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Riding the Rollercoaster of State Medicine  

Background to : The History of Medicine, Money and Politics


In 2003 I was working as a radiologist at the Bristol Royal Infirmary. I had just completed a stint as radiology section president of the Royal Society of Medicine and was the head of training for radiology for ten local hospitals in the South West.

Needless to say my workload was enormous and my days were extremely full. Unfortunately I was also finding that a lot of my time was wasted. Sitting on National, Regional and Local committees took up a considerable amount of time but influencing decisions at those committees was becoming less and less possible. I would turn up at a meeting expecting sensible debate over contentious issues only to be told that it was not the forum for discussion and that we had to implement the changes whether we liked them or not.

I warned the South West post-graduate deanery about the dangers involved in the new training procedures for doctors and the impossibility of training post-graduate doctors adequately in the hours available. I pointed out the bottlenecks in the training programmes and I warned about the inherent problems of computerising the job applications.I was told to sit down and shut up.

Being an awkward customer I refused to be treated in this way and walked out of the deanery meetings with some slamming of doors.

Back at the Bristol Royal Infirmary things were not so great either. The previous year we had received no stars in the NHS star rating system whilst other large teaching hospitals, such as Addenbrookes, had won a three-star rating. Looking at the government's own published figures I had realised that the rating system was based solely on non-clinical results. These included whether or not the hospital was within budget and the length of waiting lists or trolley-waits in Accident and Emergency. In the published data there were true clinical indicators but they seemed to have been ignored. In a letter published in the Daily Telegraph (2.8.2002) I pointed out that the areas in which my hospital, United Bristol Healthcare Trust, underachieved were the non-clinical targets, mainly waiting times (owing to lack of beds) and finance. In these we were rated bottom in the country. But in the essential clinical targets of negligence, death within 30 days of surgery (non-elective admissions) and emergency readmission to hospital , we had the best results in the country. The clinical results of the three-star hospitals were much more variable, with emergency readmission a particular Achilles heel.

In the latter part of 2002 a colleague at the Bristol Royal Infirmary had retired and another colleague had moved over to take on his responsibilities. This had, unfortunately, left a considerable gap in an area that I also covered. This gap had not been filled and I had been obliged to increase my clinical workload.

Under considerably strain from all directions and being ignored by the managers and political masters I found myself having repeated arguments with the managerial staff.

The NHS was going in a ruinous direction and nobody would listen.

Stressed by this situation I had a row with the departmental manager, fell sick and eventually retired with depression and despair. Initially I found therapy in putting these problems to music and producing a CD of songs (The Good Doctor's Ditties) including such titles as "the NHS Blues" and "Management Man".

Meanwhile on the domestic front I was having the same problems that many people face all over the United Kingdom. Both my mother and my mother-in-law had contracted dementia.

My mother's dementia worsened fairly rapidly after she was admitted to a private nursing home. She was next admitted to hospital where she, an ex-nurse who had been proud of the fact that no patients on her ward ever had bed-sores, went on to contract a bed-sore herself. This became infected with MRSA, a hospital super-bug, and was contributory in her death.

Seeing the way in which she was treated in hospital, talking to the general public about problems they faced in the NHS and reading the stories in the newspapers increased my resolve to write the expose of the National Health Service in all its present-day horror.

Having written hundreds of articles and several books I thought that I should write about the problems as honestly as possible.

This I have done in my book entitled The History of Medicine, Money and Politics: Riding the Rollercoaster of State Medicine.

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