Wednesday, February 29, 2012
NHS Reform & Scamming: Unnecessary Rx & Fraud
As England tried to cope with possible fraud of A4E causing the most untimely embarrassment to the Prime Minister, it pales when compared with:
Latest Medicare Fraud Dallas, Texas, USA.
Federal authorities announced charges Tuesday in the largest healthcare fraud scam in the nation's history, indicting a Dallas-area physician on charges that he bilked Medicare of nearly $375 million and accusing him of sending "recruiters" to scoop up patients and get them to sign for treatments he never provided.
Prosecutors said Roy and his office manager in DeSoto, Teri Sivils, who was also charged, sent healthcare "recruiters" door-to-door asking residents to sign forms that contained the doctor's electronic signature and stating that his practice had seen them professionally in their own homes.
They also dispatched "recruiters" to a homeless shelter in Dallas, paying the recruiters $50 every time they coaxed a street person to a nearby parking lot and signed him up on the bogus forms.
Even when officials suspended his Medicare license last June, they said, Roy found a way around that by shifting his business to another company.
In the current push for applying market principles, the NHS is in serious danger of paying dearly for unnecessary treatment and worse, fraudulent claims by the new “suppliers” in the market place.
I have highlighted the problems in the US
The US
By how much? In the US
26 OCT 2009
The U.S.
The report identifies the most significant drivers of wasteful spending - including administrative inefficiency, unnecessary treatment, medical errors, and fraud - and quantifies their cost. It is based on a review of published research and analyses of proprietary healthcare data.
"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," said Robert Kelley, vice president of healthcare analytics at Thomson Reuters and author of the white paper. "The good news is that by attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care.
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.
“The Federal Bureau of Investigation (FBI) estimates that fraudulent billings to public
and private healthcare programs are 3-10 percent of total health spending, or $75–$250
billion in fiscal year 2009.”
“Fraud and abuse” occupies the extreme end of the continuum of appropriateness of use and potential waste. While arguments can be made about the appropriateness of some of the care described in the previous section, and, therefore, its classification as waste, no reasonable argument can be made for the contribution of fraud and abuse to quality of care or outcomes. They are cases of intentional misrepresentation resulting in excess payment, including billing for services never rendered and the knowing provision of unnecessary care. Most fraudulent and abusive practices simply add cost with no value, but others actually expose patients to the risk associated with unnecessary procedures.
Practices leading to waste include:
• The intentional provision of unnecessary or inappropriate services
• Billing for services never provided, often with patients’ participation in the fraud, often for
deceased patients
• Misrepresentation of the cost of care by insurers to group plan sponsors
• Kickbacks for referrals for unnecessary services
• Misbranding of a drug by a pharmaceutical company
• Abuse of the healthcare system by patients to receive harmful services, such as Medicaid recipients with drug addictions enrolling in multiple states.
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.
BBC 20 May 2008
“A dentist and his wife who stole more than £30,000 from the NHS by claiming money for treatment never given to patients have been jailed.
Newton Johnson, 52, and his wife Judith, 51, also claimed for treatment for "phantom" patients, which included the name of a family pet dog.
Tuesday, February 28, 2012
Obama Health: Under One Roof
It would be interesting to see how universal health insurance will pan out in the Obama health care reform.
It made sense that insurers should not be allowed to “cherry pick”. The Cockroach Catcher just realised that perhaps there now will be a new commodity: patients.
The financial world has been about risks and derivatives were designed to minimise risks. All very laudable until some smart ones realise that much money could be made from such instruments.
Health Insurers are a special group of such financial institutions and no doubt they will want to minimise the risks. In the past, it is very simple: exclude risky patients. Reuters: Insurer targeted HIV patients to drop coverage
President Obama signed the budget reconciliation bill containing a package of revisions to the big health care legislation after giving a speech at Northern Virginia Community College, a setting aimed at drawing attention to the education component of the bill.
“Today we mark an important milestone on the road to health insurance reform and higher education reform,” Mr. Obama said. “But more broadly, this day affirms our ability to overcome the challenges of our politics and meet the challenges of our time.”
He continued, “When I took office, one of the questions we needed to answer was whether it was still possible to make government responsive to the needs of everyday people, middle-class Americans, the backbone of this country, or whether the special interests and their lobbyists would continue to hold sway like they’ve done so many times before. And that’s a test we met one week ago, when health insurance reform became the law of the land in the United States of America.”
In his speech, Mr. Obama also sought to temper some expectations. “The health insurance reform bill I signed won’t fix every problem in our health-care system in one fell swoop,” he said. “But it does represent some of the toughest insurance reforms in history. It represents a major step forward toward giving Americans with insurance and those without a sense of security when it comes to their health care. It enshrines the principle that when you get sick you’ve got a society there, a community that is going to help you get back on your feet. It represents meaningful progress for the American people.”
It was a courageous president to have taken on the might of Health Insurers the way President Obama did with his Health Reform, it is time that England should seriously consider passing legislation to rein in on Health Insurers. Many consider it too late to prevent private bodies taking over our once efficient NHS. By 2014, Health Insurers in the US will not be allowed to "cherry pick". Is that why so many of them are poised to cross the pond? Only time will tell. In the mean time legislation similar to those in the US will at least prevent the kind of things that are happening now over there.
All the insurers have notified the state Department of Insurance of their intention to resume sales.
“……There is plenty at stake. California's private insurance market — where individuals and small businesses buy coverage — generated $17 billion in revenue last year. The market is only expected to grow as millions of uninsured Californians buy coverage, beginning in 2014, through a new marketplace exchange set up as part of the federal healthcare law.”
“Regulators from the California Department of Insurance have been trying to prod insurers to start selling child-only policies once again since they announced their departure shortly before Sept. 23, when the federal healthcare law would have required them to accept all children with preexisting conditions. On Wednesday, officials sent the companies two pages of "guidance" to help them interpret the new state law.”
Guidance? Really!
Perhaps our new government is the one that needs guidance. The sooner they rein in the insurers the better:
No exclusion of pre-existing conditions and no rescission and definitely no dumping.
And a limit of say no more than double the best rates.
With the passing of the health care bill in the US, one must congratulate President Obama for achieving the impossible and he will no doubt be ranked with the greatest presidents.
A few weeks ago, Obama and health reform were doomed and Obama was not up to the job. In the coming days, we will see a jubilant Obama on the cover of newsmagazines. He will be lionized as a giant-killer. His approval ratings will rise, both because more Americans are paying attention to the beneficial features of the bill as opposed to the Republican caricatures and because Americans love a winner.
"And the health bill itself only begins the long task of wresting control of the health care system from callous insurance and drug companies. We still have to fight for a real public option that is the first step towards national health insurance." Huffington Post
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, a Republican gave a rousing endorsement of President Obama’s health plan. New York Times reported today.
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 we have a safety net: the NHS.
Let us protect it.
NHS Reform & Health Insurers: True Choice & Competition
A very personal view indeed:
Our NHS is not without faults and often the faults were to do with government. Impossible targets set up by successive governments have one aim: limit access to health care.
I wrote in 2008 in The Cockroach Catcher:
The doctor’s position had over the last ten years moved nearer the bottom end with no such counter moves by politicians. Some argued that the rot started with Shipman and the move to check on doctors’ competence will soon become law. The sad truth is that incompetence was not Shipman’s problem as he was able to shield the deaths that he created with his expert medical knowledge. The incompetence was with those that regulated him. He was probably more up-to-date with medicine than most, and expert at euthanasia. Recent scandals relating to Cleveland, Bristol, Alder Hey, Kent Authority, and MMR all help to erode people’s trust in their doctors and their regulator, the GMC.
Then we have Mid-Staffordshire & Baby P amongst others that demonstrated how if you try hard to meet targets patients died and if you whistle-blow, you die professionally. Successive governments tried to pretend that the problems have nothing to do with their main aim: cutting funding to Health Care of the citizens of the land in the form of covert rationing.
So, a new sales pitch came in: Choice & Competition to improve the quality of health care plus let us involve the privateers as they are good.
Good at what!
Making money: for themselves. Remember Southern Cross and now A4E?
Then we have world class cancer hospital and third world cancer survival. No it did not make any sense at all.
So the decision was to get rid of the NHS as it was but retain the name as a brand.
But!!! And a very big BUT!!!
Why not legislate to rein in Health Insurers?
- Ends discrimination against people with pre-existing conditions.
- Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.
- Limits premium discrimination based on gender and age.
- Prevents insurance companies from dropping coverage when people are sick and need it most.
- Caps out-of-pocket expenses so people don’t go broke when they get sick.
- Eliminates extra charges for preventive care.
- Contribute to an ABTA style cover.
·
We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.
Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital.
This will eliminate problems like PIP breast implants.
It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.
To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.
Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!
In fact, to save money, government can buy insurance for the mental patients and the chronically ill.
This way their will be real choice and insurers will be competing with each other to provide the worst deal.
Why?
What Health Insurer will want the business?
Perhaps they will go back to the US and we will have our own NHS back.
“……The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it……..” These are the very same people we pay market rate or they will go elsewhere!!!
The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US
Friday, February 24, 2012
Private & NHS: Choice & Competition for same Consultants
It is amazing that the debate on the NHS Reform continues and the emphasis is on choice and competition that will in turn improve quality!
"But, excuse me, did I not just see you at the NHS Clinic?"
The above is still the most common exchange when one gets persuaded to see a consultant at a Private Clinic on the belief that you might get your hip earlier and wait, "better" treatment.
But private clinics and hospitals need to make a profit and that means less money for treating patients when we started sending NHS patients to private clinics.
Please Mr Lansley, explain to me the good of the AQP of your new world order!
In the new world order of our NHS, private provider (AQP)for commercial reasons need not let the public have access to information about their activities etc, and even the doctors they provide.
Just look at one of the OOH, one doctor for 950,000 population! As they say, be very afraid.
Even as we like our NHS as much as our woods: looks like private providers for public services is in the PM's mind. Sometimes it is public (taxpayer) money for private failures: catastrophic failures when it is someone's life.
Wait, most of the time they are the same doctors so introducing competition is not going to improve anything.
Choice? Really!!!
Anyone who cared to Google Private Health Insurers will find that many conditions are excluded from their "comprehensive" Health Care. The full list is too long and I might be infringing their copyrights. See if dialysis and intensive care treatment are covered. What kind of "comprehensive" Health Care is it to exclude both.
Check out the John Lewis Hospital, sorry Circle. Same story: exclude baby intensive care, dialysis and mental health.
Just try not to get this funny E. Coli. As when you need dialysis you may have to choose NHS. But then, you might be so ill and unconscious.....mmm interesting thought. How does one choose when very unwell?
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.
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
Sunday, February 19, 2012
Animal Farm: 2012 Special Meeting!
Reform is happening too down in the farm & the pig called a special meeting but only of supporters:
©2012 Am Ang Zhang
Dear Supporters, thanks for coming today. The dissenters did not realise the most important part of our plan.
There will be two kinds of CCGs. They may look the same, but in truth they are going to be different. In simple terms, the ones you people are going to run will be different to those run by non-supporters.
We have promise that there will be choice. Yes, there will be. Your choice!
You can choose the healthy patients and leave those in care homes or those with chronic illnesses to the others. We will make sure that the other CCGs cannot refuse.
There will be integration but here we really mean our kind of integration. Or was it your kind? Anyway, your kind of CCGs will run the special Hospitals that will have the help of great financiers from the City. Like Kaiser Permanente (which we should not mention outside these doors) we will not let other hospitals make money. No true competition, just think about airlines, utility companies andADM.
Some hospital will fail and you can buy them up and run it profitably and we already have people that know about Real Estate helping you. Imagine a Central Luxury Apartment with easy access to the best hospitals in the world? World Class Real Estate and World Class Medicine!
Just in case you are worried about the few Hospital Consultants that did not agree, do not worry, we have people everywhere.
Run, get cracking!
20 years in the planning and we are nearly there.
“In the case of the consultants, a show was made of trying to make them accept much closer supervision by hospital managers, and cut back on their private work. But it soon came to seem that the real aim of doing this was to make them feel more disenchanted with working as salaried NHS employees and readier to go into business – to form doctors chambers, on the model of barristers, or other kinds of business, and sell their services to any employer, public or private, that offered them the best terms. A significant number began to plan to do so and some have begun to. And as the cuts begin to bite there will be unemployment among hospital doctors. As you will have read, consultants are among those scheduled to be laid off by St George’s
I think there is something fundamentally scary about our democracy…. Because I think people have a sense that the system is rigged, and it’s hard to argue that it isn’t.
Michael Lewis: The Big Short
Kaiser Permanente:
Animal Farm
Price competition links: airlines, utility companies and ADM.
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
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 as Circleis 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
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.
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.
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 & Iceland
NHS: 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
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: Bells toll 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
Thursday, February 2, 2012
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 a dialysis 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. >>>>Hinchingbrooke Next Steps
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
Tuesday, January 31, 2012
Shakespeare: Winter's Tale for NHS
Despite the hard work by a few bloggers, most of the NHS reform are in place one way or another and some say that to kill it now would mean that there will be none of the old NHS left anyway.
Modern day government way ignore the public and even Parliament. If the NHS is dismantled long before any legislation, how can one save it.
In my work I have seen great injustice of parents wrongly accused of abuse and children removed from them. After eventually proving themselves the courts decided that it would be too disruptive to return the children to them.
Looks like the same tactic is being used in this the biggest shake up of the NHS.
The NHS have many faults and most of them due to government policies. Mid Saff. happened because of central policy.
The government's mistakes started with GPs and OOH, then MTSA and now the reform that will totally dismantle this great institution. The government did not know that they had the specialists on the cheap for years and like the cheap OOH care from GPs, they are giving it up.
But why should they care, private health insurance will take care of that.
Please do not forget, many will not cover dialysis or intensive care. So be careful Prime Minister when you eat in Germany as it will not be any good catching one of those E. Coli food poisoning.
The NHS does its best to deal with the consequences but it is the politicians who have to frame society and its response in terms law and policy who have failed. Who pays for the elderly mentally frail, who makes the laws to change our diets and lifestyle? They have no idea what to do to make us thin and care for us humanely and cost effectively as we get older.
Demanding headroom and cuts to NHS budgets as an excuse to deal with problems politicians are too timid to address is not the answer.
Shoving the NHS into the arms of the private sector will not solve the problem it simply passes the buck.
The editorial prompted a discussion on Radio Four’s Today programme, featuring Dr Godlee and a Dr Charles Alessi. Dr Godlee remained firmly un-updated. Dr Alessi, on the other hand, appeared either to have tuned in or plugged in, for he was fully updated.
As well he might be, as Chair of the National Association of Primary Care, a pro-reform outfit not only aligned with the equally pro-reform NHS Alliance, but also partnered with a lugubrious assembly of drug companies, management stooges and American connected vultures hovering in the hope of rich NHS pickings.
How one would save money by allowing private providers to take profits from us is beyond my comprehension and a few other bloggers.
Personally, there is too much vested interest by a few GPs and Hospital Consultants in the reform as they are going to make a lot of money out of this.
So would private providers. Many hospitals are in prime sites for property development. Billions to be made by someone.
England will again return to its old class system, those with and those without: Private Insurance.
The RSC predicted the demise of the NHS when they last performed the Winter's Tale. The Cockroach Catcher was there!
Yet there is so much we can learn from Shakespeare! The King offended Apollo and his heir was dead!!!
Hansard fell on stage at Winter's TaleTristram Kenton Guardian
Servant
O sir, I shall be hated to report it!
The prince your son, with mere conceit and fear
Of the queen's speed, is gone.
LEONTES
How! gone!
Servant
Is dead.
LEONTES
Apollo's angry; and the heavens themselves
Do strike at my injustice.
(Act 3, Scene II). The Winter’s Tale.
.........Apollo chose to kill King Leontes' heir brought him to his senses but by then it was all too late. As he left the stage the two giant bookcases that we barely noticed started to collapse towards the middle of the stage with all the “books” falling onto different parts of the stage. It was real and scary. Civilisation must indeed be coming to an end!
Our party was sitting by the stage and so we all tried to pick up some of the torn pages: WOW!
All the books were indeed hard cover bound Hansards. (Hansard: The Official Report of the proceedings of the main Chamber of the House of Commons, United Kingdom.) How topical. One page was Hansard 1950 with questions on the new NHS. We duly put the pages back on stage for re-reuse.
Most if not all reviewers missed this powerful metaphor.
Hermione: "You pay a great deal too dear for what's given freely". -
(Act I, Scene I). The Winter’s Tale.
Abandon the NHS internal market:
“……So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice…….”
Here is the advice:
“……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…….”
Abandon PPP/PFI:
“PFI makes me particularly angry. It is a guaranteed loan to property investors, where high-rate mortgage payments are kept off-balance to reduce the country’s declared debt. In other words, it’s the Enron of the NHS. This is money the NHS has committed to leave frontline healthcare for the next 35 years.”
"In other countries this would be called looting, here it is called the PPP." Boris Johnson: Mayor of London.
Private Finance Initiatives are intended to harness private funding for public building projects, such as schools and hospitals.
Under the schemes, introduced in the 1990s and expanded under Labour, private firms pay for work on buildings, then lease them back to local authorities on a contract of up to 25 years.
Abandon Business Model/Bonus Culture:
If we are not careful, the NHS will move towards the same model of NHS Trusts and PCTs with highly paid CEOs and their management staff. Below them a number of highly dispensable doctors, nurses and other workers. Firing of staff is the norm to balance the books in the NHS.
Look at what happened to Out Of Hours service and hospital weekend and holiday manpower levels and you will know what I am talking about.
Unfortunately, it may be too late to try and bring back the good will that has kept the OLD NHS going for so many years. The good will that was slowly destroyed by modern management ways and silly Pavlovian bonus culture.
Cassius:
"The fault, dear Brutus, is not in our stars,
But in ourselves."
Julius Caesar (I, ii, 140-141)
Same soup new name: PCT now NCB
.......We will however not be commissioning all the NHS care for your constituents. Specialist care for those of them with rare diseases will be commissioned nationally by the National Commissioning Board. The NCB is a new national quango set up under the Bill going through Parliament. The NCB will also be commissioning GP services in your constituency. So if you have a problem with either specialist care or the standard of GP service the body you need to complain to will be the NCB – run from Leeds.
The NCB will have a field force at our local level. Your old local PCT which had a local chair and non-executives has been abolished and formed into a cluster of PCTs. This PCT cluster will now become a part of the National Commissioning Board in our region.......
Sunday, January 29, 2012
Emperor's New Clothes: Tailor speaks again!
Chris Ham in the Guardian:
The time for grandstanding about the bill has passed. The challenge now is to carve out a path to implementing the reforms that brings about necessary improvements in patient care at a realistic pace. If this means modifying the direction and speed of change in response to legitimate concerns, then it will be a small price to pay to deliver an outcome that is good for patients.
Market Forces and Choice is suppose to give us better value with our shopping, the OFT judged that nine companies colluded to rig the price of cheese and milk in 2002 and 2003. The scandal is thought to have cost consumers about £270m. The OFT had intended to fine the guilty parties more than £116m, but reduced the penalties after a period of consultation. The consumers did not get any of the millions. Yet the NHS Reform is still pushing ahead with similar ideas.
Parliament debate:
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.”
Guardian: OFT dairy price-fixing fine
NHS-Kaiser Permanente: A Class! Seriously!
NHS: The Way We Were! Free!
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Email: cockroachcatcher (at) gmail (dot) com.
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.