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Posted: 16 Aug 2018 11:27 PM PDT

In 1976, we ate more than we do today. So why are we fatter?

By George Monbiot, published in the Guardian 15thAugust 2018

When I saw the photo, I could scarcely believe it was the same country. The picture of Brighton Beach in 1976  featured in the Guardian a few weeks ago appeared to show an alien race. Almost everyone was slim. I mentioned it on social media, then went on holiday.

When I returned, I found that people were still debating it. The heated discussion prompted me to read more. How have we changed so far, so fast? To my astonishment, almost every explanation proposed in the thread turned out to be untrue.

Unfortunately, there are no consistent obesity data in the United Kingdom before 1988, at which point the incidence was already rising sharply. But in the US, the figures go back further. They show that, by chance, the inflection point was more or less 1976. Suddenly, at around the time when the photograph was taken, people started becoming fatter, and the trend has continued ever since.

The obvious explanation, many of those debating the photo insisted, is that we’re eating more. Several pointed out, not without justice, that food was generally disgusting in the 1970s. It was also more expensive. There were fewer fast food outlets and the shops shut earlier, ensuring that if you missed your tea, you went hungry. So here’s the first big surprise: we ate more in 1976.

According to government figures, we currently consume an average of 2131 kcals per day, a figure that appears to include sweets and alcohol. But in 1976, we consumed 2280 kcal, excluding alcohol and sweets, or 2590 when they’re included. Can this really be true? I have found no reason to discredit the figures.

Others insisted that the cause is a decline in manual labour. Again, this seems to make sense, but again the data don’t support it. A paper in the International Journal of Surgery  states that “adults working in unskilled manual professions are over 4 times more likely to be classified as morbidly obese compared with those in professional employment”.

So how about voluntary exercise? Plenty of people argued that, as we drive rather than walk or cycle, are stuck to our screens and order our groceries online, we exercise far less than we did. It seems to make sense – so here comes the next surprise. According to a long-term study at Plymouth University, children’s physical activity is the same as it was 50 years ago. A paper in the International Journal of Epidemiologyfinds that, corrected for body size, there is no difference between the amount of calories burnt by people in rich countries and in poor ones, where subsistence agriculture remains the norm. It proposes that there is no relationship between physical activity and weight gain. Many other  studies suggest that exercise, while crucial to other aspects of good health, is far less important than diet in regulating our weight. Some suggest it plays no role at all, as the more we exercise, the hungrier we become.

Other people pointed to more obscure factors: adenovirus-36 infection, antibiotic use in childhood and endocrine-disrupting chemicals. While there is evidence suggesting they might all play a role, and while they could explain some of the variation in the weight gained by different people on similar diets, none appear powerful enough to explain the general trend.

So what has happened? The light begins to dawn when you look at the nutrition figures in more detail. Yes, we ate more in 1976, but differently. Today, we buy half as much fresh milk per person, but five times more yoghurt, three times more ice cream and – wait for it – 39 times as many dairy desserts. We buy half as many eggs as in 1976, but a third more breakfast cereals and twice the cereal snacks; half the total potatoes, but three times the crisps. While our direct purchases of sugar have sharply declined, the sugar we consume in drinks and confectionery is likely to have rocketed (there are purchase numbers only from 1992, at which point they were rising rapidly. Perhaps, as we consumed just 9kcal per day in the form of drinks in 1976, no one thought the numbers were worth collecting). In other words, the opportunities to load our food with sugar have boomed. As some experts have long proposed, this seems to be the issue.

The shift has not happened by accident. As Jacques Peretti argued in his film The Men Who Made Us Fat, we have been deliberately and systematically outgunned. Food companies have invested heavily in designing products that use sugar to bypass our appetite control mechanisms, and packaging and promoting them to break down what remains of our defences, including through the use of subliminal scents. They employ an army of food scientists and psychologists to trick us into eating more junk (and therefore less wholesome food) than we need, while their advertisers  use the latest findings in neuroscience to overcome our resistance.

They hire biddable scientists and thinktanks to confuse us about the causes of obesity. Above all, just as the tobacco companies did with smoking, they promote the idea that weight is a question of “personal responsibility”. After spending billions on overriding our willpower, they blame us for failing to exercise it.

To judge by the debate the photo triggered, it works. “There are no excuses. Take responsibility for your own lives, people!”. “No one force feeds you junk food, it’s personal choice. We’re not lemmings.” “Sometimes I think having free healthcare is a mistake. It’s everyone’s right to be lazy and fat because there is a sense of entitlement about getting fixed.” The thrill of disapproval chimes disastrously with industry propaganda. We delight in blaming the victims.

More alarmingly, according to a paper in the Lancet, over 90% of policymakers believe that “personal motivation” is “a strong or very strong influence on the rise of obesity.” Such people propose no mechanism by which the 61% of English people who are overweight or obese have lost their willpower. But this improbable explanation seems immune to evidence.

Perhaps this is because obesophobia is often a fatly-disguised form of snobbery. In most rich nations, obesity rates are much higher at the bottom of the socio-economic scale. They correlate strongly with inequality, which helps to explain why the UK’s incidence is greater than in most European and OECD nations. The scientific literature shows how the lower spending power, stress, anxiety and depression associated with low social status makes people more vulnerable to bad diets.

Just as jobless people are blamed for structural unemployment and indebted people are blamed for impossible housing costs, fat people are blamed for a societal problem. Yes, willpower needs to be exercised – by governments. Yes, we need personal responsibility – on the part of policymakers. Yes, control needs to be exerted – over those who have discovered our weaknesses and ruthlessly exploit them.
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Posted by Jean Smith on behalf of author Zsuzsa Ferge.

The Orbán regime introduced legislation to shut down accredited gender studies programs offered by universities in Hungary. Academics now have 24 hours to respond to the government’s plan. The ban will primarily impact students at Eötvös Loránd University in Budapest (ELTE)–the only institution in Hungary, other than Central European University, to offer gender studies at the graduate level, and the only one to provide this program in Hungarian.

The number of students impacted by the ban is small–only 11 applicants were admitted this year at ELTE and two at CEU. The maximum number of students that ELTE can admit any given year is 18 and those enrolled this coming academic year will be the last to take this program in Hungary. The decision to give those impacted 24 hours, in the middle of the summer vacation, to respond to this plan is a prime example of the spectacular arrogance that this regime has displayed for the past eight years. Gender studies in Hungary hardly pose a risk to the social narratives espoused by Fidesz and the Christian Democrats, but this regime is best known for kicking people and sectors of the society when they are down.

Although the government is not formally citing ideological reasons for its decision to cancel gender studies (the official reason is that this program is not “economically rational”), circles within Fidesz, most notably its Christian Democrat (KDNP) wing, have been calling for this for some time. In 2017, Lőrinc Nacsa, the leader of KDNP’s youth wing, labelled gender studies at ELTE as a wasteful luxury and also as destructive. “We must raise awareness to the fact that these programs are doing nothing to lift up our nation. In fact, they are destroying the values-centered mode of thinking that is still present in the countries of Central Europe,” wrote Mr. Nacsa in his letter to the rector of ELTE.

As well, HVG reminds its readers today that State Secretary Bence Rétvári (KDNP) in the Ministry of Human Capacities questioned whether gender studies even qualifies as a legitimate academic field, adding that this field of research is at odds with everything that the Fidesz government espouses.

I could feign shock at this news or recite the obscene mantra of how Fidesz has now truly crossed a red line–a line that up until now nobody would have thought that they would pass. Yet this would be insincere. It’s too late to be horrified that this can happen in Hungary–it’s about eight years too late. Most sectors and demographics of Hungarian society, from journalists to shop owners to NGOs, have already felt the scourge of the party state in profound ways. Academics are next in line.

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BMA: No deal Brexit could be catastrophic for health

The British Medical Association (BMA) is today warning that a no deal Brexit could have could have potentially catastrophic consequences for patients, the health workforce, services and the nation’s health.

In a new briefing paper published today, the BMA outlines what is at stake for health services if the UK and the EU fail to reach a deal on the Withdrawal Agreement by March 2019. The paper warns that, in a worst-case scenario, a no deal Brexit could:

  • Cause real disruption for almost a million patients receiving treatment for rare diseases as the UK would be excluded from the European Rare Disease Network;
  • Cause delays in diagnosis and treatment for cancer patients because the UK would have to source important radioisotopes from outside of EURATOM;
  • End reciprocal healthcare agreements which could disrupt patient care and increase insurance costs. If 190,000 UK state pensioners currently signed up to the S1 scheme and living within the EU return to the UK it could cost the health services between £500 million and £1 billion per year;
  • Weaken the UK’s response to pandemics and increase the chances of diseases spreading as we lose partnerships with key EU bodies, such as the European Centre for Disease Prevention and Control;
  • Risk the return of a hard border between Northern Ireland and the Republic of Ireland which could see doctors leaving the profession and patients having to travel miles to receive care;
  • See fewer doctors and other medical staff, at a time when there are already huge shortages of these roles, due to uncertainty over future immigration status and confusion around the mutual recognition of medical qualifications across the EU.

At the BMA’s Annual Representative Meeting in June, doctors made it clear that they believe Brexit poses a major threat to the NHS and the nation’s health. With less than eight months to go until the UK leaves the EU, there is still far too much uncertainty and confusion around the implications of Brexit for patients, doctors and wider health services.

The BMA supports the idea of the public having a final say on the Brexit deal, now that more is known regarding the potential impact of Brexit on the NHS and the nation’s health.

Commenting on the briefing paper, Dr Chaand Nagpaul, BMA council chair, said:

“The consequences of ‘no deal’ could have potentially catastrophic consequences for patients, the health workforce, services and the nation’s health.

“The UK Government has finally started planning to ensure the health sector and industry are prepared in the short term for a no deal Brexit, but this is too little, too late and quite frankly, proof that the impact on the NHS has not received the attention it deserves in the Brexit negotiations.

“Some will say we are scaremongering by warning of the dangers of a ‘no deal’ Brexit, but this is not the case. We aren’t shying away from being honest about what is at stake for health services if the UK and the EU fail to reach a deal. As experts in delivering health services and providing care for our patients, we have a duty to set out the consequences of leaving the EU with no future deal in place.”

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Principles for a National Health Service

One of the Centre’s friends, Jack Czauderna, recently shared this with us:

Dr Julian Tudor Hart, who has recently died, was a pioneering GP who inspired generations of health workers. He coined the term Inverse Care Law in 1971 which asserts:

“The availability of good medical care tends to vary inversely with the need of the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

Here are his 9 distinctive and essential characteristics of a National Health Service:

  1. A united national service devoted directly and indirectly to care, fully available to all citizens.
  2. A gift economy including everyone, funded by general taxation, of which the largest component is income tax.
  3. Its most important inputs and processes are personal interactions between lay and professional people.
  4. Its products are potentially measurable as health gains for the whole population.Its staff and component units are not expected to compete for market share but to co-operate to maximise useful service.
  5. Continuity of care is central to its efficiency and effectiveness.
  6. Its local staff and local populations believe they have moral ownership of and loyalty to neighbourhood NHS units.
  7. None of its decisions and few of its procedures can be fully standardised. All of its decisions entail some uncertainty and doubt. They are therefore unsuited to commodity form, either for personal sale or for long term contracts.
  8. The NHS is a labour-intensive economy. Every new diagnostic or therapeutic machine generates new needs for more skilled staff able to control and interpret the work of the machines and translate them into human terms.

We believe that this is from Tudor Hart’s The Political Economy of Health Care: A Clinical Perspective, published in 2006.

You can also read Tudor Hart’s Feasible Socialism online at the Socialist Health Association.

Principles for a National Health Service © Julian Tudor Hart

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By 999callfornhs, Aug 9 2018 12:35PM (PERMISSIONS  GRANTED)

Steve Carne keeps getting dragged into the pit…

The image of vicious piranhas fighting for flesh, (made in desire for a dramatic context I confess in yesterday’s blog about Babylon), seems to be ever more relevant and continues to grow as more corporate quibbling and quarrelling now truly “disrupts” every layer of the once public service NHS.

Including the basics of supplies and logistical planning that supports the once joined-up network of hospitals and healthcare NHS units (clinics etc.) All under the guise of greater integration of course and using the Carter Review 2015 which called for something called the Procurement Transformation Programme (PTP) which has led to the Future Operating Model (FOM!) and its new rather confusing logistical planning landscape.

NHS Supply Chain Logistics is now being revamped (not a top-down reorganisation you understand nobody likes them do they?) at the end of September it seems – after DHL have run it since 2006.

And even though Health Care Supplies Association (HCSA) in 2016 thought that the commercial procurement arrangements with the outsourced service NHS Supply Chain were working well and should be extended NHS and they warned that “New NHS Procurement structures may be disastrous” – NHS Procurement, NHS Improvement and Uncle Tom Cobblybollox and all have decided that it’s best if NHS Supply Chain is revamped into something called the Future Operating Model (FOM) and ‘has been designed to realise £615m of savings in real terms over the next 3 years (2018-21).’


Yes apparently the new structure is all about Towers. Category Towers. Stick with me as I attempt to climb the dark staircase…

So NHS resources – things to buy, sorry PROCURE – are now divided up into these Eleven Category Towers (which Lord of the Rings numpty thought that one up I wonder?) So below, courtesy of Dept of Health info pdf  is a simple chart of these Eleven Categories.

Bottom Right is interesting…

The Health Care Supplies Association (HCSA) says “the eleven tower system is hard to understand” – but they shouldn’t be alarmed because apparently there are 200 very intelligent people employed to become the Intelligent Client Coordinator… fingers crossed.

Still with me?

Blimey so… what this is supposed to do (apparently) is save money through making more resources flow through less broken up chains of command – we assume. Sort of what it must have been like before the tendering competitive market moved in – back in the 90’s – and festered until getting the boost it needed in 2012 with the Health & Social Care Act that did all the damage. The Dept of Health kindly offer a nice graphic to help us get the picture.

Trouble is …

this is where the piranha-profit fish now get really pissed off cos they are missing a meal and they see other corporate piranhas munching into their prey. And DHL are pissed off enough to take the Dept of Health to court claiming that the tendering process is faulty because they haven’t been given a big enough slice of the dish.

You see to make it fair the Dept of Health thought best if procurement companies were only allowed to take hold of THREE TOWERS at a time (joined-up thinking see?). DHL already have three towers – the procurement of large diagnostic capital devices, ward-based consumables, and infection control /wound care.

But what they are really pissed off about is the fact that after 13years of being the logistical handler of the NHS Supply Chain they have now lost out to UNIPART.

And it’s a fairly big contract… look. Estimated £730million over 5 years…

So Unipart are happy no doubt trolling about twixt towers. And they do have good experience in the “Unipart Way” – oh yes that old Toyota Car Factory chestnut the Lean Management System is something they are enormously proud of. I expect NHS Managers up and down the country will be clapping their little hands because they understand that after their three-day “how can we show Compassion whilst burning the workforce” training course.

Well Unipart can keep their hands well away from my bottom thank you very much.

The whole point is…

What the hell are we doing letting all these multi-national businesses scramble our public services in search of ever-more profit? Just like piranhas the smell of blood money is overpowering and will dominate their motives and actions. How can they be allowed to hold to ransom the Department of Health? Or any of our government departments?

How this all fits into the other NHS restructures and redisorganisations is the next step to understand. Campaigners are often told by politicians on both sides of the House that the NHS can’t afford another Top-Down Reorganisation. Seriously we can’t afford not to once and for all take the big step and bring the NHS back into public control. The poor NHS has been and still is (frontline staff will tell you) being attacked and thrown into chaos by more and more corporate top-down changes usually requiring yet more top-down levels to provide muddy transparency.

The shrinking, cutting and slashing we have all seen over the last four years (more I know now) is nothing more than the government desired move to a reduced, poor-quality NHS based on the USA system with corporates like DHL and Unipart taking more control and more money out of the system with their in-fighting and board room battles.

And once companies learn they can use the courts to fight their commercial interests and “bugger the consequences” there is no stopping them. After all they can afford it. And the prize is probably worth it. Eventually local councils, public departments will have to give in just because they can’t keep on paying costs.

Meanwhile people die. Paramedics and many many NHS staff watch them die. And they know there is a better way. It’s not the Unipart Way. It’s the Reinstatement of the NHS Way. There has never been a more urgent time for campaigners and public alike to understand that we are about to hand over the NHS to a bunch of piranhas.

The only way now is renationalise the health system – bring back the values of a healthcare system based on equality and the improvement of people’s lives. In that there is hope of a better society and future.

The public service model NHS used to be a world leader in that.

By Steve Carne


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LATEST figures on A&E waiting times reveal the “astonishing” collapse in NHS standards under Theresa May, Labour said today.

Monthly statistics for July 2018 published by NHS England show that just 89.3 per cent of people attending A&E were seen within four hours, well below the 95 per cent target.

That dismal performance means NHS England has consistently failed to meet the 95 per cent four-hour target — lowered from 98 per cent by the coalition government — since July 2015.

The number of people attending A&E in July 2018 also hit a record 2.176 million people in July 2018, the highest figure since records began in 2010.

Shadow health minister Justin Madders said: “After two years of Theresa May’s premiership, patients are left with the worst-ever July A&E performance, thousands more people waiting too long for cancer treatment and waiting lists well above four million.”

“The sheer scale of the collapse in standards for patients since the Prime Minister took over is astonishing.”

Chris Hopson, chief executive of NHS Providers, said there had been “no respite” for NHS staff this summer.

“We have also seen exceptionally high numbers of patients then admitted to hospital beds,” he said. “This has led to more patients waiting longer to be seen in A&E with performance against the four hour standard slipping further.

“All of this is a symptom of an NHS running at boiling point all year round.”

Royal College of Emergency Medicine president Dr Taj Hassan said: “The recent heatwave will have had an impact, but this should not be used to excuse inappropriate resourcing.

“It should also not come as a surprise that whatever the weather conditions, working in a continually under-resourced and declining system has consequences — all of which are detrimental to our patients.”

NHS England also published the 2018 GP Patient Survey yesterday, which revealed that 24 per cent of patients had to wait a week or more for an appointment, up from 20 per cent in 2017.

Shadow minister for community care Julie Cooper said: “Today’s patient survey is yet more evidence of the Tories’ devastating failure to deliver for GPs and their patients as staffing shortages lead to cuts in services and reduced availability of treatments.”

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The Commonwealth Fund

The Issue

How medical practices are organized and structured keeps changing. But as more practices merge and more physicians sell their practices to hospitals, we don’t have a good understanding of whether, and how, these factors affect the quality and cost of health care.

Using 2012–2013 data from the National Study of Physician Organizations linked with Medicare claims, Commonwealth Fund–supported researchers writing in Health Services Research (July 5, 2018) examined how the size of a practice, along with other characteristics, relate to the total amount spent on a patient’s care and the quality of care provided. Quality was measured by two indicators: 30-day hospital readmissions and admissions for “ambulatory care–sensitive” conditions, which usually don’t require hospitalization when appropriate outpatient care is provided. The study focused on all Medicare beneficiaries with a special focus on those with high health care needs.

Large practices — with 100 or more physicians — spent


more annually per high-need Medicare beneficiary than practices with one to two physicians.

What the Study Found

  • Annual risk-adjusted spending per high-need Medicare beneficiary was $1,870 (12.5%) higher in practices with 100 or more physicians than in practices with just one to two physicians. In practices with 50 to 99 physicians, the spending difference was similar — $1,824 higher.
  • Practices with a higher percentage of primary care physicians had lower total spending compared to practices with a lower percentage.
  • Relationships were similar for hospital readmission rates. Practices with 100 or more physicians had readmission rates 1.64 times higher than small practices with one to two physicians; for practices with 50 to 99 doctors, rates were 1.71 times higher.
  • There were no statistically significant associations between practice characteristics and ambulatory care–sensitive admissions.

The Big Picture

Though larger practices are often thought to provide better care, the results of this study do not support this assumption. Despite spending more per high-need patient and having more quality improvement processes, health information technology systems, and care management programs in place, larger practices in this study did not incur lower spending or achieve higher quality than smaller practices. It is possible that larger practices, which tend to have a higher percentage of specialist physicians, may attract more complex patients that may not be totally accounted for by the severity of illness risk-adjusted measures currently available for analysis. Or it is possible that they provide care that costs more than, but is not superior to, care provided by smaller practices.

The Bottom Line

Large physician practices spend more per person and their patients are readmitted to the hospital at a higher rate than the smallest practices.

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New BMA poll show nine out of ten doctors regard latest government pay award as “unacceptable”

A BMA poll of more than 12,000 doctors in England shows that nine out of ten regard the recent pay offer from the government as unacceptable, while a similar number believe that their morale has worsened in the wake of the announcement.

The BMA received responses from 12, 717 doctors to its survey asking for their opinion on the pay uplifts for doctors in England which were published in July 2018.

In making the award, the government ignored the recommendations of the independent review body, which many already regarded as insufficient, and announced what the BMA described as an “inadequate” pay settlement. The deal will see junior receive just a 2% increase, consultants 1.5%  and GPs 2%.

The findings from the BMA show:

  • When asked how acceptable the government’s offer was, three quarters (74%) said it was “highly unacceptable” while almost two out of ten (18%) said it was “somewhat unacceptable”.
  • Less than one per cent of respondents regarding the deal as “highly acceptable”.
  • As result of the pay announcement, almost six out of ten (58%) felt “significant reduced” value working as a doctor in the NHS, while a further three in ten (30%) felt a “reduced” value.
  • Less than 1% felt more valued because of the pay uplifts, of this only 0.1% felt their morale had “significantly improved”.
  • In total, more than four in ten (45%) felt their morale had “significantly worsened”, while a four out of ten (40%) felt it had “worsened”.

Dr Chaand Nagpaul, BMA Council Chair said

“Today’s survey findings of doctors in England should be a wake-up call for the Government. They have seriously misjudged the mood of the profession with what is another sub-inflationary pay award.

“The government’s decision to not implement the recommendations of the Doctors and Dentist’s Review Body (DDRB) has been compounded by its unjust decision to not back-date this pay award to April 2018 for hospital doctors. This is wholly contrary to the definition of an “annual” pay uplift.

“The government’s headline figures are inaccurate and misleading for doctors since this six month pay uplift commencing in October effectively halves its value for the year. Far from the government claiming to lift the pay cap for public sector workers, most doctors will continue to receive an uplift of 1% or less – and appear uniquely targeted in this unfair manner.

“For those thousands of our hard-working members and their families this is nothing more than an insult and the figures speak for themselves. More than 9 in 10 feel that the Government’s offer is unacceptable. Since 2008, doctors have experienced the largest drop in earnings of all professions subject to pay review bodies, with consultants seeing a 19 per cent fall in pay, junior doctors 21 per cent and GPs 20 per cent. The effective pay uplift this year for some doctors will be as little as 0.75 per cent as a result of the government’s interference form the pay body recommendations, which will be widely seen as derisory.

“After the Secretary of State’s recognition that NHS staff are feeling ‘under-valued’ what is most troubling is the devastating impact this has had on doctor morale. 84% say theirs has worsened in the wake of the Government’s offer, with 88% saying that the value they feel as a doctor working in the NHS has reduced over the past week.

“With the NHS facing severe shortages of doctors across all specialities, it is more important than ever that the Government recognises the contribution declining pay has had on the ability to recruit and detain doctors and takes steps to reverse this.

“These results give the Secretary of State compelling evidence to make tangible improvements to the morale and well-being of doctors. Back-dating the pay to April and increasing the offer would go a long way towards showing doctors that the Government does recognise their invaluable contribution and I look forward to meeting with the Secretary of State in person to discuss how this can be done.”


Notes to Editors

The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

A full copy of the survey findings can be found here.

Key questions from the survey include:

Overall, how acceptable is the pay offer from the Government?

Highly unacceptable


Somewhat unacceptable


Neither acceptable nor unacceptable 3.3%
Somewhat acceptable


Highly acceptable



Overall, how acceptable is the pay recommendation from the DDRB?

Highly unacceptable


Somewhat unacceptable


Neither acceptable nor unacceptable 12.4%
Somewhat acceptable


Highly acceptable



As a result of the government’s offer, has there been any change in how valued you feel working as a doctor in the NHS?

Significantly reduced




Neither increased nor reduced




Significantly increased



As a result of the government’s offer, how would you describe your current level of morale?

Significantly worsened




Neither improved nor worsened




Significantly improved






Paul Gadsby

Senior BMA Media Officer

T: 07827 858 992


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Consultation events in Birmingham, Exeter, Leeds, London on government plans for dismantling England’s NHS

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Radical Statistics  (Radstats):  2019 Annual Conference & AGM

Liverpool:  Saturday  23  February  2019

Inequalities  and  the  Life-course  – the  Impact  of  Austerity  across  Generations

Key questions for this conference include: How do inequalities affect life chances?  What effect has austerity had on inequalities across generations?     Does austerity affect younger cohorts differently than older ones? How does this differ across social groups, class, gender, etc.?  How to measure inequalities across the life-course?    What data exists; what is needed?

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The thing I’ve learnt the most from my experience as a patient is that the world doesn’t actually “do” binaries.

My law training gave me training in being able to argue both sides of a case, and to present the case convincingly, so that I almost believed myself. A client pays a lawyer to win the case, and not to sit on the fence – or even worse, argue the opposite side.

As a doctor, I am taught to believe that people have diseases or not, and that each disease will have a relatively predictable outcome assuming that all the diseases act independently. As a doctor, I am not encouraged to think about what a condition makes a person feel like. I can think about it if I wish, but I don’t have to.

As for the difficulty with binaries, I am both a doctor and a patient. When the MPTS panel asked me in 2014 what I’d learnt the most from my time off the GMC Medical Register, on the assumption made by both me and the GMC perhaps that I would never be making a comeback, I replied, “I finally know it’s like to be a patient.”

Maybe it was the adrenaline talking. But I meant it.

I was a patient on the neurorehab ward in 2007 at the National Hospital for Neurology and Neurosurgery at Queen Square where indeed I’d been a junior SHO in 2002. I had just suffered a six week coma on the ITU of the Royal Free. My best friends were a young man who’d just got married but fallen down a pothole, meaning that his life had been totally changed by the fitting of a titanium plate as a skull. Another friend had been admitted as he had problems with his intermittent self catheterising at home, living with multiple sclerosis, and was now newly in a wheelchair.

People were describing to me conditions which I had read about in textbooks. But rather than hearing the history compressed in a short clerking, I got the full impact as an equal, as a fellow patient, but me with substantial problems of my very own.

When I later nearly went blind in the late 2017 due to a vitreal haemorrhage (but which was later then successfully operated on), I would listen to people who were blind on local radio describing what it was like to lose their disability living benefit. They like me felt as if they had nobody to turn to.

When I had been decisively erased from the GMC register in 2006, later to be restored in 2014, I spent a few weeks in rehab at various places around the country. I used to chat at length with various other people with histories of substance abuse. Some are now dead. They all had individual tragedies, but all had in common a long period of time when they thought they could tame the beast that is substance abuse.

I realised late on that there’s no magic bullet for substance misuse. And I can see how others are making the same mistakes as I did.

It’s taken me years to get to the stage of applying to return to medicine. In fact, nobody really knew at all that there is a scheme run here in London for doctors like me to return. It’s not as simple as finding a job off a website. It’s a scheme where you’re actually supported, given your health and wellbeing concerns, and where your training needs can be met.

The person doing the interview today on behalf of Health Education England admitted today I was starting from a much higher baseline than most people wanting to start medicine at my age. And, if it had not been for the arse-covering of my seniors, lack of support by colleagues, and my own illness over which I was powerless, I could have also done something too with my medical degree, my MRCP and my Ph.D. And I wouldn’t have become physically disabled either, maybe.

I think the concept and background of the ‘wounded healer‘ is interesting, and I’d like you to read some of the background from elsewhere. There are texts and subtexts, for example Jung and Picasso – but, like my own alcoholism, it’s not worth trying to make sense out of overintellectualisation.

But my tendency is to feel that my period of being very ill, with my life imploding, as an alcoholic who then became physically disabled, should ideally not go to waste, and I feel that looking after patients is now my genuine calling. I have to be careful though, as my own psychiatrist warned me against turning into one of those of people who likes to rewind the ending of his favourite movie, hoping the ending will be different one day. He coincidentally loves the idea of me joining the workforce – he’s one of those psychiatrists who believes that people with a history of mental illness have a lot to offer.

I have come to have a strong passion to want to help patients, which totally overrides the fear of the ‘hostile environment’ from my regulator who would take great delight in any future misfortune of mine. I am sure my comeback would not even deserve a smidgeon of embarrassment from the clinical consultants who failed to support my health years ago.

But I feel that as a ‘wounded healer’, the time is right. I am not doing this for the fame, title, or salary. Admittedly, I am doing this partly for my late father who died with the public shame of my downfall. I am doing this partly for my mum now.

I feel I have quite a lot to offer still, and I’m not finished yet.



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For a moment – guess who said this, and when?

“We will be studying the report carefully to identify learning points.  We are committed to taking any further action necessary in light of information revealed by this report.”

Do we need another report?

More lessons learned?

It seemed like – not that long ago – we were discussing Southern Health or Winterbourne?

This saying above was in fact reported to have been the responseof Charlie Massey, CEO of the General Medical Council (GMC), in response to the events at Gosport War Memorial Hospital.

Dr Jane Barton, meanwhile, the doctor at the centre of this, is reported to have said,

“Throughout my career I have tried to do my very best for all my patients and have had only their interests and wellbeing at heart.”

It is very hard for one  to know what Dr Jane Barton’s precise reasoning was behind the management of her patients, without reading the transcripts of her evidence in her GMC hearings. Media accounts and headlines can be misleading, and lend themselves to ‘trial by media’.

Dr Barton was found guilty of “multiple instances of serious professional misconduct” by the General Medical Council in 2010 but was not struck off and soon retired. But – likewise unfortunately – it is perhaps very hard to avoid one of the other problems in all: the concern that, if Dr Jane Barton had not been a Causasian graduate but been a BAME trainee, would she have been struck off? It has been recently announced that the General Medical Council (GMC) has today announced that Roger Kline and Dr Doyin Atewologun will lead a major project to better understand why some doctors are referred to the regulator for fitness to practise issues more than others. Although previous studies have apparently found that the GMC’s processes do not introduce disproportionality in investigations into doctors, research has not yet established deeper reasons behind why certain groups of doctors are referred to the GMC by their employers more often. We know from the fiascos of how various cases have been dealt with, such as Dr David Sellu’s where the GMC is reported to have wanted to proceed with fitness to practise proceedings after his conviction for gross negligence manslaughter was squashed,  that a review into “medical manslaughter” could not come a moment too soon.

Dr David Nicholl’s comment in the BMJ is truly chilling:

“The GMC’s own regulator, the Professional Standards Authority, has pointed out that the GMC did not have to appeal the MPTS (medical practitioners tribunal service) decision to suspend rather than strike off Bawa-Garba. This contrasts with the GMC’s failure to take action against convicted sex offenders. There is a higher rate of complaints about BME doctors to the GMC. My fear is that if the GMC lose the appeal court hearing, these aspects will be brushed aside, there will be a rush to blame, and a failure to properly investigate. Neither the Williams nor Marx reviews will fully address the wider issues of how gross negligence manslaughter is relevant to all healthcare professionals, not just doctors, for example, the nurse Isabel Amaro was given a suspended prison sentence following the death of Jack Adcock.”

Furthermore, there is, potentially and problematically, a fine line with an intent to kill a particular individual, the mens rea for murder in English law, and ‘symptom control’ as per palliative medicine. But, by keeping Dr Barton on the register, was the General Medical Council acting to maintain public confidence? Or, other hand, would a stronger sanction for Dr Jane Barton have had the inadvertent effect of criminalising palliative care? Contrast this with the case of Dr Bawa-Garba, who had had an unblemished career as a trainee. Dr Bawa-Garba was faced with a number of serious problems which could face any junior doctor: for example, there may be inadequate senior cover, or inadequate access to blood results. Here, in addition to the possible as yet unproven racist element, there are wider system factors.

If doctors cannot whistle blow or discuss errors, then there will definitely be a problem with public confidence.

Sir Robert Francis QC once remarked:

‘It’s not a system which is conducive to openness and learning and a blame-free culture. But we are not going to get away from prosecution and people being held to account until the public can be confident that proper processes are in place to address their grievances. Patients and their families need to properly involved in the process of looking at what happened after things go wrong.

Investigations need to be blame free and the outcome of all of this must not only be full disclosure of what happened, why it happened, a recognition by all professionals involved of what their part was and a commitment to take any remedial action. Only then can we get the trust the patients and public need to end the climate of fear.”

This means a holistic look at what is going on. For example, in a BAME junior doctor with a blatant alcohol misuse problem, the regulator could look at why that junior doctor’s consultants or the Trust did not actively deal with an alcohol problem when that junior doctor was seeing patients on the ward? Or if there was an incident what did the Trust’s clinical governance procedures do, if anything, at the time? If the answer to both questions is nothing, the GMC should look carefully at the morality of its case. There should be opportunity for a detailed ‘right to reply’ from accused doctors, especially when they have been ganged up on former bosses years after leaving their posts. I feel that a big step foreward would be to allow junior doctors or allied health professionals to whistleblow against their senior colleagues, if necessary, if they feel inadequately supported there is a clear threat to patient safety. We do know that, from the legal events and the response of institutions such as the BMA regarding Dr Chris Day, whose career was effectively prematurely destroyed, that institutions have felt uneasy about whistleblowing protection for junior doctors.

In summary, I feel that the GMC needs to be totally clear what its actual rôle in patient safety is, and, if it is not capable of promoting patient safety, I feel that parliament should take away its statutory power. All doctors, including Consultants, need training, and need to be able to learn from things which go wrong. Doctors are not above the law, and are commonly accused of shroud waving. But clearly there is a problem if patients are also dissatisfied with the actions of the medical regulator in the light of various cases, including Mid Staffs, Ian Paterson, Gosport War Memorial. Stunts, such as doctors being allowed to emigrate without sanction, or allowed to retire before being erased for serious misfeasance, have got to stop, and, again, Parliament may need to legislate.

As for the long term future of the GMC, I feel with the reform of the NHS and social care to be reported later this year, I leave this in the hands of parliament, such as the Health Select Committee. It could be argued that ‘there is nothing to see here’, but, if promoting patient safety does not include learning from mistakes, I strongly believe that the GMC should not survive. But I would be the first to be truly delighted if the GMC had the humility to learn from its serious mistakes.

Otherwise, as I myself have discovered, no-one or no entity is indispensable.












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