Blocking HSMPs 'unlawful!'

Title amended now that I have read the lords judgement.

Foreign doctors block 'unlawful!'

"There is likely to be tough competition for junior doctor posts this year after a bid to give UK-trained medics priority in applying for jobs failed."

A Department of Health spokesman said: "We are disappointed that the Lords have ruled that our guidance as it stood was unlawful.

Ministers in England wanted overseas doctors to be appointed only if suitable UK medics were not available.

It would have meant that the thousands of overseas doctors who came to work in the NHS in recent years to plug gaps in the service would have been penalised.

But the restrictions were ruled unlawful by the House of Lords."

"A Department of Health spokesman said: "We are disappointed that the Lords have ruled that our guidance as it stood was unlawful."

"But Dr Terry John, chairman of the British Medical Association's international committee, said: "It's right that we have a debate about the numbers of doctors coming to the UK in future, but it's completely wrong to scapegoat those already here."

Just one question:

How was the government able to amend the law to stop free accommodation for young doctors, but can not do the same to give them priority?!

Australia, here they come ... Our brightest and best! :-(

“For all sad words of tongue and pen, The saddest are these, 'It might have been'.”

Alisandra ...

"People seem to get nostalgic about a lot of things they weren't so crazy about the first time around."

Every Tuesday, we all wake up very early, get a hurried breakfast while standing on our feet then everybody quickly race to the door .. fast ... before Alisandra arrives ...

Alisandra, or Alissa, as I am now used to calling her, is my cleaner. She is from Brazil and looks very much like the Andy Warhol's famous painting of Liz Taylor in the picture below .. exactly as it is but without that look of serenity, or the smile for Alissa only smiles after she's finished working ...

Alissa says that she has five children, all young adults, but has always insisted she was 29 herself .. not a day older since the day I first met her! I have never dared to question her mathematics but ... I did dare ask, on a few occasions, how she got into her 'trousers' and how she manages to walk, let alone work, in them! See, they do look as if they were painted on by the great Warhol artist himself, same look, same nostalgic style! And, she has a huge collection of the 'thingies', printed with nature, sometime, animal scenes. The one she wore yesterday was printed with a dolphin jumping into the ocean on one leg and plain blue on the other! And no, I have no idea where she buys them from.

Alissa is a true Latino of course, make up and all. Despite being here for the past three years, she can not speak one word of English, well, apart from 'cleani', 'thanko', 'no, no, no' and 'rubbiss.' Two years ago, when she started cleaning for us, I used a web translator to try and communicate with her but found out that she could not read or write her own language. So, at first, we used to phone-a-friend of hers to translate but they both used to speak, and shout in Portuguise for aaaages before Alissa passed the phone to me, only to be told by her friend that Alissa would come on the Monday instead of Tuesday of the following week! ... I had no other option but to learn a few words in Portuguese myself ... and si, Alissa still comes every 'Terca feira' to clean for us ....

Alissa starts her day screaming really loud, "Nooooooo Suja, Suja, Noooo" and then she mumbles ... I do not care to understand what she says because, from the tone of her voice and the look on her face, I am sure I won't like it ...

As soon as Alissa screams her way into the kitchen, the two cats pull their ears back, look petrified, then hurriedly head for the cat flap and leave! ... As I sometimes work from home now .. I quietly go up to my room and close the door until it is time for my room to be cleaned and then, I too must leave ....

For those who do not speak the language, ... suja means dirty ....

Alissa starts with the kitchen and finishes with my bedroom. While she is working, my movements are restricted to just between the kitchen and my room .. and I am only allowed two coffees while she is in the house but do not dare to be seen smoking in front of her ...

"Suja, Suja Aikheeee, Nooooo"

Since Alisa came to help with the cleaning, I have never seen toilet seats up on a tuesday morning, ever! And, by the time she leaves, our house is fully sponged and scrubbed so clean, you could eat off the kitchen or even the bathroom floor ... Alissa, with the use of her four word English, also managed to tame our whole family, even the Don himself and our house does stay fairly clean until she arrives the following week ... ... Amazing woman! .. :-)

The morale of the story is ... Lord Darzi, if you want to rid yourself of MRSAs, Clostridium Difficiles and the like, forget about that sourced out deep cleaning 'rubbiss' .. put Alissa in charge of cleaning your hospitals, that is if you do not close them down of course. ... employ this great woman as 'Director General' of cleaning @ only a tenner an hour. Let her answer directly to yourself, .. then, sit back and watch as all the bugs 'disappear' when alissa screams:

Nooooooooo ... Suja, sujaaaa!

Maybe Alissa will be the one 'force' finally convincing those 'up there' that it is best to allow everyone to only do the job they were trained for ... and that this would save many lives as well as a lot of money ..

Viva Alissa ...


"Bakers do bake the best bread .... "

The shape of future training

“Truth is so obscure in these times, and falsehood so established, that, unless we love the truth, we cannot know it.”

This slide was included in Prof Snowdon's as well as Prof Blurr's Presentation at the BMA's Junior Doctor Conference.

From the slide, CCT means 'Proficiency' and follows the intermediate level of training (Ends on the diagram whee the orange and blue end.) On completion of CCT, a doctor would be classified as 'Proficient'. However, the two blue boxes on top are what a doctor must do post CCT to reach 'expert' level (S) ; attaining the first box means 'gerneralist or Specialist' and attainment of the one right at the top means 'Expert Specialist or generalist.'

What will be the requirements of those top 2 blue boxes? Hands on experience? Proof of work done in the work place? Like a portfolio? Then again, I wonder where those 80 surgical post CCT fellowships fit in? To an outsider like myself, this looks as if CCT no longer means consultant or GP as we know it today! CCT, in the diagram above, is in the middle, not at the top?!

And, two things I remember most from Prof Snowden's presentation, the first one I like very much and feel is long over due. He said(not exact words) that it was time doctors didn't worry about offending other health staff when talking about doctors abilities and attributes.

He also said something else I found somewhat 'uncomfortable', that juniors have to realise the fact that not everybody will reach an 'expert' level and that this was OK! Given the slide above, I wonder what he meant, exactly?

Prof Blurr doesn't see why should doctors be guaranteed jobs at the end of their education or training, since others don't! Forgetting that ,unlike other professions, doctors were 'commissioned' specifically to work in The NHS and hence, do not have as many transferable skills as other professionals so, no job means total ruin and waste of 6 years studying medicine only to graduate to huge debt as well as unemployment.

Prof Rubin thinks it would be a great waste if doctors don't get a job on graduation.

The feel of the young doctors attending the conference was of worry and confusion IMO, mostly because of the prospect of unemployment, uncertainty for the future, the 'possible' introduction of a middle grade, the creep of other health professionals on doctors duties, How to train in that climate of confusion ..etc.

One thing that the juniors agreed upon that I felt was very important, informing would be medical students of the reality of the situation out there ...

If only current junior doctors had the 'luxury!'
In the slide above, why are there 2 blue boxes 'above' CCT? and, what are the requirements of those top 2 blue boxes? How will 'expert' status be awarded?

The BMA strongly opposed the 80 post CCT fellowships but their creation is now inevitable since Mr Ribeiro believes they are an opportunity to acquire more delicate surgical abilities. Since then, they have been passed and agreed upon by the programme board, so, they are happening.

Surgical trainees do not like the idea .... has Mr Ribeiro just opened the doors wide for the introduction of the sub-consultant grade?!

Can someone explain this slide above to me please? It looks strange ..... but, ... I am no medic


“POSTERITY, n. An appellate court which reverses the judgment of a popular author's contemporaries, the appellant being his obscure competitor.”

The junior doctor conference

The BMA junior doctor conference 26/4/2008 ... Complete, long and Uncut!

The theme of the conference is ‘the role of the junior doctor in the future’.

Speech by Mr Ram Moorthy, chairman of BMA Junior Doctors Committee

The NHS @ 60

2008

“ Wars may be fought with weapons, but they are won by men. It is the spirit of the men who follow and of the man who leads that gains the victory.” George S. Patton


Ram Moorthy, chairman of the British Medical Association's Junior Doctor Committee is expected to say tomorrow in the junior doctor's conference:

"Junior doctors feel that they are not viewed as dedicated professionals who embrace a difficult role, and make decisions of fundamental importance.

"They keep the service running, working anti-social hours, covering gaps in the rota, whilst always ensuring that patients receive the high quality care they deserve and expect.

"Instead junior doctors are made to feel like a nuisance, a problem to be 'got round' by employers and government.

"We need not only unity in the profession, but respect from the civil servants and the managers, an acknowledgement that we are all on the same side, striving for an excellent service for patients."

That's the way BMA .....



I wonder how many thousand 'aspiring' doctors will be unemployed or stuck in dead end careers at the end of the 2008 MMC recruitment?


“You will never do anything in this world without courage. It is the greatest quality of the mind next to honour” Aristotle


1948

War on The Professions

“Red sky at night, sailors delight; red sky at morning, sailors warning”

BBC Radio 4's Analysis: War on the professions was broadcast on Thursday, 24th April 2008 at 20:30 and repeated on Sunday 27th April at 21.30 BST

'Government wants access to legal services to be much more widely available and cheaper. It also wants more flexibility in, say, the medical world, so that nurses can do some jobs historically done by doctors.

The professions warn that this risks reducing quality and lowering standards for everyone

The question of who polices the professions is also bitterly contested. They have long been largely self-governing, seen as a guarantee of protection from government interference and a way to uphold the highest standards.

But government has begun to regulate more and more directly, through powerful new bodies - for example the new Legal Services Board, the Architects Registration Board, the Postgraduate Medical Education & Training Board, PMETB.'

Listen or read the transcript of to the programme here

Attended by

• Sir John Tooke

• Bernard Ribeiro President of the Royal College of Surgeons of England
• Professor Peter Rubin chair of PMETB

In the same programme, Bernard Ribeiro, head of The Royal College of Surgeons warns:

Top Doctors are not ready for posts

'The dispute centres on candidates who may not have a conventional UK-based training but who claim to have equivalent qualifications and experience. '

What do you think? Are the professions untiting to face this aggression?

“One timely cry of warning can save nine of surprise.”

Coffee beans for brains!

"If you're a pretender, come sit by my fire, for we have some flax-golden tales to spin. Come in! Come in!”

The BMA today 22/4/08 gave it's backing to 'targeted' expansion of hospital consultants in needed areas

“At its recent meeting, the Joint Medical Consultative Council (JMCC) formally welcomed the launch of the CCSC campaign for a targeted increase in consultant numbers. In the NHS Plan, the Department of Health made a commitment to draw on national service frameworks to ensure that 'workforce plans will match the new standards of care with the numbers of staff required to implement them' and that 'NHS trusts will be performance managed against these standards.' The Council therefore endorsed the need for an immediate, focussed and planned expansion of consultant numbers where the evidence and need exists."

Dr Alan Russell, Chairman of the JMCC said:

‘Consultants are highly skilled specialists in their field and are valued by patients. They are also cost effective in providing all patients with the highest standards of care. In order to maintain and indeed improve this high quality care, the JMCC believes that a targeted expansion in consultant numbers is essential now. Further to this, proper workforce planning with strong local input is needed and national oversight in the medium to long-term to ensure that we will be better able to produce the number of doctors we need.’ “

Of course, in his BMA TV broadcast, Dr Meldrum, chairman of the BMA said the same. He also justified the need for more consultants, in particular, in specialities that currently suffer under provision of consultants such as Obs &G, Paediatrics, Trauma, Emergency Medicine. He explained that a consultant led health service will not only address the current under provision of consultants but will also address the increase in the medical school intake as well as being clinically and cost effective ... reasoned logic.

And, a good solution to many problems. That's if you ask anyone with the even the smallest degree of ability to think logically .. but, not this lady! Dr Karen Bloor is a Senior Research Fellow and a PhD in Health Sciences at the University of York.

As soon as the BMA launched their campaign to expend consultant numbers, she published this article in 'Onmedica' In it, she, sarcastically, even vindictively, suggests further grounds on which the BMA should have used to enhance and build this campaign, like the European Working Time Directive as well as the impact of more doctors, especially women, working part time .. etc. ... then, she proceeds to her 'real' aim, questions the need for more consultants:

'There are, counter-arguments to the BMA’s position. Firstly, it seems that they are arguing for a short-term or even immediate expansion in the consultant workforce, rather than the usual medical workforce planning tactics of increasing medical school intake and waiting for a decade or so.'

Hasn't she seen what Dr Meldrum said on this point on BMA TV?! He was talking immediate, short term as well as long term! a comprehensive solution to the current problems that were the direct result of disastrous workforce planning! A consultant led health service is the answer to the increase in medical school intake which was the result of uncoordinated and ill thought workforce planning. The flawed planning which did not take into account that roles will be stolen from doctors and given to nurses instead, thus reducing the need for all the increase in medical school intake in the first place, even if Britain is aiming for self-sufficiency !

"The BMA makes no comment about the overall expenditure consequences of their proposed expansion, or the opportunity costs foregone. The substantial recent increase in salary costs of employing consultants creates considerable incentives for further exploration of a different skill mix in health care, and there is increasingly an evidence base for the potential of non-medics conducting routine endoscopies, radiography and other previously medical roles. Physician assistants are also increasingly in place in areas of medicine such as anaesthesia."

Of course, the lady is not a qualified doctor to be able to appreciate and consider the cost of litigation by those poor patients who will suffer the results of her 'expert' (In economics and not medicine) opinion, and/or their families if all the roles she mentioned became previous to doctor's duties for good! And, if the duties she mentioned have gone to the nurses for good, how will young doctors be trained? Not only on the stolen roles but on bigger roles that require firm knowledge and extensive hands on experience in the roles she mentioned?!

Then again, does it ever occur to anybody that training nurses to specialise in those roles costs money too? that those trained nurses demand, and will keep demanding, more and more money to do these roles? Of course, on the skills escalator, 'specialist' nurses stop at just one level below that of a consultant! So where are the savings on costs then?! Especially when you consider that a consultant's help may sometimes be needed when these nurses get themselves into deep waters and the resulting litigation if no consultant is available to come to the rescue!

She then return to her area of 'expertise:'

' it is impossible to comment on this area without raising the issue of the huge variations in medical practice that have been ignored for decades in the NHS and elsewhere, the substantial variations in activity rates of existing consultants and the lack of attention to productivity in the consultant contract. '

And what do you base your 'extensive' knowledge in this area on Karen Bloor? ... your long list of research perhaps?

'The public accounts committee pointed out that following the new contract, consultants pay increased by around 27%, their working hours decreased and there was no measurable improvement in productivity.'

No! She based her opinion on on The public accounts Committee decisions! so, this is not a 'finding', it's an opinion ... and we all have opinions, don't we?! But science does not pass judgement based on an opinion! Or, .. Maybe it does nowadays, does it?!

Didn't The BMA said before that the above decision was misleading because it did not take into account the extra unpaid hours consultants were doing anyway before the new contract?! Is she ignoring this for a reason?

'The Department of Health continues to produce comparative data on consultants’ clinical activity in ten specialties, which illustrates the level of variations between individuals, with and without adjustment for casemix differences, and highlights hospitals’ own consultants within the national distribution. This should be developed further and used to improve measurement and management of consultant activity and variations in care. This should inform gradual adjustment of the consultant workforce, rather than precipitate large-scale expansion. '

There you are! Loud and clear, she is effectively saying that there is no need for more consultants, promote 'noctoring' instead! ... No solution as to what to do with the increase in medical school intake and the current numbers of doctors competing for the small number of training posts?! Then she goes:

'Let’s stir the coffee before we add more sugar, and then add just a little at a time.'

... and what if 'they' do not want to take suger in their 'coffee'?! .... all the 'leaner', I suppose!

This is the most stupid quote I have ever heard in my whoooole life! It's dumb to say the least! .... good only for the simple minded, products of Polytechnic cr@p having a go at interfering with 'excellence!' ...

There you go Dr Meldrum, when she was being sarcastic, she meant to say to The BMA .. blah, blah, blah ... that's waaahy the laddyy is a .... senior researcher and ... a PhD

And where did the lady get this 'quote' she most admires from then? Professor Kevin Grumbach of the USA!

Better we all packed our bags and just went over, instead of them all coming here ... then again ... no way coffee head!


“These high wild hills and rough uneven ways

Draw out our miles and make them wearisome;

But yet your fair discourse hath been as sugar,

Making the hard way sweet and delectable.”

Opportunity knocks!

“A man is rich in proportion to the number of things which he can afford to let alone.”

DoH "We consider it appropriate junior doctors are treated exactly the same as other NHS staff."

Despite being awarded a pay increase less than inflation, hospital accommodation for FY1 doctors has also been removed! The loss is equivelent to a 20% real pay cut! The doctors and their representatives objected to this start unfairness but the DoH says doctors should be treated 'exactly' the same as other NHS staff because:

"Changes to working patterns and new rotas making it unnecessary for junior doctors to be 'on call' have allowed the Government to remove the residency requirement."

Of course FY1 doctors still do on-call duty even work 'unpaid' overtime to fill gaps in the rotas caused by the rushed implementation of MMC and the resulting 2007 training debacle ... but, Ms/Mr DoH spokesperson, these are not on-call rooms! They are permanent accommodation for the FY1 year! .... Amazing when the DoH 'spokesperson' doesn't know what they are talking about! No wonder, they haven't got a clue so how can we expect them to be fair!

Then again, the spokesperson said the juniors should be treated exactly as other NHS staff. Does this mean medics will have their university tuition fees paid for them and a yearly grant for the six years at university, like other health professionals and the huge debt they currently owe due to the current unfair discrimination be wiped out?!

Will this also mean that junior doctors will be considered 'key workers' like other NHS staff and be allowed all the benefits of same, including buying and/or renting property, something which is currently not the case?

Isn't the mess of 2007 regarding specialty training for junior doctors and the security breeches that left all their private details exposed online enough? The 2008 competition ratios are between 3:1 and 50:1 because of the debacle of 2007, not fair? In 2007 thousands of juniors were made unemployed or left the country to find work abroad, the same will happen this year and beyond. Morale is at an all time low!

If the juniors are to be treated 'exactly' as other NHS staff then the juniors should get their tuition fees paid while at university and also get grants similar to those awarded to the nurses, for example, who get over £7000 a year. Of course adjustments will have to be made to reward the medics for the depth of study they endure which is much more intense in nature compared to other NHS staff and compensate for the expensive books and equipment they must buy to facilate the study of medicine. Hence, their yearly grants should be much higher than that of the nurses for example.

Again, to treat the juniors 'exactly' as other NHS staff means they should be paid a 'full' wage as if they were employed by the NHS on full time basis, from year 4 on while at university, since other NHS staff spend only 3 years to graduation and since it is the DoH who wants the medics to study for 6 years instead of 3 and 'commissioned' them for that purpose and for the purpose of mastering the full time consuming, packed and extremely labourious made to measure and fit for purpose syllabus. It is therefore only fair to pay medics a full wage while at university for those further 3 years.

This means that current juniors should have all their debt removed and any payments they made refunded, with interest. They should also be compensated for the loss of grants for three years plus the loss of earning for a further three years. For those who paid tuition fees, this money should also be refunded.

Here are some calculations of the sums the government must pay back to every F1 doctor in the land, (approximate and rounded up) ,that will ensure junior doctors are treated 'exactly' as other NHS staff:

£
3 years loss of grants @ say £10,000 per year = 30,000
+ compound interest for 6 years @ say, current base rate of 5% = 8,000
3 years on full pay while medics @ £19,000 per annum = 57,000
(assuming the same wage as a graduate nurse and no year2,3 rises)
Plus same compound interest for 3 years = 6,000
Pay back tuition fees with interest = 8,000
_____
Owed by government to each F1 doctor = 109,000
Plus the government must wipe the junior's current debt
averaging £25,000 (taking into account final year grants for medics)
Hence, cost to government per F1 doctor = 109,000 + 25,000 = £134,000

Around 5000 doctors graduates to F1 in 2007,
hence, one years's cost to government = 134,000 x 5000 = £670,000,000

Of course these are rough calculations that account for the current F1 doctors only. The figure will run in billions and billions, should are doctors currently in training be treated 'exactly' the same as other NHS staff!

Forget about this run-down and depressing hospital accommodation doctors,

go demand your right to be treated 'exactly' as other NHS staff, as the DoH spokesmen at the link said you should be!

Then you can stay at the local Hilton for the whole of your F1 year and buy a nice brand new BMW to go to work with too! ...

maybe play some golf on the way too ... if you have time ... :-)



“No man is rich enough to buy back his past.”

Morale

“Morale is faith in the man at the top.”

Your Excellence

“An ambassador is not simply an agent; he is also a spectacle.”

Appreviated 'HE' as in His/Her Excellence, this title is attributed to those who mainly work in diplomacy and/or represent their countries on foreign land, sometimes even as heads of state, prime minsters ... etc. However, it is mainly how Ambassadors of any country are addressed. Wikipedia doesn't explain how or why the title came about but the clue is in the title itself. Since ambassadors represent their countries wherever they are appointed, the embassy building itself is then considered to be a small version of the country being represented within the host country, hence it enjoys diplomatic immunity and is allowed, within the confinements of its building/s to apply it's own countries' laws and this is respected by the host country so long that this is done within reason.

The ambassador's role is key to the success of his/her diplomatic mission in dealing and negotiating with the host country, many of whom are sometimes not friendly, even hostile but hide prejudices behind curtains of diplomacy. Sometimes the host country even opposes certain aspects of how a particular country is governed or its laws and policies or tries to manipulate same to protect it's own interests in the region where the particular ambassador presents a certain country.

Therefore, unless an ambassador has excellent diplomatic as well as personal attributes and abilities in order to portray and present their country's interest in the best possible light and gain the most benefit, unless they are excellent in negotiating and achieving the most for their people, they lose out on the world's diplomatic stage and the consequences can be dire for the whole people concerned. A lot is always at stake hence, ambassadors have to always be vigilant as well as diplomatic as well as tough and vigilant in the same time. it is a vital that an ambassador is excellent, hence the title of HE.

Everything about an embassy from its top to its bottom contributes to it's image and own degree of success in the host country. Including the character and behaviour of the ambassador as well as his all other members of his/her mission who are always closely monitored by the their superiors and equally by the host country. Even the building/s that houses an embassy is of vital importance because it's depicts the status of a country on the world stage so the more imposing, the perceived more prominent status. British embassies around the world are known for their elaborate and imposing architecture and/or it's grandeur, no wonder :-)

Ambassadors as well as their whole mission and entourage are always under the microscope and have to bear this in mind in whatever they say or do.

Excellence IMO is of vital importance the weaker the countries because ambassadors representing strong and powerful countries will only be assigned to impose their ready made foreign policy taken back at base. It is then up to the weaker country to negotiate a better terms or a 'compromise.' To do so, an ambassador receives instructions from his own foreign minister or directly from his head of state, then convey same to his counterpart who then comes back with his/her own instructions and so on ... But, sometimes, an ambassador has to improvise and innovate to reach a beneficial compromise for his/her people. In doing so, s/he has to then convince their own superiors that their innovative way is the right route to take, then convince his/her counterpart of same .... It is this ability to convince/compromise/innovate/initiate that leads to the ambassadors being rightly addressed as 'your excellency.'

The BMA is the embassy of medicine to Britain.

The organisation had clout up to the beginning of this millennium. It is not short of grandeur in status and/or architecture and has always enjoyed top status amongst the embassies of other 'professions'. Actually, it probably enjoys the best standing amongst same ....

Dr Meldrum is the Ambassador of British Medicine to Britain. Unlike some 'others' who were in this important role before him, Dr Meldrum is thought of as a man of true integrity, intelligence and good will. But, if he is to succeed in facing the huge challenges he inherited, fix and heal as well as win back the trust of his own people, especially those who were estranged by the 2007 saga, he must make sure that he as well as every other person inside his grand and imposing building abides by the rules of embassy. Everybody inside the BMA mush always act and behave just as if they were another Hamish Meldrum.

Thus far, his attempts at modernisation are good and well intended, although a little meek at times. However, I think that he is on the right road and that he will do much more to modernise his organisation as well as improve it's slagging image. I was very impressed when he apologised unequivocally to the juniors for the debacle of 2007, which wasn't even his own fault, but the very act shows that he sincerely means well. His suggestion of 'a day of action' over the F1s accommodation is the type of tough stand that needs to be adopted to face the many hostilities faced by the profession these days. This move is therefore, very welcomed and long overdue. I hope consideration of such action does not stop at the accommodation issue only but to be adopted whenever a tough stand is needed, to show that doctors will fight back ... on all fronts.

Dr Meldrum was confident in his broadcast but the BMA as the sole representative of the profession needs to show some teeth. Dr Meldrum needs to present his members and the profession as the confident, important and leading profession that it was up to a little time ago.

He has the huge task of bringing back British medicine to life, to reclaim the status and standing of medicine in the UK and restore its reputation for excellence around the world.

Watching all the video clips on BMA TV, I would suggest that his 'presenters' should, like the most professional presenters in the world, rehearse their material before they go on air. Everything counts when you are an ambassador entrusted with heavy tasks, including how you present yourself. You must make sure you are believable if you want people, including your own to believe in you. In order to do so, one has to personally believe in the material they are presenting themselves! Very important, specially when you are engaged on all fronts in a battle you can not afford to lose.

Lat, If I were Dr Meldrum and am sincere about my apology to the juniors, about modernising, healing and gaining back the trust of my members, especially the younger ones whom I badly need if my organisation is to have a future, I would take those, whom I have already liked and adopted most of their ideology, who have already proven to their followers as well as their opposition to have 'teeth', who have been in the 2007 debacle themselves and have been and still are successfully fighting and achieving lots for their rightful cause,

I would finance the innovators, Remedy UK and take them and their members fully under my wings, if only for my own benefit.

Modernisation means; new ideas, new blood, new strategies that are sure to lead to a winning all the way .... this is but one 'guaranteed' route

Dr Meldrum needs to think like an Ambassador ... and to think 'teeth' sometimes!

.... He has a blank canvass to set his own laws within his organisation to depict his own ideology and his own excellent standards

... and your most urgent challenges Dr Meldrum are UNITY and MORALE!

Everybody is waiting ..... Good luck



“What is your substance, whereof are you made,

That millions of strange shadows on you tend?”

Dr Meldrum on BMA TV ..

He wants more jobs for the juniors, more consultants for the near future .... But, what is happenning with the specialty recruitment in 2008? .. No clarification ...

He likes facing challenges and, he has lots of them!

Anyone out there?!

"Do not stand in a place of danger trusting in miracles."


Any idea when is the HSC report on Modernising Medical Careers coming out?

Any idea when will the Lords decision regarding priority for the Brits be known?

Any idea how is recruitment to specialty training 2008 is progressing?

With competition ratios as crazy as 50:1 and a minimum of 3:1, where are all the applicants? Have you been suited? Or, not been suited?

Remedy's forum should be full of stories by now but it is vertually deserted!

Where are all the parents? Deanery progress reports, MMC announcements, DoH media releases, channel 4, The Telegraph, Professors, anything at all ..... ???

Does anyone ahve any information at all?

Where is everybody?!

Anyone out there?



Talon:"WILL SOMEONE PLEASE KILL LUSIPHUR!?"
Fleece:"YOU KILL HIM!"

BMA TV

"United we stand, divided we fall"

It seems the BMA has taken my advice and is modernising! ;-) The BMA has been a lot more active with regards to junior doctors of late and has been making much more noise than it did in 2007. One can even go as far as to say that it is beginning to really care. As part of the modernisation, it's now got a few clips on YOUTUBE, no less. And, they have their own link, it is called BMA TV ;-) Good idea!

They already have a small number of video clips on different issues concerning all levels of doctors. In this 'broadcast' above, Dr Jonathan Fielden speaks on consultant issues. I like what Dr Fielden said about consultants taking back leadership to ensure high quality patient care as well as support junior doctors through these hard times. I also like the fact that the BMA is adamant not to support the sub-consultant grade and it's reasoning for doing so; not good for patients, disaster for the juniors in training and their aspirations and destabilising for current consultants. It seems however, that a post CCT 'fellowship' programme has already been agreed by 'the programme board', The BMA is very opposed to the decision to implement same and has made this statement on it website .

As you can see in that video clip above, Dr Fielden says the government is listening, but not enough and can listen more, how very true!

I wonder, does the BMA have any idea how recruitment to specialty training 2008 is progressing? If it does, maybe they should shed some light, maybe make a broadcast on BMA TV to put the minds of those waiting, and their families at ease.

I did expect the BMA will improve under the leadership of Dr Hamish Meldrum, who enjoys a good reputation among his peers as well as in the very important 'higher circles.' IMO, the difference in leadership is beginning to show with some positive results so far. However, I believe the BMA is capable of doing much more to highlight and demand ease the difficulties currently faced by the juniors and seniors alike.

Dr Fielden says in the clip above that he wants consultants to have a bigger role in leadership but, as Dr G said in a 'comment' on one of his 're-released' posts, he said that management seem to want to wriggle out of involving senior doctors in the decision making process. I have heard the same from another consultant before. Such a shame, to exclude those who definatly know best and are committed to do best by their patients. It is therefore, the duty of the BMA to fight for the seniors right to leadership as well as the right of training for the juniors ... if doctors of all levels, especially those it lost in 2007, are to believe again in the BMA and that their union is serious about modernising and about standing united to face the uncertainties of today and of tomorrow.

It is the duty of the BMA to unite this great profession and effect real change for the better for all doctors.

I think the BMA can achieve a lot more if it tried harder ... including win back the trust of it members, of all ages ...

Is the BMA doing anything about the number of doctors who will face unemployment this year as well as fight for enough future posts for the 70% increased intake of British medical schools?

This would be an excellent move to show good will.


“The glue that holds all relationships together - including the relationship between the leader and the led is trust, and trust is based on integrity.”

Pregnant males ... and why not?!

“The poetry is all in the anticipation, for there is none in reality”

Not that it is something new! Sea horses have been doing it since they were put on earth!

"When two parties discover a mutual interest at the beginning of breeding season, they court for several days, even while others try to interfere. During this time they have been known to change color, swim side by side holding tails or grip the same strand of sea grass with their tails and wheel around in unison in what is known as their “pre-dawn dance”. They eventually engage in their “true courtship dance” lasting about 8 hours :-0, during which the male pumps water through the egg pouch on his trunk which expands and cleaves open to display an appealing emptiness. When the female’s eggs reach maturity, she and her mate let go of any anchors and snout-to-snout, drift upward out of the seagrass, often spiraling as they rise. "The female inserts her ovipositor into the male’s brood pouch, where she deposits her eggs, which the male fertilizes. The fertilized eggs then embed in the pouch wall and become enveloped with tissues." New research indicates the male releases sperm into the surrounding sea water during fertilization, and not directly into the pouch as was previously thought. Most seahorse species' pregnancies lasts approximately two to three weeks.

As the female squirts anywhere from dozens to thousands of eggs from a chamber in her trunk into his pouch, her body slims while his swells. Both seahorses then sink back to the bottom and she swims off. Scientists believe the courtship behavior serves to synchronize the movements of the two animals so that the male can receive the eggs when the female is ready to deposit them. The eggs are then fertilized in the father’s pouch which is coursed with prolactin, the same hormone responsible for milk production in pregnant women. He doesn’t supply milk, but his pouch provides oxygen as well as a controlled environment incubator. The eggs then hatch in the pouch where the salinity of the water is regulated to prepare the babies for life in the sea. Throughout the male’s pregnancy, his mate visits him daily for “morning greetings”. The female seahorse swims over for about 6 minutes of interaction reminiscent of courtship. “They change color, wheel around sea grass fronds, and finally promenade, holding each other’s tails. Then, the female swims away until the next morning, and the male goes back to vacuuming up food through his snout.

When the babies are ready to be born, the male undergoes muscular contractions to expel the “fry” from his pouch. He typically gives birth at night and is ready for the next batch of eggs by morning when his mate returns”

I don't mind men being issued with pouches to hold and give birth to their own children! Let them get a real taste of what we women go through when carrying and giving birth to their babies.

.... and ... I actually find the life of a female sea horse really appealing ... clever girl ...

But, as the telegraph says in the article, the world is still waiting for the first true male pregnancy....

When this really happens and when the novelty wears off, how boring is this idea?!

Then again, can the need justify the means? If some women can not bear children, why shouldn't the husbands do it themselves instead, if science can find a way?


"Fencing is a game of subtlety, and bluff can be met with counter-bluff."

A bit of day dreaming ...

“Develop a built-in bullshit detector.” ... Ernest Hemingway

Being a non medic, I sometimes wonder what patient confidentiality means these days? How could this confidentiality possibly be protected when 'the Spine' is fully implemented and everybody and anybody working within the NHS, anywhere in the country can access patient information at a touch of a button?

Then again, outsourcing , as far as I understand, is done without patient consent! Delicate information about real people is being sent around the globe to either be typed, because most consultants no longer have secretaries, or X rays being reported on by doctors in a far away land who have never heard of the patient's name, let alone met with them.

Well, the Spine database is not cheap, it is predicted to cost around 14 billion when it is finished. I do not believe that outsourcing, either X rays or typing abroad is cheap either. Not when you consider the cost of all the mistakes, the litigation it is bound to generate and the cost of the man power that was and will be made redundant as a result, include highly trained professionals like radiologists.

I know someone who does a bit of gambling every now and then. I once asked if he does not feel a little stupid to see his hard earned cash lost in a flash on the Roulette table like this? His reply was; you don't feel it is real money when you are by the table, you only play with the chips! Did I spell 'chips' right?

I wonder what 14 billion pounds look like in real money?! How high a mountain will they be if they were mounted up in front of the politicians who make decisions such as 'The Spine?' Maybe if they saw, in real life, what they are about to spend, they would be a bit wiser with this money and spend it on 'real' things to make their people happy and fulfilled instead. Employ everyone who wants a job, including our young doctors and pay them well for their life long effort. Provide for their proper training, give the juniors as well as the seniors, their desk space and their secretaries back. This doesn't cost much, no where near 14 billion pounds but will make one's own family happy, doesn't it? ... Just some tender, loving care and the results will just be wonderful ... including ensuring proper patient care and confidentiality ....

Won't that be the wise thing to do?


"if i could rearrange the letters of the ABC's i would put U and I together and next to each other forever...."

What did you expect?!

“Kind hearts are the gardens, Kind thoughts are the roots, Kind words are the flowers, Kind deeds are the fruits, Take care of your garden And keep out the weeds,

Number of complaints against the NHS soars.

'The Healthcare Commission, the independent watchdog, investigated more than 10,000 cases last year. Complaints included cases of patients left in soiled bedding and allegations about rude nurses.

'The commission upheld 20 per cent of complaints, more than twice as many as the previous year. Almost a third of complaints about hospitals involved lapses in basic nursing care.

Patients reported that they did not receive regular baths or showers and, in some cases, were left for hours in soiled bedding or clothes.

Nurses barged in on patients when they were changing and could be "abrupt" or "sharp" when speaking, making them feel like a nuisance, the watchdog found.

In some cases call bells were left out of reach and elderly patients were not given help with eating

Other complaints were that accident and emergency services withheld pain relief and that women were left on their own while in labour.'

But, why blame the nurses? Blame those who took the nurses away from what they do best, care for needy and sick people, to dangerously play doctor instead!

This is simply pay back time ... and, it will prove to be spectacularly expensive if this state of affairs is allowed to continue!

But, it's not about money, it's about those people who thought they were in good hands, or is it?

For every action, there is an equal and opposite reaction.

We are training our competitors!

“You were put on this earth to create.”

The number of home-grown chemistry and physics PhD students is in a worrying decline

And soon, PhDs in medicine will be on the decline too, if this is not the case already! Now that a PhD in medical discipline, no less, counts for only 1-2 points when applying for a job, while a bit of summarised prose counts for 4 points! When you ask a PhD doctor to describe a 'time when they worked under pressure!!' ....

One junior is currently in an academic post, gained in the second round of the 2007 feast of fury! Despite being in a far away land, he is happy because he is training in a specialty he likes. MMC rules means he is now doing an integrated MSc and in two years time and will have to decide whether he should take sometime out to do a PhD or leave academia and continue with clinical run through.

Being Academic also means the possibility of needing more time in order to cope with research, the MSc and the clinical training, ie, one year as an ST1 and possibly 2 years as an ST2. As he always wanted academia and has the ability for its rigours, gaining a PhD one day was not even spoken about much because it was considered to be a natural outcome, inevitable .... not anymore! He is having second thoughts now and for so many reasons. None of which is because it will be difficult to achieve or will require real hard work to conquer its tough demands.

First, he had to pay for his MSc because there were no funds available from his academic source, then there is not much help or understanding from the consultants he works with. In one rotation, the consultant would not understand why he be in the hospital for only three days of the week rather than the full five. Of course he has to attend one day at university for his MSc and another is dedicated for research. In any case, this consultant will only pay 75% of his wage and the rest is borne by his academic dept .. but, despite that, there was an argument that lasted for a while, then everybody had to compromise. It was agreed that he would work the full week in the hospital, apart from one afternoon for three months and do all the required on call and night duty of the 4 months within the same period, then dedicate the fourth month to academia. These were three exhausting and quite unfriendly months to say the least! When those finished and despite the agreement, he was asked to do more on call after his academic office hours and he did. Then he was asked, only two days before, to do a few nights and he refused on the grounds that he no longer belonged to that particular rotation and because it was during Easter and he had arranged and paid for a short break away with a friend.

He does not have any ill feelings against that particular consultant because he too was under great pressure and with very little and inadequate resources ...

Its the system that does not understand, not the humans within.

There is also no incentive when a whole PhD in medicine is rewarded at the end with two points when applying for a job and ... all those returning from research were treated like dirt last year. They lost out instead of being rewarded for their extreme effort and hard work! To top it all, there are not enough jobs and competition is much fiercer as well!

Now he is having second thoughts and although he has not ruled it out yet, he is beginning to ask, why do a PhD? Why struggle with financing this study and why lose out on jobs or watch as those of the same age bypass him without having to endure a PhD that will at the end act against and not for you? .. and maybe no chance of ever becoming professor either because there are hardly any academic jobs!

It will be a shame if he decides not to go for a PhD at the end ...

As the article in the link says, British universities are full of PhD students from rising countries, starving for the knowledge and the science we possess and good for them. But, unless you provide an incentive for the home grown talent, those with the ability to excel and desire to invent, unless they are properly acknowledged and rewarded ... Britain will no longer be able to hold it's position as a top class center for scientific excellence and innovation. And, as we train those from abroad, they will return home to build centers of excellence in their own countries and while we fall behind, those will rise! ... and no one will come to us to get a piece of our excellence anymore ... In effect .... we are letting our own down and at the same time ...

We are training our competitors!


“If the world operates as one big market, everyone will compete with every person anywhere in the world who is capable of doing the same job. There are lots of them and many of them are hungry.”

Dr nurse!

“No man, not even a doctor, ever gives any other definition of what a nurse should be than this - 'devoted and obedient'.”

'Dr nurse' is one of Dr Grumble's 'shared items list

'A fresh supply of well-trained primary care practitioners could help counter a physician shortage.'

'since these nurses with a doctorate can use “Dr.” some physicians worry that patients could become confused. “Nurses with an advanced degree are not the same as doctors who have been to medical school,”

Of course! and how misleading and dangerous is that?

Why are they not considering training more doctors to be GPs instead then? And the 70 extra medics recruited by medical schools, what will become of them?! It seems that, in the UK, everybody is having a go at medicine apart from doctors! With not enough training posts and according to MMC, many FY2 doctors who do not secure a post in 2008 will be given councelling to leave medicine!

Madman's logic! train doctors at great expense then ask them to leave medicine 2 years after graduation and 'upskill' nurses to do their work instead and pay for the upskilling too! ...PhD are now a penny a dozen! Any Tom, dick and Ali can get a PhD nowadays! I bet hospital porters will soon be doing PhDs on bed maneuver in hospital corridors! PhDs are a plenty these days, some not worth the paper they are written on while some others in diciplines than can't possibly satisfy the rigour of a 'true' doctorate degree!

With this Dr nurse in mind, is there any hope of Professor Tooke's recommendation regarding redefining the role of a doctor being implemented? If there is, how?

Some of the junior doctors I know tell me that some nurse practitioners have their own rooms or offices in the hospital where no one is allowed in, even the doctors, while those same nurses are allowed to walk in anywhere they like including the doctor's space. A doctor posted on the Remedy forum that his hospital wants to close the rooms used by doctors while on call! He said that the hospital intends to also make any on call rooms left 'mixed sex!' How will female doctors rest under these conditions? Of course, many will not, so, how safe for patients to be treated by an extremely tired doctor is this? ... I wonder if this does not go against a person's human rights? Is this legal? ... I wouldn't be surprised if this doctor posted again on Remedy that ttheir on call rooms were converted into offices for the Dr nurse brigade! Post MTAS, nothing surprises me now ... It disgusts me ...

... I am really beginning to dislike the term 'junior' and think it is acting against those highly trained and very well qualified fully registered professional doctors whose only fault is that they are young!

All this above is a disgrace! ... insanity!


Reading this Florence Nightingale quote at the bottom, this is one nurse, who should be listened to by those who decide on these crazy ideas, even that she is long been dead ....

“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion”

Florence Nightingale

Yes, he can

“Innovation distinguishes between a leader and a follower.”

This article in the times is asking; Can Lord Darzi reform the NHS?

Well, if it about ability, then, of course he can! He is an intelligent man with lots of skills and attributes and despite becoming a British citizen only in 2003, he has lived here for long enough to learn and understand how the system works and, being a doctor, he also knows enough about the psyche of those he needs to influence. Because of all this, he was able to reach higher than most immigrants ever aspire to reach. All through his hard work, his attention and coupled with a bit of luck of course. So, This is one lord not short of ability or drive. But, are abilities and drive enough to successfully tackle and affect positive change to the might of the NHS?

His nouveau ideas for large polyclinics to replace the traditional GP surgeries as well as suggesting that the relationship between GPs and their patients is 'fantastic' , hence should be severed, has led GPs to say that he does not know much about primary care! Of course Lord Darzi, being a surgeon, sees his patients but they don't see him because they are mostly asleep when he is working on them apart from the little time they meet with him before and after going under his knife of. Even in his case, how can he possibly miss the look of near adoration, total surrender in the eyes of his patients before they go into deep sleep and the look of gratitude when he is done and they are awake? Are these feelings fantastic too? No, me Lord, patients come in two categories; vulnerable hopeful and vulnerable hopeless. In both, a doctor can literally change patients lives by how he interacts with them ... this IS real and is definitely not 'fantastic' ... I am sure he knows!

In this article in the times, he too said that 'we need more doctors' but he does not elaborate on this. Surely, as a doctor who knows the meaning of reaching one's goals through total dedication and hard work, you don't mean trust grade doctors and/or untrained trust doctor GP .. or whatever this mess will be called if allowed to happen!

In his blog, Lord D is also inviting his fans and regular visitors opinion on how to encourage 'innovation,' ... Do you mean excellence which leads to innovation Lord Darzi? .. As we have already established that you know, more than most, he real meaning of 'aspiring for excellence', then, if you want innovation, you have to provide:

security, peace, improved moral to aid the sense of belonging and, of course, 'opportunity' ...

no innovation without these conditions me lord. ....
Could this possibly be the reason why you were addressing the nurses instead?!

Let me tell you;

'they' will not reinvent the wheel for you ... not possible ... protocols don't invent, they just use what 'was' invented .......

And, You get what you pay for! If you want 'real' innovation Professor Darzi, you know where to go shopping for the proper ingredients because you know very well who is capable and have a long track record of ability, dedication and of aspiring and reaching excellence ... Always ... like you
... then you will prove me right when I said at the beginning yes, Lord Darzi can reform the NHS ... and do it well too .... if he has the security, peace, morale and opportunity .... ?

To Each his own ... or so, the wise would say .... and, please 'never' forget; bricks (and mortar) make Britain Beautiful! .. ;-)