The Cockroach Catcher: January 2015

Sunday, January 25, 2015

Greece! Greece! Greece!

Two older posts:

Greece: Where are you heading?

Hot News:

The Guardian:

European leaders and financial markets braced for Greece exit from euro!!!

Der Spiegel

Greece Can No Longer Delay Euro Zone Exit

© Am Ang Zhang 2011

© Am Ang Zhang 2011

I returned from Greece after a lovely cruise. Greece has been hit by more financial problems and it was clear that market forces caused much hardship to its ordinary citizens! One taxi driver told me that Greece will never pay back the EU. He may well be right.

A Chinese Story:

The Yangtze River is rising. Man is on the roof. A traditional pigskin boat rowed along: let me get you off.

“No, Buddha will protect.”

Man is now knee-high in water. Naval boat came along: old man, let’s get you off.

“No, Buddha will protect.”

Man is now up to his neck in water. Rescue helicopter came along: let’s winch you off, stubborn old man.

“No, Buddha will protect.”

Man died and saw Buddha. “Why didn’t you come when I needed you most?”

I did, I sent pigskin boat, Naval boat and even my best helicopter, but you refused!

The Greeks have their own Gods, but perhaps they should try Buddha.

So first the Gods sent in Antigone:

So Antigone had a part in this tragedy too. That's Antigone Loudiadis of Goldman Sachs, who arranged a complex currency swap deal that helped Greece to conceal the scale of its debt, in what the Financial Times delicately calls "an optical illusion", as the country snuck into the eurozone.

Then God showed how it could be done in Argentina: defy the I.M.F.

When the Argentine economy collapsed in December 2001, doomsday predictions abounded. Unless it adopted orthodox economic policies and quickly cut a deal with its foreign creditors, hyperinflation would surely follow, the peso would become worthless, investment and foreign reserves would vanish and any prospect of growth would be strangled.

But three years after Argentina declared a record debt default of more than $100 billion, the largest in history, the apocalypse has not arrived. Instead, the economy has grown by 8 percent for two consecutive years, exports have zoomed, the currency is stable, investors are gradually returning and unemployment has eased from record highs - all without a debt settlement or the standard measures required by the International Monetary Fund for its approval.

He even took out the head of I.M.F. just to be on the safe side.

Then came Iceland:

Unlike other disaster economies around the European periphery – economies that are trying to rehabilitate themselves through austerity and deflation — Iceland built up so much debt and found itself in such dire straits that orthodoxy was out of the question. Instead, Iceland devalued its currency massively and imposed capital controls.

And a strange thing has happened: although Iceland is generally considered to have experienced the worst financial crisis in history, its punishment has actually been substantially less than that of other nations.

For good measure Iceland’s god huffed and puffed.

But no, the Greeks have not learned anything.

This was written last year:

Germany will agree to some form of eurozone bailout. However, it will only support the minimum needed to placate the gods, and only with the most astringent, Creon-like conditions being imposed on Greece. It is an important but ultimately secondary question whether this help comes in the form of bilateral loans, loans from the European Investment Bank, purchases of Greek government debt, EU spending transfers, jointly issued eurobonds or any of the other mechanisms suggested. EU leaders will deny that this is a bailout and everyone will know that it is a bailout. Guardian.

The Greeks will do well to go back to their own Gods and not the I.M.F.

Are the bells tolling for Greece?©2011 Am An Zhang

The Guardian Greece: what happens next?

The Cockroach Catcher: The Next Europe: Left-over Euro & Deutschmark

To Intervene Or Not: A Colossal Failure Of Common Sense.

Michael Lewis: The Big Short

NHS: Business Model? Spare Us Please!!!

The Next Europe: Left-over Euro & Deutschmark

Dominique Faget/Agence France-Presse — Getty Images

Historian Hans-Joachim Voth gives the euro only another five years unless the euro zone is transformed into a full transfer union with massive redistribution. The continent is too culturally different to warrant a single currency, he says, adding that it would be best ifGermany and other stronger economies left the euro zone.

SPIEGEL: Professor Voth, how much longer do you think the euro will survive?

Voth: Five years. The euro can't survive in its current form. We could, of course, make a full-fledged transfer union out of the euro-zone countries, complete with euro bonds and massive fiscal redistribution. In that case, we would have a different euro than the one that was originally conceived and promised to German voters. In the end, if the heads of state and government don't want that, it's likely that the euro will have to be dissolved.

SPIEGEL: You give the euro another five years -- what will Europe look like then, in your opinion?

Voth: I can imagine a world where there will a left-over euro: with France, Italy, the Mediterranean countries, perhaps Belgium as well. Apart from that the old Deutschmark zone will return, comprising Germany, Austria and the Netherlands, perhaps Denmark as well, perhapsFinland, which have no problems conducting the same monetary policy as Germany. We had a similar system during the European Exchange Rate Mechanism ERM. That was the optimal system, and then we gave it up for the euro. Der Spiegel

Wednesday, January 14, 2015

There are two futures: NHS future now!

As the sun sets and it was clear that we have lost the first privatised NHS hospital :

©2014 Am Ang Zhang

Hinchingbrooke - why did England's privatised hospital deal REALLY collapse?

CAROLINE MOLLOY 14 January 2015

Hinchingbrooke - the flagship of NHS privatisation - was given the CQC’s worst ever rating for ‘caring’. Both safety and leadership were also bottom of the heap. Circle’s cleverly branded ‘mutual’ model, far from ‘liberating’ NHS professionals’ to make grassroots-led improvements, had in fact replicated some of the worst hierarchical, bullying practices to be found in the NHS. And it had lost the caring and expertise that are the NHS’s strengths, principally as a result of poor leadership and financially-driven staff cuts to satisfy investors.

But does that mean privatisation is dead?

No. Too many have staked their careers - and their fortunes - on it, for them to back off that easily.

No-one who understands the NHS has ever really expected the private sector to make profits from running full service hospitals with A&E departments.

Just as opponents to the Health & Social Care Act pointed out, what the private sector really want to do is cherry pick, taking the government money to run all the predictable and easy stuff - starving the rest of the NHS of funds as a result.

But the government had to pretend otherwise, to get through the Health & Social Care Act, and Ali Parsa's hyperactive hyperbole was very useful during those turbulent months.

“Forget the cherries - give us the potatoes” Ali Parsa told the Times in November 2011 on winning the contract. That years’ business plan set outgrand visions of Circle taking over 20 or more hospitals across the country. Parsa even told Newsnight "We would love to run a major teaching hospital".

But Parsa left at the end of 2012 for pastures new - his PR job done. And with the Act secured, and former Vice President of US healthcare giant United Health, Simon Stevens, now at the helm of the NHS, private health companies see better profits (and less brand damage) than openly taking over full service hospitals, as Circle’s statement on Friday hinted:

If doctors running local Clinical Commissioning Groups won’t hand over the NHS cash, there’s various ways decisions are being quietly wrenched away from them, from ‘commissioning support’ and ‘personal budgets’ to ‘chain hospital networks’, ‘Kaiser-style integration’ and ‘prime contractor’ models.

All of this will help companies like Circle sort the cherries from the potatoes.

And if the tariffs paid for many treatments are currently too low to squeeze a profit from, well, it's only a waiting game till the cherry picking undermines the NHS to the point the private sector providers can start flexing their muscles and demanding more money.

It's already starting.

In nearby Bedfordshire, Circle recently won a huge ‘integrated’ ‘prime contractor’ contract for all musculo-skeletal services in the area - and promptly tried to sub-contract the undesirable bits back to the NHS on Circle’s own terms. As the local NHS hospital told the BBC, “Our concern is that if we don't have the planned work coming through, then with the way the NHS is financed, we don't know whether we will have sufficient money to provide the emergency service.” Recent reports suggest Bedford Hospital is now in severe financial difficulties.

A little further afield in Nottingham, Circle runs the largest Independent Sector Treatment Centre in Europe, having pulled off an eyebrow-raising deal to force the NHS to pay it £42 million to buy its clinic in the hospital grounds, then lease it back to it. Circle then continued to expand, recently successfully bidding to take over the hospital’s routine NHS dermatology services - to thedisgust of the doctors who left rather than be transferred to Circle. Now, the local NHS hospital is closing its acute dermatology services too, because it can’t afford to provide only the more expensive dermatology services Circle doesn’t want. Patients will be forced to travel ever further afield for anything more complicated or less profitable.

Hinchingbrooke, As it failed I am putting out my future blog again:

The future is now!!

“There are two futures,

the future of desire and the future of fate,

and man's reason has never learnt to separate them.”

J. D. Bernal, Professor of Physics, Birkbeck College, London, FRS ( 1901—1971)

Scenario 1: Grandpa, why didn’t you save the NHS when you were Prime Minister?

But, why, we had enough money; you do not need the money like some third world leader?

But why did you let the private firms get in. All the papers and bloggers were warning you?

I know you did buy the hospitals back, but at what cost.

Hindsight? It is not hindsight, everybody was saying it.

Scenario 2: Grandpa, you were great. You listen to your own advisers from King’s Fund, and the bloggers and you stopped privateers taking over any health care.

No, the privateers only want to sell the land, float the hospitals and make money and leave. Many are not from here.

We had enough money and you do not need a job from them when you are not Prime Minister.

Lets enjoy the sunset.

Circle

LONDON -(Dow Jones)- Circle Holdings PLC, an employee co-owned healthcare provider, said Wednesday it plans to float on AIM June 9.

MAIN FACTS:

-Circle is 50.1% owned by the Company and 49.9% owned by the Circle Partnership which is 100% beneficially owned by Circle's clinicians and employees.

-Circle's objective is to redefine secondary healthcare delivery in the

U.K.

Guardian:

Circle’s CEO, ex-Goldman Sachs banker Ali Parsadoust set out his view that the NHS is “an unsustainable industry” that costs too much to run. “In his view, Britain has world class retailers, telecoms and financial services firms, as these sectors have been opened to competition over the past few decades,”

Really?

Retailer:

The collapse of national retailer Focus DIY has sparked a fresh wave of attacks on private equity firms as details emerged of a decade of deal-making and financial engineering in which buyout specialists shared payouts of nearly £1bn.

An analysis by the Observer has found that one private equity firm, Duke Street Capital, which made an initial investment of £68m in 1998, took £700m out of Focus after presiding over a series of capital and debt restructurings that turned the small Midlands-based chain into a DIY giant with sales of £1.5bn. Apax, its investment partner, which put in £120m, pocketed £183m when the Wickes chain was carved out in a £950m deal that ultimately left the remnants of the chain struggling.

Telecom:

Really: BT’s Pension Is Everybody’s Problem

BT’s pension trustees are going to court to find out if there really is a crown guarantee covering a large portion of the company’s £40 billion pension fund.

They’re asking: if the company goes bust, will the government (and the RBS-owning U.K. taxpayer knows what that means) step in to plug any gap in funding for the thousands of pensioners who were in the scheme in 1984 when Margaret Thatcher was waving her privatization wand.

Financial Services Firm:

Goldman Sachs:

Goldman Sachs has been fined £17.5 million by the FSA for not letting it know that Fabrice Tourre, a trader who moved to Londonfrom New York in 2008, was being investigated by the U.S. Securities and Exchange Commission.

Goldman is a bad, bad boy. But if you think the firm is the only to be blamed in this game, think again.

On the Goldman side, what else can we expect from the firm that has already admitted making a bigger mistake in the same case? To refresh the memory, the firm agreed to pay $500 million in July to settle SEC civil charges that it duped clients by selling mortgage securities that were secretly designed by a hedge-fund firm to cash in on the housing market’s collapse. The firm didn’t admit to, or deny the charges, but it acknowledged it made a “mistake” by not disclosing to investors the role of the hedge fund, Paulson & Co.

Ali Parsadoust was with Goldman Sachs.

Circle Latest

Backed by some of the City's most powerful hedge fund tycoons and run by former Goldman Sachs vice-president Ali Parsadoust, Circle was selected in November as the first private company to run an NHS hospital. But with losses of over £27.4m, according to accounts filed at Companies House last year, Circle recently lost two lucrative contracts with the NHS worth £27m, representing more than 42% of its £63m turnover.

Looks like some clever Financial manouvres!!!

Best money is government money: our money!

Guardian again:

Caring for vulnerable older people is a statutory obligation under the 1948 National Assistance Act and is exercised on a means-tested basis through local authorities. The National Health Service and Community Care Act 1990 allowed councils to farm out care to any willing provider.

The big companies moved in, including Southern Cross, buying up small care companies or building new homes. As they grew, private equity firms started to show an interest, among them the US firm Blackstone Capital Partners. Investors, when they look at a home full of older people, see a stream of guaranteed income, most of it from local authorities and underpinned by the 1948 legal requirement to provide care. Since the elderly population is rising, investing in care looked like a one-way bet for long-term profit.

Money can be made by separating the income flows from the actual business of care and packaging them as saleable investment instruments – securitisation. Blackstone took control of Southern Cross in 2004 from another private equity firm, West Private Equity. Significantly, that year it also bought NHP (Nursing Home Properties), whose business included leasing care homes to providers (Southern Cross was its biggest tenant) and turning the resulting rental income into high-yield bonds to be sold to investors.

Blackstone floated Southern Cross on the stock market, selling up in 2007. It also sold NHP to an investment fund, Three Delta, with controversial upward-only rental agreements with Southern Cross. This has left Southern Cross with an annual rent bill of around £240m.

Latest: Southern Cross

From one of your own advisers: Prof Chris Ham

Parliament debate: Public Bill Committee

Chris Ham"May I add something briefly? The big question is not whether GP commissioners need expert advice or patient input or other sources of information. The big problem that we have had over the past 20 years, in successive attempts to apply market principles in the NHS, has been the fundamental weakness of commissioning, whether done by managers or GPs, and whether it has been fundholding or total purchasing."

Developing integrated care in the NHS: adapting lessons from Kaiser

“………The barriers include government policies that risk further fragmenting care rather than supporting closer integration. Particularly important in this respect are NHS Foundation Trusts based on acute hospitals only, the system of payment by results that rewards additional hospital activity, and practice based commissioning that, in the wrong hands, could accentuate instead of reduce divisions between primary and secondary care.”

Cassius:

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

But in ourselves."

Julius Caesar (I, ii, 140-141)

Hinchingbrooke, this is their timeline of how the hospital was put up for tender:
July 2007 – Department of Health gives the Strategic Health Authority approval to examine different options, including franchises.

July 2009 – Department of Health approves the business case for an open competitive tender for a franchise.
October 2009 – Open competitive tender announced and 11 organisations submit bids, six are selected to move to the next stage. Of those six, only one was NHS-only: Addenbrooke’s in Cambridge. Circle say there was no mention of a preferred provider at any point in the tender.
February 2010 - Addenbrooke’s pull out of the bidding process.
March 2010 – Shortlist for the franchise announced: Serco, Ramsay and Circle. Serco’s bid did include a partnership with Peterborough NHS Trust.(May 2010 – General Election in which Labour leaves office)August 2010: shortlist narrowed to the final two: Serco and Circle.
November 2010 – Circle announced as preferred bidder.
November 2011 – Contract signed with Circle, which began work in February 2012.

Mayo Clinic: Health Care is not a Commodity!!!

NHS-Kaiser Permanente: A Class! Seriously!

NHS 1978: Hope, Faith & Supermarket

Links: People, Patients, Privatisation, Profits and the NHS at HyperCRYPTICal

It Could Be Fatal at Bad Medicine

Friday, January 9, 2015

Bells toll for Greece or Circle?

Blame?

Detailing examples of “poor care provided to patients”, it said patients who lacked the capacity to consent had been sedated on medical wards, despite no “best interest decision” about their treatment having been taken. “The use of sedation without best interest decisions in place can be classified as restraint or a deprivation of liberty safeguarding concern,” said the letter sent to the hospital chief executive, Hisham Abdel-Rahman.

Inspectors who visited between 15 and 18 September also encountered examples of staff caring for patients in an “undignified and emotionally abusive manner”.

Standards of handwashing among staff in the A&E department and some wards were “very variable”, the letter said. It cited “an incident whereby staff failed to follow handwashing guidance after seeing to a patient isolated for C difficile”.

Blatant? Guardian

Hunt is likely to face pressure in parliament next week after the damning CQC report. It said that some children arriving at A&E were left “potentially unsafe” at times because of a lack of specially-trained paediatric nurses both there and in some operating theatres, while patients told inspectors of a poor response from nurses if they rang their bells, especially at night. Drinks were found to have been left out of reach of patients, even after inspectors had pointed that out.

“Our inspection at Hinchingbrooke Health Care NHS Trust highlighted a number of serious concerns, surrounding staffing and risks to patient safety, particularly in the A&E department and medical care. There were substantial and frequent staff shortages in the A&E department”, said Prof Sir Mike Richards, the CQC’s chief inspector of hospitals. Other failings related to the way the trust was run and led, he added. For example, “both the Circle management team and the trust board told us that the other was responsible for holding the trust’s executive team to account”, the CQC said.

Bribery?

“@HSJnews: Exclusive: Hinchingbrooke backtracks on controversial £50 referrals offer http://ift.tt/1z8ey16"

Guardian latest:

Hinchingbrooke hospital will be placed into special measures after a report by the Care Quality Commission (CQC) revealed a catalogue of serious failings at the privately run hospital, including in its A&E unit, which put patients in danger and delayed their pain relief.

Circle, the private company in charge of Hinchingbrooke, told the London Stock Exchange earlier that the CQC’s report was one of the reasons it was pulling out of running the hospital.

The CQC was scathing about the hospital, rating it as “inadequate” overall, and specifically for patient safety, displaying caring towards patients, and leadership.

So did Bevan strike: Bell tolls for Circle a bit before Greece!

Most of us do not realise how brilliant those people that have worked at Goldman Sachs are:

Antigone managed to help Greece "relocate" their debt before they entered the EU. In the business world, Antigone or Addy was highly regarded:

"A defiant Goldman Sachs says it did nothing wrong by concocting a deal that temporarily masked Greece's bloated government debt, an arrangement that has sparked outrage across Europe."

Now Ali Parsa is from the same Goldman Sachs stock and he is either altruistic or very smart & has done the unthinkable of "buying" a failing NHS hospital. "Buying" is perhaps wrong as he is smart and will not do anything like that. There were little if any detail about the deal but knowing someone with a Goldman background, the government would not be a match at all as far as the contract goes. But then the government was not that good with ISTC or PFIs.

For Hinchingbrooks to succeed it must do more cases and yet CCGs are suppose to cut referrals to hospitals. Ali Parsa must know that and my assumption is that it will not happen with Hinchinbrooks. Being private means we the public cannot access the details of the deal.

Another smart move then.

But perhaps they too were smart as it is one means for the ruling class to secure their future and ration health care at the same time. Sorry---getting GPs to ration Health Care

After all Greece still has more Porsche per capita if you must know and most of their rulers' money are safe in Switzerland.

To say the Circle is the John Lewis of Health Care is indeed a blatant insult to that much loved high street store. John Lewis had no Cayman connection and Circle is not fully 100% employee co-owned.

But Circle is really a first step by our government to COVERTLY ration HEALTH CARE. Canada is doing it using waiting time and so are many western and indeed eastern countries.

The distraction of the current NHS Reform is to allow the debate to be focused on Primary Care.

That has now changed thanks to Circle.

Please everybody it is about Consultants & Secondary 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.

According to the NAO:

In 2009 the total value of the market for PH(Private Healthcare) in the UK was estimated at just over £5.8 billion. Private hospitals and clinics account for the largest part of the overall PH market, generating an estimated £3.75 billion in revenue during 2009. Fees to surgeons, anaesthetists and physicians generated an estimated £1.6 billion in 2009.

The total number of UK citizens with Private Insurance is estimated to be around 90,000. It is not difficult to work out what good value the NHS has always been.

The NHS was not perfect, far from it and yet successive attempts at fixing it has produce the opposite effect: it needs more fixing.

If you read that line again from the NAO report, it was clear where the problem was: fees to surgeons, anaesthetists and physicians!!!

Yes, that was the main recipient of Private Health income.

To become a Consultant in the NHS used to be prestigious and even those aiming to doing mainly private work will have to wait till they achieve Consultant status in the NHS.

The NHS for all its sins tried to keep every consultant as close to the MAYO ideal by insisting on the same pay-scale.

Several levels of Distinction Awards were used to keep some professors and top consultants happy. Later the name of the Awards was changed and yet it was still the same soup.

If Consultants were prepared to give up one session of pay, then there is no limit as to the private work they can take on. It was a safe way to start your private work and you keep the rather nice NHS pension.

What is generally not talked about is that you keep one foot in your NHS hospital and one in your private one.

So far so good and yet this is where the problem starts.

It does not need a genius to work out that people worry about their health and do not want to wait for a suspicious lump to stay in their body too long. They will pay. We need not even mention the manipulation of waiting lists, etc. Then big companies realise that they can attract staff by offering Health Insurance and the rest is as they say history.

Then the rules changed and every consultant can do a maximum of 10% of their NHS pay in private work without having to give up anything. Some hospitals even allow you to use their facilities for a small fee.

Why not, more private patient means less expenditure for the NHS.

Private Insurers discovered that too and they started offering a small fee if you can wait for your operation at your free NHS hospital.

There has never been any control of Health Insurers and I suspect if was not even because they have a strong lobby: just the feeling that the NHS was for everybody so no one could be excluded.

But Health Insurers are cleverer, they exclude chronic conditions, many psychiatric ones belong to that group and often they will exclude after a while.

So, indeed it was a clever move by the present government to simply hand over a portion of money to the GPs and say: get on with it, the best price or better still, why not treat them yourself. You are all doctors, forgetting one of their own just had neurosurgery done at Queen Square.

Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.

There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.

How else could the government continue to claim that competition will improve standard and bring down cost.

Private or NHS, they are the same Surgeons, Anesthetists and Physicians. Yes, the same consultants. Only in Private Hospitals you may get free cappuccinos.

It is so simple: Private Providers need to make a profit so there is going to be less money for patient care, not more.

Mark Porter: Chairman of the British Medical Association's consultants committee.

NHS services in some parts of England could be "destabilised" by private firms taking advantage ……….to win contracts for patients with easy-to-treat conditions. This could lead to some hospitals no longer offering a full range of services and ultimately having to close.

The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.

The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.

The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porter. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.

Clare Gerada:

"Like blood, health care is too precious,

intimate and corruptible to entrust

to the market"

Greek Gods & Euro: Bevan Curse ...

Guardian: Circle Health admits care may suffer.

NHS & Market Forces: Fund Holding & Medical Ethics