Is it just women that eat breakfast in the army?

Or maybe it's only women that turn up for the photoshoot. Good idea to show that the army's not just made up of men, but is Gordon sexist? I doubt it. It wasn't Sarah Brown's idea this picture, was it?

Why do staff report high levels of bullying in the NHS?

As mentioned in the previous post, Ian Kennedy has finished at the Healthcare Commission, which has now been taken over by the Care Quality Commission. In a farewell interview for the Heath Service Journal (HSJ), he talked about bullying "permeating the delivery of care in the NHS". He, at least partially, comes to this conclusion because 1 in 6 staff say in the NHS annual surveys that they have experienced bullying, harassment or abuse from either their line manager or other colleagues.

Why should this be the case? In the HSJ interview article, Sian Thomas, joint acting director of NHS Employers is quoted as saying that chief executives needs to take a lead in encouraging an open culture. Why have CEOs not been doing this?

NHS Trusts have been measured by targets. Believe it or not, it's only recently that reporting requirements have put quality at the top of Board agendas. It remains to be seen whether this intervention from Monitor will change the target culture, but at least they've got the focus right.

Professional staff have found it difficult to get their voice heard in a culture centrally driven by business notions and targets, which do not always relate to patient care. To speak up about how such manageralism is affecting health services is not welcomed. The Royal College of Physicians has produced a report Doctors in Society: Medical professionalism in a changing world. At least the most recent Darzi review Our NHS, our future includes a focus on clinically led services.

Healthcare Commission ends its time with "appalling" report

At the end of the month the Healthcare Commission gets taken over by the Care Quality Commission. In its dying pangs, it's published an investigation report criticising Mid Staffordshire NHS Foundation Trust for significant failings in emergency healthcare, leadership and management. As I've noted before in this blog, Ian Kennedy, the outgoing chairman, really does think the Healthcare Commission has improved quality of health care.

The Commission in its press release says that it began the investigation at the trust in March 2008 "in response to concerns from local people and when it became clear that the trust stood out statistically in terms of the high death rates of patients admitted as emergencies". They've produced findings from the investigation but don't say how those findings compare with other hospitals. For example, are they sure the Trust was the only hospital where A&E triage is routinely carried out by receptionists? Is A&E consultant cover any worse than anywhere else, producing inadequate supervision of juniors? Was it the only hospital to have had "dumping grounds" to avoid breaching the A&E 4 hour target? Was it really the only hospital not to have enough nurses to care for emergency patients or inadequately trained EAU nurses? Or where there were delays in operations? I could go on. At least the Commission admits the findings are potentially relevant to the whole NHS. And this is the Commission that Ian Kennedy says has improved the NHS!

The trust’s data on outcomes for patients had caused the Dr Foster Unit at Imperial College, London to bring concerns to the attention of the trust and the Healthcare Commission. Dr Foster’s Hospital Guide showed that the trust had a hospital standardised mortality ratio (HSMR) of 127 for 2005/06. For the three years from 2005/06 to 2007/08 that the Heathcare Commission examined, the trust’s SMR for patients admitted as emergencies aged 18 and over varied between 127 and 145, statistically significant at the 5% level. There are trusts with a higher HSMR. Dr Foster says it has the fourth highest HSMR for 2003-6. Where are the inquiries into those Trusts with a higher HSMR? I'm not saying Mid Staffs is a particularly good Trust but someone's got to be at the extremes of a distribution of HSMRs.

Do you loathe me?

Like Terry Wogan I worked in a bank for 5 years. He was in Dublin; I was in Lancaster and Preston. We both got out, so we can't be blamed for the current crisis.

Still Gordon Brown is putting people before bankers. "In short, we need stronger business banks, mortgage banks and savings banks." And there's nothing wrong with getting rid of more than 100% mortgages.

She is a woman and has to die; after all

Watching someone die

Lenrie Peters

Watching someone die
is a fraudulent experience
The deep significance is felt
the meaning escapes
like a child's first punishment.
The dying ravish your strength
whether by throttle of convulsive gasp
or tideless fading away
like ancient familiar sounds in sea shells
the moment is the same
reinforced brutality to life
a rugged cliff bloodstained
with the agonising rhythm of many heads.
A cold demise; each
successive moment a banishment.
The terror is in leaving behind
the ache is in departing.

Humming fantasies crowd their stings
to seize and record the moment
the hands curl in spasm
to hold it back; this life, this infidel.
It is too late. Everything and nothing
has happened. A huge machine
the earth, grinds to a bolt-knocking halt.

It is the changing of the tide
at the boundary hour
Life like handful of feathers
engulfed by cliff winds
one like yourself swept
Oh so swiftly into the anchorage of history
Tears and sighs; sighs and tears
stamping the leaden feet
the solid agony of years
they all abound.
One life or a million
contrived by nature or by man
greatly obscures the issue.

Face to face with dying
you are none-the-wiser
Yet it seems most ignoble epitaph
'He was a man and had to die; after all.'

Lenrie Peters was born in Bathurst (Banjul), The Gambia, in 1932. He studied medicine at Trinity College Cambridge and later trained as a surgeon. He currently practises in The Gambia. He has been Chairman of the West African Examinations Council. He has published one novel, The Second Round, and four volumes of poetry - Poems (Mbari Press, 1964), Satellites (Heinemann, 1967), Katchikali (Heinemann, 1971) and Selected Poetry (Heinemann, 1981). He is the Officer of the Republic of the Gambia.

I would like to hear David Lammy's mother's experience as a young woman in Guyana

Sad story of death of David Lammy's mother. Glad to see a politician being so willing to talk about their person forming experiences. Another example. Must be taking a leaf out of the new US president's book.

What does Jeremy know about Gordon?

BBC World wide is the commercial arm of the BBC, which makes Top Gear, whose presenter, Jeremy Clarkson has called Gordon Brown a "one-eyed Scottish idiot". How much does the BBC pay for the programme? What nothing from the mole inside the TV show? Not much of a mole.

Clinicians and finance

There is evidence that disengagement can have a detrimental effect on NHS organisations. Statement from Academy of Medical Royal Colleges, Audit Commission, DH, Royal College of Nursing, NHS Institute for Innovation and Improvement, and the Healthcare Financial Management Association. They say "Clinicians should be encouraged to take financial responsibility for their service with the freedom to make changes and use the funds available to improve services". Are we going full circle to consensus management and medical superintendant?

Summary of a Prescription for Partnership. "Clinical engagement depends on effective communication and good working relationships." As I said in relation to the Ian Kennedy interview "[C]reating a manageralism that fails to provide the organisational infrastructure to support doctors in the exercise of their responsibilities is not the way forward." Eminent bodies seem to be agreeing with me.

BMJ publishes five commentaries on Doctors, patients and the drug industry

Origins of the present mass protest

Good description by Andrew Rawnsley of the fear, resentment and anger.

Fear for your job if you still have one and fear that you may not see work again if you are already unemployed.

Resentment that the agony is not being evenly shared and that some will profit from the miseries of others.

Anger with the unapologetic financiers who made billions from their follies and left less affluent folk to pick up the bill.

If Henry Porter was 20 years younger he would take to the streets.

My perspective on the economic crisis

I was in a lot of debt when the credit crunch happened. Now I'm better off and I'm supposed to spend to get you out of recession. Is this right?

Rare "feel-good" movie that actually makes you feel good?

Ok, so love triumphs in Slumdog Millionaire when we didn't expect it to, but that doesn't innoculate us against the violence. Same point made by Alice Miles.

Ian Kennedy really does think that Health Care Commission has improved quality of health care

Interview with Ian Kennedy in BMJ in which he defends use of health indicators. Measurement of quality is not easy and failure to recognise how indicators can create perverse incentives is not helpful. In fact, focus on indicators can paradoxically make quality worse.

For example, I've just looked at the first core standard in the safety domain in the Annual Health Check for mental health trusts. This is that trusts self certify that they have a system for learning from patient incidents. It doesn't matter how well the Trusts do this - just that they have a system. In fact, undertaking a root cause analysis is extremely difficult, often mistakes and misinterpretations are made leading to recommendations which are never fulfilled, even if they were appropriate.

People forget Kennedy upset the medical establishment when he gave the Reith lectures in 1980 "Unmasking medicine". He answered his critics. Medicine does need to be more patient centred. But creating a manageralism that fails to provide the organisational infrastructure to support doctors in the exercise of their responsibilities is not the way forward.

Baby P

The Ofsted Joint Area Review of Haringay Children's Services is light on detail about the findings. We need more information to be clear about the basis on which they made their judgements.

Happy New Year 2009

My webdomain is at www.dbdouble.co.uk