NHS & The Ruling Class: Disgusted! Disappointed! Dismayed!

The Ruling Class:  Jeremy Hunt.

Cousin  of  Virginia Bottomley: Secretary of State for Health 1992-95   

The Slog

So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector.

As I listened to the Ring Cycle (Solti), I am reminded of the genius of Wagner who warned us about the Ruling Class years ago.      

Soon they will start selling off the famous hospitals.

The NHS (England) as we know it will soon disappear. 

Wagner’s opera will always be there: The Ring: Child Psychiatry & Human Behaviour

So will Finland's forest!

© 2012 Am Ang Zhang

A culture of corruption

pervades the links between government and business,

fuelled by and fuelling privatisation.

These relationships are  – a conspiracy against the public interest.

Adam Smith

                                                                                                                                                                                                                                                                                       


Lesson from Sweden:

• Randeep Ramesh in Stockholm
• The Guardian, Tuesday 18 December 2012 09.57 EST

Perhaps most damaging for private investors drawn by the potential profits to be made from the state has been the probing of their affairs by tax inspectors. The industry has been under scrutiny since 2007, when a spate of high-profile deals, including the buyout of Capio, led to investigations into financiers.

The charge is that private equity firms siphon profits out of the state's coffers while avoiding their fair share of taxes. Berglund, of Capio, says: "It is always thrown about that we are not paying taxes but it is not true."

Swedish tax authorities are, however, taking some companies to court because pay in private equity groups is often linked to the profits made on deals and has been incorrectly taxed, it is said, for years at rates lower than that required for income in Sweden.

Earlier this month one of Capio's owners, a private equity firm called Nordic Capital, lost a court case against the Swedish tax agency, leaving it with a bill of 672m Swedish krona (£63m). The authorities, it is reported, will also slap a tax bill collectively of 2.6bn krona on another 34 individuals.

"There has been a strong reaction in Sweden. These people have been paying themselves enormous sums of money," says Dahlgren. "It should be a worry for every health system where you have competition and private firms arriving."   

Allyson Pollock:  CQC

We now know that England's healthcare regulator, the Care Quality Commission, tried to cover up an investigation into a hospital trust where babies were dying. This appalling tale has been spun to be about the "rotten culture" at the heart of the NHS. The true story of the Morecambe Bay cover-up, however – just like Mid Staffs, where hundreds of patients died – is one of market failure.

Two questions in particular have not been properly addressed. Why would the CQC be complicit in the cover-up of poor performance? And why was the University Hospitals of Morecambe Bay NHS foundation trust so desperate not to expose the failings at its Furness hospital? The answer to both questions lies with the new market system that brought the CQC into being, a system introduced by New Labour and implemented by the Tories.

.....The CQC is has a legal imperative to get the market up and running by developing the systems to register more than 22,000 health and social care providers. The real story of the CQC scandal is that market-led changes are creating deficits and poor quality of care, which managers must seek to conceal in order to survive. Central to the government's NHS reforms is the concept of a well-regulated market. Behind the CQC controversy is an assumption that if a commercially run hospital is failing it has simply not been well enough regulated. But experience from the US shows that effective regulation of large healthcare corporations is impossible: we cannot afford it, or get the data necessary to carry it out. That is why the NHS had direct management in the first place.

Remember East Coast Rail:

There is no end, it seems, to the fiasco of rail privatisation. For the second time in three years, the holder of the coveted east coast franchise has walked away from a contract it can no longer afford. Not only that, but it turns out that National Express – whose chief executive, Richard Bowker, has decamped to the Gulf in a hurry – has protected itself from the vast bulk of the £1.4bn it owes the government by insulating its subsidiary, Fred Goodwin style, as a "special purpose vehicle".

But far from slinking off into the corporate undergrowth, National Express is now threatening to sue the government if it also takes over the company's two other profitable franchises. Once again, we are in the world of the Metronet consortium, whose collapse finally discredited Gordon Brown's disastrous public-private partnership for the London underground: where instead of transferring risk to the private sector, the government ends up subsidising private profit and picking up the bill when the music stops.

For all its rise in passenger numbers, Britain's rail system remains hobbled by the folly of privatisation: overcrowded, unreliable, fragmented and exorbitantly expensive. But far from putting it out of its misery to create a reintegrated publicly owned railway at zero cost, the transport secretary, Lord Adonis, was yesterday insisting the east coast line would be up for tender again as soon as he could manage it.

Now NHS:

As we are ourselves experiencing the worst from our ruling class over the NHS and its so called reform, Wagner’s opera is an uncomfortable reminder that we should never have trusted the ruling class.

Even before the new Bill was passed, changes were in place in the NHS that made it impossible to go back. Now it looks as though the changes were much worse than first thought. Doctor leaders were hoping that there is still decency in our ruling class. 

Well, unfortunately many of us will be disgusted & disappointed & dismayed!

Please do not get me wrong, it is not a simple privatisation. We are not really following the US. They regulate insurers where we do not. If we were required to get insurance Obama Style it might have been better. No, basically even if you get the top insurance there will be conditions that will be left to your friendly NHS hospitals. Just check your policy if you do not believe me. 

No it is under the guise of COMPETITION.

It is allowing Any Qualified Provider (privateer if you must know) to cream off. But it is not as simple as that. Recent PIP private clinics not only refused to remove the implants but went into administration to avoid paying compensation. There is as yet not legislation to guarantee NHS patients. Even travellers seem better protected.

In health care, DEATH is irreversible.

The NHS has been by and large highly efficient as it has avoided the pitfall of internal market system until recent years.

The crazy bonus system, internal market and Pavlovian style reward system skewed the efficient NHS to breaking point.

A once fairly integrated health care system where many doctors and nurses contributed free extra hours became a scandal ridden system where OOH fight not to see patients and not let A & E see them either. Or else OOH are run by so few doctors that patients suffered or died.

But it could be worse as the new AQPs do not seem to be liable:

The Guardian:

Family sues out-of-hours GP provider and nurse over death liability

The family of a young woman is suing the country's biggest out-of-hours GP provider and one of its nurses, whose failures meant her fatal condition was not diagnosed, because neither will accept liability in a test case over legal responsibility in a privatised NHS.

Clare Secker, 19, died of bronchopneumonia in December 2008 after a nurse working for the privately-run telephone service told her parents to give her paracetamol and fluids.

Earlier this year the nurse admitted through her lawyers that she had been "in breach of her duty by failing to arrange for [Secker] to be seen by a doctor". If the young mother, who died when her son Tyler was less than a year old, had been prescribed antibiotics she would have recovered fully.

Despite this neither the firm, which was part of the Harmoni out-of-hours service until it was bought by Care UK in November 2012, nor the nurse has offered compensation to the family.

The nurse claims she does not need to pay out as her employment contract specifically states that the company had insurance in place "to indemnify … for any claim arising from any wrongful act committed by … any employee while carrying out their contractual obligations". But Harmoni says its insurance excludes responsibility for negligence by nurses.

With the Health and Social Care Act 2012 leading to more NHS contracts going to private providers, lawyers are concerned that the fragmented system will lead to a loss of accountability.

"It cannot be right that patients no longer know who is actually providing their care, or for those who are harmed to have the additional stress of providers trying to dodge responsibility by pointing to a clause in a contract or insurance policy. Until something disastrous happens we, the public, think we are still within the safety net of the NHS and increasingly that's just not the case. There is little transparency or protection, it seems to me."

Hospitals now fight other hospitals and the failed ones will be handed over to privateers. Some of these have the highest mortality rates. I am surprised that they are not sold  off for just a single pound.

The more failed hospitals, the better for the government. Once they washed their hands off, it is not their problem. If the privately run hospital failed, they change CEO, change ownership and continue. 

The GMC has been quiet about them as they have with the Breast Implant ones and many other plastic surgery private hospitals. 

Yet, right now the NHS picked up the mess of the PIP implants. The private companies pocketed the money. Lots of money.                                                                                                   

                         

If they are not RULING, where are they?

Virginia Bottomley: Secretary of State for Health 1992-95 now with BUPA. Cousin of Jeremy Hunt.
The Slog

So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector.

The Guardian

“Interestingly, former health ministers have done particularly well. The ex-health secretary Patricia Hewitt earns more than £100,000 as a consultant for Alliance Boots and Cinven, a private equity group that bought 25 private hospitals from Bupa. After leaving the department, her predecessor, Alan Milburn, worked for Bridgepoint Capital, which successfully bid for NHS contracts, and now boasts a striking portfolio of jobs with private health companies.”

Alan Milburn
Following his resignation as Secretary of State for Health (to spend more time with his family, his partner is a hospital doctor), Milburn took a post for £30,000 a year as an advisor to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and the Robinia Care Group. He has been Member of Advisory Board of Pepsico since April 2007. Wikipedia

 Alan Milburn now also holds a place on the board of PepsiCo as an advisor.        Wikipedia

Patricia Hewitt

In January 2008, it was announced that Hewitt had been appointed "special consultant" to the world's largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt's former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee. Hewitt will also become the "special adviser" to private equity company Cinven, which paid £1.4 billion for Bupa's UK hospitals.

In March 2008, it was announced that Hewitt will join the BT Group board as a non-executive director.[40] She joined the group on 24 March 2008. In July 2009, Patricia Hewitt joined the UK India Business Council as its Chair.

In May 2009 The Daily Telegraph reported that Hewitt claimed £920 in legal fees when she moved out of a flat in her constituency, stayed in hotels and then rented another flat inLeicester. Claimed for furniture including £194 for blinds delivered to her London home. In June 2009 Hewitt announced that she will be stepping down from the House of Commons. She said she was leaving the Commons for personal reasons as she wanted to spend more time with her family.   Wikipedia

Ex-NHS: Patricia Hewitt: now with Cinven (Bupa Hospitals)

Simon Stevens: now with UnitedHealth

Shadow Elite: They are everywhere! Come fly with me!

The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.                                      

  Janinie R. Wedel

NHS Plot : 5% & Disintegration!

Inspector: Okay. The rules exist because 95% of the time, for 95% of the people, they’re the right thing  to do.

Question: And the other 5%?

Inspector: Have to live by the same rules. Because everybody thinks they’re in that 5%.

©2012 Am Ang Zhang

Most of us who specialise in different specialist medical disciplines do so for the purpose of dealing with 5% of patients.

Yet it is these 5% that central government try their best to not treat. Despite clever attempts, the NHS soup stayed the same: CCGs, FT Hosp., AQPs, OOH, NHS 111. 

Now:

Referral Scrutiny GPs had been put under pressure to refer through their local scheme. One GP partner in England said a local project that started as a 'very useful and helpful referral assessment service' was starting to become a 'referral blocking service'. The scheme amounted to 'arbitrary decisions made by unqualified administrators', said the GP. Others complained the schemes were 'designed to massage waiting list figures'.

Try calling patients clients too! 

Nowhere in the world is health care more disintegrated than in England and there is even pretend integration speak: integration could mean signing away your right to hospital care when you most need it. NHS reorganisation is an attempt to reduce the 5%. Unfortunately some of the 95% tried to gatecrash the 5% hospital party. No, no NHS111 or OOH or even GPs. 

A&Es are still trusted. Why? Because in England the only difference between public and private health is the Cappuccino; the docs are the same. Except perhaps PIP implants.

In one of the episodes of House M.D.

Inspector: Okay. The rules exist because 95% of the time, for 95% of the people, they’re the right thing  to do.
Question: And the other 5%?
Inspector: Have to live by the same rules. Because everybody thinks they’re in that 5%.

In recent days medical tragedies hit the news with regular frequency. What has happened to medical training?

Being brought up in the older medical tradition I have found it engaging to watch the ever so popular House M.D.

It was a relief to hear from my classmates that they too like watching it.

It would not surprise anyone to find that House M.D. has made it to Medical Humanities, a BMJ Journal:Medical paternalism in House M.D.

M R Wicclair Medical Humanities 2008Deborah Kirklin in the editorial of the same issue commented:

"Fear and pity are not emotions that Dr Gregory House, star of the popular television series 'House M.D.', acknowledges or accommodates in either his professional or private life. He is arrogant, rude and considers all patients lying idiots. He will do anything, illegal or otherwise, to ensure that his patients—passive objects of his expert attentions—get the investigations and treatments he knows they need. As Wicclair argues, House disregards his patients’ autonomy whenever he deems it necessary So why, given the apparently widely-shared patient expectation that their wishes be respected, do audiences around the world seem so enamoured of House? Wicclair’s answer raises interesting questions about the extent to which patients trust the motivations of their doctors. Perhaps, he suggests, for the many viewers drawn to this arch paternalist, there is something refreshing about a doctor willing to risk all—job, reputation and legal suits—in order to fulfil his duty of care to his patients: the duty to take care that his actions or inactions do not harm his patients. Because, for good or for bad (your call), once you’re House’s patient there is nothing he won’t do, no inaction he will tolerate, if he believes that by failing to act he will harm you.”

First do no harm.

Wicclair stated:“Paternalism is clearly against the norms of mainstream medical ethics. Informed consent—the principle that, except in emergency situations, medical interventions require the voluntary and informed consent of patients or their surrogates—is a core ethical principle in healthcare. A corollary of informed consent is that patients who are able to decide for themselves have a right to refuse treatment recommendations. Another core principle is that when patients lack decision-making capacity, surrogates should make decisions in line with the wishes and values of the patient. Both of these principles reflect a strong opposition to paternalism in contemporary medical ethics.”

Contemporary medical ethics! Except perhaps in Anorexia Nervosa where the Mental Health Act could be used to force feed in a number of countries. The fact that such force feeding did not seem to reduce mortality is a different matter as some deaths are not by direct starvation.

Wicclair asked:

“Yet House repeatedly acts paternalistically without giving it a second (or even first) thought. Is he right, and is the antipaternalism of mainstream medical ethics wrong; or is House mistaken and is a strong moral presumption against medical paternalism justified?"

To prevent House M.D. from becoming God they have to make him out to be rude and full of personal problems and he even rides a motorbike.

Wicclair offered a way out:

“In the world of House M.D., choices typically are life-or-death choices: if a patient doesn’t receive a certain medical intervention, the patient will die.
“However, in the real world, choices are not always so stark. ……If, after careful consideration, a competent patient decides against having the procedure, it would be unwarranted for a physician to insist that the patient needs it.”
You can read it here (may require subscription).

Yet my personal view is this, you may be rich, famous or even well educated, but you may not know all that you needed to know to make that judgment.

As Dr Crippen pointed out there are just three medical procedures that can be dramatically live-saving. You might also want to read Dr Grumble’s personal account here.

At the Hudson Plane Crash earlier this year a quick thinking ferry captain Brittany Catanzaro came quickly to the rescue of passengers in near freezing water. She was not a doctor.

In Hong Kong a man died outside a medical centre because a nurse receptionist was following guidelines, Guideline V to be precise.Kevin M.D. was charitable about Canadian Health Care when he looked at the tragic death ofNatasha Richardson. A number of papers only picked up the fact she turned away the earlier ambulance, but then this happened:

"After picking her up from the hotel, there was a 40-minute drive to the community hospital, the Centre Hospitalier Laurentien. She did have a CT scan there, and the decision was made within 2 hours to transport her to a tertiary care center, another hour away in Montreal." 

And still no burr holes after the CT scan?

Dr. Crippen said that the brave physician would have drilled the burr holes without the benefit of a CT scan:"It would be a career making or career breaking decision. Few American doctors are brave. Defensive medicine is the order of the day. You cannot have a migraine in the USA without someone ordering an MRI scan."

Has modern medical training managed the unthinkable of producing a new generation of doctors and other medical staff forgetting that they should use their brain? Or have they all been “guidelined” out? Has the 5% finally become the 95% too? 

3212009

Grand Rounds 5.27: Code Blog 5:29 Getting Closer To Myself
A simple bump on the head can kill you,Natasha Richardson’s Brain Injury
The wussification of the American medical profession. 

Related: House M.D.: Modern Tyranny

Links: Covert Rationing Blog Better Health

Where were you when we needed you, Dr House M.D.? 
House M.D. must have the last words:
Question: "Isn’t treating patients why we became doctors?"
House: "No, treating illnesses is why we became doctors."

Hospital Infection: Quorum Sensing?

If Quorum Sensing plays a bigger role in hospital infections should there not be measures to tackle germ carrying areas particularly where faecal matters are? So washing hands may not be enough. Japanese style toilettes?

This is the story of a much respected retired professor. As he celebrated his 82nd birthday, we have to be thankful that he must have some strong genes to have survived the last eight months. An unfortunate slip at home fractured one of his ankles, and as a pin was needed a surgical procedure was performed in a local hospital by the Orthopaedic surgeon. For the following eight months an otherwise independent and healthy eighty one year old had to suffer the indignity of many more hospital procedures because of a lingering infection.

“I don’t know” was his answer when we visited him and asked if it was the dreaded MRSA.

He was never tested!

Nearly 15 years since the discovery of Quorum Sensing by Nottingham University the topic seemed to be shrouded in some mystery. The Cockroach Catcher read about it by chance in an airline magazine and his own survey of some recent medical school graduates from Cambridge and Southampton indicated that this was not in their curriculum and they had never heard of it.

There is of course a Nottingham Quorum Sensing website and certainly Cambridge produced some research papers.

Why?

Bonnie Bassler said that all we knew about bacteriology in the last 300 years is all wrong. Strong words indeed. So are we still teaching medical students all the wrong stuff?

Is professional jealousy at work here? Surely not. But Quorum Sensing will itself lead to other exciting findings about the world of the microbe that has so far got the upper hand on the ever so clever Homo sapiens.

Think MRSA and C.difficile and I am sure you will agree.

I know that it is a new field and much of it theoretical and conjectural but I was a medical student once and the greatest buzz for me then was Heart Transplant, and VAMP treatment for some kind of leukaemia. So could we not let the future doctors have some excitement other than the 4G iPhone?

Surely we need to inspire some great brains to go where no men have gone before.

It is now well established that in France and Holland where hospitals do not run to capacity, they do not have the level of MRSA and C. difficile problem that we have here.

I do not think that is the result of them using some of the methods we have been known to use here, i.e. not testing the patients. Their standard of care is probably different and their wards are not as crowded.

We do seem to have lots of “good” lateral thinkers working in the NHS. In the meantime, our well loved professor has decided to move to sheltered housing. Months of struggling with his immobility and inability to go walking, swimming, shopping and getting on with his daily chores robbed him of his desire to be independent. But at least he survived.

What about his hospital manager? Did he or she get the bonus? 

Bonnie Bassler

Related:

Hospital Infection: Quorum Sensing

SARS and Quorum Sensing

Old & Young: E. Coli O157

MRSA & Antibiotics: Obama & Farmers

Cockroaches & Superbugs

NHS & Specialists: AQPs or Barracuda?

Was it Barracuda or Mad Dog?

Great Barracuda waiting / ©2009 Am Ang Zhang

Roy Lilley:

Is it worth worrying about Monitor?  Too bloody right it is!  Worry, be anxious and lose sleep.

Monitor is David 'Mad-Dog' Bennett, ex-McKinsey and, it appears, paid well on the way to £300,000 a year.  He told us in the FT and the Times it is his role in life to 'dismember' the NHS.  Damage to clinical linkages aside, I'm not sure anyone actually voted for NHS dismemberment?

In my view David Bennet is clumsy, ham-fisted and a klutz.  Whitehall insiders tell me his 'dismembering' remarks did not go down well, particularly whilst the La-lettes were trying to calm everyone down.

Well, he's done it again.  With all the sensitivity of Colonel Gaddafi turning up at the Royal Wedding, Mad-Dog-Monitor is now saying the NHS will have to find savings of nearer 7% and not the 4% ordered by Big-Beast Nicholson. 

Roy Lilley: Mad Dog again!!!

Mad-Dog Monitor is a menace.  He is a menace to the Big Beast, who has no power over him. One wonders; does he even have his phone number?  Mad-Dog is a menace to the morale of the NHS.  Mad-Dog is a menace to public confidence in the NHS.  He is a menace to LaLa, who is desperately trying to look like he is listening and an absolute nightmare for Cameron who is desperately trying not to look like he is selling the NHS.

In fact I cannot think of anything kind, warm or sympathetic to say about David Mad-Dog Bennet.  I cannot think there is anything he can do, or has done, or will do that makes him worth £300k to the public purse. 

A reprint: Rationing of Hospital Care: Very Clever!

Is it really that difficult to grasp!

Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

When there are not enough specialists to go round in any country money is used to ration care.

So we are going to but in a peculiar manner as NHS hospitals used to be state run and free. Reform is needed!!! Enter GP commissioning. If it is your GP doing the rationing it is no longer the State's problem.
Some very clever people indeed are working for the government. 

Is it Conspiracy or Cockup? You decide.

But strangely they thought there is still money to be made.

That is why many GPs in the consortia have links with private providers.

It is a sure way of directing patients to secondary care.

The AQPs are already there and many specialists are working for them. It really does not need a genius to work out that Foudation Hospitals if they fail will be bought up by private firms.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in consortia arguing about the price of hips or knees. 

Private patients will now have priority and NHS patients will fill in the slack. Very clever indeed. The notion that one should “let them eat cake” does not apply here.

More like: “Let them not see a Consultant!” And if you do, we will make money.

Reform will not save any money but it will make a few City people very rich, very rich indeed

David Cameron, it is not too late. We will believe you if you legislate against private involvement. Yes, legislate and we would hopefully not have another Southern Cross.            See FT

CIRCLE:

Looks like the future is here, one of them: the sale not the buy back yet!

Some smart people dreaming up some smart solutions: NHS for loss making hospitals and PRIVATE for the profit making hospials!!! 

Hinchingbrooke Next Steps

1) Hinchingbrooke hospital is a modern purpose-built district general hospital, which opened in 1983.

2) Hinchingbrooke hospital serves people in Huntingdonshire and surrounding areas; approximately 160,000 people.

3) Hinchingbrooke Health Care NHS Trust provides a wide range of outpatient, daycase and inpatient services, a 24 hour accident and emergency department and maternity services.

4) Cambridgeshire Community Services provides services on the hospital site including 25 children’s beds and 12 special care baby unit cots*.

5) There are also two wards for patients with mental health needs, run by Cambridgeshire & Peterborough NHS Foundation Trust*, and Addenbrookes runs a dialysis unit from this site*

*The services marked with an asterix will not become part of the operating franchise agreement detailed on the East of England website.

Circle will have the power to hire and fire staff, and change operating procedures as long as the hospital meets NHS standards. The move opens the way for other financially failing hospitals to be run by private firms. Around 20 are thought to be candidates for a takeover.

                                                                                                       Daily Telegraph 

RNOH: You are next!!!