Monday, December 29, 2014

NHS Privatisation: Snorkel & QinetiQ!

Whenever I went snorkelling something happened to our beloved NHS!

"The fault, dear Brutus, is not in our stars,

But in ourselves."
Julius Caesar (I, ii, 140-141)

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.      More>>>>

©2014 Am Ang Zhang


The Care Quality Commission’s report on Harmoni, Britain’s biggest provider of out-of-hours care which runs services across the country and earns £100m a year from NHS contracts, is the first evidence from an official body that cost-cutting by private companies may be harming patient care.

Jeremy Hunt will say “disastrous” changes to GPs’ working hours have led to an extra four million people attending hospitals annually, a situation he will demand is reversed.

The growing pressure on hospital emergency departments is the “biggest operational challenge” facing the health service, he will warn.

The NHS is conducting a review of out-of-hours care which may lead to GPs again taking responsibility for looking after patients outside normal working hours.
Controversial changes to GPs’ contracts made under Labour in 2004 allowed them to opt out of treating patients outside normal office hours. The review could see that policy reversed.

When the contract was initially renegotiated in 2004, GPs had their salaries reduced by £6,000 if they stopped providing care out of hours. However, other changes to the contract meant that average pay rose by a third, with many GPs earning six-figure salaries.
Following the changes, 90 per cent of family doctors stopped providing emergency cover, leaving patients to rely on phone services, agency doctors or hospital visits. In 2004/05, 17.7million people used England’s A&E departments. By last year, that had risen to 21.7million.

In opposition, the Conservatives pledged to renegotiate the contracts. However, attempts to change them have proved difficult, and the Government is scrutinising other ways of improving the out-of-hours service. The official review on the issue is expected to report at the end of the May.

Last time, this was in the news!

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.

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.

Five family doctors have this week become millionaires from the sale of their NHS-funded firm to one of the country's biggest private healthcare companies in a deal that reveals how physicians can potentially profit from government policy in the new NHS.

On Tuesday, the private health company Care UK announced that it had paid £48m for England's biggest out-of-hours GP service, Harmoni, originally set up as a GP co-operative, creating a new private health concern that could treat 15 million patients. The deal shows how GPscould profit from the coalition's health reforms by using their expertise to bid for contracts, then cashing in when a corporation buys them out.

Death & Harmoni:

The family of a young woman is suing the country's biggest out-of-hours GP provider and one of its nurses, whose failures meant her fatal condition was not diagnosed, because neither will accept liability in a test case over legal responsibility in a privatised NHS.

Clare Secker, 19, died of bronchopneumonia in December 2008 after a nurse working for the privately-run telephone service told her parents to give her paracetamol and fluids.

Earlier this year the nurse admitted through her lawyers that she had been "in breach of her duty by failing to arrange for [Secker] to be seen by a doctor". If the young mother, who died when her son Tyler was less than a year old, had been prescribed antibiotics she would have recovered fully.

Despite this neither the firm, which was part of the Harmoni out-of-hours service until it was bought by Care UK in November 2012, nor the nurse has offered compensation to the family.

The nurse claims she does not need to pay out as her employment contract specifically states that the company had insurance in place "to indemnify … for any claim arising from any wrongful act committed by … any employee while carrying out their contractual obligations". But Harmoni says its insurance excludes responsibility for negligence by nurses.

With the Health and Social Care Act 2012 leading to more NHS contracts going to private providers, lawyers are concerned that the fragmented system will lead to a loss of accountability.

"It cannot be right that patients no longer know who is actually providing their care, or for those who are harmed to have the additional stress of providers trying to dodge responsibility by pointing to a clause in a contract or insurance policy. Until something disastrous happens we, the public, think we are still within the safety net of the NHS and increasingly that's just not the case. There is little transparency or protection, it seems to me."

AQPs are like Brittle Seastars invading our beloved NHS.

Brittle Seastars invading corals ©2013 Am Ang Zhang
Hospitals now fight other hospitals and the failed ones will be handed over to privateers. Some of these have the highest mortality rates. I am surprised that they are not sold  off for just a single pound.

The more failed hospitals, the better for the government. Once they washed their hands off, it is not their problem. If the privately run hospital failed, they change CEO, change ownership and continue. 

In less than 10 years with GP cooperatives had built up a great deal of expertise in organising out of hours cover and their management boards comprised local GPs. It might be supposed that PCTs would automatically want to use this expertise.

But this was not the case. The NHS Confederation (the managers own organisation) told the Health Select Committee that few PCTs were working positively with GP co-operatives, often instead being adversarial and generating conflict. 

In Buckinghamshire the GP cooperative was forced out of business literally overnight when the PCTs awarded the contract to a large company called Harmoni.  In Cornwallthe exemplary Kernowdoc was passed over in favour of Serco. Both Harmoni and Serco has since been the subject of major complaints and in particular have been accused of failing to employ sufficient doctors. Ironically these cases mirror the very situation which led to the Carson Report. Despite these experiences a recent bid by a group of East London GPs to take back organisation of Out of Hours care for their patients was passed over in favour of a private company.

GMC:The GMC has been quiet about them as they have with the Breast Implant ones and many other plastic surgery private hospitals.

Yet, right now the NHS picked up the mess of the PIP implants. The private companies pocketed the money. Lots of money.                                                                                                   


May 11, 2011

“……Tom Clark our leader writer says the real problem with the bill is the fact that the new regulator has a duty to promote competition where appropriate. He points out that in a previous life as a special adviser the regulator used his powers to squeeze state bodies in order to open up the space for private providers. It's why he is so against competition.”

For my money, the most important line in the whole of the health and social care bill is found – if I have the chapter and verse citation system right – at clause 56 1(a). It lists the first duty of the regulator Monitor, which is being transformed from the Foundation Trust hospital's overlord into being the economic regulator of the whole healthcare market, as being "promoting competition where appropriate".

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.  

Saturday, December 27, 2014

Spring City & Golf: ADHD & Piano!

Spring City ©Am Ang Zhang 2011

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.

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.

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.


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.

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>>>>


Thursday, December 25, 2014

Christmas & Bach: Kandel & Dementia!

Christmas Anemone 

© Am Ang Zhang 2014 

As I listen to Bach's Christmas Oratorio I am reminded of the work of Kandel on memory. Why is it that listening to the same piece of music as rarely as once a year evoke such pleasing brain syntonic response.

There is now a fair bit of research on the use of music for dementia patients. This is encouraging. 

However, the work of Kandel showed that it would have been more beneficial if the memory of the music were imputed at an early age only for the brain to be stimulated at a much later age for maximum beneficial effect.

The Cockroach Catcher was very pleased to be at  La Traviata as it was one of those operas that you do know inside out. The scenes might be different but the music essentially stimulates the re-programming of Kandel's memory proteins. 

I am reminded of the grand father of one of my daughter's good friend who at the age of 102 was still playing Chopin Preludes a few days before he passed away. He had full command of his mental capacity until his death.

Could taking away much of classical music education have a devastating effect on the memory health of the nation as a whole? If so, should we not bring it back to give most of us a fighting chance?

Britain might then be able to supply the next generation of musicians as a result.

Think about it, SoS and Mr. Simon Stevens.

Eric Kandel, M.D.:
"We are what we are through what we have experienced and what we have remembered."          

In 2001 I was fortunate enough to be in New Orleans for the American Psychiatric Association Annual Conference. One of the lectures attracted a long queue and it turned out that the Nobel Laureate Eric Kandel was giving his lecture. I was fortunate enough to be able to secure a seat.

"What learning does is to change the strength of the synaptic connections in the brain," Kandel explained, "and this has held true for every form of learning so far analyzed. So, what genetic and developmental processes do is specify the cells that connect to each other, but what they do not specify is the exact strength of those connections. Environmental contingencies, such as learning, play a significant part in the strength of those connections.""Different forms of learning result in memories by changing that strength in different ways. Short-term memory results from transient changes that last minutes and does not require any new synthesis of proteins, Kandel said. However, long-term memories are based in more lasting changes of days to weeks that do require new brain protein to be synthesized. And this synthesis requires the input of the neuron’s genes."

In his book In Search Of Memory, he remembered his arrival in New York in 1939 after a year under the Nazi in Vienna:

“My grandfather and I liked each other a great deal, and he readily convinced me that he should tutor me in Hebrew during the summer of 1939 so that I might be eligible for a scholarship at the Yeshiva of Flatbush, an excellent Hebrew parochial school that offered both secular and religious studies at a very high level. With his tutelage I entered the Yeshiva in the fall of 1939. By the time I graduated in 1944 I spoke Hebrew almost as well as English, had read through the five books of Moses, the books of Kings, the Prophets and the Judges in Hebrew, and also learned a smattering of the Talmud.”

Eric Kandel/Amazon

“It gave me both pleasure and pride to learn later that Baruch S. Blumberg, who won the Nobel Prize in Physiology or Medicine in 1976, had also benefited from the extraordinary educational experience provided by the Yeshivah of Flatbush.”

In Hebrew and English!!! That did not seem to have done him and Blumberg much harm. Right now some governments seem hell bent in doing away with rote learning and that includes some medical schools.

Vienna was, as recently as 1939, the year he and his family fled the city for the United States, the most important cultural center in the German-speaking world. "The city's great tradition of scholarship provided a foundation for experiments in literature, science, music, architecture, philosophy and art, experiments from which many modern ideas were derived," he writes. "Vienna's culture was one of extraordinary power, and it had been created and nourished in good part by Jews." The Nazis drove out those Jews they did not murder, and with their departure a city of verve and excitement — a city of intense intellectualism and the acme of cultural attainment — became a prosaic place.

If there is another book that does a better job of demonstrating how biological research is done, or of telling the story of a brilliant scientist's career, I don't know it. Nor do I know one that better conveys the unique excitement that drives the success of research and permeates the thinking of its most able practitioners, or that gives a better descriptive narrative of the historical evolution of our understanding of mind. True, in places the detail is so minute and technical that certain parts of it will prove to be nearly inscrutable to any but the most diligent reader, or to those with a background in molecular science. But it hardly makes a difference if some passages are judiciously skimmed. Like the good teacher he no doubt is, Kandel has sprinkled his more abstruse sections with an occasional summary sentence that clarifies entire previous pages. His is an important and marvelous book. Sigmund Freud and the illustrious cavalcade of pioneering neuroscientists, psychologists and philosophers who have contributed so much to our understanding of the human mind during the past century would look with pleasure on it.
La Traviata

Apparently the prima, the week before (I attended the second performance, on December 16th), was thrown into disarray when tenor Stephen Costello cancelled just an hour before the performance. There were no problems with Mr Decker’s tricky staging or ensembles on the 16th. Musically and dramatically well-prepared, soloists, chorus and orchestra were on top form. Marina Rebeka, whose only previous Met performances were as an unimpressive Donna Anna in Michael Grandage’s tedious Don Giovanni four years ago, was a superb Violetta.

Attractive, comfortable on stage (and standing on the minimalist furniture), and with a shining soprano, she negotiated the coloratura difficulties of the first act with ease, even touching on an interpolated high E flat at the close of “Sempre libera”. She has several degrees of pianissimo as well; the spun lines of “Dite alle giovane” and “Addio del passato” were lovely and touching. She uses no chest voice at all and it was occasionally missed late in the opera, but the voice opens up to a grand size when needed, and she did well with “Amami, Alfredo” and her death scene. She should be a valuable asset to New York’s opera lovers.

Other Opera Posts:

NHS: Learning From Boris