parallels between these stories and the experiences of Professor Joseph Meirion Thomas, a cancer surgeon who had the temerity to write a series of articles questioning certain aspects of the way health services are run in the UK.

The resultant Twitter storm would have looked entirely familiar to BH readers, with GPs and nurses all over the country flinging vulgar abuse at the good professor. This probably all falls under the heading of "free speech" (although also under the heading of "bad manners"), but as ever with these things there were less reputable ideas floating around, with one GP trying to organise a complaint to the General Medical Council and, in a painful echo of Andrew Dessler's contemptible behaviour during the Bengtsson affair, a GP from Fulham asked if the professor was "unwell". A letter describing Meirion Thomas as "vile" and "evil" was circulated to doctors in the area where the professor worked.

Also familiar were the attempts by those at the head of the relevant institutions to retaliate: Dr Maureen Baker, chair of the Royal College of General Practitioners called for Barnardo's to refuse a donation from Professor Meirion Thomas.  An email from one Professor Azeem Majeed of Imperial College, was sent to his employers, asking them to dissociate themselves from the articles and insinuating that local doctors would stop referring patients if he was not dealt with. The result was a fortnight's gardening leave and then a gagging order being imposed.

It's interesting to see Prof Majeed's attempts to defend himself on his twitter feed:

He clearly has no idea that he has done anything wrong. His mind seems to struggle with the idea that his implied threats might have overstepped the mark.

Of course Majeed probably believes that Meirion Thomas's complaints are wrong or misguided; he probably believes that he is doing the right thing in trying to get him silenced. But why does a mere difference of opinion over the views of a middle manager in the NHS end up in a situation where we are discussing freedom of speech and what many would take to be outright fascism? I can't remember anything like this when working in big businesses in my younger days. In fact it's hard to imagine a business having anything other than a passing interest in the views of a middle manager of one of its suppliers.

What is it about the public sector that makes differences of opinion among well-meaning people lead to evil? 

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Reader Comments (106)

Onion @ 6.16pm

And this is really nothing to so with public sector vs private sector. The Royal Marsden depends in part on GP referrals for its income. He slagged them off. It's not surprising he was censured. If an investment banker slagged off his institutional clients in the media, I bet his bank would fire him

Question is whether the relevant comparison is with an investment bank or, say, a university, where academic freedom means that academics can say pretty much anything with fear of censure. Or, quite possibly, neither.

Depressing if GPs decided to base their referrals to Royal Marsden not on the standard of medical care provided but on the political views of one doctor who does not speak for or on behalf of the institution.

Jan 3, 2015 at 7:17 PM | Unregistered CommenterRichieRich

Many thanks to MD. Having read the article it reinforces my already held view that GPs should either be abolished or cut back in favour of more consultant nurses and the mentioned superb paramedics. Luckily, I live in Wales where the NHS ( despite being badly maligned) did not suffer the ravages of the recently promoted Andrew Raundsley.

Jan 3, 2015 at 7:31 PM | Unregistered Commentertrefjon

Bastiat explained the socialist mindset thus:

Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.

— Frédéric Bastiat, The Law

Jan 3, 2015 at 7:33 PM | Unregistered CommenterWill J. Richardson

The way to deal with this is to expose the people who lead the smear tactics, bullying and toxic behaviour.

Shining a bright light on dirty goings-on has a wonderful disinfecting and cleansing effect.

Jan 3, 2015 at 7:36 PM | Unregistered CommenterSchrodinger's Cat

You are really suffering a lapse in judgement over this story.

You really should read the stuff you regurgitate and scan it assiduously in order to prevent resorting to non sequiturs. Indeed, what has private v public got to do with it? Not to forget, making spurious analogies concerning investment bankers.


Andrew was careful to steer clear of the controversy pertaining to Prof' Thomas's original comments. What was I deem, vexing to our host, was the extraordinarily harsh reaction of his fellows within the medical profession and the uncalled for, unnecessary but insidious response of Majeed. A cynic may suggest, Majeed he espied an opportunity to burnish his PC radicalism credentials under the wide gaze of his profession. A chance too good to be missed, to make political capital and personal aggrandizement and scurrilous at that.


A couple of observations, the opprobrium of the medical profession towards Prof' Thomas was somewhat manufactured.

I can see the wheels turning within the 'wimmin community' - what doesn't rile them? More, certainly "my rights to be offended and often" - Socialism4UK at work here. I would also warrant that, the majority of medical professionals venting their spleen at Professor Thomas - were of a certain age, probably below - say, ah 35?


I have said it for many years, at point of access, the NHS is a life saver for thousands because it is absolutely unquestioningly FREE.

Time and again this year the BBC has sought desperately to make political point scoring on the woes and ills of an overstretched A&E facility, never once do the BBC ever give mention to one of the greatest NHS costs - mass immigration. Evidently, from natal wings, to overstretched A&E departments, to tending to elderly family and caring for genetic infirmity due to close relative intermarriage, and rampant health tourism. All of it because Britain has a health service which is free at the point of access. The shortage of GPs, A&E specialists and locums is in part due to the EU working time directives and down to incompentency of hospital trust management and remember; that, Labour ran the health service for 13years prior to the Tories and they haven't helped much either.

A push over?

Compare and contrast - If you will, have a gander at the case of the girl and her boyfriend over on an extended weekend in New York, she was 28 weeks pregnant and went into labour producing an immature infant which thankfully is doing well but in need of intensive care. Lo, the bill runs into $thousands already and with little prospect of a speedy return to this side of the Atlantic - the meter is ticking and it will be big time in big apple. Appositely, you hear , read in the papers all the time about Nigerian women flying over here to drop their kids in London - gratis.
Natal clinics, foreign births, it is a small example and at prohibitive costs to the NHS - of the enormous unseen and one of THE totally unmentionables within the politically correct lala land we now live in.

I could mention the rights to family life and the ECHR which enshrines in law the right to settle in Britain and then to be able to bring over your extended family, elderly, notwithstanding those infirm and tropical diseased abounding [TB a common complaint] - it is another taboo subject among NHS staff and another elephant in the room - one which no one is allowed to mention. The constant pressure on A&E, is intertwined with GPs not being up to the job, foreign physicians credentials if at all are seldom rigorously checked - PC again rearing its ugly head.

NHS Omerta is indoctrinated.

Pass by the Unite union boards in hospital and by the day there are courses in diversity, equality and all sorts of PC taxpayer funded lectures and year long announcements, the same with NHS management and if they ain't going on another equality course the likelihood is, the lecture will be upon "patient safety and future man made warming".

Finally.

I can't for the life of me, see anything wrong in the good professors [Meirion Thomas] utterances and even though we no longer do live in the 'land of the free' - speech, I'd defend to the death his right to say what he feels is right.

The politicians, irrespective of political affiliation are frightened, beaten down and run off -by the NHS and in the end, the NHS will be the death of us all, as the old joke goes, said the orderly to the nurse; "if it wasn't for the patients, it would be a good job here!"

Jan 3, 2015 at 8:08 PM | Unregistered CommenterAthelstan.

"What is it about the public sector that makes differences of opinion among well-meaning people lead to evil? "

The public sector always leads to evil. Sometimes sooner, sometimes later -- but it always leads to evil.

Consider the opposite of public sector, free market -- and by free market, I mean a society where every permissible interaction is voluntary. Because people desire to better their situation, every interaction which they voluntarily take part in will make them (in their own opinion) better off.

Now consider the public sector -- and by public sector, I mean that part of society which is based on legislation and regulation. Remember that legislation and regulation is just another way of saying "do what we say, or we will send men to steal, arrest, kidnap, imprison, or kill you, as the situation demands. How can you ever expect good to come from a system which at its very heart is based on forcing men to do that which they do not think is in their own interest? This is like expecting to develop a loving relationship with a person whom you beat and rape.

Jan 3, 2015 at 8:13 PM | Unregistered CommenterJason Calley

Another example on the Beeb website at the moment "Hundreds ignore Port Talbot speed cameras"

http://www.bbc.co.uk/news/uk-wales-south-west-wales-30378801

The speed restriction does not come into force until 19th January, so what the hell is the Beeb doing claiming that "up to 700 drivers per day are ignoring the speed limit. It seems that the BBC has now taken over road traffic policing on the M4 in Wales.

(BTW, another large onshore windmill has fallen down in Northern Ireland, I wonder if it's the same as the two that fell over in SW England, on which the HSE refused to release the report that they were incorrectly installed?).

Jan 3, 2015 at 8:26 PM | Registered CommenterSalopian

My experience of the public service (fortunately brief, and a long time ago) was that many of its practitioners are not entirely sure in their minds that what they are doing is useful, and justifies the enormous cost of paying them every week. Naturally enough, when someone else puts forward the same idea they feel extremely threatened, and seek to bolster their own failing faith in their importance by going after that person with all the vigour they can muster.

Jan 3, 2015 at 8:48 PM | Unregistered CommenterJon Jermey

The parallels might be further explained by the political 'elevation' of both the NHS and 'Climate Change' as replacement socialist religious beliefs. There is an interesting piece in the Spectator at the moment rationalising UKIP's uncharacteristically meek acceptance of the untouchable status quo regarding the NHS.(But not energy policy!)

'When Carswell was a free-thinking Conservative backbencher, he proposed — with his friend and ideological compadre Dan Hannan — that government should ‘allow patients to opt out of the NHS and instead pay their contributions into individual health accounts’. Since joining Ukip, he hasn’t publicly repeated this sentiment. Instead, he and Ukip’s other MP, Mark Reckless, have voted for a Labour Private Member’s Bill that would unwind some of the very limited competition measures that the coalition has brought in.

Ukip has shifted because, ironically, it has come to the same conclusion as the Tory modernisers: acceptance of the current NHS settlement is the price of admission to British politics. For all its boasts of saying what the other parties don’t dare to, when it comes to the NHS, Ukip’s courage fails.

And Farage and his team can’t be blamed for being afraid. As Nigel Lawson, a former editor of this magazine, wrote in his memoirs, ‘The National Health Service is the closest thing the English have to a religion.’

http://www.spectator.co.uk/columnists/politics/9405202/even-ukip-dont-dare-break-the-unhealthy-consensus-on-the-nhs/

Jan 3, 2015 at 8:54 PM | Registered CommenterPharos

Gagging is everywhere, public and private sector. Ever heard of a compromise agreement when even people with nothing to say are barred from saying it for fear of losing a redundancy payment etc. It is rooted in the fact that moral cowards fear standing up against critics. The perfect world of authority must not be challenged, the hive must defend itself at all cost. It is pretty clear that when someone talks bo**ox it is easy to prove it is bo**ox. When someone doesn't talk bo**ox then it is impossible to show it is bo**ox. But in each situation the easy life of suppression of expression is preferred.

Jan 3, 2015 at 9:26 PM | Unregistered Commenterson of mulder

With all respect to G K Chesterton, belief in God is part of the astonishing anything that people can find ''reasons'' to believe in. In a godless universe theology helps pass the time.

Jan 3, 2015 at 9:56 PM | Unregistered CommenterJoseph Sydney

In the past, the way you dealt with flaws in a system was to punish those involved. Businesses still have the option (albeit a laborious one) of getting rid of flawed employees but public services are tied up by the unions and a desperate shortage of staff. Even doctors who have been convicted of serious mistakes have been allowed to resign rather than be struck off but most moderate mistakes go completely unpunished. The customers have even less say in what happens and their complaints just bounce into the void until some huge scandal hits.

In our no blame culture we try to replace a good butt kicking with training and paperwork. While the first option wasn’t always fair it did tend to get results. The second option is neither strong enough to persuade the lazy, nor significant enough to prompt the forgetful. Problems that everyone knows about just fester because there’s no incentive to fix them. Even bloody obvious stuff drags on.

Example – on admission to A&E you will not be allowed to eat or drink or take any kind of medicine. People admitted for dehydration and/or a flare up of a pre-existing condition are left without even those things they could have been supplied with at home and wait for hours upon end, often greatly exacerbating what those people came in for. The theory goes that you might need an anaesthetic but a certain body of people are either too poorly to survive an operation or too old to get one. Nobody will make a decision until the doctor has seen them. Even once that person has been admitted you can see regular cases where nurses cheerfully say that a patient isn't thirsty because they've not finished their drink. Never bothering to work out if the patient is able to drink unaided or indeed loath the drink they've been given. Aparently people who have lost the ability to talk also lose their preferences... which is of course bollocks.

What medical staff will do is fill out endlessly duplicated forms that they never read, and carefully document the vitals of an already sick person deteriorating. The medical staff feel like they’ve worked very hard and resent the patient or their relative criticising the lack of actual caring or curing.

Can you tell I'm cross?

Jan 3, 2015 at 10:56 PM | Unregistered CommenterTinyCO2

If anyone wants to complain to the Royal Marsden over its treatment of Dr Thomas and its foolish decision to take notice of Professor Majeed, there is a complaints form on the Contact Us page. In my opinion the correct response would have been to send Majeed's email to ICL's Registrar and ask if using the University's computers to send an email of this type was a breach of ICL's usage policy.

Jan 3, 2015 at 11:29 PM | Unregistered CommenterGladiatrix

...Why do good intentions in the public sector lead to evil?...

No one thinks that they're doing evil. But they don't think they're doing good either. They are just defending their jobs, and stopping someone rocking the boat.

Cyril Northcote Parkinson is your friend here. he explained quite clearly why the public sector acts as it does in 1955. Your starting point might be: http://en.wikipedia.org/wiki/Parkinson%27s_law

Jan 3, 2015 at 11:37 PM | Unregistered Commenterdodgy geezer

I am a Doctor. Most of what the good Prof says has elements of truth in it, but it is simplified for the DM.

The hysteria will have been fed by Twitter and a private only Docs website called Doctors.net.uk, a place
I no longer frequent. The GPs there act like little Caligulas and will round on anyone who disagrees with
them, strangely they round on people who question global warming etc as well.

Jan 3, 2015 at 11:42 PM | Unregistered CommenterMaurice

Frightening. But get used to it. It is becoming the norm whenever there is any criticism of that great Godess: the NHS.

Jan 3, 2015 at 11:42 PM | Unregistered CommenterPeter Stroud

I like the formulation 'Who believes nothing will believe anything'. Yes, it's not Chesterton, who danced all around the pyreful.
============

Jan 4, 2015 at 12:13 AM | Unregistered Commenterkim

It is obvious that better healthcare would be achieved with more technology.
Think screenings that are patient friendly, in a patient friendly fast executed context, with the best equipment.

Think MRI scans / gene tests.

Also technology that can handle mass testing eg 1 million DNA tests a month would make a difference.

Why? a cancer found in begin stadium is easier to block. Now and in the future.

It would also be nice if equal amounts of money were spent on men as on women, wimmin now get 80%.
To be fair they also get 80% of the NHS jobs maybe that is the reason ?

Don't say "men do not come" but say: "what can the NHS do to spend equal amount of money on men"
Lure them with crates of beer maybe? Pay them. And they will come.
Also for the easy high pay all security jobs btw.


Men should associate and SUE the government for 100% existing DISCRIMINATION of the most OUTRAGEOUS sort.

I think about an Iraq war of men die in excess to wimmin every year, thanks to this all wimmin scam.

Jan 4, 2015 at 12:56 AM | Unregistered CommenterSir Raoul Nurse and his madam

"wimmin now get 80%.
To be fair they also get 80% of the NHS jobs"
Extraordinary claim ..evidence ?? Please supplyc
..based on some level of truth perhaps
- ( true that the vast majority of people dying at work are men)
..Perhaps you are an activist trying to parody BHers

Jan 4, 2015 at 3:08 AM | Registered Commenterstewgreen

Re: stewgreen,

>> wimmin now get 80%
> Extraordinary claim ..evidence ?? Please supply

This article from 2001 states:

There is eight times as much money spent on specific female health issues as on male ones.

Whist I can not vouch for the 80%, most large hospitals I have been in have a wing set aside for the treatment of women. Some hospitals are solely for the treatment of women. I don't know of any that have similar resources set aside for men only.

Jan 4, 2015 at 9:58 AM | Unregistered CommenterTerryS

Wimmin may get more NHS money for two significant reasons. Firstly, they're more likely to get stuff checked out but most important, they're the ones having babies. By far and away the biggest 'drain' on the NHS is the elderly. Almost certainly they are the ones most likely to miss an appointment - sometimes through forgetfulness but often because they're unable to attend for some reason or other eg already in hospital. Since women live longer than men (a recent phenomena because for the bulk of history it has been the other way round) they stay in the system longer.

Jan 4, 2015 at 10:04 AM | Unregistered CommenterTinyCO2

I saw the storm break as it happened on doctors.net

It was not manufactured. GPs were genuinely mad. So were a lot of consultant colleagues.
The reaction of those GPs who referred him to the GMC or threatened to stop referring to the Royal Marsden was terrible particularly the GMC referral. I'm a GP and would continue referring patients to that hospital.

But the Royal Marsden is a business that depends on its income in part on GP referrals. If an employee of any business slagged of its main source of income in the media, his employer has every right to censure him.

Some people here advocate replacing GPs with nurses and paramedics. We are also business owners. If I could deliver a higher quality lower cost service using nurses and paramedics, I most definitely would. I know that costs and risks would rise and productivity fall, hammering my profits and the quality of patient care.

Jan 4, 2015 at 10:19 AM | Unregistered CommenterOnion

@ Onion

Get lots of bed rest and keep taking the tablets.......

Jan 4, 2015 at 10:42 AM | Unregistered CommenterAnoneumouse

Re: Onion

> The reaction of those GPs who referred him to the GMC or threatened to stop referring to the Royal Marsden was terrible particularly the GMC referral. I'm a GP and would continue referring patients to that hospital.

The very first item in the GMC duties of a doctor is:

Make the care of your patient your first concern.

It appears to me that any GP that refuses to refer patients to a particular hospital for any reason other than what is best for the patient is acting contrary to this statement.

Another item in the GMC list is:

Work with colleagues in the ways that best serve patients' interests.

By refusing to work with Professor Joseph Meirion Thomas for his views on the NHS as opposed to his ability as a cancer surgeon they are again acting contrary to GMC guidance.

Do you think that those doctors who have put their personal views ahead of the best care of the patient should be censured by the GMC?

Have you reported them to the GMC for not putting their patients care first?

Jan 4, 2015 at 12:11 PM | Unregistered CommenterTerryS

I thought we had a system of choose and book in this country, so enlightened patients can ask for a referral to the good doctor. However, a GP friend (who always complains about how underpaid they are - I bite my tongue a lot) says most patients are clueless and ask the GPs to recommend a surgeon/specialist for them.

I hear it time and again about the difficulties of finding full-time GPs as so many are women.

I have another pal who works at GOSH. You want to hear about the health tourism that goes on there!

I can't understand why all these GPs are up in arms. There are problems in the NHS and they need addressing; one would hope that the doctor has started the ball rolling, but the closed shop mentality obviously doesn't want to set its own house in order.

Jan 4, 2015 at 2:34 PM | Unregistered CommenterGrumpy

Jan 3, 2015 at 12:28 PM | Steve
"My personal Bete Noir is Brian Cox, whose reiteration on television some time ago that 'the science is settled' struck me as the dumbest remark ever by a physicist. He lies at the opposite end of the spectrum to giants like Plank and Feynmann."

Why do you think he's a professor? He is also my bete noir.

Well before I retired a letter came round in the hospital where I had worked for more than 30 years. Basically, what it demanded was total loyalty and to say nothing to anyone about anything at all.
In other words, if you see something wrong, turn a blind eye!
No wonder the NHS is in such difficulties.

Jan 4, 2015 at 2:56 PM | Unregistered CommenterMargaret Smith

Jan 3, 2015 at 12:59 PM | Jeff T

The Civil Service since 1997......

Now what happened, I wonder, in 1997?

Jan 4, 2015 at 3:30 PM | Registered Commenterdennisa

The issue is this:

A private-sector operation that operates as a monopoly has a lot of good people who want to do the right thing, but it also has substantial bodies of those who believe one or both of the following:

a) We've won, we run this show, you have no alternative and you should have no alternative, we will tell you what's right and what's wrong.

b) We're thisfar from losing, this is the last ditch and we have to defend it to the death.

It's slightly contradictory to say "we've won our way to the last ditch" but we clearly see that from the organized-clime community as well.

Jan 4, 2015 at 5:21 PM | Unregistered CommenterJEM

Stumbled upon this today-
http://www.dcscience.net/2014/12/23/some-experiences-of-life-at-imperial-college-london-an-external-inquiry-is-needed-after-the-death-of-stefan-grimm/

Jan 4, 2015 at 8:14 PM | Unregistered CommenterSpillinger

"Why do good intentions in the public sector lead to evil?"

Because the intentions voiced by progressives are a smoke screen. The only real purpose of progressivism is the accumulation and maintenance of power. Look at any of their public policies. As policy they are abject failures: education, healthcare, financial regulation etc. As examples of attaining power, they are resounding successes.

That is why debate must be prevented at all costs. If the stupid voters ever start thinking about the actual results of their "good intentions," they might stop voting progressive. "Fairness" and "for the children" are catch phrases, political PR, not policies.

Jan 4, 2015 at 8:16 PM | Unregistered CommenterGaryM

TerryS - it's up to the patient where they're referred so the point should be moot. Prof Majeed who made the veiled threat and indeed any doctors who prevent referrals to the Marsden on the basis of this article would be likely to have complaints against them upheld (probably by the ombudsman).

Stopping referrals to Mr Thomas is much more defensible. His articles in the Mail are riddled with factual inaccuracies that call into question his judgement. He has been criticised by the President of the Royal College of Surgeons. And he tried to pass himself off as a Professor in the media when his honorary position had expired, calling into question his integrity.

As for the second item in the GMC list (work with colleagues in the ways that best serve patients' interests), that formed the basis of the complaint against Mr Thomas. It is a woolly guideline that I think would be unenforceable in a more competitive healthcare market.

The GMC is a truly dreadful organisation. It is quasi-legal - what this means is that it is far more incompetent than the legal process. Doctors have successfully sued the GMC due to excessive delays, inconsistency, flawed evaluation of the evidence and undue weight given to accusers (source - a Civitas report: http://www.civitas.org.uk/pdf/GMCFittoPractise.pdf )

I expect a new wave of lawsuits by doctors against the GMC due to the new system of regulation (revalidation) which will massively increase inconsistency. GMC-managed regulators now literally act like the thought police. They judge the quality of our reflections about our education and development, and if these reflections are deemed unworthy, have the power to withdraw our licence to practise. That is why I find doctors misusing the GMC this way really depressing - it should be put down, not used to suppress free speech.

Jan 4, 2015 at 8:37 PM | Unregistered Commenteronion

"Stopping referrals to Mr Thomas is much more defensible. His articles in the Mail are riddled with factual inaccuracies that call into question his judgement. He has been criticised by the President of the Royal College of Surgeons. And he tried to pass himself off as a Professor in the media when his honorary position had expired, calling into question his integrity."

Eh. I have no dog in this fight, but I think we both know that if Thomas had written an equally flawed article parrotting the medical establishment "conventional wisdom", no one would be threatening to boycott him or worrying about his honorary professorship.

He's being attacked because he dared to have a contrary opinion, however right or wrong it may be. The Japanese have a saying "The nail that stands up gets hammered down" and that's what's going on here. Mr. Thomas is being made an example of. Conform and get with the program...or else!

Jan 4, 2015 at 10:11 PM | Unregistered CommenterBloke in Central Illinois

Five precepts of intellectuals:

Don't think.
If you think, then don't speak.
If you think and speak, then don't write.
If you think, speak and write, then don't sign.
If you think, speak, write and sign, then don't be surprised.

Jan 4, 2015 at 10:18 PM | Unregistered CommenterManniac

NHS, 80%:

The vast majority of Alzheimers are wimmin.
The vast majority of NHS costs is Alzheimer clinincs.
q.e.d.

But there is also the whole IVF thing and all matters babies, which are, for some strange reason covered by the NHS although these are(or should be) planned costs and controls for individuals etc. I do not see any reason why we would need to SUBSIDIZE (cover by NHS) babies. Rather we should TAX them. This is the ecological thing to do. We would need babies in a context of greying population as such. BUT, we have a greying and increasingly HEALTHY population who is going to be supported by AUTOMATION, not people. Why automats/robots? think your bank statement, would you like peope involved? Thats to get sloppy faults when you have people involved.

If we need to subsidize for babies I want to have all my ski holidays and eventual costs, training and after care covered by the free NHS as well? I'll send the bills. I want an elephant.

Luckily wimmin PAY IN, into the NHS also 80%..
Oh no, wait! it's only 20% they pay in (men 80%)
Why : most wimmin jobs are gov jobs so they do NOT pay taxes but are paid OUT OF taxes (nurses, teachers, quango city council university bureaucracies..)

Jan 4, 2015 at 10:52 PM | Unregistered CommenterPauline Nurse

Well, it is not surprising that he got jumped on - he went out with an AK47 and mowed down sacred cows all over the place. And I don't think that this is a public or private sector phenomenon - just look at what happens to companies or their executives when they annoy the Perpetually Outraged.

As a danged furriner, I can't comment on most of his criticisms. But there are two things I can comment on.

The first is his analysis of the feminisation of general practice. This has happened in Australia too - more than half of all medical students are now women. The good news is that here at least they are expected to eventually repay at least a portion of the cost of their education - but over a very long period, and there are loopholes. Still, it's better than nothing. But his point about their lower productivity is true, which no doubt is why it infuriated so many people. Their workforce participation is considerably lower than male graduates', and of course they are under-represented in specialist disciplines, for the same reasons. Mind you, the frightbats claim that it is all down to sexism, but the evidence indicates that it is a matter of choice.

So he really stuck his hand into an ant's nest with that one. IMO, his question is perfectly fair and valid in a world where educating doctors is a very expensive exercise.

Secondly, any threat to stop referring patients for reasons other than clinical ones is absolutely scandalous. I hope that this gets investigated by whoever is supposed to be in charge of monitoring ethical standards.

Jan 4, 2015 at 11:48 PM | Registered Commenterjohanna

It really ain't rocket science. If someone writes an article calling for the extinction of your job and profession, you will not be inclined to throw any business his way. I wonder how this will impact his private sector referrals from GPs.

Jan 5, 2015 at 7:35 AM | Unregistered Commenteronion

> TerryS - it's up to the patient where they're referred so the point should be moot.

Except the patient relies upon the doctor for his unbiased advice. If the doctor tells the patient that they should use A instead of B then it is unlikely that the patient will go against that advice.

> Stopping referrals to Mr Thomas is much more defensible. His articles in the Mail are riddled with factual inaccuracies that call into question his judgement. He has been criticised by the President of the Royal College of Surgeons. And he tried to pass himself off as a Professor in the media when his honorary position had expired, calling into question his integrity.

He is a surgeon. His competence and ability as a surgeon is what matters for the patient, not how accurately he portrays the inner working of the NHS. As for "tried to pass himself off as a Professor" I would be more inclined to think that the media decided to drop the "former" from his title in order to improve his credentials. They don't have a reputation for accuracy or trustworthiness.

I personally believe that joining Greenpeace, FoE, WWF, BNP, Socialist Workers Union or any number of other organisations demonstrates a lack of judgement but that poor judgement in one part of their life does not mean they have bad judgement in other parts of their life

> If someone writes an article calling for the extinction of your job and profession, you will not be inclined to throw any business his way.

Unless his article revealed the existence a universal panacea I don’t see how it could make the job and profession of doctor extinct. Your job, as a doctor, is to do what is best for the patient. It isn't to use the patients as pawns against somebody whose views you dislike. Any doctor that lets their personal opinions affect their professional ones to the detriment of the patient should reconsider their profession.

Jan 5, 2015 at 9:50 AM | Unregistered CommenterTerryS

He's calling for GPs to be replaced by nurses and paramedics managed by hospitals in TFA. So he is advocating for the extinction of my profession. I would never refer a patient to him for the reasons outlined earlier. There are good sarcoma surgeons without his probity issues working in London

Jan 5, 2015 at 10:16 AM | Unregistered Commenteronion

> I would never refer a patient to him for the reasons outlined earlier. There are good sarcoma surgeons without his probity issues working in London

I'm glad you agree that it is effectively the doctor who decides where the patient goes.

By not referring patients to him you are unduly increasing the workload of other surgeons. Using your patients as pawns in this way can not be good for them.

Jan 5, 2015 at 10:25 AM | Unregistered CommenterTerryS

There’s nothing going to kill the NHS faster than ignoring problems with it. Doing your best should not be confused with being successful. A big part of the problem is that doctors and nurses have been paid above their ability to improve. Like a juggler, beyond a certain point, there are no more balls one person can keep in the air. Paying them higher salaries will not change that.

As a country we have never had a debate about what we want the NHS to achieve. So at one end we want parents to have unlimited access to a doctor with the smallest symptom and at the other we want doctors to cure complicated and expensive conditions. Given the range of conditions and cures, it’s impossible for most people to learn all the things that a young doctor needs to know to pass their exams. It’s time the job was split into different groups and that training for some fields were much shorter and more specialised. I also think medical training should be free.

If 75-80% of women can successfully self diagnose using the internet then someone with a modicum of training and a diagnosis program should be able to do better. What most GPs lack is time to ask enough questions to separate significant symptoms from insignificant ones. To determine dementia, they need a decent amount of time to chat on issues other than sore hips or that cough that won’t go. No matter how much you pay GPs you can’t make them spend more time than they feel able to give now. So you need more doctor time. We can’t afford much more when they’ve got very high salaries. More doctors aren’t even available without taking more and more from abroad with dubious qualifications and language abilities.

We need a filtering layer of professionals who are skilled at extracting the things fully qualified doctors need to concentrate on. They can be the one who is there if all the patient wants is a chat. They can take the blood pressure, ask the questions about smoking and drinking, fill out the stuff the NHS will then sell on to outside companies. Any obvious tests like urine sample can be done before they ever see a fully qualified doctor. The useful information is then processed by the computer and ready for the doctor to review when the patient sees them. Needless to say, this bunch of professionals don’t need years of training or sky high salaries.

One of the things that was missing from any of the complicated treatments I or those around me have had was a request to keep a diary of symptoms. This would have simplified things tremendously and anyone who has a niggling problem should start one. A doctor can prompt what sorts of things the patient should record.

Nurses also need to be separated into those who do complicated stuff and need a degree and those who don’t. It’s almost universal that anyone with a degree feels that they should be above wiping bottoms and fetching drinks. A good memory is essential for the first type of nurse and the willingness to do as they’re told would be essential in the second.

Jan 5, 2015 at 10:53 AM | Unregistered CommenterTinyCO2

onion
Neither you nor any of the other tweet-first-think-later professionals has stopped to ask why Thomas is saying what he is.
In the UK GPs are obscenely overpaid compared with virtually every other country in the world and for doing less work.
The argument about the increase in the number of part-time GPs is perfectly accurate. In the last practice that I was registered with covering a population of around 7,000 (as an estimate; there were two practices for about 18,000 and the other was the bigger of the two) there were seven GPs, four women who all job-shared and three men of whom one worked full-time, one was semi-retired and the third did two days a week at a local hospital.*
You can imagine the problem with continuity or trying to get an appointment with a GP of your choice!
My local practice in France has three doctors (1F, 2M) for about 4,000 people; all work full-time and I have never had to wait for more than 24 hours for an appointment with "my" doctor (holidays excepted, of course).
(Out of interest, the last time I was referred to a specialist (of my choice though I would have been happy to follow his recommendation since I assume he knows his colleagues and their reputations better than I) I phoned for an appointment the day she returned from holiday and was seen that afternoon. And no, the matter was not considered urgent.)
One difference is that French GPs are not bribed to report when their patients are putting on weight or to take their blood pressure every time they visit or any of the other things that Nanny in Whitehall thinks are good for you to have done (this week; it'll be something different next week). They just get on and treat their patients and pass specialist stuff on to specialists.
And the other big difference is that every time I visit a GP it costs me 23€, all of which I get back provided I can present my Carte Vitale and if the UK were capable of operating a similar swipe card system (and the Lord alone knows why it can't) then either you adopt the French system or you charge everybody who doesn't have a card unless they present with a genuine medical emergency.
And "charge" does not mean send an invoice to some bogus address; it means let us see the colour of your money now! I suspect that the average British GP would consider handling anything as grubby as money as being beneath them. The French have no such qualms, believe me!
And somewhere along the line the WHO reckons the French system to be, over-all, the best in the world (or at least did five years ago).

*I might add that the staff included a practice manager, a receptionist, and at least two other clerks of some description; my local practice has an admin staff of one!

Jan 5, 2015 at 11:24 AM | Registered CommenterMike Jackson

I would definitely support the swipe card system including payments, and actually have patients own their own data that they can transport to the doctor of their choosing. In the UK, the state owns medical records which is abhorrent.

The Commonwealth Fund updated an international comparator report a year ago, that put the UK at number 1 for many parameters:

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

UK GPs see on average each of their patients over 6 times per year (though many aren't see at all, and many are seen much more than that). This is higher than elsewhere. It is because the service is 'free'. Charge €23 and demand would fall and patients would take more responsibility for their own health.

Your point about bribery is also correct. We are now paid to look for chronic diseases according to whether or not a computer model suggests our prevalence is too low - this includes hypertension, diabetes, copd, dementia and chronic kidney disease. We are penalised if we cannot get our prevalences up. This reliance on computer models at the expense of actual reality reminds me of the global warming catastrophists. It takes up time and means we have less resources to devote to seeing people who are ill - hence the long waiting times.

GPs are resigning the NHS contract. It began as a trickle last year. I think it will be a large number this year. If the contract is unprofitable, we'll use our skills elsewhere. If you think GPs are expensive, just wait until we're gone! If GPs are resigning the contract, clearly they're not 'obscenely overpaid'.

So here's the thing. Thomas is saying what he's saying because he is prejudiced and ignorant. If you read his article, you'll see there's no coherent proposal. You've come up with something more constructive than him. He's ignorant of how GPs work. He's ignorant of the limitations of his proposed paramedic/ nurse solution. For example, me and my partner sign around 50 prescriptions per day, read and action 80 hospital letters, review 50 lab and X-ray results while seeing 70-80 patients. That is a typical day's work. Thomas proposed nurse specialists - well the asthma nurse might be able to deal with about 5% of the prescriptions and one or two patients. Neither nurse nor paramedic would be willing to make clinical decisions that they owned and took medico-legal responsibility for. They would want a doctor to do that.

Jan 5, 2015 at 12:20 PM | Unregistered Commenteronion

Tiny

"a diagnosis program should be able to do better"

I've long thought that the first encounter in a GP clinic should be with a computer. The majority (probably vast majority) of patients will have simple conditions that can be readily diagnosed with a suitable set of questions and answers. Combine this with measurements of weight, heart rate, BP and temperature and you will get a more thorough test than by normal means, and with little skilled intervention, leaving the doctors free to tackle the more difficult cases.

GP's must weary of assessing every patient who turns up, with the conflicting requirements of speed and thoroughness, but there seems to be a lot of resistance when it comes to anything that looks like de-skilling. I wonder why?

Jan 5, 2015 at 12:43 PM | Unregistered Commenterjamesp

Tiny and james - I wonder what percentage of patients who go to a GP already know exactly what is wrong with them? My sample of one indicates that this is usually the case. If I get the flu, I know what it is. If I have a chronic condition like arthritis, I know that too.

My (thankfully rare) visits to my GP have been mostly to get a medical certificate for work, or to renew a prescription. Mind you, there have been times when his diagnostic skills, which are excellent BTW, were needed. But that has probably been only 10% or less of my visits.

I reckon that as a job most of it would be boring as all get out.

Jan 5, 2015 at 12:57 PM | Registered Commenterjohanna

Tiny

"those who do complicated stuff and need a degree"

But do they? I remember the old SRN/SEN arrangement, i.e. staff nurses, who had a few 'O' levels, and enrolled nurses, who didn't, but were literate and numerate and suitably motivated, which seemed to work pretty well. The less glamorous duties were shared, and because of the contact with patients during such procedures, they often learned or observed things that were missed by doctors on their rounds.

Now we have graduate nurses who feel they are overqualified for anything messy, and assistants who have little clinical knowledge, all at much greater financial cost.

Jan 5, 2015 at 1:02 PM | Registered Commenterjamesp

johanna

"If I get the flu, I know what it is."

Which is probably why your GP visits are so rare, but there are plenty of patients who don't know, don't use the Internet and want 'some medicine' to correct their current (and mostly temporary) symptoms. Add a few hypochondriacs to the mix and the 'big pharma' pressure on GP's to test-drive their latest products and you have the current state of affairs.

When my mother was an anaesthetist (who never got to prescribe anything) our postbox was inundated with medical samples and propaganda, although in those days no golfing trips which, ironically, she would have enjoyed!

Jan 5, 2015 at 1:11 PM | Registered Commenterjamesp

> GPs are resigning the NHS contract. It began as a trickle last year. I think it will be a large number this year.

Do you have actual evidence for this or is it just anecdotal?

The reason I ask is because the GMC has the number of registered GP's in 2013 as 63,770 and 65,168 as the current figure, an increase of nearly 1,400.

Now I know that the number of registered GPs isn't necessarily the same as the number of GPs on the NHS contract but the NHS statistics site doesn't provide up to date information. The latest I can get from the NHS is that in 2012 England had 40,265 GPs, and Scotland had 4,859.

Jan 5, 2015 at 1:39 PM | Unregistered CommenterTerryS

I've seen these extremely hostile reactions now in archaeology, climate "academia" and now in medicine.

What characterises these episodes is that a group of people who consider themselves as being "experts" and with authority over an area are challenged by an "outsider".

In archaeology this occurred when metal detector users showed they were better at finding ancient sites and artefacts.
In climate it occurred when engineers and scientists from outside academia became interested in climate and started expressing our own views.
So, I suspect given the style of response, this is another "demarcation" dispute.

In essence the response is exactly what you see when one troop of chimpanzees go into another troop's territory.

The defending troop gather together, make as much noise as possible, run too and fro in frantic activity, make mock charges and attack inanimate objects like trees.

In other words, they are just saying: "this is not your area go away".

The problem of course, is that those using metal detectors do not go away, climate sceptics aren't intimidated to leave climate "science" alone and this professor presumably feels he's got a right to comment on doctors.

When the initial "stand off" fails, the troop defending its position feel justified in attacking the other. The bigger animals show their strength by attacking weaker members of the opposing group using killing their "infants" (for this read your precious work) or if this is not possible - they attack anything and everything else and if all else fails, I believe they also literally throw their shit at the other troop.

Usually the aggressors are younger males, often watched by sexually active females. So in part this is as much a display to their own social group as to the opposing group. But the real coordination is by older males - who usually allow the younger males to do the attacking for them.

But why the public sector?

Unlike the private sector which is used to competition, the public sector doesn't learn how to behave in a civilised way when facing competition or opposition. More over, they tend to see themselves as a more cohesive group, so the "they are not us" reaction is stronger. Finally they've got an (unjustified) belief in moral superiority.

Jan 5, 2015 at 2:21 PM | Registered CommenterMikeHaseler

@TinyCO2 Here's a possible response to the "if your doctor said" argument.

The best way to show this is nonsense is to ask:

1. If doctors say that childbirth is a medical condition and needs a doctor - who are you to disagree?

2. Climate academics are researchers not practitioners. They are therefore not the equivalent of a practising doctor but instead someone like an academic drug researcher.

In effect, this argument is this: "if a drug researcher said you needed their drug - who are you to disagree?"

So, if e.g. a drug academic researcher working on Tamiflu suggests that because he's heard we have a temperature - and despite the fact they've never successfully treated a single patient nor correctly predicted the progress of their temperature in the past, they say we all need to take Tamiflu - who are we to disagree?

Jan 5, 2015 at 2:47 PM | Registered CommenterMikeHaseler

""those who do complicated stuff and need a degree"

But do they? " jamesp

I'm not sure they need a degree but they do need specialist training (that most don't seem to be getting now). My experiences with hospitals tells me some are much more knowledgeable than others. Knowing how to deal with certain conditions like dementia or asthma which are not necessarily what a person is admitted for, is important. Doctors seem to flit in and out but rarely set out detailed instructions on how to care for people with complicated needs. Somebody needs to be trained and in charge of that.

Jan 5, 2015 at 3:04 PM | Unregistered CommenterTinyCO2

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