Wednesday, January 29, 2014


In Health Care, death is irreversible.

That good will from doctors and nurses were as important as regulation in providing good health care has now been ignored. Years of micro-management, protocols and silly performance related pay has just about removed the last thread of good will from doctors and nurses. A friend’s daughter just graduated in nursing and in her class of 26 only 2 were offered vaguely nursing relevant jobs. She left nursing. 

The word out there is the newly de-regulated free market NHS will be safe. As there is: Monitor.


Roy Lilley

I'm wondering how much longer Monitor, NHS's very own Off-Sick regulator can hang on for?  They cost us £43m.  If you had £43m to spend would you blow it on a superfluous, bureaucratic, unwanted, poorly performing quango?

In a really interesting interview with Sarah Calkin of the HSJ, David Bennett, Off-Sick's CEO, went off on one, trying to explain that Monitor was going to be a 'translator' between the NHS and the competition authorities. 

Bennett palavered on; "NHS organisations have a legal duty to consult on service change and this was a 'significant issue' that needed more work and 'something the competition authorities' haven't had to deal with before".   

No, I don't understand a word of it.  Bennett the great 'translator'?  Not for me he's not.
Here's a question; in the middle of austerity NHS, if you had forty three million quid would you invest it in an arcane organisation, steeped in competition law, 'translating' the bleedin' obvious or would you use it to buy some nurses, a few operations, some mental health services or end of life care?

If you were going to spend +£40m would you spend it on care or contracts, outcomes or outputs, the front-line or fiddling about with a market that has delivered nothing, no one wants and no one voted for?

Well brace yerself!  It looks like +£40m ain't gonna be enough.  A reader tipped me off; this from their internal Exec Committee minutes:

"As part of ongoing organisational design work, directorates have identified a number of additional posts (up to 86) required in addition to the currently signed off organisational structure."

Eighty six more people!  To do what?  Translate?

We had DEFRA and we had the “organic” egg scandal.

Keith Owen, who ran Heart of England Eggs Unlimited, admitted providing false information for accounting purposes to firms in the egg supply sector between June 2004 and May 2006.

Officials estimate that as many as 100 million eggs were falsely labelled.
The court heard he sold battery and "industrial" eggs imported from France and Ireland to suppliers.

They were told the eggs were British, free range, organic or that they met the RSPCA's Freedom Food welfare standards.

Judge Hooper said Owen's business had made very substantial profits at the expense of consumers who believed they were buying free-range eggs.

DEFRA only need someone (not even a scientist) to read this scientific article and they would know. How many scientists do they have and indeed how many doctors do they have at Monitor or do they all have to have MBAs

Instead we had 100 million fake eggs.

They are not even changing the name of DEFRA this time. They are the FSA and the report on RBS may not even appear! So much for regulation!

There is much talk of the role of the regulator Monitor in safeguarding our health care.
Perhaps we should look at our most famous regulator: FSA. (Financial Services Authority).
The FSA was dragged into the news recently as its first head Sir Howard Davies, resigned as director of London School of Economics for eight years over "a mistake". The "mistake" was to advise the LSE's council to accept £1.5m research funding from a foundation controlled by Colonel Muammar Gaddafi's son, Saif.                                 More>>>>>>>>>

So, were there any other "mistakes" when he was head of FSA?

17 July 2008
The Financial Services Authority will be dealt yet another hefty blow to its credibility today, as the Parliamentary Ombudsman, Ann Abraham, reverses her decision of five years ago and accuses it of maladministration for its role in the collapse of Equitable Life eight years ago.

"The case of Equitable Life, which echoes earlier cases such as Vehicle & General in the 1970s and shares some similarities with the current example of Northern Rock, illustrates the need for absolute clarity as to what can and cannot be expected from financial regulation and the development of shared understandings as to the limits to the protection that such regulation offers to investors both before and after problems arise, as they inevitably will," said Ms Abraham.
"Key, however, is that those responsible for undertaking financial regulation should act in a way that is compatible with the duties and powers which Parliament has conferred on them. Those responsible for the prudential regulation of Equitable Life failed to do so throughout the period covered in my report."

Sir Howard Davies was previously employed by McKinsey and Company and was Special Advisor to the Chancellor of the Exchequer.

ReutersUPDATE 3-Resolution's Cowdery, chairman, execs probed by FSA
Mar 9, 2009 9:42am EDT
"LONDON, - The founder of British buy-out company Resolution Ltd, insurance entrepreneur Clive Cowdery, is being investigated by Britain's financial watchdog (FSA), as is company chairman Mike Biggs and three others.

"Resolution Ltd said the probe into their actions as directors of Cowdery's previous investment vehicle, also called Resolution (Plc), would undermine its core business acquiring financial services firms because such deals needed Financial Services Authority approval.

"‘The company would not expect to ... complete any acquisition until this matter has been resolved,’ Resolution Ltd said in a statement on Monday.

"The FSA is also investigating three other former Resolution Plc executives who along with Cowdery are involved in running the new venture under the stewardship of John Tiner, a former chief executive of the FSA."

From the 
FSA Web site:“John Tiner joined the FSA in April 2001 after a 25-year career at Arthur Andersen, the accountancy and management consultancy firm. He was an Andersen partner for 13 years and was appointed head of the global financial services practice in 1997.” 

He left Andersen just nine months before it collapsed in the wake of 
the Enron scandal.

The Independent
FSA chief Tiner to quit for top job in private sector
Wednesday, 17 January 2007

“The chief executive of Britain's City watchdog yesterday said he planned to quit his £572,000 post in July to seek work in the private sector.

"John Tiner, 49, will have been with the Financial Services Authority for six years when he departs, becoming chief executive in 2003. He will remain on the FSA payroll until 2008 and will not be able to work for any financial services business or listed company during that time.

"Mr Tiner has picked a good time to leave the FSA, with tributes from the City ringing in his ears and no major crises on the horizon.

"It follows the decisions of both Richard Harvey, the Aviva chief executive, and James Crosby, who held the top job at HBOS, to depart at times of their own choosing.”

He left the FSA in good time indeed. I wonder if they pay our 
Chief Medical Officer £572,000.

Then I found this in the Financial Times Website High Net Worth.
From gamekeeper to poacher – mandarins easily shed their skins

Pádraig Floyd
Published: 01 September, 2008

"Until I got on the train this morning, I knew exactly what I was going to write about in this column. It was then, as I sat thumbing through the press releases on my BlackBerry, that I saw something that changed my mind.

"That something wasn’t that Resolution boss Clive Cowdery is going to float his business, although that was of course very interesting. No, what caught my attention was that he had managed to land the transfer of the season, by securing Jon Tiner, former chief executive of the Financial Services Authority (FSA), as the new CEO.
Maybe I am the only person who has a problem with this, because as I write this some hours later, there has been no commentary from any quarter outlining concerns about such an appointment."But can it really be right that a man who held the shape and direction of the financial services industry under his control between 2001 and 2007 should then be allowed to work for a company that operates within that regulatory regime?"

You can read the full article here. 

Monitor: Recent exchanges in ParliamentPublic Bill Committee
There is much talk about Private Health provider may have to be subsidised for their disadvantage over pension.

Q 199 Mr Kevin Barron (Rother Valley) (Lab):  A question for Mr Bennett. The impact assessment for the Bill refers to “fair playing field distortions” and says: 

“The majority of the quantifiable distortions work in favour of NHS organisations; tax, capital and pensions distortions result in a private sector acute provider facing costs about £14 higher for every £100 of cost relative to an NHS acute provider.” 

My understanding is that you would be responsible for addressing that system. What is your view of those fair playing field distortions? 

David Bennett: In due course, I think one of the things that the economic regulator will need to look at is the issue of the level playing field. The analysis that you are quoting, of course, was done by the Department of Health, not Monitor. 

I think I can say that when the appropriate time comes for the economic regulator to look at those issues, we will need to look very carefully at that analysis. There are level playing field issues on both sides. There are additional costs incurred by the public sector, as well as advantages, the obvious ones being— 
Q 200 Mr Barron:  This says that it is the other way around, actually. The public sector costs are higher than private. Do you agree with that? 
David Bennett: What I am saying is that we would seek to do a more extensive piece of research before reaching conclusions. 
Q 201 Mr Barron:  If this is the case, what are the implications for public sector workers? 
David Bennett: If those numbers are correct? 
Q 202 Mr Barron:  My first point is that our starting point must be to do the analysis more extensively, looking at a broader set of issues. I cannot say that those figures are the ones that we would come up with. 
Sonia Brown: I think we can identify areas where we can see that the Department’s analysis has not gone to the point of being able to quantify the numbers. A really good example of that is that the NHS tends to treat much more complex cases. At the moment, the NHS is rewarded at the same rate for doing that as the private sector is for treating less complex cases. 

David Bennett is the current head of Monitor (a sort of health FSA!) He is NOT a medical doctor.

Monitor: All recent posts.                                    


NHS & Market Forces: Uncomfortable Readings!!!

Tuesday, January 28, 2014

NHS Reform: Democracy is for the Elite! So is Health Care!

Is it really that difficult to grasp! Our democracy is for the ELITE. Why pretend? So is Health Care!

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 the NHS 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. 

Is it Conspiracy or Cockup? You decide.

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

That is why many GPs in the consortia have links with private providers.

It is a sure way of directing patients to secondary care.

Great Barracuda waiting / ©2009 Am Ang Zhang

Rationing & Redistribution
Rationing of Health Care is unpopular at the best of times and different ways have been tried by the previous governments first through Fund Holding and later PCTs.  

It would have been very unpopular for PCTs to continue to ration health. They have been doing it one way or another and it has been a costly exercise for some PCTs. 

It has even caused unnecessary deaths.

The current concern for the NHS Reform is perhaps too focused on privatisation.

The main aim by some very clever people in government is that somehow there must be a way to limit health spending.

The first obvious way is to find someone that could do it without the blame coming back to the politicians who needs to worry about the next election or next job.

GP Commissioning was thought to be the answer as the blame would now be on the GPs.

Integration of Health Care
Integration of Health Care now carries a new meaning: integrated as long as it is all within the remit of Primary Care and not between Primary and Secondary Care. Yet there is only so much that Primary Care can do unless they started employing their own consultants and running there specialist hospitals. That is one way of saving money.

The other way is to refer to Any Qualified Provider, the new NHS speak for Private Providers. Better still if these are owned by the same organisations that own some of the GP practices. Believe me, it is already happening and it will spread.

How could this be done? Simple, NHS Foundation Hospitals will not stand a chance if they have to continue with the expensive and unprofitable conditions or expensive dialysis and Intensive Care that many private insurers will not touch. In the new world order, they will fail and be closed or be bought by private companies. We have the regulator called Monitor that will see to it.

Again it will not be the politician’s fault: just bad management.

The new structure of HSCB is perfectly geared towards failing FT Hospitals. Some will survive through high levels of private work for those from wealthy countries. There is only a limited number of specialists to go round in England and in fact in most countries.

Which means that there will be a long waiting list for NHS patients!!!

Rationing by any other name.

It really does not need a genius to work out that Foundation Hospitals if they fail will be bought up by private firms.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in consortia arguing about the price of hips or knees. 

A big portion of the NHS money will now be spent in the counting houses of the new Commissioning Offices. Gradually more and more of that money will be re-distributed to Privateers.

Those who could afford to will now get their own Health Insurance and when the Insurers refuse to cover some conditions you may have to return to the NHS. But who knows, it might just be too late then as those hospitals may no longer be there

In Health Care, death is irreversible.

Monday, January 27, 2014

Walnuts & Music: Mozart & Mahjong

On Mozart's birthday: 27 January 1756

© 2005 Am Ang Zhang
As the cock crowed, the grandfather left the house on his half mile walk to the little park by the river for his morning Tai Chi with a group of seniors. He was in fact the leader of the group and it fell upon him, a young looking 83 year old to go through the sequence of Tai Chi moves that had been passed down by his grandfather and others before him. His wife sometimes accompanied him but today she had to baby sit the grand-children as their parents were on an early shift. When they finished they sat around for some social chat and drank green tea from their thermal flasks. He walked home refreshed from the morning’s exercise and social gossips. As he neared home he could hear his grand-daughter practicing the piano. What lovely Mozart! He stepped into the house to find his grandson busy at a Nintendo game.

“Why aren’t you practicing your violin? If you just play computer games, your brain will turn into water.”

His grandson shut down the Nintendo, “Grandma, you should try it some time. It will be good for your brain.”
 “I am too old for it. My brain is all water anyway, according to grandpa!” She just remembered that she had to take her Ginkgo capsules.

The grandson played some scales on the violin and then the Vivaldi A minor. From memory, as that was how he was trained.

At breakfast, the young children listened to Grandpa reciting ancient classical Chinese poems - a long standing family tradition. Soon the grand-children left for school.
Grandma now cracked some walnuts while grandpa got ready to go to the market to see what fresh fish he could buy that day. The walnut was to go with their home reared free range chicken. They grew their own vegetables too.

Later that day they would be having a good game of Mahjong with a retired couple.

Much of what they did would help to maintain their brain fitness.

Ginkgo biloba with its romantic botanical history is no longer the Dementia buster it promised to be. (Those who know of the village in Japan where there are loads of Ginkgo trees could have told you that. The village has the highest Alzheimer rates in Japan.)

I was reminded of Woody Allen’s film, Radio Days, where the young Allen (who else) was brought before the Rabbi by his mother for his advice because Allen was hooked onto the radio. The Rabbi’s skepticism was perhaps not that dissimilar to ours nowadays about iPhones, computer games and brain exercises. Indeed the young Allen should be concentrating on his upcoming Bar Mitzvah and the Torah memorizing.

The Old views on Brain.

When I was training in London in the 70s, I spent some time at Queen Square. Those in the know will recognize it as the place for neurology this side of the Atlantic. It was drilled into us then that sadly we were given a number of brain cells when we were born and it was all downhill from then on or something to that effect. It was well known that neurologists were great diagnosticians but for most neurological conditions, not much could be done. How depressing indeed. Even as recently as four weeks ago, I heard a young doctor told his father that there was nothing he could do with his brain cells. One is given so many at birth and no more can be expected. Lord Brain (1895-1966) would have been so proud.

Yet it was also London that shook the world with new discoveries about the brain, and the study was on the most unlikely group of people: Taxi drivers. Their “KNOWLEDGE” was the basis of our knowledge on brain plasticity today. The “KNOWLEDGE” is a term officially used to describe the test the Taxi Drivers had to take to get the licence to drive Taxis in London. Streets in Londonhave evolved over time and are not on any grid system at all. Early postmortem examinations led some pathologists to note the small size of the Taxi drivers’ frontal lobes. Yet actual weight measurement showed that size was all relative. It was the enlarged hippocampal region that created that impression. Later work using modern scanning techniques confirmed the early impressions.

If two to four years of “KNOWLEDGE” acquisition can change the size of the brain in a grown adult, what else could we do?

The rest, as they say, is history.

The book covers the changes to the brains of musicians and medical students. It tells us that just three months of memory work can have noticeable effect on the brain of medical students, and music memory work has similar impact on musicians. I was pleased to learn that Bilingualism helps too. From infancy, I and my siblings were brought up with speaking two Chinese dialects at home.

Will medical schools that have abandoned traditional teachings please bring back Anatomy-the old way?

Did the 300,000 or so that took up piano this year in China know a thing or two about brain plasticity? Currently 30 million children are reported to be learning the piano in China.

As a child psychiatrist, I find the ones on ADHD showed great promise but I doubt if we are ever going to see the end of the stimulants’ hold on the condition in the West. It is interesting to note that Stimulants never took off in China, a country with a fifth of the world’s population. Computer games, on the other hand, have really taken off there.

Bridge and Sudoku were mentioned in passing, along with other favourites like crosswords. There is no mention of Mahjong although in the East it is all the rage, nor the memory work required in some religions. Their gods might know a thing or two about the brain.

Other Posts:

Nobel: Kandel and Lohengrin

Lohengrin: Speech Disability, Design & Hypertension

Autism, the Brain and Tiger Woods

'The Knowledge' and the Brain