Posted by: Witch Doctor | April 11, 2011

They will NOT cut front line services!


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What is wrong with The Humankind, My Black Cat?

Why are the nurses getting their knickers in a twist?

Why can they not understand that this government (or any government for that matter) will NOT cut back on front line services?

Do The Humankind not understand what we have been telling them for years?


What is it about this they do not understand?

I suppose, once more, we are going to have to spoon feed The Humankind.

Let’s take them to The Skill Escalator one step at a time, My Black Cat.

1. “Front line” in the context of health care  are those services closest to patient care.

2. For example, referring a patient to hospital, performing clerking in and examining a patient, taking blood for laboratory investigations, imaging, making a diagnosis, prescribing medication, administering medication or anaesthetics, performing surgery, bed bathing and other toileting, mobilisation, feeding, portering to Xray etc etc etc etc etc etc etc are ALL front line services.

3. Most of the above services can be carved up, and carved up again till each becomes a tiny activity the size of an atom.

4. These atoms are called competencies.

5. For example there might be a nail clipping competency that can be subdivided into two …. the “Hand Nail Clipping Competency” and the “Foot Nail Clipping Competency.” These two competencies can be further subdivided into twenty … the “Right Big Toe Nail Clipping Competency” and the “Left Thumb Nail Clipping Competency” and so on….

6. Once this principle has been grasped it can be extrapolated into many different procedures. For example, today there is news that unpaid members of the general public can be taught how to diagnose cardiac arrest (patient not breathing) and use a super-intelligent de-fibrillator which will, before shocking the patient with electricity, confirm whether the member of the public made the correct diagnosis. Apparently though, there is a slight glitch, the member of the public has to be able to hear when the super-intelligent defibrillator tells them not to touch the patient during the electrical procedure, so we suspect the hard of hearing or those who do not speak English, or whose native tongue is a strong regional accent should stay clear of these super-intelligent, diagnosing, talking machines!

7. The point above demonstrates how anyone with an atom of a competency can participate in even the most fraught and sophisticated healthcare activities.

8. Enter The Skills Escalator that me and My Black Cat have been wittering on about for years on this blog!

9. The Skills Escalator DOES NOT “DO” PROFESSIONS or university or college graduations. The Skills Escalator abhors elitism. It also abhors meritocracy. The Skills Escalator is concerned pure and simply with COMPETENCIES. That’s correct. You need to grasp this when you consider front line services and health care reforms. The Skills Escalator is concerned with these little atoms of knowledge that anyone can easily pick up.

10. It does not matter whether you are a doctor or a nurse, a physiotherapist or a laboratory scientist. What matters is your competencies.

11. What matters even more, is this….. which of your competencies can be removed from you as a professional and given to someone else with less training or even just one atom of training?

12. Cutting toe nails does not need a chiropodist. Defibrillation does not need a doctor. Bed bathing does not need a nurse. Growing MRSA in the lab does not need a scientist. Amputating a leg used to be done by the local barber.

Get it?

Thirteen is a number that is reserved for witches, so we’ll stop now until The Humankind have ingested this much, then we’ll explain the rest soon.

If we can be bothered!




redapple.jpg a red apple ……………………

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  1. […] On the other hand, taking into account the parentage of “Action for Happiness” it is possible there could be a highly political agenda indirectly related to what we posted yesterday. […]

  2. Academic rather than post-doctoral on-the-job training. Designed more for the expansion of universities and benefit of banksters rather than patients?
    …The Modernising Scientific Careers (MSC) programme has developed new MSc programmes to support the delivery of the Healthcare Scientist Training Programme.

    The 2010 / 2011 version of the Infection Sciences MSc Learning Outcomes and Indicative content is available to view and download on

    All seven MSc programmes have been made available for 2011 commissioning purposes and are now available to view and download on

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