Tag Archives: Jeremy Hunt

It starts with a wrong label

Yes, merely ‘the wrong label’ is the beginning of what we see (at https://www.theguardian.com/society/2017/oct/16/nhs-data-loss-scandal-deepens-with-162000-more-files-missing) when we see the press look at ‘loss‘ and data files. You see, when we see a million documents that have been removed, that whilst the media (in this case the Guardian) uses expressions like ‘went missing‘ and ‘gone astray‘ we need to worry about the media as a whole. You see this is nothing less than an optional cover up of intentional negligence, multiple acts of manslaughter and perhaps even mass murder. That is quite a leap is it not? You see, when 137 documents are removed and wiped from a system it is a clear cover-up. Just lose those and 925.000 other documents and you get a systematic failure and no one looks too deeply, because now we have an optional situation where MP’s can vie for a few billion to ‘fix it‘. Yet the levels of what went wrong and more important the fact that I myself had a solution available (which would require another year to implement) is exactly the solution that would be preventing this. By the way, this is not about me trying to sell ‘some’ solution. This is merely the application of common sense. We can all agree that a document can get lost, it should not, but it happens. After the loss, if the system is set up correctly, the loss could be recovered. That is when a system is properly set up.

Yet, the opposite is what we see now. Now, we get a mess that is even larger and no one has any clue on how to proceed.

This last statement requires clarification, because merely stating an issue, does not make it one. It is initially seen in the quote “Officials said that in the course of their inquiries, they had identified a further 150,000 medical documents that had been mistakenly sent to the outsourcing firm Capita by GPs; and a further 12,000 missing papers that had had not been processed by SBS“. So it involves several GP’s, which means that the infrastructure has either a systemic failure, or has been mishandled by those in charge. The document went out of the hands of the GP’s, and those who had no copies basically threw away the health of their patients. So what happened when it went to the outsourcing firm? They should still have the papers, or they have forward them to someone else. You see, 12,000 papers (with envelopes) is a large bundle of paper and that does not just go missing, someone received it, processed it and what happened afterwards? How was it processed? The systemic failure is larger when we consider “However, despite staff raising concerns, the firm – which is 49.99% owned by the Department of Health – did not alert the department or NHS England until March last year, 26 months later. SBS was then “obstructive and unhelpful” to NHS England in the inquiry it then instigated, the NAO found“. The 26 month period implies in my view that arrests and prosecution of staff becomes clear. Was that done? What were the actions of the Department of Health, the NHS or the DPP for that matter? 26 months of inaction, it is perhaps the first clear part in this that gives rise to my suspicions. The additional “SBS has paid £4.34m for the loss” gives rise to the fact that the negligence goes a lot higher up the ladder than we are shown. In a place where anything more than £10,000 requires autographs from people who usually cannot be found to sign for anything for months at a time, someone dished out £4 million plus to make it go away.

There is the foundation of mismanaged events that are also the stepping stones of endangering the lives of people. The alleged issue, or is that evident issue that there is more going on can be seen in the quote “People should be reassured that despite reviewing over 97% of the records that SBS failed to process not a single case of patient harm has been identified”, so how does the NHS spokesperson know this? 97% whilst hundreds of thousands of documents including treatments and health plans are missing, how are they so sure? It gives rise to my suspicions of something else. What else? I do not know and it is mere ‘conspiracy theorist’ waves to make any alleged setting here, but the setting in the end that we read about is not about prosecution, it is about an upcoming wave of spending that the UK government cannot afford at present, giving rise to even more issues to come. With “Jeremy Hunt must urgently come before parliament to explain what steps are being taken to ensure this does not happen again“, You see, the ‘happen again‘ part implies that it is clear how it happened in the first place and that is the part where the DPP should have visibly stepped in, and as far as we can tell this did not happen. In addition, with ‘what steps are being taken‘, there is an implied setting that there was a thorough investigation and that might have been part of those steps, yet that did not happen (as far as we can tell) and the fact that the mess was covered up for 26 months gives rise to my suspicions that this was not merely about records. We only need to loop sat the Pharmaceutical scandals in 2013 and 2017, the link to Aspen holdings and the fact that someone saw the option, through a loophole to drive prices by 4,000%. Perhaps that now gives more suspicion to so many documents being ‘misplaced‘. I am not implying that Aspen Holdings is involved in this (or implying that they were), I am merely stating that there have been larger bungles costing millions upon millions that might not survive the scrutiny that the light of day brings. With the Times and the Independent howling one side, the report of ‘lost’ documents is even more unsettling, because that now implies that the usage of certain medication is now only in the hands of the NHS, and they seem to be very uneasy of seeing certain numbers appear. Those numbers will still appear, but now possible on a whole stack of other medication, so that the impact of 3-5 medication suppliers remains unseen. So am I correct? Do not take my word for it and do not merely believe me, I am not asking you to do that, I am asking you to see the failure of these lost documents is a lot bigger than ‘merely’ one outsourcing firm, to lose this amount of paperwork require orchestration on a higher level, that is one part that should be pretty apparent. Yet that last part is still speculative in nature because with the loss of one side, reporting and data dash-boarding on the other side is not a given and may not be impacted, that is the part I will admit to, there are unknown sides in that part, yet the question and the speculative consideration remains in place.

Now, this is not a new revelation, In February and June we saw this news hit the papers and magazines. In all this the DPP remains unseen. When we consider the impact that the events are having and the possible dangers to people’s health, to see nothing at all in relation to Alison Saunders is pretty weird to say the least. It looks fine when she makes a speech regarding the expectations of the NHS on fairness. So as we see “Alison Saunders said the Crown Prosecution Service will seek stiffer penalties for abuse on Twitter, Facebook and other social media platforms“, we think she is doing her job and she is, yet she has yet to give us anything on the entire lost paper trail, the documents, the actions by the NHL and the outside resource. Is that not even stranger?

You see this all started in February with ‘More than 500,000 pieces of patient data between GPs and hospitals went undelivered between 2011 and 2016‘ (at https://www.theguardian.com/society/2017/feb/26/nhs-accused-of-covering-up-huge-data-loss-that-put-thousands-at-risk). With “The mislaid documents, which range from screening results to blood tests to diagnoses, failed to reach their intended recipients because the company meant to ensure their delivery mistakenly stored them in a warehouse” we get a new part. You see, stored does not mean lost, and this gets weirder with “NHS England secretly assembled a 50-strong team of administrators, based in Leeds, to clear up the mess created by NHS Shared Business Services (NHS SBS), who mislaid the documents“. So at this point 8 months ago, the DPP had a clear responsibility. You see when we look at the CPS we see (on their own website ‘the three specialist casework divisions are: the Specialist Fraud Division (which also incorporates Welfare Rural & Health), the Special Crime & Counter Terrorism Division and the International Justice and Organised Crime Division. They deal with challenging cases that require specialist experience, including the prosecution of cases investigated by the Department of Health and Medicines and Healthcare products Regulatory Agency‘ (I skipped the other departments), so we see here that there was a clear setting last February alone, the longer the inaction, the worse the damage becomes, that has been proven again and again.

In June we see ‘Health secretary forced to respond to urgent Commons question after withering NAO report on loss of 700,000 health documents‘ (at https://www.theguardian.com/society/2017/jun/27/jeremy-hunt-nhs-shared-business-services-data-loss-scandal). With “answer questions from MPs after a damning National Audit Office report found that the scandal may have harmed the health of at least 1,788 patients and had so far cost £6.6m“, we see one side, I expect the damage to be distinctively larger. You see the DPP (as well as the whole of the CPS) seemingly ignored “The private company, co-owned by the Department of Health and the French firm Sopra Steria, was working as a kind of internal postal service within the NHS in England until March last year“, so was this an experiment gone wrong? Was this a PLM error (product lifecycle management) on a massive scale and this does not stop with Sopra Steria, there was an increasing risk that CIMPA S.A.S was linked to all this. The operative word is ‘was’ as the DPP and her CPS seemingly sat on their own hands for at least 8 months, maybe even more. You see, my suspicions are taking me to the fact that the Department of Health knew more on a higher level. That suspicion is shown with “the NAO report pointed out that the DH had chosen not to take up two of the three seats in the boardroom it was entitled to as 49.99% owner of SBS“, so please tell me when was the last time that ANYONE in the department of Health was willing to pass up any boardroom seat. Even if the pay sucks (which it never does) it opens up networking avenues for people they never had before, to the ‘let’s not take this seat‘ would be completely out of the question, dozens at the DH would be chomping at the bits to get a leg up in visibility, so that is how I personally see this mess. When certain members steer clear, there is a larger issue and the DPP was fast asleep (or at least so it seems).

And now the plot thickens!

With: “The government’s response has been complacent and evasive. It’s still not clear how much public money has been wasted in this affair or how this private company is going to be held to account. It’s totally unreasonable for Jeremy Hunt to wash his hands of this when more and more details of his department’s failures keep emerging“, that whilst it had been known that up till 8 months ago £6.6 million was spend and it is not mentioned now is only the top of the issue. With the absence of Sopra Steria and CIMPA it seems that certain sides are pushed away from the centre of the room. It is equally seen when we see “Geoffrey Clifton-Brown, a Conservative committee member, said: “You tell us the bombshell that whilst on a trawl of local trusts you find another 12,000 and then you found another 150,000 missing items“, here I cannot tell whether the issue was raised or not (it was not in the Guardian article), yet there is no way that Geoffrey was unaware, a graduate of Eton and Freeman of the City of London. There is no doubt in my mind that he was aware of the links, the question is why questioning in this direction was not pursued and/or reported on. So when you might have been thinking that I was all about some ‘conspiracy theory‘ in the beginning. Do you still think so? The entire PLM issue is one that is not bathing in millions, but in billions as infrastructure crack more and more on the paper trails and reports they require PLM solutions are the only one stopping systems from collapsing overnight. In this regard even India is on par with the needs and CIMPA is taking every step to be the only player of significance there. So now some of the events make a lot more sense, do they not? You see CIMPA was on the right track, until AI becomes the path that solves certain issues, it will be about automation and data processing. For a lack of term ‘from paper to digital data without people’ is what is required as people are the drain on speed and the postal sorting machines had proven that side decades ago. In the end what exactly happened is uncertain and might never be known, especially as the DPP is seemingly still asleep in all this. Did the solution fall over, did the data collapse? We might never know, yet in all this the one part I left for the very end. With the mention of ‘private company, co-owned by the Department of Health and the French firm Sopra Steria‘ there is one side not mentioned. You see private companies have revenues and profits, these profits go to private individuals. None of the articles shed any light on those people involved did they? The DPP, the CPS, Vince Cable, and the Guardian made no mention of that at all and Geoffrey Clifton-Brown didn’t ask these questions either did he?

5 parties all with interests are avoiding looking into a direction to the extent that it needs to get. The fact that it happens under our noses is particularly interesting. I wonder what we will learn in a few weeks, especially as this 26 month ‘slicer’ is as quoted by Simon Stevens, the NHS’s chief executive to be dealt with in the next 5 months with: “This should be wrapped up by the end of March. End of March is a feasible goal.

By that time what else will they not have looked at?

 

Advertisements

Leave a comment

Filed under Finance, IT, Law, Media, Politics, Science

When the trust is gone

In an age where we see an abundance of political issues, an overgrowing need to sort things out, the news that was given visibility by the Guardian is the one that scared and scarred me the most. With ‘Lack of trust in health department could derail blood contamination inquiry‘ (at https://www.theguardian.com/society/2017/jul/19/lack-of-trust-in-health-department-could-derail-blood-contamination-inquiry), we need to hold in the first stage a very different sitting in the House of Lords. You see, the issues (as I am about to explain them), did not start overnight. In this I am implying that a sitting with in the dock Jeremy Hunt, Andrew Lansley, Andy Burham and Alan Johnson is required. This is an issue that has grown from both sides of the Isle and as such there needs to be a grilling where certain people are likely to get burned for sure. How bad? That needs to be ascertained and it needs to be done as per immediate. When you see “The contamination took place in the 1970s and 80s, and the government started paying those affected more than 25 years ago” the UK is about to get a fallout of a very different nature. We agree that this is the term that was with Richard Crossman, Sir Keith Joseph, Barbara Castle, David Ennals, Patrick Jenkin, Norman Fowler, and John Moore. Yet in that instance we need to realise that this was in an age that was pre computers, pre certain data considerations and a whole league of other measures that are common place at this very instance. I remember how I aided departments with an automated document system, relying on 5.25″ floppy’s, with the capability that was less than Wordstar or PC-Write had ever offered. And none of those systems had any reliable data storage options.

The System/36 was flexible and powerful for its time:

  • It allowed 80 monitors (see below for IBM’s description of a monitor) and printers to be connected. All users could access the system’s hard drive or any printer.
  • It provided password security and resource security, allowing control over who was allowed to access any program or file.
  • Devices could be as far as a mile from the system unit.
  • Users could dial into a System/36 from anywhere in the world and get a 9600 baud connection (which was very fast in the 1980s) and very responsive for connections which used only screen text and no graphics.
  • It allowed the creation of databases of very large size. It supported up to about 8 million records, and the largest 5360 with four hard drives in its extended cabinet could hold 1.453 gigabytes.
  • The S/36 was regarded as “bulletproof” for its ability to run many months between reboots (IPLs).

Now, why am I going to this specific system, as the precise issues were not yet known? You see in those days, any serious level of data competency was pretty much limited to IBM, at that time Hewlett Packard was not yet to the level it became 4 years later and the Digital Equipment Corporation (DEC) who revolutionised systems with VAX/VMS and it became the foundation, or better stated true relational database foundations were added through Oracle Rdb (1984), which would actually revolutionise levels of data collection.

Now, we get two separate quotes (not from the article) “Dr Jeremy Bradshaw Smith at Ottery St Mary health centre, which, in 1975, became the first paperless computerised general practice“, as well as “It is not developed or intended for use in any inherently dangerous applications, including applications that may create a risk of personal injury. If you use this software or hardware in dangerous applications, then you shall be responsible to take all appropriate fail-safe, backup, redundancy, and other measures to ensure its safe use“, the second one comes from the Oracle Rdb SQL Reference manual. The second part seems a bit of a stretch; consider the original setting of this. When we see Oracle’s setting of data integrity, consider the elements given (over time) that are now commonplace.

System and object privileges control access to application tables and system commands, so that only authorized users can change data.

  • Referential integrity is the ability to maintain valid relationships between values in the database, according to rules that have been defined.
  • A database must be protected against viruses designed to corrupt the data.

I left one element out for the mere logical reasons.

now, in those days, the hierarchy of supervisors and system owners was nowhere near what it is now (and often nowhere to be seen), referential integrity was a mere concept and data viruses were mostly academic, that is until we get a small presentation by Ralf Burger in 1986. It was in the days of the Chaos Computer Club and my trusty CBM-64.

These elements are to show you that data integrity existed in academic purposes, yet the designers who were in their data infancy often enough had no real concept of rollback data events, some would only be designed too long later, and in all this, the application of databases to the extent that was needed. It would not be until 1982 when dBase II came to the PC market from the founding fathers of what would later be known as Ashton-Tate, George Tate and Hal Lashlee would create a wave that would get us dBase III and with the creation of Clipper by the Nantucket Corporation, which would give a massive rise to database creations as well as the growth of data products that had never been seen before, as well as being the player that in the end propelled data quality towards the state it is nowadays. In this product databases did not just grow with the network abilities within this product nearly any final year IT person could have its portfolio of clients all with custom based products all data based. Within 2-3 years (which gets us to 1989), a whole league of data quality, data cleaning and data integrity base issues would surface for millions of places, all requiring solutions. It is my personal conviction that this was the point where data became adult, where data cleaning, data rollback as well as data integrity checks became actual issues that were seriously dealt with. So, here in 1989 we are finally confronted with the adult data issues that for the longest of times were only correctly understood by more than a few niche people who were often enough disregarded (I know that for certain because I was one of them).

So the essential events that could have prevented only to some degree the events we see in the Guardian with “survivors initially welcomed the announcement, while expressing frustration that the decades-long wait for answers had been too long. The contamination took place in the 1970s and 80s“, certain elements would not come into existence until a decade later.

So when we see “Liz Carroll, chief executive of the Haemophilia Society, wrote to May on Wednesday saying the department must not be involved in setting the remit and powers of an inquiry investigating its ministers and officials. She also highlighted the fact that key campaigners and individuals affected by the scandal had not been invited to the meeting“, I am not debating or opposing her in what could be a valid approach, I am merely stating that to comprehend the issues, the House of Lords needs to take the pulse of events and the taken steps forward from the Ministers who have been involved in the last 10 years.

When we see “We and our members universally reject meeting with the Department of Health as they are an implicated party. We do not believe that the DH should be allowed to direct or have any involvement into an investigation into themselves, other than giving evidence. The handling of this inquiry must be immediately transferred elsewhere“, we see a valid argument given, yet when we would receive testimonies from people, like the ministers in those days, how many would be aware and comprehend the data issues that were not even decently comprehended in those days? Because these data issues are clearly part of all of these events, they will become clear towards the end of the article.

Now, be aware, I am not giving some kind of a free pass, or give rise that those who got the bad blood should be trivialised or ignored or even set to a side track, I am merely calling for a good and clear path that allows for complete comprehension and for the subsequent need of actual prevention. You see, what happens today might be better, yet can we prevent this from ever happening again? In this I have to make a side step to a non-journalistic source, we see (at https://www.factor8scandal.uk/about-factor/), “It is often misreported that these treatments were “Blood Transfusions”. Not True. Factor was a processed pharmaceutical product (pictured)“, so when I see the Guardian making the same bloody mistake, as shown in the article, we see and should ask certain parties how they could remain in that same stance of utter criminal negligence (as I personally see it), but giving rise to intentional misrepresentation. When we see the quote (source: the Express) “Now, in the face of overwhelming evidence presented by Andy Burnham last month, Theresa May has still not ordered an inquiry into the culture, practice and ethics of the Department of Health in dealing with this human tragedy” with the added realisation that we have to face that the actual culprit was not merely data, yet the existence of the cause through Factor VIII is not even mentioned, the Guardian steered clear via the quote “A recent parliamentary report found around 7,500 patients were infected by imported blood products from commercial organisations in the US” and in addition the quote “The UK Public Health Minister, Caroline Flint, has said: “We are aware that during the 1970s and 80s blood products were sourced from US prisoners” and the UK Haemophilia Society has called for a Public Inquiry. The UK Government maintains that the Government of the day had acted in good faith and without the blood products many patients would have died. In a letter to Lord Jenkin of Roding the Chief Executive of the National Health Service (NHS) informed Lord Jenkin that most files on contaminated NHS blood products which infected people with HIV and hepatitis C had unfortunately been destroyed ‘in error’. Fortunately, copies that were taken by legal entities in the UK at the time of previous litigation may mean the documentation can be retrieved and consequently assessed“, the sources the Express and the New York Times, we see for example the quote “Cutter Biological, introduced its safer medicine in late February 1984 as evidence mounted that the earlier version was infecting hemophiliacs with H.I.V. Yet for over a year, the company continued to sell the old medicine overseas, prompting a United States regulator to accuse Cutter of breaking its promise to stop selling the product” with the additional “Cutter officials were trying to avoid being stuck with large stores of a product that was proving increasingly unmarketable in the United States and Europe“, so how often did we see the mention of ‘Cutter Biological‘ (or Bayer pharmaceuticals for that matter)?

In the entire Arkansas Prison part we see that there are connections to cases of criminal negligence in Canada 2006 (where Canadian Red Cross fell on their sword), Japan 2007 as well as the visibility of the entire issue at Slamdance 2005, so as we see the rise of inquiries, how many have truly investigated the links between these people and how the connection to Bayer pharmaceuticals kept them out of harm’s way for the longest of times? How many people at Cutter Biological have not merely been investigated, but also indicted for murder? When we get ‘trying to avoid being stuck with large stores of a non-sellable product‘ we get the proven issue of intent. Because there are no recall and destroy actions, were there?

Even as we see a batch of sources giving us parts in this year, the entire visibility from 2005-2017 shows that the media has given no, or at best dubious visibility in all this, even yesterday’s article at the Guardian shows the continuation of bad visibility with the blood packs. So when we look (at http://www.kpbs.org/news/2011/aug/04/bad-blood-cautionary-tale/), and see the August 2011 part with “This “miracle” product was considered so beneficial that it was approved by the FDA despite known risks of viral contamination, including the near-certainty of infection with hepatitis“, we wonder how the wonder drug got to be or remain on the market. Now, there is a fair defence that some issues would be unknown or even untested to some degree, yet the ‘the near-certainty of infection with hepatitis‘ should give rise to all kinds of questions and it is not the first time that the FDA is seen to approve bad medication, which gives rise to the question why they are allowed to be the cartel of approval as big bucks is the gateway through their door. When we consider the additional quote of “By the time the medication was pulled from the market in 1985, 10,000 hemophiliacs had been infected with HIV, and 15,000 with hepatitis C; causing the worst medical disaster in U.S. history“, how come that it took 6 years for this to get decent amounts of traction within the UK government.

What happened to all that data?

You see, this is not merely about the events, I believe that if any old systems (a very unlikely reality) could be retrieved, how long would it take for digital forensics to find in the erased (not overwritten) records to show that certain matters could have been found in these very early records? Especially when we consider the infancy of data integrity and data cleaning, what other evidence could have surfaced? In all this, no matter how we dig in places like the BBC and other places, we see a massive lack of visibility on Bayer Pharmaceuticals. So when we look (at http://pharma.bayer.com/en/innovation-partnering/research-focus/hemophilia/), we might accept that the product has been corrected, yet their own site gives us “the missing clotting factor is replaced by a ‘recombinant factor’, which is manufactured using genetically modified mammalian cells. When administered intravenously, the recombinant factor helps to stop acute bleeding at an early stage or may prevent it altogether by regular prophylaxis. The recombinant factor VIII developed by Bayer for treating hemophilia A was one of the first products of its kind. It was launched in 1993“, so was this solution based on the evolution of getting thousands of people killed? the sideline “Since the mid-1970s Bayer has engaged in research in haematology focusing its efforts on developing new treatment options for the therapy of haemophilia A (factor VIII deficiency)“, so in all this, whether valid or not (depending on the link between Bayer Pharmaceuticals UK and Cutter Biological. the mere visibility on these two missing in all the mentions, is a matter of additional questions, especially as Bayer became the owner of it all between 1974 and 1978, which puts them clearly in the required crosshairs of certain activities like depleting bad medication stockpiles. Again, not too much being shown in the several news articles I was reading. When we see the Independent, we see ‘Health Secretary Jeremy Hunt to meet victims’ families before form of inquiry is decided‘, in this case it seems a little far-fetched that the presentation by Andy Burham (as given in the Express) would not have been enough to give an immediate green light to all this. Even as the independent is hiding behind blood bags as well, they do give the caption of Factor VIII with it, yet we see no mention of Bayer or Cutter, yet there is a mention of ‘prisoners‘ and the fact that their blood was paid for, yet no mention of the events in Canada and Japan, two instances that gives rise to an immediate and essential need for an inquiry.

In all this, we need to realise that no matter how deep the inquiry goes, the amount of evidence that could have been wiped or set asunder from the eyes of the people by the administrative gods of Information Technology as it was between 1975 and 1989, there is a dangerous situation. One that came unwillingly through the evolution of data systems, one that seems to be the intent of the reporting media as we see the utter absence of Bayer Pharmaceuticals in all of this, whilst there is a growing pool of evidence through documentaries, ad other sources that seem to lose visibility as the media is growing a view of presentations that are skating on the subject, yet until the inquiry becomes an official part we see a lot less than the people are entitled to, so is that another instance of the ethical chapters of the Leveson inquiry? And when this inquiry becomes an actuality, what questions will we see absent or sidelined?

All this gets me back to the Guardian article as we see “The threat to the inquiry comes only a week after May ordered a full investigation into how contaminated blood transfusions infected thousands of people with hepatitis C and HIV“, so how about the events from 2005 onwards? Were they mere pharmaceutical chopped liver? In the linked ‘Theresa May orders contaminated blood scandal inquiry‘ article there was no mention of Factor VIII, Bayer (pharmaceuticals) or Cutter (biological). It seems that we need to give rise that ethical issues have been trampled on, so a mention of “a criminal cover-up on an industrial scale” is not a mere indication; it is an almost given certainty. In all that, as the inquiry will get traction, I wonder how both the current and past governments will be adamant to avoid skating into certain realms of the events (like naming the commercial players), and when we realise this, will there be any justice to the victims, especially when the data systems of those days have been out of time for some time and the legislation on legacy data is pretty much non-existent. When the end balance is given, in (as I personally see it) a requirement of considering to replace whatever Bayer Pharmaceuticals is supplying the UK NHS, I will wonder who will be required to fall on the virtual sword of non-accountability. The mere reason being that when we see (at http://www.annualreport2016.bayer.com/) that Bayer is approaching a revenue of 47 billion (€ 46,769M) in 2016, should there not be a consequence of the players ‘depleting unsellable stock‘ at the expense of thousands of lives? This is another matter that is interestingly absent from the entire UK press cycles. And this is not me just speculating, the sources give clear absence whilst the FDA reports show other levels of failing, it seems that some players forget that lots of data is now globally available which seems to fuel the mention of ‘criminal negligence‘.

So you have a nice day and when you see the next news cycle with bad blood, showing blood bags and making no mention of Factor VIII, or the pharmaceutical players clearly connected to all this, you just wonder who is doing the job for these journalists, because the data as it needed to be shown, was easily found in the most open of UK and US governmental places.

 

Leave a comment

Filed under Finance, IT, Law, Media, Politics, Science

Thomas the Tank wreck

Parents will have seen a program if they have kids, they all love to see that cheeky tank engine. The simple life in the town of Knapfort, or is that Nap Forth? The complication of not getting uncoupled, and even as it was merely an episode one, the not so young population might remember the rap edition of this Thomas (at https://www.youtube.com/watch?v=ETfiUYij5UE), so in all this. Is it about the music or the story? Consider that, when we see the Guardian claim ‘Revealed: NHS cuts could target heart attack patients in Surrey and Sussex‘ (at https://www.theguardian.com/politics/2017/jul/14/revealed-nhs-cuts-could-target-heart-attack-patients-in-surrey-and-sussex). So when we see “Organisations in the area are considering limiting angiogram and angioplasty despite positive evidence for procedures” should we be surprised? You see, I have had one, I understand that it is at times essential and that it is needed to assess the situation. We might see: “Hospitals routinely use an angiogram to assess the health of a patient’s heart“, so there is not surprise here. Yet when we see “Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under NHS plans to make £55m of budget cuts in Surrey and Sussex, the Guardian can reveal“. Why is anyone surprised? You remember that vague promise from some politician named, I think it was Jeremy Carbonite? Labour was going to hire a thousand nurses. So with what money were they going to do that? The NHS is out of cash and out of options. Whilst we see the NHS being politicised, everyone forgot that whilst those optional solution bringers remain talking, not much gets done whilst they talk and whilst they contemplate the decisions that need to be made; no resolutions and the money kept on draining for another 5 months. So we might feel sorry to the smallest degree for Tory MP Sarah Wollaston, with the mention of “the secretive cost-cutting regime which the NHS is imposing on 14 areas of England in an attempt to save £500m – because it involves “draconian” cuts to services that will hit patient care“, which is fair, it is Draconian and nobody wants it, but as the politicians were shouting at each other time went on and nothing was done, the changes for long term gain were all not done, pretty much none of them. Perhaps Labour can help? Do they not have a leader named Jeremy Carbonite? Is Carbonite not a backup program? Perhaps he has a backup option? He was so ‘speechy’, so clear on what needed to be done. So, Jeremy, what would you do next? Spend more money? It’s gone, your Labour predecessors took care of that, to have an NHS, you need an actual economy, if your side had not wasted the massive chunk of a £trillion in total, there would be options to move the track. Did you think of that as you paraded your addition of 4 figure amounts of nurses, police officers and others?

Did you think that the governing party was not aware of the issues? Did you think that those who are governing are not aware of the fact that the NHS is ending far below the line of zero before the end of quarter three? When we see the quote “Hospitals routinely use an angiogram to assess the health of a patient’s heart. The number of people in the UK undergoing angioplasty has risen eightfold since the early 1990s to almost 100,000 a year, reflecting its growing popularity as a non-invasive alternative to a heart bypass“, we understand that it is routinely done (I had one), oh wait! I never had an angioplasty, I had an angiogram. So why is the Guardian just shovelling two issues together on a pile making it seem as one? Perhaps it is done to make it all a little more trivial? When we consider that an angioplasty is set at roughly £17,500, we see that this procedure alone would cost £1,750,000,000 annually, that is a lot of fish and chips repair, or am I trivialising here? So how much are the costs of an angiogram? One source gave me £5,529, so how many a year operations are needed of those and why was there one number, but not the other? It should be a larger number of ‘operations’ needed, but with the cost being merely a third, the impact is less severe. None of that part matters when it is needed, yet what does matter was given to us in 2010 by USA today. Here (at http://usatoday30.usatoday.com/news/health/2010-03-10-heart-angiograms_N.htm) we see a point that matters. With “A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests. The researchers said the findings suggest doctors must do better in determining which patients should be subjected to the cost and risks of an angiogram. The test carries a small but real risk — less than 1% — of causing a stroke or heart attack, and also entails radiation exposure“. Now, we get that it is an American source on US patients, and not on UK patients, yet there have been correlations in health care in many nations, so it is not without merit to state that there is the chance that the same issue to some extent in the UK is taking place. Now, in the NHS age where £500 million in cost cutting, is it such a stretch to cut the one procedure that is seemingly only actually required in 1% of the cases? I am not stating that it is a great idea, yet if we accept that we need to get £500 million down, going after the 1% group might be one of the better ideas. In all this Labour should not object, a truckload of their politicians have made a career out of going after the 1% group their entire life, so there should be a consensus on both sides on the isle on this subject! The quote that is hugely helpful is ““We have to rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals. We’re looking into why that is. Who in future won’t get an angiogram? That’ll be up to cardiologists,” said one senior doctor“, which makes perfect sense and as we accept that there will be a group of people that goes through one way of treatment, some of this will be done because a doctor had a certain education from a certain medical school, another takes route 2. I am largely convinced that both paths have merit and are in the best interest of the patient. In addition, when we see the 60%-70% variation, what happens when we drill down deeper and set it against the years of practice of the cardiologist. Will there be clustering? I am not stating that any of them are wrong. Yet, is there a chance that a junior cardiologist would see a few more (perfectly valid) reasons to do the cardiogram? I am not stating, not judging, I am merely asking. You see, as stated by: ‘the Guardian can reveal‘, yet that part they did not reveal. Why not? Perhaps the data was missing, yet the article on how “NHS organisations in Surrey and Sussex are considering restricting the number of patients who have an angiogram or an angioplasty” it would have been nice to see more than merely quoting “I don’t think that these extra cuts are reasonable. You can’t justify £500m to the DUP while taking another £500m out of the English NHS“. When we see the numbers I see that £500 million can be cut from one side where the costs are implied to be £1.75 BILLION, meaning that here we see that cost cutting is met whilst that budget remains to get 72% and none of the other parts are affected.

So cutting 28% from a program, whilst one of the other considerations is ‘Shut beds or even whole wards in community hospitals‘. It is merely a good idea to contemplate what could be cancelled, postponed of even considered in other ways. Another part that is true, yet limited to merely a small paragraph is “Saving the £55m this year will prove to be a false economy that costs the NHS more money in the long term, warned Nigel Edwards, chief executive of the Nuffield Trust health think-tank” Now, we might think that Nigel Edward is talking politics to the people that hire his consultancy (which is fair enough), yet he has a point and the point he is trying to make has been proven again and again. Yet, the NHS needs a massive overhaul and for the longest of times, people seemed to have been merely talking about it. Is it mere complacency or is there more? Consider the American source 17 years old gave us a 99% not needed rate. There is no evidence (at present) that this is as high in the UK, yet when we see “rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals“. In an age of cost cutting that 60-70% is an enormous amount of variation and until properly looked at that data there is no way to tell how valid it is in the end.

The article merely gives us a lot more questions than they answer. That is gotten from the final part with “A Department of Health spokesperson said only that “Given the NHS budget has gone up by £6 billion in the last two years in real terms NHS England and NHS Improvement are ensuring that local areas spend their increasing share equally based on best clinical practice.”“, and in addition we see the mention of Tory MP Sarah Wollaston and “while taking another £500m out of the English NHS“, whilst at the end we see “Jeremy Hunt, the health secretary, declined to comment on the £55m cuts“. In addition there is “under NHS plans to make £55m of budget cuts in Surrey and Sussex“, so the article does not give us many things. Like why these two counties have to cut a little over 10%, the final part is given in the weirdest of ways. Now, it could be merely the reporter having a creative thought. If that is not the case, the entire issue in the NHS is a lot weirder and even more problematic than the Guardian could have revealed. The issue “The bodies made clear that they have to contemplate such controversial measures because NHSE and NHSI have told them to save the £55m. Despite already having “ambitious financial plans for 2017-18”“, so here we see part of a larger problem. We have seen for the longest time that the NHS over overspending, that the cash is gone and that cuts were needed, we have all seen that news for about 2-3 years and here we see “ambitious financial plans for 2017-18“. So based on what budget were those ambitious plans conceived, perhaps on a gurney with a few nurses (a somewhat speculative imaginative thought)?

The clarity of the problem has been there for the longest of times, the governing bodies need to take several matters a lot more serious, and in all this the shifting numbers, the mentioning of the blended events and numbers give rise to several other questions too. All this because certain numbers were thrown at the readers, yet the overall numbers called in questions from the very first moment and as such the article (in my humble opinion) merely stats that there is a lot more wrong at the NHS than most people realise, with all that, caught in the middle are the doctors and nurses. None are getting hired in addition and there are issues for the doctors two, so when they rightfully demand that these ‘ambitious financial plans for 2017-18‘ are being made public, what kind of a story will they receive? The tension should be an interesting one as the pay rise for health care workers was capped at 1%.

So as we conclude today’s event, we all need to take a long hard look at the decision makers in the UK NHS, they are seemingly wasting too much time of the preferential prospect of presentation, whilst the reality was never a given element of that presentation at all. The fact that there are actual issues rising to the surface of the NHS, whether already looked at or not, when we see the amount of issues linked to high variations, in an age where costs are cut to the extent they need to be, is it not weird that those numbers had not be properly looked at and reported on at least 2 years ago? The 2010 article is indicative of that to at least some degree. You see, if it had been, that that would have been evidence that could have been added to this article. The fact that it was not gives rise to the questions I added and in all this it took not that much time. Now in all fairness, to add 30% on a £105M cut. Yet in all this, there is still the issue with the £1.75 billion of angioplasty in the UK.

In addition, to add the amounts that are added, how was it decided where they would fall?

Now we get that there are issues in several places and some would state ‘It will be alright‘, and ‘things will get fixed‘. Yet from my point of view and from the issues presented there are merely more and more questions coming up and it seems to me that the growing issues with the NHS is due to inaction, not merely through cut backs. That is one actual clear given, the issue at that point is not how we can solve the NHS issues, it becomes how can we temper towards zero the amount of idle time and inaction, not in the staff, but in the governing and infrastructural sides.

The additional part that was not seen at present is the realisation that the NHS issue will tighten, and get worse for the next foreseeable future (up to 5 years), you see, the turnaround will take longer with every delay and the recovery from any delay will take longer with every delay we see. The second part that we will be shown with the time to come is that there is a growing concern that the UK aging part has been shelved with the NHS for too long, so in about three years we will see that the NHS geriatric division is not up to scrap and there will be additional increasing pressures on the NHS soon thereafter.

 

Leave a comment

Filed under Finance, Media, Politics

Slaves of a different nature

The sci-fi fan sees in his/her mind a woman, all green, preferably close to naked growing lust in their mind. It is the Orion Slave girl fantasy. This comes from a TV-series that is half a century old. In that universe created by Gene Roddenberry these green ladies were introduced in the original pilot of the Star Trek series in the episode ‘the Cage’, there they were depicted in a sexual context. This is not that kind of slave. Neither is it the kind that is forced to create products through prisons or work camps where they make license plates, or set up governmental mailings. Neither are they children under 18, forced into some kind of servitude. No, these are not one of the 5 forms that the National Underground Railroad Freedom Center is illuminating, this is a sixth kind.

It is the kind of servitude that was once a calling, once a choice of life, which governments and insurers alike have been putting under pressure beyond any normal acceptance of labour. That part has been ignored for too long. People all believing in the wealth that a doctors and lawyers income brings. Later in a career that might have some level of truth when you ignore the elements on the other side of the scale. The fact that someone in IT will surpass the income of those graduates from the very beginning is often ignored. When I see some of my friends in health care, I see friends who are exhausted 70% of the time, some working in excess of 14 hours a day. So when I read ‘Nearly 60% of Scottish GPs plan to leave or cut their hours‘ (at http://www.theguardian.com/society/2016/apr/28/nearly-60-of-scottish-gps-plan-to-leave-or-cut-their-hours), I am not overly surprised.

We all claim that we are against slavery and injustice, yet the governments on a global scale are seeing their health systems collapse and as such, hiding behind the false image of all doctors are wealthy, they have been cutting into the incomes of doctors and stretching the hours they have to make. Underfunding practices and making them work ungodly hours. What we see in Scotland is only the beginning. In the Netherlands we saw in 2014 that GP’s would work around 60 hours per FTA (Full Time Equivalent), making that 13 hours per day, whilst IT staff would get more for a mere 40-45 hours a week, 9 hours a day at the most.

So in all this, whilst health care workers availability are at an all-time low, we see the quote: “26% planned to leave general practice in the next five years“, so one out of four is stopping whilst one in 6 patients will at current pressure not receive the minimum level of care which will now get close to another 1.5 out of 6. This gives us 33% to 50% of the patients in a tough spot. One foot in the grave will get a whole new meaning soon enough when that comes to pass. Certain elements of these changes are already visible in France and the Netherlands, the United Kingdom is in a harsher place than the Netherlands, but I cannot confirm how France is set. Outside of the large cities the information tends to be sketchy and cannot completely be relied upon (read: my knowledge of French sucks big time). Sweden is heading towards a new economic crises on more than one side. Healthcare is one (but less visible), the issue that is visible is the economic drain that the refugees are causing, well over 100,000 have no place and no matter how obliging Sweden is. The refugees are confronted with language issues and a skill set problem. The latter one can partially be adjusted, the first one can be overcome by the refugees who truly want this, but it takes time, which is one side Sweden is having less of. Sweden is trying to recruit doctors in many ways and their approach might work, but it will work slowly and it will cost the Swedish government a fortune. The reason for focussing on Sweden is because for the most, Sweden is a social success. Sweden has made social changes that the nation accepted (including paying a lot more tax than there neighbouring nations). The refugees are changing this, a social system can only survive in balance, the refugees arrived in such massive amounts that the system cannot cope. The total refugees that recently arrived have surpassed the size of the Swedish city of Västerås, which by the way is not the smallest of places. With the banking in disarray and Sweden missing sales marks gives additional problems for Sweden and healthcare will feel the brunt as doctors are now moving to other non-Swedish shores. Sweden illuminates the required need for the UK, a need that the UK is unable to adopt at present. In addition, the approach that Jeremy Hunt is taking will not help any.

When we see the British Telecom News page, we see “But in a letter to the BMA’s junior doctor committee chairman, Dr Johann Malawana, Mr Hunt said: “It is not now possible to change or delay the introduction of this contract without creating unacceptable disruption for the NHS.”

As I see it, my response would be ‘Yes, Mr Hunt!‘ you had alternatives but you chose to ignore them. Focussed on a system that had collapsed, focussing on the approach of slavery, you saw in your school years the Slavery Abolition Act 1833, yet as we see the words from the English poet William Cowper (1785) as he wrote:

We have no slaves at home – Then why abroad?
Slaves cannot breathe in England; if their lungs
Receive our air, that moment they are free.
They touch our country, and their shackles fall.
That’s noble, and bespeaks a nation proud.
And jealous of the blessing. Spread it then,
And let it circulate through every vein.

 

Bankers are overprotected whilst being vultures, for not being held accountable for the mess they created (as it was not illegal), whilst at the same speed, junior doctors are reset with contracts that amounts to becoming an involuntary slave labour force. This to the degree that doctors are packing their cases and moving to Australia and other Commonwealth nations that will take them and with the shortage the world at large has, for them moving to Nassau and live by the beach with a small practice would be preferred to a city job with a mortgage they cannot pay off and working 60 hours a week. Jeremy Hunt dropped the ball. He did not do this intentionally. He was given a bad hand from the start, yet in all this instead of going on the same way, the NHS needed another direction entirely, that part was never really investigated.

For me, with whatever I have left?

If I had to go into healthcare, I would try for Radiologist position in Essex or something like that. I still have 15 years in me. For now, I have a nice idea for Google to grow their revenue by 3.5 billion dollars over the next 5 years, and gradually more after that and for £25M post taxation it is all theirs! For now, I am considering to do some teaching in Italy in the future. Teaching English in Catholic Public Schools near the Vatican. You see, this crazy merry go round we have in Europe now will collapse, there is no viable way to stop that at present as I personally see it. We must focus on what comes after. That part is now gaining visibility as we see the US President (read: Mr Lame Duck Obama) is quoted in Forbes “President Obama’s Implicit Message To Taxpayers: ‘I Own You’“. My response?

No, Mr President, you do not. You never did. Like a weakling you stopped taking taxation to a realistic level, you refused to do anything to stop greed. That part was clearly shown at the G-20 in 2013, three years ago. You might actually end up becoming the most useless president in the history of the United States of America

That would be my response!

When we look at Forbes (at http://www.forbes.com/sites/johntamny/2016/04/10/president-obamas-implicit-message-to-taxpayers-i-own-you), we see that the Obama treasury stopped one deal, one deal only. This is about a lot more than just that 212 billion dollar deal. You see, this is not about the Panama Papers, this is what they enabled. When we consider the Guardian (at http://www.theguardian.com/news/2016/may/06/panama-papers-us-launches-crackdown-on-international-tax-evasion), we see that same duckling state “the president will take executive action to close loopholes used by foreigners in the US and call on Congress to pass legislation“, how interesting that it is just about the foreigners, so how much is in Rothschild wealth management directly from foreigners and how much is arranged through American agents?

In addition we have “The Panama Papers underscore the importance of the efforts the United States has taken domestically, and the efforts we have undertaken with our international partners, to address these shared challenges”, which is an empty statement as I see it, because over the next 6 months too little will be done and it will be left to the next person in office. The final quote is “The problem is that a lot of this stuff is legal, not illegal”, which is something we already knew. Yet when we consider the change that could have been brought in 2013, he (read: the Democratic Administration in power) backed off, forcing a watered down version that was close to useless. This is the evidence I see as to the level of uselessness that the USA currently represents. Poverty levels are still at a high and in Europe that number is growing, this is the foundation that allows for the growth of what can be regarded as legal slavery. It is legal because it is governmentally arranged, it is slavery as the medical industry is pushed into a level of servitude of no-choice. In Europe, some are now claiming that the amount of people under the poverty line is now one out of four. That push is a great hammer for Jeremy Hunt to use to push for cheap contracts and ungodly working hours, but in the end, when doctors stop working, there is no NHS to continue to cure people (source: http://www.euractiv.com/section/social-europe-jobs/news/eurostat-one-out-of-four-eu-citizens-at-risk-of-poverty/).

There is no clear solution, but another path needs to be taken. The push from NHS and the deal that people get through what I call ‘deceptive insurances‘ and ‘skewed medicinal solutions‘ is changing the game. It now reflects back towards the change I was willing to make. What if we make hospitals self-sufficient? What if we take the insurance out of the equation and push for a self-sustaining level of hospitals on local foundations? You might think that the given logic forces us to look at Behemoths like the NHS and large medical corporations. I am stating that it is my belief that the medical gravy train is losing too much cargo on route. So it is our need to have a neutral solution. When medical suppliers start pushing on ‘how it will be too expensive that way‘, the people will have to push back. So that means that the UK hospitals start getting supplies from other sources, independent and possibly even non-UK sources. How long until greed driven corporations cave? They only need to fail 2 quarters of forecasting and THEIR nightmare begins! Trust me when I state that a merger making the board of directors over 200 billion means that their margins were really really good and via Ireland they were only getting better.

That is the issue and solving that is a first step in solving the slavery riddle, which is not a riddle, it is a mere puzzle that can and should be solved.

 

Leave a comment

Filed under Finance, IT, Law, Politics

The Medic and the Medici

There are several issues exploding, yes, they are literally exploding in the faces of people all around us, especially in the UK. The first event is ‘Leaked Brexit email claims David Cameron has ‘starved’ NHS‘ (at http://www.theguardian.com/politics/2016/apr/01/senior-tories-brexit-vote-leave-attacks-david-cameron-letter-nhs-staff).

This article gives us the following quotes: “David Cameron and Jeremy Hunt must accept responsibility for this – they have starved the NHS of necessary funding for too long.” The claim is more than outlandish, it is for all intent and purposes a clear fabrication. So who is Cleo Watson? What evidence has she produced? These two elements are important. Apart from her short time with the Vote Leave campaign, she is an unknown. This letter is also a clear visible act where both Michael Gove and Boris Johnson need to question their support for this group. Michael Gove gave his reasons clearly and well written in the Independent. Boris Johnson has his business and governing mental experience regarding the link between the UK and the European Union. I am on the fence, yet to some extent I am leaning more and more heavily towards Brexit. Yet I want to do this on the facts that matter, people need to vote based on actual facts. Cleo Watson is just making a joke everyone needs to ignore. This we see when we take the following facts into account:

#1. 2011, NHS pulls the plug on its £11bn IT system, a system abandoned after 9 years of spending and no result.

#2. 2013, The NHS says it has lost millions of pounds in the last year because of the number of patients failing to turn up for appointments.

#3. 2015, The NHS saw the worst performance by A&E departments since records began in 2010, with only 91.4% of patients being seen within the four hour target time.

#4. 2016, Nurse staffing levels, missed vital signs observations and mortality in hospital wards: modelling the consequences and costs of variations in nurse staffing and skill mix.

Now, this is not about laying blame with the NHS, yet serious questions need to be asked. You see, only the arms industry has at times the luxury to blow away 11 billion and not feel the consequences. It’s pretty much the operation expenses of the Patriot Missile system in the US. Oh wait, the UK cannot afford that system, so it selected the Aster which gives more bang for the buck (50 missiles more bang for the buck). It had issues after that in both quality and availability. In addition, a study to be completed in 2017 is costing the NHS half a million.

There are other issues that play, they are all with the NHS; the issue is that these things just happen. Any machine has cogs that aren’t pulling their weight, they are there in case something else goes wrong, or they are in support, or even just idle because the system requires them to be. The response in the Guardian was also direct: “A senior source at the Department of Health hit back by claiming the government had provided an additional £10bn for the NHS and said that “every Conservative MP stood on a manifesto to deliver this package”. They added: “So we expect every Conservative MP to have absolutely nothing to do with this letter”“, which for the moment might sound very correct, but within all this a serious question remains. How could any project go this far out of bounds? In a time when the NHS is not smothered to death, but only a step away from drowning in costs and costings, we must demand a firm hold on expenses. Yet, this goes a lot deeper than just expenses, you see in all this, especially in regards to the squandered £11bn, questions must be asked of the political side, did they interfere, was there interference at all and how did that explode costs? That is an equally important question in this race for comprehension.

So as we see one part nullified from Vote Leave. We are not done, not by a longshot. You see, these matters are tried again and again. This becomes more outspoken when we see ‘Female doctors may be forced to quit over new contract, experts say‘ (at http://www.theguardian.com/society/2016/apr/01/female-doctors-new-contract-medical-royal-colleges). Now, let’s be fair. There was always a small chance that this was the Guardian entering its own April fool’s day article of the year. Yet that part can be ignored when we read: “The MWF is worried that will force female doctors who are mothers to try and find childcare at those times. The new contract could breach junior doctors’ right to a family life under the Human Rights Act“. In addition there is “Dr Roshana Mehdian, one of the leaders of the junior doctors’ campaign against the contract, criticised the DH for saying that women should make “informal childcare arrangements” if they are affected by having to work more antisocial hours“. When we look against “This is ludicrous in the 21st century when childcare costs are spiralling and access to out-of-hours childcare is limited. This discriminates against women, single parents and working couples“, we must ask ourselves ‘Are these doctors on drugs and please can we get some of them?’

You see, there is no denying that the MD’s in this world work really ungodly hours. I do not think it is fair, yet the current system does not have that much margin to work with. In addition, a personal view is that any woman who now goes into medicine, who also wants to be a mother needs to realise that she can do one or the other, not both. Those in the medical and legal industry tend to work an easy 50-60 hours a week. Unless those women have chosen to marry a househusband, that option is gone! All this bickering and especially Dr Roshana Mehdian who not unjustly stated “This is ludicrous” is forgetting that in the old days the man worked, the woman stayed at home. Now, if we accept (and I do), that someone has to be with the kids (to some extent), in an age where a man and a woman can make the same fortune, she must also realise that if she is making the fortune, she needs to realise that Mr Mehdian might be expected to be at home to raise the kids. In a bad analogy I would rephrase this into, you can’t be a hooker and expect to be given the options of a virgin. One excludes the other. And in an age of spiralling childcare costs, the cost of living went up for all. This is not about fairness, this is about reality and realism. Because only labour seems to feed the public the idea that all can have a job, free education is a given and childcare is priced under the tax deduction act, those who believe will not have a life, not have a family and they will not have any money left.

The article calls for another two quotes that have relevance and importance. The first is “The DH analysis, published on Thursday, has intensified the long-running dispute between the profession and ministers over the contract. There is particular unease about its statement that “while there are features of the new contract that impact disproportionately on women, of which some we expect to be advantageous and others disadvantageous, we do not consider that this would amount to indirect discrimination as the impacts can be comfortably justified”“, the second is: “This contract is a huge step forward for achieving fairness for all trainee doctors”, a spokeswoman said. “For the first time, junior doctors will be paid and rewarded solely on the basis of their own hard work and achievement. That is ultimately what employers and the BMA they want and everyone deserves: a level playing field.

You see, these might seem like two sides of the same coin, but I reckon they are not and this is a lot more of an issue that some might realise. You see, the Guardian and the Independent are both on the same side when we see “the measures would discriminate against single women“, I disagree! From my point of view, being a single parent and in law or medicine is massively stupid and selfish. It is clearly given at the beginning of your career, already in University for some that the immense amount of hours made will equally mean that being a parent (in any other way than the old way is the real story that will not be a reality). I reckon that any person becoming a parent whilst working 50+ hours a week is a bad parent and should not be allowed to be a parent. You can’t have it all and for the most, most of the population knows this to be a truth. Is it possible down the track? That remains to be seen, there is a clarity that unless the economy does not drastically improve the family life for many will be a mere concept that will never become a reality to many couples. Nourishing any act in that direction is self-delusional.

Is it fair?

Of course it is not, but the current economy is not about fairness, in all fairness the previous administrations should not have pushed this government with a 14 hundred billion pound debt, but that happened and until now, no serious acts have been performed to rein in spending and to reign in debt, which is part of all this as well. The full contract can be found at http://www.nhsemployers.org/case-studies-and-resources/2016/03/junior-doctors-terms-and-conditions-of-service. I am not going to bore you with the contract as such, because some of the elements discussed require a person much more versed in contracts than I am. Yet, I feel that it is imperative to mention: “The work schedule for a doctor on a general practice training programme working in a general practice setting should reflect the 2012 COGPED guidance or any successor document on the session split during the average 40-hour week that comprise a minimum full-time contract. Any additional hours of work above 40 must be included in the doctor’s work schedule and linked through to the curriculum, as per those for doctors in hospital settings“, which we see on page 28. This part has a reference to “The doctor’s actual total ‘new contract’ pay at appointment to the first post and subsequently at appointment to each new post under these TCS will be calculated as per the provisions of Schedule 2 of these TCS” I cannot state whether this is fair or unfair. Yet there is one given, there is no mention of gender here. I have seen how Emma Watson gave her speech at the UN (I am completely in support of this), yet when we see equality, for me it means on all fronts. This also implies that you do not get to have a career and be a mother. You see, in that same view, nearly every man worked every day (and sometimes nights) and did not get to be a father, they merely became the provider of the family. We have to accept that, because the rent and the food must be paid for, in that same light women will have to face that too. So, they do not get to complain that as a single mother there are debilitations. So is this what the Department of Health claims to be, a ‘level playing field’, or is there another side? You see, Dr Roshana Mehdian did not convince me of her side with: ‘when childcare costs are spiralling and access to out-of-hours childcare is limited’, in that same light, it took two to tango, so why is the child not with the father? If there is true gender equality that question is fair and valid. Of course, reality tends to be not in equal measure and we would accept that, but in all this when we see the pressures in the medical profession, it makes sense that having an equal weight responsibility means that in the medical and legal profession, having a child will impact your value on that market, merely because your head was not in the game, for 15 hours it was with your own bundle of joy. That premise is valid, it will make massive sense for some to start a family, but in equal measure it means that it will either cost you a family or a career. We have come to the stage that both is no longer an option, especially as a single parent. From my personal viewpoint, raising a child is a career all in itself. Now answer the following question honestly: “How can you have two careers and do right by both?

An answer not easily given, because it is not an easy question!

What is a matter of concern is that the political parties (on both isles) have taken certain stances, both are debatable and both have had little options and the shortage that was strangled upon these parties is equally a problem. By trying to maintain a medical elite in the UK, the balance shifted. You see, when we consider the Social structure within the United Kingdom as it was, where the upper class included the barristers, judges, dentists and doctors, yet were also in the middle class. We see a shift after WW2, so those who were in the high field tried to keep themselves and their family in that higher echelon, therefor rejecting fiercely a foreign infusion of highly needed talented workforce. After WW2 this became a shift towards a services-dominated economy with additional mass immigration. The medical profession, due to unrealistic standards saw their workforce diminish over the last 10 years giving us the issues we see nowadays. Consider the following response “I wrote my exam on 12 Dec 2015 and got my result 24 Dec 2015. I promptly went online and started the application and 2 days later I got the Pearson Vue testing reference number and booked and paid $280 for the computer based Test of Competency. I could have sat this next week but I chose to sit it on 2 Feb to give myself more time to practise as I can’t afford to fail. So far the process has been really smooth and quick“, another voice was a lot less positive, but there could have been a clear issue of timing involved. Overall the issue remains that by making a transfer of knowledge so hard, especially as some applicants have degrees in Commonwealth nations, it seems to me that some players are trying to dampen the influx of foreign talent, which is just my personal view in all this.

This path could have been smoothened out by the politicians a long time ago, but it seems that schooling and re-schooling nurses does not sound as sexy as a new innovative IT system (which didn’t work anyway). Last I get to that list of 4. The first one is old news now, but 11 billion is a lot to lose and it has to come from somewhere. The second one is one that can be dealt with. If the patient misses two appointments, they can either pay a penalty fee for not cancelling in time. Cancelling an appointment is just a phone call away. If you forgot it, there is a fair assumption that there was not a pressing medical need (I know the ice of that statement is very thin). In all this we must realise that doctors work ungodly hours, so steering clear from giving them additional pressures seems to be a given first. A task at which, as I personally see it, Jeremy Hunt failed miserably at present. The third in my list is the one I would give A&E a pass for. My reasoning is that the skewed scale that A&E works with has not been properly adjusted for growth in patients and stagnating staff numbers. We get these numbers from http://www.parliament.uk/briefing-papers/sn06964.pdf, where we can see in the introduction and the summary that the title ‘Accident and Emergency Statistics‘ is ever so slightly misleading. I wonder what Carl Baker had in mind with this paper and what purpose it serves. It seems to ‘focus’ on the +4 hour people way too much. The one summary number that does matter is ‘There were 4.0 million emergency admissions to hospital via A&E in 2014/15 – up 4.8% on the previous year’, which only paints a partial picture. You see, ‘Chart 2: Annual A&E attendance, England, 2004-2015‘ seems to tell the story, but other ways could have been more explicit to deal with the issue. Over a period of 10 years, the attendance of the minor injury units nearly doubled. Yes it doubled! The major injury unit also rose, but not by a large part, although, from just over 13 million to close to 15 million is still a growth that is not to be ignored. This report ‘writes it off’ as a mere 10%, which still amounts to 1.4 million additions. Yet in all this staffing levels are not addressed at all, leaving this ‘work’ with some uneasy questions. What I like the most is the disclaimer at the end. “This information is provided to Members of Parliament in support of their parliamentary duties. It is a general briefing only and should not be relied on as a substitute for specific advice. The House of Commons or the author(s) shall not be liable for any errors or omissions, or for any loss or damage of any kind arising from its use, and may remove, vary or amend any information at any time without prior notice

So how does staffing levels in answer to 4 hour waiting times not assist? From this I must question what the Rt Hon Jeremy Hunt MP had in mind with this writing? From my point of view, a bad paper does not make the NHS look bad, it makes the Secretary of State for Health look bad not less good than he should look, especially as he should be fighting for the plight of the members of the Department of health, a side I have yet to see at present. He has been called a lot worse by many, it seems unproductive to go that way. What is matter of urgency is the fact that the Prime minister needs to ascertain if Mr Hunt is the right person in the right place and if not, he needs to get someone there that will take the side of the doctors and fast, because at present they do have the power to let it all collapse, and woe be onto the administration that is governing when that happens.

 

Leave a comment

Filed under Finance, Law, Media, Politics

The excuse from a failed politician

The NHS has been in the news more than once as it is an important issue. It is today’s article in the Guardian that is a much bigger issue than most people will realise. Let’s take a look at the issue. The title ‘NHS would be put under threat by Brexit, says Jeremy Hunt‘ (at http://www.theguardian.com/politics/2016/mar/26/nhs-under-threat-from-brexit) is only the beginning.

To show you part of this we need to look at this part by part. The first part is shown at the very beginning “The National Health Service will face budget cuts, falling standards and an exodus of overseas doctors and nurses if the UK leaves the European Union, health secretary Jeremy Hunt has said“, which gets my initial response ‘Let me play the worlds tiniest violin for you Jeremy! Why don’t you consider an alternative job like in a taxi or perhaps become a barber, it’s just a suggestion!

Is my response to harsh? In this light, which should always be considered, we need to state the following:

  1. The NHS will always face budget cuts, Brexit is not a factor in that reality. Remember that the NHS works off the UK national budget, which is under pressure to say the least, the EU donation not being the smallest expense in all this.
  2. Failing standards if Brexit happens. This might be the most ludicrous reasoning. Ludicrous because standards are either being met or not and at present from several sources they are not being met, the EU seems to be setting unrealistic high requirements in some cases, requirements that many nations are failing, it should be about British standards, they should be the highest and they should be met, EU be damned (and all that).
  3. An exodus of overseas doctors and nurses when Brexit happens. This could have been an issue, but it was clearly stated in my blog ‘The News shows its limit of English‘ (at https://lawlordtobe.com/2015/06/22/the-news-shows-its-limit-of-english/), where I showed how both Sky News and the Guardian were basically fucking up and creating unneeded panic. That article called ‘New immigration rules will cost the NHS millions, warns nursing union‘ showed the lack of investigation by both news sources as the UK government had published clearly in section 79E ‘is expected to demonstrate that he is being paid either at or above the appropriate rate for the job, as stated in the Codes of Practice in Appendix J‘, the nurses are clearly mentioned and the expected income as set out in the charter.

As I see it, I had to explain that to the press in my article on June 22nd 2015, so why would Jeremy Hunt state option C? In his defence, some people might be nervous if the UK leaves the EEC, yet a British passport is one of the most revered ones on the planet. So any non-EU medical employee would do a lot to gain that status and the UK government has done its share of keeping these highly qualified people interested in staying in the UK. So tell me, why is Jeremy giving us part C?

He actually gives us a decent answer through “Hunt argues that, with the NHS budget already under huge pressure, funding levels can only be maintained if the British economy remains strong“, it is only partially an acceptable answer as the NHS has been a mess for almost half a decade now, so these issues had been known, even if Brexit is an additional element, the danger of Brexit had been a fact for at least 6 months, that is, the chance of it becoming a reality, so the consequences of diminished economy has been an element for almost a decade. Even as the UK had been fortunate, the dangers of a receding economy have been a danger for the larger extent and when we realise that other EU nations have not been this fortunate, we should see that part in the light of ‘Jeremy hunt has had an economic advantage until now’. Not being ready for that risk is clearly a failing of health secretary Jeremy Hunt (as I personally see it).

After that he then kicks in his own windows when we read “He cites a series of economic surveys, including from the CBI as evidence of the adverse impact of an exit on the UK economy“, the CBI survey, which was an absolute joke, as shown in ‘Is the truth out there?‘ (At https://lawlordtobe.com/2016/03/21/is-the-truth-out-there/), it makes for a decent read and shows how the CBI survey could be seen as another chapter from one of the most famous books in statistics called ‘How to Lie with Statistics‘ by Darrell Huff, a 1954 publications that shows us never to ignore the classics.

The quote: “Hunt suggests that progress the government is making in employing 11,000 extra doctors and 12,000 more nurses will be threatened and warns of the “damage caused by losing some of the 100,000 skilled EU workers who work in our health and social care system”. Some could leave because of uncertainties over visas and residence permits, he suggests“, which again I consider to be a load of (the word starts with a ‘B’ and ends with ‘locks’). There shouldn’t be any uncertainties on visas or residency permits and offering that even as a suggestion makes (again, in my personal opinion), Jeremy Hunt unqualified for his present position. It is his job to create calm and take stress away, not to introduce additional stresses to an area where he already failed, in addition to these points I am raising, personally, as a conservative. I believe that there are questions on Brexit and to be against Brexit might be the party line, but there are too many questions regarding the European Community, there are conservatives who seem to support Brexit. For one there is Lord Chancellor Secretary of State for Justice Michael Gove, who gave his reasons at http://www.independent.co.uk/news/uk/politics/eu-referendum-michael-goves-full-statement-on-why-he-is-backing-brexit-a6886221.html, that part is not up for discussion. The only quote in all this is “The EU is an institution rooted in the past and is proving incapable of reforming to meet the big technological, demographic and economic challenges of our time“, which applies to the NHS because it is facing both technological and economic challenges already. The Labour party bungled the option to get part of the technological solution implemented that could have helped the NHS (perhaps you remember the loss of roughly £11.2 billion in NHS IT restructuring).

My issue in all this is that (again, as I personally see it) Jeremy Hunt is not much of a visionary, which means that as expected, he will follow the party line as any governing body needs to adhere to. Yet in all this, scaremongering is the wrong approach. We need to be the enlightened party, the leaders that give rise to inspiration by properly informing the people. The growing problem for the Conservatives is that like Michael Gove, more will see that the EU has stopped being a solution. Many will not be as eloquent as Michael was in his essay, as printed by the Independent. This does not matter if we are united in finding a solution. My big worry is that scaremongering is a dangerous tactic. It is also the wrong one to make for the reason that enlightening the audience creates trust, needlessly scaring them will only drive part of our party towards UKIP (or Labour), a choice that is a lot more dangerous! To govern one must be elected and the view given at present is not that encouraging.

Stephen Dorrell, the former health secretary and ex-chairman of the Commons health select committee gave us this “EU research programmes and single market legislation have greatly strengthened European cooperation in this area with substantial benefits for both healthcare and employment in the UK. It is a simple fact that Brexit would put all this at risk“, which we might see (initially), as a fair enough statement. Yet in my view, the information could be regarded as incomplete (read: speculative view). You see, when we consider Stephen Dorrell, Healthcare and Public Sector Senior Adviser to KPMG in the UK (at https://home.kpmg.com/uk/en/home/contacts/d/stephen-dorrell.html), we need to consider what KPMG could lose, apart from the NHS £1 Billion revenue solution, as one might phrase it. When we re-consider the info the Guardian gave, which is correct in the view that NHS funds will find cutbacks, KPMG has a clear danger that it will reflect on their 10 figure deal, all in pounds and a lot less on medical staff. This gives an additional weight to the view that Stephen Dorrell did not give all the information, because there is a lot more, not on the hands of Stephen Dorrell or in the hands of him mind you, but in the hands of his friends (read: associates), possibly with KPMG who are realising that Brexit will impact their juicy pharmaceutical profits, with a growing chance that India could move more and more into the UK pouch of generic medication and the expenditure cutback solutions they bring. Now, reader be warned, there is a fair bit of speculation here (the part about India), that speculation is partially because I think there are long term solutions here for the Commonwealth at large, partially because it seems to me that I (and the public at large) have had enough of fat cats (especially pharmaceuticals) avoiding taxation to the degree they have whilst selling overpriced solutions, that are being re-patented again and again.

The list of misinformation appears to be growing and I am trying to offer resistance, because my party should be better than that! After all, we aren’t the Labour party!

 

Leave a comment

Filed under Finance, IT, Media, Politics

Is there a doctor on this budget?

The title ‘Is this doctor (and Ukip candidate) right that EU migrants will destroy the NHS?‘ seems inflammatory to say the least, but the reality is actually a lot less appealing. Even when we see today’s article: ‘NHS vows to transform mental health services with extra £1bn a year‘ (at http://www.theguardian.com/society/2016/feb/15/nhs-vows-to-transform-mental-health-services-with-extra-1bn-a-year), the quote “People facing mental health crises will be able to get community care 24 hours a day, seven days a week as part of the biggest transformation of NHS mental health services in England for a generation, to be unveiled on Monday“, that quote now reflects back to the initial NHL article. There we see that Professor Angus Dalgleish is giving us another view: “He says the NHS is on its knees and “could collapse completely” because of immigrants from the EU that we are legally obliged to treat“, so even as the Guardian is hiding behind the identity ‘Pass notes‘, there are issues. The first is the unintelligent trivialisation by ‘Pass notes‘. The quote “Eighteen British hospitals made £42m from people coming here for treatment on 2010” is just too ridiculous to be considered valid. I am not stating that it is a lie, but consider that the NHS budget is set to be around £115b for 2015/2016, that £42m amounts to roughly 0.000365%, so how insignificant is that trivialisation? Especially when we consider that many papers (including the Guardian) reported the NHS to be £1.6b in deficit, so there is an issue already.

Now we get the next step.

From several sources we see that refugees are coming. That is not an accusation, or negativism, it is merely factual that over the next 5 years 20.000 refugees will arrive. Now consider that these people come from actual devastated locations, on a horrendous trip that has lasted years (including their stay in refugee centres) to get to the UK, if only 75% needs mental health care, the UK should be thanking their lucky stars. So that £1bn will not last too long, especially considering the current population is in dire need of mental health in one form or another. So as ‘Pass notes‘ complains the quote “But I expect doctors to be liberal! By which I mean intelligent! By which I mean liberal! We expect much. And sometimes we are disappointed“, which is just the Guardian showing that its own values are not set on intelligence. The NHS itself states: “However, if you are now living in an EEA member state and pay into a state healthcare scheme then you are entitled to apply to that member state for an EHIC. Under EC law, this entitles you free of charge to ‘all medically necessary treatment’ here, which provides a greater coverage than that mentioned above since it includes routine treatment for chronic conditions such as diabetes“, which gives way to the claim that Professor Dalgleish is making. In addition the National Health Service Act 2006, section 83 states that “all reasonable requirements to provide or secure necessary primary medical services for all patients, irrespective of their immigration status, within their areas” must be met, this is a legal duty for the primary care trust as reported by the Primary Care Commission (at https://www.pcc-cic.org.uk/sites/default/files/articles/attachments/pcc_briefing_-_illegal_immigrantsv6.pdf), which now implies that Professor Dalgleish has indeed reported an issue that the Guardian casually trivialises. Yet, we must also ask, what if the Guardian is correct? Well, section 83 of the National Health Service Act 2006, literally states at s83(1) “Each Primary Care Trust must, to the extent that it considers necessary to meet all reasonable requirements, exercise its powers so as to provide primary medical services within its area, or secure their provision within its area“, which bakes the cake on one side. The issue is however not done, it is about to get a lot ‘worse’, because s83(2)(b) gives us: “A Primary Care Trust may (in addition to any other power conferred on it) make such arrangements for their provision (whether within or outside its area) as it considers appropriate, and may in particular make contractual arrangements with any person“, which now gets us two elements:

  • Make contractual arrangements with any person, which also implies that it could be a contract set at £0.00.
  • Arrangements for their provision (whether within or outside its area), which now implies that the Primary medical services can transfer a refugee or illegal immigrant to psychological care and/or specialised mental health clinics.

So ‘Pass notes‘ is not reflecting on the dangers that Professor Dalgleish was trying to illuminate. More important, these issues have been known for some time. Issues on these elements have been illuminated in plenty of publications going back to 2012. There is even more information at http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Dec/1650_Gray_hlt_care_undocumented_migrants_intl_brief.pdf, yet overall they tend to give the same reflection, especially when you look at page 3, where the cubic impression titled ‘Exhibit 1. Three Dimensions of Health Care Coverage Policy for Undocumented Migrants‘, gives rise to the massive growth of costs that could be associated with migrant health care (not to mention due to incoming refugees).

So how much valid weight can be given to the statements of Professor Dalgleish? I personally believe that the weight of his statements should be weight on a debatable high level (evidence to follow at the near end). The issue is not just regarding the costing the immigrants and refugees bring, the fact that the Euro systems is wreaking havoc all over the world is an equal concern. I cannot state for certain what will be the best path, what is a given is that trivialisation was never an option.

When we add ‘Jeremy Hunt on the NHS: ‘I think this decade needs to see the quality revolution’‘ (at http://www.theguardian.com/politics/2016/feb/15/jeremy-hunt-on-the-nhs-i-think-this-decade-needs-to-see-the-quality-revolution) to the fold, the plot thickens. You see, quality revolution sounds fair and essential, it is in fact at resent likely the least important part. There is a massive shortage of medical professionals, there is a lack of funds and that lack can be sized into the billions. This implies that quality, though nice is nothing compared towards the lack of resources. Which gets us to the Junior Doctor contracts. You see the quote “none of the 152 foundation trust hospitals in England will be obliged to force their junior doctors to accept the deal and can instead offer them better terms“, which gets us back to that massive deficit and more important, what additional pressures will be added onto it?

That is a part which has been known for a while, I voiced it at least 2 years ago and the current investigation that the BBC gave visibility to in January 2016 (at http://www.bbc.com/news/uk-scotland-scotland-politics-35361908) is still centre in all the issues that will come. You see, without a proper IT system, the NHS will have less and less options to streamline any solution, with that I mean larger operational matters for streamlining. Even as Tavish Scott (Lib Dem Scotland) asked on who got figuratively axed, we got the answer: “The chair of the board is no longer there, the chief executive is no longer there and the chief finance officer“, a very unsatisfactory answer. When we consider “he was not informed of a ‘fundamental flaw’ in the system being delivered for 22 months, adding “other, more junior staff were aware of omissions” in the contract, “but they didn’t tell me”“, we see a systematic shortening of another matter. The fact that junior staff were aware, implies that the documentation was an issue from day 1, in addition, no clear QA protocol was in place. No drilldown teams, from Junior to board member line was in play and overall the system was beyond merely defective. Consider the simple quote: “Mr Turner, who signed the 1,000-page contract for the IT system in March 2012, said he felt “very let down” by a senior colleague, saying they “didn’t advise me at all”“, can anyone explain to me, how such a document does not come with an excerpt chapter by chapter (by members of the NHS) underwriting per chapter how the contract impacts the NHS, the system and their services? A mere SWOT analyses (Strengths, Weaknesses, Opportunities and Threats) would have made all the difference before signing. A waste of £40-£50 million is more than just a few doctors, the lack of such a solution will give additional worry to the claims Professor Dalgleish made. In light of refugees, illegal immigrants and costings, the lack of oversight will soon pressure resources down further.

This all gives a clear view that a doctor is required to take the pulse of the budget. It is billions in deficit and the drain will only increase. The fact that most parties have not given clear light to several sides is only a first reason why Ukip is gaining momentum. That view goes a little further when we consider “Committee convener Paul Martin said there must have been issues with management if staff did not feel able to come forward“, Scottish Labour has more than just a point, the issue becomes why junior members were not asked directly. Someone had to make an inventory, which means that the step was skipped, or intentionally overlooked. That now gives way to the fact that axing three members is not nearly enough. There is, what could be regarded as an institutional failure within the NHS. Considering that the NHS 24 is only one of several systems that are not on par, or even worse, then never got properly managed is proof further still that the NHS cannot handle too many pressure points at present.

What was wrong from Professor Dalgleish is that ‘EU migrants’ are only one of several straws, each currently heavy enough to separately break the camel’s back (read: NHS), which might be a case that the professor was trying to make, but ‘Pass notes‘ was too busy writing lame non-jokes, whilst the editor of the Guardian remained absent in this matter, which is why its readers are left in the dark (and in the near future untreated too). It was interesting to see that Rochdale Online did give more information through the statement by Louise Bours, UKIP health spokesman and North West MEP.

Here you must ask yourself the question: “Is this all just a storm in a teacup?” Especially as the larger papers ignored the ‘Dalgleish matter’. I myself expect that the statement from Dalgleish is out of context and incomplete. This failing as other elements that are driving the NHS over the cliffs were ignored could have been an option to illuminate why Ukip might not be the answer, yet as we see these levels of trivialisation, people are wondering the why; mainly because no clear explanation is coming forward they start to listen to Ukip more and more. Which is EXACTLY why I wrote the initial view with supporting documentation of a more academic level. So it is not a storm in a teacup, as we can clearly see that the NHS could be seen as close to ‘terminal’, but the factors here are a lot more than just the EU-migrants, what is a given is that unless certain things change, the EU-migrants could be breaking the NHS back, but that is equally a given for a few more factors that are currently in play.

Should any of these elements drive you crazy, then you will be equally out of luck as the BBC reported that finding a mental health spot has become pretty impossible, in that element alone, the £1b might be a great help, but there is a decent chance it will not be enough, because it is not just the beds that are unavailable, services are an equal worry, services that require staff and the refugee pressure will only add to that shortage (which is not the fault of these refugees mind you).

 

2 Comments

Filed under Finance, IT, Law, Media, Politics