OB1
Improvements can only be made when change is accepted as being needed and commitment is made for that intent.

The National Health Service - 1. Flaws, 2. Faullts & 3. Reversals - [A brief gist]

History

1. The NHS was conceived with an incomplete plan and rushed into place.

The Doctors took advantage of the naive idealistic political urgency and dragged their heels as one negotiation tactic. This resulted in the doctors being given everything [even more] than they wanted.

Right from the outset in 1948 when [Aneurin Bevan] begged the reluctant Doctors [a negotiation] to staff the NHS while [“I stuffed their mouths with gold”] and handed them full management control. The doctors have increasingly and inevitably been locked in a control and funding war with the government.

They ran the hospitals. They controlled the training and functional practices of doctoring. They could work as private doctors as well.

2. Over the decades successive governments have attempted to address the rising costs and size of the NHS without much success. By focusing almost entirely on cost in a big picture way and with costs also rising in a global industry way, the junior doctors and nurses have received the greatest snip in numbers and working conditions, under lower than inflation salary rises. Jeremy Hunt made that his primary Legacy.

The set up was never corrected. [Albeit with adjustments and evolutions that were handled with the agreement of the doctors and mostly controlled by them.] The core power ratio and the self-serving control issue has never been addressed.

3. Politics being the game doctors kept winning until Thatcher’s [failed] attempt to create competition within the NHS that only resulted in corporate costs of management being replicated into dozens of CEO’s in every county. Then middle management got in on the money river. [Management should not be so incredibly expensive].

Can you imagine what would happen if the military was managed in the same way as Thatcher’s failed [but perpetuated] competitive management [vision] structure? There would be lots of different methods for similar tasks, differing policies, differing standards and very few little metal boats.

Priority number One:

The Government needs to Govern – The ‘NHS’.

A Constitution should be created to regulate the ‘NHS’ fundamentals, the uniform practices and the Limits [listed] for an auto-matic managing way.

A management structure should be put in place using a pyramid hierarchical structure to replace the current Jupiter moon design of sea urchins, frightened of Dr. Otters.

Priority number two:

Must be to reverse and correct the standards and procedures for junior doctor mentoring, weekend absences of any senior experienced doctors, industry [military] uniform [agreed costed] practices.

A law / regulation requirement for private Cosmetic Surgeons need for: Qualification, testing, grading & annual licence fee with 5-year re-testing/grading with ‘free’ updates. And all other private [&Non-British] medical degree qualified surgeons.

Universal Key Rule: Doctors Are Not to be Trusted. [“Bevan”]

Change: ‘Do No Harm’ to adding ‘Prevent Harm’!

An introduction of applied services cost by legitimate client/patient qualification. The simplest and easiest way is by [avoiding and ‘smashing’ all Humphey’s into pension ‘legitimate reduced’ access, line] by using as a regulation the Uniform requirement of the ‘Ni number’ [National Insurance Number] as the free-till access to The NHS Services, in Great Britain.

The Ni number must be re-valued at point of given/value/donation/ease.

Further key detals:;

Stop Life on Earth! I spot a Bug!
Look who's talking.

The allopath doctor

1.2 Treats [the patient –nhs as a recipient not as a patient] [the patient - $ as an emergency & a permanent 'electricity' supply customer opportunity] ‘symptoms’ as a billing opportunity [“people should eat what they like”] Symptom ‘industry’ incentivised [$] standard [business] design NHS opportunity and client perpetuation and growth, thinking [modern]..  

The holistic doctor

3. Treats ‘the whole’ Patient., Symptom/s, History and the spectrum of life-style choices, involved. [in addition to conditions and physical factor influences, in affect] for the benefit of the ‘patient’ [Considering the benefactor client’s objectives]

[Without parasitic attack on all financial fronts - from disposables to hospital infrastructure]

https://www.bbc.co.uk/news/health-43504125

https://www.bbc.co.uk/news/uk-politics-45495384

Food: 

1.2. Alopathic Doctors have an aversion to diet and life-style advice or any advice that would promote good health. “People should eat what they like”. Was the BMA’s mantra and advice before decades of evidence of the obvious causation became blatant to public opinion, after years of positive pressure groups upon the government. For a time salt intake through accumulated processed food was a cause of death that led to quiet government action. [Diet was now as tricky a subject as fossil fuel use and the climate destiny.] The doctors modestly supported a healthy diet and exercise as a way of preventing chronic diseases.

The conflict still exists for the Alopathic doctors that the more people that adopt a healthy diet and life-style the fewer presenting ever younger patients they will expect with chronic symptoms from obesity and other unhealthy habits.

I remember visiting a hospital canteen on a daily basis and too often the best choice was mushy brown broccoli, mince in a soup of coagulating gravy with chips. Pudding was cake [sugar, butter and flour] with a further dose of coagulant custard. Meanwhile blood thinners were being prescribed £? throughout.  

3. Near Heathrow there are crew hotels with 1,000 rooms that serve breakfast, lunch and dinner and room-service in 30-minutes [Restaurant quality & menu] from one kitchen.

Key Rule: Aldente is cheaper than Overcooked.

Catering: Training with quality standards maintenance with refresher courses.

The one time people with bad habit diets can be re-trained by introducing them to healthy food only, in hospitals, should not be squandered.

The green world food revolution is being totally ignored in most hospitals and those that offer healthy choices still have the choice of fried rissoles, chips and other carb heavy foods.

Nothing should be fried. No sugar. No more coagulants. Reduced need £ for blood thinners.

Rehabilitation not Amnesty

1.2 Of course Holistic doctors cannot avoid surgery with acute presenting conditions, orthopaedic issues and injuries.

But who is conducting those surgeries their training, mentoring, in surgery ability, individual skill, monitoring and behaviour when an error occurs and a personal responsibility for correcting any lacking should be matter of great interest for government, a monitoring regulator, the Department of Health and the BMA. [Or it should be]

‘The NHS could be bankrupted by an “unsustainable” increase in the cost of payments to patients who have been the victim of medical errors, with future liabilities already topping £65bn, health service chiefs have warned the Justice Secretary.’

‘It means that clinical negligence costs will consume about £1 in every £3 of the extra funds that the NHS is set to receive annually under plans to raise England’s NHS yearly budget by £20.5 billion by 2023/24.’

The reasons for clinical negligence going unchecked and growing are principally 2-fold.

A. The self regulating BMA in mentoring and working standards and procedures are happy with the ‘originally’ set up status quo.

B. Increasing pressures with reduced doctor intake and reduced quality skills has led to an escalation of clinical negligence, under the original status quo.

Within an industry where surgical training and mentoring is reduced to – “See one, Do one, Get on with it”. It should be no surprise that ability, quality and outcomes vary widely.

Can you imagine an airline training its pilots based on “That” method? The industry standard would be used to several crashes a months and any increase would be dealt with by saying “The situation is within expected parameters”.  

3. After the BEA 548 Trident crash in 1972 the FAA decided that the training given to pilots trained for WW2 were not appropriate for a higher civilian safety standards and needed to be modernised. To this effect NASA was brought in to design the modern team management system we have today. Pilot safety, craft and flight safety is Outstanding proved by the modern history with the reduction in errors.

Of course The Majority of NHS surgeons know their job and are good at it all. It is the increasing minority that is [in compensation cost] growing un-corrected. And everyone makes mistakes but in Surgical theatre in the NHS [under the BMA, Department of Health and the Government] too many fakes, poorly mentored surgeons, [with widely varying untested, unmonitored, ungraded] with individual abilities are ‘landing on the runway with their wheels up’ everyday and then walking straight into a theatre the next day with no remedial investigation or action. Meanwhile the government gives away tax-payers money hand over fist to the surgically damaged and the ‘Dead’s’ living families and looks bewildered at consultant doctors hiding under their desks [and the facts of the missing physics of the guilty] at the BMA.. [Who want to avoid the fundamental changes that would be necessary and put an additional work load and responsibility on their time and personal quality private career freedom and the reduced competition by keeping most NHS surgeons average at best].

What is needed is:

A. A more thorough mentoring process.

B. An individual grading system for surgeons [through their careers] and specific surgeical procedures. The grading system should be for safety, quality assurance and development comparison. It should be an internal record available to all [and patients upon request] departments involved.

C. An internal clinical review department should be set up to monitor surgeons and investigate all errors [whether reported from theatre of detected in recovery or beyond]

D. An independent [from the nhs] regulator authorty [for the nhs] should be set up to review randomly and investigate specifics including the internal clinical review department. The independent regulator authority should report to the Dept of Health, the Health Minister directly and number 10 [where necessary]. The independent regulator should have the Full Power to Intercede. 

Oliver Twist

1.2 Paracetamol costs £2 for 100 at Boots. Paracetamol costs [the People.Gov. NHS] £8 for 12. [From memory article mail.online approx 15 years ago. No further looking is required to make this ‘little’ point.]

3. A [new] purchase and value, aquisitions dept authority should be set up to ensure best use of [benefactor client authority] funding. 

Ultrasound Machines:

I recently went to an NHS hospital for another ultrasound on my kidneys.

Over the last 26 years I have had ultrasounds every 2 to 4 years in various locations within the NHS. The ultrasounds are to check to see if my sedentary situation [caused by a spinal cord injury C-6 in 1994] is resulting in any visible kidney distress.

In the ultrasound room there were 2 new GE Industries ultrasound machines. Only one was being staffed by a senior consultant supported by a model user advisor from a technical department of one of the sub-contractors of the manufacturer. There was a second unit [in the 2 unit room] but it was off and not being staffed or used. The inference taken by me from this scene was that these new ultrasound units were first being learned one-on-one by the consultants with the tech-use-advisor [while she was paid to be on location by GE Industries].

Against the far wall there were 4 other ultrasounds machines, varying slightly in size and age looking. The biggest were the new ones. [Inference taken based on experience and questions answered by ultrasound medical-tech users over the years – 2 sets of replacement upgrades had happened so fast that the redundant units had yet to be picked up and moved on to their next £ destinations].

The first ultrasound that I was given was on my lungs in 1978 was in Sidharth Hospital, Wai, Maharashtra. I remember looking closely at the screen as the untrasound probe was slid over my chest. I was 13 years old. No infection was visible. I have looked at every screen ever since.

It is Amazing how good that untrasound was in that tiny town hospital in India in 1978 because every ultrasound image is much the same. It is a little clearer but the ultrasound ‘sonar’ technology is essentially the same. The trained reading has improved along with the slightly clearer image but the big difference [only] is how to use the machines - [which buttons to press and how to work the new menu-selection options]. Diagnosis is still the domain of the specialist medical technician – for now.      

It looks to me that the NHS had bought the latest Porsche 356 [ultrasound machine] in 1948 and upgraded to the Porsche 911 [ultrasound machine model] in 1964 and then allowed the purchase of every single Porsche 911 model released since its design creation and evolution. Any boy/man interested in cars will tell you there has been very few years which Porsche have not offered its rich market, something new for the back-slung lightweight V-Six fun machine boy toy, at an ever increasing perceived value.

There is no genuine reason to buy every model [until the old model cannot see a view of a condition] Any Clarkson could tell you which One 911 is a benchmark model [1978- Whale-tail] [1989- 2 or 4 tiptronic] [2004- any] But every single model?! What are you Stupid, being Ripped-Off or “Is your name Sheikh”?

3. The new purchase and value, aquisitions dept authority should be run and controled by the indepedant regulator authority. All employment will be their choosing [apart from 1 Depatment of Health appointed director, roving manager and a randomly moving audit investigator] 

The Independant Regulator Authority will have total power of authority, Over all of [when necessary] the NHS, its Employyees and all policy and procedures including, clinical method, drug choices, aquisitions and expenses. 

The independant regulator authority will report to the Dept of Health, The Health Minister directly and Number 10 [Where & When necessary]. The independant regulator will Serve number 10 and its chain of command.  

The Hippocratic Oath {Common modern version} 

A Self-Serving, Arrogant with a superiority complex [Phychiatric State]

The Hippocratic Oath [Revised]

I Swear to Fulfill, to the best of my ability and judgment, This Covenant;

I Will Apply, for the benefit of the sick, all measures which are required, treating my patients as though myself in health value. I will avoid under treatment, over treatment and harmfull treatment that is without health outcome merit.

I will, at the centre of my doctoring have a personal view and relationship with everyone patient, giving my best practice equally.

I will offer the best prescription for best outcomes regardless of cost, for patient consideration. And offer second and third and all options for treatment where needed or appropriiate for patient / client / guardian consideration.

I will respect the privacy of my patients, for their problems are not disclosed to me for me to disclose to others. Outside medical personel with a need to know basis. This is the basis of Doctor patient confidentiality.

Most especially must I tread with care in matters of life and death. Above all, I must not act to bring about death upon my own judgement. Where the end of sufferring is requested and permitted I will follow the regulation of a region [personal faith permitting] to proovide an end to sufferring with death. [Or I will refer the patient request / situation to able collegues]

I will not be ashamed to say "I Do Not know" nor will I fail to call in my colleagues when the skills of another are needed for a patient's diagnosis, treatment, or recovery. I will accept that in many circumstances my service will be as part of a team. And by teaming expertice cooperativly, efficiency of expertice is increased and mistakes decreased. This compatriate team work will be the ethos for all my collaborative future.

When a mistake has been made I will honestly do my best to correct the error and minimise any harm or damage. I will not allow a patient to suffer by covering up my own or a collegues error or cover up a faulty system in place. I will ensure that my professional conduct is covered by insurance for full remuneration and compensation.

Where systems or actions are detected that are faulty / dangerous / hamful or lethal I will take actions to correct those faults. I will not accept criticism or prejudice by my good actions. Neither shall the governing body of my profession.

I will remember that there is art to health & medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. And remember that mental health states is subject to a spectrum of psychologies of stresses, in that only sensitive observation can aid diagnosis or avoidance strategies and that good practice for any patient requires this dilligence.

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow, in accordance with best evolving practice set in agreed and respected best practice regulation.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being.

I will prevent disease whenever I can, for prevention is preferable to cure. I will advise all patients of preventative measures of nutricianal choices and an excercise life style and to avoid or minimise unhealthy choices and habits - In an holistic view of lifes long health - to avoid unnessesary chronic dependencies upon medicines.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body and otherwise as well as the infirm.

If I do not violate this oath, may I enjoy my life and art, respected while I live and am remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and never to disshonour my trade or the governing body. May I long experience the joy of healing those who seek my help.

She needs some help but she is not the 'one' that is sick and the alopathic sickness and its dishonest disinterest £ in the mind, is why no-one is interested or placed correctly to help her.

Louis Theroux: Talking To Anorexia - Took me on a tour of an NHS psychiatric unit.

It is clearly apparent from Louis Documentary [and from my extensive experience inside the NHS as a patient and as a visitor to psychiatric units] that the patients are being let down by a poorly planned, poorly managed, poorly staffed, under qualified service approach.

While the NHS is staffed with many very good, qualified and diligent individuals in the system, they are working in a system that was constructed to favor medicines for symptoms and chronic dependence.

Doctors view value in symptoms treated directly with engineered pharmaceuticals and the skilled intervention of surgery. Both are straight forward and without much complication.

The human mind however is packed with complexity and variations. Diagnosis [accurate] is difficult and requires much more time than other parts of the body. Once a diagnosis has been reached pharmaceuticals mostly only suppress the issues for a time or cause other problems [behavioural or physical medical] to manifest. Psychiatric analysis and then therapies take time and are often so complicated [no matter the apparent simplicity of the patient] that only the best students of the human condition are able to have a go at untangling the ‘noodle’.

It takes a passion for psychiatry, a keen understanding of the subject and a great tolerance for people ‘the mind’ and an acceptance of various levels of failure/success and the probable compromises of expectation.

The very damaged or dysfunctional mind is only as repairable as a smashed China vase. Less damaged, dysfunctional minds can usually be fixed with a wise experienced guiding hand and often just a rest from mental exhaustion. All analysis and therapies however require a passionate and committed psychiatrist and their trained and understanding team to help.

Unfortunately the [observed] NHS status-quo has resulted in the weakest doctors being pushed side-ways into mental health [with only an apparent psychiatric memory from the medical school mental health module. They seem to just carry a folder containing the nhs mental-health guidelines and service policy, for reference.

The doctor featured in talks with one anorexic girl said [in effect] “Hmm, well shape up. It is how you deal with it all that is going to count” Not helpful at all. In fact downright crap.

Even the moment caught with the consultant psychiatrist in the hallway, spoke only in a dismissive, transient fashion, in negative terms and she appeared to be flying between 5-minute reviews before leaving the building.

All of the anorexic patients without exception have conditions/issues behind/underneath the symptom or being unable or unwilling to eat.

Unfortunately there is no pill prescription to rewire a malfunctioning attitude or to dissect to dissolve a childhood or adult life trauma.

It is my opinion that people that do not turn up for a GP appointment or cancel within 3 hours should be charged £40 prior to booking their next appointment. [Or go elsewhere] [Single mothers and people on welfare – will not be charged – just given a reprimand leaflet]

Eliminating the trend of obesity:

An early on-set [schools] 'set-up' life-long Healthy productive Life-Style Attitude

Reducing costs within the NHS:

Purchase efficiency & {The elimination of the Corruption of purchasing Costs}

Management structure review – NHS ethos & NHS ethical constitutional adherent guide.

A Preventative ethos – Eliminate non essential medical treatments. [Doctor's that breach 'medical uneeded' should be imprisioned for 6 months per breach auto on conviction.] 

Low Self esteam should not be corrected with surgery by surgeons or unqualified surgeons. [All surgical procedure in Britain must be carried out by qualified, certified, registered active & insured surgeons] {A Basic No Brainer} 

Make educational diet set-up & life style investments - Introduce diet nutritional national health standard institutional regulation. [C addendum 4]

Introduce Life style training an inclucive occupational service time for psychiatric patients post accute treatment.

Introduce national procedure harmonisation.

Eliminate global free service, service attitude.

Your Pension and your employment Depends on You following it.

[work in progress]

Viral & Bacterial Outbreaks

[With the rise in temperatures caused by climate change and the possible growth of more potent and anti-biotic resistant bacteria, a constitutional addition needs to be added to help/prevent government from needing to think / [be led] to react to infection spread [and to keep the needs of the Heath Service / Doctors & epidemiologists from over-reacting and putting their perspective needs over] under the needs of wider society.]

Where and when an outbreak appears the gauge of risk and reaction should be not based on infection spread & speed but on lethality.

All preventative reactions / changes in behaviour should be restricted to prevent wider damage to society and any social & economic damage unless the lethality exceeds 1.5% of population.

Lock-downs [quarantine] should [in the first instance] be local to hot spots of infection growth. A radius [post-codes] should be established from the epicentre out to 1 mile from the detected infection [and its current visible] and current estimated current spread point.

Even if a highly infectious airborne virus [Such as Covid-19 of 2020] emerges to spread through the UK, that has a lethality of 5% of population [example] a total national lock-down is not sustainable and will not block the spread but merely slow it down to crate other types of damage while saving very few lives from the very old, weak, vulnerable and the unlucky susceptible groups.

Society must continue to function while implementing personal preventative behaviour and blocking [quarantine] radius Lock-downs. All Lock-downs will be limited to 14 days max.

‘The needs of the many outweigh the needs of the few’.

The NHS will provide as much at home Oxygen and community service as possible. When max intensive endemic in hospital service is arrived at, the intensive viral/bacterial hospital areas will stop admissions. At no point in any outbreak will the NHS cease or cancel all other medical services. NHS / Ministry Planning & Management must be adequate for a balanced function.