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Thank you Geoff.  I had read the much truncated 'confidential' report in the Guardian.  But this is more than stark.  Skimmed - so much evil to read here and everywhere.  I bet the opthalmologists at Taunton advised against this Poundland exercise.

I noted Conclusions 7 1 especially.  Outrageous.  And leaning over to make the 'letting' of a contract to an outfit run by 2 money grubbing GPs in BUCKINGHAMSHIRE sound normal and capable of high standards.  'The Practice' - what practice?

In the late 80s, with waiting lists for THRs too long, (mine was, but it was not inflated intentionally), we were instructed by Dr Hignell, a medical officer for 'health' in South Devon to sanction the sending of patients to Plymouth Nuffield and St Mary's (private) in Bristol.  We agreed with great reluctance.  In fact we had no choice.  Part reason was that the listing of a patient for a major operation with their agreement was doctor to patient  **.  It was personal - very.  I was especially concerned that some people on the list were at more risk with major surgery.  I instanced the patient with very severe 'rheumatoid'.  There were some with such bone loss, that bone grafting and greater levels of skill were needed.  The rheumatologist referred a large majority to me.  So it was agreed by the hierarchy controlling ourselves and the care of our patients (in my case I regarded them very much as my responsibility - of course) that I could pick off these 'high risk' patients from my list.  I think the other 3 surgeons did likewise.  We ended with the more testing conditions of course.

So they were dispersed.  Some no doubt did very well under skilled surgeons in Bristol.  But I bet there was no detailed examination of outcome by the Hignells.  All I know is that I had to take into our wonderful Princess Elizabeth Hospital (now an up market housing estate against the wishes of all staff) two difficult complications of surgery performed in Plymouth.  One might forgive both hubris and anger.

I often referred to the Kwik Fit mentality that crept into 'replacement'.  The shallow and the ignorant, with many politicians in this large group, have NO idea.  For instance, the shoddy THR will almost certainly need revision.  The cost to that paient and OUR NHS is large, especially if deep infection is the diagnosis.  I refer to this in the link below as disastrous.

You know I care deeply about the service and the people who come to need it.  But when I read the Healthwatch tripe, be insulted by the body, and the rubbish emitted from the NEW CCG etc etc I begin to feel that, for my health at 74, I should spend all my time in my woods.  The only way push back the Kestrels, the Vanguards and the battalions of the administrative class with doctors amongst them, is massive public resistance.  There are signs of it, but 400 plus at Axminster against bed closures will not cut the mustard unless they see the universal urgency.

Good example of the ordure they pump out  - 'patient experience'.  Obviously the three that suffered 'severe pain', or the one who was shouted at, under the Vanguard would rate it zero.

Best wishes