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A World War 2 Trilogy

By FRED NATH (Novelist and Neurosurgeon)

Fred's Blog


Dr Bawa-Garba and Manslaughter

Posted on 9 February, 2018 at 11:30 Comments comments (205)
Many will have heard of this terrible, tragic case. The doctor involved was tried for manslaughter and convicted despite serious Trust flaws which led to the tragedy.
My feeling here is rather different to the majority. I do agree that a junior doctor, left unsupervised with two juniors below her, each of whom had only a months’ experience of paediatrics, and had herself just returned from 13 months maternity leave was particularly vulnerable to a mistake being made. Where I depart from many people’s stated views is that I do not think the registrar is culpable.

After 32 years as a consultant, I know that my duty working with junior doctors is to ensure they manage every case with knowledge and insight. This is done by closely supervising the least experienced ones and checking that all the right things have been done with every case admitted under my care. Those patients admitted when I am on call are my responsibility. The buck stops with the consultant. It has always been so.
If the registrar makes a mistake then it seems clear to me that I am the one who should be held accountable, not the junior who is following my instructions. I am the consultant and the patient is my patient. If I leave a junior in charge, it remains my responsibility and I have a duty of care.

In this case, the clinical biochemistry details were given to the consultant in charge of the case, by Dr Bava-Garba before she went off shift. The matter is then his responsibility. Even had she not imparted the correct information, it remains the responsibility of the consultant to ensure the patient is safe and being treated properly.

If I have a failing registrar one must ask oneself who’s responsibility is that? Junior doctors are not a few months out of the pram, they are qualified, responsible medical practitioners, with medical and often post-graduate degrees. They are all capable of learning. Those that do not learn, remain the consultant’s responsibility and the failure is his and his alone with only rare exceptions.

Consultants are at the top of the clinical salary scale in the NHS for only one reason - because they take responsibility in the end. The registrar in this case was scapegoated and was not adequately backed up by her consultant who it seems, was elsewhere, teaching at the time. I find this below a reasonable standard, in my opinion. A consultant who knows the inexperience and limitations of the junior doctors under him, and who is absent in any case, is not doing right by the patients or staff. He should not have been allowed to be away from the hospital if he was not immediately available for the patients being admitted under his care. He must have planned the teaching, accepting that it was a commitment which once begun could not be easily left. Did he arrange for another consultant to cover in his absence? Apparently not. Accepting commitments away from work when you are on call has always been regarded as wrong. This is especially true if the consultant is engaging in private practice or other fee earning work. How is it different to arrange a teaching session elsewhere? He was on call and therefore responsible.
If the registrar in the hospital needs supervision, then that is the responsibility of the consultant. When I am on call with any new registrar, I always check with them what experience they have and what operations they have already done with and without supervision. When I am called by them I always take their experience and ability into account.

Dr Bawa-Garba, in my opinion is the victim of scapegoating to protect others who should stand up and accept the responsibilities which they assume on appointment as a British consultant.

I really hope the case is appealed once more, and others are prepared to speak out in support of this victimised and wrongly punished doctor. 

The Junior Doctor's Strike

Posted on 1 May, 2016 at 3:26 Comments comments (193)
So, the strike went well, I’m told. Rumour has it that there were no junior doctors and the consultants had to do the routine and emergency work without the help of the juniors.
Think again. A number of juniors are not in the BMA. They can’t strike partly because they are afraid of losing their visas or their jobs. This meant that there were juniors working on both strike days. Elective work was cancelled – consultants can’t be in two places at once and there is no one available to look after the operated patients during the night. The Trusts won’t pay for consultants to sleep in, to truly cover the absence of the younger doctors anyway. But… the juniors were covering emergencies between 5 pm and 8 am in any case. They just had to do the day's work after 5.

Why did the juniors modify the strike to make it safe?
It’s because they are DOCTORS.

Unlike politicians they have integrity and they are in this job to care for you, Joe Public. I think (my personal view) that if you want to do a job then do it in a fully committed way. If you’re going on strike then do it. I believe all UK doctors should resign at once or withdraw their labour completely. The doctors did this in Australia (I think). The strike lasted four hours. Justice prevailed.

In this country however, the medical profession have traditionally never taken concerted action and stuck together. Things became worse when Margaret Thatcher thrust consultants into management roles. It was a clever ploy to pit doctor against doctor and allow the government to sit back and avoid the ‘shroud waving’ which had hitherto been the doctors’ only way of pressurising the government into providing resources.
If the juniors really want to make progress they have to enlist the main body of consultants and GPs.  All the doctors should work together and allow the government to reap what they have sown. Yes, people will suffer but it won’t be because of the doctors. It will be because slimy politicians are using the integrity of the medical profession against the doctors themselves. It is an abuse and it is immoral.It is what they do to policemen, except in the doctor's case it is self-impose because of moral responsibility not the law.

When will we take a leaf out of the miner’s book and fight back together?
All doctors should withdraw their labour at once. Jeremy *unt can then take responsibility for the consequences.

Phew! I feel better for that!

Junior Doctor's Strike

Posted on 30 November, 2015 at 17:52 Comments comments (200)

So, haven’t written much for a long time. Been busy – still busy but felt I should comment on the coming junior doctor’s strike. Also want to plug my book THE PROMISE.

Why would any junior doctor want to take industrial action? It’s simple. All of them have spent five years qualifying as doctors – they had to get straight ‘A’s’ at A-level to get into medical school. In the last two years all their friends are earning because most other degrees require only three years of study. Then they have to do a compulsory year working in hospital for a pittance to get GMC registered.

They have to complete a further year as a very junior chap on the team before they can go for specialist training. Then they embark on 7-8 years further training, during which time they are abused by the system and have to work gruelling hours and make serious life-changing decisions for you.
Yes, you – the public.

At the end of all that they then apply for a consultant post. When they qualify, the average age is around 23. Ten to fifteen years later they are in a consultant post. They’ve done all this training to be able to help all their patients. It’s a vocation and not a job. They have given so much by that time they think they are appreciated for saving you lives. Are they?

Now if you have a young family at the age of 27 (say) and you have to work shifts that make you do nights and days reducing your family time to unsocial and limited time. They’re paid far less than the average banker, lawyer or other professional; what would you do with a health Minister who jumps up and vilifies you to the public, forces a contract on you which cuts your pay and makes you work longer unsociable hours and won’t listen to anything you said – well what would you do?

Time and again the juniors have tried to tell that stupid hunt that what he is suggesting isn’t good for the NHS, not good for patients and not rewarding enough for people who have dedicated so much time to be able to provide NHS – public – service. The silly hunt turns his back on them and tries to misinform the public to make doctors look bad. He believes that like Tony Blair with weapons of mass destruction, if you say something in public which is publicised often enough it becomes true in the public’s eyes.

He’s not fooling you is he? Please tell me the public and patients aren’t that stupid? That hunt is trying to bring down the health service so they can substitute a private system which will cost you people money.

Don’t be fooled!

That said, next Tuesday Like my colleagues, I’m covering the ward and hoping I don’t have to put up a drip – haven’t done that for 25 years. Gods! Surely I can do that, can’t I? :-)

Oh yes, please read my book THE PROMISE. It’s a WW2 adventure taking the main character to Bohemia, France, England and Poland. Interestingly, the link to this post is that the main character is a medical student! In the context of the book of course, he isn't on strike!!

I like it – let me know.
Click on the image to buy it on Amazon.

Rant on Hunt and the NHS!

Posted on 16 August, 2015 at 4:03 Comments comments (201)
How can a government get facts and figures so wrong?

Fact: the NHS has functioned all the way through because of good will. Even stuffy consultants give everything they can to the NHS. The patient alwys comes first and many hard-pressed consultants work long hours and come in to the hospital when they are not on call – they are available 24/7.

I’m on call this weekend. At a moment’s notice from Friday morning to Monday at 9 a.m. I can be called in for an emergency operation or even to assess a patient. I have a registrar who is a professional surgeon who sleeps in the hospital all weekend. He will be off on Monday morning – I won’t be. I’m doing a clinic on Monday morning even if I have been up all night.

On Tuesday I’m on call again. Whether I’m phoned throughout the night or in operating I still have to work the normal 9-5 during the week. Most people don’t realise that consultants don’t get the next day off when they’re on call. Even when we aren’t on call we may be called upon to deal with our patients – in hours or out of hours. I've been doing that as a consultant neurosurgeon for thirty years - believe me I know.

Disparaging remarks from politicians (like Hunt) do nothing for NHS morale and morale is what the NHS depends upon – it certainly isn’t the tiers of corporate thinking managers that take the blood clots out of peoples brains at 2 a.m. It’s a full team of surgeons, anaesthetists, nurses, porters and ancillary staff. They are all people of high integrity and a heartfelt wish to help the sick patient.

It may be true that there is a higher mortality rate at weekends. This is not because consultants don’t cover the work – all we do is a team effort and you have to pay for the whole team or there is no show! So if staffing has anything to do with it (which I doubt) it’s staffing across the board not just consultants. I can’t operate without my team. If I want to do a case out of hours, I have to ring the anaesthetist and negotiate. I have to inform theatre and wait around until an emergency theatre is available. I have to field the calls from the nurses who have to be called in to do the specialised assisting for the kind of stuff I do.

It isn’t just about money. It’s the logistics of planning a whole 7 day week with rotas and shifts. You would have to pay 2/7ths more to provide the service. It can’t be done unless they increase funding by 2/7ths can it? Any man in the street can understand those figures, cant they?

Will the government fund it? They made the plans and now surely they should pay to implement them? They can’t and they won’t. IMHO this whole thing is a smokescreen by a government who wants to bring about the downfall of the NHS and replace it with a pay-for-service system with insurers suddenly becoming top dog.

Our poor NHS. Bevan would turn in his urn!

An Insulting Budget

Posted on 20 March, 2014 at 3:56 Comments comments (332)
What does the coalition think they are doing? I thought when I saw the campaign poster they were joking. A penny off beer and Bingo. Helping hard-working people to do what they enjoy??? The concept is so insulting to the average working man in Britain the mind boggles.
I hadn't realised how out of touch and unintelligent the conservatives had become until I saw that. To label working class people in that way is not only an insult, it's a way of underestimating their intelligence.
I can't see how insulting the electorate will help win an election. At first I thought it was one of those Facebook jokes created as a parody to illustrate how uncaring and out of touch the present government has become.
Think about it. For many the choice between eating and heating is a very real one over a cold winter. To help, these bozos think you'll vote for them if they offer one penny off something you can't afford anyway.
George Orwell paints a picture in '1984' of a proletariat that will never change whatever government is in power and that the strength of a nation rests in their hands. In that book the 'workers' discuss the size of their beer glasses as if it is all they care about. It is as patronising and short sighted as the present government's recent budget.
There's more - encourage saving. Suppose saving increases dramatically. They tax you on the interest and your income from saving won't keep pace with the RPI (retail price index). So you will lose money and they will take it.
It's gone and so is your life-long supplement to the state pension. The clever thing is the pain won't happen for a few years. The Conservatives might be popular in the short term for the pension release but they will damage people's long-term finances through this. Once your money is out of the pension envelope, it will earn interest and they can tax it. Clever aren't they?
With this budget they are waving two fingers in the air at the working classes. They don't need / want their votes anyway. With Scotland separated a swathe of labour voters disappear. They'll probably like that too.
Who would I vote for? I wouldn't trust the Labour party either. They are economically incompetent and their massive wastage of money for 13 years is what got us into this mess (not just the banking crisis) and they won't nationalise energy either (which is the only way to really help people).
How about the Monster Raving Looney party? They look pretty attractive to me nowadays, but maybe they are in power at the moment?

Hunt, the NHS, A&E and GP's.

Posted on 24 May, 2013 at 3:01 Comments comments (292)
Hunt, the Health Minister is now speaking out and proclaiming from the rooftops that GP’s should now shoulder the burden of out-of-hours patient care. Unusually, he’s talking a little sense in amongst the rhetoric and garbage we usually hear from politicians.
In 2004, the Labour government in a bid to ruin doctors’status forced an hours-based contract on GPs and hospital consultants. We didn’t like it because we knew it made us into clocking in and clocking out ‘health-care workers’. That was what they wanted. They were sick of the fact that polls showed that of all professional people the public regard(ed) doctors as themost trustworthy and politicians the least. Part of that downgrading of GP’s was to take them out of the original NHS concept of 24/7 care for theirpatients.
The result was fragmentation because GPs could now clock off at 5 or 6 pm. At night, the patients were no longer their responsibility and a relief service would take over at night. Freed from night-time working, less and less GPs wished to cover rotas and foreign, poorly skilled doctors would do night duties – many of them very foreign, many without good language skills. They sent everything into A&E. A&E became over worked and because there were no consultants in the hospital at night, most patients were admitted whether they needed to be or not – it would seem safer to an inexperienced junior doctor who doesn’t know the patient, to admit than to discharge a patient. The GP ‘family’ doctor would probably have kept many of the patients at home because they often knew the whole story, but of course, there aren’t any. The result – hospitals full with medical patients on surgical wards – no bed for the surgical patients and so less revenue coming in to the hospital, whichwould have been earned by the patients getting their operations.
It has become a disaster. The problem now is how can we getback the ‘Family Doctor’ who Labour stupidly decided to get rid of? Labour wanted a Russian type of communist NHS where doctors are a small cog in a big administrative machine and of equal status with the cleaners. They failed and damaged a really good health service in doing so. Is there an answer? Yes, but itwill be expensive. You won’t get GP’s back into the fold unless you pay them and you can’t afford to pay them properly.
What do I really think? I’m afraid I believe you get whatyou deserve – you voted Labour three elections running – they wrecked the economy, they wrecked education and they wrecked the NHS. It’s your own fault so don’t come whining to the medical profession saying it’s their fault. It can be reversed, but it will be painful and you’ll need to get back some good will from the medical profession – wish you luck with that one Hunt the ****.
NB This is my personal view as a voter - not my view as a doctor!

Hunt, Mid-staffs and the NHS

Posted on 8 March, 2013 at 14:51 Comments comments (371)
To-day I heard Jeremy Hunt Health Service Minister on the news. He said and I quote, ‘Just imagine that our Olympic athletes had the attitude of not coming last instead of winning. That is just what the NHS has been doing.’
Hearing that insult from a politician is both astounding and risible. As a Consultant in the NHS for 27 years, I can honestly say I have strived throughout to ensure my patients get the best possible treatment, whether I have had to fight for it or even whistle-blow. It's a matter of integrity and I cannot imagine a greater insult. All the time, I’ve witnessed how politicians have expected to use the NHS as a political football, making daft changes whenever they get into power, and thrusting unnecessary changes and targets upon us at the same time as we are under-resourced and grossly over-managed.
Presently, it is impossible to do the best possible job. We have paperwork, managers breathing down our necks and numerous ‘NHS Policies’ thrust upon us and receive  nothing but criticism.  I overheard two theatre porters saying that they couldn’t understand why a theatre manager introduced a checklist for them to fill in every time they brought back a theatre trolley, to indicate that it had been cleaned. They have known to clean the damned trolley for years and years, but now paper is wasted and people’s time is wasted too to check on something which happens in any case.
I could cite numerous examples of top heavy management and politically correct time-wasting brought about by bad Government changes and now to cap it all, what has Hunt got to say about it? He blamesthe hospitals and their staff. He should have acted instead of shot his big mouth off.
If the NHS is to continue as a viable entity then it must be withdrawn from the political arena and run, not like some corporate Kafkaesque industry, but like a humane and effective service to patients. isn't it all about patients not targets after all? It should be run by a non-political body whose remit should be excellence above all else and resources adequate to the task. To have a Government Minister insult the integrity of dedicated NHS workers just shows how they think. Running someone else down takes the heat off them.
Bottom line – if you want a good NHS get rid of the politics and ensure that there are adequate resources available for the targets and reforms that have dogged it for the last 30 years.

The Strike Ballot is Here!

Posted on 30 March, 2012 at 2:54 Comments comments (856)
Well, finally the BMA have seen the light. They are going to ballot all their members over industrial action. They want doctors, for a 24-hour period, to go to work but refuse to do some routine things like clinics. Of course, emergency work will still be carried out as one might expect. Tough eh?
Truth is, the BMA have always been a toothless tiger when it comes to action. They will be more effective if they embark on a really tough, hard-line, radical leaflet campaign. 24 hours? It is like a bank holiday and nothing more. What is required is concerted action. All NHS work should stop apart from life-saving surgery or medical emergency work. It should continue until the government concedes it is wrong. We have to fight for our younger colleague's pensions and simply being polite and weak won't cut any ice. 
The medical pensions are self-sustaining and already produce millions in revenue for the exchequer and now the greedy SOB’s want twice as much in contributions from us. As far as I know, medical pensions are the only ones that make money for the government and always have. And to cap it all, they’ve linked pensions to the CPI so the value of pensions will reduce year on year. Combine this with the current three-year pay freeze and one wonders why anyone would want to be a doctor in this country. It sure isn’t for money.
Meanwhile back at the piggy farm, the PM entertains his supporters to dinner if they pay a few six-figure sums to the Conservative Party.The last Tory government was thrown out ignominiously because of sleaze and after the last election, I wondered how soon the rot would set in. It’s happened so fast it has surprised even me.
My favourite quote? Politics gets its name from the Greek ‘poly’meaning many and as most of us know ‘ticks’ are blood-sucking parasites.

Is the NHS Dying?

Posted on 11 February, 2012 at 5:44 Comments comments (172)
For thirteen years we put up with a sort of 'Animal Farm' change in NHS culture - 'more for less' was the dogma - pay freezes etc. It functioned but at a lower level than before - a knd of dumbing down of expertise and ability. It became rather like the principle in schools where some stopped having a Sports Day becaus some kids might get upset if they didn't win.
Now the conservatives (coalition my a***). They want change for change's sake to convert the NHS into a kind of competetive 'free-for-all' market place. Yes, I'm old enough to look back at the NHS and realise what's missing. It's the dedication to patients, that's what. Years back people worked extra hard for extra ill patients, because we wanted to. People worked days when they didn't get paid to get the job done and the satisfaction was saving someon's life. No, I'm not shroud-waving, I'm telling it like it was. No one counted the hours. No one looked at the clock. Now? Hard work isn't appreciated any more. It's all this time based contract, targets - for which no one in the NHS gets a bonus (except for managers).
The only way forward is to have a non-political, multi-party group who oversee the NHS. A group with a common aim - to run the NHS for the distant future not just so as to get elected next time round because they can say they have changed it.
Policy now is often dictaed by Government think tanks who formulate an idea in the pub on Friday night and institute change for change's sake on the Monday and then turn around with consternation on their faces when things don't work out. Like the massive computer system costing millions which never got off the ground. They could have saved the money and paid it out as bonuses now, for bankers instead.

A Million Pound Bonus, a Cure for National debt and My Pension

Posted on 1 February, 2012 at 9:28 Comments comments (90)
Much is being written of thebanker who working for an unsuccessful and largely state-owned bank has beenawarded a million quid for sitting on top of a pile of manure for a year. Well, I for one, don’t mind as long as the bank is doing well. It is usual inbusiness to reward those who work well with a bonus, if the company is doing well. Frankly, RBS isn’t doing well at all. They owe the tax-payer a fortune and if you ask me – I’m sure you won’t – no one deserves bonuses in an industry which is partly responsible for the complete wrecking of the nation’s finances.
On another tack, it strikes me that the huge national debts of the European countries as a whole is a paper exercise. If one were at once to agree between nations, that all national debts are wiped out, then everyone can start again. It resets the clock. No countries would be in debt and no one would be owed any paper money or e-money. Just wipe it all out and have a fresh start.
And hands off my bloody my pension! The medical NHS pensions have been in positive balance since their inception. The pension payments we all make, support the pensions of those who have retired. When my turn comes, the existing employees will be paying my pension. The fund is billions of pounds in the black. Increasing our pension payments does nothing but introduce a new form of taxation. The excess money goes straight to the exchequer. No tax-payers ever contribute a single penny to medical pensions and they never have! So bloody hands off!