David Cameron & NHS: Lenin & The Lives of Others

Please do not listen to Beethoven’s  Appassionata.

Maxim Gorky wrote about Lenin listening to Beethoven's Appassionata:

“I know of nothing better than the Appassionata and could listen to it every day. What astonishing, superhuman music! It always makes me proud, perhaps naively so, to think that people can work such miracles! 

“Wrinkling up his eyes, Lenin smiled rather sadly, adding: ‘But I can't listen to music very often. It affects my nerves. I want to say sweet, silly things and pat the heads of people who, living in a filthy hell, can create such beauty. One can't pat anyone on the head nowadays, they might bite your hand off. They ought to be beaten on the head, beaten mercilessly, although ideally we are against doing any violence to people. Hm—– what a hellishly difficult job!”

It was said that Lenin was indeed afraid he would otherwise never ‘finish’ the revolution!!!

Henckel von Donnersmarck said he based his film The Lives Of Others on the Appassionata anecdote. 

The Lives Of Others/Sony

Anyway, The Berlin Film Festival refused to accept it as an official entry.

They stopped listening too!

In 2007, it was awarded an Oscar for Best Foreign Film.

                                                             Berlin Wall, Appassionata & The Lives Of Others

Beethoven’s  Appassionata.

Time Magazine

Times
The Guardian

EBM & Royal Marsden: Private Income Cap & Cancer Survival

There is a good deal of debate on Private Income Cap for NHS Hospitals so I dug out what I have written recently: The evidence is not looking too good Secretary of State as the Royal Marsden was one of the few with a higher than 5% cap and yet England's OECD cancer figures are worst than Slovenia and the Czech Republic. I know that we have many Czech pharmacist over here, but please, Slovenia? 

The Royal Marsden NHS Trust

The first dedicated cancer hospital in the world, founded in 1851, is still the best. With the Institute of Cancer Research, the Royal Marsden is the largest comprehensive cancer centre in Europe, seeing more than 40,000 patients from the UK and abroad each year.

It has the highest income from private patients of any hospital in Britain, testifying to its international reputation.

The Independent:

Royal Marsden seeks wealthy patients as budget cuts bite

Britain's premier cancer hospital plans to boost its income from private patients by 38 per cent over the next two years as its NHS income is squeezed.

The Royal Marsden Foundation Trust, which opened a new, private in-patient wing last month, aims to increase private earnings by almost £9m this year, taking the total to £54m – nearly a quarter of its turnover. It plans a further £8.1m rise in 2012-13.

The figures are revealed in its three-year "Forward Strategy" plan submitted to Monitor, the foundation trust regulator. They highlight efforts made by trusts to maximise income from private sources to make up the shortfall in public funding as the NHS budget 

Very ready for Medical Tourism!!!

What about UK NHS patients:

Telegraph:

A report by the Organisation for Economic Co-operation and Development (OECD) has found that, despite record spending on health care, cancer survival rates in Britain are worse than in Slovenia and the Czech Republic.

Survival rates for breast cancer, prostate cancer and cervical cancer were below the average for the 34 developed countries in the study.

Mr Lansley lays the blame for the poor performance on the previous government’s failure to make sure that extra investment in the NHS reached the front line. He claims patient care was ignored in favour of increased salaries and botched computer systems.

It looks as if somehow our own NHS patients are losing out on the expert knowledge of our colleagues  at the Royal Marsden.

Yet we are going ahead with increasing the caps to 49% to all NHS hospitals.

I have called it a Rashomon moment: Unbelievable! Unbelievable! Unbelievable!

 Rashomon (1950) was made by one of Japan’s top directors Akira Kurosawa when Japan was just recovering from the Second World War. The director even had difficulty finding a horse for a crucial part of the film. I am sure many working in the field of mental health have heard of the Rashomon Effect, although many may not have had the chance to see the film. I used to keep a copy to loan to my staff. The Film, in black and white, was extremely well made and has been hailed by other film directors as near perfect. It just shows how lack of funding does not necessarily mean lack of quality.

Rashomon is fundamentally about truth and subjective truth. At the end of the film you are still not too sure but you have some idea. The story was simple enough:

“This landmark film is a brilliant exploration of truth and human weakness. It opens with a priest, a woodcutter, and a peasant taking refuge from a downpour beneath a ruined gate in 12th-century Japan. The priest and the woodcutter, each looking stricken, discuss the trial of a notorious bandit for rape and murder. As the retelling of the trial unfolds, the participants in the crime -- the bandit (Toshiro Mifune), the rape victim (Machiko Kyo), and the murdered man (Masayuki Mori) -- tell their plausible though completely incompatible versions of the story.”

(from the: New York Times Review: March 1, 2008)

The murdered man was in fact a Samurai who had the task to maintain the honour of the Samurai tradition, even as a ghost. This was to some the most shocking part.

We know people lie: but GHOSTS?

So what is going on? Best cancer hospital in Europe if not the world and the worst figure for cancer survival!

Is this just an excuse to sell off Royal Marsden.

Or did they treat too may foreigners so that the survival figures of their country was better than ours.

If the Royal Marsden cannot help our Cancer doctors, why are we treating so many Medical Tourists?

Or is this the future, or should we become Medical Tourists to other countries.

With the way the government is charging ahead with the Reform, it is difficult to tell who might be telling the truth.

Remember: even ghosts lie!

Rashomon has remained one of the top hundred films ever made. The ending at least gave the poor monk, who probably would have committed suicide or would nowadays be reaching for Prozac or other SSRIs, some hope.

A baby was heard crying. It was an abandoned baby. The woodcutter, who was poverty stricken, decided to adopt and look after this poor baby. He had six children – one more mouth would hardly make much difference.

There is hope in the world still.

National Park & National Health: Lessons?

Yosemite, California, USA © 2007 Am Ang Zhang

USA offers great photo opportunities. This is in part due to the integrated National Park system that has allowed easy & universal access from the days of Ansel Adams to the present.

From the home of Capitalism it is perhaps very telling that it would legislate against any commercial exploitation of one of their country’s most important assets: natural beauty.

Over the course of more than 150 years, a once-radical idea has evolved into a cohesive national parks system, with a sometimes conflicting two part-mission: to make the parks accessible to all and to preserve them for future generations.

Is there anything else we could learn?

Why has the might of McKinsey not been able to privatise some of the US National Parks? Should there not be Time Shares in these most beautiful of places?

Could our National Health Service be like the US National Park?

Providing world class medical care to all and preserving it for future generations!

California has Yosemite and it is also the home of Kaiser Permanente.

It is amazing how planners often overlook the most important aspect of why an organisation such as Kaiser Permanente is a success. We need to now look at why Kaiser Permanente is such a success.       New York Times

Dr Zorro in his latest post: Private practice

The Earl Howe amendment to the Health & Social Care Bill was announced, with perfect timing, just before the Christmas break. This is the amendment to allow English NHS Trusts to raise half their income from private practice. At present only 2% of their funds may be derived privately.

This could be used to insist that you do this work as part of your NHS contract, for your basic NHS pay, while the Trust charges the patient or insurer premium rates for your work, and makes a profit on you.

The alternative is even worse. They could allow consultants to charge these private patients in the traditional manner.

This would be hugely divisive. The almost complete unity of the profession in opposition to the bill would evaporate, as a considerable proportion would suddenly see great potential financial benefit, and switch sides. And we all know how much bitterness, backstabbing and conflict is caused by consultants competing for as big a slice of private pie as they can get their grasping paws on.

Foundation Trusts will be expected to balance books or make a profit. Instead of controlling unnecessary investigation and treatment Trusts would need to treat more patients. This is not the thinking behind Kaiser Permanente and is indeed the opposite of their philosophy. It may well be fine to make money from rich overseas patients, but there is a limit as to the availability of Consultant time. Ultimately NHS patients will suffer. 

The current thinking of containing cost in the NHS by limits set to GP Commissioning will end up in many patients not getting the essential treatments they need and GPs being blamed for poor commissioning.

What perhaps the NHS should not ignore is one very important but simple way to contain cost: salaries for doctors, not fees.

The side effect of the current drive of GP Commissioning is that it would no longer matter if Foundation Trusts are private or not. Before long most Hospital Consultants would only offer their expert services via private organisations. Why else are the Private Health Organisations hovering around!!!

What can GP Commissioners do?

Do exactly what Kaiser Permanente is doing: integrate!!!

Integrate GP and Consultant care. Pay doctors at both levels salaries, not fees! In fact both the Mayo Clinic and the Cleveland Clinic pay their doctors salaries as well as the VA and a number of other hospitals including Johns Hopkins.

Yes, employ the Hospital Consultants; buy up the hospitals and buy back pathology and other services.

Not big enough: join up with other commissioners.

But Kaiser is not without problems:

When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire. In most states’ individual insurance market, insurance companies can retroactively cancel the entire policy if any condition was missed – even if the medical condition is unrelated, and even if the person was not aware of the condition at the time. Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition.

The government and Kaiser may well argue that its not-for-profit status engenders different behaviour. But in the US, the not-for-profits use the same tactics as the for-profits when the environment gets competitive. Kaiser actively seeks younger, healthier members and imposes different rates for employer groups based on their history and risk of healthcare.

Sometimes their competitive behaviour gets them into trouble. The California branch of Kaiser has had cumulative fines of $1.6m, 63% of all the fines levied by the Californian department of managed healthcare. The activities for which they have been fined include denial of care, use of unqualified staff and inadequate staff-patient ratios.                         From:  NHS-Kaiser Permanente: Which Bits?

 

NHS-Kaiser Permanente: Recent Posts

THE NATIONAL PARKS: AMERICA'S BEST IDEA.

It could indeed be:

The NHS: Great britain’s best idea.

Royal Marsden & Rashomon Moments

Yesterday I posted about the various famous hospitals that may be for sale.

The Royal Marsden NHS Trust

William and Catherine meet patient Ellis Andrews at the new Oak Centre

for Children and Young People at the Royal Marsden Hospital. (Kirsty Wigglesworth - Reuters)

The first dedicated cancer hospital in the world, founded in 1851, is still the best. With the Institute of Cancer Research, the Royal Marsden is the largest comprehensive cancer centre in Europe, seeing more than 40,000 patients from the UK and abroad each year. It has the highest income from private patients of any hospital in Britain, testifying to its international reputation.

But then something I saw today gave me a Rashomon moment!

Telegraph:

A report by the Organisation for Economic Co-operation and Development (OECD) has found that, despite record spending on health care, cancer survival rates in Britain are worse than in Slovenia and the Czech Republic.

Survival rates for breast cancer, prostate cancer and cervical cancer were below the average for the 34 developed countries in the study.

Mr Lansley lays the blame for the poor performance on the previous government’s failure to make sure that extra investment in the NHS reached the front line. He claims patient care was ignored in favour of increased salaries and botched computer systems.

 Rashomon (1950) was made by one of Japan’s top directors Akira Kurosawa when Japan was just recovering from the Second World War. The director even had difficulty finding a horse for a crucial part of the film. I am sure many working in the field of mental health have heard of the Rashomon Effect, although many may not have had the chance to see the film. I used to keep a copy to loan to my staff. The Film, in black and white, was extremely well made and has been hailed by other film directors as near perfect. It just shows how lack of funding does not necessarily mean lack of quality.

Rashomon is fundamentally about truth and subjective truth. At the end of the film you are still not too sure but you have some idea. The story was simple enough:

“This landmark film is a brilliant exploration of truth and human weakness. It opens with a priest, a woodcutter, and a peasant taking refuge from a downpour beneath a ruined gate in 12th-century Japan. The priest and the woodcutter, each looking stricken, discuss the trial of a notorious bandit for rape and murder. As the retelling of the trial unfolds, the participants in the crime -- the bandit (Toshiro Mifune), the rape victim (Machiko Kyo), and the murdered man (Masayuki Mori) -- tell their plausible though completely incompatible versions of the story.”

(from the: New York Times Review: March 1, 2008)

The murdered man was in fact a Samurai who had the task to maintain the honour of the Samurai tradition, even as a ghost. This was to some the most shocking part.

We know people lie: but GHOSTS?

So what is going on? Best cancer hospital in Europe if not the world and the worst figure for cancer survival!

Is this just an excuse to sell off Royal Marsden.

Or did they treat too may foreigners so that the survival figures of their country was better than ours.

If the Royal Marsden cannot help our Cancer doctors, why are we treating so many Medical Tourists?

Or is this the future, or should we become Medical Tourists to other countries.

With the way the government is charging ahead with the Reform, it is difficult to tell who might be telling the truth.

Remember: even ghosts lie!

Rashomon has remained one of the top hundred films ever made. The ending at least gave the poor monk, who probably would have committed suicide or would nowadays be reaching for Prozac or other SSRIs, some hope.

A baby was heard crying. It was an abandoned baby. The woodcutter, who was poverty stricken, decided to adopt and look after this poor baby. He had six children – one more mouth would hardly make much difference.

There is hope in the world still.

Paris: Then & Now

Kristin Scott Thomas in Sarah's Key. Photograph: Julien Bonet

As Police in England tried their best to restore order, police in Paris in 1942 were doing something quite different!!!

The Guardian: Vél d'Hiv, Paris 1942: 'These black hours will stain our history forever'

In June 1942, 12,000 Jewish adults and children were removed from their homes in Paris and sent to Nazi death camps. It was the largest mass arrest in wartime France. The film Sarah's Key follows one woman's fight against French society's post-war attitude of silence and denial over its role in the roundup.

The roundup was prepared in great secrecy and involved a massive force of 9,000 police and auxiliaries. But given the scale of the operation it was almost inevitable that news of the impending action leaked to the French resistance and various Jewish organizations. As a result, some were able to escape. But most tamely accepted the police's orders to gather up a few possessions before being bused to the Vélodrome d'Hiver.

The film: Sarah's Key

Right now the Parisians have other things on their mind!!!

The Guardian: French bank shares slump as rumours swirl around Société Générale

Wednesday 10 August 2011

French banks collectively hold more than €40bn of Greek debt, which is almost four times more than any other country. Last week SocGen revealed that its profit for the second quarter fell to €747m, down 31% from a year ago, after a €395m writedown on its Greek debt holdings. SocGen has about €2.65bn worth of Greek sovereign bonds and warned that its 2012 profit target would be "difficult to achieve".

Its shares have lost more than half their value since February and Wednesday's plunge dragged down the shares of other French banks, including BNP Paribas, which fell 9.5%, and Crédit Agricole, which dropped 11.8%.

泥菩薩過江自身難保

A clay Buddha crossing a river----- hardly able to save itself

Berlin Wall, Appassionata & The Lives Of Others

Quantum & M: Penny & Monitor

Metro-Goldwyn-Mayer
Columbia Pictures
On the flight to the US, I saw Quantum of Solace (again) as there was not much else worth seeing. I wanted to look at the Atacama desert. The film missed the fact that it has a very important treasure: lithium. See my previous post.

Also a major part of the film was made in Panama and not Bolivia.


Mathieu Amalric played Dominic Greene, the main villain. He is a leading member of Quantum posing as a businessman working in reforestation and charity funding for environmental science. Amalric acknowledged taking the role was an easy decision because, "It's impossible to say to your kids that 'I could have been in a Bond film but I refused.'” Amalric wanted to wear make-up for the role, but Forster explained that he wanted Greene not to look grotesque, but to symbolise the hidden evils in society. Amalric modelled his performance on "the smile of Tony Blair and the craziness of Sarkozy,"          Wikipedia

But the best bit is in the opening sequence:

Judi Dench as M was told: We have people everywhere!!! 
Then her bodyguard for 8 years turned on her!!!

Thanks to JULIE MCANULTY: A Tangled Web - Who Knows Who in Private Healthcare

 

Looks like they too have people everywhere!!!

This amazing and alarming graph can be found in'The Plot Against the NHS' by Colin Leys and Stewart Player. (Click on the graph to see it full size.) A version to download can be found here.

A quick random check:

Penny Dash:

Penny started her career as a doctor, training in Cambridge and London, and is a member of the Royal College of Physicians. She trained in public health before going to the United States to study for an MBA at Stanford University, where she was a Fulbright Scholar. While at Stanford she worked briefly with Kaiser Permanente.

Penny returned from the United States in 1994 to work for the Boston Consulting Group in London, leading strategy and change projects with blue chip companies.

In early 2000 she joined the Department of Health as Head of Strategy and Planning, working closely with Alan Milburn in the development of the NHS Plan.

From McKinsey Site:

Most recently, she led the work conducted for the Darzi review of London's healthcare system, and supported Lord Darzi in his national review.

Penny is also Vice-chairman of The King's Fund and Founder/Director of the Cambridge Health Network, a discussion and networking forum for over 500 senior executives from organizations working in health.

From 2004 until 2006 she was a non-executive Director of Monitor, the regulator of foundation trusts.

Prior to joining McKinsey, Penny was Head of Strategy for the NHS, during which time she played a lead role in the development of the NHS Plan.

Interesting that both sites did not use Dr but Penny. Penny was of course the nickname of Moneypenny.

NHS & McKinsey: FSA & Monitor

Monitor: Recent exchanges in Parliament

Q 195 Jeremy Lefroy (Stafford) (Con):  I have a couple of questions about the role of Monitor. The first is about the Mid Staffordshire trust into which the Francis inquiry is looking at the moment. It seems to me as the local Member of Parliament that Monitor approved the foundation trust status without going into sufficient detail as to the status of that trust, particularly the quality of care at the time. What assurances can you give us that Monitor’s approval of foundation trusts will be more rigorous in the future than it was in the case of Mid Staffordshire? 

David Bennett: Yes. I was not around at the time, but looking at the evidence, the trust was approved at a time when it was not delivering appropriate care to its patients, and that was wrong. Monitor has done three core things in the light of that, all based on an external review of what happened and why, and therefore what lessons can be learned. First, it has set a clear quality bar. That did not exist before—there was no clear definition of what was an adequate level of safe care for any trust to be providing to be authorised. In conjunction with the CQC and the Department of Health, there is now a clear definition of what the quality bar should be. 

Q 196 Jeremy Lefroy:  Sorry, are we saying that there was not a clear quality bar for approval of foundation trusts up till now? 

David Bennett: There has been for a while, but not at the time of Mid Staffordshire. 

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

David was a Director at McKinsey & Co. In his 18 years with McKinsey he served a wide range of companies in most industry sectors, but with a particular focus on regulated, technology-intensive industries.

We have people everywhere!!! 

Chile: Salar de Atacama & Bipolar Disorder.

Learning from Panama History: Politician vs Professionals

NHS & Monitor: Toyota & McKinsey

NHS-Kaiser Permanente: What Now?