NHS & McKinsey: FSA & Monitor

There is much talk of the role of the regulator Monitor in safeguarding our health care.

Perhaps we should look at our most famous regulator: FSA. (Financial Services Authority).

The FSA was dragged into the news recently as its first head Sir Howard Davies, resigned as director of London School of Economics for eight years over "a mistake". The "mistake" was to advise the LSE's council to accept £1.5m research funding from a foundation controlled by Colonel Muammar Gaddafi's son, Saif.                                 More>>>>>>>>>

So, were there any other "mistakes" when he was head of FSA?

Independent:

17 July 2008

FSA is accused of maladministration over collapse of Equitable Life

The Financial Services Authority will be dealt yet another hefty blow to its credibility today, as the Parliamentary Ombudsman, Ann Abraham, reverses her decision of five years ago and accuses it of maladministration for its role in the collapse of Equitable Life eight years ago.

"The case of Equitable Life, which echoes earlier cases such as Vehicle & General in the 1970s and shares some similarities with the current example of Northern Rock, illustrates the need for absolute clarity as to what can and cannot be expected from financial regulation and the development of shared understandings as to the limits to the protection that such regulation offers to investors both before and after problems arise, as they inevitably will," said Ms Abraham.

"Key, however, is that those responsible for undertaking financial regulation should act in a way that is compatible with the duties and powers which Parliament has conferred on them. Those responsible for the prudential regulation of Equitable Life failed to do so throughout the period covered in my report."

Sir Howard Davies was previously employed by McKinsey and Company and was Special Advisor to the Chancellor of the Exchequer.

In: NHS: Business Model? Spare Us Please!!!

I was reading a book by Philip Delves Broughton on Harvard Business School (HBS): Ahead of the Curve.

He may not be the first to observe that HBS loves Marines, Mormons and McKinsey. Kim Clark  must indeed be the most famous sons of The Church of Latter Day Saints and PDB’s article in The Sunday Times: “Harvard’s masters of the apocalypse” may indeed be aptly titled.

He opened with:

If his fellow Harvard MBAs are all so clever, how come so many are now in disgrace?

From Royal Bank of Scotland to Merrill Lynch, from HBOS to Lehman Brothers, the Masters of Disaster have their fingerprints on every recent financial fiasco.

We MBAs are haunted by the thought that the tag really stands for:

Mediocre But Arrogant, Mighty Big Attitude, Me Before Anyone and Management By Accident.

For today’s purposes, perhaps it should be Masters of the Business Apocalypse.

On RBS (Royal Bank of Scotland)
When I was a student at Harvard Business School, between 2004 and 2006, I recall a distinguished professor of organisational behaviour, Joel Podolny, telling us proudly of his work with Fred Goodwin at RBS. At the time, RBS looked like a corporate supermodel and Podolny was keen to trumpet his role in its transformation. A Harvard Business School case study of the firm entitled The Royal Bank of Scotland: Masters of Integration, written in 2003, began with a quote from the man we now know as Fred the Shred or the World’s Worst Banker: “Hard work, focus, discipline and concentrating on what our customers need. It’s quite a simple formula really, but we’ve just been very, very consistent with it.”

Harvard Business School alumni include Stan O’Neal and John Thain, the last two heads of Merrill Lynch, plus Andy Hornby, former chief executive of HBOS, who graduated top of his class. And then of course, there’s George W Bush, Hank Paulson, the former US Treasury secretary, and Christopher Cox, the former chairman of the Securities and Exchange Commission (SEC), a remarkable trinity who more than fulfilled the mission of their alma mater: “To educate leaders who make a difference in the world.”

Read more here>>>>>>>

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!)

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.

There were more:

ISTC

Q 203 Mr Barron:  I was on the Health Committee during the previous Parliament, when it looked into the independent sector treatment centre programme. I had conversations with more than one company running the programme that said they felt threatened by the pensions implications, with the work force working in the independent sector while keeping the NHS rewards such as pensions. I call them distortions, but most of us have one. By implication, what does that mean? 

David Bennett: I think again of Sonia’s point. There are lots of considerations. Yes, pensions are an issue, but as someone said there is an issue around the complexity of the cases that we have dealt with. 

Q 204 Mr Barron:  I accept that. ISTCs were contracted for cases that were not likely to go wrong in surgery, because there was no back-up in the hospitals or institutions if someone needed to go into ITU, and so on. I understand that exactly. 

Sue Slipman: The only thing I would add is that it is clearly the public sector that is carrying the responsibility for the education and training of people across the system as a whole. There are balances here in those imbalances, and we would certainly be pressurising Monitor very hard to take them into account. 

The Chair:  I think that they accept that. 

Trust!

Emily Thornberry:  I am tempted to press you further, David, given the profound implications of what you said in relation to work force pensions. We are about to pass this legislation and you are saying, “Take it on trust, as it will all be sorted out.” But we are talking about millions of people’s pensions here, and it is difficult not to push you at this stage. 

Worse than that, you said in an incomplete answer earlier that there were other obvious distortions and advantages that the NHS had over the private sector. I wonder whether you could list anything else, on top of pensions, that you might think might of? 

David Bennett: I said that obvious distortions are creating advantage within the NHS. I was also saying that there are other distortions in the market, and Sue has just pointed out two of them. At the moment, it is the public sector that has to pay for R and D, and it is the public sector that pays for training. That places the public sector at a disadvantage. That needs to be taken into account. 

Q 208 Emily Thornberry:  Do you have any others? 

David Bennett: I do not have a comprehensive list.        More>>>>>>>>>>

Health and Social Care Bill 2011

Banks: Northern Rock, HBOS, RBS, Bonus at RBS

Out Of Hours service, bonus culture, Hospital Dr

Related:

NHS & McKinsey: Barracuda & Nye Bevan Curse

NHS & McKinsey: The Professor & 10%

NHS & Monitor: Eggs & Enron.

NHS & Market Forces: Uncomfortable Readings!!!

Germany: Bayreuth, The Ruling Class & Wagner

It looks as if Bayreuth may now be famous for another reason: its own son or was it Google’s.

Germany is not immune from the problems of the ruling class.

Spiegel:

24 Feb 2011

University Withdraws Guttenberg's Doctor Title

German Defense Minister Karl-Theodor zu Guttenberg has gotten his wish. After requesting that his alma mater withdraw his doctor title in the face of accusations that he plagiarized large sections of his dissertation, the University of Bayreuth complied on Wednesday evening. The minister's popularity does not seem to have suffered.

Now it is official. On Wednesday evening, following more than a week of mounting indications that German Defense Minister Karl-Theodor zu Guttenberg had inadequately cited several extensive passages in his dissertation, the University of Bayreuth, which had awarded him a Ph.D. in 2006, withdrew the title of doctor.

The Guardian

1 March 2011

German defence minister resigns in PhD plagiarism row

“He was voted Germany's most popular politician, a chisel-jawed, gelled-haired aristocrat who held such rock-star status that his party used to play an AC/DC track every time he took to the stage. But Karl-Theodor zu Guttenberg has resigned as defence minister after being engulfed by a plagiarism scandal, leaving the ruling coalition with a serious charisma vacuum.

“His departure is a huge blow for Chancellor Angela Merkel and her Christian Democratic Union party (CDU). Already weakened after defeats in recent regional elections, she is facing the prospect of implosion at six other local polls this year.”

“Despite his privileged upbringing – or perhaps because of it – Guttenberg was hugely popular with the tabloid Bild newspaper, which rarely referred to him without mentioning that he was "Germany's most popular politician" – an honour he received via a poll in 2009, when he took the top spot from Angela Merkel. He was also referred to as the ‘German Kennedy’, with his stylish TV presenter wife inevitably described as his ‘Jackie O’.

“But over the past two weeks, Guttenberg has received yet more nicknames, most notably Baron zu Googleberg, the minister for cut and paste.”

Spiegel Again:

'You Have Lied and Deceived'

Germany's opposition remains unconvinced. Guttenberg was in parliament on Wednesday to face questions about the affair, and politicians from the center-left Social Democrats, the Green Party and the far-left Left Party demanded that he resign.

"You have lied and deceived," said leading SPD parliamentarian Thomas Oppermann. "I find it intolerable that the chancellor has decided that an academic impostor and a liar can continue to be a member of her cabinet." Jürgen Trittin of the Green Party said, "Ms. Chancellor, it cannot be allowable that the German military is commanded by a Felix Krull," a reference to Thomas Mann's famous con-man. Left Party parliamentarian Dietmar Bartsch, referring to Guttenberg's title as a baron, said "there was a time when the nobility knew what to do in such a position."

Wagner warned the Germans and the rest of the world a long time ago:

The dark side of the gods: (it is sometimes easier if one take GODS in the Ring to mean those in POWER. For the characters read here.) In fact, the gods need not work at all, the Nibelungs work almost all the time.

Disrespectful Wotan is hardly revered unanimously, and even he acknowledges higher authorities. Erda knows things he doesn't; his almost bureaucratic dominance derives solely from treaties engraved in runes on his spear, treaties to which he is subservient.

Born liars
Characters lie as it suits them. Events are initiated by Wotan's spurious promise to the Giants to pay them by giving them Freia in exchange for building Valhalla, a promise he knows he cannot keep, as she is the indispensable symbol of love whose golden apples keep the gods alive. His shady ally, Loge, is defined as a double-dealing trickster. Brünnhilde breaks her promise to her father to allow Siegmund to be killed in combat. Mime makes dissembling a veritable life's work, ably carried forward by his nephew, Hagen, in Götterdämmerung. 

Contemptuous

Brünnhilde disobeys Wotan, and his grandson Siegfried destroys his power. Mime, who raises Siegfried from infancy and even makes him toys, is treated with disturbingly cruel contempt by the bumptious hero. Hagen, whom Alberich sired via gold-empowered lust as a tool to retrieve the Ring for him, mutters that if he succeeds he will keep it, not hand it over to his Nibelung father.

Thieving & Misappropriation 
……. misappropriation, of persons or of things, provides much of the plot machinery. First, Alberich plunders the Rhinegold, and afterward, theft of others' possessions, including the Ring, motivates action upon action. 

Incest and other illicit sex
The teasing of Alberich by the Rhinemaidens which leads to his abjuring love--love, not lust. The definitive heroine, Brünnhilde, and her Valkyrie sisters are the offspring of an adulterous liaison between Wotan and Erda; Wotan also illegitimately fathers the Wälsung twins by a mortal. Sieglinde's infidelity is excoriated by marriage-goddess Fricka, as is her violation with Siegmund of an even more basic taboo, incest. But Wotan defends the twins ("…those two are in love") and, like most audience members moved by the ardent love music, views both transgressions kindly. 

Homicidal

Fafner kills his brother Fasolt, the first victim of Alberich's curse, and we are off to the homicide races. Hunding slays Siegmund, only to be destroyed by Wotan's contempt. Siegfried kills Fafner, the Giant-turned-dragon, and then, after realizing that Mime is trying to poison him, kills him as well. By the time the gods' destiny climaxes, Hagen has murdered both Siegfried and Gunther and is himself drowned by the Rhinemaidens. Eventually Brünnhilde sets Valhalla ablaze as part of her self-immolation upon Siegfried's funeral pyre ("Thus do I hurl the torch into Valhalla's proud-standing stronghold") and all the gods die.

Greed, greed, greed!
Finally, "coveting that which is your neighbor's" is pretty much the whole raison d'être for the Ring story, starting with Alberich's desire for the Rhinemaidens, then for the gold they guard. Thereafter everybody seems to want what doesn't belong to him or her: the Ring, a sword, a treasure, someone else's wife, sheer power. 

From: Bayreuth: The Ruling Class & Photography

NY Times

NHS-Kaiser Permanente: A Class! Seriously!

Mom, they are not wearing clothes!

Hermitage Museum ©2008 Am Ang Zhang

Much money and resources must have been spent to study and emulate the best of Kaiser Permanente. I have followed Kaiser Permanente closely and have first hand discussion with Medical School friends that worked for Kaiser Permanente.

To emulate Kaiser Permanente it is very important to have primary and secondary care working together.

Simple enough?

Yet even when the evidence was so clearly written out for the politicians they still act as it they did not know and wanted to push forward the agenda of using market forces to lower the cost of health care.  Or did they know and were just pretending????

It reminded me of the Mercedes A-Class when it first came out:

Jeremy Clarkson

“Contrary to what many may think, we road testers do get swayed by the opinions of colleagues and I found myself in a quandary. Here was a car from one of the world's most ruthlessly efficient manufacturers, a car that my colleagues liked very much.

It takes a very special kind of bombastic arrogance to be that little boy in The Emperor's New Clothes - to stand up and say: "Actually, its handling is appalling."

But thank God I did, because just a week later, a Swedish magazine found to its cost that while performing what's become known as the ‘Elk Test', the A-class rolled over and put its occupants in hospital. A German mag then repeated the procedure and subsequent examination of the film showed that what we had here was A-class One Disaster.”

From one of their 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.”

Kaiser Permente Model:

Integration The most distinctive feature of the KP model is the way in which it integrates care:

Integrated inpatient and outpatient care enables patients to move easily between hospitals and the community, or into skilled nursing facilities should this be needed.

Medical specialists are not tied to a particular building – such as a hospital – but provide care in the most appropriate setting. Specialists work alongside generalists in multi-speciality medical groups that help communication between physicians. There is no incentive to build up facilities and resources at the expense of other settings.

Integrated prevention, diagnosis, treatment and care. A high priority is attached to keeping people healthy and avoiding the use of hospital services. Chronic disease management programmes, where care is delivered within the framework mentioned above, help ensure that care is provided as close to home as possible. Doctors have fast access to diagnostic services in the outpatient setting and practice from relatively large medical centres where diagnostic and other equipment is easily accessible.

Nowadays, it seems that the Emperor does not even listen when he is told.

Clarkson said of the A Class Elk problem: it worries me that Mercedes, if they did not know about the problem they should not be in the business of making cars. And if they did know: it is very worrying!

I somehow think that politicians knew. Very worrying indeed!

Perhaps our Emperor did know, he knew about what he was wearing or not wearing.

The Guardian

A Class or S Class (S for second class or scary!)

The NHS had, I later gathered, been obliged to take the second-class service offered by a disorganised offshoot of some US corporation: unsurprisingly its low standards allowed it to undercut Marie Curie's bid for the work. It seemed bizarre that the NHS was manoeuvred by an aggressive privatisation lobby into accepting a clearly inferior service from a company run from a country incapable of organising a health service for its own citizens.


Links: Jobbing Doctor

Weep, oh weep, for what we are going to lose

Dr Grumble: One policy fits all

NHS 2011: PCTs & Exit Bonuses

In Pulse today:

GPs told to delay referrals until April

01 Mar 11

By Ian Quinn

Exclusive: Thousands of GPs are being told to delay referrals until the next financial year, sparking fears that consortia will be passed crippling ‘legacy debts’ in the form of back-logged hospital activity.

“The Government bowed to pressure following Pulse’s A Clean Slate campaign and spared consortia debt built up by PCTs in this financial year – but anything accumulating from April will be GPs’ responsibility.

“A Pulse survey of 450 GPs has found as many as one GP in eight has been asked to delay referrals for the final quarter of the year until April, as trusts desperately seek short-term fixes for deficits.

“The move has ramped up tensions between NHS managers and GP consortia, who fear they will be hamstrung if they inherit back-logged hospital activity.

"NHS West Kent plans to cut nearly £30m by a wide-ranging clampdown on referrals, including deferring all IVF, gender reassignment and bariatric surgery. NHS North Yorkshire and York has told GPs to suspend all referrals for male and female sterilisation services until the end of the financial year.”

Now why in the last hours of PCTs should the CEOs and managers be so concerned to balance the books? Responsibility! Integrity! Honour! Professionalism! Love of the country!

The answer may be simpler: remember Pavlov!!!

The Cockroach Catcher worked out that it must be to do with “exit” bonuses.

Some very clever people working for the PM then!!!

Enemy Of The People: NHS, Internal Market & Safety Net

NHS: Market Forces, Genuine Medicine & BMA

NHS: Changes Or A Conspiracy Against The Public Interest

NHS 2011: Learning from Ireland.

The Prime Minister:

How we will release the grip of state control

"……We will create a new presumption – backed up by new rights for public service users and a new system of independent adjudication – that public services should be open to a range of providers competing to offer a better service…….Instead of having to justify why it makes sense to introduce competition in individual public services – as we are now doing with schools and in the NHS – the state will have to justify why it should ever operate a monopoly."

It is a well known fact that banks pay good money for the “best” people to run them, let us look at our neighbour: Ireland.

Allied Irish Banks became the fourth of Ireland's "Big Six" financial institutions to be nationalized, following Anglo Irish Bank, Irish Nationwide, and EBS Building Society. AIB was delisted from the main market of the Irish Stock Exchange on 25 January 2011.

Many subsidiaries of overseas bank went into Ireland and introduced competition, fuel the crises by creating the “boom” and left.

Four out of six state controlled!!! 

Related:

Ireland bailout: Banker who got out just in time

Photography: Garden Route, South Africa.

Fynbos © Am Ang Zhang 2011

Another WPPI

Photography:

Vacation: Bird Photography

Fun with Photoshop

House M.D. : Canon 5D Mk II

WPPI Las Vegas: Digital Photography & Art

Photography: Old & New
High End Photography & Wine

Photography: Pictures at an Exhibition

Kodachrome: 1935-2010

Billingsgate: Sea Bass & Puligny-Montrachet

There has been too much NHS and not much fun! Lets change that.

Billingsgate is arguably London’s best place to get fresh sea food. You need to be there early to get Wild Sea Bass.

 The simplest way to cook it is with a fish kettle.

After cleaning the fish (gut and scale) line the kettle with a few spring onions (to prevent sticking) and add water to the base of the kettle. We steamed for exactly 7 minutes for our fish which was around two pounds.  You can really taste the ocean.

The wine: well what else but the best valued Burgundy.  We picked a 2004 Puligny-Montrachet. How they compliment each other! It has such a silky feel on the tongue, a hint of nuts that compliments the fish with some citrus flavour that is not overpowering the delicate sea bass. Beautiful finish. A delicate big wine!!!

Billingsgate Posts:

Billingsgate Market: Scallops, Crabs & Dover Sole

Billingsgate: The Cockroach Catcher’s Guide

 Billingsgate: Wild Sea Trout & Saint Amant