Tuesday, June 17, 2014
Sunday, June 15, 2014
Winter’s Tale & Blood: NHS & Hansard
Rulers of the world are confidently doing what they like! Could it be that Apollo has taken early retirement or has Apollo appeared in some different guise?
The RSC predicted the demise of the NHS when they last performed the Winter's Tale. The Cockroach Catcher was there!
The Winter's Tale at the RSC, Stratford-Upon-Avon.
I overheard some guide telling a group of tourists that in Shakespeare’s days, in order to please everybody, animal blood and entrails were used as props. At least we were spared of entrails and I was sure that Hermione’s blood stained post-partum garment was not of animal origin.
The audience loved the bear-a paper puppet of enormous proportions thus sparing Antigonus actual bodily harm on stage and so no blood or entrails here. In the play he was of course devoured by the bear, in the act of preventing the King’s attempted infanticide.
Rough justice indeed! Or was it Shakespeare’s insight and warning to those of us daring to disobey.
Apollo chose to kill King Leontes' heir brought him to his senses but by then it was all too late. As he left the stage the two giant bookcases that we barely noticed started to collapse towards the middle of the stage with all the “books” falling onto different parts of the stage. It was real and scary. Civilisation must indeed be coming to an end!
Tristram Kenton Guardian
Our party was sitting by the stage and so we all tried to pick up some of the torn pages: WOW!
All the books were indeed hard cover bound Hansards. (Hansard: The Official Report of the proceedings of the main Chamber of the House of Commons, United Kingdom.) How topical. One page was Hansard 1950 with questions on the new NHS. We duly put the pages back on stage for re-reuse.
Most if not all reviewers missed this powerful metaphor.
More powerful than blood and entrails.
Reviews: Telegraph. Independent. Guardian. Times.
Synopsis: RSC
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Yet there is so much we can learn from Shakespeare! The King offended Apollo and his heir was dead!!
I overheard some guide telling a group of tourists that in Shakespeare’s days, in order to please everybody, animal blood and entrails were used as props. At least we were spared of entrails and I was sure that Hermione’s blood stained post-partum garment was not of animal origin.
Hermione's blood stained post partum garment
RSC Website.
The audience loved the bear-a paper puppet of enormous proportions thus sparing Antigonus actual bodily harm on stage and so no blood or entrails here. In the play he was of course devoured by the bear, in the act of preventing the King’s attempted infanticide.
Rough justice indeed! Or was it Shakespeare’s insight and warning to those of us daring to disobey.
Apollo chose to kill King Leontes' heir brought him to his senses but by then it was all too late. As he left the stage the two giant bookcases that we barely noticed started to collapse towards the middle of the stage with all the “books” falling onto different parts of the stage. It was real and scary. Civilisation must indeed be coming to an end!
Tristram Kenton Guardian
Servant
O sir, I shall be hated to report it!
The prince your son, with mere conceit and fear
Of the queen's speed, is gone.
LEONTES
How! gone!
Servant
Is dead.
LEONTES
Apollo's angry; and the heavens themselves
Do strike at my injustice.
(Act 3, Scene II). The Winter’s Tale.
.........Apollo chose to kill King Leontes' heir brought him to his senses but by then it was all too late. As he left the stage the two giant bookcases that we barely noticed started to collapse towards the middle of the stage with all the “books” falling onto different parts of the stage. It was real and scary. Civilisation must indeed be coming to an end!
All the books were indeed hard cover bound Hansards. (Hansard: The Official Report of the proceedings of the main Chamber of the House of Commons, United Kingdom.) How topical. One page was Hansard 1950 with questions on the new NHS. We duly put the pages back on stage for re-reuse.
Most if not all reviewers missed this powerful metaphor.
More powerful than blood and entrails.
Hermione: "You pay a great deal too dear for what's given freely". -
(Act I, Scene I). The Winter’s Tale.
Reviews: Telegraph. Independent. Guardian. Times.
Synopsis: RSC
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A Brief History of Time: CPR (Cardiopulmonary Resuscitation)
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Picasso and Tradition
Saturday, June 14, 2014
NYBG: Green! Green! Green!
All photos ©2014 Am Ang Zhang
Book I recently read: Superhero for grown ups!
Flash Boys: Michael Lewis
Over the past week, a host of U.S. authorities have confirmed that they are looking into certain practices used by high-speed traders, whose strategies can involve executing thousands of trades in milliseconds. The FBI, the U.S. Securities and Exchange Commission, the U.S. Justice Department and the attorney-general of New York State all have investigations underway.
For Mr. Katsuyama, the probes are partial vindication. Several years ago, while working for Royal Bank of Canada in New York, he began to suspect something was amiss in the execution of stock trades – namely that high-speed traders were, in effect, getting a tiny sneak peek at his transactions before they could be completed.
RBC “was the perfect place to discover what we discovered,” he said. It was a firm where “choosing to do the right thing was not a hard decision.”
Mr. Katsuyama left RBC in 2012 and launched IEX’s stock trading platform last October. Its objective: creating a market where high-speed traders do not enjoy any advantages over their slower peers. For now, the IEX share of overall trading volume is minuscule, but it is growing; this week, the platform experienced its biggest day on record, with 58 million shares traded.
Sitting in a bare office overlooking the former site of the two World Trade Center towers, Mr. Katsuyama appeared slightly shell-shocked by his transformation into a semi-public figure and by the passionate responses to Flash Boys – both in support and in opposition.
Friday, June 13, 2014
Doctors: Kind Heart & Kind Skills!
As the NHS faces the greatest
scandal regarding CQC; it became clear that the idea of putting a
non-doctor as its regulator is akin to getting a butcher to check on a top
passenger aircraft. The Cockroach Catcher is of the opinion that despite the
rhetoric, no SoS would put a doctor there.
Why? A doctor might, just might have a heart.
A coroner
has criticised hospital staff in Cumbria
Joshua
Titcombe died at nine days old from a common infection that could have been
cured by antibiotics after medical staff repeatedly ignored his parents' fears
for his health and told them "not to worry".
Ian Smith,
the Cumbria
They
included failing to recognise the symptoms of an infection, failure to act on
those symptoms, failure to listen to the couple's concerns, inaccuracies in
records made by staff, a lack of record keeping, an absence of continuity of
care and a lack of special training for midwives on the postnatal ward.
The coroner
also found a "strained and dysfunctional" relationship between
midwives and paediatricians.
Smith said
he believed 11 midwives at the hospital - all of whom gave evidence at the
inquest - had colluded to cover up knowledge that low temperature is a common
sign of infection. He said "incriminating" notes containing
observations about baby Joshua's condition may have been deliberately destroyed.
The inquest
heard there was an 80% chance Joshua would have survived if antibiotics had
been administered in the hours after he was delivered. He was transferred by
air for emergency care after he became seriously ill at Furness hospital in
Barrow, and died in November 2008.
Joshua's
father, James Titcombe, said he and his wife, Hoa, had urged staff at the
hospital to treat their son with antibiotics, but were told he seemed well and
did not need to see a doctor. He said they were told a paediatrician was
"too busy" to deal with them.
Titcombe
said: "The day after he was born I had come to take my wife and baby home
when they found him not breathing well. It was a horrific shock. They told us
he had a problem with his heart, then with his oesophagus. All the time I just
suspected he had the same infection as his mother."
The baby
was transferred to a paediatric centre in Manchester Newcastle
One should perhaps ask the question: who put the head of CQC there and who is there now. Certainly not a doctor.
In the
new world of doctoring, money comes into it and with that many doctors are
losing their hearts. But we did have the infra structure to preserve it.
It would
be such an irony if the new SoS be drawn in and become the unlikely and perhaps
unwilling hero that Bevan used to save his NHS: a sort of reverse curse.
The
Guardian:
Jeremy Hunt has said the Care Quality Commission's alleged cover-up of failings at a Cumbria hospital are shocking, and he will back appropriate action against those responsible "absolutely to the hilt". The health secretary told BBC Radio 4's Today programme: "These are very, very serious allegations and they should have very, very serious consequences if they are proved. "I know the CQC are looking into disciplinary procedures and what can be done: what sanctions are available; whether you can have forfeiture of pensions, all those things. There has to be due process, but … it is totally appalling that this kind of thing should happen." Hunt said such failings damaged the NHS and undermined "the millions of doctors and nurses who do an amazing job day in, day out". The health secretary also acknowledged serious systemic flaws with how the CQC was set up in 2009, saying it was wrong to have the same regulator charged with both identifying and rectifying problems. He said the CQC's "generalist" system meant that the same inspector would visit such different facilities as a dental practice, a GP surgery, a hospital and a care home.
This is from one of my earliest posts:
“… in this cutting edge work everything counts and the trust and respect of your patient and his or her parents is of paramount importance, just like the trust and respect my parents used to have for the Chinese doctor that they used to take me to.”
In the unfortunate event of a child having a fever and needing to visit a doctor, he would be taken to the consulting room of a Traditional Chinese Doctor. The room was generally sparsely equipped, with a redwood consulting desk in the middle, set with some calligraphy brushes, an ink well and Chinese rice paper. On the wall behind the doctor you could expect a giant calligraphy piece extolling his skills – literally translated as “kind heart, kind skills”. On another wall there would perhaps be a Chinese water-colour with a theme relating to doctoring. Doctors were said to have the “heart of a parent”.
This is a Chinese painting that used to hang in my consulting room. The Chinese characters can be translated as "the warmth of spring in almond groves". In the Chinese tradition, "almond groves" signify medicine, originating from a Chinese legend of a doctor who lived in the Three Kingdoms era. Instead of paying him, his patients were asked to plant almond trees, five for a serious illness cured, and one for a minor ailment and so on. Both the painter and calligrapher were leading figures in the literary/art world of their times.
The doctor himself usually had a solemn and yet kind look and wore a traditional Chinese costume. No, the mother did not have to tell him anything. All he had to do was to check the child’s pulse and his tongue. There would be no listening to the chest, or any other examination, and definitely no X-ray or ECG.The respected doctor would write his prescription of around ten to twelve medicinal herbs.
Beijing , one member of our tour group consulted a famous Traditional Chinese Doctor in the Capital City Reunion Island
U.K. were amongst the top three most respected professions and Members of Parliament shared the bottom ranking with Estate Agents.
When I was growing up, the Traditional Chinese Doctor was possibly the most respected person a child was ever going to meet. More so than his teacher, grand-father, or father. That was the pecking order of respect.
The doctor himself usually had a solemn and yet kind look and wore a traditional Chinese costume. No, the mother did not have to tell him anything. All he had to do was to check the child’s pulse and his tongue. There would be no listening to the chest, or any other examination, and definitely no X-ray or ECG.The respected doctor would write his prescription of around ten to twelve medicinal herbs.
The mother would thank him and then get the prescription from the Herbal Counter outside his consulting room. Each herb would be carefully weighed and individually wrapped in paper. Back home, the herb mixture would be boiled in water in special pots. Generally three bowls of liquid had to be reduced to eight tenth of a bowl. During the boiling process the pungent stench could be smelt from a block away. The sick child who was kept in his bed could certainly smell it. I always thought that was part of the treatment.
A black bitter tasting liquid would eventually be presented to the sick child. How we ever managed to down these potions I was never quite sure. The one possible inducement could be the two preserved plums at the end, given as a sort of reward for the child who managed to drink the full portion. These preserved plums came from the Herbal Counter with the medicinal herbs.
One thing was for sure. Children did not fake illness. Not often anyway unless they wanted to drink that black potion.
I too was impressed.
Alas, I fear that the respect for and trust in doctors in today’s world is waning fast. In my book, I wrote:
The doctor’s position had over the last ten years moved nearer the bottom end with no such counter moves by Politicians….”
18
July 2013
Health regulator bosses accused of covering-up
a review of baby deaths will not face a police inquiry.
The Care Quality
Commission (CQC) will not be investigated for failings noted in an independent
report that suggested an internal review had been suppressed.
The review highlighted
the CQC's failure to investigate a spate of baby deaths at Furness General
Hospital
Tuesday, June 10, 2014
Saving NHS England: Use a Pencil!
Remove competition, ban AQPs.......
Sometimes in life the solution to a big problem could be so simple.
Remember the very old Urban Myth about NASA spending millions on developing a zero gravity pen:
The Myth did get into one episode of The West Wing: We Killed Yamamoto
Leo: We spent millions of dollars developing a pen for the astronauts that would work in zero gravity. Know what the Russians did?
Toby: Used a pencil?
Leo: They used a pencil.
Well it was not exactly true but it illustrated a very important point: solutions could sometimes be very simple and cheap.
Now most readers know that I love snorkeling and when I started my wife on it she, being a scientist, wanted to know the names of things she saw whilst snorkeling. The West Wing came to mind.
We used a polypropylene chopping board (the smaller one), drill a hole in the corner to tie a strap so that the hand could sometimes be free to operate the camera. We then use a golf pencil tied to the board with a fishing line to write.
Blue Brittle Star ©Am Ang Zhang 2010
So what about The NHS: A pencil solution?
Just copy Scotland; that “country” north of the border.
As much of the opposition to the new Bill is to do with the simple fact that it was a back handed way to privatise a major part of the NHS, the profitable part. Ordinary citizens without insurance will be left with a much depleted hospital service and those with insurance may find that over time they too might be dumped by their Private Health Insurers.
The Herald
JULIA HORTON
25 Feb 2009
Radical new legislation stopping private companies from running GP surgeries in Scotland is to be unveiled by ministers - further widening the divide between how the health service is run north and south of the border.
Explaining the purpose of the new legislation, which won near "unanimous" support from Scottish doctors during a recent consultation, Ms Sturgeon told The Herald: "We have decided to go ahead and legislate to effectively remove the possibility of commercial companies running GP practices.
"We want people providing GP services to be committed to the NHS and not to see it as a way of making a profit. I would hope that we would get considerable support for the bill from opposition MSPs."
The legislation, which ministers also expect to garner cross-party support, was sparked by concerns over a legal loophole which could allow into Scotland the kind of "creeping" privatisation of the NHS which is supported by the UK Government south of the border.
Trust in the government will return. There will not be any privatisation of primary or secondary care and that it would not go the way of the dental services.
Then those of us who could not afford private health care might be able to accept genuine and well thought out changes to the way the NHS will be run.
No more internal market, no more cherry picking and back to an integrated service.
By the way why not use the Scottish model that has now survived 10 years.
After devolution the NHS in England increased its reliance on a market-based approach – now one of the various controversies surrounding its future direction.
By contrast, NHS Scotland set about developing partnership agreements at national and board level as part of a strategy to engage staff in improving services.
The result, according to a study funded by the Economic and Social Research Council, is an “incredible common agenda” among interested parties from all quarters.
Research co-author Dr Peter Samuel said: “Although partnerships are found elsewhere in the public sector, NHS Scotland’s stands out as distinct and novel. It has survived for over a decade, defying reorganisation and changes in administrations, and it can offer valuable lessons in how to improve industrial relations.
By contrast, NHS Scotland set about developing partnership agreements at national and board level as part of a strategy to engage staff in improving services.
The result, according to a study funded by the Economic and Social Research Council, is an “incredible common agenda” among interested parties from all quarters.
Research co-author Dr Peter Samuel said: “Although partnerships are found elsewhere in the public sector, NHS Scotland’s stands out as distinct and novel. It has survived for over a decade, defying reorganisation and changes in administrations, and it can offer valuable lessons in how to improve industrial relations.
………Dr Samuel said: “The policymakers of NHS Scotland clearly concluded the only way to deliver better healthcare was to improve the way staff were engaged. This led to the establishment of various structures at national and local levels to give staff more say in decisions affecting their working lives and healthcare provision.
“NHS Scotland has even passed into law a ‘staff governance code’ that compels all its health boards to engage and involve staff and their representatives.
“This innovation in industrial relations is arguably one of the biggest examples of industrial democracy to be found anywhere in the world – and they have made it work.”
Privatisation of utilities & public transports leads to increase cost to users and high profits to privateers.
The Herald:
Cate Devine severed her left index finger last December and after an intensive three-hour operation to re-attach it, plus several weeks of healing time, she felt compelled to talk about it non-stop.
No matter how carefully we look after our own health, the sad fact of life is that accidents will happen, violence will be visited on the innocent, and illness or disease will defy even the most rigorous diet and exercise routine. And when there's an emergency to deal with, Scotland's NHS unflinchingly steps up to the plate.
8 Hospital Departments:
My finger has required treatment at two different hospitals and has involved the emergency, orthopaedic, surgical, anaesthetic, radiographic, orthotic, outpatient and physiotherapy departments. Yet what has struck me is a tangible sense of unity and cohesion. On all levels, the practitioners I've been fortunate enough to encounter know each other by their first names and my meticulously updated case notes have always been presented on time - and my GP was fully up to speed within hours.
Now, imagine internal market and complex cross charging in the new English NHS or worst having to be referred back to your GP to be re-referred? She was lucky to be living in Scotland.
While I do agree we all need to take more responsibility for our own general health, I'd argue that achieving this is not the NHS's core remit. For all the patients who present with problems associated with conditions such as obesity, Type 2 diabetes, drug and alcohol abuse (many of whom seem to treat the their own health, and the NHS, with a perversely casual disdain), there must be as many again who find themselves forced to swallow their pride, ask for help and – even after a lifetime of payslip deductions to help fund it – are hugely grateful when it comes.
Hang on, the jury is out still on diabetes, could a pre-diabetic because of sensitivity to hypoglycaemia inadvertently ate to combat the low sugar leads to obesity? What about the 30% of Chinese that are low weight or normal weight?
England:
Should we all move to Scotland?
The truly democratic nature of our NHS is what makes it truly remarkable. In our hour of need we are all equal in its eyes. And that is the mark of a dignified nation.
Some words from the heart!
Pulse:
07 Mar 11
The health service in Scotland remains united, sees patient care as central and rejects a market vision.
It has been said to me, and it was meant as more of an insult than as praise, that Scotland remains a basically socialist country. I take that as a compliment, as I read it as saying that we care what happens to our folk, and don’t think about money first.
……….. We need to get back to using clinically relevant measures of performance that tell us how we are doing in comparison with our peers.
This has been repeatedly shown to be one of the most potent ways of modifying GP behaviour, and we should go back to it as a way of influencing clinical practice.
Scotland has no real truck with private medicine; APMS (Alternative Provider Medical Services) is not allowed. There is no market in healthcare as health boards keep primary and secondary care working together, and we actually speak to each other. Some of my best friends are consultants.
………… that trusting us to do our job is more effective than micromanagement.
English prescription charge to go up to £7.85. (Already free in Wales and Northern Ireland.)
Scotland: Serco NOT allowed to run GP practice
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