Monday, November 29, 2010

NHS & Weather: Believe! Believe! Believe!

Just as we are supposed to believe that the NHS is not being privatised we are also supposed to believe that this winter is going to be warm.

29 Nov 2010
Snow closes roads and schools from Cornwall to Scotland
Britain's worst November snowfall for decades shut schools and roads from Cornwall to Scotland as forecasters warned that Siberian winds could bring temperatures as low as minus 20C in the coming days.

Minus 20 C!!! That is freezer temperature!!!
In Cornwall, 44 schools were closed because of the weather, with another 12 opening later in the morning, Cornwall Council said.

Let us go back to the beginning of the year:

The Met Office gives us the warmist weather
©2010 Am Ang Zhang

The UK's official weather forecasters are determined that winters should be mild, in the face of the frozen facts, says Christopher Booker
7:12PM GMT 02 Jan 2010

……. But hasn't the time come for us to stop treating the serial inaccuracy of Met Office forecasts as just a joke and see it for what it is – a national scandal?

The reason the Met Office so persistently gets its seasonal forecasts wrong is that it has been hi-jacked from the role for which we pay it nearly £200 million a year, to become one of the world's major propaganda engines for the belief in man-made global warming. Over the past three years, it has become a laughing stock for forecasts which are invariably wrong in the same direction.

The year 2007, it predicted, would be "the warmest ever" – just before global temperatures plunged by more than the entire net warming of the 20th century, Three years running it predicted warmer than average winters – as large parts of the northern hemisphere endured record cold and snowfalls. Last year's "barbecue summer" was the third time running that predictions of a summer drier and warmer than average prefaced weeks of rain and cold. Last week the Met Office was again predicting that 2010 will be the "warmest year" on record, while Europe and the US look to be facing further weeks of intense cold.

What is not generally realised is that the UK Met Office has been, since 1990, at the very centre of the campaign to convince the world that it faces catastrophe through global warming. (Its website now proclaims it to be "the Met Office for Weather and Climate Change".) Its then-director, Dr John Houghton, was the single most influential figure in setting up the UN's Intergovernmental Panel on Climate Change (IPCC) as the chief driver of climate alarmism. Its Hadley Centre for Climate Change, along with the East Anglia Climatic Research Unit (CRU), was put in charge of the most prestigious of the four official global temperature records. In line with IPCC theory, its computers were programmed to predict that, as CO2 levels rose, temperatures would inevitably follow. From 1990 to 2007, the Department of the Environment gave the Met Office no less than £146 million for its "climate predictions programme".

But in the past three years, with the Met Office chaired by Robert Napier, a former global warming activist and previously head of WWF UK, its pretensions have been exposed as never before. The "Climategate" leak of documents from the CRU, along with further revelations from Russian scientists, have shown the CRU/Met Office alliance systematically manipulating temperature data, past and present, to show the world growing warmer than the evidence justified. And those same computers used to predict temperatures 100 years ahead for the IPCC have also been used to produce those weather forecasts that prove so consistently wrong.

Scientific method has gone out of the window, to support a theory that looks more questionable than ever. The whole set-up – Met Office, Hadley Centre, the CRU, the IPCC – looks hopelessly compromised. It is a state of affairs so bizarre that it cries out for political intervention.

Yet our politicians, from Gordon Brown and David Cameron down, are so in thrall to this new religion that they cannot see evidence staring them in the face – that the show has gone off the rails. How many more winters and summers will it take before sanity finally breaks in to put an end to this scandal?


Sunday, November 28, 2010

Snorkel to Serco

©2010 Am Ang Zhang
One needs to be on the look out when snorkeling and when not.
Three doctors working at Yarl's Wood immigration detention centre are facing investigation by the General Medical Council, amid calls for healthcare at the centre to be transferred from the private sector to the NHS.
A complaint about the three has been submitted to the GMC after accusations over numerous alleged cases of substandard patient care, the Guardian has learned. The complaint to the medical body follows a succession of damning reports highlighting inadequate healthcare at the Bedfordshire centre.
Any GMC investigation would increase pressure on ministers to address growing concerns about healthcare at Yarl's Wood, which is the responsibility of Serco, the private company that runs the centre. Last month the children's commissioner raised concerns about "significant areas" of care for the 1,000 children held at Yarl's Wood, saying it fell below NHS standards.
On Wednesday the chief inspector of prisons, Anne Owers, will publish a report into Yarl's Wood, which is also expected to criticise conditions at the centre.
Last night two MPs called for Serco to be stripped of responsibility for healthcare at Yarl's Wood. John McDonnell, Labour MP for Hayes and Harlington, said: "There is an underlying conflict of interest when you have a private company which is run for profit running healthcare. The best way of ensuring openness, transparency and avoiding conflict of interest, and ensuring that people are getting a fair standard of healthcare, is to have it run by the NHS.
Will future doctors (GPs and Consultants) working for such private companies risk being “looked at” by the GMC?
They are not as lucky as another person I read about:
Reuters: David Steeds:

Mr. David William Howitt Steeds is Independent Non-Executive Director of Jetion Holdings Limited. Mr. Steeds was a member of the team that built up Serco Group plc as one of the UK’s support services companies and then joined DERA (now QinetiQ Group plc) as corporate development director.

QinetiQ: Ten former civil servants at the Ministry of Defence who made more than £100m in one day from the privatisation of its research agency are today accused by MPs of behaving "dishonourably" in arranging the sale. A report from the Commons public accounts committee on the part-sale of QinetiQ accuses the 10 of a "serious conflict of interest" in selling the idea to the MoD without explaining they stood to benefit personally from the sale.

Mr. Steeds is currently non-executive chairman of Telspec plc, and non-executive director of Tinci Holdings Ltd., a company listed on AIM. He is a former chief executive of the Private Finance Panel, the UK government agency previously responsible for the Private Finance Initiative (PFI). He was conferred a Degree of Bachelor of Arts by Cambridge University in June 1970, a Master of Arts in industrial relations by Warwick University in July 1972 and qualified as a Chartered Accountant in England & Wales with Coopers & Lybrand in 1974. Mr. Steeds is considered to be an independent nonexecutive director.

Then I read:
Serco acquired a GP out of hours service in Wales by buying out a company called Clinical Solutions UK. Between 19th October 2004 (only 2 weeks into the contract), and March 2005 Cardiff Local Health Board awarded the company £58,726 to manage what the company claimed were unprecedented levels of demand. According to the Welsh Audit Office, “when we examined the figures we found that the supposed extra demand simply wasn’t there”,
Serco is a provider of ‘PFI’ hospitals, including being part of the Octagon consortium that made an over £100 million windfall ( £100million !!!) keeping the overwhelming amount to be shared amongst the consortium. In a scathing report, the Parliamentary Public Accounts Committee accused the private consortium involved in the rebuilding of the Norfolk and Norwich Hospital of "lining investors' pockets" and putting the trust at increased risk of further losses.

A private firm that was controversially chosen to provide out-of-hours services in Cardiff has sold its contract for a 'significant' profit after just five months.
In a deal that has outraged GPs, Clinical Solutions last week struck a deal with Serco, a Leeds-based firm that has been involved in hospital PFI contracts.
GPs accused Clinical Solutions of having provided an 'appalling' service and of profiteering at the expense of patients.
Board members of Cardiff local health board, which chose the company, were also understood to be furious after having been told nothing of the sale until after it had happened.


Serco Group plc (Serco), the international service company, is pleased to announce that it is expanding and strengthening its UK pathology business with the addition of a leading NHS foundation trust to its joint venture to form the UK's largest single provider of pathology services.
Under the agreement, King's College Hospital NHS Foundation Trust (King's) has joined GSTS Pathology, the joint venture between Guy's & St Thomas' NHS Foundation Trust (Guy's and St Thomas') and Serco GSTS Pathology has been awarded a ten-year contract valued at around £300m, starting October 2010, as the principal provider of pathology for King's.  It is anticipated that the agreement will result in incremental revenue to Serco over the term of the King's contract of approximately £110m.

Concern about price of complex testing
GSTS’s ambitions were revealed at a CCSC pathology subcommittee meeting by Guy’s and St Thomas’s Local Negotiating Committee chair Anthony Wierzbicki.

London chemical pathologist Dr Wierzbicki, who works for GSTS while on secondment from Guy’s and St Thomas’s, said he believed the price of complex testing would ‘increase significantly’ if and when GSTS took over a ‘critical mass’ of the market.

He also had concerns about the terms and conditions of seconded consultants.

Dr Cox said that while their ‘activities day to day’ were managed by GSTS, seconded staff retained their NHS rights.

CCSC pathology subcommittee chair Anne Thorpe said she was ‘very concerned’ about NHS consultants being seconded to privately-run enterprises.

'Terms and conditions of service must not be downgraded or ignored'

BMA central consultants and specialists committee chair Mark Porter (pictured) said ‘Pathology services are vital to the NHS and to patients. Putting them out to private or shared ownership in this way can be portrayed as change for the better. Too often though the experience of consultant pathologists is that an assertive management sees them as work units rather than integrated members of an NHS team. Terms and conditions of service must not be downgraded or ignored in the pursuit of price efficiency.’

Concerns about NHS marketisation prompted the BMA to launch its Look After Our NHS campaign.

But Guy’s and St Thomas’s associate medical director Jonathan Edgeworth said: ‘The contract expects a 30 per cent efficiency improvement over the next three years and we have already developed new tests and driven down phlebotomy and cervical screening waiting times. I sit on the trust side and hold GSTS to account. Because it is a 50-50 split half of any surplus comes back to the trust.’"

I know when I snorkel I need to be aware of good looking things!!!

©2010 Am Ang Zhang



NHS: Perfectly Safe?

NHS: Changes Or A Conspiracy Against The Public Interest

Enemy Of The People: NHS, Internal Market & Safety Net

Wednesday, November 24, 2010

Thanksgiving: Jamon Iberico de Bellota, Pata Negra

Happy Thanksgiving!

Ham is often part of the traditional meal at Thanksgiving.

Here is my offering of arguably the best ham in the world:

©2010 Am Ang Zhang
Jamon Iberico de Bellota: Ham from the acorn fed black hoofed pig in southwestern Spain. Some might worry about the high fat content of the ham. Rumour has it that the fat is monounsaturated and will reduce LDL and raise HDL. Perhaps that was why one of the oldest men in Okinawa had potato fried in pork lard every day; much to the surprise of the journalist who was looking for the ideal fat free Okinawa diet.

Wine pairing is simple really with food like this: the best of anything will do nicely.

For those that wanted to leave the claret till later what better to start the festivity with a good champagne: Dom Pérignon. Many food and wine bloggers commented on how the two brought out the best in each other.

I have to confess to a preference for a white burgundy: A Puligny Montrachet would do very nicely.

In places where only red wine will do, then any of the top French ones in a good year would do very nicely. Dare we mention Opus One for the Californians celebrating Thanksgiving? I must confess that a top Lapostolle from Chile is very tempting.

In Spain it is often served with a fine Fino sherry or a good Rioja.

Sunday, November 21, 2010

Vacation: A Break for Medicine.

I have to take a break from my snorkeling: for the future of medicine!

 © 2010 Am Ang Zhang

The teaching and practice of medicine: a fine tradition betrayed
Irrespective of the political dimension of medicine, the care of patients and the prevention of disease depend on practising clinicians; the medicine of the future relies not only on scientific advances but on the education of doctors. Since the last edition, leaders of our profession in Britain have presided over, and in some cases acquiesced to the partial dismantling of arguably one of the finest systems of medical education. The implementation of a national process for the appointment of junior doctors has disaffected many trainees and their clinical mentors, who feel that they have become pawns in a bureaucratic political game. More important, if they understood the full implications, we believe that the British public and patients would be horrified. Within Europe, matters have been compounded by implementation of the European Working Time Directive, which threatens the professional apprenticeship and mentoring relationships between junior and senior doctors that best nurture young colleagues. The frequently heard mantra of the ‘consultant-led service’ is all very well, but the ideal will be short-lived if training is put in jeopardy.

We, the editors of this textbook, learnt how to practise as clinicians from such ‘hands-on’ apprenticeships and ask: how can young doctors accumulate adequate working knowledge and acquire essential skills if their clinical work is restricted to 48 hours each week? One might pose the question: would a patient prefer to be treated by a fully rested but inexperienced doctor whom they had never seen before, or a tired doctor with immense medical experience who knew them and their illness? We know whom we would prefer, as does Christopher Booth (On being a patient—Chapter 1.1). Short hours and other radical changes in the organization of clinical teams impair the continuity of medical care, an element of key importance for the patient but also critical for clinical education through time-honoured individual experience. Many countries are seeking to improve their systems of medical education, but for those who might consider adopting the current UK training timetables, we humbly offer advice—don’t. It would be better to provide their medical students and young doctors with sufficient time and resources to acquaint themselves with the principles and practice of modern scientific medicine that are emphasized in this book.

I am grateful to Julie and JD for alerting me to the preface in the new edition of the Oxford Textbook of Medicine.

Friday, November 12, 2010

Music: Fit for a Spa

© 2001 Am Ang Zhang


Our resort has a luxury spa complete with a huge indoor heated pool.  I always wonder where spa and restaurant owners can turn for help in choosing their background music. 

Out of the top of my head, the following pieces of music may be good:

1.       Pachelbel Canon – by Johann Pachelbel  Play

2.       Prelude to Lohengrin – by Richard Wagner Play

3.       Symphony no.5  - Adagietto - by Gustav Mahler Play

4.       Meditation From Thais - by Jules Massenet Play

5.       La Traviata – Act 3 Prelude – by Giuseppe Verdi Play

6.       Adagio in G Minor – by Tomaso Albinoni Play

7.       String Quartet in C, Opus 163, D956 – 2nd movement Adagio - by Franz Schubert Play

8.       Cello concerto in E Minor, Op 85 Adagio Moderato – by Edward Elgar Play

9.       Tristan und Isolde – Prelude - by Richard Wagner Play

10.   Adagio for Strings, op.11 – by Samuel Barber Play

11.   Andante Cantabile Op 11 – by Pyotr Il'yich Tchaikovsky Play

12.   Das Lied von der Erde - Der Abschied – by Gustav Mahler Play 

My thanks to Jobbing Doctor, who had the following additional suggestions:

  •     The Swan of Tuenola – Sibelius Play
  •     Second Movement of Bach's Double Violin Concerto Play
  •     Fantasia on a Theme of Thomas Tallis by Vaughan Williams Play
  •     Sinfonia from Bach's 21st Cantata ('Ich hatte view bekummermis') Play
  •     First Movement of Schubert's String Quintet in C Play
  •     Dido's Lament from Purcell's Dido and Anaeas Play
  •     September from Strauss's 4 last songs Play

Other Music Posts:

Tuesday, November 9, 2010

Sunday, November 7, 2010

NHS: Circle to Serco

It has already started!!!

08 April 2008
GPs are being offered a host of incentives to join up with private firms, with companies such as Chilvers McCrea Healthcare, US giant UnitedHealth and Atos Healthcare already employing salaried GPs at a growing number of APMS (alternative provider of medical services contract )practices across England.
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 PMS/GMS.’
The company is also planning to develop a network of polyclinics across the country, where consultants and GPs will work alongside each other.
Dr Neal, who is chair of the Portsmouth GP-company Spinnaker Health, whose 160 members recently voted unanimously to join Circle, hopes that GPs will play an active role in developing ‘more secondary work in the community’.
‘If you’re happy to continue doing your general practice and nothing else, that’s fine. If on the other hand you want to get involved with Circle national partnership to create new care pathways, you’ll be rewarded through shares.’
Like Circle, Assura is another firm offering GPs shares in return for joining up. But GPs who work with Assura do so through locally agreed Limited Liability Partnerships, with profits split 50/50 between GPs, who have full control over clinical services, and Assura, who provide administrative and IT support.
Although it has been at the centre of national patient protests about privatisation of the NHS, Sir Richard Branson’s Virgin Healthcare is another firm that says it will allow GPs to keep their GMS contracts while offering them a share of profits from other paid-for-services in their new polyclinics.
Other firms such as Serco and Care UK employ large numbers of GPs in a range of settings, but say they are also open to partnership agreements.
Dr Mark Hunt is managing director of primary care services at Care UK, which claims to offer ‘a pipeline of doctors at PCTs’ disposal’ and has been involved in APMS services, independent sector treatment centres and out-of-hours services.
No free lunch
But some GPs believe getting into bed with private firms will mean giving a way far more than just administrative headaches. ‘There is no free lunch here,’ says Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, Middlesex.
‘While companies have a variety of ways of getting involved in general practice, including those that appear not to be predatory, all of them have a longer term agenda behind the initial innocuous offers.’
Dr Nagpaul also warns GPs who enter into salaried arrangements with private companies will be subject to ‘highly variable’ terms and working conditions, ‘very much subject to market forces’.
Dr Richard Fieldhouse, vice chair of the National Association of Sessional GPs, cautions that the initial ‘squeaky clean’ image of private sector employment might not be the reality in the long term. He says: ‘The problems we get with salaried GPs tend to be two to three years down the line, when they’ve not had pay rises, and practices are unilaterally changing contracts and really pushing the limit.’
Dr Fieldhouse’s claim is fiercely denied by the likes of UnitedHealth. A spokesman for the company says it aims to make the transition for GPs into the private sector ‘as seamless as possible’, including following BMA guidance on salaried GPs.
GPs who shun any form of commercial partner may at least have to commit to collaborating more with their colleagues, with the Government increasingly looking to larger more financially robust providers.
The offers:
- 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 services.
- GPs continue on normal contracts, and can either develop additional services with Circle’s help or act as ‘sleeping partners’
- A welcoming gift of 300 shares in the company each year, (which currently have a nominal value of about £3.50)
- A non-repayable grant of £2.00 per registered patient, to be spent on additional services to be pursued jointly with Circle.
- Locally agreed Limited Liability Partnerships (Assura GP Provider Companies)
- Profits split 50/50 between GPs and Assura
- GPs run clinical services
- Assura provides accommodation, IT and data storage, back-office support and bidding expertise, and incurs any potential losses
- GPs retain existing terms of contract and offered new premises
- A profit-share from other paid-for services in Virgin Health centres and extra quality payments.
- Virgin will employ all non clinical staff.
- GPs and staff will have to undergo Virgin customer training and be subject to a Virgin quality framework.
The salaried option
- Private companies employ GPs under APMS contracts
- Private firms currently employing GPs under this model include Chilvers McCrea, Care UK, Serco Health, United Health and Atos Healthcare
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