Saturday, March 30, 2013

Winter's Tale & NHS: Free advice!

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.

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.

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)

Thursday, March 28, 2013

Shadow Elite & NHS : Public-Private Players & Money!

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

Jeremy Hunt:

So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector.

Virginia Bottomley: Secretary of State for Health 1992-95   now with BUPA. Cousin  of  Jeremy Hunt.

David Miliband

Like his mentors Tony Blair and Peter Mandelson, Mr Miliband is one of that unappetising breed of modern politician that has chosen to profiteer out of public service. It is a pity that the BBC did not ask him whether his sudden decision to abandon his constituents was not informed by a desire to keep his huge earnings out of the public eye.
During his short, undistinguished career, Mr Miliband has done grave damage to British politics. He is part of the new governing elite which is sucking the heart out of our representative democracy while enriching itself in the process. He may be mourned in the BBC and in north London, but the rest of us are entitled to form a more realistic view. David Miliband has belittled our politics and he will not be missed.
Money? Really?
The House of Commons register reveals that he has earned an incredible sum – nearly £1 million – from outside interests since losing the party leadership to his brother, including £125,000 for 15 days’ work as a director of Sunderland, a constituency-based football club owned by a super-rich businessman with interests in private equity. Approximately £60,000 has come his way from the UAE, a gulf state with an unappetising human rights record, and another hefty chunk from St James’s Place, a company that advises very rich people how to invest their money.
It looks as though these people are everywhere! The Shadow Elite.

Are you ready to read it? 


It is scary!!!

"The new breed of players," writes Wedel, "who operate at the nexus of official and private power, cannot only co-opt public policy agendas, crafting policy with their own purposes in mind. They test the time-honored principles of both the canons of accountability of the modern state and the codes of competition of the free market. In so doing, they reorganize relations between bureaucracy and business to their advantage, and challenge the walls erected to separate them. As these walls erode, players are better able to use official power and resources without public oversight."
"That's a spot-on description of what happened with health care -- as well as a spot-on description of the totally-lacking-in-transparency bailout of the financial system. Remember how the bailout was supposed to take care of not just Wall Street but Main Street? Well, the former ended up with record profits and bonuses while the latter is looking at double-digit unemployment -- and millions of foreclosures and bankruptcies -- for the rest of the year."

Perhaps the decade!
                                            Janinie R. Wedel is an anthropologist.

"We Are Wall Street" that circulated this spring, directed at Main Street America

: "We eat what we kill, and when the only thing left to eat is on your dinner plates, we'll eat that."

The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.                                      
Janinie R. Wedel

Looks like they are here and targeting our much loved NHS.

“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 £1.4 billion 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.

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
David Bennett is the current head of Monitor (a sort of health FSA!) He is not a medical doctor.
David was a Director at McKinsey & Co. In his 18 years with McKinsey he served a wide range of companies in most industry sectors, but with a particular focus on regulated, technology-intensive industries.

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

NHS & Monitor: Eggs & Enron.

Councils blamed over Iceland savings

Sunday, March 24, 2013

Mahler: Resurrection!

And behold, it is no judgment;
there are no sinners, no just….
There is no punishment and no reward.
An overwhelming love illuminates our being.
We know and we are.

 ©2013 Am Ang Zhang

"Rise again, yes, rise again thou wilt! Then the glory of God comes into sight. A wondrous light strikes us to the heart. All is quiet and blissful. Lo and behold: there is no judgment, no sinners, no just men, no great and no small; there is no punishment and no reward. A feeling of overwhelming love fills us with blissful knowledge and illuminates our existence.

From silence, the chorus enters, at first almost inaudibly, singing Klopstock’s resurrection poetry. The solo soprano detaches imperceptibly from the chorus and floats above it. Mahler used only two of Klopstock’s three stanzas, and omitted the concluding ‘Hallelujah!’ to each. The remainder of the Symphony’s text was Mahler’s own, started with ‘O glaube’ (‘Oh believe!’), introduced by the mezzo soloist. The end is a soaring E-flat major hymn, from which ‘an overwhelming love lightens our being. We know and we are.’


Musicologists explained the early rejection of the Second Symphony as a result of Mahler's new harmonies. Never before had these been found in music. He overstepped the boundaries of what was considered "beautiful." Music critics and concertgoers found his music too long, too complicated, too bombastic, too neurotic, overly melancholy, and so on. Leonard Bernstein, who led the Mahler revival of the 1960s, claimed that "There was something much deeper in the rejection of Mahler's music." He suggested that "Mahler's music simply hit too close to home, touched too deeply on people's concerns and their fears about life and death. It simply was too true--telling something too dreadful to hear."

Fortunately, the above elements, which were so strongly rejected by the musical establishment of Mahler's day, are now passionately embraced by new generations of listeners. His genius lies in his unique ability to draw together such wildly contrasting elements as intense post-Wagner/Strauss/Bruckner harmonies, Austrian peasant music, Jewish childhood motifs, children's innocence, and a distressing fascination with death. He moulds all of them into a convincing and compelling musical structure.

Youtube: Simon Rattle

Tuesday, March 12, 2013

NHS & Spring: A New Game!

Hospital Avoidance

Only the view of flowers will be free!  Or at least of my photos:

©2012 Am Ang Zhang
©2012 Am Ang Zhang

©2012Am Ang Zhang 
A new game will start: Hospital Avoidance!!!

In a few days rationing of health care will start. 

The part of Health Care  delivered by Hospital Consultants will be severely rationed. Many so called Foundation Trust Hospitals would be in severe financial difficulties as the new CCGs will be rationing Hospital based work from A & E to Stent procedures so that the FT Hospitals will be forced to make money from private work and mainly from overseas as most citizens are still paying for the collapse of the likes of RBS, Northern Rock & HBOS.

Just look at A & E, Urgent Care Centres are set up by the new CCGs to avoid paying hospitals and if you use OOH or A & E too often, you might by removed from their list. There will be other life style excuses to exclude even Type 2 Diabetes.

Waiting time may once again be used as an excuse for rationing and this may be because of the 49% private work load. Who knows, would many consultant still be with the State side of NHS? My dentist went totally private years ago and never looked back. Do we really have such short memories?

If you do not believe the plot, the tactics are already in place to separate Primary and Secondary Health Care: 

Care pathways
Case management
Demand management
Clinical and financial alignment
Risk stratification

Inappropriate referrals
Referral protocols 

Rules-based medicine
Referral management systems 

Admission avoidance

Doctors will not be involved to avoid problems with the GMC!!!

Insulting terms, like "frequent flyers", are being used to describe people who are sick and need our care and attention. The problem now is that they may have to keep flying as there is no where to land.

I have written about this earlier:

Is it really that difficult to grasp!

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 realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

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 NHS hospitals 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.

Some very clever people indeed are working for the government. 

It is becoming clear that with your right to choose your GP, GPs have the right to reject you. You may find that if you have a condition that requires expensive care and medication, some excuse will be found to reject you. 
Culling will be the new game especially CCGs run on the advice of the likes of major management consultants including McKinsey.

Business will be business and the doctors will be protected. 
Is it Conspiracy or Cockup? You decide.

But strangely they thought there is still money to be made.

                                                                               This Post first appeared last Spring.