The NHS, a lesson in politics part XII

The NHS, a lesson in politics part XII

Greetings doctors. Shits got a bit complicated hasn’t it? We’ve discovered that Osbourne forced a 14 billion cut on the NHS. We learnt that Cameron earns £46,000 a year net from renting out his house, while he lives rent free at number 10 (surely he should be paying the bedroom tax? It is after all a benefit paid for by the taxpayer…)

Then we get to the biggest turd of them all, Sir Bruce Keogh. Author of the “independent” mortality study which was used to such great effect by Hunt et al.

If we overlook the borderline fraudulent misrepresentation of this study as “independent”, past the refusal to release the statistical modelling (If it’s not repeatable it’s not. fucking. science.) What do we get? A political football.

Beware the charming man.

We’ve seen Sir Bruce go on a PR campaign, expressing (in private, of course) to anyone that’ll listens how much he is pained by the current impasse. If only he was in some sort of position to do something about it… Apparently the imposition was “one of the saddest days I have seen in the NHS”

Of course it’s wasn’t sad enough to actually do something about it, like tender your resignation. More constructively he could provide some leadership, and create a path out of this mess. But of course that would imperil his chances of being “Lord Keogh of Brown-nosington”

You are wrong, everything you do as a junior doctor is wrong:

Here is a dissection of Keogh’s Essay entitled: “Withdrawing emergency cover crosses a line – it will damage trust in doctors”

First, as titles go, that’s a bit shit. Trust doesn’t cost lives. Would have been better to go with: “Full strike allows foreign Paedos teach Arabic to OUR children.”

Over the next fortnight, junior doctors will be grappling with their consciences as they consider withdrawing emergency cover from every hospital in England. This is a watershed moment for the NHS – and a difficult time for the medical profession.


The current unrest is not just about contracts, but is the culmination of growing frustration over many years about the difficult conditions in which junior doctors work and train, and about the way they are treated and valued by the multitude of organisations that constitute the NHS. They feel disengaged and powerless, and are expressing their frustration through industrial action, with the support of many consultant colleagues.

Yup. Which of course you’ve done little to change. Apart from securing a £4,000 a year bung for all doctors who worship your feet Leadership fellows. 75% more than A&E specialties, something we actually need

Whatever the rights and wrongs of this complex dispute, this is a very serious state of affairs, with serious consequences.

Well no shit, with observational powers like that, it’s no wonder you’re a medical director. Shame you didn’t use your razor sharp intellect to solve any of the problems you’ve failed to highlight. Do you even know what’s actually wrong? Or are you the 1930s viceroy sitting on the veranda drinking your G&T wondering why your servants are looking grumpy?

First, although there is a fundamental right to withdraw one’s labour, the recent strikes have caused distress, anxiety and confusion for thousands of patients. Hospitals have reported that many thousands of operations have been postponed – and there is no end in sight.

That’s kinda the point of the strike. The NHS, and by extension you, have not listened to the doctors concerns. The point is this Brucey: The ratio of NHS staff to patients is too low, and it’s getting exponentially worse. Everything that has happened so far has made it worse. This is your fault, as director of the NHS.

As a leader, why don’t you demonstrate to your legions of followers, how to take responsibility? You know, like the leader you supposedly are.

Second, we cannot offer our patients a quality service without the active and enthusiastic involvement of all staff, including junior doctors. They provide an important service and many will become future leaders of the NHS. That is why it is so important to do whatever it takes to rebuild relationships and repair trust. The longer this goes on, the deeper the damage and the longer it will take to fix. The medical profession is firmly rooted in a strong set of values and a principle of “first do no harm”. Yet as the NHS prepares for the next strike, which is a significant escalation that includes the withdrawal of emergency cover, the consequences will be different, immediate and long lasting. This new action will put additional significant strain on A&E, intensive care and maternity services, particularly in smaller hospitals.

This is a brilliant paragraph, this sums up everything that’s wrong with the NHS. “The NHS has only been working on good will, but now that’s gone it’s all turning to shit. This is your fault as junior doctors for questioning those who know better, like me.”

So what, as “medical director of NHS England” are you going to do to solve it all? If only you were in a position of power. If only you had the ability to say “This contract is a mistake, the imposition is wrong, I will resign if it imposed, here is a list of things I want changed”

But of course the £190,000 a year salary is only buys a puppet, not a backbone. As Keogh demonstrates so wonderfully well, the job of Medical Director is like that of a super model: Shut your face, look pretty and wear these Policies/clothes.

I worry that the withdrawal of emergency cover will put our sickest, most vulnerable patients at greater risk. This challenges the ethical framework on which our profession is founded and runs against the grain of our NHS and our personal and professional values.

The professional values also state that doctors should work towards the greater good. There is no point treating a heroin addict without treating the addiction. Sure it’s not pleasant going cold turkey, but it’ll make them live a longer life if the manage to stay clean.

Doctors are the most trusted profession. This trust is a privileged gift bestowed on us by society, but it brings responsibilities and expectations. One of these expectations is that we are there when people need us most. By withdrawing emergency cover, we risk crossing a line, which will irreparably damage this trust and the reputation of our profession. So I encourage every doctor considering withdrawing emergency cover to dig deep and ask whether such action is fair to patients or compatible with the values and privilege of being a doctor.

As a doctor your job is to put up and shut up. No, no, the future is not your concern. Trust your superiors, we have a solution. Yes I know in the previous paragraph made it sound like I have no idea how to solve this problem. That’s just noise, let it wash past, just like the family life you could have had.

More importantly, the need to solve all the underlying issues has become increasingly urgent given the cumulative impact of unrest on our NHS. This is a collective responsibility owned by all parties. Everyone has a role to play in resolving the issues. We owe it to our patients.

Go on then, facilitate talks. Use your power to actually do some good… Oh, wait you worried about your peerage? Don’t worry I’m sure your personal progress is far more important than the populace of England.

Closing thoughts

Some of you might be thinking that actually he’s a nice guy. I’m sure he is. He is certainly personable. However he’s a two faced little shit. Sure in private he likes to be quoted as “distraught”, “extremely upset” and “full of rage” at the misuse of his study. He’s done nothing substantive to correct it.

Withdrawing the study would at a stroke destroy the key policy driving the recent fervour of contract negotiations. Of course that requires balls, and a belief in the greater good over one’s personal progress.

There is something deliciously ironic about a man who has created his own cult of leadership, through cash handouts and fellowships, who has yet to show any type of leadership.

So my dear doctors, nurses, consultants, porters, caterers, and the legions of NHS staff: Strike, strike hard and do what is right. True leadership is standing together in the face of immediate destruction, and despite ever mounting odds pushing back against the darkness.