NHS: Demolition? No! No! No!

As private companies offer free shares for GPs in the new market based healthcare system that will soon replace the current NHS, it is amazing that there remain doctors that will continue to point out the dark forces driving the current change.

The Cockroach Catcher has retired from the NHS, but there are other doctors who still work in it, and I respect how verbal some of them are against the initiatives that are currently underway to turn the NHS into an essentially private system without the safeguards of the new US system.

But hang on, no, the NHS will never be totally demolished.

The inspiration came from the natural world: good parasites do not kill their hard working hosts!!! Nor do predators kill the whole species. Keep some alive!!!

Giant Barracuda (Sphyraena barracuda) ©2003 Am Ang Zhang 

As the US insurers found out, Government money is the best money to make and that is really tax payer’s money. The new NHS will be the private sector’s main source of income, as only 90,000 in the UK are covered by private insurance and often they are offered cash incentives to use the NHS.

It is therefore essential for the private health care companies that the NHS is around, at least in name, so that they can make money by providing a “better value and more competitive” service to the NHS!

Some parts of the NHS will have to remain too, as it is necessary for the private sector to dump the un-profitable patients: the chronic and the long term mentally ill, for example. (Right now, 25% of NHS psychiatric patients are treated by the private sector.  But why? Even in psychiatry, there are cherries to be picked.)

Finally, in order to keep the mortality figures low at competing private hospitals, they need to be able to rush some of their patients off to NHS hospitals at the critical moments!

Clive Peedell:

For ‘Liberating the NHS’ read ‘Dismantling the NHS’

By Clive Peedell, consultant clinical oncologist at James Cook University Hospital, and co-chair of NHSCA - 4th January 2011 10:18 am

The NHS white paper is the government’s roadmap for a market based healthcare system, which is designed to encourage increasing roles for the private and third sectors, whilst diminishing the role of the public sector in the England. The NHS is going to be dismantled by using the market forces of ‘creative destruction’. This will have profound effects on the medical profession with attacks on T+Cs, pensions, medical training, professionalism. More importantly, the knock on effects for patient care will be devastating.

The key policy levers enabling this to happen are:

1. The purchaser provider split, with GP commissioning consortia taking the leading role on the purchaser side of the divide.

2. Patient Choice.

3. Competition between a plurality of ‘any willing providers’.

4. Payment by Results with price competition.

5. Patient held budgets.

6. Foundation trusts becoming social enterprises and the abolition of the cap on their private income.

These policies are mutually reinforcing and this is how they will work:

GPs will be formed into GP consortia and will control 80% (£80bn) of the NHS budget to buy in services for their patients from a variety of providers (including FTs, private hospitals and third sector organisations) competing against each other in competitive healthcare market. Market competition will be enforced by applying EU competition law and overseen by the economic regulator, Monitor, as well as the new National Commissioning Board. Money will follow the patients via the Payment by Results (PbR) system. This has traditionally been a fixed pricing system, but the tariffs will now be opened up to price competition (I’ll come back to this).

GP consortia will take over most of the roles of PCTs and SHAs, which are being abolished. Since the process of purchasing healthcare, designing care pathways and interpreting healthcare outcome data is a complex process, they will need to buy in management expertise. Although some consortia will employ ex-PCT staff, many will take on private companies through the Framework for Procuring External Support for Commissioning (FESC). These companies include US HMOs like United Health and Aetna, as well as UK companies like BUPA. These companies will therefore be involved in both purchasing and providing healthcare. Consortia will have strict financial responsibilities and will therefore be encouraged to ration care or opt for cheaper services.

Meanwhile, all hospitals are going to become FT, which will subsequently become social enterprises, i.e. owned and run by their staff and essentially not-for-profit private hospitals. They must be able to make a small surplus to re-invest and will not be able to be bailed out if they fail financially. If they do fail, they will be merged or taken over by the private sector. Hospitals will need to make money through Payment by Results. However, the marketplace will be competitive and PbR tariffs will no longer be fixed. This will lead to a ‘race to the bottom’ as consortia look to save money by referring to hospitals with the cheapest tariffs. As tariffs fall, Hospitals will need to generate more income by cutting costs or treating more private patients. In addition, increasing numbers of people will take out additional healthcare insurance as consortia ration more and more services and waiting lists increase because of the abolition of waiting list targets.

Over time, we will see an increasing role for the medical insurance industry and a two-tiered mixed funding healthcare system, ending one of the founding principles of the NHS. There will also be a new health insurance market for patients with patient held budgets, who will want the option to ‘top up’ their care to avoid the risk of running out of money.

It is clear that many hospitals in poorer areas will be able to attract less private patients and will be seriously disadvantaged by this system. Meanwhile, hospitals in wealthier areas may be able to continue to reduce their tariffs, supported by greater private income, putting even more pressure on struggling hospitals.

As tariffs fall, all hospitals will be pressured to drive down costs. This is most easily achieved by cutting staff and changing skill-mix. In addition, national T+Cs will no longer apply to hospitals that are social enterprises because they are private organisations. Thus, they will be able to set their own local T+Cs. Existing NHS staff will be protected by TUPE legislation, but new members of staff will not and they will potentially no longer be entitled to NHS pensions. If medical students and future students think it’s bad now, then they should think again. It’s only going to get worse.

In addition, since some hospitals will fail, many staff will be transferred to the private sector and have to accept worse T+Cs, especially is unemployment levels are high. This whole process will set in train wage deflation and the destruction of the NHS pension system, which is paid for by current employees.

The white paper is therefore designed to fulfil a longstanding Tory dream - to dismantle the NHS and replace it with the private sector, which will receive its profits from the UK taxpayer.

This NHS will not fall overnight because the market’s invisible hand will destroy it in a piecemeal fashion, leaving the unprofitable areas of healthcare firmly in public sector hands. It is also political suicide to dismantle the NHS, so it is being performed using the political rhetoric of patient empowerment through the patient choice agenda, and clinician empowerment by giving GPs a budget of £80bn.

Amazingly, Lansley is getting away with it because there is far too little understanding and resistance from the medical profession, which is realistically the only group of people that can prevent this assault on the NHS.

It’s time for the medical profession to heed Aneurin Bevan’s words: “It will last as long as there are folk left with the faith to fight for it.”


    More>>>>

The internal market has been a costly disaster. Let the professionals manage medicine

April 30, 2010  Jonathan Waxman

“There is a general feeling in the NHS of disempowerment of the professionals. People can’t face up to the incredible struggle, the disapproval that faces any of them if they have the temerity to suggest that things should be run differently.

The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it. The reality is gravediggers working with a cost improvement shovel made of rust.

Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh. So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice.

So what should we do? Let us go back to the old discipline of the NHS. Let the professionals manage medicine, empower the professionals, the doctors and nurses and shove the internal market in the bin and screw down the lid. At this election time please let us hear from all political parties that they will ditch this absurd love-affair with the internal market. Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.”

More>>>>

Pulse:

Circle: 
- Currently largest partnership of clinical doctors in the UK. Says services could include telehealth, enhanced diabetic services, urological services, day case surgery, endoscopy, community-based ENT or ophthalmic services. 
- GPs continue on normal contracts, and can either develop additional services with Circle’s help or act as ‘sleeping partners’ 
- A welcoming gift of 300 shares in the company each year, (which currently have a nominal value of about £3.50)
- A non-repayable grant of £2.00 per registered patient, to be spent on additional services to be pursued jointly with Circle.

Assura
- Locally agreed Limited Liability Partnerships (Assura GP Provider Companies)
- Profits split 50/50 between GPs and Assura
- GPs run clinical services
- Assura provides accommodation, IT and data storage, back-office support and bidding expertise, and incurs any potential losses

Virgin

- GPs retain existing terms of contract and offered new premises
- A profit-share from other paid-for services in Virgin Health centres and extra quality payments. 
- Virgin will employ all non clinical staff. 
- GPs and staff will have to undergo Virgin customer training and be subject to a Virgin quality framework.
The salaried option
- Private companies employ GPs under APMS contracts
- Private firms currently employing GPs under this model include Chilvers McCrea, Care UK, Serco Health, United Health and Atos Healthcare

Madness: Ethnicity or Marijuana?

News hit the world today:

Marijuana's health impacts reviewed in U.S. report   CBC

Lack of scientific information on marijuana and its chemical cousins 'poses a public health risk'

From a psychiatrist's point of view, this is very important and to be truthful, we always knew but most like to think that it just unmasking what is going to happen anyway. 

Strong evidence links marijuana use to the risk of developing schizophrenia and other causes of psychosis, with the highest risk among the most frequent users.

Here is a reprint:  

Madness and Ethnicity: Part A

          The idea that all men are created equal is a very attractive one. It is also politically correct and it pleases every modern open-minded person.

          

Table Mountain, Cape Town, South Africa ©2013 Am Ang Zhang

          When I at last visited the great nation of South Africa, I realised how real the concept of a superior race was in our own time and in our own generation. The one thing Apartheid (supposedly good neighbourliness) did for the black people was to unite them, most of them anyway, in South Africa. One only has to look at the neighbouring countries to realise how indirectly Apartheid strengthened the resolve of the South African people.

          It is a generally held view that world wide the rate of schizophrenia stays the same regardless. However, according to some reports, in England the ETHNIC population has twice as high a rate for developing psychosis than white Caucasians[1].  Why should that be? 

          Could it be that doctors and especially psychiatrists in England are reluctant to diagnose the most serious of mental illness in the white population, but not so for the ethnic groups?  Could it be that ethnic people by virtue of their migratorial history inadvertently put their descendants at risk[2]? Could the rate of drug abuse be a contributory factor?

          Although puzzling, it cannot be denied that at any one time half of our psychotic patients were Ethnic, and all of our eating disorders were white.

         

Thomas

          Thomas was a white boy with loving and doting parents. He was the only child. His mother must have been a ballerina at some point in her life as the house was adorned with black and white ballet photos. His father worked hard as one of these young store managers for a big national supermarket.

          Thomas had a good pocket money allowance. He had all the latest gadgets a boy could want.   PS2[3] was his latest Christmas present. He used to have wall posters of Ferraris and Porsches as he could not quite decide on which one he liked better. No pop stars, no girl posters, no, that was not Thomas. Mother did let on later her worries that he might be gay.

          Then during the summer school break, he suddenly tore off all his posters, stopped playing with his PS2, as mother could no longer hear the racing car noise, and started writing copious amounts. He used to get food for himself as both parents had a busy social life and he was sixteen and liked to get his own food. Mother noticed that he went through the ice creams, Mars bars and biscuits but not much else. He was often up till the small hours, writing.  He did not sleep much and when the family finally saw him he looked dreadful.

          One day mother decided to go into his room to check. That was when she found all the posters torn off.

          His bed was unmade and his dirty clothing and sweet wrappers and paper were all over the place. She thought the room had a funny smell too. Not the usual boy smell.

          She looked at the pages and pages of his writings. It was the Bible, the Bible according to Thomas! Her son had turned into the new Saviour and was writing a new version of the Bible.

          She looked under his bed. No, no Playboy or Penthouse or worse. No such luck. Instead she found three strange glass structures.

          It is simply astonishing how little parents know of the youth culture of today.    

          Thomas had been taking marijuana for some time and just had his first psychotic episode. He had been having MUNCHIES[4]and those strange glass structures were BONGS[5]

          Drug and sex education should be for parents not the children, I have always maintained, but nobody would listen to me. U.K. has now the worst teenage pregnancy problem in Europe despite its vigorous Sex Education program and not far behind in teenage drug problem.

          Father in his neat modern management way wanted to know how it happened, what Thomas should take and how long it would be before he could recover, what his chances of relapse were and what he should do to prevent future relapses. Mother just cried, listened and cried.

          “My nice boy uses drugs and is now psychotic and the two are probably related!  What have I done wrong?” wailed mother.

          There really was no family history I could find.  Even in my cautious way I had to concede that this white Caucasian teenager had drug induced psychosis but the prognosis might not be as bad as the parents feared. Only time would tell.

From The Cockroach Catcher:  Chapter 44  Madness and Ethnicity

---

[1] Detention figures in England & Wales – Using datasets for the purpose of examining detentions under Part II of the Mental Health Act 1983 in England, a study reported that Black people were over six times more likely to be detained than White people. In the cases of Black men this rose to an eight-fold increase, while Asian people were 65% more frequently detained under Part II (Audini and Lelliott 2002). This study analysed 31,702 incidences of Part II detention over the period 1988-99 from areas with a combined population of 9.2 million.

  Previous studies have placed the figure for detentions for Black people at closer to three times more likely than for White people although one article that reported this statistic included Asian in its definition of Black (Keating et al 2003).

  An update on current literature relating to Chinese mental health reported returns to the Mental Health Act Commission detentions for Chinese as 0.3% for the period from 1996-98 (Cowan 2001). This percentage detained is exactly the same as the proportion of Chinese people in the England & Wales national population with 40% residing in Greater London.

  A study which conducted a retrospective case note analysis on hospital records and clinical notes of restricted hospital order patients conditionally discharged from a large medium secure unit in England between 1987-2000, compared data on those of Black African-Caribbean race and origin with all other ethnic categories (Riordan et al 2004). Most of the subjects in both groups had a diagnosis of schizophrenia and there was an over-representation of Black people (36%) as compared to the general population.

http://www.scotland.gov.uk/Publications/2005/07/1595204/52295

[2]  Migration and schizophrenia, a paper published in Social Psychiatry and Psychiatric Epidemiology - The last decade of the twentieth century has seen an unprecedented increase in the number of reports in the psychiatric literature documenting increased rates of psychotic illness among migrants in a range of European countries. In countries where high rates of immigration have been long-standing such as Britain and the Netherlands, these increased rates have also been seen in the second generation of migrants. This has impacted on psychiatry significantly with regard to the aetiology, diagnosis, and treatment of schizophrenia.

http://www.ingentaconnect.com/content/klu/127/2004/00000039/00000005/art00002?crawler=true

[3] PS2: Play Station 2. A Computer based game console made by Sony.

[4]Munchies - Smoking cannabis often triggers an urge to eat - what smokers sometimes refer to as "the munchies".

[5] Bong - A bong, also known as a water pipe, is a smoking device, generally used to smoke marijuana.

 Full review on Amazon.

Madness and Ethnicity: Part B

Readers' views.

The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US

Goethe & Bipolar: Werther or Lithium!

©2014 Am Ang Zhang

The Cockroach Catcher could not miss the great opportunity to see a new production of Werther at the Met.

The 5 hour wait for the day ticket was worth it as one gets to chat to other opera lovers. One originates fromPoland and he managed to get to Bayreuth after a good seven years. Another one tries to be there twice a week during the season.

The Metropolitan Opera in New York offers 150 day tickets and some at the front have been there since 9.30 in the morning.

Even Goethe admitted that killing Werther probably saved him. He completed The Sorrows of Young Werther in just 6 weeks perhaps in a fairly manic phase and established himself as Germany's foremost writer.

Sophie Koch, left, as Charlotte and Jonas Kaufmann in the title role in "Werther" at the Metropolitan Opera.CreditSara Krulwich/The New York Times

The Massenet Opera had one of top tenors Jonas Kaufmann singing Werther and Sophie Koch, Charlotte. The days of fat ladies are probably over as the new breed of female singers are slim and beautiful with very high quality singing to match. One cannot say as much for tenors and so it was such an experience to hear Kaufmann who suited the role perfectly.

Kaufmann in an interview agreed that Goethe probably would have been medicated nowadays.

Lithium perhaps.

 

Just as well it never happened.

 

Jonas Kaufmann in the title role of 'Werther' at the Metropolitan Opera (Brigitte Lacombe/The Metropolitan Opera)

"The greatest tenor of today": Jonas Kaufmann in the Met's new production of "Werther"

„... currently the most in-demand, versatile and exciting tenor in opera. …. To be a great Werther, a tenor must somehow be charismatic yet detached, vocally impassioned yet ethereal. Mr. Kaufmann is ideal in the role. He sings with dark colorings, melting warmth, virile intensity and powerful top notes. There is a trademark dusky covering to his sound that lends a veiled quality to Mr. Kaufmann’s Werther and suits the psychology of the character.”

Anthony Tommasini, New York Times

 

Jonas Kaufmann

Interviews :    1, 2

The Book: The Cockroach Catcher

Lithium Bipolar and Nanking
Bipolar Disorder: Lithium-The Aspirin of Psychiatry?

Other Opera Posts:

NHS: Learning From Boris

The Dark Side: Il Trovatore
Illness and Morality

Doctor Atomic

Lunar Eclipse
Lohengrin: Speech Disability, Design & Hypertension 

Bayreuth: The Ruling Class & Photography

Bright Young Thing: Medicine or Opera!

Peter Grimes: the individual against the ...

ROH: Lulu & Booing

Kandel & Lohengrin: Music & Brain

Capriccio: Poetry or Music

Doctor Atomic

The Ring: Child Psychiatry & Human ...

NHS Must Strike Back: BUPA & Health Insurers!

How the NHS must strike back!!!

1: Legislate that Insurers must pay for NHS treatment.

2: Offer Cappuccino/Green Tea if patients provide BUPA or other insurance details.

3: Patients will still be allowed to be paid by BUPA. Ha!

"In fact, to save money, government can buy insurance 

for 

the mental patients and the chronically ill."

 ©2016 Am Ang Zhang

BUPA is right now paying insured to use NHS!!!

The official letter from Bupa detailing the scheme is headlined: “Giving our members improved choice.”

The patient, speaking on condition of anonymity, said he was “shocked” to be encouraged to seek treatment on the NHS in exchange for money.

The letter said: “The payment you will receive depends on the cardiac treatment you need.

"Payments usually range from between £500 to £2,000.”

Operations can cost fives times more than the cash payments offered by Bupa. One procedure patients can pocket £2,000 for having on the NHS is for a pacemaker to be fitted.

BUPA raked in a staggering £2.57billion in revenue last year, and pocketed £139million in profit - up 26% on 2012.

Consultant oncologist Dr Clive Peedell, co-leader of the National Health Action party, accused Bupa of “cashing in on the NHS”.

He said: “It’s disgusting that a leading private healthcare company is paying patients to use the NHS.

“This is an outrageous example of how the private healthcare sector is happy to take patients’ money but then has to turn to the NHS when it realises it can’t afford to meet the high cost of treating patients privately.

“This underlines yet again that private healthcare is all about the money.”

Dr Peedell added: “It looks like Bupa have calculated that it’s cheaper for them to pay patients to use the NHS than fork out themselves for private treatment which would cost them thousands of pounds.

"They are effectively cashing in on the NHS.”

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.

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.

 

Summary of a popular post:

 ©2016 Am Ang Zhang

·                     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.

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 “Personal Health Budgets ” 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.