Thursday, April 7, 2016

Simon Stevens: Tannhäuser & Vanguard!


Tannhäuser is opening at Covent Garden in the spring.


©2015 Am Ang Zhang 


The thing that hath been,
it is that which shall be; and that which is done is that which shall be done:
and there is no new thing under the sun.

Ecclesiastes 1:9



Last summer’s entertainment has been that of the alleged ritualistic sexual activity of some well known politician.

Why should so much media time be wasted on such matter or was it a deliberate distraction from something more important?




Tannhäuser in the kingdom of the goddess Venus, by Henri Fantin-Latour. Photograph: akg-images

The sexual exploits of the elite Parisians were no different to that of modern day politicians:

Wagner's decision to place the obligatory ballet in the opening scene also offended the influential Jockey Club, whose members were in the habit of arriving at the interval to see their mistresses dance before going backstage for sex. By the third night, dog whistles could be bought in the streets outside the Opéra for the express purpose of interrupting the performance.


But what is most important is the new NHS Vanguard:

Without new legislation or public debate a new NHS is happening or so we thought. The Cockroach Catcher wrote on September 7 2015:

Simon Stevens spent some years in the US. Is Vanguard a re-working of Kaiser Permanente?


I have always admired Simon Stevens and his ability to quickly picked some of the best loved people in the NHS to promote Vanguard. The like of which has not been seen in any State run change since Bevan. But Vanguard is going to mean a good deal more than we were led to believe. I suspect that the people working for him are either not aware or they were told not to divulge it. Like Steve Jobs, the smartest people keep their main aim to themselves. He has picked the people that were very savvy with Social Media and that part of the NHS is exploding with little reference to the plight of Junior Doctors or the bribery of GPs. Nothing should distract now! But is everything about Vanguard new inventions of Simon Stevens?

Remember:
The thing that hath been,
it is that which shall be; and that which is done is that which shall be done:
and there is no new thing under the sun.

Ecclesiastes 1:9

Lets see what Bloomberg say:
BRITISH EXPERIENCE

UnitedHealth followed up on June 30 with another report for lawmakers pinpointing $332 billion in savings through better use of technology and administrative simplification. If enacted, those changes would potentially benefit UnitedHealth's Ingenix data-crunching unit. Ingenix, with annual revenue of $1.6 billion, is poised to establish a national digital clearinghouse to ensure the accuracy of medical payments and provide a centralized service for checking the credentials of physicians.

Stevens, an Oxford-educated executive vice-president at UnitedHealth, once served as an adviser to former British Prime Minister Tony Blair. In that capacity, Stevens tried to fine-tune the U.K.'s nationally run health system. Today he tells lawmakers that theU.S. need not follow Britain's example. Concessions already offered by the U.S. insurance industry—such as accepting all applicants, regardless of age or medical history—make a government-run competitor unnecessary, he argues. "We don't think reform should come crashing down because of [resistance to] a public plan," Stevens says. Many congressional Democrats have come to the same conclusion.

UnitedHealth has traveled an unlikely path to becoming a Washington powerhouse. Its last chairman and chief executive, William W. McGuire, cultivated a corporate profile as an industry insurgent little concerned with goings-on in the capital. From its Minnetonka(Minn.) headquarters, the company grew swiftly by acquisition. McGuire absorbed both rival carriers and companies that analyze data and write software. Diversification turned UnitedHealth into the largest U.S. health insurer in terms of revenue. In 2008 it reported operating profit of $5.3 billion on revenue of $81.2 billion. It employs more than 75,000 people. 

Stevens argues that while UnitedHealth will likely benefit financially from health reform, the company will also aid the cause of reducing costs. He cites what he says is its record of "bending the cost curve" for major employers. 

During a media presentation in May in Washington, Stevens said medical costs incurred by UnitedHealth's corporate clients were rising only 4% annually, less than the industry average of 6% to 8%. But that claim seemed to conflict with statements company executives made just a month earlier during a conference call with investors. On that quarterly earnings call, UnitedHealth CEO Hemsley conceded that medical costs on commercial plans would increase 8% this year. 

Asked about the discrepancy, Stevens says the lower figure he is using in Washington represents the experience of a subset of employer clients who fully deployed UnitedHealth's cost-saving techniques, including oversight of the chronically ill. "These employers stuck at it for several years," he says. "We are putting forward positive ideas based on our experience of what works."

Now 4 days later Steven Carne in Open Democracy:

And Stevens' PACS (part of Vanguard) are explicitly modelled on San Francisco's Kaiser Permanante’s Accountable Care Organisation model (a latter development of the American HMO model)- despite US concerns about restrictions on which patients can be treated where, long wait times, and still high costs.

I asked a friend in California recently what Kaiser were like. She smiled, “Oh they're great! ‘Til you get sick”. Their focus on prevention and health resilience belies a reluctance to provide full health care that might cost shareholders their profit. Only a top-up payment plan will see you in the real hospital.

SNAP.

England has never seen anything quite like this:
Steven Carne again:

This dishonest vocabulary aims to fool the public into supporting a host of dubious changes. It relies on a counterpoint image of a desperately archaic NHS, crumbling in an inevitable apocalypse of overweight aging diabetic bed blockers who really should know better and die in their own beds – “Care Closer to Home”.
It glosses over the fact that public funding is being withheld (and wasted on market bureaucracy).
The manipulative buzzword bingo tries to persuade us that when we take part in their endless focus groups, petitions and surveys, we are helping the ‘struggling’, ‘failing’ NHS to meet the ‘challenges of the 21st century’.
It hides the fact that private corporations are moving in and setting the agendas. It hides the fact that behind the trusted blue square of the NHS logo, private health and insurance firms are already operating, mostly unseen by the public.
At a recent event we were given another buzz phrase. “Be the Change You Want to Be...”
We are learning as quickly as we can. But the actions and spin of NHS England and the corporate health, insurance, technology and pharma companies are bewildering and confusing to those of us trying to keep up. Just as we’d begun to get our heads around 2012’s Clinical Commissioning Groups (CCGs) and Commissioning Support Units (CSUs), new NHS boss Simon Stevens’s Five Year Plan ushered in a new layer of jargon and organisational spaghetti – Primary & Acute Care Systems (PACS) and Multidisciplinary or Multispecialty Health Teams (MHTs).

If you read it thinking it made any sort of reasonable sense - then we need to worry.

One of the key weapons being used against the NHS, public and campaigners is the growing misuse of socially minded vocabulary and community development buzzwords.

You’ll all have come across them. Engaged, participatory, resilient, empowering, co-produced, personalised, sustainable….

You’ll find these buzzwords all over the NHS, mixed with a dash of new age personal therapy speak borrowed from the West Coast of America (as we’ll see shortly, there are other imports from the West Coast, too).

……. This dishonest vocabulary aims to fool the public into supporting a host of dubious changes. It relies on a counterpoint image of a desperately archaic NHS, crumbling in an inevitable apocalypse of overweight aging diabetic bed blockers who really should know better and die in their own beds – “Care Closer to Home”.

It glosses over the fact that public funding is being withheld (and wasted on market bureaucracy).





The thing that hath been,
it is that which shall be; and that which is done is that which shall be done:
and there is no new thing under the sun.

Ecclesiastes 1:9


Book I am reading:
.... Kandel is not just one of the most important scientists of our time – he’s also an omnivorous public intellectual, deeply knowledgeable about everything from German art to the history of psychoanalysis. In his marvelous new book,The Age of Insight, Kandel puts this learning on display. He dives into the cultural ferment of 19th century Vienna, seeking to understand why the city was such a fount of new ideas, but he also explores the neuroscience of aesthetics, attempting to explain why some works of art, such as Klimt’s “Adele Bloch-Bauer I,” continue to haunt us. In many respects, the book imitates those famous Viennese salons, in which artists, scientists and doctors exchanged ideas and gave birth to a new way of thinking about the mind. (The city was a case-study in consilience.) If you’re interested in the intersection of art and science, the book is a must-read.

NHS-Kaiser Permanente: Integration or Fragmentation?

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