Dr No's Editor's Choice

A selection of Dr No's posts, ordered by number of page views. Older posts tend to have more weight because they have been around longer, and so have more time to gain page views.

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Drive-By Surgery

David ‘Ozymandias’ Cameron’s five NHS pledges – worthy of only the briefest flash in the news-pan yesterday – are already showing all the substance of five brown ballerinas. Even as he made his speech, the smart finger was on the money. PCTs have been running rings round the fixed national tariff for months, allowing private providers to compete on price.

The Bureau of Investigative Journalism has spotted a loophole, a loophole, we might add, that is as wide, open and inviting as a barn door, that allows – forgive the jargon – community services provided under the any willing provider procurement process to escape the national tariff. Since this is the kind of terminology that gives the rest of us a migraine, we may translate this to mean stuff done outside hospital, excluding normal general practice, that is not subject to fixed prices.

The XX Factor

Were it not for the genuinely sad nature of the case, the last few hours of Lynn Gilderdale’s life could almost have about it the air of a grotesque Benny Hill sketch. In a surreal speeded up video, complete with that memorable theme tune, one might see Kay Gilderdale rushing around their home, searching out pills and potions, furious grinding in pestle and mortar, frantic googling, over-size syringes full of air…

…and all in very bad taste, Dr No fully agrees. But sometimes he wonders whether it isn’t necessary to look a little harder at the current wave of mother-love hysteria that has risen on the back of the Inglis and Gilderdale trials for murder and attempted murder of their respective children.

More Stackery

stackery n., – the art of confounding people about statins.

Just when you thought it was safe not to take your statins, another report hits the fan. Or rather three. The Oxford academic Sir Rory Collins, who does for statins what Viagra does for old men, has been banging on BMJ editor Dr Fiona Godlee’s back door – curiously he declined to provide an open letter for publication - demanding she retract two articles published in the journal recently. Both articles claimed, as part of their arguments, that statins had high rates of side-effects, affecting up to 20% of all patients taking the drugs. The gist was that not only were statins pretty useless for primary prevention of cardio-vascular disease (folk with no prior history of CVD: NNT’s in the high tens if not hundreds), they also caused unacceptably high rates of side-effects, some of which were serious. The implication, though not stated in such lurid terms, was that peddling statins to low-risk folk was little short of institutionalised quackery.

Death Bandits

The Hospital Manager’s Association

Top Secret – Eyes Only

The Hospital Manager’s Guide to Massaging HSMRs

Members will be aggrieved to hear that the Doctor Foster Intelligence Unit and its lottery hospital standardised mortality ratios (HSMRs) are here to stay, despite several recent papers showing the methodology to be unsound.

Members will appreciate that they supply the raw data used by Dr Foster, thus providing opportunities to ‘cook’ the figures before they are passed to Dr Foster. The Association does not condone directly tampering with the data; however, faced with the intractable use of flawed statistics, the Association does believe members are entitled to ‘game’ the system to their advantage.

Lest We Forget: A Poppy for the NHS

Dr No observes Remembrance. Last Friday, the day before yesterday, at the eleventh hour on the eleventh day of the eleventh month, and this time as it happens of the eleventh year of the century, he fell silent and still for two minutes, and remembered those who have given their lives for the freedom we enjoy today. It is a moment of solemn awe for the sacrifice made, and of great humility in the face of such selflessness.

Remembrance was made that bit more poignant this year by the breaking news that Circle Health had signed the long foretold contract to run Hinchingbrooke Hospital. This contract is a clear challenge to the authority, competence and perhaps most of all to the values of the NHS; a challenge which, if not seen off, will in short order threaten the very life of the NHS.

The Ultimate Quack Remedy

Top Prize in the recent busting homeopathy stakes undoubtedly goes to Simon Singh for his wonderfully effective puncturing and deflating of the pompous David Tredinnick MP on the Today programme. Tredders was wind-bagging on about how they do homeopathy better in France, but he hadn’t bargained on Singh doing his homework. The best selling homeopathic remedy in France, said Singh, is a ’flu remedy made from the mashed up entrails of a single Muscovy duck that generates a staggering $15 million of revenue. It was, said Singh brilliantly, ‘the ultimate quack remedy’. Tredders had more than his wings clipped: he was permanently grounded; while Humph was reduced to muttering something about getting his hands on ‘that duck’.

Frankie Goes to Holloway

The trouble with love is that it can cover a multitude of sins.

No doubt a number of the catholic priests who abuse little boys believe they have ‘love in their heart’. Those that do not have cynically used the love of the Mother Church to mask their obscene acts. Where better for those with sin in their heart to hide than under the cloak of the priesthood?

And as in priesthood, so in parenthood. Not all parents will have the best interests of their children at heart. Some will be misguided, others more sinister in their intent. And what better mask for such a parent than a plea of ‘love in the heart’?

The Lies of Others

Twenty five years ago, the General Medical Council’s Annual Retention Fee for doctors to remain on the Medical Register was £20, and the “Blue Book” – the Council’s code of professional conduct for doctors – ran to some thirty pages. Today, the same fee is £410, and the code, which is now issued in several volumes, runs to hundreds of pages.

The Fracticalities of Regulation

The Care Quality Commission have reported on Winterbourne View, the rogue hospital exposed in May by Panorama - so that’s alright then, isn’t it, only, of course, it isn’t. The CQC headline, ‘CQC report on Winterbourne View confirms its owners failed to protect people from abuse’ belongs to the ‘report confirms thugs are thugs’ category, and is, as many have observed, a clear case of doors being bolted after horses have fled. No wonder the CGC has been dubbed the ‘Can’t Quite Cope’ commission. The moniker – undoubtedly British Dentistry’s greatest contribution to National Lampoonery – says it all.

The CQC, speaking on R4’s You and Yours, took the oleaginous line, and added what will surely become known as the Cameron defence – ‘we have all been in this together’.

Captain Mainwaring’s Commissioning

The government continues to push its quaint vision of local GPs doing local healthcare commissioning. Many who know rather more about the National Health Service than the government do have pointed out this is a non-starter. But let us imagine for a moment what might happen if all GPs did take on commissioning. It might go something like this:

Scene: Walmington-on-Sea Church Hall. Platoon drawn up, Mainwaring and Wilson face them.

MAINWARING: Right, Men. I’ve a very important announcement to make. (inflates chest) We’ve orders from the ministry to fix the NHS. Its going to be the next big thing. (inflates chest further, taps swagger stick on flipchart for emphasis) Its called Home Guard Commissioning. We’re going to show these Johnny-come-lately American chaps how it’s done.