MTAStic

The MTAS system is down for routine maintenance. This is apparently not a reaction to the discovery that the system lacks even rudimentary protection, and so allows the personal data of thousands to be accessed freely from the web. Or maybe the daily failings of MTAS are simply considered routine, which perhaps seems more likely.

So, we have a system which crashes, is difficult to access, loses data, and fails to match the best doctors with the right jobs - that as an added bonus makes identity theft a doddle, allowing anyone to masquerade as a qualified doctor and seek work as a locum.

It is reassuring to be told that these problems won't affect the rest of the £12billion pound CfH white elephant - which will make everyones medical records accessible nation-wide. Well, everyone except important people like government minsiters, whose health data will be protected. Even more reassuring to reflect on the long list of successful government IT programmes - the Child Support Agency system, for example, or the Working Families Tax Credit syestem, both of which wasted billions. Absolutely reassuring to be reassured by the same people who have repeatedly told us, despite all the evidence, what a great success MMC and MTAS have been.

Does anyone else wonder why the government feels it needs to know about sexual orientation, or why it wants GPs to record the ethnic origin of every patient? The only other governments (as far as I am aware) that have done this are Nazi Germany, Stalin's Russia and Apartheid South Africa. Are these the models we really wnat to be associated with?

Here a Quago, there a Quango,....

I have a couple of patients who need rare and expensive drugs. In my fantasy world, the specialist, patient, and GP could prescribe this - and, as mature responsible adults, the doctors could perhaps be trusted to agree what steps needed to be taken to protect the patient, and by whom.

Sadly, life is not so simple. A whole array of people sit on committees to decide whether a drug is one that GPs should prescribe. Expensive people. People who presumably believe all GPs have identical compentencies. My patients pay for NICE (national), MTRAC (regional), and local PCT prescribing committees. These all agree I should not prescribe these drugs.

All well and good, except - these drugs are expensive, so either the hospitals send patients home with a supply for all of seven days, or the patient's treatment needs to delayed for some months while all the relevant bureaucrats agree to give the hospital the money to pay for the drug (and they do always agree eventually, although sometimes the Sun pushes the Government to push the PCT to tell the committee to say yes....). In either case, the NHS deliberately leaves the patient up a money-saving creek with only a GP as a paddle.

In the meantime, we poor GPs write lots of unneccessary letters - and either obey the instructions from on high (and watch the patients become ill, their transplants fail, complications ensue) , or ignore the bureacracy and prescribe it anyway (and await flak from above)

Which would you do?

Given that the structure of the NHS routinely forces clinicians to ignore the guidance from high ivory towers a long way from reality, and that most of the guidance issued is a 'motherhood and apple pie' regurgitation of existing guidance, how many of these bodies do we actually need?

There were officially 849 Quangos in 2003 (plus more in Scotland, Wales, Northern Ireland)
Sadly, that doesn't include 43 Non-departmental Public Bodies in the Health field, and presumably excludes hundreds of others in other fields.

Yo ho Yo Yo

My man has a problem. Every month I take some fluid out of his scrotum while he waits for an operation. So far I have removed the equivalent of a pint of lager, for which he is suitably grateful. He is to polite to complain about the waste of his time, my time, and the unnecccessary discomfort, so I will. The system is failing him, and creating work for me, as he yo yos back and forth to the surgery whenever the pressure begins to tell.

North, South, East, West....

My patient has a problem. I think she needs an operation (as everything else has failed). She thinks she needs an operation. The local consultants she has seen several times think she needs an operation - but while they would like to do the op, the budget has been sent to St Elsewheres, and the patient must follow. Since I referred her, the budget has moved twice, and will probably move again before she gets to the top of the list.

So far, in nine months, she has had three hospital appointments, four GP consultations, and I have written several letters. She still has the same problem and needs the same treatment - but all these extra appointments will be taken as evidence of better efficoiency in a better health service that is doing more for patients.

Loons, Loons, and more Doubloons

Piles. Stop smiling, they aren't funny - at least not if they were yours. Once upon a time, not long ago, I could write a letter to a hospital somewhere in England - and the piles would be addressed. Slowly, perhaps - but simply.

Now, in our brave new world - I refer via Choose and Book -and the patient gets offered a choice of several consultants - but isn't allowed to know in advance which lower gut consultants treat piles!. Psychic powers, time wasted all round, and a third letter from me some months later sent the old-fashioned way.

Of coursethis lunatic system is so chaotic that many patients pay for a private appointment - so saving the NHS a fraction of the billions wasted on this computerised farce.

Holed beneath the waterline

Alex Liakos, the Medical Student Advisor appointed to the MMC panel in the belief that he was being invited to contribute, has resigned, realisying that he was being used as window-dressing for the ambitions of others. His resignation letters, combined wityh the resignations of both the national director and the clinical advisor, should be sufficient for any intelligent being to recognise that the whole process is flawed and expensive, and should be scrapped.

Sadly, there are none so blind as those who cannot see - and Patricia Hewitt (for the Government) and Sir Liam Donaldson (for his own ego?) are determined to drive MMC and MTAS onwards, come what may.

Shelley jumps ship

Shelley Heard, the National Clinical Advisor to MMC resigned, making it clear that the 'original vision' of MMC (which was perhaps well intentioned) has not been delivered, that the core principles have been lost, and that the Review committee appointed to salvage the mess is making decisions that are unfair to doctors, and which undermine the principles behind the process.

Crockard walks the plank

The pressure is finally beginning to tell - and even those involved in the MMC/MTAS debacle are beginning to admit that it is a failure. Professor Alan Crockard, the National Director for Modernising Medical Careers resigned, statingthat he had authority but not responsibility, that the project lacked clear leadership, and that it had lost the confidence of the profession. Only a cynic would suggest any link between the resignation, and his recent referral to the GMC.