Wednesday, July 31, 2013

NHS & Lewisham: Barricades & Bloodshed!


Expect further bloodshed as A&E reorganisation leads to departments being replaced with low-key urgent care centres.

But the reorganisation of stroke and trauma care happened below the radar. A&E is highly visible. NHS medical director Sir Bruce Keogh will soon put forward plans to rationalise it, which will have to mean closing some hospital departments and replacing them with low-key urgent care centres.

Politicians inevitably join their constituents at the barricades to defend local services, as they did at Lewisham and in north-west London, where there are also closure plans. Consensus seems impossible. Bloodshed is far more likely.



Plans to slash services at a successful London hospital have been declared unlawful, in a blow to the health secretary Jeremy Hunt, which could have major repercussions for future NHS hospital shake-ups.

In an unexpected triumph for local campaigners, a High Court judge ruled yesterday that cuts at Lewisham Hospital, approved by Mr Hunt earlier this year, should never have been recommended in the first place.


NHS A & E: Lewisham downgrade!



A genius has decided you can have a 75% heart attack or stroke as he has decreed that Lewisham will run a 75% A&E department. Wow!


The truth may be simpler: in an internal market system soon to be exposed to external market forces, A & E is the only department where CCGs have very little control over. Punters, (sorry patients) still hope they might see a real doctor at the A & E (soon to be ¾ doctor). Government figures showed that attendance figures are not dropping.

Punters have little faith in OOH services and UCCs as well and can you blame them? In health care, death is certainly not reversible.

So the genius has decided not to use UCC for Lewisham and that is why he is a genius. But when the rumour is that the rest of the hospital will gradually be “3-quartered”, call it anything you want.

In time over a third of A & Es will have to be downgraded to reverse the rising trade! Read more in a previous blog post:

NHS A & E: Unpredictable, Unruly & Ungainly


As I wandered through the forests of Sibelius' Finland, I marvelled at how well the different plants co-exist in an integrated fashion. 

Why can't our NHS be integrated like this forest? With berries and mushroom growing in abundance! Looks like our A & E departments will be the first of the Hospital Services to be culled. 

Why?


 ©Am Ang Zhang 2012

It must be hard to believe that with the number of highly paid management consultants working for the government that any apparent oversight is due to cock-up rather than conspiracy. Yet reading through the Select Committee reports one begins to wonder.

Could it be that for too long, accountants dominated the NHS reforms and somehow nobody took any notice of what the doctors are saying anymore?

On the other hand, could the need to pass health care provision to private providers before anybody could raise enough objections be the reason or was it simply a means to contain cost and let the patients blame their GPs?

Can politicians really blame us for not trusting them? They did in Japan, didn’t they?

A & E (ER to our US readers) is perhaps something accountants would like to get rid of. It is unpredictable, unruly (literally) and ungainly as there is a need for the specialist backups. In the era of PCTs and Hospital Trusts, serious battle is fought around A & E. The silly time limit set has caused more harm than the good it is suppose to achieve. That many major A & E departments are staffed by Trust staff and the new GP Commissioners will try their best to avoid paying for A & E attendance & any unplanned admission. 

All too messy.

Hospitals tried their best to make more money from A & E and admissions in order to survive. Where is the patient in this tug-of-war of primary care and Hospitals!

What happens when there is a major E. Coli disaster. Who is going to pay for all the dialysis?

There is no better illustration to the wasteful exercise then in all of this internal market and cross charging during recent years and one must be forgiven for concluding that the purpose was to allow private involvement in our National Health Service.

We must be forgiven for not believing that all these AQPs are not great philanthropists and are all there not for the profit but for the common good.


Christmas and New Year will be here soon. The count this year is that over 20 million patients would have attended A & E: A rise from 12 million around 10 years ago!

It is not difficult for anyone in the NHS to see how the internal market has continued to fragment and disintegrate 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.



A decision is expected later on plans to close the Accident and Emergency department at Lewisham Hospital in south-east London and downgrade its maternity unit.
The proposal came after neighbouring South London Healthcare NHS Trust (SLHT) ran up debts of £150m.

What hope is there for the NHS when a hospital without the problems of Mid Staffordshire face downgrading? Would it not be better for bankruptcy and a true default of the PFI? Or should we bankrupt the government?

After all, Metronet did, didn't they?


Bare Foot Doctors & ADHD: Golf, Piano & Swimming!

It has long been held that there is no alternative treatment to ADHD! Stimulant in its various forms is the answer. In life nothing is easy or indeed straightforward. Unfortunately pill popping is the preferred mode to deal with any problem by most and the sale of various OTC medication without prescription kept high street chemists busy and very happy.

The alternative to medication treatment for ADHD is there, has always been.
Just look at Michael Phelps.

I have blogged sometime back about swimming, golf and music and I firmly believed that we may indeed have the answer all along. We just refused to work so hard.

Golf:
My friend just returned from a month at Spring City Golf & Lake Resort in Kunming, Yunnan. He showed me the score cards.



One golf course was designed by Jack Nicklaus and the other by Robert Trent Jones Jr.

“You have to go. The weather is perfect, and so are the courses. You can play 18 holes and not sweat. The ball goes further at this altitude and the caddies are just wonderful.”

I went in 2011.  It is north of Vietnam and is well known for its biodiversity and superb year round weather.

China, which just celebrated 60 years of Communist rule, is now embracing golf in a big way. Most golf courses are designed by big name western golf designers or golf champions turn designers. It must indeed seem ironical, as golf is seen by many as a game for the elite. Venezuela has just banned golf for that reason.

Bare Foot Doctors:
Changes in China since the early 80s have been phenomenal. First it abandoned the “Barefoot Doctors” that was started by Mao when doctors and intellectuals were seen as the elite and sent to remote villages to farm. “Barefoot Doctors” with minimal training cannot really deal with more complicated medical cases. It is a shame that we in England do not seem to have learned from the bad experience of China and the politicians have been pushing ahead with reforms in the NHS with the result that “Barefoot Doctors” known as Noctors (Dr. Crippen) are taking over.

Piano:
At the height of the “Cultural Revolution”, the piano was seen as the definitive sign of bourgeois decadence.

Petroc Trelawny wrote in The Spectator that Fou Ts’ong (one of my favourite Chopin pianists) was forced to seek exile in London, where he later heard his parents had fatally poisoned themselves. Liu Shih Kun, who came second in the Tchaikovsky Competition when Van Cliburn won, was imprisoned by Madame Mao. He survived and has now established a number of piano kindergartens across China, in response to the craze created by Lang Lang’s performance at the 2008 Beijing Olympics. Many Chinese parents now want their children to learn the piano. The BBC reported that an estimated 30 million children in China are now learning the piano.

BBC

Is the piano China’s answer to the problem that is facing many parents in the west, i.e. ADHD? Could it be a novel substitute for Ritalin and other stimulants? With the advent of unproven modern approaches to education at all levels, very few subjects require memory work. Yet in the last decade or so, memory work has been shown to be beneficial to “brain power”, leading to a whole new approach to neuroplasticity. Learning a musical instrument is one way to give the brain the right amount of training.

For now, just as the west is abandoning classical music training as part of the school curriculum, parents in China are paying for their children to have piano lessons. By some reckoning, North America probably consumes 90% of Ritalin and similar stimulants, whereas China is probably consuming 90% of the pianos produced. One factory in the south of China is currently producing 100,000 pianos a day.

Swimming:
Some will argue that such pressure on children is not good. Yet we have to look at Michael Phelps, whose parents abandoned drug treatment for his ADHD in favour of swimming. 


.....For an athlete who took Ritalin for attention deficit hyperactivity disorder (ADHD) as a child, it is also his most surprising asset.

"Michael's ability to focus amazes me," says his mom, Debbie Phelps, a middle school principal who occasionally speaks on panels about ADHD. It's a condition that most frequently affects children, making it hard for them to pay attention to one thing or to sit for long periods.

Bowman, who began coaching Phelps at the North Baltimore Aquatic Club when the swimmer was 11, recalls how much time Phelps spent sitting near the lifeguard stand as a kid, benched because he was being too disruptive.
"He never sat still. He never shut up; he would never stop asking questions," his mom says. "He just wanted to go from one thing to another."

When he was in elementary school, a teacher told his mom that Phelps would never focus on anything. His mom disagreed. She had seen him at swim meets.....

The modern Chinese parent may indeed have stumbled upon something similar to Michael Phelps’ swimming in dealing with problems of concentration. Many parents actually believe that the discipline of learning the piano is helpful in building a more rounded person, although some may have aspirations that their offspring might be the next Lang Lang.
As China now moves into a new era, the piano practising child may have something else to practise: golf.

The Independent reported that it is the new game that is the game of choice for China’s new elite.

My friend told me that when he was at the Spring City Golf & Lake Resort, a nine year old just won a junior tournament. The boy was only 9 and he scored 71 on his final round playing from the red Tee
He may well be the next Tiger, a piano playing Tiger.

“There’s a sense that greater powers, profit-driven and amoral, are pulling the strings in our children’s lives. There’s a sense that those who should best protect us — our government and our doctors — are so corrupted that they can no longer do the job. There’s a sense that childhood has, in many ways, been denatured, that youth has been stolen, that the range of human acceptability has been narrowed for our kids to a point that it has become soul-crushingly inhuman.”

                                                Judith Warner      New York Times



Ritalin has also become popular because it takes the blame away from those responsible for the child – the parents and often the teachers as well. Some parents who do not wish for their child to go on Ritalin are often put under tremendous pressure by the teachers. Very few have even bothered to find out if there is any non drug related method at all.”




“According to data obtained exclusively by Education Guardian under Freedom of Information legislation, there has been a 65% increase in spending on drugs to treat ADHD over the last four years. Such treatments now cost the taxpayer over £31m a year.”                          More>>>>





Related:

Sunday, July 28, 2013

NHS & Wagner: Reform & The Ruling Class!

Wagner's Götterdämmerung  is at the Royal Albert Hall for the Proms. 

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 was passed, changes were in place in the NHS that made it impossible to go back. Now it looks as though the changes were much worse than first thought. Doctor leaders were hoping that there is still decency in our ruling class. 

Well, unfortunately many of us will be disappointed, dismayed and disgusted.

Much effort by the modern day Brünnhilde will be in vain and the old NHS will end up destroyed.

The NHS (England) as we know it will soon disappear. Wagner’s opera will always be there.

So will Finland's forest!


© 2012 Am Ang Zhang
Here is a reprint:

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. 

Contemptuous
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. 
Homicidal
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.

The one-word secret of Hunt’s success: NEPOTISM His relationship to Virginia Bottomley…..his dealings with the British Council….his inheritance of the SW Surrey constituency….

…..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……



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
               

                                                    From:    Shadow Elite: Public-Private Players & The NHS

        
        
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


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


Wagner website.
Independent: Mariinsky Ring
Other Opera Posts: