How doctors strikes save lives...

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It's OK dear reader, I'm not getting all soft in my dotage, I still think that doctors - give the oaths they swear and the moral high ground they inhabit - shouldn't go on strike. But, slightly ironically, the strike may save a few lives:

Curiously enough, it has been shown that patient mortality typically falls during doctors' strikes, a finding replicating on a number of occasions across different nations. Cunningham et al's meta-analysis is the most notable recent review of this peculiar fact. In one of the most entertaining studies in the literature, the researchers interviewed the directors of major Israeli burial societies, who seemed slightly disgruntled at the loss of business associated with a major doctors' strike in 2000.

One, bemused, reported a 39% drop in funerals as compared to the same month in 1999. Another, much more confidently, was sure that his loss of custom was due to the striking doctors, because he had been in business long enough to see the exact same phenomenon occur in 1983, the last time Israeli doctors had walked out.

As they say - most peculiar. And it raises the question of whether it's all that expensive medicine stuff that's driving our longer, healthier and happier lives or something else.

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Quote of the day: Why doctors shouldn't strike

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Nothing to add to this:

When a country operates under a healthcare monopoly, its citizens are fundamentally at the mercy of the provider. That provider has an ethical responsibility to show up to work every day and look after its patients; if they don’t, no one else will.

Absolutely spot on. It's unethical for doctors to strike.

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In which the medical profession reminds us how monumentally stupid it is

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Seriously these doctors are utterly ignorant, they have not the first conception of human behaviour:

Norway's biggest medical organisation wants to ban the sale of cigarettes to adults.

In a drive towards a smoke-free society by 2035, the Norwegian Medical Association (NMA) is pressing the government to back its proposal for a ban on tobacco sales to citizens born after the year 2000.

What could go wrong here? Right now it's anyone younger than 16 which I'm guess means they can't buy fags anyway. They do however have friends who are 17 and can buy fags. And since the stupid doctors don't intend to ban possession of cigarettes, this secondary market (doubtless a pretty profitable one) still exists and won't go away until the last of those 17 year olds has died in about eighty years time. All this, of course, is without the capacity of Norwegians to pop to Sweden, Denmark, Germany, Finland, the Baltic States from where they can bring back - perfectly legally - loads of cigarettes.

Fortunately Norway has some politicians with a modicum of common sense:

Yet despite the NMA's hopes, health spokespeople for the Conservative, Labour, Centre and Christian Democrats parties in the country told Aftenposten the idea was not currently feasible.

Indeed the idea will never be feasible. In other news teen smoking in most places - including Norway and the UK - is at its lowest ever level. Something that's down to vaping and nothing to do with public health at all. Not that the health fascists and nannying fussbuckets will ever admit to this.

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Thoughts on NHS finances - and why some doctors don't like privatisation

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I've felt for a long while that there is something of a problem with the distribution of money within 'Our NHS' (this is, I understand, the official and approved title of the august organisation). Some of this is down to the pseudo-market created and elaborated upon by governments since the 1980s - the idea that instead of people making choices in a free system we use a proxy of commissioning. But another problem is that the money flows to the producer of healthcare (primarily doctors and senior administrators) rather than to benefit the consumers of healthcare (patients and their families).

This isn't to say that doctors should be paid less. I'm sure, like me, you're pretty cool about the way in which the high status and high income associated with medicine attracts the very brightest young people. Not because they are especially caring or sharing but because medicine offers the best rewards.

So it's clear that becoming a doctor is, at least partly, driven by the prospect of that high status and high income. And, like you dear reader, I have no problem with this (any more than I have a problem with the best and brightest being incentivised to go into other important work by that same high status and high income offer) but it carries a risk where the level of that remuneration is under the control - wholly or partly - of the particular high status, high income group.

And this, quite simply, is the problem with putting doctors in charge of the NHS. It remains in this groups interest to maintain, indeed enhance, the status and income of the group. Again I'm not making doctors out to be ghastly mercenary exploiters merely suggesting that they will always behave as any group behaves - in their own interests. Much of the time this is not a problem - the high status, high income stuff means we get better doctors clearly something that us patients desire. But the problem comes when the choice is between specific care and the remuneration of doctors.

Over the past year I've sat on Bradford's Health and Wellbeing Board and have tried to get my head around the way in which the budgets for health operate. We read about different parts of the NHS system 'making a loss' or 'overspending' but never ask how this is so given the nature of the system. I recall having a conversation with a senior council officer about this problem. Essentially the pseudo-market requires 'commissioners' to guess how much of a given type of health care is going to be needed. Obviously, for elective care this can be rationed - once we've used up the 100 knee operations the next patient has to wait until the next period for his op.

For non-elective healthcare the problem is that the commissioner has to contract for enough geriatric care, cancer treatment and emergency heart operations to meet the actual need. And this mean commissioning more rather than less. So every time - up to the number commissioned - a patient arrives at the hospital there's a big 'kerching' sound. The problem comes when the commissioners guess is wrong - either too many or too few patients access the service. If too many the commissioning body (currently 'clinical commissioning groups') has an overspend and if too few the hospital makes a loss because it has set on doctors, nurses, beds and so forth to meet the commissioner's guess.

If you're a doctor in a hospital - typically these days a Foundation Trust - then you want the hospital to do more very predictable and controllable elective surgery so as to protect from the financial unpredictability of emergency medicine. But if you're a doctor in general practice you want more of those knee operations and hip replacements for the money you've got to spend on them. And using general hospitals for this work therefore makes less sense - far better to pay efficient specialist (often private) organisations to do the elective surgery. You may call this 'privatisation' but it is clearly intended under the pseudo-market that more of this commissioning will be used - good news for patients wanting hip replacements, great news for the surgeons who do those hip operations and pretty good news for GP-led commissioning groups.

But if you're an oncologist working in a general hospital (or for that matter a doctor in accident and emergency) this 'privatisation' is bad news because it means less money coming into your hospital but little or no change in the numbers of patients. To add insult to injury those surgeons doing the elective surgery are earning fatter wages for doing (however efficiently) a repeated and routine operation. The hospital doctor (assuming he doesn't have a lucrative private practice) looks at the world, sees his peers getting fatter pay packets for a nine-to-five job in the private sector and wonders what he did wrong.

The responses to this disgruntlement vary. Some doctors swallow their pride and switch to the private sector, others focus on specialisation in the anticipation of building a private practice and a third lot get all political and oppose 'privatisation'. Even though the evidence seems to suggest that we get slightly better health outcomes from a mixed economy in healthcare. And it is absolutely in the interests of those hospital doctors to oppose privatisation because under the pseudo-market the big bucks are rewarding efficiency rather than skills or expertise. Because the private sector saves the commissioners money, the owners of those businesses are prepared to pay lots of money to doctors (and other health professionals) who can allow them to remove more cataracts, do more hernia operations and fix more knees.

All of which brings us back to those incentives. If we're right and the high status, high income thing matters then perhaps we should worry about a system that rewards doctors performing routine operations efficiently rather than doctors who manage more complicated care such as treating cancers. But the answer here isn't necessarily to simply oppose 'privatisation' but to create a market in those skills needed to provide complex surgery and multi-faceted care.

Much of our debate about healthcare is useless. Instead of asking how we will meet the demand created by an ageing population while continuing to innovate what we do is shout pathetic slogans at each other and make gushing pledges of loyalty to 'Our NHS'. It seems to me that the current financial system within the NHS privileges some doctors but not others and similarly rewards cost efficiency in medicine better than it does innovation and skill.

Currently about 80% of the NHS budget is spent in the acute sector - mostly by general hospitals and mostly on paying the staff of those hospitals. The problem is that the people spending this money (by doing whatever medical thing it is they do) in the hospitals have little say over how it is distributed with the result that there are places filled with sexy medical gizmos and gadgets while other places are making do with old - even jerry built - equipment and too few staff.

I'll be honest here and say that I don't know the answer. However, I also feel - with some good evidential support - that further liberalisation and a slightly less pseudo pseudo-market remains the right way to go. Not because I want to 'sell off the NHS to the highest bidder' but because we need to find a better way than central planning to manage the flow of money through the health system. I also feel that the commissioning of places rather than people sits right at the heart of the problem - we buy services from a big Foundation Trust not from a doctor or group of doctors. Yet it's the doctors' expertise that is central to the health care us patients demand.

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Things public health say that simply aren't true...

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'The idea of an older woman with a glass of sherry is way out of date. It is more likely to be a bottle of wine a day.’

This from Andrew Langford of the British Liver Trust is a classic of the public health genre. Old ladies may not be drinking a little glass of sherry but, let's be clear, most of them - nearly all of them in truth - are not drinking a bottle of wine a day. They are more like to be drinking no alcohol.

According to the ONS (this is for 2009) just 4% of women aged over 65 had drunk more that six units on any occasion in the week prior to survey. And 74% of such women had consumed less that 3 units. Indeed 57% of women over 65 had not touched a drop.

And just for completeness, the average weekly consumption for women aged 65 or over is just 4.6 units.

There may be a few elderly women with a drink problem but it is not a hidden' public health scandal. Not even a little one.

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Shooting the messenger - doctors, smoking and mental health

Today the BBC is reporting on the latest press release from The Doctors:

The NHS in England is not doing enough to help people with mental health conditions quit smoking, an influential group of doctors has warned. 

The influential group (and to think I was kind to them just this morning on the radio) is the Royal College of Physicians aided and abetted in this case by the UK Centre for Tobacco Control Studies at Nottingham University. The top professor there had this to say about the mentally ill and smoking:

"The patients are seen as having a hard time and are ill so they need a cigarette and it is also a way for staff to build relationships and so they end up facilitating smoking breaks, finding time to supervise people who want to go outside to smoke, rather than spending resources on helping them to stop."

It seems to me that these influential doctors are doing the worst thing possible - focusing on something that is less harmful out of ideology. Rather than treating the mental illness, The Doctors tell us we must first stop the mentally ill from smoking - must spend "resources" on this rather than treating the mental health problem.

Perhaps, in an idle break from their nannying fussbucketry, the influential doctors might consider why people with mental health problems are more likely to smoke? Have these so-called "doctors" not thought for a second that, for someone with severe depression for example, a fag is a welcome little lift?

But no. Instead these supposed doctors want to take away another little pleasure, to regiment and control what the mentally ill do as if they're not able - with support - to live their own lives and make their own choices. And what makes matters worse is that those who claim advocacy on behalf of the mentally ill fail completely to tell The Doctors to shut up and treat the mental health problems. But MIND simply make a knee-jerk 'mentally ill people's needs aren't being met' statement - a complete failure considering that they had the chance to set matters straight.

The needs of those mentally ill people is support - whether medical or social - to allow them to lead a fuller live. And when that's done perhaps helping them to quit smoking has a chance of succeeding. In the meantime can we stop shooting the messenger and focus instead on the thing that means mentally ill people have such a lower life expectancy - their mental illness.

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About that underage drinking...

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Yesterday "The Doctors" were in full cry about alcohol and "the children":

Sir Ian Gilmore, the AHA's chair, said action was especially urgent given that UK teenagers drink much more than the European average.

Well it may be 'much more' (although, like the £55 billion 'cost to society' of alcohol, this is unevidenced and probably untrue) but it isn't very much:

Regular alcohol consumption by 11 to 15 year olds has fallen by two-thirds in the last decade - from 20% to 7% - and the proportion of these children who had ever drunk alcohol fell from 61% to 45% in the same period.

As always - and it should worry us - "The Doctors" just make stuff up about health risks knowing that reporters who stopped any studying of science at 14 will simply believe everything they're told.

Quite simply, we really don't have the problem with booze that prohibitionists and temperance campaigners like Sir Ian Gilmore would have you believe.

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Dear doctors, if you're going to be fussbuckets can you at least get the facts right

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The media is all afroth with the latest press release from "The Doctors" about us getting a little chubby. This is accompanied by images of podgy middles being manhandled and reams of self-righteous judging of other folks' lifestyles.

In a report spelling out the problem in stark terms, the academy says doctors are "united in seeing the epidemic of obesity as the greatest public health crisis facing the UK.

I mind greatly about doctors wanting new taxes, controls and so forth - nannying fussbucketry is not just wrong it's immoral. But I mind even more about the facts - and these doctors can't even be bothered to get these right.

Firstly there's the epidemic - well there isn't one. This is an epidemic:

A widespread occurrence of an infectious disease in a community at a particular time.

These are doctors for heaven's sake, surely they care just a little about the precision in using medical terms? Or am I crediting the fussbuckets with giving a damn? Obesity isn't infectious - I'm not going to catch it from the fat person round the corner however hard I try. I'm going to get fat if I eat too much food and exercise too little - nothing catching at all.

Then there's the line that obesity is "getting worse". This too is wrong - here's the Joseph Rowntree Foundation (not a regular enemy of nannying fussbuckets) on the subject:

Over time, there is little sign of the inexorable rise in obesity that underlies some of the concern about the issue. Rates for children did rise and peak in 2004 but have since fallen and are now no different to what they were in the late 1990s.

So we're fatter than we were in the 1980s but not actually getting even fatter.

So those doctors have misused (quite deliberately) the term 'epidemic' and lied about obesity getting worse. They also ignore the pesky research showing that being a bit chubby isn't a problem - it might even be good for us:

Results showed that overweight people were six per cent less likely to die during the average study period. Mildly obese people had a five per cent lower rate of premature death.

The research showed that men and women hold an equal advantage when it comes to being overweight, and that the conclusion was not affected by age, smoking status, or region. 

Has anyone considered that what we call "normal weight" is, in truth slightly underweight?

Even if we accept the (plainly wrong) we're all getting fatter argument, the nannying fussbuckets are after the wrong targets - fizzy drinks and burgers:

Over the last 10 years, the consumption of soft drinks containing added sugar has fallen by 9%, while the incidence of obesity has been increasing. And 61% of soft drinks now contain no added sugar. 

Doesn't look like full fat coke's to blame - the burgers then?

 ...there was no significant association between increasing takeaway and fast food consumption and obesity as measured by BMI corrected for age and gender. This is not a new finding. For example, French and colleagues found no significant relationship between frequent consumption of fast food and being overweight in their analysis of a cohort of 11-18-year-old boys and girls. Similarly, Simmons et al found no correlation between increasing takeaway consumption and obesity measured by either BMI or waist circumference.

Blast - it's not the burgers either.

This is the problem - there is a problem but the doctors are too fussed about nannying us to ask why and what might be done. Here's our friends at JRF again:

There is also a difference for adults with a clear social gradient for women (with 31% of the poorest being obese compared with 19% of the richest) but pretty much equal rates for men across all incomes (between 24-29%).

Spotted that - I'm sure you have on your high street. Let's call it the Jack Sprat Principle. But why? Why are working class women so much more likely to be obese - trying to understand this might be a whole load more valuable than banning advertising or taxing fizzy drinks.

This is the problem with public health - too terrified to target risky groups, our fussbuckets find it simpler to propose whole population solutions to problems that, in truth, affect only a minority of that population.

However, the biggest lie today is the idea that the solution lies in ever more draconian controls, more taxes and taxpayers money poured into unpleasant and aggressive "public health" campaigns. And all because - we're told without evidence or foundation - that slightly less than 3% of NHS resources goes to deal with the health problems contingent on obesity.

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Doctor know everything...

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Including about marketing and pricing strategies:

...citing an article from a medical journal in 2009 by a leading liver specialist which suggested supermarkets were overcharging for food to pay for cheap drink.

This is the Prime Minister - yet again revelling in his ignorance of business. Or rather his minions at No 10 digging him out from the latest hole into which he'd dived. It seems that the PM believes that offers on beer are "subsidised" by more expensive food.

This is nonsense on sticks. For two reasons - firstly we don't go to supermarkets, in the main, to buy drink we go there to buy food and other household necessities. And secondly, the price of X isn't subsidised by the margins on Y - supermarket pricing strategies just don't work like that.

More importantly however, what qualification does a "leading liver specialist" have to talk about the pricing strategies of supermarkets? None whatsoever - I'll take his advice on my liver, maybe on some other doctoring stuff but not in an area where (despite not being a specialist) I know more than he does.

But then 'Doctor know everything', he is mighty god and great know-all.

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So when are GPs going to make it easier to make an appointment?

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I heard a chap from the Patients Association talking about how GPs provide an "office service" these days - no home visits or out-of-hours - and this lies behind some of the rise in complaints about GP services. But more worrying -and pretty scandalous - is that the difficulty in getting an appointment (especially for working people) at most GPs is a potential health risk:

Health experts are encouraging people not to put off seeing their GPs after research showed that almost a quarter of Britons would not see a doctor for a complaint because of the hassle of getting an appointment.

Now these "health experts" have grasped the wrong end of the stick. it is the doctors who are providing (or, it seems, not providing) the service to us not the other way round. And they seem to have slipped into a world where people have no choice but to take time off work so as to see the doctor. One of my favourite sick jokes was discovering that the "evening surgery" in Wilsden was at 3pm. Either doctors are very early to bed of this is something of a redefinition of "evening". 

So perhaps those GPs would like to focus on giving us all some service rather than moaning about the government.

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I always knew a lot of doctors were in it for the money...

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Not all, of course, as this comment shows:

Dr Dan Poulter MP said: "As a doctor, my first duty is to my patients. That is why I would not participate in strike action. Doctors have taken the wrong decision today, urged on by their trade union the BMA.

"Industrial action will harm patient care. With the Government's final offer to doctors being a pension of £68,000 a year, the public will simply not understand why doctors have called for strike action over pensions that private sector workers and many other frontline NHS workers can only dream of."

I watched a row of wealthy men in suits - the BMA bosses - lined up at a press conference claiming to be hard done by because some doctors will have to wait until they're 65 (like the rest of us do) to get their pension of nearly seventy grand a year (like the rest of us don't).  And I wanted to put a bar stool through the telly. How dare these people act in this way, how dare the BMA - usually so ready to lecture us on how we're living our lives wrong - threaten patient care so they can retire to the golf course or the Dordogne a few years early. How dare they....

...they're only in this for the money it seems so perhaps they'll shut up with all the "caring public sector professionals" rubbish now. I do hope so.

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Obesity rates are falling not rising - so why must doctors lie about this?

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We've got rather used to the various clubs of doctors - BMA, RCS and suchlike - telling us that alcohol consumption is rising when it isn't (even the BBC now recognise that it is for heaven's sake). Now these New Puritan institutions are lying about obesity:

According to the latest research, 48% of men and 43% of women in the UK will be obese by 2030, a trend that will significantly increase the prevalence of strokes, heart disease and cancer, and lead to higher costs for the NHS.

Now unfortunately, the Guardian doesn't link to that latest research. However, the latest actual statistics from the Office of National Statistics tell us that rates of obesity are falling:

Despite the government ignoring the anti-obesity lobby's urgent suggestions for traffic light labelling on food and suchlike, the latest figures show that obesity amongst men has fallen to 22% and the female obesity rate has fallen to 24%.

So something must have changed - either the Academy of Medical Royal Colleges are scandalously misinformed or else the British public has been on a massive eating binge in the last year (those latest figures are from 2011).

Ah but what about the children say the doctors:

Charlie Powell, campaigns director of the Children's Food Campaign, applauded the academy's intervention. He said: "Andrew Lansley should act on this excellent set of robust recommendations, but his track record suggests that he will once again ignore the advice of our best medical experts."

Ah yes those children - I don't have figures for everywhere but I'm pretty sure Bradford won't be out of the ordinary in terms of obese children -  here, for Year 6 children, there has been a slight fall over the past three years and the rate remains below 20% (marginally above the national average). And note that this uses the very discredited measure of Body Mass Index.

None of these actual facts supports the argument of the Academy that we should set about banning advertising & sports sponsorship, fast food outlets near schools and celebrity endorsement. Let alone introducing "fat taxes".

There really isn't a growing obesity crisis and doctors should help people who get too fat rather than seek to punish the vast majority who never get past being slightly chubby.

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Advertising isn't the cause of dodgy boob jobs - why ban it?

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Apparently the boob job industry is a pretty big one. And we have a scandal as thousands of women were given what turned out to be faulty implants. It would appear that (as is often the case) the fault isn't self-obsessed women and greedy doctors but advertising:

The British Association of Aesthetic Plastic Surgeons (BAAPS), which represents the top plastic surgeons, is urging ministers to impose the advertising ban as part of a crackdown on the multi-million pound cosmetic surgery industry. 

You see folks, BAAPS (an acronym of which Peter Simple would have been proud) don't advertise! Oh no, these men are more discrete. And advertising is queering their pitch:

Fazel Fatah, consultant plastic surgeon and BAAPS president, said: "In no other area of surgery would one encounter Christmas vouchers and two-for-one offers.

"No other kind of surgery is advertised. You don't see adverts for metal hip replacements or gall bladder operations. Advertising in cosmetic surgery feeds into the worries and insecurities in a group of vulnerable people."

So rather than working gently through the euphemisms of the the medical profession's market-fix on cosmetic surgery, women are buying from bright and shiny advertising. The problem is that the fault doesn't lie with the advertising, it lies with the doctors (and trust me, folks, the men doing the operations on those "dodgy" clinics are doctors) who prefer making cash to selling a safe product.

However, Fazel Fatah really isn't any different - rather than have an open accessible market for what is (in all but a few cases) a luxury, this surgeon wants a world where cosmetic surgery isn't advertised. One wonders why given that Mr Fatah works for a profit-making cosmetic surgery business?

Is it because such controls reduce access to the market and allow the 40% of cosmetic surgeons who belong to BAAPS to charge higher prices, prevent new entrants to a lucrative market and corner the market for medical rather than aesthetic work?

Advertising isn't the problem - even tacky post-divorce promotions or two for the price of one offers. The problem is that some people thought it OK to offer lower quality products and no-one was checking on this or ensuring the customer had the information she needs.

But then that wouldn't suit Mr Fatah's business now would it?

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This is what they push to help you stop smoking...

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...and it's pretty scary:

Varenicline, meanwhile, already carries warnings, as a result of Health Canada advisories issued in 2008, 2009 and 2010, concerning potential serious neuropsychiatric adverse events such as depression, agitation, hostility, behavior changes, suicidal ideation and suicide. 

All that plus:

The meta-analysis of data from 14 double-blind randomized clinical trials found that people taking varenicline had a 72% higher risk of adverse heart-related events than those on placebo.

So when your Doctor tries to prescribe you Champix (what Pfizer call this drug in the UK), ask him or her whether they really think it's safe.

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Trust me, I'm a politician!

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Trust is a tricky old thing – that headline probably brings out the sense of irony in you (although you don’t know for sure whether or not I actually mean “trust me”). Indeed our default position is, as Martin Vander Weyer points out, more often distrust:

...trust is no longer offered, in any sphere, as it used to be; distrust is now the default response. It’s easy to argue that business leaders, especially in the City, have brought this on themselves by behaving greedily and uncaringly. But that’s not the whole story, which is also about social change.

At the core of this is a presiding sense that they’re out to rip us off. Politicians, lawyers, doctors, journalists – the entire panoply of professions – are cynical, driven by personal success rather than by any concept of service. And our mistrust extends further – we see train drivers striking on boxing day and see self-interest rather than a collective response to injustice, we tell tales or teachers or council officers seeing the “strike day” as an excuse for a jolly and we’ve got used to anger at huge bonuses in large firms and big public organisation that seem merely to reward failure or incompetence.

The other day, Jack of Kent pondered on why everyone hates lawyers and concludes that it is the majesty of the law that we fear rather than its agent, the lawyer:

It is perhaps not so much that lawyers are hated, but that law itself is feared and mysterious.

That this is the case is unfortunate, and it is an entirely fair criticism that many lawyers do not do more to promote the public understanding of law.

Of course, barriers to lay understanding can suit the interests of lawyers. Lawyers have no general interest in enabling potential clients to work out their own legal problems.

And, so to that extent, lawyers really only have themselves to blame.

But it isn’t quite so simple – what has happened is that we have stopped trusting lawyers because they are lawyers, doctors simply for the fact of their doctoring and politicians by dint of their elected authority. The brands of these professions are corrupted by our awareness of their failings, our recognition that lawyers, doctors, MPs and other ‘professionals’ will close ranks, will protect their privileges, rather than have those failings exposed.

This is a good thing although we still give too great a credence to the self-interest of the Law Society, the BMA or the ‘senior backbencher’. However the growing doubt as to motive means that trust must be earned. It’s perfectly possible to trust a lawyer, a doctor, even a politician but only in so far as we trust the individual behind the badge.

When I urge you to trust me because I’m a politician, I’m asking you to trust the idea of such a person rather than to trust me. Such heuristics damage society by granting to a given organisation, professional body or political party the power to bestow trust.

You should trust Simon Cooke because he has proven himself trustworthy not because he has the stamp of politician.

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One wonders why?

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...people in Bradford are using a walk-in service rather than their own GP?

Dr Damian Riley, medical director at NHS Airedale, Bradford and Leeds, said: “This change was needed to make sure the walk-in service is used to its best advantage and continues to provide real value for money.

“More patients than expected, especially those who already have a GP elsewhere in the district, have been using the service, even though their own GP has been available.

Perhaps getting an appointment with their own GP is a living nightmare? Maybe people want a "turn up when you're ill" service from their GP?

So who is the service for then, if not Bradford people? Ah, yes...

The change allows appointments at the walk-in service to be prioritised for patients who are not registered with a GP, and in particular communities such as asylum seekers, homeless people, travellers and refugees. A service will also be offered for people who are temporary residents in the district and not registered at a Bradford and Airedale practice.

So it's back to the same old lousy GP service then folks!

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In which the NHS begins to learn about targeting...

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In a previous life (so to speak) we proposed this to Bradford Health Authority some 21 years ago. Back then targeting was a no-no. It seems the NHS is learning - for example about the impact of alcohol:

Targeting 'risky' male drinkers could save NHS £120m - report

Note that, rather than the usual target,alcohol itself, the proposal is to target the actual problem - the alcohol abuser. And with sensible intervention too:

A 10-minute advisory session with a doctor or nurse can reduce alcohol consumption by up to five units a week.

So much better, fairer and more effective than minimum pricing, bans of advertising and sending out hyperbolic press releases to the Daily Mail!

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Lower than vermin - a Tory muses on "Our NHS"

A while ago I celebrated 35 years of being Tory Scum, of knowing that the ease with which Labour tribalists and, indeed, the left in general reaches for insults demonstrates the complete absence of any rational arguments in support of their contentions.

Today the passing of the Health Bill through the House of Commons has brought out another version of that insult - a version introduced by the original bigoted Welsh windbag:

No amount of cajolery, and no attempts at ethical or social seduction, can eradicate from my heart a deep burning hatred for the Tory Party. So far as I am concerned they are lower than vermin.

Well down here with the rats, life is good. At long last we are seeing the great monoliths of British socialism - a sclerotic health system, a school system that fails the poor and a planning system that favours the rich - gradually moved aside in favour of the patient, the parent and the worker.

You see Nye Bevan was wrong. Comprehensively wrong about almost everything. But this did not matter as this man could wallow in ignorance and bigotry, could opt for the insult above the evidence and could paint his opponents as evil. And his Party loved him for it. Loved him for his insults, for his uncompromising hatred of not just the Conservative Party but of Conservatives.

Men like Bevan set the tone for the manner in which Socialists debate - not just the 'lower then vermin' gibe but the genesis for "Tory scum, here we come". All this ferocious insult mixed in with hyperbolic predictions of gloom and despondency - or what the layman might term "outright lies".

The Health Bill is taking a small step - putting the tiniest of tippy-toes into the waters of freedom. Moving us a small way - not enough but a start - towards a public health service that actually serves the public well. A service that isn't hung up on the financial interests of doctors, that doesn't prosecute a New Puritan 'nanny knows best' approach and which focuses on the basic care and medical support that the public want.

And, yes, that might mean some competition. It might mean that GPs no longer had a local monopoly but must compete a little with eachother. It might mean that some treatments, operations and interventions are provided by the private sector (as an aside it seems odd that the left are so supportive of private sector abortions while steadfastly opposing private sector hernia operations). And it might mean that the numbing, duplicating, obsessive and incompetent bureaucracy that is the dominant feature of "Our NHS" begins to go. Replaced, I hope, with some customer service and maybe, just maybe, a smile or two.

I sat in a meeting at which the health reforms were discussed. Not one person there mentioned how to improve the patient experience - instead it was the same old discussion about who was chair of this and chief executive of that, how to manage and organise the process so as to sustain the same old faces round the same old tables. I came away profoundly depressed - this is the NHS that the Labour Party (and the truly awful Dr Evan Harris) want to "save". A place of favours and fixes, of discussions in closed rooms and of make-believe boards with no real power that discuss matters of no real moment.

If I'm 'lower than vermin' for wanting a public health service that responds quickly to patient needs, that presents choice where choice is right, that is accessible and flexible and that stretches the value from that inevitably limited public purse as far as it will go, then so be it. I'll get down with the rats and make sure ordinary people stand a fighting chance of getting an accountable, efficient and effective NHS.

The changes that might be coming - there's a while to go yet before they're law - aren't enough. But they are a welcome start. And I hope we will start now calling for it really to be "Our NHS" not an NHS owned and controlled by the bureaucrats and the medical mafia (including their big pals in the drugs industry).

Lower than vermin I might be. But it's good down here where real people live real lives and want a decent health service from the government they pay so richly from their meagre earnings.

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So it might be something other than the drink?

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Data from the Health Protection Agency suggests around 4,200 people could need a transplant owing to serious damage to their liver, with many unaware they have the condition at present.

Ah, yes! It's that "pandemic of binge-drinking" the doctors are on about isn't it?

It would seem not...

Experts estimate around 216,000 people in the UK are living with chronic hepatitis C, many of whom are currently undiagnosed. People can catch the disease through contact with the blood - and less commonly the bodily fluids - of an infected person.

Those who share needles and use unsterile drugs equipment are particularly at risk, although people who had a blood transfusion before 1991 or received blood products before 1986 have a higher chance, as well as those having treatments abroad.

Sharing toothbrushes, razors and scissors also heightens the risk, as does having tattoos.

So not just the drink then?

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GPs are acting in their business interest on this, not the interests of patients

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The GP bit of the British Medical Association - with the Law Society, Britain's most effective trade union - is in a froth about competition. The GPs don't like it. This is because it might mean the practice owners will have to work a little harder for all that cash or else someone else might come and steal away all those lucrative patients!

Speaking after July’s meeting of the BMA’s general practitioners committee, chairman Laurence Buckman said there was “discomfort” from GPs about the plan. He said it amounted to “enforced competition”.

He said: “The implication is ‘go and look to someone outside the NHS to provide services that are currently inside the NHS.’”

In short competition is good news for patients and bad news for doctors, NHS managers and other vested interests currently cashing in royally from our system of healthcare.

That is why the GPs oppose competition.

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