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A picture named permalink.gif Wednesday, February 27, 2008
Knee jerk problem solving and conflicting inter-departmental targets

Where? The NHS.
Who? The British Government.
Why? Incompetence.
Dr John says what he thinks about it...

Sarah is 55.
She works in security at Birmingham Airport. If a female causes a 'beep' as she goes through, Sarah does the body check. She has been working at the airport for 18 years. Before that, she worked for W.H. Smiths. In her late thirties she had the best part of a year off work when she went into renal failure during her second pregnancy. She recovered but with compromised renal function and hypertension. I have been seeing her regularly for years. She is intelligent, conscientious and she does not take time off work with coughs and colds. Sadly, over the last two years, her kidneys have packed up and she is on peritoneal dialysis (PD). To complicate matters further she has developed diabetes. During the three months when she was approaching PD she felt wretched and had long periods of work. As soon as the PD started she picked up dramatically.

Her employers at the airport treated her fairly. They offered her early retirement on medical grounds with an augmented pension. She had no idea if she would ever be able to work again, and so she took it. She is a single mother. Her ex-husband departed many years ago, and she has brought up two boys single handedly. They are both now at University. Sarah is proud of them. They have their student loans but she tries to help them financially as often as she can, which is not as often as she would like.

Sarah cannot manage on her pension. She was not a high earner and even with the augmentation, the pension it is not enough. She needs to work. Also, she wants to work. She signed on, and has been actively "jobseeking". She has been for numerous interviews but, as soon as she talks about dialysis, she can see the employer's faces fall. She has become dispirited. She is not used to being unemployed. She came to see me yesterday. She has just had another interview with the Jobseeker Commissar. She had previously told them she had been off work with 'kidney problems' but had not gone into details. Yesterday, she did. The commissar's reaction was immediate.

"Go and see your doctor and tell him (tell him, note) to sign you off work so that you can get invalidity benefit."
Naturally, I refused. I do not need directions from Alan Johnson. I know what my job is. I have no time for the work-shy. Sarah needs to be taught a lesson, so this is what I said to her:
"It's idle benefit scrounging scum like you who are bringing this country to its knees. Why should the taxpayer featherbed idle malingerers like you? Stop whinging and get behind a till at Tesco. Do something with your life, you indolent sod. People like you make me sick."
Oddly, that is not true. I signed her off work for six months, and I shall keep her signed off until she gets her transplant or reaches retirement age.

This is a classic example of government hypocrisy. GPs are being blamed by Alan Johnson and the DOH for the high number of people drawing invalidly benefit but at the same time another branch of government is pressurising the unemployed, and their doctors, to get people onto invalidity benefit. It makes the unemployment figures look better.

GPs will not act as government police officers. We act for our patients not for the government. I will not deliberately issue a fraudulent certificate, but I will always give the benefit of the doubt to my patient. And 'Renal failure, peritoneal dialysis & diabetes' in a 55 year old is unchallengeable on a certificate. Sarah will not be called for an independent medical. Sarah is ready, willing and able to work 'with limitations.' Who does get called for medicals? Often it is those with chronic mental illness which the inexperienced doctors who work for the benefits agencies do not have the skills or often the understanding of English to assess properly. It is so much easier to take benefits off a schizophrenic.

Soon, of course, GPs will be gone. Patients such as Sarah will see some callous, protocol driven quacktitioner at the polyclinic who knows nothing of their previous life and will not hesitate to offer a "wellness" certificate. There will be a financial bonus for quacktitioners who hit government defined wellness certificate targets.

I want no part of this health policing. By Dr John Crippen. [NHS Blog Doctor]
12:43:19 PM  
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Scandal of patients left for hours outside A&E

Hospitals were last night accused of keeping thousands of seriously ill patients in ambulance 'holding patterns' outside accident and emergency units to meet a government pledge that all patients are treated within four hours of admission.

Those affected by 'patient stacking' include people with broken limbs or those suffering fits or breathing problems. An Observer investigation has also found that some wait for up to five hours in ambulances because A&E units have refused to admit them until they can guarantee to treat them within the time limit. Apart from the danger posed to patients, the detaining of ambulances means vehicles and trained crew are not available to answer new 999 calls because they are being kept on hospital sites.
8:46:42 AM  
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