Monday, September 24, 2012

NHS Sale: Best Hospitals!

Looks like some of our best specialist hospitals will be in PRIVATE hands soon. The high quality of British Medical training is now at risk. 

"Good education is amongst the rarest things going; 
difficult to buy at any price"

The Lancet, 1886


Those with some saving thought they could beat the system and neighbour and buy insurance!  Without stringent control of insurers, even when you pay for insurance, not all treatments will be covered and you may still need to supplement what little insurers will pay. 

The view is still free.



© 2012 Am Ang Zhang

Looks as though the following might be surplus to requirements by the new NHS, as it was decreed that clients or service users do not really need hospitals.

The Background:
Historically, London Medical Schools were established in the hospitals in the poorer areas in order that medical students could have enough cases to practice on and in return the poor patients had the advantages of free treatment. There is nothing like volume for medical training.

For a very long time, doctors trained in London were one of the most valued. A Senior Registrar (yes, in those days) can easily get a Consultant job anywhere else in the Commonwealth and often a Professorship (British styled ones). In other words London trained doctors are a highly exportable commodity.

“The shape of the London hospital system has also been affected by developments in medical science and medical education. In many ways it has been the activities of doctors which have determined the pattern of the hospitals. The increasing ability to treat disease and improved standards of care shortened the time patients spent in hospital, raised the demand for services and led to an escalation of cost. The development of specialisation led first to the development of the special hospitals and later to special departments within the general hospitals. Advances in bacteriology, biochemistry, physiology and radiology cre­ated the need for laboratory accommodation and service departments, so that hospitals no longer consisted merely of an operating theatre and a series of wards. Sub-specialisation ultimately meant that services had to be organised on a regional basis and the very reputation of the capital’s doctors affected the number of patients to be seen. The hospitals of central London have long served a population much larger than their local residents.

It is against this complex background of population movement, poor social conditions, disease, wealth and poverty, professional expertise, critical comment and publicity that the London hospitals developed. A complex institutional pattern emerged. Voluntary hospitals grew up beside the ancient royal and endowed hospitals. A local government service providing institutional care for sick paupers developed alongside the hospitals. A network of fever hospitals, scientifically planned from the outset, was established. Physically near to each other, staffed by doctors who had trained in the same hospitals, and often serving the same people, the different objectives and status of the institutions led them to work in virtual isolation from each other. Each hospital had its own traditions and nobody standing in the middle of a ward could have doubted for a moment the type of hospital he was in. Countless details gave each an atmosphere of its own, and the different methods of administration and levels of staffing set them apart.”                  Geoffrey Rivett





Most of my Medical School Orthopaedic Surgeons were trained here.

The hospital treats almost 10,000 patients a year.

Although most patients would not consider travelling too far for a routine hip replacement, which can probably be done as well in their local district general hospital, the specialist clinics at the Royal National Orthopaedic may provide a reason to make the journey.

Specialist clinics deal with bone tumours, scoliosis (curvature of the spine), rheumatology, spinal injuries, specialist hand and shoulder conditions and sports injuries.

One word of warning – the RNOH's trust did not do well in the Healthcare Commission annual health check.

Strange that. So it may be the next to go.


The Cockroach Catcher was there.

So was the MP, as a patient.

If you have a head injury, stroke or condition affecting the brain, such as Alzheimer's, epilepsy or multiple sclerosis, this is the place to go. Along with the nearby Institute of Neurology, it is major international centre for treatment, research and training. The National Hospital for Neurology and Neurosurgery has 200 beds at its central London site near Euston station, and treated more than 4,500 in-patients and 54,000 outpatients last year.

Healthcare Commission quality of services rating: Good

Perhaps not for sale so soon. Or saving it for the needy MPs?

Neurologists wear bow ties in my days.


The largest specialist heart and lung centre in the UK, the Royal Brompton and Harefield acquired its reputation through the work of Sir Magdi Yacoub, the internationally renowned surgeon who pioneered heart transplants in the UK the 1980s.

The trust attracts staff and patients from across the country and around the globe, and is a centre for research with between 500 and 600 papers published in scientific journals each year. Its 10 research programmes each received the highest rating in 2006.

Each year, surgeons perform 2,400 coronary angioplasties (where a balloon is threaded through an incision in the groin to the heart and expanded to widen a blocked artery), 1,200 coronary bypasses and 2,000 treatments for respiratory failure – so they do not lack for experience.

Other specialist heart units with strong reputations are Papworth Hospital, Huntingdon, where Britain's first successful heart transplant was carried out in 1979; and the Cardiothoracic Centre, Liverpool, formed in 1991.

Healthcare Commission quality of services rating: Good

It could not be anything else.


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 and abroad each year.

It has the highest income from private patients of any hospital in Britain, testifying to its international reputation.

Very ready for Medical Tourism!!!

Healthcare Commission quality of services rating: Excellent



The country's largest ear, nose and throat hospital is also Europe's centre for audiological research, with an international reputation for its expertise and range of specialties, all on one site on London's Gray's Inn Road.

Its services range from minor procedures such as inserting grommets (tiny valves placed in the eardrum of a child to drain fluid from the middle ear) to major head and neck surgery. A quarter of its 60,000 patients were referred from other parts of the UK and abroad last year. The hospital has a cochlear implant programme, a snoring and sleep disorder clinic, and a voice clinic, the oldest and largest in the UK. One in 25 people develops voice problems such as hoarseness, but it rises to one in five among, for example, teachers, actors and barristers.

A measure of the Royal National's success is the fact that one third of patients referred from other clinics or hospitals with voice problems has their diagnosis changed on investigation there. Although there are many other centres where throat, nose and ear problems can be treated, none are pre-eminent enough to be included in this guide.

Wow!

Healthcare Commission quality of services rating: Good

Britain's leading national and international referral centre for diseases of the bowel is the only hospital in the UK and one of only 14 worldwide to be recognised as a centre of excellence by the World Organisation of Digestive Endoscopy.

It is a chosen site for the NHS bowel-cancer screening programme being rolled out across the country, which seeks to detect and treat changes in the bowel before cancer develops. Bowel cancer is the second most common cause of cancer in the UK but often goes undetected because sufferers can fail to report important symptoms, such as blood in the faeces, often out of embarrassment.

Bowel cancer can be treated via colonoscopy, to find and remove polyps – growths on the wall of the bowel. The hospital's education programme attracts clinicians from across the UK and overseas with the aim of spreading good practice elsewhere.
The hospital is part of the North West London Hospitals Trust.


The liver unit at King's is the largest in the world. It is one of 31 specialist liver units in the UK, but none can match it for expertise, facilities or state of the art equipment. It offers investigation and treatment for all types of acute and chronic liver disease, which is increasing in the UK.

The unit performs 200 liver transplants a year, and more than 200 patients with liver failure are admitted to its intensive care unit each year.

King's carried out the first successful transplantation of islet cells – part of the pancreas involved in producing insulin – in a Type 1 diabetic, greatly reducing his need for injected insulin. Last month, the Department of Health announced plans to establish six new islet transplantation centres round the country, based on the research at King's.

Healthcare Commission quality of services rating: Excellent


No bargain price, I am afraid.

The Maudsley Hospital

The Cockroach Catcher was there too.

One of Britain's oldest hospitals, the Maudsley's contribution to mental-health care stretches back at least 760 years.

Today it is a centre of excellence for the delivery mental-health care. Its addictions centre offers new treatments for drug abuse, alcoholism, eating disorders and smoking, it provides innovative care for disturbed children and adolescents and is the largest mental-health training institute in the country.

It has pioneered new approaches to the treatment of heroin addiction and its specialists have raised concerns over the link between cannabis and schizophrenia which have led the Government to review changes to the law.

Healthcare Commission quality of services rating: Good




If you have a child with a rare or complicated disorder, this is the place to come.

And they do and many are from the Middle East.

So the bad press would not matter, good for the Medical Tourist trade.

It is the largest centre for research into childhood illness outside the US, the largest centre for children's cancer in Europe and delivers the widest range of specialist care of any children's hospital in the UK.

Great Ormond Street won't treat just any patient, though: it only accepts specialist referrals from other hospitals and community services – in order to ensure it receives the rare and complex cases and not the routine.

I have done that: see Teratoma: An Extract


Paediatrics is one of the most rewarding areas of medicine for doctors because it has seen some of the most spectacular advances over the past 30 years, especially in cancer, where survival has improved dramatically.

Many of those cared for at GOSH still have life-threatening conditions but they are promised the best care both because of the expertise of its medical staff and because of the trust's extraordinary success in attracting charitable donations, which have made it among the best-funded medical institutions in the country.

Healthcare Commission quality of services rating: Excellent.

Baby P or no Baby P.


My eyes still well up when Moorfields is mentioned. Honest.

The largest specialist eye hospital in the country and one of the largest in the world, Moorfields was founded in 1805. It treats more patients than any other eye hospital or clinic in the UK and more than half the ophthalmologists practising in the UK have received specialist training at Moorfields.

However, in recent years the hospital has relied too heavily on its reputation and grown complacent. Though standards of academic excellence are still high, it has neglected the services it offers to patients, which were rated weak on quality by the Healthcare Commission in its annual health check last year.

The hospital carried out 23,000 ophthalmic operations last year, providing surgeons with extensive experience on which to hone their skills. The reputation of the trust is such that it has started to run clinics in distant hospitals, capitalising on its brand. The hospital employs 1,300 staff who work on 13 sites.

Perhaps it is not so good to be following on commercial branding. Stick to medicine!!!

Despite its recent problems, Moorfields remains Britain's most highly-regarded eye treatment centre. No alternative hospitals have a comparable reputation.
Healthcare Commission quality of services rating: Weak

For bargain hunters then.


Material drawn from The Independent.


So do you really think that hospitals are not necessary, or not necessary for the average citizen of England. Soon they will be sold and it will be costly to buy them back.

What about medical training? If these hospitals are sold, who pays?

And watch out, someone, your parent, your spouse, your child and even your MP may need a Hospital Consultant one day. 

Say something now.


Cassius:
"The fault, dear Brutus, is not in our stars,
But in ourselves."
Julius Caesar (I, ii, 140-141)
If you think you have read this before: you have indeed. As NHS reform is just re-cycling of earlier political dogma, the Cockroach Catcher can re-cycle his blog posts!!!


FREE FREE FREE
I would like to convince readers that the NHS is worth saving so for a limited time I am offering an electronic version free to any medical blogger, nurses and doctors that worked in the NHS and other health care systems totally free. Please drop me a note to my email address <cockroachcatcher (at) gmail (dot) com >or through COMMENTS.

Saturday, September 22, 2012

Friday, September 21, 2012

Finland: National Parks!

The National Parks of Finland near where we stayed:

Hiidenportti National Park: 




©2012 Am Ang Zhang



©2012 Am Ang Zhang



Tiilikkajärvi National Park



©2012 Am Ang Zhang





©2012 Am Ang Zhang



©2012 Am Ang Zhang



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

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


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Thursday, September 20, 2012

Rare Earth Element: Ecology!





Stringer Shanghai/Reuters - A man works at the site of a rare earth metals mine at Nancheng county, Jiangxi province on October 20, 2010.


Two years after China limited its exports of “rare earth minerals,” unnerving developed countries that depended on them for industrial uses, production is expanding at sites outside China.

And as new sources of rare earth minerals have appeared, that has meant new jobs — including in the tiny town of China Grove, N.C., where Japan’s Hitachi Metals is planning to produce high-tech magnets from rare earth minerals.

Alarmed over Chinese restrictions on rare earth exports, the United States, the European Union and Japan filed a World Trade Organization complaint alleging that China was using its monopoly over the minerals as a political and economic weapon — for instance, to punish Japan over its claims to contested islands in the South China Sea and to entice companies to relocate factories inside China by offering a cheaper supply of rare earth materials.


One of the top non-medical posts:

“No, we are not getting the Prius anymore.”

“Why, isn’t it supposed to be green-er!”

“Not according to my daughter. She told me that it uses REE and is not as ECO friendly as we first thought.”

REE? Whatever is that, so I Googled it and found the USGS site:

The rare earth elements (REE) form the largest chemically coherent group in the periodic table. Though generally unfamiliar, the REE are essential for many hundreds of applications.

Chemical periodic table delineating the 16 rare earth elements (REE): the lanthanides, La through Lu, plus Y, whose geochemical behavior is virtually identical to that of the heavier lanthanides. Promethium has no long-lived isotopes and occurs naturally on Earth only in vanishingly small quantities. An represents the first 14 actinide elements; Lr is the last actinide.

Then from Channel 4:

Green campaigners love wind turbines, but the permanent magnets used to manufacture a three megawatt turbine use about two tonnes of 'rare earth'.

Wind turbines on the Silk Route © 2008 Am Ang Zhang

Champions of a low carbon future have yet to wake up to the environmental price Chinese workers and villagers are paying. At Copenhagen politicians talk of cutting carbon emissions, but they cannot meet any targets without 'rare earth' – that means a sustainable supply and not all from China.

Each Toyota Prius motor uses 1 kg of neodymium, and each battery 10- 11 kg of lanthanum, both 'rare earth' elements.

Compact fluorescent light bulbs use europium, terbium and yttrium. Without these, they don't work.

Hard discs, LEDs, I-phones and various military technologies also need rare earth minerals and metals.

The Independent: On the main Inner Mongolian city of Baotou-capital of REE.
Independent
The development of Baotou into the global capital of rare earths, which occupy their own obscure corner of the periodic table, is due to two things: its proximity to the Baiyunebo mine, a vast open pit that is the world's largest rare earth mine, and Beijing's deliberate policy of at least two decades to turn this "Mother Lode" into a stepping stone towards status as an economic superpower.
As a result, Baotou has rapidly become of great interest to the outside world. China, which by accident of geography holds about 50 per of the world's rare earth deposits and currently produces 97 per of global supplies, has made no secret of the nature or scale of its ambitions, summarised by former premier Deng Xiaoping when he said: "The Middle East has oil. China has rare earths."
Latest:


Sunday, September 16, 2012

NHS: Protocols & Guidelines Only!!!


As I watched the view in Finland:
We could indeed have saved vast sums of money doing away with medical schools;
with all the protocols & guidelies around who needs doctors anyway!

©2012 Am Ang Zhang



Here is a reprint:



©2012 Am Ang Zhang


Every time there is a medical disaster, the management will try and bring in a new protocol in the belief that it will be enough to avert criticism. 

But wait: We as doctors already have our protocol and it is called medical training.

The one condition that most of us remembered as an emergency is acute appendicitis and even our Bare Foot Doctors knew about those.

One could hardly believe that a father was asked to be the Bare Foot Doctor!!!


The father of a six-year-old boy who died as a result of a burst appendix was asked to examine him in a Cornish hospital car park, an inquest was told.
Ethan Kerrigan's father Lee had taken him to Penrice Hospital's out-of-hours clinic in June last year after his son had been vomiting for several days.

So he was taken to A & E but why was Serco OOH involved?

In the early hours of 15 June, his father took him to Penrice Hospital in St Austell.
When he arrived he was told to phone out-of-hours service Serco, which he did from the hospital's car park, the inquest heard.

Could this be why? From an earlier blog:

It is not difficult over the New Year period for anyone in the NHS to see how the internal market has continued to fragment our health service.

Look at major hospitals in England: Urgent Care Centres are set up and staffed by nurse practitioner, emergency nurse practitioners and GPs so that the charge by the Hospital Trusts (soon to be Foundation Trusts)  for some people who tried to attend A & E could be avoided. It is often a time wasting exercise and many patients still need to be referred to the “real” A & E thus wasting much valuable time for the critically ill patients and provided fodder for the tabloid press. And payment still had to be made. Currently it is around £77.00 a go. But wait for this, over the New Year some of these Centres would employ off duty A & E Juniors to work there to save some money that Trusts could have charged.

Triage: I now cringe when I hear the term:
On the phone, a triage nurse asked him (father )to examine Ethan's abdomen.

Mr Kerrigan and Ethan's mother, Theresa Commons, both told the inquest that the nurse had asked them to give him ibuprofen, a hot water bottle and make an appointment to see a GP the next day, saying there was nothing to worry about.
The next day, Ethan collapsed in the doctors' surgery in Roche and died later at the Royal Cornwall Hospital, near Truro, from acute gangrenous appendicitis.

It is such a tragic story and it happened in England!

In a statement, Serco said that the death was "a terrible tragedy".
It said: "Serco is committed to providing the highest quality of service to the NHS and the people of Cornwall and the Isles of Scilly, and like any responsible healthcare provider, we seek continuously to learn lessons and to improve how we work.

"Since then we have worked with the local NHS to develop enhanced protocols for handling illness in young children, and these have now been in place for some time".

But wait: this would be the very first clinical lesson from any decent medical school. Why is Serco allowed to continue?


But something is not making sense: in an NHS hospital when this happens, heads roll, but this is Serco and this was reported:

"Serco, which receives over 90% of its business from the public sector, paid Christopher Hyman an estimated £3,149,950 in 2010. This is six times more than the highest paid UK public servant and 11 times more than the highest-paid UK local authority CEO."                       The Guardian

No sign of any resignation!!!

Remember: The best money is Government money, our money. Cherie Blair knows too.

“The medical profession has not been allowed to do its job. The government has forced doctors to implement focus group predicated health care. Professional judgment is neither respected nor required. Doctors' morale is at an all time low. Medical care is now all protocols and process. Protocol driven medical care can be done by monkeys, and often is.”            NHS Blog Doctor.

Protocol unfortunately is there to protect the Serco staff and in turn Serco itself. It really has little to do with actual patient care!!!




Has Serco got a good record of providing GP services?

No. The company runs an out-of-hours GP service (OOH) in Cornwall. It won the contract in April 2006, undercutting local GPs by reducing staff, clinics and  cars. Since then, many people have had problems seeing a doctor in the  evenings and at weekends, and Cornish MPs have warned that patients’ lives  are being “put at risk”. Serco missed almost all of its targets, including emergencies and urgent home visits. Only 55% of emergencies received a visit within one hour in the peak holiday month of August 2006, and the service regularly failed to hit the 100% target for non-urgent cases that should be attended within 6 hours. It was even forced to fly in doctors from Eastern Europe because of a shortage of local GPs willing to work for the company.

One GP who resigned said that during a busy shift a non-medical supervisor “insisted” they leave a patient who was in a “potentially life-threatening situation” to go to the next appointment.




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FREE eBook: Just drop me a line with your email.

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


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