Dr Temp MD

It did not take too long for things to get outspoken, the elections are gone, Greece is against the wall making all kinds of claims regarding Blackmail and creditors and the NHS issues are also waking up. Actually, it is the Health Secretary that is waking up. Actually, that is a little too unkind. Jeremy Hunt was not asleep, let’s just state that the elections slowed issues until the ‘after’ election moment. That moment is now!

I have kept my eye on the NHS issues that play. The NHS IT, which partially collapsed the NHS due to 11.2 billion under labour, which impacted all sides of the NHS, yet it is not all political, the NHS has many sides that do need addressing. It was not their fault, I am not laying blame here, but the pressure that the NHS gets from binge drinking must stop!

If we go by the BBC (at http://www.bbc.com/news/health-32418122), we might see that a detox centre is saving millions, which sounds nice in theory, yet the problem is not the saved millions, it is the £3.8bn a year that is a concern, a worry and the NHS can no longer afford it. So we can go two ways, we can shift the problem with drunk tanks like in ‘the good old days‘, which suits me just fine, and if you have enough money to pay for private treatment, that that is fine too, yet here we see a debatable injustice, should the rich be non-accountable? Do we approach this from a ‘if you can afford it, fine!‘ which amounts to the same. When we see statistics that 1 in 3 for A&E is alcohol related, than there is a clear issue, if there is the additional pressure that the weekend gives up to 70% of the cases which are alcohol based, we have an issue.

There are of course other means, three strikes in the weekend and your academic options are forfeit, it is an option, but will it actually make a difference? The article also has a worrying side, the quote “as much as 50% of the patients [that we see], were not open to any services and some of them had never been seen by alcohol services before“, in that quote Dr Chris Daly is illustrating that the drinking population is changing, which makes for an uncomfortable truth, is it truly alcoholism, or escapism from austerity and bad economy? It makes all the difference, but the NHS is still getting hit, so it is time to seek alternative solutions, but where to go? You see, many solutions is about shifting blame and responsibility. In my case it is about shifting responsibility and in my view, the responsibility is given to he/she who drinks! They get the bill or go into the drunk tank. My view has not unique, I did not know this last year when I championed the idea, it seems that in 2013, the Association of Chief Police Officers (ACPO for short) coined that same idea, those who get thrown in are fined and that pays for the upkeep. The ACPO is now getting replaced by the NPCC (National Police Chiefs’ Council).

I know that there are issues and it is not the best solution, but in a perfect world, the large corporations would not be ‘screwing over’ the nations it is draining of income and as such, the tax coffers could have paid for it all, but that is not the case at present. When a trillion in commerce is taxed at less than 1%, any government comes up short and that is exactly where the UK is now and changes, drastic ones will need to be made. If the pressure of 1,000,000 patients goes away, staff will be under less pressure, £3,500 per shift doctors become less on an issue, which saves additional coin and the NHS can than better be reassessed. The problems of the NHS will not be gone, but the £2Bn gap it faced as was stated on the BBC in June 2014 would suddenly drop to almost zero. How is that for a good idea? Now if we can find a few options for generic medicine by cooperating stronger with India and the NHS will suddenly show signs of life again. Now, there is every chance that people will object. They will mention that there are medical risks and I agree, but guess what, the ‘adult’ who thought he could quickly have 15 pints was supposed to be an adult, now he/she gets to see the consequence of this choice. Should the patient ‘pass away’ than we could also see a drop in rental pressure, which helps more people, and possibly another job opens up, lowering unemployment rates further. Now, if you think that this is over the top, than I will not disagree, but my side states, ‘well, stop them from binge drinking!’ It might seem hard, but dying solves everything!

Hey, that could make for a nice health care advertisement.

The doctor walks into the waiting room, states “I apologise, your … passed away”, “I have a cousin who is very interested in the apartment, and we gave his job details to our janitor, he thought it was a cool job, I heard he starts on Monday!”

Then it fades out and we see the slogan “Alcohol kills!” and under it we see “your apartment and job were filled quite quickly! Only your mother/spouse will possibly miss you”, is that not a killer advertisement?

No, it is not! But it seems that being soft around this subject is not solving anything either, that part has been proven for some time now. I think I know what you will state next. ‘It will be about the alcoholics and their mental health!’ This could be valid, yet some studies show that binge drinking is for over 70% associated with the premise that it is ‘really fun’. Most doctors and nurses disagree and they are NOT laughing!

So, even though I feel that it is not fair on the population at large, the NHS can no longer facilitate any of it. There is a small shimmer of hope, consider that the drunk tank comes with a £150 fee to get out, that invoice should be scary enough, because there will be no more money for food, rent and a few other things, which will reset the focus of such a person. Perhaps once is all they need to get a grip on the consequences, apart from looking like ‘road kill’ and smell like nothing anyone want to be next to, so that person will hopefully sober up, has to walk home and will have no other options for a little while. I personally am not convinced it would work, but if the binge drinking group is lowered by a mere 5%, we would see massive savings, deep into the millions, which opens up the debate, is it worth the risk? I would say: “look at Greece, inaction has now pretty much made them slaves to the creditors for the next 5 generations”, as binge drinking is self-inflicted, I would go for the yes vote, but in all this there is another side, how are they able to get into the binge drinking habit? There are a few options that comes to mind, but this is not about binge drinking, this is about the NHS.

Alcoholism and drugs are only a few factors, the NHS has a massive problem which for one part was addressed in the article.

We now get to the issue that is hard to oppose (but I will try). The quote “Dr Mark Porter, chairman of the British Medical Association, said the NHS’s greater reliance on agency staff “is a sign of stress on the system and the result of poor workforce planning by government”“. Is that entirely true? I think that there is a hidden non-mentioned fact here. The NHS stresses have been an issue for a longer time and yes, there are issues, but let’s go over all this. Simon Stevens is the government CEO now (that title never stops making me chuckle), before that it was David Nicholson and before that it was Lord Nigel Crisp. I want to step over all the scandals as they are just getting in the way of the issues. You see, the entire chuckling bit is an issue. It is hilarious to see a political appointed CEO, I personally believe that it is a recipe for disaster with a 100% chance of leaving a sour taste in the mouth, one way or another! It needs to get a more commercial appointment with a new board, a board of executive advisors, one political, one financial and a few medical advisors. It would be great if the CEO is a medic, but the UK is short of them already, pushing them to a governing desk is not really a solution, which of course is a little shoulder thump to Dr Mark Porter (with the friendliest intention). Of course, the quote by Shadow minister Andy Burnham is equally entertaining “mistakes by the Conservatives had led to the expanded use of agency staff“, which sounds a little over the top as the staff issues would be resolved by an IT overhaul, which Labour fumbled whilst spending over 11 billion, so that solution did not pan out and now, the conservatives are still fixing the mess. In addition, the statistics show a sheer increase of costs. In the term of Labour 1997 – 2010, the costs for the NHS doubled. The earlier mentioned IT failure being a chunk of it. Before Labour the hospital services represented 4.9%, whilst by 2010 it had grown to 21%, which is like 400% more. Yet, be careful and do not just blatantly accept my numbers either! My source (at http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf) has a few issues, and there is a lack of clarity on reasons here. However, pharmaceutical services went down from 43.5 to 39.8 and even in 2010 to 31.8, which is good, but the history of generic pharmaceuticals is not clear in this regard, which is reliant on the ending of patents. Dental services has a fluctuation around 5%, so there does not seem to be a lot of options here. Yet, we must give clear admittance that there are elements that Labour could not foresee. The NHS costs went from 6.6% of GDP in 1997 to 9.6% in 2010, which happens when people grow old and do not die, they require treatment. The adjusted GDP was £279Bn in Q1 1997, £373Bn in Q4 2010, which means that the shift is a lot more than 3%, it is an additional £11Bn on top of the 3% shift. That shift in this ‘greying’ population will only get stronger. I am all for giving them the best care, they did their job. Which made me look at the drunk tank for those who have not done anything yet.

Yet, there is also other evidence. One part is found in the Public expenditure on health and care services (at http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/651/651.pdf). On page 35 we see “The evidence presented to the Committee demonstrates that the measures currently being used to respond to the Nicholson Challenge too often represent short-term fixes rather than the long-term transformations which the service needs“. I do not disagree with that statement, yet the commercial side remains an issue. Sir David Nicholson needed to cut 20 billion, or more. The Nicholson challenge was there to (attempt to) achieve this. When we see the political side whinge left, right and decently less from the centre, we need to accept that they are not paying the bills, when was there an agreement on both sides on how much the NHS was allowed to cost? Drastic cutbacks were the challenge and I am not stating that it was a great or the right solution, but it was close to the only solution. By the way, these cutbacks got started under the previous administration, headed by none other than Andy Burnham, so as he is stating issues with agency staff, I need to voice ‘howls of deriving laughter!’ it amounts to this blogger calling MP Andy Burnham a dunsel. You signed off on the need to cut back, you now do not get to steer the conversation in that manner Mr Burnham! The additional quote in his name is “Andy Burnham, the shadow health secretary, has further complicated the picture by suggesting a reformed NHS may need less than £8bn“, in what universe? After we dehydrate the drunks and drown the elderly? The mere increase in needed funds over the term 1997 – 2010 is an adjusted £11 billion that is just the increase, not including the required amount, which was already £18 billion in 1997. If I was a mean man I would point out to Mr Burnham that Excel does not treat the mean and the sum function in the same manner. So the sum over 4 years is not the same as the average per year per 4 year term. As stated, I am not a mean (not the same as average) person, so I will not say that to Andy Burnham MP for Liverpool. However, we need to be fair, Liverpool has its share of famous people, but perhaps no famous science people? In music there are the Beatles, in comedy there is John Bishop, there are actors, writers, but perhaps not any math people? Ah Darn, the famous John Horton, who came with the Combinatorial Game Theory (CGT) as well as revelations in Quantum mechanics. Mr Burnham, you should have known better!

Back to the NHS issue we go!

You see, it is in its most basic concept a simple equation BUDGET = SUM(COST1,COST2,,,COSTn); budget is known and for a while budget had to go down, which implies (using the word ‘means’ here might be confusing) that costs MUST go down. The biggest ones are usually location, maintenance and personnel. Location can usually not be tempered with, maintenance can be looked at, but with too much specialist equipment in NHS locations, there is not too much you can do and these devices usually come with a servicing fee that is not the cheapest one and with 20 devices you are usually looking at 15+ contracts. There are more devices and parts that fall under maintenance, yet there tends to be minimal movement here, so personnel remains. It is not fair, I completely agree, yet the list tends to be not that large and staff is usually the first cut (or not replaced). We all agree that it is short sighted, which The Health Committee agreed with. By the way, how many committees are there in the NHS and how much do those events cost? I’ll bet you that they are not playing for the cat’s violin, so there are costings there too. So as we see the following “As set out in the Health and Social Care Act 2012, each CCG must have a governing body. This body must have an audit committee and a remuneration committee“, now what will that part cost?

So you see, the list goes on and on. Some costings are a given, some are not and the needed funds increase every single year. In 10 years, the percentage increase over the GDP growth amounted to those eleven billions alone. We would like to do it better, more intelligent and cheaper, but how? If healthcare depends on high quality, there was never that much leeway to begin with. So are we left with the inhumane choices? I refuse to believe that, but to start to be less pampering to the binge drinkers seems in my humble opinion to be an acceptable first step.

I also believe that Jeremy Hunt is on track with the agency staff cuts, which is outrageous, but where to get the people then? I mentioned to him that he should consider opening the door to Australian medical graduates. Even though there is a rural shortage (no one wants to go there) the urban shortage is less true shortage. Perhaps Canada has that same option? What if these graduates work in the UK for a few year, for a decent income and an annual percentage payment to their study debt? It is usually easier to find graduates willing to be a little adventurous for a few years. It could work (at least lessen the pressures) and it will be a lot cheaper than £3,500 per doctor per shift, that will be an absolute given. If this solution works in getting the issues of the boil, the agencies will have no other option but to lower prices, their prices are linked to demand plain and simple. The NHS is literally experiencing the pounding the CIA got in 2003-2010, analysts went external as their income went up by 250%-400%, which was all the rage back there! So as the NHS HR literally knows how a CIA HR representative feels, we giggle a little more. But it is no laughing matter, analysts are 13 a dozen, Medical practitioners and nurses are an entirely different ball of wax and that equation is not easily solved.

So as the pressure of shortage remains, so will the existence of Dr Temp MD, it could even shift further into the temp direction, which spells bad times for the NHS. There is however one final part. In that Dr Mark Porter has a role to play too. The British Medical Association (BMA) is the trade union and professional body for doctors in the UK and has always ‘pushed’ for the highest standards, this was done to such an extent (before Porters time) that willing graduates from several nations were unable to get a VISA and rebuild their life in the UK, there is something to say for that ruling, but by keeping the ‘projected’ level of care so unobtainable high, the UK now faces a shortage issue. I think that these rules of immigration need to be looked at and additional solutions should be tapped into. I cannot guarantee that this will be THE solution, but it seems clear that not looking at this possibility will leave the NHS in the near death state it is now!

It is only one step, but any solution for the NHS should only be taken step by step, which is always better than no action at all.



1 Comment

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One response to “Dr Temp MD

  1. Pingback: Identitatis simplifico | Lawrence van Rijn - Law Lord to be

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