Good morning. I hope you had a good weekend, and return refreshed for another foray into the fray.

And fray is exactly what's happening to a veil of secrecy that's been drawn over some pretty ugly things. They are poking their pustular noses into the mainstream media, as discussed below.

Today, we have fresh Maynard Doctrine for you, in which The Good Professor discusses the literary influences and political consequences of the NHS White Paper for its professed goals of equity and excellence.

Inconvenient NHS truths hit the headlines
With Westminster on its holiday, August can be a slow news month for politics. It seems that this week, the NHS is stepping in boldly to fill the gap in column inches.

On European time
Laura Donnelly revealed in the Sunday Telegraph the mess that the European Working Time Directive has created in surgeons' training. The Royal College of Surgeons has done well on this.

A distrurbing diary by Tony Strong accompanied the piece.

UPDATE: NHS Employers. whose contract was renewed by the DH in early July, has released the following statement from Bill McMillan, head of medical pay and workforce at NHS Employers, said: “We are surprised that the Royal College of Surgeons’ survey shows that its respondents believe that the implementation of the European Working Time Directive (EWTD) has resulted in an NHS that is less safe for patients.

“We believe that NHS organisations are committed to ensuring that doctors are able to work and train in a way that is safe and effective for both them and their patients. We are not aware of any evidence that suggests that the new legislation specifically has led to an increase in errors.

“There continues to be significantly more qualified applicants than available surgical consultant posts, and appointing committees are able to successfully appoint suitable candidates. This suggests that currently trainees are meeting the required standard during their training.

“No one wants to return to doctors in training working excessive hours. This created tired doctors and led to significant risk to both patients and doctors’ own well-being.

“Professor Temple’s report: Time for Training – A review of the impact of the European Working Times Directive on the quality of training, published in June this year, concluded that quality medical training can be delivered within a 48-hour working week. The report highlighted some challenges for the service and its doctors and we continue to work with the BMA, the Academy of Medical Royal Colleges and the government to agree the best way forward.

“The interaction of working time regulations and the contract of employment for doctors in training, the way in which consultant doctors work, the quality and management of doctors rotas, and the most effective use of handovers all need to be addressed by employers and doctors working together to ensure their own and their patients’ safety.

“We welcome the Government’s support for a more flexible Directive and are contributing to the European Commission’s consultation on the review of the Directive.”

Suppressing the sound of whistles
Tonight's collaboration, trailed here between Victoria MacDonald of Channel 4 News and the Bureau For Investigative Journalism reveals the extensive use of gagging clauses in confidentiality and compromise agreements in the case of whistleblowers.

There are some deeply flawed aspects of the NHS's tendency to centralised, closed culture which leads to dishonesty about mistakes. The proof these reports offer of frequent legal recourse to covering up clinical safety problems (as opposed to learning from them) reminds me of the abuses of UK libel law.

It also strikes me as another entry for the august annals of Things That Are Not Surprising, which is sad.

Perhaps I have been around this game for too long. Because I should be a lot more surprised, and angry and offended. And so should you.

But a system which so abuses whistleblowers - remember the fate of Bristol Royal Infirmary anaesthetist Steve Bolsin, who had to go and work in Australia - and which allows so much power to accumulate centrally or regionally - can sweep only so much under the carpet.

Not every whistleblower can automatically be assumed to be a saint. The threat of blowing whistles can be associated with wrongs on all sides, or even mostly on that of the would-be siffleur / siffleuse.

Yet still, almost a decade after the Bristol Inquiry, too much of the NHS has a culture which can only be described as anti-candour about safety risks.

Add this to the news that the National Patient Safety Agency's functions will be reallocated into the National Commissioning Board, and you have a recipe for potentially significant problems.

A profit with honour?
The Guardian's Randeep Ramesh and Rachel Williams have chased down FTs' plans for increasing their private patient income.

In the epoch-defining litany of Things That Are Not Surprising, the discovery that FTs plan to act like the aggressively expansionist private businesses that government policy now encourages them to be, without apparent assessment of associated risks, is writ large.

It is A Thing That Is Not Surprising.

It is, however, very newsworthy.

The justification on offer – that the extra private income will benefit NHS patients (who no longer have a centrally performance-managed maximum waiting time of 18 weeks for elective care or 4 hours in A&E) is an interesting one.

A conflict of interest seems inevitable. And who knows? Perhaps every single foundation trust (which in a few short years, is planned to mean every trust) will manage that conflict of interest brilliantly, openly and wisely.

Yes. Perhaps they all will.

I’m writing this on a train: opposite me is a very severely disabled young boy in a wheelchair-pram. He has two oxygen cylinders in the base, a strong neck support which straps his head, and a nurse with him.

That boy’s severe disability is absolutely no reason why NHS services should not change and improve. They should. And change is not always and everywhere about more moey, or keeping everything open and preserved in comfortable-for-providers aspic.

He and his health needs are absolutely what a risk-pooling NHS is about and for, though. And he is the reason we want to be making changes with great care and thought.

And I am very unsure whether we are doing that.

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