The rise of the Health Care Professionals : don't say I didn't warn you

Health professional

From day one of NHS BLOG DOCTOR I have been determined to warn of the gradual destruction of the NHS. Like government taxation policy, it is being done by stealth; by gradually dumbing down front line NHS services.

The destruction of psychiatry.

Three days after I started I wrote about the Community Mental Health Team in Shocking Psychiatry. In days gone by, when I had diagnosed someone as suffering from a serious mental illness that required more specialist treatment than I could reasonably provide, I referred then to a psychiatrist. Not with much enthusiasm it must be said as the psychiatric services in my area are, for the most part, dreadful. GPs no longer have direct access to psychiatrists. In my area the psychiatrists are so lazy that they refuse even to read GP referral letters. Instead, the letters go to the collection of unqualified amateurs who think psychiatry is a game; a game that can be played by anyone who has learnt a little plausible jargon. Some are well-meaning; some are arrogant fuck-wits, so intoxicated by their own perceived “power” over the patients that they think they know more than doctors. Their mickey-mouse tick-sheet medicine causes incalculable damage and demeans the patients. Those who read the Times may have seen this today:

Mentally ill are 'jollied along' rather than treated by psychiatrists

People suffering from mental illness are frequently being misdiagnosed or receiving inadequate treatment, according to a group of leading psychiatrists. The doctors say that patients with serious problems are often referred to psychologists and social workers rather than clinicians and do not receive the medical therapies they need.

“If a GP suspected a patient had cancer, he wouldn't dream of referring him to anybody other than a cancer specialist. A cancer patient might need jollying along, but what he really needs is the correct diagnosis and treatment. That's what he gets from a specialist. But patients with mental illness are not automatically referred to psychiatrists. If they only see a social worker, there's every chance that mental illness, or underlying physical illness, will be missed. Patients are getting a bum deal.” (Professor Nick Craddock)

Describing their letter as a “wake-up call” to British psychiatry, the psychiatrists say that the desire not to stigmatise people has also done damage by implying that there is no such thing as mental illness. Patients are now known as “service users” rather than patients — even though, when asked, 67 per cent preferred the word patient and only 9 per cent service user. Treatments are provided at “mental health” centres, not mental illness clinics.

Psychiatry, the group says, is the only medical speciality to adopt an approach that so distorts its original purpose. “For those with severe mental illness, to avoid medicalisation is at best confusing and at worst damaging or even life-threatening ... these individuals are being let down by the current state of affairs.”

Full article here

Don’t say I didn’t warn you. Of course, the government loves it. It saves money. To make it sound good they call it “New Ways of Working” as though there is some intrinsic merit in the something new.

A spokeswoman for the Department of Health said: “The introduction of New Ways of Working has been widely welcomed by service users, carers and psychiatrists. Working with multidisciplinary teams has allowed the needs of people who use mental health services to be better met and frees up psychiatrists' time to work with more complex clinical cases.”

You can fool some of the people some of the time… It is extraordinary how the government can get away with this breathtaking dishonesty. But make no mistake, they are getting away with it and they are extending it to the whole of the health service.

The destruction of general practice

NHS review to push for more nurse-led care.
The long awaited review into the future of the NHS by Lord Darzi will next week propose a big boost in the size of independent nurse-led provision of primary care, similar in ambition to the rise of independent foundation hospitals. The government has proposed an expansion of nurse-led services in the primary care sector in the past, but progress has been slow. In an effort to speed up the process, Darzi will suggest that nurse-led partnerships should be given a statutory right to request a local primary care trust to allow them to set up as a not-for-profit trust. (source)

Here we go again. Remember, nurses are much cheaper than doctors. Five GCSEs and three years as a student nurse and out pops nursey. Ten GCSEs, four “A” levels, five or six years at medical school and another four or five years post-graduate training and out pops a family doctor. Who do you want diagnosing you?

Darzi quotes the Central Surrey Health Partnership as example of independent nurses working in primary care. Dr Crippen has never heard of Central Surrey Health Partnerhip and had to call in Dr Google. It’s all here.

Central Surrey Health is a not-for-profit, limited liability company under contract to provide community nursing and therapy services on behalf of the East Elmbridge and Mid Surrey Primary Care Trust. The contract is similar to those held by GP surgeries (a specialist medical services contract). Central Surrey Health employs around 650 staff who formerly delivered community nursing and therapy services from within the PCT. They are:

district nurses
community hospital nurses
school nurses
specialist nurses
health visitors
nursery nurses
physiotherapists
podiatrists
dieticians
speech and language therapists
occupational therapists
support and administrative assistants

On transferring to Central Surrey Health all staff were presented with a single share in the company. As co-owners, they are responsible for delivering patient services and shaping the company's future. (Source)

Surry PCT has flogged off some of its nursing and other community services to an independent body of entrepreneurial nurses. I have no problem with that. New Labour would never admit it but this is stealth privatisation of the NHS. Is it working? I have not got a clue. Can anyone in Surrrey let me know?

Whether or not it is working does not matter. To take the usual airline analogy, this is just a load of trolley-dollies joining together and taking over the on board cappuccino and sandwich franchise. You would not want them flying the aeroplane. Which is where my Lord Darzi is being fraudulently dishonest. He is suggesting that because the sandwiches are good, the trolley dollies can fly the aeroplane.

Ministers believe nurse-run services have enormous potential to cut bureaucracy in primary care and focus care more directly on the needs of patients. (source)

Ministers also believe that you can employ four nurses for the price of one doctor but they are not going to say anything as vulgar as that. As always, you get what you pay for and, in this case, pay peanuts, get monkeys. The government knows that untrained monkeys are no substitue for doctors but thinks they may be able to fudge it by issuing the monkeys with Disease Management protocols.  With a protocol, anyone can play doctor. As Professor Sir Michael Rawlins the Chairman of NICE, the National Institute for Clinical Expedience, said today they are going to produce “guidelines for health professionals”.

Say hello to the “health professional” run polyclinics and say good bye to the family doctor. This will save you, the taxpayer, a lot of money. Maybe you will be happy to have your health problems managed by people who are not medically trained.

If that is what you want, so be it. It’s a free world. If that is not what you want, take out private health insurance as soon as possible.