NHS & The Elite: Community & Specialist Hospitals!

In Hong Kong, we do not have State funded GP services but there are State funded public hospitals where you get top quality treatments. In Singapore, public hospitals are not free but the poor that are on Social Security will have their fees waived. Singapore public hospitals are so well run that most prefer to go to them for major illnesses. 

                                                                                           

Singapore Health Care: Best Public Hospitals!

The truth is that medical tourists do not come for the 

GP services 
we provide, they come 
for 
the cutting edge medical procedures.

The Elite

Zebra in fact belongs to the same family as the horse (Genus Equus) but unlike the horse has never been domesticated. It is believed that the stripes in a herd is protective as many animals merge together and thus appeared larger.     

National Geograhic

There is now a new plot on the horizon: Persuade people that they only need community hospitals near them to be run by Primary Care and they may not even be doctors.

 

This way the punters might be tricked into not going to Hospital A&Es but Urgent Care Centres at these locals.

 

Really.

 

Punters would not be punters if they are that stupid.

 

No matter; as we will close A&Es and even their hospitals.

 

Why?

 

It is the one big drain on NHS spending and it cannot be controlled. We can pay GPs if they do not refer but self referrals to A&E is now the norm.

 

A reprint:

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.

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.

                                                                       All photos ©2012 Am Ang Zhang

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. 

 

Privateers

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

So do you really think that hospitals are not necessary, or not necessary for the average citizen of England. Soon they will be sold and it will be costly to buy them back.

What about medical training? If these hospitals are sold, who pays?

And watch out, someone, your parent, your spouse, your child and even your MP may need a Hospital Consultant one day. 

Do we still have those: yes we do!  See here>>>>

In London alone these are specialist hospitals that are famous the world over:

Royal National Orthopaedic Hospital

National Hospital for Neurology and Neurosurgery

The Royal Marsden NHS Trust

Royal National Throat, Nose and Ear Hospital

St Marks Hospital, Harrow

King's College Hospital NHS Trust

The Maudsley Hospital

Great Ormond Street Hospital NHS Trust

Then there is Papworth. Need I say more!!!

I know that when you visit them nowadays, these places seem to be full of: non locals. Or could it be that these are now the new locals, I doubt as you can sometimes see the lovely foreign plated cars parked outside them. If I am wrong, I do apologise.

The truth is that medical tourists come not for the GP services we provide, they come for the cutting edge medical procedures and in England, it is also about value for money.'

So, opening up many of these rather precious hospitals for up to 49% private will mean a severe reduction in actual medical times available to NHS patients.

That is why: the pretending is over. No, at the end of the day it will not be the medical care you can get from your GP or Noctors, it will be well trained specialists with up to date complex procedures that you or one of your relatives may need!

Save the NHS: Control Health Insurers!

Government can have the power to control Health Insurers thus allowing those that like to have free Cappuccinos when waiting for their Medical Consultation. And make sure if the Privateers mess up and NHS had to take over, they pay. 

©1994 Am Ang Zhang

It must be very obvious that all the talk about medical cover for visitors to England never mention the need for health insurance.

Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US where cost of medical care is extremely high.

It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US without proper insurance.

We have managed to get people to insure their cars, why not their bodies.

There is of course the need to fully control Health Insurers for those that live in England if they want cover. 

Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing. 

Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.

©1994 Am Ang Zhang

If we are not careful Private Insurance will creep into England without a single bit of control as it is singularly important to stop Insurers to reject those with pre-existing conditions or dump them once they have a chronic illness such as Type 1 Diabetes. 

NHS is going Dental, not Mental!

Patients could have to start to pay charges to use basic NHS services such as GPs because the health service’s finances have become so dire, the leader of Britain’s doctors has warned. 

Dr Mark Porter, the head of the British Medical Association (BMA), said that whoever takes office after the general election will inevitably be tempted to bring in charges and may not be deterred by the unpopularity of such a seismic change to the health service.

....“You say it’s politically toxic. It’s not, really, is it? Look at dentistry and look at social care. They carry with them exactly the same offer to the public by which the NHS was set up; that we will remove from you – this society, us acting collectively – the terrible fear of bankrupting yourself by having an illness, by needing healthcare.

“And yet we allow people to be bankrupted by social care and we allow people to be deterred from seeking dental care because of charges,” Porter said.

Can we think of ways round this?

There is little doubt that a system based on insurance will need smart legislation to control the insurers. If the NHS is going to make use of wealthier individuals to use Health Insurance, then the same smart laws will need to be enacted for the regulation of Insurers. We should have learnt through the banking failures that in business, there is no such thing as self regulation.

Here are some things the law will do:

·         It will prohibit insurance companies from refusing to sell coverage to people simply because they have one or more pre-existing conditions.

·         It will also prohibit them from cancelling our coverage when we get sick just to avoid paying for our care.

·         It will prohibit insurers from charging women more than men for comparable coverage and will not allow them to charge older folks more than three times as much as younger folks.

·         It will require them to spend at least 80 percent of what we pay in premiums actually paying claims and improving care.

·         It will allow young adults—who comprise the largest segment of the uninsured—to stay on their parents’ policies until age 26.

 

Summary of a popular post:

·                     Ends discrimination against people with pre-existing conditions.

·                     Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.

·                     Limits premium discrimination based on gender and age.

·                     Prevents insurance companies from dropping coverage when people are sick and need it most.

·                     Caps out-of-pocket expenses so people don’t go broke when they get sick.

·                     Eliminates extra charges for preventive care.

·                     Contribute to an ABTA style cover in case Insurance Companies go bust and many might.

We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.

Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital.

This will eliminate problems like PIP breast implants.

It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.

To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.

Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!

In fact, to save money, government can buy insurance for the mental patients and the chronically ill.

This way there will be real choice and insurers will be competing with each other to provide the worst deal.

Why?

What Health Insurer will want the business? 

Perhaps they will go back to the US and we will have our own NHS back.                                                                                   

Trauma and Human Resilience: II

Part 1: 

 Trauma and Human Resilience

 View from World Trade Center © Am Ang Zhang 1994

         Then came September 11. I remembered I was on holiday in Spain when it happened. I had just finished golf. I put my clubs away and went to the club house for a drink with my playing partners. As I approached their table, I sensed that something was wrong. There were no drinks.

         Then one of them said, “One of the World Trade Centre Towers is down!”

         I was trying to see if I heard right.

         “In New York?”

         “New York.”

         Then moments later, the Spanish waitress came out and said to us, the second tower was down too.

         I rushed back to our villa and shouted to my wife to turn on CNN and tried to contact our children, one of whom worked in Manhattan.

         Lines were dead.

         Luckily, an Email came through our other daughter who was in England: Sis OK, at a meeting on 55th Street. Now trying to walk home to Brooklyn.

         What a shock.  Unlike my parents’ generation we have had a long period of peace and prosperity but now everything was shattered.

         The following day my office put a call through and I talked to my Associate Specialist.

         The clinic just had an urgent referral. A local girl was referred. Very disturbed by what happened as one of her father’s good friends was one of the pilots whose plane went down. The family spent many holidays with them in their Florida home and she was now most upset.

         “Whatever you do, by all means talk to the parents but not to the girl. No one should see her. They should not turn on the TV and avoid any reminder of what happened.”

         I then nearly said, “Give her Vodka, Gin or similar,” but I did not.

         I gave the next best thing.

         “Put her on a short course of Benzodiazepine to let her sleep for a few days.”

         It shocked my Associate Specialist. It was not a drug I normally used, if at all, and why now?

         Well, whatever happened, all I could say was that the family was in total agreement and months later my Associate Specialist told me that it was brave of me but it seemed to have worked for this girl.

        

        

         In July last year I met a young couple at the swimming pool of our holiday condo. I thought they were Chinese but it turned out they were Vietnamese Chinese.

         We started chatting. He said he left Nam (Vietnam) on the last day.

         Jokingly, I said, you mean you were on the Helicopter?

         “Yeah, how did you know?”

         “You looked too young to be working for the Embassy.”

         “My mum worked there. But my story was nothing, you should hear hers.”

         His wife, an elegant looking petite Chinese swam closer.

         “So, tell me.”

         Well, she came out later. Her mother put her and four sisters on a junk (a Chinese fishing boat), one of those that took refugees out of Nam for an exorbitant fee and generally it had to be gold. Their boat sank outside Hong Kong but they swam ashore. She spent the next three years in one of the Hong Kong camps.

         “Yes, I remember those.”

         “I know - the stench. We got used to it.”

         Those camps were run under the auspices of the United Nations but the UN never really paid Hong Kong a single dollar. However that is beside the point. Conditions were very poor and one could hardly decide if it was Hong Kong’s or UN’s fault. Every time we drove past it was like passing a local authority rubbish tip. We had to wind up the windows. Yet there were politicians who felt they needed to keep it bad to deter people. They continued to flow in right up to the handover. As it was still under British rule, Britain tried its best to keep people from going to Britain. They needed not have worried. Most wanted to go to U.S. An irony really.

         I said something that sounded like an apology, an apology for Hong Kong, and for mankind.

         “No. It’s fine. I am not bitter. We waited and we got to the U.S. There was nothing you could have done anyway.”

         She told me someone suggested that she should have some therapy. She never did.

         “Some things you can never change. If it happened it happened.”

         But she managed to get most of her family out of camps and settled in the US. She was very successful in her business and her only regret was that her parents never made it.

        

         What a story of human resilience and triumph over adversities.

         And I can still remember that lunch time meeting and the learning from King’s Cross.

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

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

Latest Views on the book:

5.0 out of 5 stars A Must-read for Students of Psychiatry August 10, 2014

By John Yam

Format:Paperback

We all have stories to tell with regard to our experiences as physicians. Zhang is one of our medical school classmates who took it to a different level by writing and publishing a book. The book details how it all started, from the time his family moved to Hong Kong from China, to his years in medical school, to his experience as a child psychiatrist in the UK. The book is full of interesting case studies of actual patients he saw and the challenges he faced dealing with them.
I was captivated by many of the interesting stories in the book. It’s a must-read for all students of psychiatry. It also makes for good reading material for anyone during their leisure moments.

From another doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice (including me giving up private practice and my wife giving up a promising administrative career ) paid off.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.

From Australia:

I have finished reading The Cockroach Catcher and thoroughly enjoyed it.

Zhang, I particularly liked the juxtaposition and paralleling of your travel stories and observations with your case studies, Of course, I could appreciate it even more, knowing the author and hearing your voice in the text. Because I’m dealing with anorexia, ADD and ADHD students I was very interested in your experiences with patients and parents and your treatment. Amazing how many parents are the underlying causes of their offspring’s angst. It was an eminently readable text for the medically uninitiated like me. Keep writing, Zhang

Review on Amazon

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