Posted by: Witch Doctor | January 19, 2011

Home deliveries and haemorrhoids


I would imagine, My Black Cat, they’ll all be wondering why The Witch Doctor revealed to the whole of the World Wide Web that she has a dinky little pond fracture under her hair. It seems a bit odd to reveal such a personal matter. Of course, The Witch Doctor could be spinning a yarn. On the other hand, it could be true. If you ever come across someone you think might be a witch, then just lift up a lock of hair ….. then if you see this fascinating skull depression you l will know it was not a yarn and The Witch Doctor has just crossed your path. You might also give a thought about how you feel about home deliveries.

For example, you might want to ask yourself :

How many doctors or doctors’ wives have home deliveries?

In particular, how many obstetricians or obstetricians’ wives have home deliveries?

Wonder if that research has been done, My Black Cat?

Anyway you can find out what The Witch Doctor thinks about home deliveries here. She said she would never mention it again. But a witch can change her mind.

What made us think about this topic anyway?

Well, My Black Cat was skulking around The World Wide Web when she discovered a piece of paper.

She was intrigued that Houslow was getting into bed with United Health UK, whose parent company is a giant in the USA. She wondered what was going on in NHS Hounslow, and she wondered who this Dr Nicola Burbidge was that we mentioned the other day.

This piece of paper is the’ minutes are of a PUBLIC BOARD MEETING: THURSDAY 11 FEBRUARY 2010.

The rationale behind the meeting was as follows:

“To update the Board on clinical issues and the activities of the Commissioning Executive Committee (CEC). The key purpose of the CEC is to provide the PCT with clinical commissioning leadership.”

It’s not very interesting to read and it is full of abbreviations that will mean very little to most people. It is the kind of paper that those outside the Committee (i.e. patients and staff) are very unlikely to read or indeed have time to read, and as a consequence they won’t have a clue what is going on round about them.

Here are some of the things My Black Cat noticed……..

“Challenges for next year will be to curb expenditure in real terms which will necessitate looking at de-commissioning services, management and consultancy costs, reducing referrals and delivering more at current cost levels.”

Note “de-commissioning services” and “reducing referrals.”

It is also noteworthy that back then it was Aetna rather than United Health who were grooming themselves to set up a referral facilitation service.

Aetna featured in one of our last government’s Menu of Services.

The poor GPs would require to be educated in how to make a proper referral.

“It was agreed that individual sessions with all clinicians at individual practices will be required to educate them on pathways and the referrals system.”

It seems to have passed them by that GP’s over the years have always had a simple way of referring patients by writing a letter to the consultant of their choice about the patient whose full medical history they know and whom they have clinically examined.

It seemed to My Black Cat that this “education” was more about constructing a shark infested moat between GP and consultant and therefore between patient and consultant.

They want GP’s to CHANGE.

Commissioning Intentions

JC set out the priorities for next year with consideration to limited resources. PS stressed the challenge in getting GPs to do something new, or different, as opposed to asking them to do more of what is already in place.

Now here comes the bit about RATIONING.

They hate it in our neck of the woods when we call their “Change” by the name “Rationing.” Don’t they, My Black Cat?

“DT advised that a letter is to be sent out to the GPs stating that as per the SLA those procedures deemed low value l will no longer be paid for as of 1st January 2010. This list of low-value operational procedures will also include:

Carpal tunnel (needs more work)
Menorrhagia (to be reinforced. Excludes coils) –

NW London Policy defining interventions not normally funded DT to provide GPs with an explanatory letter which can be handed to patients who will be refused treatments when they don’t met the criteria.”

Rather than the long complicated ECP form, it was decided that a detailed referral letter, that fits all the detailed criteria, can be submitted by the GP to the ECP. Template to be made available on PbC portal of website. If ECP denies the referral request both GP and patient to be advised in writing.”

My Black Cat then had to find out what the devil the ECP was. More about that in another post maybe.

The gist is – if you have haemorrhoids don’t expect NHS Houslow to sympathise. Same goes fora carpal tunnel syndrome (but they haven’t made up their mind about that.)

Menorrhagia is bad news too.

There is RATIONING going on in Hounslow.

The Witch Doctor has no idea how widespread this aversion to haemorrhoids is throughout the UK.

She doen’t even know whether it’s a good or bad thing to have your haemorrhoids removed or to stick to stick with them nowadays.

Same for varicose veins.

She is not an expert in these matters. She certainly had two acquaintances who died following a complication from each of these procedures. But she remembered many many more who survived to tell the tale and whse lives were improved by surgery.

She also has a young acquaintance who was admitted recently for routine gyn surgery for menorrhagia. Her curable endometrial cancer was totally unexpected and may not have been diagnosed in Hounslow.

None of this is the point, however.

The point is there is RATIONING is going on.  That is what “commissioning” is really about. The Witch Doctor wonders how many constituents in this part of the world know about this rationing, whether they have had it explained to them and whether they really care. Until it affects them, that is.

It is important to know. Because once blatant rationing starts it is liable to Creep. It has to be watched closely for this developing.

Especially in these days of “Patient Choice” which really means “Restriction of Choice”

Now then, if you look down at some other boring stuff in these minutes, you will find another little snippet:

“Maternity and New Born:

Point 2 – percentage of homebirths not of highest priority”

What exactly does this mean? It surely begs the question “have there been targets set on home deliveries not only in Hounslow but elsewhere in the UK?”

So My Black Cat continued to look elsewhere………..



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  1. I think that the world of Varicose Veins has moved on substantially since most GPs were last involved and little of this massive change to minimally invasive, low morbidity, office-based procedures has been fed through.

    This is probably the case with much surgery and medical treatment in hospital nowadays – things have changed massively from when I qualified in 2006 let alone for those GPs nearing retirement. How on earth are local GPs going to be able to manage their own work AND commissioning?

  2. To save your Black Cat some trouble, the Strategic Health Authority for the South West says that it expects 10% of babies to be born at home by 2011.

  3. …orifice (sic) procedures…fed through? Feedback is bad enough as jargon…now it seems that which we do not want is to be fed through! Enough to give anyone piles!

    • sadly I put office, not orifice, but fair enough. to feed through becomes fed through, does it not? I wasn’t aware that such english terms were considered jargon, but then as I am not a manager I would never know.

  4. Most concerning, WD; I was wondering about home deliveries after your recent post. I noticed that the last but one statement in AOB on the piece of paper your Black Cat found suggests that GPs are asked to keep patients at home due to a lack of ambulances – I have to say, this is concerning!

  5. Threestain,

    You are spot on. Local GPs can’t possibly cope with their own work AND commissioning unless they follow a new career while retaining the title Dr. Governments are fully aware of this and so they have cleverly capitalised on it so that private companies will capitalise on it too, employing cheap or voluntary labour to boost profits. Everone “employed,” economy boosted, large profits made somewhere.

    The huge oyster has been opened – and your health, my health, My Black Cat’s health becomes a commodity.

    All the major political parties have been gradually levering the oyster open for many years now and have succeeded because the medical profession is ambiguous.. so the pearls will be grasped, but not by coalface doctors and certainly not by patients.

  6. Thanks, Dr G, no doubt MBC will have something to say about it all later. At the moment she’s out catching big rats.

  7. quasiserendipita,

    I noticed the bit about the ambulances too. If you can get your head round all the abbreviations, it is worthwhile looking up public minutes of meetings. No-body else reads them and things slip under the radar.

    DN wrote an interesting post way back, showing that even if things are published, they are referred to wrongly and it begs the question whether it is assumed no-one reads these documents

    “It never does any harm to check whether a reference actually supports what an author says it does.”

  8. […] Dr Grumble comments elsewhere : “To save your Black Cat some trouble, the Strategic Health Authority for the South West says that it expects 10% of babies to be born at home by 2011.” […]

  9. In case your Black Cat hasn’t found this yet:

    In 2002, former Wales Health Minister Jane Hutt and the Heads of Midwifery Advisory Group for Wales, set a target of 10% home births by 2007, a figure that’s not been reached, although it has been exceeded in some pockets.

    Helen Rogers, director of the Royal College of Midwives in Wales, hopes rates will snowball as women see home birth works and says we should still aspire to 10% and more.

    Read More

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