The Rt Hon Patricia Hewitt MP
Secretary of State for Health

I used to think that the Rt Hon Alan Milburn was the pits of stupidity and unintelligence as Secretary of State for Health.   He was the one, you may recall, who thought the way to get doctors on-side was to control them to the extreme degree.  To this end, he seemed to set up a new disciplinary body every week.   The Milburn method of man-management was to eat the carrot himself and beat the slaves but what else could one expect from a man of his ilk?

Fortunately, he suddenly decided to spend more time with his family whilst seeking employment in, it is alleged, a health related industry – and, of course, carrying on as a back-bencher in Parliament.

However, even Milburn has been surpassed in sheer incompetence by his latest successor, the Rt Hon Patricia Hewitt.  She has succeeded in even annoying the BMA – and that, believe me, takes some doing.  

Mind you, it was the negotiating ineptness of the BMA GPs’ committee which has made Mrs Hewitt’s primary care idiocies possible.  Dr John Chisholm CBE, the GPC Chairman, almost railroaded his reforms through against a great deal of opposition.   He was trusted.  Somewhat unwisely as it turns out.  The overall effect of the Chisholm reforms has been to fatally fragment general practice to make it easier for the Department of Health to control and, boy, are they controlling!!

Dr Chisholm, together with a fellow GP negotiator, gave a personal vote of no confidence in his own reforms by quickly leaving the NHS to enter private general practice.

But I digress!   Back to Mrs Hewitt.

This intellectually challenged incumbent is rewarding the GPs, whom she says are doing a splendid job for the NHS, by, as one medical newspaper (PULSE) put it, instituting “an era of scrutiny and suspicion”.   She is driving a coach and horses through medical regulation.

Professional self regulation will vanish as a lay majority takes over the GMC and the standard of proof required to find a doctor guilty will diminish to “the balance of probability” rather than “beyond reasonable doubt”.

If Mrs Hewitt had had the intelligence to think this through she would have understood that if a doctor’s livelihood is to be so easily ripped away from him he is going to attempt to prevent that by practising ever more and more expensive defensive medicine, “just in case”.   Not only that, doctors who are found guilty will, with the help of their defence bodies, be appealing every case, cluttering up the High Courts for years to come.  Not to mention Mrs Blair’s Matrix Chambers.

But, of course, she did not see that.   Nor did she anticipate the seething resentment caused by the changes.

Within general practice Mrs Hewitt thought it an excellent move to deny GPs a pay rise – any rise at all – for a second year running.  This because she and her own negotiators had freely agreed a contract with the GPC which meant that GPs would, at last, be paid for the work they did.  Unfortunately for her, GPs worked very hard and had to be paid for it.    Whilst claiming to the press that GPs are worth it Mrs Hewitt took lessons from her Chancellor colleague, who has been stealthily thieving from the peoples’’ pockets for years, and is seeking to equally stealthily claw back hard earned income from GPs.

All very morale boosting.

Whilst that is going on, one of her juniors, health minister Andy Burnham has written to GPs to tell them that they face “a real drop in income unless they deliver government priorities in future”.  This unpleasant young man seems to be telling GPs not to concentrate on clinical needs or patient care but to do what the government wants.  Sieg Heil!

Those who do not do what the government wants will very likely be fined by their Primary Care Trust as yet another national disciplinary body is rolled out on top of all the Milburn punishment QUANGOs.    And just to help the managers in their quest, Mrs Hewitt is to make it easier for “whistleblowers to “take their concerns directly to the PCTs or the GMC”.

Yep, doctors really enjoy working in today’s NHS.

Talking of patients, GPs are being coerced into switching patients on to the cheapest drugs possible despite the proven threat to patient safety from counterfeit drugs or greater side-effects. 

Morale in general practice has not been improved by the government’s intentions over revalidation and appraisal of GPs.  Mrs Hewitt is pushing through measures to ensure that appraisal should become a summative performance assessment.    Already scores of GP appraisers are threatening to resign their posts if this comes about.

Even more Departmental idiocy has entered general practice in the guise of “choose and book”.   This scheme was intended to allow patients a choice of where they are treated.  The only thing is is that the system is electronically so inadequate that patients have even less choice than before and GPs are wasting hours of consulting time trying to make it work.   Consequently only the managers choose where patients end up – and, by the way, bye-bye confidentiality.

In the golden days of yore the GP knew all the local consultants and hospitals and simply asked the patient where he would like to go.   That was too simple for the Hewitt’s of this world, so they imposed “choose and book”.   Worse, in some parts of the country GPs are being actively discouraged by their PCT from direct referrals to consultants they know and respect.

The above are but a small number of the many, many irritations and extreme annoyances which Mrs Hewitt has wantonly imposed on the profession. There are others, such as enforced out-of-hours work, despite agreeing a contract to abolish it, and the cap on GP pensions.  I could go on.

One has to wonder at her thought processes if she believes that she will gain a willing medical work-force this way.  

Is it because she is sufficiently small-minded to be jealous of a profession which, despite all her serious and deliberate efforts to denigrate and belittle it, has so far come consistently at the top of popularity and trust polls whilst, as a politician, she and her colleagues wallow in the mire at the bottom of the scale?

For a reason for that, of course, she should look no further than her present boss.

Small wonder, then, that in a recent poll in Doctor magazine, 82% of GPs wanted a ballot on industrial action. 

Well done, Mrs Hewitt. You are a credit to your government.

And I have not mentioned the fiasco and dangers to patients from the multi-billion pound unworkable NHS IT system which she is attempting to foist on a unwilling profession,  Mind you, she has lost all chance of the majority of doctors being willing to do anything voluntarily for her.

Nor have I mentioned the deceit of arch-stealth operator Gordon Brown in taking the credit for financing large numbers of hospitals.  The truth is that  the PFI project, in fact, hides the payment for future generations to stump up as they pay private industry a huge amount of around £53billion in rent for hospitals costing a mere fraction of that sum.  

But I mustn't finish without giving a mention to the dumbing down of consultant training where the training period is being shortened by some years whilst, at the same time, the working time directive shortens the working week.   The effect will be that the government will achieve its target for consultant numbers but they won't be anything close to as well trained as current consultants.  British excellence will be diluted but what does the government care?

Whilst all this is going on, of course, there is the on-going utter fiasco of the junior (training) doctors' search for their next job.  The childish and petty computer interview system which seems to make a specialty of doing anything but match candidates for the job.  The system which denies choice to the doctor of where he shall work or even of specialty - and where these 30-odd year old adults shall uproot their family and children to - does not even accept CVs or references.  Junior doctors don't have lives, apparently, they are trash to be dealt with as Hewitt dictates.

This article has concentrated almost entirely on primary care but PCTs and hospitals are all in utter chaos.  Some are even technically bankrupt but Mrs Hewitt has cooked the books with creative accounting to make it appear that the NHS is actually in profit.

It isn’t.  It’s dying and, not withstanding all the chaos, ineptitude, arrogance and stupidity she has been responsible for the woman still clings to her job – just like her discredited and discreditable boss, Tony Blair.   When will the country be rid of them?

  (10/3/07)