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And the price goes to?

This is the thought that started me this morning. The two articles in The Guardian, ‘Al-Qaida tempts Yemen recruits with quiz offering AK-47 as top prize‘ as well as ‘Jeremy Corbyn says Labour manifesto will transform people’s lives‘ gave me that feeling. Both hollow, both set in a weird form of fanaticism. The only thing that Labour does is push people to their doom by giving false hope and setting in motion promises that cannot be kept, for the mere reason that previous Labour administrations left the people in the United Kingdom with minus a trillion pounds. That requires £100,000 pounds per person to clear. So do you, the UK voter have £100,000? I guess that in well over 99% of the cases that is a no. So Labour is pushing a game that cannot commit to and should they push for it, it will leave the UK without any hope, pretty much pushing the UK people towards the Greek way of life. You might have seen that on the TV. Consider, that if the Tories could secure the election by just giving 10,000 nurses a job, would they not have done that? They are committed to grow the UK back to strength, it will take at least 5 more years to get the UK in a much stronger position. In addition, the European zone is in an unsecure place too. Even if they hide it in some good, some bad; They keep on spending. The quote “Mario Draghi said the European Central Bank’s stimulus hasn’t finished the job yet” refers to his monthly billions upon billions of spending on things that are not bringing anyone an economy tht brings money or jobs to the people. They are not securing jobs and they are increasing the debt by about 80 billion euro’s a month. Basically they are adding a second trillion euro’s in the second year that this is going on. So as we see some hollow promises, look at the Al-Qaida article where we see: “Al-Qaida is attempting to recruit new members in Yemen by holding a quiz, with an AK-47 assault rifle as top prize, according to local residents and media“, by the way, the second price is a motor cycle and the third price a laptop. It is one way to get militants, via direct mailing, yet what this organisation has in common with Jeremy Corbyn is that they both advocate a path to certain death. Who signs up for that?

In the previous election we did not fall for the unsubstantiated offers by Ed Miliband, the UK voters should not do that this time around either. The Labour party realises to get anything done, one needs to govern, yet when labour gets close to be in that position, we see infighting. discord amongst the ranks and power hungry labour MP’s the moment they think that they can get ahead. This is not the path to help the people of the UK.

So when we look at the mere examples:

  • Abolish university tuition fees
  • boost infrastructure investment
  • renationalise the railways
  • increase the minimum wage to £10 an hour

In these examples, how can any government a trillion pounds in the red do any of this? Because any government pulling this off, I would vote for that player, but when it is a hollow promise, one that cannot be kept, what are they other than wannabe’s with no clue how to get it done? It is only the 4th one that has a certain merit, yet when they do that, how many places will lose jobs and one person have to do the work of two? I have quite literally been in such places in the 80’s. I can tell you, there will be no objections, because you have a job and the few pennies more will reflect in longer hours (often not paid for) and as you get home with less and less energy it will become the hell you never wanted. All because the labour party failed calculus. In this we can speculate with a decent amount of certainty that they are doing this as they noted that the UK unemployment rate is at its lowest. Yet, bosses report to people who want to see return on investment, so as wages go up, production will either go up by certain amounts, and if that is not possible jobs are shed, because the bosses want their pound of commission, so the game is played on. Still the fourth past is the most likely option to work, the rest will cost the coffers of the chancellor, which is currently an empty chest filled with outstanding debt notices. debt notices the previous labour government dumped into that same coffer and we are still paying for those. So do you honestly want to add to that? So as we see this we now need to focus on: “Senior insiders say the drafting process involved a very small group, led by Corbyn’s policy chief, Andrew Fisher, in close consultation with McDonnell. Individual shadow cabinet members were only given details of policies in their own area; while the political officers of the affiliated trades unions were allowed to come and see the entire document, and discuss its contents with Fisher, earlier this week, but were not allowed to take a copy away“, so Labour makes a manifesto that is shown to a few insiders, yet it needs to be kept under wraps, all this whilst the elections are merely a little over 3 weeks away. So now we see them stating “each faction in the Labour party blames the other side for the embarrassing leak“, so they are blaming the Tories? All this should have been known to the optional Labour voter weeks ago. To drop something that I can shoot holes in in merely 5 minutes implies that Labour has gotten more clueless, they have no direction and they are giving voters the idea that they have a clue by offering things that cannot be achieved in this economy. If labour was true to all people, they would set in motion to raise the price of milk by £0.50 per litre so that the farmers in deep debt could find some relief. Where is that in their manifesto, where are they voicing this? People do not want to hear about raising the cost of living, because for the most the people in the UK have lost their quality of life. This is why Labour is pretty much bullshitting you. True Labour would have stood up for the farmers and their hardship, but the sexy side of governance is not found in that part of the world, so they remain silent. There you see the first direct evidence that this Labour is the same waste as the previous three ones, the two elected who drive us into debt, one non elected because there was no way to make good on the promise and the present one trying to razzle dazzle you with a manifesto that has no bearing on the reality of life, that is their embarrassing moment. In that whose story would you go for 1st, Al-Qaida with their Kalashnikov or Labour with nationalising the rails (which the BBC already showed in details in 2013 that it was not possible) and 60% in renewable energy. An absurd notion that the Swedes achieved as they have 3 cities (Stockholm, Goteborg and Malmo), with a total national population of 10 million people. The UK with 68 million and a lot more cities. the Greater London area alone is the size of the entire Swedish population, after that we get Manchester, Liverpool, Nottingham, Sheffield, Bristol, Leicester, Edinburgh, and these are merely the places larger than Malmo, the smallest of the three cities. The UK would require renewable energy amounts in excess of 750% of what Sweden has, a feat that is not possible as the UK would be short by well over 90% of the required need at present. So again we see how the Labour party is just full of… that stuff the cows make and makes the grass grow (read: it is a 4 letter word)?

There is just the small part of the manifesto I saw and some of what the media leaked. In addition, the fact that some in that small inner circle leaked it gives reason that they know that what they claim to offer is nowhere near feasible. That is modern labour for you. I could have made a much better manifesto in hours, one that might not have good news, but one that labour people could be proud of. Jeremy Corbyn basically left them with nothing and as we read that the other two were Andrew Fisher and John McDonnell, I just have to ask. Was Fisher not the one sacked in 2015? So how did he get back in the good graces of Corbyn? There is less against McDonnell the man is pure labour and we can ask how it is Corbyn and not McDonnell that is leading labour. That being said and how we is making the tuition free claim, how can he stand with this? Several sources have been asking how it will be paid for and not one valid answer came back at present. I will not fault them for the attempt as it is a noble one, yet when the treasury is showing well over minus a trillion, there is no way to get it done. Consider that there is still a deficit at present (it is a lot lower, but there is a deficit none the less), how can this be paid for? The government can pay for it, driving their costs up, or offer a tax incentive to companies lowering their income, there is no real solution. Some have been speculating into IP and letting students earn value whilst they study lowering their debt. Yet in that they would either take someone’s else’s job, or the last one there would be discriminatory value as IP Law Students and Engineers will have an unfair advantage against other students as patents are valued more and more. It is the most likely and the least fair system. It would drive business and art students in a rage as they need to pay full fair, which would be an unjust path.

If there is one side in the Labour manifesto that I support to some degree is that there would be a tax bracket for those making in excess of £80K, yet only if the 0% tax amount gets raised to give the lowest group a little more cash. If the 0% bracket is raised by £1500, whilst the 80% bracket is no more than 3% higher, there would be a social justice in play. Oh, and all references on how the higher bracket funds nurses, better realise fast that the highest income class, constitutes a group of less than 25,000 people, so how much extra would you charge them? The HMRC has those numbers (to some degree) and when you consider the cost of 10,000 nurses, you will realise that there is no validity or reality in such claims. Labour is failing the people if the United Kingdom in several ways and it started with a laughable presentation on a manifesto that has no bearing on truth or reality, the fact that it will be shown to the people in the 11th hour, how much faith can you have in any manifesto that is not openly shown, will not be in play until they are in office and the fact that large parts are already shown as non-achievable, how can you give them any consideration? In that I recall the UKIP manifesto, I might not agree with it, there are plenty of opposing views, but they gave it out when they tried to go for the election trophy, at the beginning, not at the point where the readers get a two-minute warning.

Oh, and for the little heads up. I will soon treat you to a story on how a place like the Australian Foodco, who is presenting the sale of franchises and only afterwards tell the people that its business model relies on underpayment, which actually will never work at all. Just in case you are interested in starting a franchise.

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Dr Temp MD

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

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

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

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

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

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

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

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

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

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

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

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

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

Back to the NHS issue we go!

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

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

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

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

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


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