Tag Archives: Denis Campbell

The truth that kills you

It started in a setting that I observed and wrote about for the last few years, every now and then the NHS rears its ugly head. My look into this started when the Labour party has created a £11.2 billion fiasco that involved IT. When it comes to governmental IT issues, the UK does not score that high. In addition, when you drain a resource in one path, the other path tends to fade away and there were always politicians who claim they could do better, yet experience for over 20 years have shown me that they tend to remain clueless on the matters at hand. The moment they accept it, they go have lunch with friends who all see opportunities and before he/she knows it, the required scope has grown by 250% and soon thereafter it becomes too large to manage. From there onward it goes from bad to worse and that is how the NHS got sliced and diced (just one of many issues plaguing it).

So when I saw ‘Shock figures from top think-tank reveal extent of NHS crisis‘ (at https://www.theguardian.com/society/2018/may/05/nhs-lowest-level-doctors-nurses-beds-western-world) I was not convinced that the Guardian had even ruffled the top layer of feathers here. So I took a look. Now, the article is linked to the King’s Fund that has the numbers (at https://www.kingsfund.org.uk/publications/spending-and-availability-health-care-resources). The work by Deborah Ward and Linda Chijiko is actually really insightful, and an amazing read. So let’s take a look and they do not disappoint, the start gives us “Although it can be difficult to find data on health care resources on a comparable basis across countries, international comparisons can still provide useful context for the debate about how much funding the NHS might need in future. There is also precedent for this approach – for example, when Tony Blair famously pledged on the ‘Breakfast with Frost’ programme in 2000 to get health spending up to the European Union average“, I have to consider the value of adding flair of Blair, but it is fair enough (or was that flair enough). Yet, data is everything and proper data rules the setting, this paper recognises that and that is a massive victory.

It is important to add (pasted) the following, because it shows the value to a much larger degree.

Alongside the UK, we have chosen to look at a selection of 20 European or English-speaking countries drawn from across the OECD. For some analyses, data was available for only a subset of these countries. For some indicators, data was only available for services delivered by the NHS and did not include resources in the private or voluntary sectors.

List of UK comparator countries in this report

Australia Czech Republic Germany New Zealand Slovak Republic
Austria Denmark Ireland Norway Spain
Belgium Finland Italy Poland Sweden
Canada France the Netherlands Portugal Switzerland

Unweighted averages and medians have been used throughout this report to summarise data for the collection of countries as a whole. The amount of people who relied on weighted data cannot be underestimated on stupidity to some degree, as we get raw numbers we see that weighting would look better, yet less accurate. In this we do recognise the danger we see with ‘each country is given equal importance regardless of the size of its population‘, especially when we consider that non-rural Denmark tends to me limited to Copenhagen, and rural Netherlands (if there is any rural part left) tends to reflect Birmingham population numbers on average, so when we also take into consideration the truth of ‘The median and unweighted average are often very similar across these analyses, though the median will be less affected by extremely low or high values‘, we know that we are looking at something serious, but in the micromanaged parts (bordering rural/non-rural), there will be the sliding of values at times, not on a national scale, but where we consider certain parts per nation do not properly reflect internationally (the Netherlands vs France or Canada vs Germany).

Now we take a look at certain segments. The first one is “Under the Organisation for Economic Co-operation and Development (OECD)’s new definition of health spending, the UK spends 9.7 per cent of gross domestic product (GDP) on health care. This in line with the average among the countries we looked at but is significantly less than countries such as Germany, France and Sweden, which spend at least 11 per cent of their GDP on health care“, Sweden stands out as it has a much more refined social based system, so there is a shift there, yet as Sweden has 3 cities (Stockholm, Goteborg and Malmo), whilst the rest are basically villages some no larger than 1600 people (2 of them), the rest are between 2,500 and 140,000 in size, so in that regards, the population spread required an approach that differs from several nations, especially when you consider a place like Skellefteå and Lulea in the north. To give a little more reflection Skellefteå has 33,000 people over 8.39 square miles another 40,000 live outside of the ‘city’ limits. So it is 3,900 persons per square mile that in comparison against Birmingham that has 10,391 Ashton Villa fans per square mile. Different solutions are needed, and more often it the hardware (ambulance/helicopter) is very different especially in the winter season (in Sweden) where they actually have a white Christmas and often a white Easter as well.

Now we get to what initially was considered an issue by me, but that was because Denis Campbell Health Policy Editor of the Observer messed up a little (likely unintentionally). You see the article in the Guardian gives us “They reveal that only Poland has fewer doctors and nurses than the UK, while only Canada, Denmark and Sweden have fewer hospital beds, and that Britain also falls short when it comes to scanners“, now what is stated here is true, yet by stating “Britain falls short in several ways, especially when we compare ourselves to the Unweighted average. When we do that when it comes to nurses, only Spain, Italy and Poland have a less fortunate situation“, the Unweighted average gives a proper light per 1,000 population and that is where we need to look at the start and the King’s Fund research is doing that splendidly and shows that ‘spendingly’, the UK falls behind. It falls behind more and more is still speculative, yet if the coming 3 Financial years do not show a massive increase (read: change to the NHS approach) that will become a worsening situation for the population requiring nurses, doctors and equipment.

In the reports, I find one thing missing, that is, it would be a good idea to have that, you see, in the part Medical Technology, the CT Scanner part is partially flawed, Australia scores massively high, which is nice as I am on that island, but I also recognise the part missing there, even as there is a proper notice given with ‘Data for the UK only includes MRI and CT units in the public sector, so these comparisons should be treated with particular caution‘, the missing element is not the numbers, but the distance. As Australia is an ‘island’ nearly the size of Europe, it has its own problem, most of Queensland is rural territory and when you consider that Australia is twice the size of India, the amount of technology they have is often a burden on the size of that nation and the mere fact that the 5 large villages (Sydney, Melbourne, Brisbane, Adelaide and Perth) merely represent 65% of the population, the rest is rural.

Yet the more I read on this report, the more I respect it, it clearly shows issues that the NHS UK has, partially due to its own flaws (the report does not show that). It shows at the end that there is space for jobs “There are approximately 100,000 vacancies for clinical staff in the English NHS, and nearly half (49 per cent) of nurses do not think there are sufficient staff to let them do their job effectively“, but it does not show the ‘elitist’ approach the UK has had for decades into allowing transference of other nurses (from other nations) to become part of this workforce, yet the impossible standards that the UK have used to stop that falls short of the shortages and lack of services now thrust upon the people in need of medical services. The second part is seen (at https://improvement.nhs.uk/documents/2471/Performance_of_the_NHS_provider_sector_for_the_month_ended_31_December.pdf), here we see: “Providers have not met ambitious cost improvement targets and it is critical that these plans are recovered before year-end

Providers set out plans to deliver a total of £3.7 billion savings this financial year. The sector has outperformed the wider economy by delivering an implied 1.8% productivity improvement. This was supported by cost improvements of 3.3% – equivalent to £2,139 million of improvements in the first nine months of the year, £97 million higher than the same period in 2016/17“, so how to read that? They need to show better for the same amount, they were unable to deliver and they still got paid? Is that how it reflects, because that is merely the setting of a disastrous business model, in that the elitist overkill hire approach of nurses will never be in a proper setting in that way, or solved which would be nice too.

So when we see: “By Q3 the sector had achieved 65% of the forecast efficiency savings for the year – to meet the forecast outturn, providers will need to significantly step up the delivery of CIPs in the final quarter. However, the same pattern was seen in 2016/17, so there is evidence to support the increased delivery in the final quarter“, which sounds nice, but they would still come short by no less than 20%, so even as we complement them by getting better in the home stretch, they still did not make the delivery they promised and no matter how ‘ambitious‘ the goal is, a goal not met remains a failure. So when we do address the shortages on all levels and the setting on how ‘some top think-tank‘ gives us ‘shock figures‘, it still revolved around a much larger mess that has not been addressed for the longest of times and is still nowhere near up to scrap.

The goods we need we see on page 51, with the setting of ‘Nursing vacancy position‘ we see how most other failures are shown to fail merely due to shortages, the fact that the NHS has 35,000 vacancies also shows on how timelines cannot be met, when we see that in regard to the shortages nurses to the job of 1.4 nurses, there will be more burnout and more delays on every field. Throwing money at it will not really solve the issue, because this is the one field where we see the direct impact of service levels versus the impossible demand of nurses. So when we accept that the nurses program requires a larger overhaul in setting the stage we see that this is te first field where the military are actually becoming part of the solution.

How speculative can we get?

Here is a warning that matters, because the changing of settings is essential to shaping the future. Consider two places the first (at https://www.army.mod.uk/who-we-are/corps-regiments-and-units/army-medical-services/queen-alexandras-royal-army-nursing-corps/) where we are introduced to Queen Alexandra’s Royal Army Nursing Corps (QARANC), as well as the recruitment (at https://apply.army.mod.uk/roles/army-medical-service/army-nurse). Now consider that the army is charged with the setting of training all applicant nurses to serve the NHS. So immigrants and optionally their children get a short access path to serve the UK on medical terms and it comes with complete processed nationality (after initial screening is passed). So families get the option to become British and part of the society they moved to. Now, this will not always work, yet if you see a 35,000 shortage and you get to lower that by 1,000 each year? Let’s not forget that the shortage is not going away any day soon, so any approach we can take we should consider. Now this is not for everyone, and more importantly an army nurse is still a military function, yet in this setting, there will be training in English, UK values, medical training, language and more importantly the years to come will show whether they have what it takes, in the end we use a structured system to infuse the NHS in operational ways, in addition, as the there is a growing need at the NHS, we see other parts where such reflections would grow the power of the NHS indirectly.

Both logistical and engineering sides of the Military could spell equal options to grow the NHS, or at least grow the ability of taking care of itself sooner rather than later. When we consider that the cost of agency nurses are close to astronomical (at http://www.kentonline.co.uk/medway/news/trust-spends-11m-on-temporary-nurses-180427/) gave us “Medway NHS Foundation Trust spent more than £11m on temporary nursing staff last year, a Freedom of Information request has revealed“, so when we consider that, is calling the army to aid in setting the boundaries back by a fair amount that much of a farfetched call? When we also see “There is a shortfall of 40,000 nurses across the UK, which has been driven by a lack of nursing training places in recent times“, is my call to call in the army and its instructors that much of a leap? Now we can all agree that it does not work on all fronts, but we can either stare at the missing beaches we have now, or start creating our own beachheads and see if we can see how new solutions could be implemented. There is no certainty, only the certainty that at the present course there will never be a solution that is what needs to be addressed. We need to accept that the current approach towards solving the NHS issues is not realistically set. When we look at merely one source (at https://www.nurseuncut.com.au/how-australians-can-get-nursing-jobs-in-the-uk/), we see the language that is given even after you get the NMC (the Nursing and Midwifery Council), you passed the tests, you have shown that you are who you are, your medical knowledge has been assessed, we then see “The hard work isn’t over after this point though, as you will obviously still need to find an actual job within the NHS. Fortunately, there are places designed to help – such as agencies like Nursing Personnel, where you can find a range of jobs across different disciplines and in different UK cities“, so we see that the agencies are set as a buffer, filling their pockets, so they never ever want to see that changed. In addition there is “Following this, you must apply for and then receive a valid work visa to ensure you can legally work in the UK. Finally, when all the pieces are in place, you can begin your new nursing role. Good luck!“, So even after that path is taken, after you get your NMC pin, there are still two iterations to get through, even as the Army, or even directly via QARAN, we could see that the entire path, towards the NMC, especially by those who have a nursing degree. That was never an option? Not even as I discussed such a path almost 4 years ago? When we see the shortage and the non-actions in this, can we even have faith that those around the NHS want anything fixed? It seems that they get ‘rewarded’ no matter what, especially the agencies, so when we see the money in that, why would they want to fix it? I say start by fixing this for the nurses first, which will get delays down and will give additional rise to finding as the agencies get less work, it also states that the invoices form them disappear meaning that millions become available. More staff and alternatively also more equipment could be the beginning to solving two issues to a larger degree. After that we can start looking into addressing the shortages on doctors, yet I also feel that once the nurse shortage is addressed, the doctor shortage might partially take care of itself. Even as the Financial Times reported last year that almost 400 GP’s a month quitted the NHS, addressing the nurses shortage will lower that number and when there are enough nurses we will see that it might lower to almost zero (speculative), yet as one fixes two other issues, we will suddenly see that when nurses reach above the unweighted number of 10, other numbers are guaranteed to shift too, because as agencies make millions less, those millions will shift to optional beds, medication and technology. Suddenly the UK will not look so bad overall. Now, let’s be clear this is a path that would take no less than 3 years to see certain parts turnaround, but it is a realistic path with a realistic curve of improvement. So even as we get served “Portsmouth Hospitals NHS Trust has 9,264 4 hour breaches (25.5%)“, we can also see from the other numbers that a larger extent is due to a shortage of nurses, so when we accept that they could climb to 85%-90%, we see that the entire setting suddenly looks less grim, so even as we need to realise that there is a setting (based on location) that the overall need of 95% performance is ideal, the question becomes is it a realistic setting, when all matters are equal it might be, yet at present all things are not equal and that is the part that requires attention, it is not the top 5% made that sets the standard, it is the acceptance of those in the 90%-95% range that requires merely some scrutiny, the question becomes, which one alteration might get those in the 90%-95% range there? I believe that nurses are merely one part, technology is the second part and as we deal with nurse shortages, there is a setting that technology gets fixed to some degree in the process. This paper (Spending on and availability of health care resources: how does the UK compare to other countries?) does not answer it, but gives light to the path that requires attention, the paper gives a path to investigate and that is equally massively important, so when we consider figure 2, can the change between New Zealand (10.3 nurses) versus he Netherlands (10.5) above the unweighted average of 10.4 show that difference of attaining the ‘revered’ 95% score or higher? Because of ‘irregularities’ that national needs tend to have, it is a cautious approach, yet the idea that it solves it is one thing, yet the one part not shown here (hence I took these two reports) is that even a we accept that they cannot be used in comparison, the setting of getting the 95% mark is still an essential statistic (by some) and if so, we accept that we go by the Unweighted average as a mere indicator, is that the right indicator to use (read: rely on), or is there a number missing? Is there a ‘Nominal Coverage‘ missing that is an indicatory number that aids us towards the A&E 4-hour standard setting and the attainment of the 95% score? Now it remains indicatory as there will always be a shift towards nominal nurses and actual nurses, but we need to start somewhere and if additional nurses are the first requirement to start turning this around, these numbers will become a lot more important, that part is not addressed (which was never the setting for Deborah Ward and Linda Chijiko), yet it is an issue for the NHS and the writing and results by these two ladies, might be a first step in actually getting there. When we look at the simplicity of it, was it really that far-fetched? I am merely asking, because my flair for oversimplification can be overwhelming for a lot of ‘experienced analysts’.

Yet, my mere focus has always been, how can we fix/improve the current NHS?

It is the path to solution that we need to care for, how it can be fixed, if it can be fixed. I have forever opposed the Jeremy Corbyn approach to throw money at it, because in the current setting the only one getting a better deal are the agencies and they are already cats that are way too fat. Hence I look at the directions where training and education sets the pace and in that pace we need to find opportunities for the NHS to pick the fruits form the yard, it is merely a different set of spectacles, the spectacle is not merely about the presentation, it is about setting the right focus, because focus shows us where the flaw is and where we can initially start the focal point of repairing the situation.

The weird part is that Canada, the UK and Australia have similar issues, so there is a foundation of repair missing which is equally a worry. In all this someone is getting rich, is it so hard to look at those getting rich and why that is? The fix could have been underway as early as 2014, the fact that it is nowhere there is worthy of many more questions, yet the bulk of those who could ask them, do not seem to ask them visible enough for all people to wonder how certain matters could be fixed and when one is fixed how much the other problems diminish, an equally important question. Even if it is merely for the reason that not finding these answers could kill you, either in an ambulance, or in a corner of a hospital awaiting a nurse to get you to the proper place for treatment, would that not be nice too?

 

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As the UK changes

There is no doubt about it, the UK is about to get a drastic change of image. Some of these parts is on them, other parts are set for them by others. We might all debate that it is usually the one or the other is sorely mistaken. It is when the industry and those trying to ‘guard’ their path to become members of ‘the billionaires club’, it is at that point we need to worry on who can influence our paths to a decent life and those who is trying to direct their ‘image’ from behind the screens. It is at that point ‘we the people’ must worry. You might think that me, being an Australian blogger, that I have no skin in the game. That is where you are wrong!

My grandfather was not just British, he served during WW1. In addition, there was a moment where my grandfather excelled, it was not WW1, it was a little later that he became one of the volunteers who acted and helped to unload the boats as there was a dockworker strike. I am not up to date on all the details as he passed away whilst I was still too young to comprehend the concept of ‘strike’. The reason why I remember it was because my grandmother showed me the letter of gratitude which came from King George V (I personally reckon it was done by his staff and he signed it). Still, my grandmother was proud to have the letter. This is not just some memory, the event mattered. Not all things done for King (or Queen) and Country is done in a war. We have points of view, and in the past the people had a strong moral compass. Those who did strike might have had an equally strong moral compass. I do not oppose that or their view. My point of view is different as I am from a much later era. So when we see: ‘Tories attack Labour over inheritance tax and spending plans‘  (at https://www.theguardian.com/politics/2017/may/03/corbyns-economic-policy-would-cost-voters-45bn-ministers-claim), where the backdrop is Jeremy Corbyn with the bomb stating ‘More debt, higher taxes’, we need to be concerned for our future. It makes me particularly sick that Jeremy Corbyn is making promises that have no bearing on reality. As a conservative, I would love to employ another 10,000 police officers. Actually, I prefer 4,000 Police Constables’s and 6,000 nurses, but that is just me. With over a trillion in debt the UK government cannot afford it and I get that. The previous Labour government has wasted so much money, they should not be allowed to drive the UK deeper in debt by making promises and spending cash that will take an entire generation of workers to settle. 4 years of spending and 25 years of paying it back is not a plan, it is idiocy! In that we need to realise that the game has been over for far too long. The UK needs affordable housing plans, which will also cost heaps, yet this is money they will get back as the economy is starting to employ people again and get the quality of life for all (especially the lower incomes up), in that Jeremy Corbyn has absolutely no clue what to do and it is with that level of cluelessness that he wants to be elected, so he is making empty promises (as I see it) to throw money at any sizeable group for the mere number of votes. A party that cannot even be one party and is infighting nearly non-stop, that is not a party that should be regarded as a valid choice, at that point UKIP will be a much better choice than Labour has been for close to 5 years. I reckon that even if the LibDems could find their groove and direction, they would be a better choice than the Labour party is at present, which is saying a lot.

The UK budget is an issue and those who can count know this, they have known this for 6 years that the party was over. The Commonwealth needs to pull together and find solutions that will bolster each other. In this Australia and Canada are the most likely allies, yet we should not discount New Zealand or India here either.

The second part actually intersects politically with the first. I have a few issues with the article called ‘The six Brexit traps that will defeat Theresa May‘ (at https://www.theguardian.com/politics/2017/may/03/the-six-brexit-traps-that-will-defeat-theresa-may), yet there are parts that we need to truly consider in more than one way. The first is shown with ““It’s yours against mine.” That’s how Wolfgang Schäuble, Germany’s finance minister, put it to me during our first encounter in early 2015 – referring to our respective democratic mandates.“, as well as “Brussels became the seat of a bureaucracy administering a heavy industry cartel, vested with unprecedented law-making capacities. Even though the EU has evolved a great deal since, and acquired many of the trappings of a confederacy, it remains in the nature of the beast to treat the will of electorates as a nuisance that must be, somehow, negated“. I have some issue with the second one, but that will be addressed shortly. The fact is that the writer, Greece’s favourite rock star: Yanis Varoufakis (read: former Greek Finance Minister) has been playing a game whilst in office (a politically valid one), yet the consequence is that their play pushed Brexit forth. In addition, we know that there is a long lasting issue in Brussels and the fact that the EU-zone is a mere facilitator for big business is slightly too conspiracy theoretical. Yet the fallout, which I blogged about for a few years pushes that view forward too. I believe that the truth is that the EU opened up a power broker game where large corporations had much more influence than even before. The EU players have to have one front whilst corporate divisions could play both ends of the political field against the middle, with the economic area’s being always too scared of their local needs. And those in charge had (read: have) no real need for Greece, only for the banks that could give them larger than life careers after their political day. This has been a global view and shown to be correct for the longest of times. So when we read: “From my first Eurogroup, its president, Jeroen Dijsselbloem, the Dutch finance minister, began an intensive campaign to bypass me altogether. He would phone Alexis Tsipras, my prime minister, directly – even visiting him in his hotel room in Brussels. By hinting at a softer stance if Tsipras agreed to spare him from having to deal with me, Dijsselbloem succeeded in weakening my position in the Eurogroup – to the detriment, primarily, of Tsipras“, this read completely correct from my point of view, yet I must also state that as Yanis played his public game (or is that pubic?), as the testosterone was flying off the newspapers, whether under orders of his PM or not (an unknown factor), Yanis played his game too hard and Greece was in no place to play the game that hard, especially as the Greek spending and misrepresenting transgressors never ended up in court and prosecuted, Greece did not have any options to lean on, not morally and not literally. Yet, there is a side that we see has a ring too it, we have seen it over the last two years as the ECB and Mario Draghi have been playing their political game for slightly too long, certain better financial media are now asking questions on Draghi and his non maintainable status, that whilst Draghi has been making additional Brexit threats. All this in the agony of fear because the turmoil in France is intensifying. In sight of the slip of numbers in the pro-Macron group, the financial world is now holding its breath and the next 96 hours will be the killer with adrenaline levels so high that can be cut with a knife. Wall Street will be glued to the election result screens, quite literally praying for a miracle.

Last there is the everlasting issue with the NHS (the one where the UK Labour party wasted 11.2 billion IT funds on). The article ‘Hospital waiting lists ‘will rise above 5 million’ as targets slide‘ (at https://www.theguardian.com/society/2017/may/03/nhs-annual-health-budget-increases-conservatives-ifs), is one that intersects even more. the cost of keeping it correctly alive should be on the minds of anyone voting in the UK. It is the most important long term part in everyone’s life in the UK. The issue is that it might not be immediate and therefor too many people are ignoring it because there has been too many NHS news mentions, but it will define the life of everyone in Britain, as such we need to realise that the hollow promises of Jeremy Corbyn are a direct threat to the existence of the NHS. Many might blame the Tories here, but the reality is that 2 terms of Labour did spend all the money there was and they also did the spending of 3 additional administrations as I see it, which is why they are so dangerous. The quote: “Without further help from the next government after the election, this is what the real impact will be on patients of successive underfunding of the NHS,” said Ian Eardley, vice-president of the Royal College of Surgeons” is not incorrect, yet those in charge of the NHS and those connected to high valued luncheons and board meetings should have taken a much better posture when billions were spent on a system that never worked. There is a consequence to that and as funds and infrastructure both took a dive the future will be grim, not unsolvable but grim none the less. Denis Campbell has written a good piece and should be read, this is not merely about a few quotes, there are serious issues, yet in all this there are parts missing, parts that are connected yet unmentioned. In light of what needs to be a light, the one article will never cover it (not due to the writer). Merely because the issue has become too great. Now, as we see what is in play, we need to revisit the start of this blog. My grandfather did what he thought was essential and right. Ships had to be offloaded, the goods were meant for the people and as such if not unloaded, the people would suffer. In that light the NHS is in a place where it is doing what it can, but the truth is that the NHS must change and adapt. People a lot more clever than me will need to make a reform, reforms that Greece halted and it is dragging them down, the UK will have to change the NHS is drastic ways. When we read that 5 million people are on a waiting list, we have to question the time they remain on that waiting list. The elitist approach that the nursing groups have taken as to whom can become a nurse and which tertiary education is good enough to be a nurse in the UK is one that requires scrutiny. There are too many political games being played and even as they voice ‘quality of staff‘, there has come a point where people are dying because there is no staff. We need to instigate a change that opts for a situation where 100,000 patients can get some level of care as per immediate. The Corbyn solution of throwing money at it will not do. We can argue that in equal measure privatisation is equally a bad idea, because we merely replace ‘level of care standards‘ by ‘level of profit‘ and that will never ever lower cost for the people at large. The parts we tend to ignore is not privatisation, it is interactivity of services that will lower cost, that part needs to be ascertained and not by groups trying to create a new gravy train.

We need actual solutions and it requires a different train of thought, one that needed yesterday. So as the press is facilitating on how Labour will spend more on the NHS and nurses, whilst the publishers of these papers know that there is no way that this can be funded, you need to question on what makes for an actual solution. The only solution (as I personally seen it) is to create a wave of credible positions and train the people in some places on the job. Perhaps these colleges need to accept a new degree where people can be trained on sight step by step, lowering the pressure for those who can do it all by slowly replacing those who can do it too and not just in nursing, because if the waiting list got to the millions, we need to see where surgeons could have an alternative group of people, not unqualified, but those who barely missed the grade. We need to reconfigure the pyramid shaped triangle into a parallelogram, so that some functions that cannot be filled can be done by others. Now, lets all accept that a surgeon is an extreme example, yet can the same be stated for a radiologist? an Anaesthesiologist? or even a surgical assistant? Three functions that might opt for additional people from other branches. Even as we know that they all claim ‘dedicated’ and ‘perfectly schooled’ personnel. It is time that those academic ‘advisors’ from Royal Colleges take a sharp look at wartime conditions and to the parts that some could play in aiding in a solution. Now because there is a strike and the dockworkers are busy standing up for their rights (which is a valid activity), but because in this high pressure world there are ships docked and there is no one left to unload the boats. That is where the NHS is and that is where they need to find a solution. Perhaps this will be found in the military, it is possible that those in the medical services of the Army, Navy or Air force will find that they are doing part time work at an NHS location. In that same stage, so will other defence branches find themselves. Fighting for their country, not in the trenches of the Somme, but in the tranches behind a desk of London Hospital. It might just keep that deficit down from £134.9m (that is this year alone) to something that could actually be managed.

We need another play, and it is perhaps the UK who might remember how they changed Cricket tactics in 1932-1933, so they did not get completely humiliated by Don Bradman. We still need a better solution and the Bodyline tactic was never an acceptable tactic, that whilst the ‘win at all cost‘ is not a decent play, but the NHS is now in a stage where it is ‘survive or die‘ and nobody wants the NHS to die, so in this the NHS and especially the advisory boards will need to look at tactics that will make them really unhappy, but at this stage they have left themselves no other options and the political players can only facilitate unrealistic options that are no options. They will start a path that will change the UK for generations, yet in that let that be in a way that will allow for the existence of some level of National Health Care. In this that they will need to write a new playbook, one that can offer options, not limitations.

 

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