Thursday, February 27, 2014

NHS A&E: Jacaranda & Friend's Life!

The life of a friend: Jacaranda is known as the flower of good luck. Did one drop on her or was it her A&E doctor.  Legend of Jacaranda in Pretoria, South Africa.

©2013Am Ang Zhang

“The best interest of the patient is the only interest to be considered, 
and in order that the sick may have the benefit of advancing knowledge, 
union of forces is necessary
…it has become necessary to develop medicine as a cooperative science.

It looks a though we are moving as far away from those ideals in the New NHS. It is indeed most obvious with our A & E department of hospitals in England. In the new market driven system, A & E is indeed the loss leader in Supermarket terms. If we are honest, there has not been any drop in demand. It is the one thing the NHS CUSTOMERS will buy!

Government would like us to believe that this has nothing to do with OOH service. Perhaps there is a belief by the average citizen that they will be seeing real doctors at A & Es.  
 Guardian latest: Study says it costs hospitals more to treat accident and emergency patients than they are paid to deliver service.

In a Market system, A & Es are run by Hospitals and OOH by CCG/GPs; business rivals so to speak. Hospitals wants to maximize income and CCGs did not want anyone to attend A & E if at all possible.     NHS A & E: Unpredictable, Unruly & Ungainly

Looks like the battle is over as no doctor will want to work in A & E.

A top doctor from Somerset claims emergency patients could be at risk because half of the country's A&E departments are understaffed.

Dr Clifford Mann, registrar at the College of Emergency Medicine and a consultant at Musgrove Park Hospital in Taunton, said hospitals were increasingly struggling to find enough medics.

He told the Mail on Sunday that junior doctors were unwilling to train to become emergency medicine specialists because of the intense workload and failure of hospitals to increase staffing levels to match the number of patients admitted.
The situation is worsened by the fact that 10 per cent of all full-time consultancy posts in the country's 220 A&E units are unfilled as many training in the NHS have preferred to go abroad to work.

He said the shortages will "undoubtedly" have contributed to the closure or downgrading of casualty departments.

"The key message isn't so much the vacancies out there, but that there's no one coming through to fill them," said Dr Mann, an emergency medicine consultant.

There is of course a solution: remove the payer system and rotate GP and other trainee doctors through A & E as a compulsory part of training of any doctor and have full back up of the A & E consultants.

Friends moved to France after their retirement and lived in one of the wine growing districts.

They were extremely pleased with the Health Care they received from their doctor locally. After all, not long ago, French Health Care topped the WHO ranking.

Then our lady friend had some gynaecological condition. She consulted the local doctor who referred her to the regional hospital: a beautiful new hospital with the best in modern equipment. In no time, arrangement was made for her to be admitted and a key-hole procedure performed. The French government paid for 70% and the rest was covered by insurance they took out.

They were thrilled.

We did not see them for a while and then they came to visit us in one of our holiday places in a warm country.
They have moved back to England.

What happened?

London A & E:
Four months after the operation they were back visiting family in England. She was constipated and then developed severe abdominal pain. She was in London so went to A & E at one of the major teaching hospitals.

“I was seen by a young doctor, a lady doctor who took a detail history and examined me. I thought I was going to be given some laxative, pain killer and sent home.”

“No, she called her consultant and I was admitted straight away.”

To cut the long story short, she had acute abdomen due to gangrenous colon from the previous procedure.

She was saved but she has lost a section of her intestine.

They sold their place in the beautiful wine region and moved back to England.

Thank goodness for a well trained A&E doctor. Or one with the Jacaranda flower.

Prof Waxman in an earlier post:

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

…….Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.

“The best interest of the patient is the only interest to be considered, 
and in order that the sick may have the benefit of advancing knowledge, 
union of forces is necessary
…it has become necessary to develop medicine as a cooperative science.

 Doctor William Mayo explained in 1905

NHS Killings or Savings: Simple! Outcome Based Commissioning!

Now! It is quite simple really!!!                                                                                                                                   

It is very much like  giving children the mortgage and meal money and that they buy primarily from mother, food, washing and accommodation. But then, there is no restriction on buying food from AQPs: other mothers, fish & chip shops, supermarkets and even McDonalds. What if the children sleep over at friends: is rent deducted.

They just cannot see it, can they?

  ©Am Ang Zhang 2013
It is indeed very sad to see how modern perverse incentives that were used in other institutions were used in our NHS hospitals in one part of the United KingdomEngland.

The figures are there for all to see and it is hard to believe that the very smart people that are currently running the country did not know.

In the brave new world, English Hospitals (or their managers) need to perversely increase activity to survive (or collect a good bonus before moving on or going off sick). GP Commissioners (CCGs)need to reduce hospital referrals in order to achieve government imposed savings or if it is run by privateers to find profits for shareholders.

Hospitals will fail and be bought up and the privateers will be so smart that they will only run the profitable parts.

Government will be left still running the loss making services or they could be sold out to the likes of Southern Cross .

Attempts to cull hospitals are happening in various guises and sometimes such failed. Fortunately for the government, since Les Misérables, the people may march and wave banners but they don’t do revolutions anymore. So instead of culling and closing A&Es, they downgrade them. It s a bit like, we do stomach pain but not myocardial infarcts.                                                                                                                

I have written before that A&E is the one thing that upset planners, accountants and most importantly the new CCGs. There is a belief, rightly or wrongly that A&Es still have real DOCTORS, and not someone flown in from Germany or further east. Nor are they like OOH or NHS111 where the concern is about money than your survival. As I was drafting this post another hospital is being overwhelmed by high A&E attendances.

What is most worrying is that A&E will lead to more hospital admissions: perhaps unnecessary ones or god forbid, absolutely essential ones.

In the unholy war between CCGs that hold the money and the Hospitals that needed the money patients may either be denied treatments that were needed or perversely given investigations and treatments that were not. 

But wait, they dream up something new: patient must get better or hospitals will not get paid. They called it:

Outcome based commissioning          

So plan B then, from now on admit only well patients. Or those we know that will get better. Just remember that Clinton picked the hospital with poor mortality for his bypassWhy?

So mother is now not going to be paid unless the kids get As.

But, hang on some patient will die; and not every child will get As unless we fine the schools too.

Perhaps that too.

Suddenly, there is going to be some killing and surprise, surprise; it is not what you think: no, not patients. 

That would be too simple.

From the BMJ:
Kill the QOF

The QOF simply hasn’t worked. It is a bureaucratic disaster, measuring the measurable but eroding the all important immeasurable, and squandering our time, effort, and money. It has made patients of us all and turned skilled clinicians into bean counters. Incentives and centralised targets are under scrutiny throughout the public sector because targets just lead to gaming. It’s time to look away from the screen and at the patient once again. Turn off the financial life support and let this failed intervention die.

What happened? £10bn

We are entering the 10th year of the world’s largest public health experiment in EBM—the target driven QOF (Quality and Outcomes Framework). It has cost £10bn in direct payments to general practitioners, but this is just the tip of an expensive iceberg.

From 2004 to 2011 prescriptions for statins doubled, for angiotensin converting enzyme inhibitors and diabetic drugs near doubled, for antidepressants rose 60%, and for steroid inhalers rose 30%.  Polypharmacy is the norm not the exception, and research evidence validates this approach.

Statins & others:
Yet statins, for instance, are supposed to reduce heart disease by 30% within a few years. The QOF has created three million new statin users, so why has there been no demonstrable effect on heart disease trends? Also we might reasonably expect within a decade to see a change in the trajectory of UK life expectancy, but we have not. Likewise the QOF was designed to improve chronic disease management in general practice, but instead outpatient referrals have risen 5% annually, with similar rates in acute hospital admissions.

This is leading to unsustainable pressure and costs throughout the NHS. Perhaps assessing the impact of QOF is impossible because there is no control group. But we can compare UK trends with other similar countries, and there is no evidence that UK healthcare is outpacing these countries.

The problem with the NHS Reform is the NHS itself. Because it is still to be funded by Taxpayers, there is much money to be made.

It would be different if we separate out Private Health Care and State provided one.

That the management consultants found out a long time ago.

No! No! No! Let Private Providers make money from the so called NHS.

Soon the government will discover that money would drain from the state to Privateers with no improvement in the actual care delivered.

The master plan is simple: a fixed amount of money is now given to CCGs who will be responsible for the delivery of health care.

Well, from now on blame the CCGsHa Ha Ha.

Hospitals are now in a risky position and that means 5% of you who might be seriously ill are too. CCGs may not want to fund the treatment you need or within the time frame that you will need. A once wonderful training ground for doctors may no longer be so wonderful. There will probably be fewer functioning hospitals and soon the once prestigious world famous hospitals will just be bitter sweet memories of a few of us.


Now can you see it?

Tuesday, February 25, 2014

Kit Kat & NHS: Lesson too late!

It's a lesson too late for the learning
Made of sand, made of sand
In the wink of an eye my soul is turnin'
In your hand, in your hand

Are you going away with no word of farewell
Will there be not a trace left behind
Well, I could've loved you better, didn't mean to be unkind
You know that was the last thing on my mind

©2014 Am Ang Zhang

Kit Kat is switching to palm oil! 

Now, authors of an Agricultural Research Service(ARS)-supported study published in early 2006 have addressed the question of whether palm oil, whose functional characteristics are similar to trans fats, would be a good substitute for partially hydrogenated fat.
Trans fatty acids (trans fats) are created during a hardening process called hydrogenation, which serves to make oils suitable for use in products that require solid fats, such as baked goods and breakfast bars. The clinical trial was designed to compare—on heart disease risk—the effect of four different oils as they are commonly consumed.

The findings suggest that consuming either of the diets enriched with equivalent high amounts of palm oil or partially hydrogenated soybean oil would result in similar unfavorable levels of LDL cholesterol and apolipoprotein B (a protein, attached to fat particles, that carries bad cholesterol throughout the bloodstream). That's when compared to consuming either of the diets enriched with canola and soybean oils high in monounsaturated and polyunsaturated fats, respectively.

The results suggest that palm oil would not be a healthy substitute for trans fats by the food industry, the authors wrote.

Attempts to change our beloved NHS may indeed be met with the same failure experienced by some other well known brands, sometimes at great cost.

Perhaps politicians can learn from this: you can say all the bad things about the NHS and you can quote how badly we are doing but we still love our NHS for all its short comings.

Just look at the faith we have in our A&E departments to the point that Roy Lilly suggested:

There is even argument that GPs cannot do A&E work and A&E doctors cannot do GP work. What has gone wrong with medical training?

There is a very discrete attempt to change the name of A&E to ED.

Wow! Do people never learn from history?

No!!! NHS and A&E. Original please   

So if politicians have not been so interfering and allow us doctors, nurses and patients to make things work together we may indeed have a better NHS. All the analysis on the reform is clear about one thing: someone is going to make money and that means less money for actual health care.

Kit Kat should look at the following:

Outraged shoppers have criticised cereal company Kellogg's for changing the recipe of Special K for the first time in 30 years.
Hundreds of negative comments about the low-fat breakfast choice have been posted on Facebook since the change in recipe.

Flora margarine has made an embarrassing U-turn after a consumer backlash by shoppers who launched campaigns protesting at a change in the taste of their favourite spread.  

Brand owner Unilever is bringing back the old flavour 17 months after spending £29 million on a reformulation aimed at making the product healthier and tastier. 

But the new recipe sparked a surge of complaints from shoppers who took to internet forums to voice their dislike of the relaunched version of the margarine.

Earl Grey tea is back. After complaints from customers about its tampered-with new blend, which was rebranded as The Earl Grey and made with extra bergamot and lemon for a more citrussy taste, Twinings has said it's bringing back the old blend. 

But after 116 years of being produced to a carefully guarded recipe, the brown sauce which famously bears a picture of the Houses of Parliament on the label has been secretly altered at the request of Government health chiefs.

...... John Northey, from the Isle of Man, contacted Heinz to complain. In a letter to a newspaper, he wrote: 'Gone was the familiar tang and the sauce seemed bland and sickly. Heinz has spoiled a product enjoyed by generations, adversely affected its keeping qualities and, incidentally, increased the calorie count at a time when we're all being warned about obesity.'

Coca-Cola’s now famous attempt to change the taste to New Coca-Cola was met with such a consumer backlash that the management swiftly return to the Classic formula and eventually New Coca-Cola was dropped. Or did they!!! In fact the Diet Coke’s flavour is that of the New Coca-Cola that never was. In the States, the Classic Coca-Cola is not all that classic either as it uses HFCS instead of cane sugar. In Mexico & Europe and the Far East, they still use sugar. There you have it!!! 

The PLOT to kill off the NHS Original started with Fundholding and since then every single government tried! Often in the name of improving health care.

The NHS has its faults but the fixing of it is not by bringing in privateers as they will be gaming for public money; nor would competition and choice work. We only need to look at the number of times the average household change utility providers.

But the government is pretending that Southern Cross would go away very quickly. The same with Four Seasons. We have no idea if there were any secret behind the scene deals so that the likes of Southern Cross will not hit the headlines as the HCSB tried to wriggle through parliament.
No we want the old NHS!!! NHS Classic!!! NHS Original!!! No mercury or manganese please.

Perhaps politicians can learn from this: you can say all the bad things about the NHS and you can quote how badly we are doing but we still love our NHS for all its short comings and perhaps if politicians have not been so interfering and allow us doctors, nurses and patients to make things work together we may indeed have a better NHS. All the analysis on the reform is clear about one thing: someone is going to make money and that means less money for actual health care.

Because, reading between the lines, that is what it is. If government can have its way the ordinary citizens who cannot afford health care insurance will get inferior care in a society that needs to ration its skilled medical professionals. It is no good trying to pretend it is any other way.

Our generation had the best of the NHS.  We had the best of the welfare state including free education, free health care and above all freedom from fear of health care bills.  Now it is up to your generation to fight for what we are in danger of destroying. The BMA are considering taking a legal challenge against the government, you should add your voices. Ultimately the battle for the NHS is a political battle and unless you make your voices heard then the NHS will be lost. Not one citizen in England can afford to lose their NHS; the scale of the public health casualties will be too great if the Bill is passed.  The abolition of the NHS should not be our legacy to your generation for how can you care properly in the knowledge that so many will go uncared for.  Its your NHS but only for so long as you care enough to fight for it.

NHS A&EUnpredictableUnruly & Ungainly

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NHS: The Way We Were! Free!
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Sunday, February 23, 2014

Hello New York: Winter Fun!

Winter light

Central Park


Guggenheim Museum


All photos ©2014 Am Ang Zhang

In addition to special exhibitions, the Guggenheim Museum presents permanent collection shows that focus on the museum's areas of interest and specialization. On view now from the collection are portions of the Thannhauser Collection—presenting masterpieces by such artists as Paul Cézanne, Paul Gauguin, Edouard Manet, Claude Monet, Pablo Picasso, Camille Pissarro, Pierre Auguste Renoir, and Vincent van Gogh.

Borodin's Prince Igor

In a winter dominated by headlines from the Olympics in Russia and nonstop snowstorms in New York, the Metropolitan Opera is offering its own tribute to Russian heritage and a refuge from the weather with a lavish and captivating new production of Borodin's Prince Igor, the Met's first staging of the composer's only opera in nearly 100 years.

Kodachrome: 1935-2010

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

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

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