Wednesday, 7 December 2011

Sixty tickboxes

It has been pretty obvious that Andrew Lansley, once he gets an idea into his head about the NHS is pretty tenacious. His persistent head down and keep going approach despite numerous criticisms is well illustrated by the proposed NHS reforms. Even though there is evidence of failing support even among those who initially bought the idea, he still blunders on. 
His announcement today of his “sixty steps to health” is yet another example of an ill thought out and pointless tick boxing exercise to distract doctors and trusts from their job. This is set out in a long and tedious document in which we find that the definition of quality has been laid down by none other than that well known fucker up of the NHS Lord Darzi. Why do people keep listening to this pratt, bearing in mind his record.

I have read the sixty steps. Fortunately they are divided into 5 “domains” so I thought I would give my views on these steps one domain at a time.

.....Domain 1, preventing people from dying prematurely. 
They have at least defined what this means. Apparently it means dying before 75. Sounds like a “one size fits all” statement to me. Is this an oblique way of telling us that after this age we are to be considered expendable? If, in dying. we are not, at that age going to breach any guidelines, then does not that give trusts an implicit instruction to not waste any resources on us.

So to the specifics.

.....1.1 - 1.4 Reducing premature mortality from cardiovascular, respiratory, and liver disease, and cancer.
 As is now well known a huge number of premature deaths in these areas are due to patient lifestyle. All the NHS can do in this area is advise. More and more of our patients spend their lives stuffing their fat faces with lard pausing only to drag on a fag and slosh down a quart of vodka. Exercise means hunting for the TV remote and sport is something you watch on TV. What the fuck am I supposed to do about that Lansley? He seems to share the attitude that the punters have, that after a lifetime of bodily abuse, it is my job to rectify the damage, as if it is somehow my fault.

.....1.5 Reducing premature deaths in those with serious mental illness.
Yes these are a particularly vulnerable group. So who exactly was it who decided that these people should no longer be looked after in the safe, warm, well fed and closely supervised environment of a hospital specifically aimed at their needs, and decided instead to throw them all out onto the streets to look after themselves? Care in the community it was called. All too often they were lost to care and ended up living, and dying in the gutter. Still at least closing all those hospitals saved a packet.

.....1.6 Reducing deaths in babies and young children. 
Well who could argue with that. But Britain ranks at 25 out of 197 nations when it comes to infant mortality, and the bulk of these deaths are associated with complications of gestation, which again come down largely to lifestyle or sheer misfortune. Making political statements of intent is one thing. Saying how is another.

.....1.7 Reducing deaths in those with learning disabilities.
Again this statement does not address the why and how. The figures in these people will be skewed by the fact that a considerable proportion will have their learning difficulty as one aspect of a multifaceted syndrome, often congenital. You could achieve a considerable apparent improvement by providing more intensive ante natal screening, and aborting affected foetuses. Anyone for eugenics? 

I will deal with other domains in future posts, if I can retain the will to live, but it looks to me like yet more central diktats, without thought for cause or consequence, to give the illusion that our politicians are achieving something worthwhile. Just more shit basically.



  1. Details, details. You don't expect the young Oxbridge graduate civil service fast stream policymakers in the DoH to worry about that. Get with the programme grandad, the message is everything, who cares whether it achieves anything tangible?

  2. Whilst I have much sympathy with your viewpoint Dr.Z and look forward to your further analysis of the other domains I do have some issue with the patient lifestyle link you cite as evidence.

    If you really think that the Cancer UK study has any scientific merit beyond the simplistic view that smoking causes cancer you really must be 'swallowing' the DofH propoganda. It highlights many of the unproven hypothesese that have predicated the advice churned out ad infinitum by the Healthcare Industry and the Dept for the past thirty years with little to no impact on mortality for most of the diseases of mankind.

    No one is 'cured' of cancer, just treated. There is no money or status in curing, but a lot in the creation of drug protocols and medical devices to service the 'Cancer Industry'. As someone with some knowledge of cancers brought about by Ionising Radiation and with an offspring who is an Oncologist I have followed it's inexorable rise and cost with interest and some disgust.

    Eating lard is something I would actually advocate, and eating 'five-a-day' especially fruit I would not. Those studies that looked at this aspect of diet (fruit and veg) were in the main inversely associated with good health, except for the 'green' veg bit. And the study I refer to
    is a pure piece of advocacy research with no evidence to support its conclusions, which it actually does say, if you can read all 92 pages (how sad am I?). It is as much hypothesis as is Higgs Boson. It is a 'Trojan Horse' study that is using smoking as its strapline to aid the 'gravitas' it lacks.

    As for the 'sixty steps'; well its just more of the same inane and pointless obfuscation of the real needs and issues in Healthcare that need addressing by Doctors not politicians.