Saturday, February 18, 2012
NHS Reform: Plan B or Plan 1957
Dr No has a Plan B.
But it is not Plan B! It is NHS circa 1957. Brilliant piece.
• The NHS Annual Budget should be decided by a single vote in Parliament, and then distributed pro-rata on a capitation weighted by deprivation basis by the treasury to hospitals and GPs, who would then spend the money as they see fit in the best interests of their patients. Political interference in allocations and how the money is spent should be expressly banned by primary legislation.
• Hospitals (all publicly owned) and general practices should be administered (not managed) by boards and partnerships who should include amongst their responsibilities a requirement to foster a sense of spirit and belonging in the institutions in which they serve. Matrons should be found on wards not in offices, and staff identifiable by uniform: white coats for doctors, and starch for nurses. Succour for patients should be provided by chintzy ladies pushing WRVS tea-trolleys, and porters become once again the oil that keeps the hospital wheels turning…
There is a good deal of time and effort wasted in discussing GP commissioning and some lip service paid to integrating Primary and Secondary Care.
Yet, those in power had little regard for Parliamentary democracy and all the signs are that Privateers are waiting in the wings like the Barracuda for its yummy meal.
Great Barracuda waiting / ©2009 Am Ang Zhang
Is it really that difficult to grasp! I wrote a little while back:
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.
There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals.
Stent, Hips and others
They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job.
My friend just did in some other country: a bargain at US$ 50,000. The cardiologist is easily earning $ 10 million per annum.
What about your painful hips, the Consortia decided to impose a wait time to limit cost. So you too paid for it. That is what my golfing friend did in Flroida for a bargain US$90,000 as he paid a co-pay of 25%.
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 Stents or Hips.
Private patients will now have priority and NHS patients will fill in the slack. Very clever indeed.
Reform will not save any money but it will make a few City people very rich, very rich indeed.
Ever since Barbara Castle took on Junior Doctors in 1974, there has been only losers in the battle between doctors and the government. Indemnity, OOH would be nothing compared with what is going on now.
The losers:
Not doctors, not government.
But patients.
Because if I am a good cardiologist, I am not going to waste time with all these matters as every stent is money and a life saved. I feel good either way.
Doctors stand to gain from all these reforms and so it is very noble that many of us object to it.
Prime Minister, you are on the verge of losing some of the cheapest doctors in the world.
Thursday, February 16, 2012
NHS by Hart!
The NHS was conceived and born in Wales Britain
The Government’s market-led NHS reforms are the culmination of a drift that began with Margaret Thatcher. Wales and Scotland have no intention of following, says Dr Julian Tudor Hart.
When Margaret Thatcher invited Sir Roy Griffiths to apply his knowledge of Sainsbury’s supermarkets to the NHS in 1983, she started a process which has proved unstoppable. New Labour’s contribution to this process was to open the NHS even faster and wider to anyone with enough money and experience to make its work profitable.
There’s no democratic mandate for any of this. For Labour in opposition, that should be an open goal, but their manifesto in 1997 promised: ‘Our purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.’ Why believe them now? Can they even believe themselves?
I will print the full article from Pulse.
03 Feb 11
The Government’s market-led NHS reforms are the culmination of a drift that began with Margaret Thatcher. Wales and Scotland have no intention of following, says Dr Julian Tudor Hart.
When Margaret Thatcher invited Sir Roy Griffiths to apply his knowledge of Sainsbury’s supermarkets to the NHS in 1983, she started a process which has proved unstoppable. New Labour’s contribution to this process was to open the NHS even faster and wider to anyone with enough money and experience to make its work profitable.
There’s no democratic mandate for any of this. For Labour in opposition, that should be an open goal, but their manifesto in 1997 promised: ‘Our purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition.’ Why believe them now? Can they even believe themselves?
In Wales Wales
Neither Wales nor Scotland
They have both built trust between top administrators and professionals, and have begun to weaken the irrational barriers between medical and social care.
The NHS was conceived and born in Wales Britain
In 2004, sale of practice goodwill by GP principals was reintroduced, adding to the debts incurred by the inflated house prices following collapse of social housing since 1979, and by introduction of university tuition fees following Labour’s election in 1997.
But in most cases partnership is no longer an option. Established partners earn more if they employ salaried assistants, so that’s what most of them do. After all, they are running their own little business. But not for long. In England UK
Yet I wonder how profitable the ruins of the NHS will actually be? So do the managers of Humana, one of the largest US Wales , Scotland and Northern Ireland
Dr Julian Tudor Hart is a retired GP and research fellow at Swansea Medical School
Greece: Where were you Buddha?
© Am Ang Zhang 2011
I returned from Greece after a lovely cruise. Greece has been hit by more financial problems and it was clear that market forces caused much hardship to its ordinary citizens! One taxi driver told me that Greece will never pay back the EU. He may well be right.
A Chinese Story:
The Yangtze River is rising. Man is on the roof. A traditional pigskin boat rowed along: let me get you off.
The Greeks have their own Gods, but perhaps they should try Buddha.
“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!
The Greeks have their own Gods, but perhaps they should try Buddha.
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, February 15, 2012
The Last Cook in The NHS
The sun will soon be setting for our beloved NHS!!!
©Am Ang Zhang 2012
Perhaps it is not that well known that the dismantling of our beloved NHS started long before the present government and the future does not bode well for those of us that likes to keep NHS in the public domain.
Child Psychiatric in-patient units across the country were closed some time after many adult hospitals were closed or down-sized.
To me, the government is too concern with short term results that they impose various changes across the board in Health Care & Education without regard to the long term consequences or costs.
After all, I have made good use of in-patient facilities to un-diagnose ADHD and that would in turn save children from unnecessary medication and the country from unjustified benefit claims.
Such units were also great training grounds for the future generation of psychiatrists and nurses. Instead, most rely on chemicalsto deal with a range of childhood psychological problems.
Indeed it was a sad day when the unit closed.
From The Cockroach Catcher:
Chapter 48 The Last Cook
O |
ne of the few things I learned working in some inpatient units was to be appreciative of the ancillary staff. What a cleaner might reveal to us was often more telling than a formal interview. It could well be that often parents were unguarded and more able to reveal things to someone like the cleaner or indeed the cook.
I was fortunate enough to experience one of the last NHS cooks when I was Senior Registrar at an inpatient unit. The inpatient unit catered for a middle age group spanning the older children to the younger adolescents. It was one of a kind in the U.K.
The unit was in the middle of town and was considered to be too far from the Hospital for catering purposes. Instead a cook was employed to cater for the needs of the children and nursing staff. We doctors were not supposed to eat there. But we did. Mainly for lunch.
If we arrived at mid-morning we used to get a nice cup of tea. But that was only since I started bringing in my own tea leaves. We also got served home-made scones and the like.
All very homely.
I had since wondered if our great success rate was more to do with having our own cook than all the other therapies and tit bits that we did.
You never know as people do not really research these things.
……I often arrived late at lunch time after the children and nurses had eaten as morning clinics had a habit of running late. With less than ten minutes to spare, the cook would still manage to serve me a bit of some of the things she knew I preferred. Often she felt compelled to sit with me to tell me about her grandchildren or about what the government should really be doing to help the likes of her, a war widow bringing up two sons in this Naval town. I always admired the resilience shining through her stories.
She also provided me with her down to earth views of what we should do with whichever patient that had come in. I listened. I took note. You never know.
Sheena was the mother of two girls we had to admit. They were both ‘soilers’ and they would never touch vegetables at home or anywhere.
Sheena was petite, worn and a chain smoker.
But she had two lovely looking girls.
We knew from the start there were handling issues and most likely diet ones too.
One of the other reasons for their admission was that by and large there were very few girl ‘soilers’.
It was always a good sign when a child flourished in an inpatient setting, and away from home some mothers were more capable of telling you more of what went on. Some mothers found it easier to talk to one of the non-medical staff, perhaps the cook.
Mothers got fed too on their visits. More often than not the children preferred their mother to go home than to stay and watch them. That was a different issue. With the money spent on cigarettes and drinks not much was left for food either for the children or the parents. I knew that if we checked for vitamin and other deficiencies we would find them, a problem that had taken Public Health a long time to wake up to. Increasing tax for cigarettes and drinks did not change people’s habit one little bit.
With a simple routine the girls were clean in no time. At least during the week as they all went home week-ends, when the unit was closed.
We were at a loss as to what was going on.
The girls would get worse over the week-end and soil. This went on for quite a while.
Then one day the cook talked to me.
“Sheena never stays Mondays,” she told me.
I listened.
“Have you noticed she is always in dark glasses on Mondays?”
How stupid of me. Now and again I saw her at the door seeing the girls off and yes, she wore huge sunglasses.
Sheena was not a movie star.
I arranged to see Sheena.
She said, “You knew.”
I nodded.
“But I cannot leave him. I have nowhere to go and I shall not get enough benefit money if I am divorced from him. He now goes to the day hospital. Fridays he gets drunk and beats me up. It is like a routine. I try not to get hurt and hide it from the girls. If I walk out, he will find me even if I have somewhere to go. I shall still get beaten up. Now at least I know when it will happen and I can live with that.”
I suggested that I should speak to him but she looked terrified.
She felt he might even kill her if I did and last time he threw a chair at a male nurse who tried to say something.
She was probably right. We often had no idea what people and particularly women put up with. It would be too easy for us to bulldoze in. We had to think twice before intervening unless we had something better to offer. His Schizophrenia diagnosis allowed for a higher level of benefit she would not otherwise get. Who would she meet up with next? Another violent man most likely.
Was it such a cop-out on my part?
Maybe it was, but in a strange way the girls stopped soiling after that one meeting I had with mum. The case left me with some unease - unease not just about what I did or did not do but about keeping patients in the community. Three other lives were affected here and who knows, one day he might go too far. That was before Maria Colwell.
The unit had long since been closed.
The last cook in the NHS retired .
While most doctors are content with taking a medical history, Zhang would listen to his secretary and cleaning staff to learn about the milieu, thus gleaning useful information that can help his patients. It reminds me of Confucian humility. Confucius says: "When three men walk together, I have a teacher among them".
As Western trained psychiatrists with Chinese heritage, Zhang and I are not confined to particular schools of thought. Neither of us has felt the compunction to subscribe to a particular theory, such as being Freudian, Jungian or a behaviorist. We aim to be "eclectic", that is, to use whatever that works. In 1970's, psychoanalysis dominated training institutions for psychiatrists in U.K. as well as in Canada. I can see in the book that while Zhang is educated in psychoanalysis, he is not bound by it in his practice. His creative and innovative approaches to clinical problems remind me of the now popular "C.B.T." (cognitive behavior therapy).
As Western trained psychiatrists with Chinese heritage, Zhang and I are not confined to particular schools of thought. Neither of us has felt the compunction to subscribe to a particular theory, such as being Freudian, Jungian or a behaviorist. We aim to be "eclectic", that is, to use whatever that works. In 1970's, psychoanalysis dominated training institutions for psychiatrists in U.K. as well as in Canada. I can see in the book that while Zhang is educated in psychoanalysis, he is not bound by it in his practice. His creative and innovative approaches to clinical problems remind me of the now popular "C.B.T." (cognitive behavior therapy).
Read more:
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
Tuesday, February 14, 2012
Valentine Heart & Mayo: Market & Competition in Health Care
Some words from the heart on Valentine's Day.
Pulse:
07 Mar 11
The health service in Scotland remains united, sees patient care as central and rejects a market vision.
It has been said to me, and it was meant as more of an insult than as praise, that Scotland remains a basically socialist country. I take that as a compliment, as I read it as saying that we care what happens to our folk, and don’t think about money first.
……….. We need to get back to using clinically relevant measures of performance that tell us how we are doing in comparison with our peers.
This has been repeatedly shown to be one of the most potent ways of modifying GP behaviour, and we should go back to it as a way of influencing clinical practice.
Scotland has no real truck with private medicine; APMS (Alternative Provider Medical Services) is not allowed. There is no market in healthcare as health boards keep primary and secondary care working together, and we actually speak to each other. Some of my best friends are consultants.
………… that trusting us to do our job is more effective than micromanagement.
Mayo Clinic: Competition does not serve patients’ interests.
The Mayos also made it clear that patients’ interests were not well served if doctors competed with each other. Late in life William emphasized that in addition to making a commitment to the patient, doctors must make a commitment to each other: “Continuing interest by every member of the staff in the professional progress of every other member,” would be essential to sustaining the organization’s future.
More than one hundred years later, building a health care system that adheres to such a collective vision of its mission may be difficult. Perhaps it can only be done in Minnesota
In the end, Mayo offers proof that when a like-minded group of doctors practice medicine to the very best of their ability—without worrying about the revenues they are bringing in for the hospital, the fees they are accumulating for themselves, or even whether the patient can pay—patients satisfaction is higher, physicians are happier, and the medical bills are lower. Isn’t this what we want?
Read the full article: What Makes the Mayo Clinic Different?
From: Leadership Lessons from Mayo Clinic
T e a c h i n g f o r T o m o r r o w ’ s P a t i e n t
Mayo’s combination of culture and technology is potent. The culture makes it okay for highly-trained providers to ask for help; the technology makes it easy to provide the help.
A Mayo Rochester internist speaks to the cultural influence: ‘‘The strong collegial attitude at Mayo allows me to call any Mayo physician at any time and discuss a patient in a tactful and pleasant manner. I do not feel afraid or stupid when I call a world renowned Mayo surgeon. We respect each other. We help each other. We learn from each other.’’
A Mayo surgeon recalled an incident that occurred shortly after he had joined the Mayo surgical staff as the most junior member. He was seeing patients in the Clinic one afternoon when he received a page from one of the most experienced and renowned surgeons on the Mayo Clinic staff. The senior surgeon stated over the phone that he was in the operating room performing a complex procedure on a patient with a difficult problem. He explained the findings and asked his junior colleague whether or not what he, the senior surgeon, was planning seemed appropriate. The junior surgeon was dumb-founded at first that he would receive a call like this from a surgeon whom he greatly admired and assumed had all the answers to even the most difficult problems. Nonetheless, a few minutes of discussion ensued, a decision was made, and the senior surgeon proceeded with the operation. The patient’s problem was deftly managed, and the patient made an excellent postoperative recovery. A major consequence was that the junior surgeon learned the importance of intra-operative consultation for the patient’s benefit even among surgeons with many years of surgical experience.
No Internal Market, no silly cross charging.
“…….Mayo offers proof that when a like-minded group of doctors practice medicine to the very best of their ability—without worrying about the revenues they are bringing in for the hospital, the fees they are accumulating for themselves, or even whether the patient can pay—patients satisfaction is higher, physicians are happier, and the medical bills are lower.”
Monday, February 13, 2012
Caviar of NHS: Creativity & Health Care
When all the hype is there about the John Lewis of Health Care when John Lewis might want to launch a serious complaint asCircle is 50.1% Hedge Fund owned: the creative funds that many believed conspired with the bright young things of the major banks that eventually led to the collapse of world finances.
Still, all the hope is for Circle to be really like John Lewis and not like Southern Cross, or worse: Greece (another Goldman creative endeavour )
Not far from us, a sturgeon is producing the caviar of NHS in Scotland:
Nicola Sturgeon Web Site
Nicola Sturgeon ‘a safe pair of hands’ in The Guardian:
Indeed, such is Sturgeon's record as health secretary, even her political opponents are privately full of qualified praise. "Safe pair of hands", says one, "a politicians' politician" another. Sturgeon's stature has also risen after four years at the helm of the Scottish health service, no mean feat given the tricky nature of her brief.
Not creative:
She is not creative which may not be a bad thing where Health Care is concerned.
Lets remind ourselves where creativity has led us:
Or creative Organic Eggs? Or creative big pharmas: GlaxoSmithKlein?
Sturgeon's hostility to private involvement in the NHS is well known, and she has no ideological hang ups in admitting as much. Critics say it proves she's not a creative thinker, with no desire for radical reform. Instead Sturgeon prefers more cautious change, pursuing efficiencysavings and consolidation of existing services.
Stracathro hospital returns to NHS:
"This government is committed to ensuring Scotland has a health service which is truly publicly funded and delivered. This is another step towards achieving this goal.
"Currently the private sector provides the service at Stracathro but the NHS pays for it - which means, of course, that the NHS pays not just for the service provided but for the profit margin as well.
"This is the only private contract of its kind in Scotland and it comes to an end on January 3 next year. I will receive NHS Tayside's final business case for the future of the service next month.”
Is Hinchingbrooke the Stracathro of England? Only time will tell.
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."
Hospital Infections:
Circle has made claims that it could do much about Hospital Infections. But Scotland has already achieved much:
"I think it would be a very complacent politician who says yes, I've achieved everything I wanted to," she told Guardian Healthcare. "I'll always look back and think there's more I could have done. But there has been a reduction in waiting times for cancer patients, and a massive reduction of 70% in hospital infections."
On England’s NHS Reform:
“The public, patients and practitioners can be very clear that these reforms will not apply in Scotland. Scotland’s National Health Service is independent and, as long as there is an SNP Government, it will be run in the interests of patients not profit.
“Privatisation may be the Tory way but it is not our way. I know how highly Scots value our NHS and under the SNP it will be protected.”
"It's interesting that they're majoring on GP commissioning, and although I wouldn't favour that model, that's not actually the most objectionable part of what they're trying to do. Rather it's the 'any willing provider' (AQP) part – that will open up the health service to private companies cherry-picking the most profitable bits, while the NHS is left with the less profitable stuff."
Doctors & Hearts: Sunday reading for ...
English prescription charge to go up to £7.40. (Already free in Wales and Northern Ireland.)
Scotland: Serco NOT allowed to run GP practice
England: Circle to run NHS Hospital
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Thursday, February 9, 2012
NHS: A Dignified Scotland!!!
And it hasn't been achieved by NHS staff competing against each other. It has been achieved by NHS staff working together in the interests of patients.
So we will continue to build on these achievements. We will make good on our pledge to protect spending in the NHS.
The Herald:
Cate Devine severed her left index finger last December and after an intensive three-hour operation to re-attach it, plus several weeks of healing time, she felt compelled to talk about it non-stop.
No matter how carefully we look after our own health, the sad fact of life is that accidents will happen, violence will be visited on the innocent, and illness or disease will defy even the most rigorous diet and exercise routine. And when there's an emergency to deal with, Scotland's NHS unflinchingly steps up to the plate.
8 Hospital Departments:
My finger has required treatment at two different hospitals and has involved the emergency, orthopaedic, surgical, anaesthetic, radiographic, orthotic, outpatient and physiotherapy departments. Yet what has struck me is a tangible sense of unity and cohesion. On all levels, the practitioners I've been fortunate enough to encounter know each other by their first names and my meticulously updated case notes have always been presented on time - and my GP was fully up to speed within hours.
Now, imagine internal market and complex cross charging in the new English NHS or worst having to be referred back to your GP to be re-referred? She was lucky to be living in Scotland.
While I do agree we all need to take more responsibility for our own general health, I'd argue that achieving this is not the NHS's core remit. For all the patients who present with problems associated with conditions such as obesity, Type 2 diabetes, drug and alcohol abuse (many of whom seem to treat the their own health, and the NHS, with a perversely casual disdain), there must be as many again who find themselves forced to swallow their pride, ask for help and – even after a lifetime of payslip deductions to help fund it – are hugely grateful when it comes.
Hang on, the jury is out still on diabetes, could a pre-diabetic because of sensitivity to hypoglycaemia inadvertently ate to combat the low sugar leads to obesity? What about the 30% of Chinese that are low weight or normal weight?
England:
I shudder to think what might have happened were the NHS to be privatised, as critics fear will be the case in England. Health Secretary Andrew Lansley's Health and Social Care Bill, in for a bumpy ride as it goes through the report stage in the House of Lords this week, makes priorities of the promotion of market forces and competition in the English NHS. The proposals seem predicated on Tory shibboleths and, if implemented, would greatly damage the ethos of the health service.
Should we all move to Scotland?
The truly democratic nature of our NHS is what makes it truly remarkable. In our hour of need we are all equal in its eyes. And that is the mark of a dignified nation.
Our NHS, the mark of a dignified nation
Wednesday, February 8, 2012
EBM & Royal Marsden: Private Income Cap & Cancer Survival
There is a good deal of debate on Private Income Cap for NHS Hospitals so I dug out what I have written recently: The evidence is not looking too good Secretary of State as the Royal Marsden was one of the few with a higher than 5% cap and yet England's OECD cancer figures are worst than Slovenia and the Czech Republic. I know that we have many Czech pharmacist over here, but please, Slovenia?
The first dedicated cancer hospital in the world, founded in 1851, is still the best. With the Institute of Cancer Research , the Royal Marsden is the largest comprehensive cancer centre in Europe, seeing more than 40,000 patients from the UK
It has the highest income from private patients of any hospital in Britain
The Independent:
The Royal Marsden Foundation Trust, which opened a new, private in-patient wing last month, aims to increase private earnings by almost £9m this year, taking the total to £54m – nearly a quarter of its turnover. It plans a further £8.1m rise in 2012-13.
The figures are revealed in its three-year "Forward Strategy" plan submitted to Monitor, the foundation trust regulator. They highlight efforts made by trusts to maximise income from private sources to make up the shortfall in public funding as the NHS budget
Very ready for Medical Tourism!!!
What about UK
A report by the Organisation for Economic Co-operation and Development (OECD) has found that, despite record spending on health care, cancer survival rates in Britain are worse than in Slovenia and the Czech Republic
Survival rates for breast cancer, prostate cancer and cervical cancer were below the average for the 34 developed countries in the study.
Mr Lansley lays the blame for the poor performance on the previous government’s failure to make sure that extra investment in the NHS reached the front line. He claims patient care was ignored in favour of increased salaries and botched computer systems.
It looks as if somehow our own NHS patients are losing out on the expert knowledge of our colleagues at the Royal Marsden.
Yet we are going ahead with increasing the caps to 49% to all NHS hospitals.
I have called it a Rashomon moment: Unbelievable! Unbelievable! Unbelievable!
![[Rashomon.jpg]](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIJeYNSvHt0omh-TM57Iazigk9RKiNT0ZHknoC8i5tvRzqHYo0Lv2Xu1mSgV7hj5NLAmveUXrEPY0GGvSUO6h8ueOAz38EzVTIp6Jls1KU9AJKX7bf5-o2v3QkMILpZPLU_qjTlmd5vWOW/s1600/Rashomon.jpg)
Rashomon (1950) was made by one of Rashomon is fundamentally about truth and subjective truth. At the end of the film you are still not too sure but you have some idea. The story was simple enough:
“This landmark film is a brilliant exploration of truth and human weakness. It opens with a priest, a woodcutter, and a peasant taking refuge from a downpour beneath a ruined gate in 12th-century Japan
(from the: New York Times Review: March 1, 2008)
The murdered man was in fact a Samurai who had the task to maintain the honour of the Samurai tradition, even as a ghost. This was to some the most shocking part.
We know people lie: but GHOSTS?
So what is going on? Best cancer hospital in Europe if not the world and the worst figure for cancer survival!
Is this just an excuse to sell off Royal Marsden.
Or did they treat too may foreigners so that the survival figures of their country was better than ours.
If the Royal Marsden cannot help our Cancer doctors, why are we treating so many Medical Tourists?
Or is this the future, or should we become Medical Tourists to other countries.
With the way the government is charging ahead with the Reform, it is difficult to tell who might be telling the truth.
Remember: even ghosts lie!
Rashomon has remained one of the top hundred films ever made. The ending at least gave the poor monk, who probably would have committed suicide or would nowadays be reaching for Prozac or other SSRIs, some hope.
A baby was heard crying. It was an abandoned baby. The woodcutter, who was poverty stricken, decided to adopt and look after this poor baby. He had six children – one more mouth would hardly make much difference.
There is hope in the world still.
Circles's Hinchingbrooke: Smart Hospital
Looks like not many noticed that Hinchingbrooke is not a FULL hospital. Very smart and I am sure it will work if it is not doing the money losing part.
Some smart people dreaming up some smart solutions: NHS for loss making future and PRIVATE for the profit making future!!!
1) Hinchingbrooke hospital is a modern purpose-built district general hospital, which opened in 1983.
2) Hinchingbrooke hospital serves people in Huntingdonshire and surrounding areas; approximately 160,000 people.
3) Hinchingbrooke Health Care NHS Trust provides a wide range of outpatient, daycase and inpatient services, a 24 hour accident and emergency department and maternity services.
4) Cambridgeshire Community Services provides services on the hospital site including 25 children’s beds and 12 special care baby unit cots*.
5) There are also two wards for patients with mental health needs, run by Cambridgeshire & Peterborough NHS Foundation Trust*, and Addenbrookes runs adialysis unit from this site*
*The services marked with an asterix will not become part of the operating franchise agreement detailed on the East of England website.
Ian Greener: Why Ali Parsa is wrong about healthcare (and the NHS).
Healthcare is not unsustainable, and the near public monopoly on it has made it fantastically affordable in the UK. As I’ve said many times in this blog, the entry of providers of others types means we have to keep comprehensive providers open (as Circle have benefited from at Hinchingbrooke), meaning that those providers cannot fail, while at the same time pretending we are introducing competition. There is no real failure if particular providers cannot fail. If there is no competition.
Lets enjoy the sunset.
Lets enjoy the sunset.
©2004 Am Ang Zhang
Circle Posts:
To say the Circle is the John Lewis of Health Care is indeed a blatant insult to that much loved high street store. John Lewis had no Cayman connection and Circle is not fully 100% employee co-owned. But Circle is really a ...
NHS & Circle: Smart People & Hinchingbrooke. I have always maintained that Andrew Lansley is very smart & I might be right: some very smart moves from the listening exercise to the House of Lords. But could he face his ...
Circle will have the power to hire and fire staff, and change operating procedures as long as the hospital meets NHS standards. The move opens the way for other financially failing hospitals to be run by private firms. Around ...
Dr Julian Neal, a Circle GP partner and a member of the company's primary care development team, says: 'We're about providing practices with the opportunity if they wish, to develop new services which are certainly not just ...
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 has world class retailers, telecoms and financial services firms, ...
We saw Circle's Ali Parsadoust in an altruistic posture proclaiming that Circle is the only one that can save the NHS. Then we saw the unholy gaming by one Hospital on one PCT/GP practice. Or did they? I have always ...
The financial strength of Circle Health, one of the UK's most prominent private health providers, will come under close scrutiny as its parent company prepares to float this week. ……Parent firm Circle Holdings' expected ...
Circle: - Currently largest partnership of clinical doctors in the UK. Says services could include telehealth, enhanced diabetic services, urological services, day case surgery, endoscopy, community-based ENT or ophthalmic ...
Tuesday, February 7, 2012
NHS Reform: Lessons from Coca Cola & Persil
Some politicians have an instinct to survive and dare we say even achieve greatness; others struggle and barely manage to stay afloat.
Would he be doing a Coca Cola or Persil turn?
We want NHS Classic!!! NHS Original!!!
The Plot Against the NHS
No, I do not know if he drinks it.
If our Prime Minister is extremely clever, he could do a Coca Cola U-turn now. He would be so popular as the one who saved the NHS from a number of plotters.
Coca Cola did an U-turn and has rescued what most perceived as a sure disaster. Or did they? As conspiracy theorists believe that it was part of a big publicity exercise. Only Coca Cola knew the truth.
Coca-Cola’s now famous attempt to change the taste to New Coca-Cola was met with such a consumer backlash that the management swiftly return to the Classic formula and eventually New Coca-Cola was dropped. Or did they!!! In fact the Diet Coke’s flavour is that of the New Coca-Cola that never was. In the States, the Classic Coca-Cola is not all that classic either as it uses HFCS instead of cane sugar. In Mexico & Europe and the Far East, they still use sugar. There you have it!!!
Persil Original
Persil also dabbled with Enzyme/Biological addition and later Manganese (that destroyed fabrics) only to again re-introduce what we love best: Persil Original. It may not leave your clothes as white as others but eczema sufferers won’t itch nor would non-sufferers.
Persil also dabbled with Enzyme/Biological addition and later Manganese (that destroyed fabrics) only to again re-introduce what we love best: Persil Original. It may not leave your clothes as white as others but eczema sufferers won’t itch nor would non-sufferers.
The PLOT to kill off the NHS Original started with Fundholding and since then every single government tried! Often in the name of improving health care.
The NHS has its faults but the fixing of it is not by bringing in privateers as they will be gaming for public money; nor would competition and choice work. We only need to look at the number of times the average household change utility providers.
But the government is pretending that Southern Cross would go away very quickly. The same with Four Seasons. We have no idea if there were any secret behind the scene deals so that the likes of Southern Cross will not hit the headlines as the HCSB tried to wriggle through parliament.
No we want the old NHS!!! NHS Classic!!! NHS Original!!! No mercury or manganese please.
Perhaps politicians can learn from this: you can say all the bad things about the NHS and you can quote how badly we are doing but we still love our NHS for all its short comings and perhaps if politicians have not been so interfering and allow us doctors, nurses and patients to make things work together we may indeed have a better NHS. All the analysis on the reform is clear about one thing: someone is going to make money and that means less money for actual health care.
Because, reading between the lines, that is what it is. If Andrew Lansley can have his way the ordinary citizens who cannot afford health care insurance will get inferior care in a society hat needs to ration its skilled medical professionals. It is no good trying to pretend it is any other way.
Our generation had the best of the NHS. We had the best of the welfare state including free education, free health care and above all freedom from fear of health care bills. Now it is up to your generation to fight for what we are in danger of destroying. The BMA are considering taking a legal challenge against the government, you should add your voices. Ultimately the battle for the NHS is a political battle and unless you make your voices heard then the NHS will be lost. Not one citizen in England can afford to lose their NHS; the scale of the public health casualties will be too great if the Bill is passed. The abolition of the NHS should not be our legacy to your generation for how can you care properly in the knowledge that so many will go uncared for. Its your NHS but only for so long as you care enough to fight for it.
20 years
.....But just in case you are not convinced of the design behind this, and don’t think it is fair to call it a plot, let me add just one more item. In January there was a discussion on Radio 4 between Matthew Taylor, who was once Blair’s chief of staff, and Eamonn Butler, the Director of the Adam Smith Institute, where Tim Evans also works – same Tim Evans who negotiated the concordat with Milburn and looked forward to the NHS becoming just a kitemark. They were asked if they thought the NHS was really going to become ‘a mere franchise’. Butler replied, quite casually, ‘It’s been 20 years in the planning. I think they’ll do it.’
Lancet: It’s time to kill the bill.
It ushers in a degree of marketisation and commercialisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively to communicable disease outbreaks and other public health emergencies.
While we welcome the emphasis placed on establishing a closer working relationship between public health and local government, the proposed reforms will disrupt, fragment, and weaken the country's public health capabilities.
The Government claims that the reforms have the backing of the health professions. They do not. Neither do they have the public's support. The Health and Social Care Bill will erode the NHS's ethical and cooperative foundations and will not deliver efficiency, quality, fairness, or choice. We ask the House of Lords to reject passage of the Health and Social Care Bill.” It is, indeed, time to kill this Bill.
One thing is for sure, if the HSCB is not killed, the ones that are likely to be killed are going to be hospitals & patients!!!
Poor Maths & NHS Reform: Privateers save NHS money!!!
Teenagers 'failing to study maths to a good standard'
Looks like it is not just teenagers:
The NHS is running out of money, so we must give most of it to privateers to save money!!!
Andrew Lansley/ HSCB
If the private providers are making money and the GP commissioning teams have a limited pot and that Consultants working for the likes of BMI hospitals have a 300% increase in pay compared to old NHS Hospital pay scale, either tax payers are going to be forking out more and more money or someone is not going to get their treatment.
But the sums are somehow wrong!
Government money is the best money for anyone to make and that is really tax payer’s money. The new NHS will be the private sector’s main source of income, as only 90,000 in the UK are covered by private insurance and often they are offered cash incentives to use the NHS.
It is therefore essential for the private health care companies that the NHS is around, at least in name, so that they can make money by providing a “better value and more competitive” service to the NHS!
Some parts of the NHS will have to remain too, as it is necessary for the private sector to dump the un-profitable patients: the chronic and the long term mentally ill, for example. (Right now, 25% of NHS psychiatric patients are treated by the private sector. But why? Even in psychiatry, there are cherries to be picked.)
Finally, in order to keep the mortality figures low at competing private hospitals, they need to be able to rush some of their patients off to NHS hospitals at the critical moments!
NHS Posts:
Enemy Of The People: NHS, Internal Market & Safety Net
Local Authorities: NHS Reform & IcelandNHS: Changes Or A Conspiracy Against The Public Interest
Saturday, February 4, 2012
Tribology: Hip Replacement & Cancer
My golfing friend wrote to me asking if I have read the latest in The
Telegraph.
"But Cockroach Catcher, you wrote about it in July of last year! Some even had bladder cancer!"
I suppose Medicine is still of great interest to me and one should never accept what is known now as the whole truth. Medicine cannot stagnate nor should we forget basic principles.
The Telegraph:
One of the participants in the trial, David Jose, 51, from Clifton, near Bristol, had a hip "resurfacing" operation in 2007, a year before retiring as a police officer.
The father of two had been suffering hip pain from playing football and rugby.
In May last year he was told that the tests had found atypical cells which were not at this stage cancerous.
He saw Angus Maclean, an orthopaedic surgeon at Southmead Hospital involved in the study, who said that the trial had established three cases in which patients had developed bladder cancer, and 14 more including Mr Jose who had changes to their chromosomes.
The doctor told him researchers "could not believe" what had been found, describing the findings as "shocking".
Not as shocked as my friend.
I will reprint my blog post:
Tribolgy: One Patient, One Disease.
Wednesday, July 27, 2011
© Am Ang Zhang 2011
Did you enjoy your Cruise?
Sure!
So you can get away from blogging and from Medicine.
I got away from blogging but then it was only the slowness of the Internet that was prohibitive.
Then I realised that perhaps we doctors never could get away from medicine and in a sense I did not want to either.
Medicine has become a hobby.
Cruising is an interesting way to have a holiday, you do not have to pack everyday and you get to meet some really interesting people.
On our Cruise we had dinner with an eminent professor and his wife.
Tribology!!!
Yes, a world class Medical Engineer and all I might want to know about hip and knee replacements.
Wow!
A friend came to our tropical resort to play golf with me. I have not seen him for years as we went our separate ways as he children were growing up. He was a sporty person and played rugby to a professional level.
He was walking a bit funny on the golf course.
“I used to hit 280 yds.”
“What happened”. He now hits 160 yds if he is lucky.
“Bilateral hip replacements.”
Good old rugby.
But that was not all. A year before he had bladder cancer that was diagnosed and luckily it was caught early.
“It was painful but the BCG treatment was good!”
So perhaps my professor was wrong: one patient one disease.
He obviously had hip problems from rugby and then bladder cancer.
So I asked my new found friend.
“There is a theoretical risk as the cobalt in the alloy in particular could be a problem. Check out the Swedish research.”
I told him about my friend and my professor.
“Interesting approach!”
“I know. But it concentrates the mind.”
Lisa B. Signorello et al
In summary, overall cancer risk among hip implant patients was close to expectation. However, we observed these patients to have a statistically significant excess of melanoma and prostate cancer and, after a latency of 15 years or more, of multiple myeloma and bladder cancer.
In contrast, we noted a statistically significant deficit of stomach cancer and suggestive evidence for decreased colorectal cancer risk. The incidence of bone and connective tissue cancers was not statistically significantly higher than expected for either sex in any follow-up period.
Further evidence suggesting an antibiotic effect comes from a study in Denmark (14), where a lowered risk of stomach cancer was found among patients with osteoarthritis who underwent hip implant surgery (presumably exposed to both NSAIDs and antibiotics) but not among those who did not have surgery (presumably exposed only to NSAIDs).
However, because this investigation provided the first opportunity to adequately evaluate the long term cancer-related effects of hip implants, the associations that we observed with bladder cancer and multiple myeloma, while also potentially attributable to chance or bias, should be considered carefully and require further in-depth study.
J Natl Cancer Inst 2001;93:1405–10
To remember our eminent yet formidable Professor of Medicine, Professor MacFadzean: One Patient One Disease.
I would like to pay tribute to our eminent yet formidable Professor of Medicine, Professor MacFadzean, 'Old Mac' as he was 'affectionately' known by us. He taught us two important things right from the start:
First - One patient, one disease. It is useful to assume that a patient is suffering from a single disease, and that the different manifestations all spring from the same basic disease.
Second - Never say never. One must never be too definitive in matters of prognosis. What if one is wrong?
Teratoma: An Extract,
To remember our eminent yet formidable Professor of Medicine, Professor MacFadzean: One Patient One Disease.
I would like to pay tribute to our eminent yet formidable Professor of Medicine, Professor MacFadzean, 'Old Mac' as he was 'affectionately' known by us. He taught us two important things right from the start:
First - One patient, one disease. It is useful to assume that a patient is suffering from a single disease, and that the different manifestations all spring from the same basic disease.
Second - Never say never. One must never be too definitive in matters of prognosis. What if one is wrong?
Mysterious Psychosis: One Patient One Disease
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Saturday, February 4, 2012
NHS Reform: Is there an alternative, like Scotland?
It has been stated that opponents to NHS Reform have no alternative suggestion.
This must indeed be challenged. My reading is that the government very craftily is dismantling the main bit of the NHS by all means possible. There is a total disregard of Parliamentary democracy. But then is it surprising given the recent events leading to the demise of two major Ministers.
One famous CEO of an IT company in Seattle wanted to build a house in a plot with over 200 old trees. There was no permission to cut them. She went on tour in the Far East and the trees were cut. Oh! She did not know. $260,000 fine is nothing.
As PFI is seen as a failure and grants offered to hospitals, many see it as a positive move. Not the Cockroach Catcher. If the government wants to sell off hospitals, that is what they need to do.
So in simple terms, can Reform go ahead?
Yes: but do away with Internal Market and integrate hospitals and GPs.
But then we cannot have private providers if there is no market.
So, you admit that Reform is for the privateers!
Better still, CCGs should now run hospitals as well.
But that is like Scotland. We cannot have anything in England like Scotland!
Tuesday, August 16, 2011
This is not Mayo Clinic © Am Ang Zhang 2009
One fellow blogger ( Dr No) wrote asking how the NHS could be modeled on Mayo. That got me thinking.It is of course always easier to criticise and my goodness we bloggers have and for good reasons. We loved the principles of our NHS.
My fellow blogger was right, sooner or later we have to come up with an alternative model.
I will quote from my letter back to him:
My view after studying Mayo and also Kaiser Permanente is that these two organisations avoided some of the major pitfalls that have gradually eroded a once great health care provider in the world: The NHS.
Those amongst readers that were trained in this country may not realise that we from Hong Kong would come over to theUK Hong Kong . This was despite the weather, yes the weather!!! We indeed were very well trained. Even when we started to have our local specialist training in our teaching hospitals many would still prefer to come over here. Training here gives them an edge so to speak. The US England
There were principles of the Mayo Model that was the NHS model of old.
An Egalitarian Culture.
Similar to Mayo, in the NHS, consultant pay peaked after a few years and then there was only the Distinction Awards (or equivalent) to look forward to. If we ignore private income for now, all disciplines are paid the same and it allows for a fairly nice and attractive prospect for new doctors to enter whichever specialty. Currently some specialty such as psychiatry is struggling and chances are private providers will be the norm. I hate to think that it will be the repeat of OOH service with poorly qualified doctors providing inferior care. There may be regulators but what good are they after the event.
In health care, death is irreversible.
No doubt the pay at Mayo is much better but not to the level of others in California or New York Maine
Internal Market:
The internal market has its advantages but the pitfalls are more than its worth. If reform is about better patient care then it is definitely the wrong way as it encourages distortion of good and efficient healthcare.
Mayo did well without it and we could as well. In fact we used to. Such a perverse system has caused a rift between primary and secondary care and is not helpful.
Many argued that it was there to pave the way for partial privatisation. I cannot honestly provide any counter argument. Why waste so much effort for so little return.
The only other possibility is that it is a covert form of rationing and soon not so covert but it would be done by your trusted family doctors, the GPs. It is the shifting of blame.
It has also been argued by those that promote privately controlled consortia that GPs stand to make lots of money. This could be directly from the total health budget or through some financial wizardry on the Stock Market. Remember Four Seasons, Qatar and RBS (our money) buy back?
The Royal Bank of Scotland
That is why many GPs in the consortia have links with private providers.
So primary care tried to save money and secondary care, for survival tried to extract as much as they could. Patients lose out in the process. It also encourages gross distortion of service at the hospital end and if allowed to continue leads to unholy “gaming” strategies.
On the other hand it is also very easy for some hospitals to fail and be gobbled up by privateers whose interest would be that of the money making specialties and not those that cannot be nicely packaged.
Patients come first:
A friend’s wife consulted me for a second opinion about her cardiac condition as her doctor husband has passed away a few years back. I am no cardiologist so I wrote to my cardiologist classmates (two in Hong Kong and one in the US
Mayo cross consult bottom to top and top to bottom as well. Who knows the bright young things might really be bright young things (quoted in one of my blogs).
Disincentives:
Virtually all Mayo employees are salaried with no incentive payments, separating the number of patients seen or procedures performed from personal gain. That was how it was in our NHS hospitals. Payment for performance encourages gaming.
This sound perverse and is very much against the bonus culture. But remember such culture saw the collapse of the US financial system and ours and a few other EU countries including France
The NHS of old was plagued by a covert two tier system that led to unjustified waiting lists and I do not have a quick answer except to say that paying a better salary is one and the other is a complete separation of private and public health. A limit of 10% if well monitored may work as well as close scrutiny of common waiting time.
My fellow blogger pointed out that we may need to keep that as a safety valve and I would agree.
Fully Integrated:
How else could we have a fully integrated system unless we do away with competition and the internal market and indeed private providers? The difficulty is that some of the private providers are already “in”. There is little doubt that in the long term we would be paying over the odds for what they provide and if not they will abandon what they do. Business is business.
Too Big: we cannot run the whole NHS as one Mayo Clinic.
I do not dispute that.
The solution is to regionalise the NHS. We did not have many Child & Adolescent Inpatient Units in the country and the two I used to run (one for children and one for adolescent) accepted referrals from three counties in the south of England
Regionalisation is therefore the way forward and there is no doubt that given our small country it is better to have major centres of excellence run on the Mayo, Cleveland and even the Kaiser model.
Like Mayo Clinic, our NHS could have a seamless health care with no artificial obstacle on referral to hospital consultants or admission or to specialised treatment.
“The best interest of the patient is the only interest to be considered.”
Mayo brothers.
If he is honest, he hasn’t read every line himself. Instead, he suggests you consider one core question: why is the Secretary of State so determined to remove his duty to provide, or secure the provision of, a free at the point of delivery comprehensive health service? Once you have the answer to that one, the rest falls readily into place, and the nuclear option at the heart of the Bill lies plain for all to see.
King's Fund:£1-million GP?
Scotland Posts:
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
Thursday, February 2, 2012
Antigone & Circle: Bell tolls for Greece or NHS?
Are the bells tolling for Greece or the NHS?©2011 Am An Zhang
Most of us do not realise how brilliant those people that have worked at Goldman Sachs are:
Antigone managed to help Greece "relocate" their debt before they entered the EU. In the business world, Antigone or Addy was highly regarded:
"A defiant Goldman Sachs says it did nothing wrong by concocting a deal that temporarily masked Greece's bloated government debt, an arrangement that has sparked outrage across Europe."
Now Ali Parsa is from the same Goldman Sachs stock and he is either altruistic or very smart & has done the unthinkable of "buying" a failing NHS hospital. "Buying" is perhaps wrong as he is smart and will not do anything like that. There were little if any detail about the deal but knowing someone with a Goldman background, the government would not be a match at all as far as the contract goes. But then the government was not that good with ISTC or PFIs.
For Hinchingbrooks to succeed it must do more cases and yet CCGs are suppose to cut referrals to hospitals. Ali Parsa must know that and my assumption is that it will not happen with Hinchinbrooks. Being private means we the public cannot access the details of the deal.
Another smart move then.
But perhaps they too were smart as it is one means for the ruling class to secure their future and ration health care at the same time. Sorry---getting GPs to ration Health Care
After all Greece still has more Porsche per capita if you must know and most of their rulers' money are safe in Switzerland.
To say the Circle is the John Lewis of Health Care is indeed a blatant insult to that much loved high street store. John Lewis had no Cayman connection and Circle is not fully 100% employee co-owned.
But Circle is really a first step by our government to COVERTLY ration HEALTH CARE. Canada is doing it using waiting time and so are many western and indeed eastern countries.
The distraction of the current NHS Reform is to allow the debate to be focused on Primary Care.
That has now changed thanks to Circle.
Please everybody it is about Consultants & Secondary CARE!!!
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.
According to the NAO:
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.
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.
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.
"Like blood, health care is too precious,
intimate and corruptible to entrust
to the market"
Guardian: Circle Health admits care may suffer.
NHS & Market Forces: Fund Holding & Medical Ethics
NHS & Circle: Smart People & Hinchingbrooke
I have always maintained that Andrew Lansley is very smart & I might be right: some very smart moves from the listening exercise to the House of Lords. But could he face his grand children?
I have stated this before about the future of the NHS:
“There are two futures,
the future of desire and the future of fate,
and man's reason
has never learnt to separate them.”
has never learnt to separate them.”
Scenario 1: Grandpa, why didn’t you save the NHS when you had the chance?
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.
©2004 Am Ang Zhang
Looks like one of the FUTURES has just started: the sale not the buy back yet!
Some smart people dreaming up some smart solutions: NHS for loss making future and PRIVATE for the profit making future!!!
1) Hinchingbrooke hospital is a modern purpose-built district general hospital, which opened in 1983.
2) Hinchingbrooke hospital serves people in Huntingdonshire and surrounding areas; approximately 160,000 people.
3) Hinchingbrooke Health Care NHS Trust provides a wide range of outpatient, daycase and inpatient services, a 24 hour accident and emergency department and maternity services.
4) Cambridgeshire Community Services provides services on the hospital site including 25 children’s beds and 12 special care baby unit cots*.
5) There are also two wards for patients with mental health needs, run by Cambridgeshire & Peterborough NHS Foundation Trust*, and Addenbrookes runs adialysis unit from this site*
*The services marked with an asterix will not become part of the operating franchise agreement detailed on the East of England website.
Circle will have the power to hire and fire staff, and change operating procedures as long as the hospital meets NHS standards. The move opens the way for other financially failing hospitals to be run by private firms. Around 20 are thought to be candidates for a takeover.
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 toLondon 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
Allyson Pollock
02/02/2012
Patient choice is the great con. Patients won’t choose. They will be chosen on the basis of their risk profile. Many of the health care companies now active in the UK manage financial risk by placing time limits on care, introducing cost deductibles, copayments and restrictions on the number of GP visits, hospitals visits, operations. All are commonplace in private health insurance. They are the spectre of what is to come if the Health and Social Care Bill is passed.
Hinchingbrook is not like John Lewis as it is not a full partnership.
NHS 1978: Hope, Faith & Supermarket
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