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.

It strikes me as interesting today that BBC News 24 is referring to Iran’s detention of 15 Royal Navy personnel as a “kidnapping”, which seems to me to be extremely loaded language.

Iran contests that the boats involved in the incident were in Iranian waters, while the UK and US state that they were within Iraqi territory, so it appears one word against another. If the Iranians are right (and it is very hard to tell in such disputed territory with complex divisions), then they are well within their legal rights to detain the Royal Navy personnel, so to describe them as “kidnapped” in this rather less-than-clear situation seems unfortunate at best.

Most other news organisations – including their own website – are using diplomatic terms like “seized” or “detained” which, in themselves, do not imply that either side is right. So why is BBC News 24 deliberately choosing to do differently? I hope, not least for the renowned journalistic standards of the Beeb, that this wasn’t a decision taken because “kidnapped” fits better on a headline graphic.

Some of their presentation decisions are already irritating and somewhat questionable, but if presentation is the reason for this decision, then standards really have reached a new – very depressing – low.

Image courtesy of dragonhhjh at TV Forum

Not the world’s most pleasant video… I know it’s not big, and it’s not clever, but it most certainly is Gordon Brown picking his nose and eating it at PMQs yesterday. In what I assume must be a Prime Ministerial way, of course, given that he’s after the top job. Mr Brown’s future rival Mr Cameron may be accused of not yet having a grip on the issues, but at least he’s discovered tissues.

[flashvideo filename=”http://sjhoward.co.uk/video/brown2.flv” title=”nologo” /]

Gordon Brown today announced the detail of his tenth, and final, budget. It has an environmentally green donation to African rainforests, a Labour-red increase in spending on schools and hospitals, a Tory-blue tax cut, and probably something Lib Dem-yellow in there too. Frankly, I got too bored wading through it to notice.

It’s the all-things-to-all-men budget. It sticks up for the little guy by cutting income tax, then screws them over to reward big business by increasing tax rates on small companies while cutting corporation tax. It tries to be green by increasing tax on the biggest gas guzzling cars, but then restricts itself to only the biggest gas guzzling cars. It claims to simplify the tax system by cutting the 10% rate on income tax – but confuses everybody by keeping it for savings income.

Perhaps the main message from the budget comes from all of the ensuing media coverage – nobody quite knows whether they’ll be better off or not, because this Chancellor has created a tax system so complex that it’s impossible for any human to get to grips with the changes right away. Yet he still gets his headline tax cuts, despite the fact that it’s likely many people will be worse off. So everyone loves him while also being screwed over by him.

It’s headline-driven sound-bite government. And they said Gordon Brown was different…

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…

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 BBC’s Cash for Honours injunction has been lifted – no doubt there will be more on the One O’Clock news and The World at One. Tune in now!

The Attorney General has obtained an injunction against the BBC, preventing it from broadcasting an item about the Cash for Honours inquiry. Obviously, this isn’t something I’m ‘in’ on. But with a little summation, it’s not difficult to work out what’s going on.

Iain Dale reveals this much:

So this now leads the BBC Ten O’Clock News but Nick Robinson can’t say what the injunction is all about. Let me help. I understand it is to do with an email that incriminates someone in a fairly drastic way. I do not know what the terms of the injunction are, but isn’t this an injunction which the Labour Party should have asked for rather than Her Majesty’s Government?

I am aware of the identity of the individual who is the subject of the email, but I think if I name them I’ll probably be banged up at Heathrow on my return! And, dear reader, you wouldn’t want that, would you?!

A quick look at Guido’s labelling, and the picture the BBC originally put up with it’s report, and I’d imagine we know fairly well where we are.

It’s starting to get exciting.

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?

An interesting poll to be published in the Guardian later today reveals that in a contest between Cameron, Blair, and Campbell, the Conservatives would come out with 42% of the vote to Labour’s 29% (and the Lib Dems 17%). They then go on to say how this is the Conservatives best rating since just after they won the 1993 General Election, and Tory bloggers like Iain Dale get quite excited about this – and understandably so.

Except, it’s not quite true. That is, it isn’t really a genuine poll rating in the strictest sense, because it’s asking about a hypothetical situation using a completely different question to the standard ICM polling question, which makes comparison somewhat nonsensical. Admittedly, the Conservatives have gained on the state of play garnered via the same question last month, but I’m not a great believer in the question in the first place. It’s asking people to compare two relatively established leaders with one that’s sort of in a No-Man’s-Land – of course the established visionary will come out on top over somebody who’s not really had a great chance to state his case fully in front of the nation. And spin as required.

Iain Dale reckons a couple more polls like this will get Labour MPs ‘twitchy’ about Mr Brown’s potential performance. I tend to disagree. I think Mr Brown needs a good crack of the whip before he’ll improve poll ratings, and if the only realistic alternative is John Reid… well, I think the country’s better off with Brown.

Looking at the more interesting data – the standard three-party comparison – the Tories are still doing well. They’re on 40%, to Labour’s 31%. But, of course, that’s still a slightly sticky comparison, as the current situation doesn’t reflect that at the next General Election. Essentially, what I’m saying is that polls taken right now don’t mean an awful lot, and probably shouldn’t be leading national newspapers.

That said, general trends are always of interest, and the Conservatives have been in the lead for almost a year now. That’s significant. The trends are showing that the Conservatives are taking a real hold of support, and their grip is gradually tightening. Of course, our slightly perverse electoral system means that they’ll need to keep that grip rather vice-like to actual turn it into a Parliamentary majority come election time, but perhaps that’s possible.

I would say that this poll should certainly stop Mr Cameron from crying in his cornflakes tomorrow morning, but it really shouldn’t be a champagne breakfast. He appears to be doing well – though it’s difficult to tell quite how well – but there’s an awful long way to go yet. Let’s hope he keeps fighting.