I forgot to point this out last week: There was much coverage of the increased costs of calling home from hospital in the media at large, with much criticism of the provider of the systems, PatientLine. But as I said back in 2005, when this was last in the news, it’s not PatientLine who’s to blame – it’s Mad Pat.

Have you ever stayed in a cheap hotel and thought that the sheets didn’t seem quite as fresh and clean as you might hope? Well, under the great leadership of Mad Pat, you might get the same feeling in hospital.

The Times reports today that cleaners at Good Hope Hospital in Birmingham have been ordered to top-and-tail used sheets instead of using clean ones, to save 0.275p per sheet. Infection control clearly isn’t at the top of the agenda.

The NHS is crumbling. Florence Nightingale provided clean bedding for every patient over a hundred-and-fifty years ago. Yet, in the 21st century, the NHS can’t afford it. Patients are being put at unacceptable risks to fund NHS managers and bureaucracy, yet news programmes are more interested in the love life of a 24 year old socialite.

StableSound have made two songs about the complete mess Patricia Hewitt has created in MMC, which has left thousands of doctors without an appropriate job. Perhaps this reflects a small slice of the general feeling about the problem amongst the medical profession.

MMC Song:
[audio:http://sjhoward.co.uk/audio/mmc.mp3]

Study for Nothing:
[audio:http://sjhoward.co.uk/audio/mmc2.mp3]

There are many, many more great songs from StableStound on other topics here, and I’ll be revisiting this very popular post soon for more musical discussion.

And there’s more on MMC coming your way tomorrow, right here. Can’t wait.

Labour have long wanted to reform the Mental Health Act, and made their first attempt with the Mental Health Bill 2002, which failed rather spectacularly. Several further attempts have also proved fruitless. But now they’re having an all-new attempt at reforming the Act.

Firstly, in true modern NHS style, it now means that the range of people empowered to do things is vastly extended. Where the power to detain people and force treatment upon them was previously restricted to a select few with the necessary skill and experience, the Government now wants to extend this power to a great many more people – in fact, pretty much anyone who claims to work with the Mental Health sector who’s been on a short course. And it will be the Social Service – not medics – who decide if someone can be deemed to be an Approved Mental Health Professional.

This is nurse-prescribing gone mad. Of course, Mental Health nurses have long been highly trained in the detention of individuals for short periods, and they play a very important role in this arena. But now the government wants to open this up to any Mental Health professional. Dodgy counsellors will no medical training will soon be able to sign up for a course, then will be able to detain people. That sounds unhelpful.

Just to make it even easier for these poorly trained individuals to know who they can round up, the Government would like to change the definition of a Mental Disorder. Instead of detailed definitions of each kind of disorder, the Government now wants us to accept “any disorder or disability of the mind” as a definition. This is beyond stupidity. Now, anyone who has epilepsy or has suffered a stroke or has any number of conditions suddenly falls under the provisions of the Mental Health Act, and the mountains of bureaucracy that entails. I’m sure that’ll come as a particular delight to overworked GPs, general physicians, and mental health workers nationwide.

And, ho-hum, they feel a need to better regulate these powers. So they’re introducing much greater use of Mental Health Tribunals. Anyone who’s ever tried to organise a Tribunal for a patient will know that it’s damn-near impossible, so to use more of them seems – well, not a great idea.

Yet this stinking piece of terrible legislation is getting very little media coverage because of public embarrassment about Mental Health.

There is one glimmer of hope – It’s hard to deny that most of the Cabinet have “disorders of the mind”, so we can wait till they pass the new legislation, then lock the lot of ’em up. If Yates of the Yard doesn’t get there first…

I point to this story from the UK Events Blog without comment. It’s just worth a read. (With due hat-tip to Iain Dale)

To all those people that are complaining about Patricia Hewitt distancing herself from the recent (predictable) problems with Modernising Medical Careers, and saying she’s hiding behind Lord Hunt – you’re missing the point. She doesn’t care.

Patricia Hewitt has said publically that she thinks the NHS has too many doctors and nurses. If doctors are choosing to go abroad – good riddance! That’ll help to balance the books, so Ms Hewitt can pay for more managers.

After all, if doctors are starting to complain about things, then something’s clearly wrong: They’re not being worked hard enough if they have time to make a fuss. We clearly need more managers.

The OFT published a much journalised report earlier this week about how the NHS is spending far too much on branded drugs. It’s a frustrating report, because they so nearly got to the point of the issue, but not quite.

Their problem is, effectively, that people are being prescribed branded drugs which are no more effective than non-branded generic versions. This is probably true in a minority of cases. But in many cases, the drug brand does make a difference. It shouldn’t, but it does. Let me provide a couple of examples.

First, the technical one. There is a wealth of evidence that different brands of identical epilepsy drugs have different effects. The reasons are unknown – and, in a world of evidence based medicine where we do what works rather than understanding what works, they are likely to stay that way. So in this case, the spend on the branded drug may well be justified. This is one example that springs to mind, there are probably many others.

Secondly, the prosaic reason. Believe it or not, medicine in a person works better than medicine in a cupboard. Quite often, for their own bizarre reasons, patients won’t take generic medications, but prescribe a branded version, and they’re quite happy. This is, perhaps, more common in kids where there is a choice between the generic flavourless version and the branded flavoured version. If the medication is necessary, then it’s necessary to get it into the patient. If that means prescribing a more expensive version because the patient is awkward, that’s sometimes justifiable too.

But more than this, the overspend on drugs has little to do with branded drugs. They so nearly hit the mark when they said the system should be changed “to deliver better value for money from NHS drug spend and to focus business investment on drugs that have the greatest benefits for patients”. So close, and yet so far.

You see, a great number of the drugs we pump into people have no effect. This isn’t because doctors are cruel, it’s because this is (or so it would seem) what the government wants. If your blood pressure is 139/89, you won’t get pills. If your blood pressure is 140/90, you might well do. You’re not at a hugely increased risk with an increase of 1mmHg, but the Government has decreed that patients above an arbitrary hypertension cut-off must receive treatment to prevent some of them developing future complications. There’s very little judgement in this on the doctor’s part – an untreated patient is a failure, even if the doctor’s best judgement suggests they shouldn’t be on treatment. And this story is repeated over countless conditions with countless protocols. We’re spending money on drugs that even the doctor often feels are unnecessary.

There are a whole host of other areas in which the NHS overspends on drugs, too. Drugs which patient’s use to decorate their kitchen cupboards; drugs which are on repeat prescription but never used; drugs prescribed “because” a person has free prescriptions, which cost very little in a chemist; drugs prescribed (sometimes understandably) to get patients off doctors’ backs.

Branded medications are the tip of a very large iceberg, much of which is controlled by a Government who insist on telling doctors what to prescribe, and to whom, rather than letting their years of clinical judgement be used to their full extent.

Perhaps one day, someone will actually get round to taking the NHS in hand, and righting the wrongs. Perhaps. But for the moment, it seems the powers that be are content to tinker around the edges of huge problems in a massively frustrating way, whilst avoiding the real issues and the difficult decisions. No politician wants to ‘re-educate’ patients on the things they do wrong in their interactions with the NHS, because the punters are the voters. Nobody wants to look weak by admitting past failings and correcting them. Nobody wants to actually fix the problems.

But surely someone can see that the deckchairs have been re-arranged enough, and that HMS NHS needs some urgent upward motion? Or should I find myself a life-raft now?

In the series opener of her US chat show, Tyra Banks takes on the media, complaining about a photo that was published of her under headlines suggesting she’d gained forty pounds. The tirade she unleashes was heavily promoted beforehand, and it is clearly something of a ratings-grabbing stunt. I’ve included a eight-and-a-half minute chunk of the programme below, to set the whole thing in context for the majority of my readers who may have missed the story. The much repeated tirade is in the last minute-and-a-half or so of the video.

It has to be said that this is an odd, odd piece of television. The creator and judge of America’s Next Top Model protesting at accusations she’s put on weight, whilst simultaneously claiming to think that ‘curvy women’ are ‘sexy’. The sentiment is very good, but the hypocrisy stinks: If curvy is sexy, then why is she so ‘humiliated’ by the idea of being curvy herself? She surely can’t have it both ways. She criticises others’ obsession with weight, yet knows her own exact weight from over two months ago. She says she’s no longer a model, yet shows pictures from her swimsuit shoot. She says perfection is unrealistic, yet admits that she has her photos retouched. It’s all just hot air.

[flashvideo filename=”http://sjhoward.co.uk/video/tyra.flv” title=”The Tyra Banks Show (Warner Bros)” /]

Perhaps this video symbolises everything that’s wrong with the fashion industry. Everyone pays lip-service to the ideas that big is beautiful, healthy is good, and ultra-slim is bad, but nobody in the industry actually believes it. Which is odd, because I don’t think anyone in the real world finds Size Zero models attractive.

Fern Britton won an award last week for being the woman most men ‘secretly adore’. How sad it is that men don’t feel able to say they’re attracted to women like Fern, and that The Sun insists on branding her an ‘unlikely babe’. When we finally get over these silly mass-market produced images of beauty, and accept real beauty – beauty that lies in the eye of the beholder rather than the eye of fashionistas who decree the latest ‘sexy look’ – then perhaps we’ll be finally able to tackle the misery these ill-conceived perceptions cause.

A brilliant derision of NHS direct can be found over on Pathologists Anonymous. Highly recommended (especially to those in charge of NHS policy…).

This is the story of a cartoonist’s battle with breast cancer, told through her cartoons. It appeared in the Guardian’s Weekend magazine a week ago, but has now appeared in a more extended form on The First Post.

It’s well worth reading, and very highly recommended.