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 Tale
Tristram Kenton Guardian

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.
How! gone!
Is dead.
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.
PFI: £23 Billion in 30 years                                                 More>>>>

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.  

"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.
                                     Guardian: OFT dairy price-fixing fine

Not that long ago: the same tailor!

Parliament debate: Public Bill Committee

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.”

NHS-Kaiser Permanente: A Class! Seriously!

NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

Friday, January 27, 2012

Looks & Nature: Warthogs & Politicians

In nature, there is no good or bad, just survival.

The same could be said of the looks of the animals.

Warthog, Kruger National Park, South Africa©2004 Am Ang Zhang

My own experience is that very young children are not put off by ‘ugly’ and ‘scary’ looking animals such as the Warthog.

The popularity of the latest series of children’s book, The Gruffalo is a very fine example of this.

The Warthog actually belongs to the domestic pig family and is only an herbivore. The most amazing thing about this animal is that it could go for months without drinking water and it did so by tolerating a higher body temperature and it could be very hot in Africa.

Coming to think of it, it looks a bit like the Gruffalo! Who said there is no such animal as a Gruffalo?

Indeed looks could be deceptive, just take a look at our politicians and what they are doing to our NHS. Give me a Warthog any day!

Nature Posts:

Wednesday, January 25, 2012

NHS: Götterdämmerung & The Ruling Class

Götterdämmerung at the Metropolitan Opera opens on the 27th of January 2012.

As we are ourselves experiencing the worst from our ruling class over the NHS and its so called reform, Wagner’s opera is an uncomfortable reminder that we should never have trusted the ruling class.

Even before the new Bill is passed, changes were in place in the NHS that will make it impossible to go back. Much efforts by the modern day Brünnhilde will be in vain and the old NHS will end up destroyed.

The NHS as we know it will soon disappear. Wagner’s opera will always be there.
Wagner - Das Rheingold
The cycle concludes with a cataclysmic climax of betrayal and loss as focus shifts from the realm of the gods to the power and ambition of human beings. It is left to Brünnhilde, in the legendary Immolation Scene that brings the cycle to a close, to restore balance to the world. Metropolitan Opera
The Ring of the Nibelung and The Ten Commandments
By Alan Wagner 01 Apr 2004

Alan Wagner delves into the moral and spiritual core of Richard Wagner's colossal masterwork.

Little in art created by a single mind compares to the sheer size and scope of Richard Wagner's Der Ring des Nibelungen. Only a genius with a hint of madness could have conceived anything this colossal, let alone willed it into completion over twenty-six years of gestation and creation.

Furthermore, its 18 hours comprising a single music-drama have gripped every generation since its 1876 premiere with incredible power, unleashing a torrent of commentary. In order to so possess both artist and audiences, Wagner's Ring clearly must be more than a simple sword-and-sorcery epic about giants, dwarfs, gods, and heroes.

And it is. Within that immense journey from the dawn of consciousness to the obliteration of an entire cosmic order there is a compelling moral core. However, even though the composer and his audience were unavoidably enmeshed within a Christian European milieu, it is far from your mama's Sunday-school lesson, a long way from the Ten Commandments, those pillars of Western ethics.
Wagner's philosophical convictions underwent similarly significant refashioning. When he began the Ring, he was influenced by Ludwig Feuerbach, whose principal tenet, explicated in The Essence of Christianity, was that man created God, not the other way around. Religion merely reveals truths about mankind's needs, and its most meaningful revelation is that God is love. Therefore, the pathway to salvation, personal and societal, is love.

In early drafts of the Ring, the liaison between Siegfried and Brünnhilde brought about a triumphant ending for Wotan's sovereignty. However, by 1854, when Wagner first read the masterpiece that impacted his thinking ever after,
Arthur Schopenhauer's The World as Will and Representation, he was already disillusioned about the perfectibility of either mankind or civilization. The Buddhist-like pessimism of Schopenhauer set the seal for Wagner, and he slid the metaphysical center of the Ring from Siegfried's death to where, as he wrote to his friend August Röckel, "Wotan rises to the tragic height of willing his own destruction."

I will try and look at it from the Child Psychiatrist’s perspective.

The dark side of the gods: (it is sometimes easier if one take GODS in the Ring to mean those in POWER. For the characters read here.) In fact, the gods need not work at all, the Nibelungs work almost all the time.

Disrespectful Wotan is hardly revered unanimously, and even he acknowledges higher authorities. Erda knows things he doesn't; his almost bureaucratic dominance derives solely from treaties engraved in runes on his spear, treaties to which he is subservient.
Born liarsCharacters lie as it suits them. Events are initiated by Wotan's spurious promise to the Giants to pay them by giving them Freia in exchange for building Valhalla, a promise he knows he cannot keep, as she is the indispensable symbol of love whose golden apples keep the gods alive. His shady ally, Loge, is defined as a double-dealing trickster. Brünnhilde breaks her promise to her father to allow Siegmund to be killed in combat. Mime makes dissembling a veritable life's work, ably carried forward by his nephew, Hagen, in Götterdämmerung. 

Brünnhilde disobeys Wotan, and his grandson Siegfried destroys his power. Mime, who raises Siegfried from infancy and even makes him toys, is treated with disturbingly cruel contempt by the bumptious hero. Hagen, whom Alberich sired via gold-empowered lust as a tool to retrieve the Ring for him, mutters that if he succeeds he will keep it, not hand it over to his Nibelung father.

Thieving & Misappropriation 
……. misappropriation, of persons or of things, provides much of the plot machinery. First, 
Alberich plunders the Rhinegold, and afterward, theft of others' possessions, including the Ring, motivates action upon action. 
Incest and other illicit sexThe teasing of Alberich by the Rhinemaidens which leads to his abjuring love--love, not lust. The definitive heroine, Brünnhilde, and her Valkyrie sisters are the offspring of an adulterous liaison between Wotan and Erda; Wotan also illegitimately fathers the Wälsung twins by a mortal. Sieglinde's infidelity is excoriated by marriage-goddess Fricka, as is her violation with Siegmund of an even more basic taboo, incest. But Wotan defends the twins ("…those two are in love") and, like most audience members moved by the ardent love music, views both transgressions kindly. 
Fafner kills his brother Fasolt, the first victim of Alberich's curse, and we are off to the homicide races. Hunding slays Siegmund, only to be destroyed by Wotan's contempt. Siegfried kills Fafner, the Giant-turned-dragon, and then, after realizing that Mime is trying to poison him, kills him as well. By the time the gods' destiny climaxes, Hagen has murdered both Siegfried and Gunther and is himself drowned by the Rhinemaidens. Eventually Brünnhilde sets Valhalla ablaze as part of her self-immolation upon Siegfried's funeral pyre ("Thus do I hurl the torch into Valhalla's proud-standing stronghold") and all the gods die.
Greed, greed, greed!Finally, "coveting that which is your neighbor's" is pretty much the whole raison d'être for the Ring story, starting with Alberich's desire for the Rhinemaidens, then for the gold they guard. Thereafter everybody seems to want what doesn't belong to him or her: the Ring, a sword, a treasure, someone else's wife, sheer power. 

Yet in spite of Wagner's wholesale abandonment of the Decalogue, the bastion of Western morality, Der Ring des Nibelungen generates explosive ethical and metaphysical impact. He started with the absorption, fusion and reinvention of myriad legendary sources, and layered Schopenhauer's philosophy upon Feuerbach's. In Art and Climate Wagner wrote, "there is no true freedom except that which is common to all mankind... The redeemer is therefore love… starting with sexual love, [it] strides forward through love of children, brothers and friends, to universal love of humanity." The emphasis is his. Yet, some years later he wrote to Mathilde Wesendonck, "I can conceive of only one salvation. It is Rest! ...The stilling of every desire!" 

Wagner once wrote to Röckel, "I have come now to realize how much there is, owing to the whole weight of my poetic aim, that only becomes clear through the music." He later described the discontinuity between his "rationally formed ideas" and "the exquisite unconsciousness of artistic creation… guided by wholly different, infinitely more profound intuition."

Music alone would now convey the message. The last moments of Der Ring des Nibelungen are given entirely to the orchestra: there is too much weight for words. Something greater than the story, richer than all the sources, probably better than Wagner himself knew, is brought to a healing close with a tender statement of a motif heard only once before in the Ring, when Sieglinde learns she is bearing her child of love, Siegfried. It is the motif of Redemption Through Love. 

How wonderful it is to wait this long for the protein to be activated.
In the end, Wagner fashioned a masterwork of such extraordinary strength that it transcends analyses, personalities, philosophers, his own prejudices, and even his total disregard for Judeo-Christian society's standards of ethical behaviour.
Out of the highest art came a truth beyond even his explanation. 

If they are not RULING, where are they?

“Interestingly, former health ministers have done particularly well. The ex-health secretary Patricia Hewitt earns more than £100,000 as a consultant for Alliance Boots and Cinven, a private equity group that bought 25 private hospitals from Bupa. After leaving the department, her predecessor, Alan Milburn, worked for Bridgepoint Capital, which successfully bid for NHS contracts, and now boasts a striking portfolio of jobs with private health companies.”

Alan Milburn
Following his resignation as Secretary of State for Health (to spend more time with his family, his partner is a hospital doctor), Milburn took a post for £30,000 a year as an advisor to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and the Robinia Care Group. He has been Member of Advisory Board of Pepsico since April 2007. Wikipedia

 Alan Milburn now also holds a place on the board of PepsiCo as an advisor.        Wikipedia

Patricia Hewitt

In January 2008, it was announced that Hewitt had been appointed "special consultant" to the world's largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt's former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee. Hewitt will also become the "special adviser" to private equity company Cinven, which paid £1.4billion for Bupa's UK hospitals.

In March 2008, it was announced that Hewitt will join the BT Group board as a non-executive director.[40] She joined the group on 24 March 2008. In July 2009, Patricia Hewitt joined the UK India Business Council as its Chair.
[edit]Stepping down

In May 2009 The Daily Telegraph reported that Hewitt claimed £920 in legal fees when she moved out of a flat in her constituency, stayed in hotels and then rented another flat inLeicester. Claimed for furniture including £194 for blinds delivered to her London home. In June 2009 Hewitt announced that she will be stepping down from the House of Commons. She said she was leaving the Commons for personal reasons as she wanted to spend more time with her family.   Wikipedia

A culture of corruption pervades the links between government and business, fuelled by and fuelling privatisation. These relationships are – as Adam Smith put it – a conspiracy against the public interest.

Ex-NHS: Patricia Hewitt: now with Cinven (Bupa Hospitals)

Wagner website.
Independent: Mariinsky Ring
Other Opera Posts: