Thursday, June 30, 2011
Defying The Gods or I.M.F.: Argentina, Iceland & Greece.
The Yangtze River is rising. Man is on the roof. A traditional pigskin boat rowed along: let me get you off.
“No, Buddha will protect.”
Man is now knee-high in water. Naval boat came along: old man, let’s get you off.
“No, Buddha will protect.”
Man is now up to his neck in water. Rescue helicopter came along: let’s winch you off, stubborn old man.
“No, Buddha will protect.”
Man died and saw Buddha. “Why didn’t you come when I needed you most?”
I did, I sent pigskin boat, Naval boat and even my best helicopter, but you refused!
So first the Gods sent in Antigone:
So Antigone had a part in this tragedy too. That's Antigone Loudiadis of Goldman Sachs, who arranged a complex currency swap deal that helped Greece
Then God showed how it could be done in Argentina
When the Argentine economy collapsed in December 2001, doomsday predictions abounded. Unless it adopted orthodox economic policies and quickly cut a deal with its foreign creditors, hyperinflation would surely follow, the peso would become worthless, investment and foreign reserves would vanish and any prospect of growth would be strangled.
But three years after Argentina
He even took out the head of I.M.F. just to be on the safe side.
Then came Iceland:
Unlike other disaster economies around the European periphery – economies that are trying to rehabilitate themselves through austerity and deflation — Iceland Iceland
And a strange thing has happened: although Iceland
For good measure Iceland
But no, the Greeks have not learned anything.
This was written last year:
The Greeks will do well to go back to their own Gods and not the I.M.F.
Michael Lewis: The Big Short
NHS: Business Model? Spare Us Please!!!
Wednesday, June 29, 2011
Cello & Bach: Anorexia Nervosa
Cape Floristic Region (CFR) of South Africa
South Africa reminds me of my Anorexia Nervosa patient.
In The Cockroach Catcher I got my Anorectic patient to play the cello that was banned by the “weight gain contract”:
She had to, as nobody understood that to her achieving was not a hardship but something she secretly enjoyed. She was no longer allowed to pick up her books as she had not put on any weight since her admission.
Cello would be banned too, if her nurse was to have her way.
For the unit to function the nurse must have her way. After all I was not there all the time to watch her. To watch if she was eating, vomiting, exercising or whatever else they did to avoid gaining weight.
But I was determined that it would be the first privilege she would get if she put on half a gram. Or any excuse I could think of.
Brutal confrontation is often what happened in many adolescent units dealing with Anorexia Nervosa. The brutality is not physical.
But these patients are intelligent and have such strong will power that confrontation generally fails and the failure can be a miserable one. Yet it is the kind of condition that hurts. It hurts those trying to help. It hurts because these patients deserve better for themselves. It hurts because they are not drop-outs of society.
Was it too hard for Jane to keep at the top academically? Someone offered that as an explanation. Perhaps she should be moved to a state school.
The idea horrified me.
A fourteen year old non-smoking, non-drinking, non-drug taking, intelligent Audrey Hepburn look alike virgin turning up at your local comprehensive. It sounded like a major disaster to me.
I had to take the matter into my own hands. She did put on some weight and at the earliest opportunity I decided she should get back to the cello which had always been by her bed at the unit.
Fourteen and carrying the burden of the world.
Then she started playing.
“Ah. The Bach G-major!”
“So you know it.”
Of course I do. The hours I spent listening to Yo Yo Ma and it was such amazing music, melancholic and uplifting at the same time.
For a moment I forgot that I was her psychiatrist and she forgot she was my patient.
“My grandma gave me Casals.”
I knew Casals was even more emotional than Ma, but Ma is Chinese and he was less affecting, allowing the listener to tune in to his own mood.
She played from memory. What talent! What went wrong?”
“I wish my dad could hear me.”
It was the first time she could talk about her father. They had a very comfortable life inSouth Africa
Read more:
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A Brief History of Time: Anorexia Nervosa
Tuesday, June 28, 2011
Protea: Biodiversity
Not just a pretty flower!!!
Protea, Cape Floristic Region (CFR) of South Africa
Some parts of the planet with a Mediterranean-style climate have become species-rich biodiversity hotspots, a recent study reveals.
New species of flowering plants called proteas are exploding on to the scene three times faster in parts of Australia and South Africa than anywhere else in the world, creating exceptional ‘hotspots’ of species richness, according to new research published in Proceedings of the National Academy of Sciences (PNAS).
Proteas are most well-known for being the national symbol of South Africa
This ‘family tree’ enabled the researchers to examine how these and other regions of the planet with Mediterranean-style climates have become so-called ‘biodiversity hotspots’.
Mediterranean hotspots
Until now, scientists have not known exactly why such large numbers of plant and animal species live in these Mediterranean hotspots. They are places of significant conservational importance which, like the rainforests, contain some of the richest and most threatened communities of plant and animal life on Earth.
The research published provides the first conclusive proof that plant species in two of these hotspots are evolving approximately three times faster than elsewhere on the planet. The study dates this surge in protea speciation as occurring in the last 10-20 million years, following a period of climate change during which SWA and the CFR became hotter, drier, and more prone to vegetation fires.
Dr Vincent Savolainen, a biologist based at Imperial College London and the Royal Botanic Gardens, Kew, one of the authors of the new study, explains its significance, saying:
“Something special is happening in these regions: new species of proteas are appearing notably faster than elsewhere, and we suspect this could be the same case with other plant species too. This study proves that the abundance of different kinds of proteas in these two areas isn’t simply due to normal rates of species diversification occurring over a long period of time.
“This is the first step towards understanding why some parts of the planet with a Mediterranean-style climate have become species-rich biodiversity hotspots.”
The Cape Floristic Region of South Africa and South Western Australia are two of five areas on Earth with a Mediterranean-style climate which have been designated ‘biodiversity hotspots’ by Conservation International. The others are central Chile , California
Nature Posts:
Monday, June 27, 2011
Shadow Elite: Public-Private Players & The NHS
It looks as though these people are everywhere! The Shadow Elite.
Are you ready to read it?
Why?
It is scary!!!
Why?
It is scary!!!
"The new breed of players," writes Wedel, "who operate at the nexus of official and private power, cannot only co-opt public policy agendas, crafting policy with their own purposes in mind. They test the time-honored principles of both the canons of accountability of the modern state and the codes of competition of the free market. In so doing, they reorganize relations between bureaucracy and business to their advantage, and challenge the walls erected to separate them. As these walls erode, players are better able to use official power and resources without public oversight."
"That's a spot-on description of what happened with health care -- as well as a spot-on description of the totally-lacking-in-transparency bailout of the financial system. Remember how the bailout was supposed to take care of not just Wall Street but Main Street
Perhaps the decade!
Perhaps the decade!
"We Are Wall Street Main Street America
: "We eat what we kill, and when the only thing left to eat is on your dinner plates, we'll eat that."
The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.
Janinie R. WedelMichael Lewis: The Big Short
Health:
Ex-Blair: Patricia Hewitt: now with Cinven (Bupa Hospitals)
Simon Stevens: now with UnitedHealth
David Bennett is the current head of Monitor (a sort of health FSA!) He is not a medical doctor.
David was a Director at McKinsey & Co. In his 18 years with McKinsey he served a wide range of companies in most industry sectors, but with a particular focus on regulated, technology-intensive industries.
NHS & Monitor: Eggs & Enron.
FSA:
Councils blamed over Iceland savings
Gerhard Schröder:Germany
He is currently the chairman of the board of Nord Stream AG.
Sunday, June 26, 2011
Saturday, June 25, 2011
NHS Reform & Listening: Really!
Some of us might have been lured into thinking that they have listened. Do we have to wait for the Lords?
© Am Ang Zhang 2011
Some of us might have been lured into thinking that they have listened. Do we have to wait for the Lords?
Not all of us though:
It has become very clear that on close inspection of the Government’s response to the NHS Future Forum report, the key changes that the BMA and other organisations like the RCGP have asked for have not been met:
1. That the Secretary of State should retain responsibility for ensuring provision of a comprehensive health service.
2. That Monitor’s primary role to promote competition should be removed.
Assets StrippingIn addition, the work of Lucy Reynolds from the London School of Hygiene and Tropical Medicine published in the BMJ last week also described how the bill could allow private companies to strip NHS assets “leading to more a expensive system that will deliver worse quality of care”.
We therefore totally reject the repeated claims of the Coalition leaders that their reforms will deliver greater NHS efficiency and that there will be “no NHS privatisation”.
Assets Stripping
In conclusion, the simple fact is that the Government’s proposed changes to the bill are mainly cosmetic in nature. There are no ‘significant’ policy changes that will alter the general direction of travel of the reforms and we believe the proposals will actually create even more problems for the NHS by increasing the tiers of bureaucracy. It is at this point that we would remind Mr Clegg that “no bill is better than a bad bill”. He would also do well to listen to views of his fellow liberal Democrat colleague, Dr Evan Harris, who dismissed the NHS Future Forum’s paper on Choice and Competition as “cliché-ridden, trite nonsense” at the Social Liberal Forum last weekend.
When all the talk is about trying to emulate Kaiser Permanente in the NHS reform up and down the country, my observation is that unless there is some radical rethink, the new NHS may end up as removed from Kaiser Permanente as imaginable.
Ownership and integration
Sacrifice choice:
Covert Rationing rather than true integration:
It is certainly not how Kaiser Permanente would run things: all integrated and no such thing as “cross charging”. In fact the doctors are not on a fee-for-service basis but like Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital, doctors are paid a salary.
A & E:
Look at major hospitals in England: Urgent Care Centres are set up and staffed by nurse practitioner, emergency nurse practitioners and GPs so that the charge by the Hospital Trusts (soon to be Foundation Trusts) for some people who tried to attend A & E could be avoided. It is often a time wasting exercise and many patients still need to be referred to the “real” A & E thus wasting much valuable time for the critically ill patients and provided fodder for the tabloid press. And payment still had to be made. Currently it is around £77.00 a go.
But wait for this, over the New Year some of these Centres would employ off duty A & E Juniors to work there to save some money that Trusts could have charged.
Integration indeed!!!
It must be hard to believe that with the numbers of highly paid management consultants working for the government that any apparent oversight is due to cock-up rather than conspiracy. Yet reading through the Select Committee reports one begins to wonder.
Could it be that for too long, accountants dominated the NHS reforms and somehow nobody took any notice of what the doctors are saying anymore?
On the other hand, could the need to pass health care provision to private providers before anybody could raise enough objections be the reason or was it simply a means to contain cost and let the patients blame their GPs?
The Internal Market:
There is no better illustration to the wasteful exercise then in all of this internal market and cross charging during recent years and one must be forgiven for concluding that the purpose was to allow private involvement in our National Health Service.
We must be forgiven for not believing that all these AWPs are not great philanthropists and are all there not for the profit but for the common good.
So even if those politicians in power today are not planning on moving into Private Health Care soon enough, the citizens do have a right to know why. In a strange way, it is easier to understand it if it were a conspiracy.
For us, it is our money, our health and our right too.
Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.
There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.
How else could the government continue to claim that competition will improve standard and bring down cost.
Private or NHS, they are the same Surgeons, Anesthetists and Physicians. Yes, the same consultants. Only in Private Hospitals you may get free cappuccinos.
It is so simple: Private Providers need to make a profit so there is going to be less money for patient care, not more.
Mark Porter: Chairman of the British Medical Association's consultants committee.
NHS services in some parts of England
The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.
The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.
The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porter. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.
Lord Owen:
Health is not just a commodity to be bought and sold in the market. It is not a utility in which everyone should be treated as if they are commodity managers. We must understand that and the fundamental issues which are being challenged by this Bill.
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Friday, June 24, 2011
David Cameron & NHS: No money left soon.
Our PM is right, there will be no money left soon!!! If the reform goes ahead!!!
©2010 Am Ang Zhang
Not quite perhaps: the money will always be there, only in someone’s pocket.
Re quoted from Abetternhs’s Blog:
……..If you think we are going to be endlessly decommissioning and recommissioning services according to cost and quality, you are mistaken. Commissioning is a time-consuming, expensive, complicated business. We have been offered £20 per patient to do the administrative business that our PCT was doing for £60. We do not have the time or the money. You need us in our consulting rooms.
But the government say…
“You can choose any hospital in England
……Today we looked at our costs for our patients attending outpatients at different hospitals, including ones with services we did not commission. There are enormous differences between them.
There is a large shiny hospital not so far away which is spending large, but undisclosed amounts of taxpayers money on marketing. Down the road is another hospital which appears to be spending a lot less on marketing. The shiny hospital is costing us a lot more money and there is very little we can do about it.
Here is how.
A patient referred to our commissioned antenatal service is seen 8 times, but a patient seen at the shiny hospital is seen 14 times. A patient seen for their first antenatal appointment at the shiny hospital had 5 separate health professional interactions for blood and urine tests, blood pressure etc. each of which was coded and generated a bill.
The average number of outpatient follow-ups at the shiny hospital is 4.12 compared to 2.8 at the hospital down the road. Even if the tariff was the same, a hospital can increase its profits by calling patients back more often.
The tariff for the same ENT outpatient appointment at the shiny hospital is higher, £200 vs £170 for the hospital down the road. This is supposed to cover the costs of all the polishing needed in a central london
More ways of making money:
The re-referrals. A patient referred to a commissioned gastrointestinal service with bleeding from the bowel would be properly investigated and managed by the commissioned service. If one of our patients chooses to go to the shiny hospital they need one referral to the gastroenterologists for the top end, and another referral for the bottom end. Since a referral costs approximately twice what a follow-up appointment costs, this is another way of making money.
Another way the shiny hospital makes money is by telling my patients that I need to refer them to a different specialist at their hospital. Then I have to say, “look I know Professor Spratt said you need to see his delightful colleague, Mr Nibbs, but I really don’t think it’s necessary” And the patient replies, “that’s just because you’re trying to save money” …
If you never get better:
Shiny hospitals hang on to their patients with an iron grip. Most notoriously the London Integrated Hospital
Problems of internal and external billing:
Billing has created a whole new bureaucracy in the NHS costing millions, perhaps billions every year. When a patient chooses a service we have not commissioned, there is an additional burden of a complex cross-charging mechanism. The latest changes to NHS bureaucracy completely dwarf what we had before. The very opposite of what the government promised.
If we object to the bills the shiny hospital are sending us we can challenge and complain. Sometimes an agreement is reached, but sometimes arbitration is threatened. This is far too expensive and so the threat effectively results in us coughing up. Providers like the shiny hospital have the cards in one hand, our balls in another and enormous PFI debts hanging over them. No wonder they’re squeezing.
What is obvious to everyone, apart it would seem, from the government, the department of health, health policy think tanks, health economists, the majority of journalists … in fact anyone who does not have to look after patients, is that patients do not choose on the basis of quality of clinical outcomes, or choice, or efficiency. They choose shiny, like their i-widgets.
Expanding health care markets in the NHS will see costs escalate rapidly as they have done in the Netherlands. Hospitals and other providers will ‘play the game’ and draw patients in, just like any other provider of any other commodity.
The reforms will divert money away from where it is needed and will render the NHS unsustainable in a very short time. I believe that this might very well be the government’s intention.
Dr Tony Jewell, Chief Medical Officer for Wales
“The end of the internal market in health is part of the wider Welsh Assembly Government determination to make co-operation, rather than competition, the bedrock of public service delivery in Wales
Thursday, June 23, 2011
Peter Grimes: the individual against the mass, and the corruption of innocence.
Royal Opera House Website.
Benjamin Britten’s Peter Grimes is one of the must-see genius works of 20th-century opera. Powerful and haunting music of extraordinary emotional intensity brings alive a disturbing story of prejudice, suspicion and persecution in a small fishing village on the East Anglian coast. The power of the sea and the changing moods of the landscape are famously evoked in rare subtlety by this great music as the background to a drama that requires the richest of musical and dramatic interpretation. Ben Heppner as the outsider fisherman of the title and Amanda Roocroft as the school mistress Ellen Orford – steadfast in her sympathy for Peter – are at the centre of an impressive cast under conductor Andrew Davis making a very welcome return to the royal Opera House. Willy Decker’s production has its first revival by the Royal Opera, bringing an intense focus to an introverted and judgemental world, in which intolerance leads to tragedy. the music and the drama are deeply intertwined in a great opera of menace and beauty, threat and compassion.
On Friday June 24th, Royal Opera House: The Cockroach Catcher, his wife and younger daughter will be there for a performance of Peter Grimes by Benjamin Britten.
In 1942, Britten, then living in America , came across an article by the novelist E. M. Forster on theSuffolk poet George Crabbe, an encounter that was a decisive factor in Britten’s resolve to return toEngland
From the Royal Opera House, 2004
The composer’s self-avowed aim in the opera was ‘to express my awareness of the perpetual struggle of men and women whose livelihood depends on the sea’ and anyone who has visited the coastline around the composer’s home town of Aldeburgh
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Wednesday, June 22, 2011
Guys & Dr House: Quorum Sensing & MRSA
Surgeon David Nunn reprimanding the TV crew and officials who accompanied
David Cameron and Nick Clegg on their visit to Guy's on 14 June.
Photograph: guardian.co.uk
A bow-tied surgeon who interrupted a hospital visit by David Cameron and Nick Clegg last week has gone on leave, according to an NHS trust which issued instructions to staff to say nothing to the media.
David Nunn, who burst in as the prime minister and his deputy were talking to a patient at Guy's Hospital in London, has gone on indefinite leave.
Cameron and Clegg looked briefly startled as the surgeon marched into the ward on 14 June and said: "Sorry. Just a minute. Excuse me, I'm the senior orthopaedic surgeon in this department. Why is it that we're all told to walk around like this and these people ..."
All that training and now he is no longer of service to NHS patients. Our PM must be above that. What a waste!!!
To be fair, the camera crew did ask the ward sister if they needed to wash their hands and roll up their sleeves.
They were told it was not necessary because they were not coming into close contact with patients.
Really! Camera crew might need to touch the doors etc.
The ward sister may well have been too busy with all the management meetings and not kept up with the latest advances in medical sciences from out very own Nottingham University
It is perhaps not her fault either but that of allowing non-doctors to decide on Hospital Infection policies without true evidence base.
Wednesday, 10 May 2006 BBC
The secret, explains Dr Williams is to unlock the mysterious process known as quorum sensing.
The secret, explains Dr Williams is to unlock the mysterious process known as quorum sensing.
It was a term coined about 15 years ago in Nottingham by a late colleague of Dr Williams, and refers to the way bacterium, once thought of as individuals rather than a community of organisms, can communicate with one another and make a decision.
"As the bacteria begin to grow they produce low levels of a signal molecule.
"As that concentration of the molecule accumulates, it allows more and more cells to sense there are more bacteria present.
"When that reaches a critical threshold concentration then bang! The bacteria say: 'OK there is a enough of us here, we can really make a difference and cause some trouble'."
Professor James said: "The real doomsday scenario now is that you have an increasing number of young fit people with Community MRSA, you have a flu epidemic that makes the lungs more susceptible to infection and then the MRSA will actually kill people very quickly."
Young fit camera crew!!!
Young fit camera crew!!!
No touching required.
Meanwhile in Hong Kong :
Andrew Burd Professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong . BMJ
“In Hong Kong we have personalized white coats; wear ties and long sleeved shirts and our unit has just received an award for achieving a zero tolerance for meticillin resistant Staphylococcus aureus (MRSA). My wife, who is Chinese, attributes the difference to the cultural attitudes towards cleanliness such that it is easier in Hong Kong to unite all staff, visitors and patients in anti-MRSA strategies. This derives from a greater societal awareness.
“In the West, where individuality has a stronger influence, compliance has to be achieved by control. But where will it all end? Will the comic farce of dress control continue to evolve such that staff wear less and less? One wonders what effect that will have on the pulse pressure in the orthopaedic wards for staff and patients alike!?”
Perhaps someone else should be on leave!!!
Links: Jobbing Doctor: Inevitable
Links: Jobbing Doctor: Inevitable
Margaret McCartney: Sleeves, ties, MRSA and politicians
Doctor Zorro: Backlash
Related Post:
Tuesday, June 21, 2011
Annoying? Or a return to fear!
Elephant: I have listened. So now go away! So Annoying!
©Am Ang Zhang 2005
The NHS, he told us, is simply not sustainable in its present form and its commitments can no longer be met from taxes. This controversial claim is far from true.
Cameron's twin strategy is to continue with market competition on the assumption that it improves cost-efficiency, and raise new forms of funding by facilitating the introduction of private insurance and patient top-up fees. While competition is now proclaimed by government as an unqualified good, the second prong of the strategy – moving to user charges and insurance funds – dare not speak its name. But key to both are the consequences for redistribution or fairness.
…….The bill, as designed, will allow commissioners (purchasers of healthcare or insurers) to pick and choose patients and services. It abolishes the duty to secure or provide comprehensive care, and permits GP consortiums to recruit members, and introduce charges and private health insurance, as well as enter into joint ventures with private companies.
In a market, insurers and commercial providers must be able to limit their risks by carefully selecting members on the basis of ability to pay and predictable costs.
Across the country primary care trusts, in advance of their own abolition, are closing NHS hospitals.
It heralds a return to pre-1948 arrangements
of inequitable charitable and private provision,
mixed funding –
Monday, June 20, 2011
Broccoli & Health Reform: Demand, Disguise & Deceive!
No, I am not talking about the health benefits of broccoli. Legend has it in China
Young toddlers seem to dislike broccoli. So what can the poor mum do? The Cockroach Catcher in his Child Psychiatrist hat has the 3 D approach: Demand, Disguise & Deceive.
Looks like someone else has borrowed those approaches:
'Eat your broccoli': Moms demand it. Can government?
"There is a lot of talk in the papers about if Congress can do this, it can require people to buy broccoli," Motz said.
"Yes," Staver agreed, "certainly the (judge) in this case in Virginia
Motz said she had a broccoli question herself: "Could the Congress prohibit people from buying broccoli, or to make it more real-world, prohibit people from buying trans fats, because of its bad effects?"
Health Reform:
Demand: The government wants all hospitals to become Foundation Trusts by the end of 2013 and we are currently completing our application with the aim to become a Foundation Trust in July 2011. GOSH.
It is in effect the privatisation of Secondary Care. There are 240 consultants at GOSH. FT status will mean no cap on private income. More private work means one thing: less NHS work. I just hope they collect the medical fees first before some of the “clients” claim diplomatic immunity.
For Hospital FTs that are failing, they will be bought by the likes of Circle. There is no guarantee that the successful ones won’t be either. Business is business.
All GPs in consortia by 2013.
At least half the board members of some GP consortia, the new bodies that will take over commissioning, have links with a single private healthcare company, an investigation by Bureau of Investigative Journalism, published in the Independent and Pulse Magazine can reveal.
Assura Medical, majority controlled by Sir Richard Branson’s Virgin Group, has links with 50 per cent or more of the board members at three of the 52 first-wave GP pathfinders.
The Department of Health responded to the investigation by saying it planned new guidance on the make-up of consortia and how to deal with potential conflicts of interest following Professor Steve Field’s ‘listening exercise’ report.
I don’t want any broccoli!
Disguise:
“Do whatever!”
“Listen to him. Pretend you are doing what he wants. Better still get his trusted elder sister to listen to him!”
But I don’t want any broccoli!
Deceive:
“Mix it with his favourite Red Berry Juice and grind it up. Tell him it is not broccoli!”
NHS Reform:
Andrew Lansley was right: NHS reform principles intact, Andrew Lansley insists
He told a conference of GPs in London
He also maintained the forum's approach to the bill was "not to tear it up, not to start from scratch [and] not to reject or undermine the fundamental principles of the reforms and the bill." His comments prompted claims that the experts' work, under professor Steve Field, was mainly about public relations and had produced changes to Lansley's original plans that are "totally cosmetic".
The government says
We will outlaw any policy to increase the market share of any particular sector of provider. This will prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of encouraging the growth of the private sector over existing state providers – or vice versa. What matters is the quality of care, not the ownership model.
This statement is disguised as a control on privatisation, but note "or vice versa". This means the revised bill will outlaw the Government now, or in the future, from naming the NHS as preferred provider.
The terminology of the NHS as preferred provider implies a deliberate attempt to encourage NHS public provision, so this policy will be outlawed (by legislation if the bill passes). However, the key point is that the policy of "Any qualified/willing provider" does not explicitly encourage private sector provision per se (although it is obvious that this is what it is designed to do.)
As long as Government policy is not seen to deliberately and directly encourage private sector provision, the market share will be allowed to change. In fact, the decisions to involve private companies will actually be made locally by the clinical commissioning groups. This is therefore local decision making and not Government policy itself. So increasing NHS privatisation is still clearly on the agenda and the idea of the NHS being the preferred provider with be confined to the dustbin of history.
You really have to hand it to the politicians and policy makers. They have managed to produce of paragraph that looks as though they are preventing further NHS privatisation, but it actually means that they are legislating against the NHS being the preferred provider! Guardian Live blog
Twitter: http://t.co/EbL59lx No references in Future Forum Report to keeping the SOS's duty to provide the NHS in England
Andrew George MP (Liberal Democrats, St Ives): ‘New’ NHS reforms a lot like the old reforms
Evan Harris: There are new threats to the NHS emerging as the Conservatives appear to try to bring in competition and privatisation through another route".
No! It is broccoli! I don’t want it!
Try Pink Floyd:
If you don't eat yer Broccoli, you can't have any pudding!
You might get this:
We don't need no education / We dont need no thought control!
Saturday, June 18, 2011
Doctors & Hearts: Sunday reading for David Cameron!
When I was growing up, the Traditional Chinese Doctor was possibly the most respected person a child was ever going to meet. More so than his teacher, grand parents, or parents.
In the unfortunate event of a child having a fever and needing to visit a doctor, he would be taken to the consulting room of a Traditional Chinese Doctor. The room was generally sparsely equipped, with a redwood consulting desk in the middle, set with some calligraphy brushes, an ink well and Chinese rice paper. On the wall behind the doctor you could expect a giant calligraphy piece extolling his skills – literally translated as “kind heart, kind skills”. On another wall there would perhaps be a Chinese water-colour with a theme relating to doctoring. Doctors were said to have the “heart of mothers and fathers”.
This is a Chinese painting that used to hang in my consulting room. The Chinese characters can be translated as "the warmth of spring in almond groves". In the Chinese tradition, "almond groves" signify medicine, originating from a Chinese legend of a doctor who lived in the Three Kingdoms era. Instead of paying him, his patients were asked to plant almond trees, five for a serious illness cured, and one for a minor ailment and so on. Both the painter and calligrapher were leading figures in the literary/art world of their times.
Doctors have the heart of mothers and fathers everywhere.
How true this is for most doctors. Sometimes they do literally have the patient’s heart too as thisGuardian Blog shows.
This little paragraph says it all!!!
The best doctors find this just as frustrating as patients do. One consultant used to have a system where patients suffering sudden relapses and needing urgent attention could ring his secretary direct and be seen within 24 hours. Hospital administrators now demand that all such cases are referred, much more slowly, through GPs. A dedicated cancer consultant sometimes has to postpone clinic sessions because he is attending research meetings at three or four weeks' notice. His secretary used to phone the 10 patients involved individually to apologise, explain and ask when they would like to re-book. That is now banned. His request to cancel a clinic has to be referred to four layers of management before a clipped official hospital letter goes out informing patients of the change.
Research co-author Dr Peter Samuel said: “Although partnerships are found elsewhere in the public sector, NHS Scotland’s stands out as distinct and novel. It has survived for over a decade, defying reorganisation and changes in administrations, and it can offer valuable lessons in how to improve industrial relations.
………Dr Samuel said: “The policymakers of NHS Scotland clearly concluded the only way to deliver better healthcare was to improve the way staff were engaged. This led to the establishment of various structures at national and local levels to give staff more say in decisions affecting their working lives and healthcare provision.
Allowing Private Sector into the NHS will only take away more of the little money we have for the NHS. I know they love the NHS too, but for a different reason.
Friday, June 17, 2011
NHS & Andrew Lansley: Sharp Doctor
It must be reassuring to the Secretary of State for Health that there are still sharp eyed doctors in the NHS. He might one day save him from the Bevan Curse.
The Curse of Nye Bevan usually strikes down anyone who badmouths the NHS.
Alan Milburn had an outburst; some GPs are up in arms about Consultants on the consortia but there are still sharp eyed Consultants in the soon to be re-branded NHS.
Andrew Lansley was right: NHS reform principles intact, Andrew Lansley insists
He told a conference of GPs in London
He also maintained the forum's approach to the bill was "not to tear it up, not to start from scratch [and] not to reject or undermine the fundamental principles of the reforms and the bill." His comments prompted claims that the experts' work, under professor Steve Field, was mainly about public relations and had produced changes to Lansley's original plans that are "totally cosmetic".
Doctors especially those brought up in the traditional great medical schools can naturally detect minor things that will make a difference to the management of patients. The Secretary of State should be proud that not all have moved to New Zealand or Australia
One such doctor is Clive Peedell!
Dr Clive Peedell, an influential and unashamedly pro state-run NHS member of the British Medical Council, has emailed with a statement as co-chair NHS Consultants Association. Dr Peedell, a consultant oncologist, says that the government is being disingenuous in its response to the Future Forum:
The government says
We will outlaw any policy to increase the market share of any particular sector of provider. This will prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of encouraging the growth of the private sector over existing state providers –or vice versa. What matters is the quality of care, not the ownership model.
This statement is disguised as a control on privatisation, but note "or vice versa". This means the revised bill will outlaw the Government now, or in the future, from naming the NHS as preferred provider.
The terminology of the NHS as preferred provider implies a deliberate attempt to encourage NHS public provision, so this policy will be outlawed (by legislation if the bill passes). However, the key point is that the policy of "Any qualified/willing provider" does not explicitly encourage private sector provision per se (although it is obvious that this is what it is designed to do.)
As long as Government policy is not seen to deliberately and directly encourage private sector provision, the market share will be allowed to change. In fact, the decisions to involve private companies will actually be made locally by the clinical commissioning groups. This is therefore local decision making and not Government policy itself. So increasing NHS privatisation is still clearly on the agenda and the idea of the NHS being the preferred provider with be confined to the dustbin of history.
You really have to hand it to the politicians and policy makers. They have managed to produce of paragraph that looks as though they are preventing further NHS privatisation, but it actually means that they are legislating against the NHS being the preferred provider!
This is in effect accusing the coalition of doublespeak. Dr Peedell has been effective of both Labour and the coalition when policies undermine the BMA's favoured NHS system. You can read his prescient attacks on all parties here when in 2009 he said:
It is clear that the current Labour government and — judging by the polls — likely next Conservative government want the English NHS to become a market-based healthcare system. In fact, the main levers for a market-based system are already in place, including the purchaser-provider split, patient choice, payment by results and a plurality of providers. Those in favour of the market-based approach believe that competition and contestability between healthcare providers will increase the efficiency, quality, responsiveness, accountability and equity of healthcare, by creating an environment where only the best organisations survive. However, there is a lack of evidence to substantiate these claims. Most of the available evidence suggests that market-based healthcare systems are poor value for money and deliver worse care to the populations they serve.
Wednesday, June 15, 2011
NHS : Andrew Lansley, his Doctors and MPs.
If Andrew Lansley is genuine about changes then he must first of all end the internal market that has caused all the problems with the NHS.Then there is a need to legislate and control the Health Insurers so that they can no longer refuse on grounds of pre-existing condition, dump patient back to the NHS after two years and refuse coverage or hype fees just because someone had a long term condition.
He must then legislate against any private involvement in the profitable areas of NHS work. Let private be private and keep NHS public. Please remember, they are the same doctors so introducing competition is not going to improve anything. But private ones needs to make a profit and that means less money for treating patients.
Stop privatisation by stealth!!!
It is perhaps reassuring for the Secretary of State for Health to have sharp eyed doctors in the NHS still.
For make no mistake: it is the intention of this government, as it is of all governments, to get the NHS, with its fearful risks, off the government books, and into private hands. Dumping the Secretary of State’s duty to provide would have made life easier, but its retention shall not dilute the government’s intention, nor hinder it in the execution of its plans. We must be wary of winning the duty to provide battle, and loosing the NHS war. There is plenty more to be tackled in this Bill if we are not to see the NHS set sail on the Southern Cross course.
In the meanwhile we have a dog's dinner of a bill. PCTs and SHAs (organisations that are necessary, but unloved) will disappear, with their functions moved to new organisations. The issues of training and education and the place of the Deaneries are still unresolved. Medical training continues to be taking place to train doctors to work in Australia , New Zealand and Canada
There is still a feeling that there is chaos at the head of policy making.
Also:Alan is miffed
There is still a feeling that there is chaos at the head of policy making.
Also:Alan is miffed
He left front-line politics to 'spend more time with his family' (this is code for either resigning with some dignity, or planning to do something else), and he ceased to be a Labour MP in 2010. He stopped being a socialist many years before that.
He quickly became an adviser to Bridgepoint Capital, a private equity firm heavily involved in Private Finance Initiative, and also joined PepsiCo.
……..He is unhappy because Mr Cameron has changed tack on NHS reform. That is encouraging for the Jobbing Doctor, as this means there is significance in the changes to the bill, especially if Alan is miffed.
This news is mildly encouraging.
He quickly became an adviser to Bridgepoint Capital, a private equity firm heavily involved in Private Finance Initiative, and also joined PepsiCo.
……..He is unhappy because Mr Cameron has changed tack on NHS reform. That is encouraging for the Jobbing Doctor, as this means there is significance in the changes to the bill, especially if Alan is miffed.
This news is mildly encouraging.
Interesingly, Alan Milburn now has two sons with his unmarried partner, Ruth Briel, a hospital Consultant.
The NHS was conceived and born in Wales Britain
Guardian 30 DEC.,2010
“I gave up teaching medical students about the structure of the NHS long before hanging up my stethoscope to become an MP because I realised anything I told them would be out of date before they graduated. The lesson from all those reorganisations was that they distract management from improving the service for patients, and cost far more than expected. Primary care trusts are already in trouble and many are losing staff just when they are needed to advise GP commissioners on their new roles. We must ensure that the best managers are retained and feel valued rather than derided. If they all disappeared and GP commissioners had to rely on private sector commissioning, it could start to look like privatisation.” More>>>
Dr Tony Jewell, Chief Medical Officer for Wales:
“The end of the internal market in health is part of the wider Welsh Assembly Government determination to make co-operation, rather than competition, the bedrock of public service delivery in
House of Commons Health Committee Fourth Report of Session 2009–10:
“The most radical option would be to abolish the purchaser-provider split, as Wales and New Zealand have. The BMA argued that the split between purchaser and provider had been expensive, inhibited clinician involvement in planning services, and fostered a system which is dominated by cost containment by PCTs and income generation by providers.”
NHS2011: What about Wales, Scotland & Northern Ireland?
NHS Reform: Dr House & Integrated Service.
Historically, London Medical Schools were established in the hospitals in the poorer areas in order that medical students could have enough cases to practice on and in return the poor patients had the advantages of free treatment.
For a very long time, doctors trained in London London
The Prime Minister and Deputy Prime Minister chose one of these historic hospitals to announce the change of heart on the reform.
What better place to do it until of course our Dr House appeared. The Guardian took up the story:
“Next the prime minister and his posse went on a short tour of the hospital, where he and the camera crew following were assailed by an enraged, bow-tied surgeon, who suggested they were inappropriately dressed. Or as he put it to the prime minister: "I'm not having it! Out!" Mr Cameron walked smartly out, because he knows how vital good public relations are. Especially when a furious surgeon is barking at you, on TV.”
For a brief moment the senior Consultant reigned supreme. This was after all his territory, Prime Minister or no Prime Minister. I am sure he is not going to be knighted too soon.
Someone else is not going to be knighted too soon either. He wrote a report of the South East London Hospitals. I have stated before that it would make uncomfortable reading for the government.
To be fair to PCTs and those before, these were people doing exactly as they were told and what happened: blame, blame and more blame.
The legacy of the previous governments is going to be such a problem for anyone who might genuinely want to provide a first class health service. The report is a long one so I am going to pick a few points to print.
……..competition and choice in contestable services may inadvertently cause
deterioration in the quality of essential services provided by financially challenged trusts, and therefore widen the quality gap between the best and worst performers. Market forces alone will rarely drive trusts into voluntary agreement to reconfigure in ways that will improve quality and reduce costs.
Understanding the causes of hospital deficits
It is important to understand why some hospital trusts in England
In South East London , this premise is false. Two of the DGHs (Queen Elizabeth, Woolwich, and Bromley Hospitals NHS Trust) are whole-hospital private finance initiative (PFI) sites. The annual payments to the PFI service providers are fixed in real terms (and rise in line with inflation) throughout the duration of the contracts. There is almost no scope to change the service specification or to reduce the annual payments for more than 20 years.12 These annual payments exceed, by a large amount, the Market Forces Factor (MFF)-adjusted funding provided in tariffs to pay for them.
Even if these trusts were more efficient than the average trust, because of this underfunding they would still incur significant recurrent deficits, and legacy debt would continue to increase. The corollary is that, were they to cut controllable costs to the level necessary to restore financial balance, then their spending on patient care (to fund staff costs and drugs) would be significantly lower than that of other hospital trusts. Patient care would suffer as a result.
In South East London , the two trusts with whole-hospital PFI schemes have by far the highest capital charges as a percentage of MFF-adjusted income; they are also the trusts with the largest deficits and the highest legacy debt, and provide relatively poorer quality of care. Conversely, those hospital trusts with largely depreciated capital stock and high MFF values have financial surpluses, and the quality of care they offer is much better.
There is a striking correlation between each trust’s capital charges as a percentage of MFF adjusted income and the size of its surplus or deficit; and between the size of its surplus or deficit and the observed quality of care.
Read the full summary here>>>>>
Read the full pdf report here>>>>>
Original NHS Reform:
There is little doubt in my mind that Andrew Lansley narrowly missed the opportunity to deal with the hospitals Keith Palmer talked about and no doubt many others are in the same sad state up and down the country.
Monitor would have failed them and they will be bought by Private Companies. What would they do you may ask. Well, these are very clever people and floating on the stock market is one way and perhaps a few times. There is the real estate value behind many of them and when all else fail, the government might have to buy them back when a few individuals might have made millions.
The future:
We must not overlook the fact that Monitor is headed by someone from McKinsey and my reading is that one way or another the private providers are coming in.
David Cameron and Nick Clegg can reassure us if like Scotland, all private providers are outlawed. Remember: they are the same doctors, private or NHS.
What we really need is a truly integrated service of Primary & Secondary care and the only way to do this is to do away with the internal market system that has led to some hospitals doing well and others doing badly as pointed out by Keith Palmer.
NHS-Kaiser Permanente: Integration?
Friday, June 10, 2011
Health Care Fraud: NHS Reform & US Medicare
It is likely that health care will be delivered free to patients (still) in the UK, but it is also likely that with the involvement of the private sector all patient related work will be charged: to the GPs and not the government.
With no limit as to where a patient needs to register, the system is going to be open to abuse; serious abuse.
It is singularly peculiar that governments do not seem to learn form the mistakes of others.
Money corrupts and I like to believe that most doctors are honourable and yet it is because of that that many do not realise how wicked a few of us could be.
In Best Health Care: Private Medicine, Porsche & The NHS
…..Then he started feeling dizzy and having some strange noise problems in one of his ears.
“I saw a wonderful ENT specialist within a week at the same private hospital whereas I would have to wait much longer in the NHS.”
What could one say! We are losing the funny game.
What does he drive?
A Carrera.
Another Porsche.
We are OK then.
Or are we.
He was not any better. And after eight months of fortnightly appointments, the Carrera doctor suggested a mastoidectomy.
Perhaps you should get a second opinion from an NHS consultant. Perhaps see a neurologist.
“I could not believe you said that, his two children are doctors. And he has private health care!” I was told off by my wife.
He took my advice though and he got an appointment within two weeks at one of the famous neurological units at a teaching hospital.
To cut the long story short, he has DAVF.
I asked my ENT colleague if it was difficult to diagnose DAVF.
Over in the US of A !!!
2008:
Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.
2009:
Arrests in three separate cases in Brooklyn, Detroit and Miami included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so he could bill for twice-daily nurse visits. Also>>>
But hospitals too:
>>>How about My bill from ….. for a $540 tongue depressor. Or one for a $270 2oz. cup of liquid Motrin?
>>>While she was in the hospital a few days old, we were charged for 11 pacifiers at a cost of $121.00 each.
>>>My 70 year old father was hospitalized with Legionnaires Disease. His hospital bill included a bill for a pap smear! His first name was Faye – the hospital must have assumed he was a woman and could scam the insurance company for the charge.
UNNECESSARY CARE (40% of healthcare waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure, accounts for $250 billion to $325 billion in annual healthcare spending.
FRAUD (19% of healthcare waste): Healthcare fraud costs $125 billion to $175 billion each year, manifesting itself in everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.
ADMINISTRATIVE INEFFICIENCY (17% of healthcare waste): The large volume of redundant paperwork in the U.S healthcare system accounts for $100 billion to $150 billion in spending annually.
HEALTHCARE PROVIDER ERRORS (12% of healthcare waste): Medical mistakes account for $75 billion to $100 billion in unnecessary spending each year.
PREVENTABLE CONDITIONS (6% of healthcare waste): Approximately $25 billion to $50 billion is spent annually on hospitalizations to address conditions such as uncontrolled diabetes, which are much less costly to treat when individuals receive timely access to outpatient care.
LACK OF CARE COORDINATION (6% of healthcare waste): Inefficient communication between providers, including lack of access to medical records when specialists intervene, leads to duplication of tests and inappropriate treatments that cost $25 billion to $50 billion annually.
David Cameron, is this the way forward?
Thursday, June 9, 2011
Best Cancer Care: NHS GP & NHS Specialist
Does having a good hunch make you a good doctor or are we all so tick-box trained that we have lost that art. Why is it then that House MD is so popular when the story line is around the “hunch” of Doctor House?
Fortunately for my friend, her GP (family physician) has managed to keep that ability.
My friend was blessed with good health all her life. She seldom sees her GP so just before last Christmas she turned up because she has been having this funny headache that the usual OTC pain killers would not shift.
She would not have gone to the doctor except the extended family was going on a skiing holiday.
She managed to get to the surgery before they close. The receptionist told her that the doctor was about to leave. She was about to get an appointment for after Christmas when her doctor came out and was surprised to see my friend.
I have always told my juniors to be on the look out for situations like this. Life is strange. Such last minute situations always seem to bring in surprises. One should always be on the look out for what patient reveal to you as a “perhaps it is not important”.
Also any patient that you have not seen for a long time deserves a thorough examination.
She was seen immediately.
So no quick prescription of a stronger pain killer and no “have a nice holiday” then.
She took a careful history and did a quick examination including a thorough neurological examination.
Nothing.
Then something strange happened. Looking back now, I did wonder if she had spent sometime at a Neuroligical Unit.
She asked my friend to count backwards from 100.
My friend could not manage at 67.
She was admitted to a regional neurological unit. A scan showed that she had a left parietal glioma. She still remembered being seen by the neurosurgeon after her scan at 11 at night:
“We are taking it out in the morning!”
The skiing was cancelled but what a story.
Enough is enough:
"Let us go back to the old discipline of the NHS. Let the professionals manage medicine, empower the professionals, the doctors and nurses and shove the internal market in the bin and screw down the lid. .........please let us hear from all political parties that they will ditch this absurd love-affair with the internal market. Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition." Prof. Waxman in an earlier post
Best cancer care: NHS GP & NHS Specialist
Related:
Wednesday, June 8, 2011
NHS Reform: Let them not see a consultant!!!
Unless you are private.
Is it really that difficult to grasp!
Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China
When there are not enough specialists to go round in any country money is used to ration care.
So we are going to but in a peculiar manner as the NHS used to be state run and free. Reform is needed!!! Enter GP commissioning. If it is your GP doing the rationing it is no longer the State's problem.
Some very clever people indeed are working for the government.
Is it Conspiracy or Cockup? You decide.
Some very clever people indeed are working for the government.
Is it Conspiracy or Cockup? You decide.
But strangely they thought there is still money to be made.
That is why many GPs in the consortia have links with private providers.
It is a sure way of directing patients to secondary care.
Great Barracuda waiting / ©2009 Am Ang Zhang
The AWPs are already there and many specialists are working for them. It really does not need a genius to work out that Foudation Hospitals if they fail will be bought up by private firms.
So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in consortia arguing about the price of hips or knees.
Private patients will now have priority and NHS patients will fill in the slack. Very clever indeed. The notion that one should “let them eat cake” does not apply here.
More like: “Let them not see a Consultant!” And if you do, we will make money.
Reform will not save any money but it will make a few City people very rich, very rich indeed.
David Cameron, it is not too late. We will believe you if you legislate against private involvement. Yes, legislate and we would hopefully not have another Southern Cross.
Dr No: Drive-By Surgery
BIJ: Conflict of interest fears in NHS shakeup
The Witch Doctor: Hazards of the Fourth Healthcare Market
The Witch Doctor: Hazards of the Fourth Healthcare Market
NHS or Private Health Care: Same Consultants!
In 2009 the total value of the market for PH(Private Healthcare) in the UK
The total number of UK
The NHS was not perfect, far from it and yet successive attempts at fixing it has produce the opposite effect: it needs more fixing.
If you read that line again from the NAO report, it was clear where the problem was: fees to surgeons, anaesthetists and physicians!!!
Yes, that was the main recipient of Private Health income.
To become a Consultant in the NHS used to be prestigious and even those aiming to doing mainly private work will have to wait till they achieve Consultant status in the NHS.
The NHS for all its sins tried to keep every consultant as close to the MAYO ideal by insisting on the same pay-scale.
Several levels of Distinction Awards were used to keep some professors and top consultants happy. Later the name of the Awards was changed and yet it was still the same soup.
If Consultants were prepared to give up one session of pay, then there is no limit as to the private work they can take on. It was a safe way to start your private work and you keep the rather nice NHS pension.
What is generally not talked about is that you keep one foot in your NHS hospital and one in your private one.
So far so good and yet this is where the problem starts.
It does not need a genius to work out that people worry about their health and do not want to wait for a suspicious lump to stay in their body too long. They will pay. We need not even mention the manipulation of waiting lists, etc. Then big companies realise that they can attract staff by offering Health Insurance and the rest is as they say history.
Then the rules changed and every consultant can do a maximum of 10% of their NHS pay in private work without having to give up anything. Some hospitals even allow you to use their facilities for a small fee.
Why not, more private patient means less expenditure for the NHS.
Private Insurers discovered that too and they started offering a small fee if you can wait for your operation at your free NHS hospital.
There has never been any control of Health Insurers and I suspect if was not even because they have a strong lobby: just the feeling that the NHS was for everybody so no one could be excluded.
But Health Insurers are cleverer, they exclude chronic conditions, many psychiatric ones belong to that group and often they will exclude after a while.
Cherry picking without extra labour.
Cherry picking soon©2007 Am Ang Zhang
So, indeed it was a clever move by the present government to simply hand over a portion of money to the GPs and say: get on with it, the best price or better still, why not treat them yourself. You are all doctors, forgetting one of their own just had neurosurgery done at Queen Square.
Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.
There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.
How else could the government continue to claim that competition will improve standard and bring down cost.
Private or NHS, they are the same Surgeons, Anesthetists and Physicians. Yes, the same consultants. Only in Private Hospitals you may get free cappuccinos.
It is so simple: Private Providers need to make a profit so there is going to be less money for patient care, not more.
Mark Porter: Chairman of the British Medical Association's consultants committee.
NHS services in some parts of England
The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.
The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.
The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porter. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.
NHS & Market Forces: Fund Holding & Medical Ethics
Monday, June 6, 2011
Scotland vs England: Private Sector & Competition
The Cockroach Catcher is not the only blogger that has been saying that introducing competition to the NHS is not necessary going to improve quality of care. It is obvious that very close to England
Private Sector involvement will only mean one thing: there will be less money for patient care.
David Cameron, if you are genuine about “no privatization of the NHS”, please write it into law as they have done in Scotland
Southern Cross is the clearest warning about what could go very wrong. Money people have no morals: business is business!!!
Turn back now before it is too late. At the end of the day money means little to you as your family have enough anyway. It is far better for your grand children to be proud of you and say: my Grandpa saved the NHS.
Photo: PA
HEALTH Minister Nicola Sturgeon is planning to close a legal loophole that allows private companies to run GP practices.
The Glasgow MSP is looking for an early legislative opportunity to ensure that only traditional providers can run local health services.
She is also unlikely to provide more public funding next year for an independent treatment centre in Strathcaro, Tayside, a further sign of the minister's hostility to private sector involvement in the NHS.
………"Our approach will be to build NHS capacity. I do not see the stimulation of private-sector competition as being in the interests of the health service."
A spokesman for the Scottish government said: "We have made clear our commitment to an NHS rooted firmly in the public sector. Our strategy for health, Better Health Better Care, sets out to pursue an investment strategy that builds public sector services supported by the use of the voluntary sector and the social economy."
A spokesman for trade union Unison said: "We would welcome any plan to stop private firms cashing in on GP surgeries, something Unison argued against when the legislation was first introduced. "We urge the cabinet secretary to plug this gap as soon as possible."
Dr. Charles H. Mayo and Dr. William J. MayoRemember Dr William J. Mayo:
“The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary…it has become necessary to develop medicine as a cooperative science.”
Mayo Clinic: Health Care is not a Commodity!!!
Link:
Link:
Jobbing Doctor: Five pledges
INTEGRATION : Watch this word! « The Witch Doctor
NHS Reform: Space, Snorkel & Scotland
Sunday, June 5, 2011
There are two futures: NHS
“There are two futures,
the future of desire and the future of fate,
and man's reason has never learnt to separate them.”
Scenario 1: Grandpa, why didn’t you save the NHS when you were Prime Minister?
But, why, we had enough money; you do not need the money like some third world leader?
But why did you let the private firms get in. All the papers and bloggers were warning you?
I know you did buy the hospitals back, but at what cost.
Hindsight? It is not hindsight, everybody was saying it.
Scenario 2: Grandpa, you were great. You listen to your own advisers from King’s Fund, and the bloggers and you stopped privateers taking over any health care.
No, the privateers only want to sell the land, float the hospitals and make money and leave. Many are not from here.
We had enough money and you do not need a job from them when you are not Prime Minister.
Lets enjoy the sunset.
©2010 Am Ang Zhang
MAIN FACTS:
-Circle is 50.1% owned by the Company and 49.9% owned by the Circle Partnership which is 100% beneficially owned by Circle's clinicians and employees.
-Circle's objective is to redefine secondary healthcare delivery in the U.K.
Circle’s CEO, ex-Goldman Sachs banker Ali Parsadoust set out his view that the NHS is “an unsustainable industry” that costs too much to run. “In his view, Britain
Retailer:
The collapse of national retailer Focus DIY has sparked a fresh wave of attacks on private equity firms as details emerged of a decade of deal-making and financial engineering in which buyout specialists shared payouts of nearly £1bn.
An analysis by the Observer has found that one private equity firm, Duke Street Capital, which made an initial investment of £68m in 1998, took £700m out of Focus after presiding over a series of capital and debt restructurings that turned the small Midlands-based chain into a DIY giant with sales of £1.5bn. Apax, its investment partner, which put in £120m, pocketed £183m when the Wickes chain was carved out in a £950m deal that ultimately left the remnants of the chain struggling.
Telecom:
BT’s pension trustees are going to court to find out if there really is a crown guarantee covering a large portion of the company’s £40 billion pension fund.
They’re asking: if the company goes bust, will the government (and the RBS-owning U.K. taxpayer knows what that means) step in to plug any gap in funding for the thousands of pensioners who were in the scheme in 1984 when Margaret Thatcher was waving her privatization wand.
Financial Services Firm:
Goldman Sachs:
Goldman Sachs has been fined £17.5 million by the FSA for not letting it know that Fabrice Tourre, a trader who moved to London from New York
Goldman is a bad, bad boy. But if you think the firm is the only to be blamed in this game, think again.
On the Goldman side, what else can we expect from the firm that has already admitted making a bigger mistake in the same case? To refresh the memory, the firm agreed to pay $500 million in July to settle SEC civil charges that it duped clients by selling mortgage securities that were secretly designed by a hedge-fund firm to cash in on the housing market’s collapse. The firm didn’t admit to, or deny the charges, but it acknowledged it made a “mistake” by not disclosing to investors the role of the hedge fund, Paulson & Co.
Ali Parsadoust was with Goldman Sachs.
Backed by some of the City's most powerful hedge fund tycoons and run by former Goldman Sachs vice-president Ali Parsadoust, Circle was selected in November as the first private company to run an NHS hospital. But with losses of over £27.4m, according to accounts filed at Companies House last year, Circle recently lost two lucrative contracts with the NHS worth £27m, representing more than 42% of its £63m turnover.
Looks like some clever Financial manouvres!!!
Best money is government money: our money!
Caring for vulnerable older people is a statutory obligation under the 1948 National Assistance Act and is exercised on a means-tested basis through local authorities. The National Health Service and Community Care Act 1990 allowed councils to farm out care to any willing provider.
The big companies moved in, including Southern Cross, buying up small care companies or building new homes. As they grew, private equity firms started to show an interest, among them the US
Money can be made by separating the income flows from the actual business of care and packaging them as saleable investment instruments – securitisation. Blackstone took control of Southern Cross in 2004 from another private equity firm, West Private Equity. Significantly, that year it also bought NHP (Nursing Home Properties), whose business included leasing care homes to providers (Southern Cross was its biggest tenant) and turning the resulting rental income into high-yield bonds to be sold to investors.
Blackstone floated Southern Cross on the stock market, selling up in 2007. It also sold NHP to an investment fund, Three Delta, with controversial upward-only rental agreements with Southern Cross. This has left Southern Cross with an annual rent bill of around £240m.
Latest: Southern Cross
From one of your own advisers: Prof Chris Ham
Chris Ham"May I add something briefly? The big question is not whether GP commissioners need expert advice or patient input or other sources of information. The big problem that we have had over the past 20 years, in successive attempts to apply market principles in the NHS, has been the fundamental weakness of commissioning, whether done by managers or GPs, and whether it has been fundholding or total purchasing."
“………The barriers include government policies that risk further fragmenting care rather than supporting closer integration. Particularly important in this respect are NHS Foundation Trusts based on acute hospitals only, the system of payment by results that rewards additional hospital activity, and practice based commissioning that, in the wrong hands, could accentuate instead of reduce divisions between primary and secondary care.”
Cassius:
"The fault, dear Brutus, is not in our stars,
But in ourselves."
Julius Caesar (I, ii, 140-141)
NHS 1978: Hope, Faith & Supermarket
It Could Be Fatal at Bad Medicine
Saturday, June 4, 2011
Photography: Rules! Rules! Rules!
When I started entering for competitive club photography nearly twenty five years ago at our rather traditional photographic club, the photos were generally of a rather traditional style. I remember entering for our monthly competition a picture that I thought carried a fantastic mood. I gave it the title: Dawning.
Dawning ©Am Ang Zhang1986
It did not do too well!
I scored 12 out of 20, not quite the bottom but not far. You have to be really bad though in a club to score below 11.
“It is so dark. We cannot really see any details at all. And what did he mean by dawning. It did not dawn on me at all”
One or two member came to me and said that they like the mood and they thought it did “dawn” on them. A young tree at the head of such a well lit stream.
Some might have given up altogether but I persevered, not just with other photographs but this one as well.
I sent it to a very prestigious international competition.
The judge: “A picture I could hang in my own home. Phenomenal mood transmitted and it carried the title well. Must have been done by a very advanced photographer as the light reading was near perfect”
I received my first International Gold Medal.
In photography as with other things in life, be brave, do what you believe in.
The photograph was in fact taken at Yellowstone National Park
Since then I have broken other rules: like this portrait.
Friday, June 3, 2011
NHS Sums & Money: Teachers & Lottery
The sums seem wrong: There will be less money for patient care!!!
Now that some GPs are going to make a million (according to King’s Fund) or at least £300,000 and that many Consultants will be working for the Very Willing Providers for again no less than £300,000, Mr. Lansley, the sums are somehow wrong as there will not be any saving if the Health Reform goes ahead with minor tweaks.
Now that some GPs are going to make a million (according to King’s Fund) or at least £300,000 and that many Consultants will be working for the Very Willing Providers for again no less than £300,000, Mr. Lansley, the sums are somehow wrong as there will not be any saving if the Health Reform goes ahead with minor tweaks.
As Blackstone acquire bank medical agencies we also heard what they did with Southern Cross; the question was asked: would we entrust our own grandmother with these people?
Could you answer that Mr Lansley?
So we have proof that Private Firms disposed of Care Homes before leasing them back and in the process made a good deal of money.
Less money for patient care!
Money!!!
Money!!!
Now many Foundation Trusts are going to own prime real estate sites especially those in the big cities. If you think that they will not be sold think again. Many fantastic Mental Hospitals are already being sold.
Will Blackstone move in, Mr. Lansley.
Choice may sound good but everybody knows that choice cost more money. Every mother knows that if you offer your children a choice of what they can have for dinner, the family budget will go up.
Staying with families, if you reward your son for doing certain chores, you may find that more of those chores will be done. Do you really want your car cleaned every day? What about his homework?
Reward for performance will skew anything and more so healthcare especially if private companies are involved. Less serious but profitable cases will be dealt with and nobody will want to deal with the serious and less rewarding one.
But where is the money going to come from?
Fair question!!!
Taxation: No way! Taxation = political suicide!
Indirect Taxation!
What is that?
What the teachers bought: Camelot.
You mean we should use lottery money for health care? That is amoral!!!
Those with good jobs including jobs at the GMC have private insurance and it is the lower classes and a few bloggers that did not carry Health Insurance. And we all know that more money is spent by the lower classes on the Lottery. Sounds O.K. to me if that money is spent on the NHS rather than the Royal Opera House (and I love Opera!)
By the way, while you are at it can you control the Health Insurance Industry? Or just copy Obama!
Prohibiting Insurance Companies from Rescinding Coverage. In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23, 2010.
Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014.
Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.
Hermione: "You pay a great deal too dear for what's given freely". -
(Act I, Scene I). The Winter’s Tale.
Thursday, June 2, 2011
E.Coli & Politics: Health Planning for Epidemics
There are many unanswered questions in the current E. Coli outbreak in Germany Canada
DPA/ HZI/ Manfred Rohde
The haste to blame every case on Spain’s organic cucumber may in the end prove costly to Germany or indeed the EU which means that you and I may well be compensating Spanish farmers.
Latest:
John Dalli rebuked Germany for premature and inaccurate conclusions on the source of contaminated food that have spread fear all over Europe and cost farmers in exports.
Mr Dalli told the EU parliament in Strasbourg that such public information must be scientifically sound and foolproof before it becomes public.
__________________________________
Can England ’s new GP consortia plan for a similar outbreak taking into account that those E Coli victims that survived needed kidney dialysis and Germany
Unanswered questions:
If cucumber is the culprit, then all the patients must have eaten them in Northern Germany . There is also a rumour that the E. Coli found on the cucumbers were not the same type that cause the problems.
Has the drinking water been tested properly give the low number of organism required to infect?
Canada’s major outbreak was to do with drinking water. By the way the Canadian government just agreed on a $72 million payout. If the utility company had been a private one, it would have gone bankrupt and again it would be the government that would be compensating the victims.
If Spain
The Cockroach Catcher felt strongly that Quorum Sensing should be looked into for such outbreaks.
The Germans found the outbreak puzzling too: good doctors and scientists should always question unusualness in any disease conditions.
These are their findings and questions:
Why not young people:
"Epidemics are for younger men." Tarr, the second major EHEC expert next to Karch, had also never heard of an O104:H4 outbreak.
In the email, Karch speculated over why the disease wasn't happening in children, as is normally the case, but only in adults. And why was the infection striking more people that ever before in Germany
Mutation:
Karch and others speculate that the problem could lie in the pathogen itself. Perhaps the genetic material of this rare bacterium has mutated again, so that its toxin or its bond to the intestinal cells it damages has become stronger. Doctors hope that a complete sequencing of the genome, which is now being performed in Münster, will offer some answers.
This is why The Cockroach Catcher speculated on Quorum Sensing.
Plague DNA:
On Tuesday, the German newspaper Süddeutsche Zeitung reported that Karch had discovered that the O104:H4 bacteria responsible for the current outbreak is a so-called chimera that contains genetic materia from various E. coli bacteria. It also contains DNA sequences from plague bacteria, which makes it particularly pathogenic. There is no risk, however, that it could cause a form of plague, Karch emphasized in remarks to the newspaper.
The Cockroach Catcher grew up in Hong Kong . We always boil our drinking water, (boiled and cooled) and I cannot honestly remember eating salads
Here is the scary bit: Der Spiegel
Be it liquid manure, water or slugs, cucumbers or lettuce, organic or conventional farms -- whatever the source of the bacteria, the only solution for consumers is to wash their hands. Hand washing is also effective against smear infection, or transmission of the bacteria by way of unwashed hands after using the toilet, but this path of infection is very rare.
Fruit and vegetables are only truly germ-free when cooked. And until now, washing produce with water was seen as an effective way to eliminate the risk, because it was generally understood that E. coli is only found on the surface of produce.
That was until scientists in the department of plant pathology at the Scottish Crop Research Institute in Aberdeen made an alarming discovery: The pathogens apparently felt so comfortable on the tomatoes and lettuce they studied that they migrated from the surface to lower layers of tissue to colonize the fruit.
Old & Young: E. Coli O157
According to The Union of Concerned Scientists:
Microbial Drug Resistance 13(1):69-76.Akwar et al. 2007.
Risk factors for antimicrobial resistance among fecal Escherichia coli from residents on forty-three swine farms.
"Akwar et al. found that people living and working on swine farms where antibiotics were used in feed had increased chances of carrying resistant E. coli. In some cases, the risk of resistance for the farm workers was higher than if they had taken antibiotics themselves. Once farm workers are colonized by resistant bacteria they can transfer them to family members and others in their community."
The use of antibiotics in farm animals is widespread and is not restricted to the treatment of infections but for the enhancment of weight gain. In business terms it is the conversion ratio of feed to weight that matters. The Obama government may well be taking steps to control it due to the rising incidents of Hospital Infections. (See MRSA & Antibiotics: Obama & Farmers.)Chicken and other animals can grow up to twice as fast as 30 years ago when antibiotics were not in the feeds. Scary!
It may therefore require more than "washing hands" if we do not want more outbreaks like this and other ones.
Latest: Guardian
German hospitals are struggling to cope with the surge in patients caused by the E coli outbreak, as the death toll from the virus rose to 22.
The health minister, Daniel Bahr, said hospitals in northern Germany
"We're facing a tense situation with patient care," Bahr said, "but we will manage it."
Agriculture officials said that bean sprouts grown in one organic farm between Hamburg and Hanover
Related Post:
1996 Report: Pennington Report
Wednesday, June 1, 2011
NHS reforms live blog: The Guardian
The Guardian:
NHS reforms live blog - what would you ask the health secretary? Randeep Ramesh and Rowenna Davis Monday 23 May 2011
We've been scouting the net for the best debates on the net lurking below the radar about the NHS. Here's a selection
Over at the Jobbing Doctor, the eponymous author invites dissent:
We have the worst, most subsidised and poorest co-cordinated system of railways for any similar country. By any stretch of the imagination, Privatisation of the railways has been a disaster. A similar model is contemplated for the NHS. I wonder if my critics would care to comment?
David takes up cudgels to controversially assert
One only has to travel to Birmingham, once the hub of another failed nationalisation experiment - the motor industry - to experience the chronic road congestion in a city with totally inadequate commuter rail facilities. You would do better to compare like for like. The health systems in France, Germany and the Netherlands have never been nationalised. Unlike the USA, the service is free to those who cannot afford insurance premiums, there are no waiting lists, and according to comparative studies health outcomes are better than in the UK.
The Cockroach Catcher, who is a retired consultant child psychiatrist, asks about how doctors working in the South African private healthcare company Netcare, the owners of Britain's General Healthcare Group, fare
In theory, the buck stops with the doctor doing the cutting, but in reality, the transplant surgeons were little more than skilled mechanics dealing with bodies on an assembly line, maintained, paid for and legally underwritten by the big healthcare factory that is the Netcare Group.
DrGrumble meanwhile has trawled - impressively - the current health bill before parliament and the previous one under which the NHS runs. In a post entitled "the devastating power of words" the medic says
Previously the Secretary of State had to "provide or secure the provision of services" he now only has to "promote a comprehensive health service". Please forgive Dr Grumble if he has got this wrong. Grumble has no legal training. The law is perplexing but Grumble can read and it looks very much as if Lansley is largely washing his hands of any responsibility for having to provide healthcare to us all. This is a momentous change. It is one that those of us who do not have the time to trawl through the legal gobbledegook may have missed. These words are crucial. For the NHS they are devastating.
Randeep Ramesh and Rowenna Davis Tuesday 24 May 2011
Time for a quick recap of the blogosphere:
• Dr Jest in a long post jovially explains what lies behind the current tensions between consultants and GPs and how this might affect relations in the future. Basically primary care trusts are choosing to fund services out in the community by firms like Assura, which are owned by GPs. Is this not a conflict of interest asks the consultant? Dr Jest answers
One of the consequences of these new arrangements in our locality has been an increase speed of access to specialist opinions for patients who would otherwise have had to pay personally to see a consultant privately. Under these arrangements the PCT is paying the franchise and the patient is seen as an NHS patient. I wonder if this has some bearing on my friends' consultant's concerns over conflict of interest?
• The Cockroach Catcher, who practised NHS child psychiatry for three decades, celebrates the culture of the world renowned not-for-profit medical practice and medical research group the Mayo Clinic
You may have heard that at Mayo, doctors collaborate. But did you know that after their first five years all physicians within a single department are paid the same salary? During those first years, physicians receive "step raises" each year. After that, they top out ,and he or she is paid just the same as someone who is internationally known and has been there for thirty years
• Alex Deane at Big Brother Watch
with a shouty post about the state nannying people to lose weight.
with a shouty post about the state nannying people to lose weight.
Of course, doctors have never seen a cash cow they've turned down. Under this plan, they will boost their income by giving "weight management advice" to obese patients, or offer them a free place on a diet club, which the NHS (AKA you and I) would pay for. I'm not arguing that obesity is good. I'm just pointing out that it's not the state's role to nanny us about it, or to force some of us to pay for others to receive diet club memberships - or, worse, force us to pay for quacks to spout the bleeding obviuos.
NHS reforms live blog - can health and social care work together? Randeep Ramesh and Rowenna Davis Friday 27 May 2011
A quick tour of the blogosphere reveals
The Grim Reaper targets the Lib Dem leader's flip flopping over the reforms:
Now, Nick is trying to claim that he doesn't actually agree with many of the reforms proposed. He wants to make changes to the bill, the one he used to agree with, to make it into whatever he agrees with for the next five minutes... It appears that Nick is trying to use the same strategy as he did over the issue of tuition fees.Over this issue, he signed a white paper and was probably photographed doing it. He's now claiming the reforms aren't needed, but that something else is needed. He's going back on his word - again.
However the Jobbing Doctor is more upbeat about the deputy prime minister's intervention
So we have had Nick Clegg intervening and sending the new NHS White Paper away for reconsideration by MPs. Two cheers for this.
Am Ang Zhang, who blogs at the Cockroach Catcher after three decades of NHS child psychiatry, posts about the heady years of Tory fund holding - which GP commissioning is a descendent of:
It was an interesting time during the brief few years of Fund Holding (FH). The idea that money should play no part in who gets seen was thrown out of the window. My hospital consultant colleagues all knew that preference will be given to referrals from Fund Holding practices. It was about survival. Less urgent cases would be seen if they come from FH practices.
Dr Zorro, a hospital consultant, says he is rather glad that GPs don't want him on their consortia boards - in defiance of the PM and the DPM.
I recently posted expressing my despair that the government had suggested that hospital consultants should be involved in the commissioning process. It looks as if I have nothing to worry about. The GP consortia don't want to play with us. I think it is just as well.
NHS reforms live blog - they're listening, what do you want to say? Randeep Ramesh andRowenna Davis Tuesday 31 May 2011
Here's a quick afternoon news round up:
•The Cockroach Catcher says that NHS reformers always highlight US company Kaiser Permanente as an example to emulate. Why? It's just "like the old days of Regional Health Authorities!!!"
•And on Liberal Conspiracy Sunny Hundal has another pop at the shadow health minister John Healey for not doing more on the NHS, joining Michael Meacher's criticisms referenced earlier.
Anorexia Nervosa: Private Health vs NHS Safety Net.
Il faut manger pour vivre et non pas vivre pour manger.
(One should eat to live and not live to eat.)
- Moliere (1622 – 1673): L' Avare (The Miser)
(One should eat to live and not live to eat.)
- Moliere (1622 – 1673): L
Some cannot eat that want it:
But we hae meat and we can eat,
Sae let the Lord be thankit.
- Robert Burns (1759 – 1796): The Kirkcudbright Grace
In The Cockroach Catcher, in the opening chapter I recalled an Anorexia Nervosa patient that has been “dumped” by her Private Health Insurer.
This patient’s father works for a medical supplies company that continued to insure the family. Even then the Health Insurer chose to limit her treatment to 18 months.
Why? Because there is a safety net: The NHS.
Health Insurers write their own rules.
Why? Because there is a safety net: The NHS
“….Ethics in medicine has of course changed because money is now involved and big money too. What was in dispute in this case was that the private health insurance that sustained Candythrough the last eighteen months had dried out. The private hospital then tried to get the NHS to continue to pay for the service on the ground that Candy’s life would otherwise be in danger. The cost was around seven hundred pounds a night….’
Let us not forget that many private hospitals can make more money from the NHS because the NHS does not exclude. The NHS pay for everything including those Private Health Insurers chose to exclude.
“……A quick calculation gave me a figure of over a quarter of a million pounds per year at the private hospital. No wonder they were not happy to have her transferred out. Before my taking up the post, there were at one time seven patients placed by the Health Authorities at the same private hospital. Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting anorectic patients and nobody else. It is a multi-million pound business. Some of these clinics even managed to get into broadsheet Sunday supplements. I think Anorexia Nervosa Hospitals are fast acquiring the status of private Rehab Centres. Until the government legislates to prevent health insurers from not funding long term psychiatric cases, Health Authorities all over the country will continue to pick up the tabs for such costly treatments……”
I did not agree to that patient staying on at the private hospital paid for by the NHS. That hospital did not like me!!!
The Obama Health reform is dealing a big blow to Health Insurers as by 2014 they will have to take all comers and cannot exclude pre-existing conditions not to say dumping someone like my Anorexia Nervosa patient. Until then, the State or the Federal Government steps in.
Gov. Arnold Schwarzenegger of California
The new government in a week’s time should take the first step in legislating against Health Insurers “dumping” patients because of psychiatric diagnosis or so called chronic conditions. That way, private hospitals and insurers can fight it out amongst themselves. At least the small pot of NHS cash would be safe. That would be a first step.
I doubt if any government would follow Obama’s extremely courageous move of legislating against excluding pre-existing conditions but we could watch what happens in a few year’s time. If we can at least secure the position of those already insured we could save the NHS a great deal of money.
Unlike the US
Let us protect it.
Child Psychiatrist: Just doing his job!
This really happened. The name has been changed.
Rachel
Rachel could not get to school. She was having such bad back pain. Her family doctor wrote an urgent referral. As she would not see the psychologist at school, school was considering taking mother to court.
There was a change in managing school refusal. Education Authorities suddenly turned trigger happy and all over the country parents were taken to court. I did wonder if this was due to a shortage of Educational Psychologists who were now too busy dealing with Formal Assessments as a result of the new Education Act, or whether it was due to years of public criticism of the inadequacy of the softly softly approach to the problem. There is some truth that there is a hard core of children whom no teacher really wants to see at school and the authorities are quite happy they are absent. These are children who are entitled to free meals and the hidden saving of them not attending school adds up to a pretty substantial sum. To assess them would take up precious Psychologist time and also may generate expenses in terms of ferrying these children by taxi to special tutorial units or schools.
But Rachel came from a professional family. Mother was a lawyer and father an insurance executive commuting to London
Clinical judgment is indeed a kind of “profiling”. We judge our patients from a variety of information and we “profile” them. It may not be correct but we do.
I had my suspicion that the Educational Psychologist never got to see her record to realise that she was not really the type anyone should ever dream of prosecuting.
The family doctor thought that I should be given a shot before anyone should have a go. Mother was told in no uncertain term that she needed to get Rachel to see me.
“But she was in such pain!” mother said. She did protest but in the end succumbed. With the help of a neighbour, they managed to get her to the clinic and she was lying down in our waiting area.
I had one look at Rachel, perhaps 6 ft tall, lying flat in the waiting area and asked my secretary to call an ambulance whilst I talked to the Radiology Consultant. An X-ray examination was ordered and if necessary an MRI scan.
How could I come to such a decision without even spending half a minute with mother or the patient? Was I being over dramatic? Or was it what we have been trained for? Was it why psychiatrists are trained as doctors first?
I could of course have been entirely wrong and the girl might really have been school phobic. Would I have subjected her to an unnecessary X-ray examination? Would my reputation suffer as a result?
The ambulance came. The paramedics were excellent. They treated it as potential spinal injury and transported her that way. I accompanied her onto the ambulance. You had to see her face to know you were right. She was grateful someone believed her. For me it was worth all the drama. My only wish was we were not too late that she might not be able to walk.
Mother too shook my hand as the ambulance got ready to go. I always told my juniors. “Trust them, most of the time.”
I left a message for the radiologist to call me.
The call came back from the radiologist. She had two collapsed vertebrae, a common condition among very tall children who have just had a growth spurt. The Orthopaedic Surgeon was preparing for an emergency operation.
“Good work.” The radiologist said.
I knew. He meant: “Good work for a psychiatrist, and a child psychiatrist at that.”
Some time later mother arranged to see me to tell me in detail what was done.
“She wants to thank you for believing her.”
I was just doing my job.
