Tag Archives: Lord Kerslake

Merely a starting point

There is an interesting article at the Guardian, which we were treated to mere 6 hours ago. The article ‘Virgin awarded almost £2bn of NHS contracts in the past five years‘ seems to be rubbing people the wrong way. We see (at https://www.theguardian.com/society/2018/aug/05/virgin-awarded-almost-2bn-of-nhs-contracts-in-the-past-five-years), the setting where in “one year alone, the company’s health arm, Virgin Care, won deals potentially worth £1bn to provide services around England, making it the biggest winner among private companies bidding for NHS work over the period“. In the end, the NHS either privatises to a much larger extent, or the service stops. It is basically that simple and it is only the beginning. Even when we give the right amount of empathy to Sara Gorton, the head of health at the trade union Unison, as she states: “The company has been so keen to get a foothold in healthcare, it’s even been prepared to go to court to win contracts, moves that have cost the NHS dearly. While the NHS remains dangerously short of funds, taxpayers’ money shouldn’t be wasted on these dangerous experiments in privatisation“, is that really the case? The fact that Virgin got the contract was mainly because it could be done cheaper. I warned for certain settings as early as 2014, that certain steps cannot continue that way, changes are essential. In addition, as late as January 2017, I mentioned (at https://lawlordtobe.com/2017/01/15/the-views-we-question/), in the article ‘The views we question‘, issues like: “the document, released in December, aims to address the need to bridge the local NHS funding gap of £267 million which will exist by 2020 if services stay the same in the region” gives rise to even more worry. Not only is the NHS a quarter of a billion short in roughly 1080 days in Coventry and Warwickshire, to survive they have to move? How will that aid the people in Coventry and Warwickshire? Will they end up with any health care at all, or will the local Romani Gypsies with oils and herbals need to be relied on? You think that I am exaggerating? If so, please feel free to inform me on how those two places Coventry and Warwickshire, with 340,000 and 550,000 people end up coming up short by £267,000,000 in three years? Well if advice comes at £343,000 on private consultants, that shortage might be reached rather quickly, but that is not the story is it? The story is how funding has failed and how much more it will fail over the next three years. So, as such, is my view as I personally see it of an essential judicial public inquiry that far-fetched?“, it refers to an article in the Coventry Telegraph, so with the question on how we can save money, which was billed at £343,000 , starting with common sense might have been a first solution. In addition (at https://lawlordtobe.com/2016/02/17/behind-the-smiling-numbers/), in ‘Behind the scenes‘, we get a few truths that really hurt and that was February 2016. The Guardian then gave us: ‘Income tax must rise 3p to stop NHS ‘staggering from year to year’‘, so, how much more taxation was captured for the NHS? Remember that was 2 years ago. In addition, I had issues (to some extent) on the path that Lord Kerslake took with his papers. And all these papers and consultancies (none of them free), the proper setting for mental health care was not properly set in the dimensions of cost and forecast, now add to that the setting of taxation delays and we see that the NHS is collapsing on itself, a collapse that is increasing in speed and that is merely the last two years. So in all this, someone at Virgin woke up and called Uncle Richard and asked if he was interested in making a few billion more. The setting was always falling in this direction, and most of it was not due to the tenacity of Richard Branson, but due to the political inaction and to an even larger extent the political follies seen (NHS-IT being the main one). Consider that it took me 8 hours to figure out a technological solution that could change the entire infrastructure of data, merely because I was willing to look at the larger picture and rearrange a few settings, the solution was printed in the History of Scotland, it was THAT simple. Yet none of those IT experts had a clue, or they did but the political engine would not consider adherence to change making it a bigger folly.

Now we see: “Precise details of all the contracts are difficult to establish because neither the Department of Health and Social Care or NHS England keep a centralised record. Virgin’s when it announced plans for six branded clinics offering a range of services. However, it was only in 2010 when it bought a stake in an existing provider, Assura, that it began to show greater ambition in the market“, which shows both the data folly as well of a massive lack of transparency on the health care part (optionally parts of the NHS as well), that shortcoming is the first setting into cost cutting and it is also a direct link to where services could be bettered. The second part was seen in January 2017 with ‘Dr Sarah Wollaston, chair of the Commons health select committee, criticised the government for blaming GPs for the crisis” as well as “She said in a tweet: “Pretty dismal stuff for govt to scapegoat GPs for very serious NHS pressures. Failure to understand the complexity or own responsibility.‘, the central setting was ‘Failure to understand the complexity‘, a part that was shown to a larger extent going back to 2016, even in 2015 and 2014, there were clear signs of non-comprehension in all this and the IT folly, which the Labour government was able to grow to £11.2 billion merely added to the pressures, whilst in addition to all that is also minimised options left for the NHS. all that squandering came at a price and it seems to me that both Sara Gorton and Paul Evans seem to steer in their lanes, but are equally ignoring the setting that the opportunity for Virgin grew due to a lack of flexibility in the organisations (slightly speculative) and the political branch merely added fuel to the squandering fires. Then finally the Lord Kerslake paper, which I opposed to some extent with the equations that they had in regards to the 20 OECD countries. Here I mentioned ‘Perhaps his Lordship could give a slightly more detailed explanation for the remark “Health spending needs to rise at least in line with GDP. Arguably, we may need to go faster if we want to match European funding“. Considering that the Netherlands and Belgium are next to one another and their budgets per person are apart by a mere 49.404%‘, I believe that it is not merely the stretch of the ‘holier than thou‘ GDP, I believe that there are additional elements making the comparison for the UK not merely dangerous, I believe them partially to be unusable (well a bit more than just partially). In all these settings there has been delay on delay and in the end Virgin had to step in. The funny part is that this also opens up data and reporting centres where Virgin has a much larger trove to work with. It would end up that a new VirginAnalytics could be what Dunnhummby was for Tesco, although with a data growth close to 500% of what Tesco allowed for, there is a decent setting where Virgin creates new levels of data cohesion giving the NHS an actual first time where there is a better level of reporting transparency as well as a better quality of Dashboard presentations, which will grow Virgin even more and also allows Virgin to skim the cream of the NHS sections that will be more profitable in the mid-term range of investments, opportunities grown from political complacency as well as political indecision.

So whilst people are going emotional with slogans like: ‘Not His to Seize‘, they all forget that the NHS and its political branch did this to themselves, Uncle Richard merely picked up the pieces and made it all work. This is getting even more traction when we consider the Lancashire Post where we saw almost a month ago “Opposition politicians have demanded an urgent inquiry into the way the authority awarded a £105m child health contract to Virgin Care, only for the decision to be blocked in the High Court. County Hall is continuing to consider its options after the ruling two weeks ago, one of which could be to re-run a part of the procurement process which the judge ruled fell short of the standards required

The article (at https://www.lep.co.uk/news/inquiry-call-over-lancashire-county-council-105m-virgin-care-health-contract-1-9241205) gives rise to questions not only on the awarding of contracts, but on the entire setting on investigating the amount and not to mention the fact that the contract was awarded whilst there were two NHS trusts on it, it shows that it not merely transparency. With ““We are in a real mess and the Government needs to intervene,” said Labour leader Coun Azhar Ali“, it implies that the NHS (as well as the local government) is to some degree riddled with incompetence. I cannot come to any other conclusion. The setting we see with “Coun Fillis added: “The Conservatives in Lancashire have been stopped once again from privatising public services, in this case our children’s health services“, is on Labour, not the Conservatives. The governing party decided to push for public health privatisation, and opposing it might be valid, but that legal invoice is still due, so crying over it with ‘tide of mounting legal costs, which the people of Lancashire will have to pay for‘, especially when you consider that “in view of the ridiculous comments from LCC’s Labour group, it should be borne in mind that the decision to seek tender for the provision of health services for Lancashire’s children and young people was actually taken by cabinet in February 2017, and both Couns Ali and Fillis were members of that cabinet“, so basically it was a decision that has suddenly hijacked by a minority and they are crying for the setting of cost? Go cry me a river, please!

It is in that setting, where politicians (especially labour) was lax with spending, squandered billions upon billions and they thought the Virgin train would pass them by. Now as this is not the case, not only do we see larger changes, there is the valid concern that mere niches are saved and a much larger setting still goes into the drink. If there is one setting that might change it is by taxing every person an additional £1 per payslip to save the NHS. It seems like a little, but with currently 32.2 million people working, that could add up to £65 million per fortnight. It might not be a lot, but it is a start and with that start you can begin to create momentum for the NHS that is by the way separate from all other funding due to the NHS. The question will people accept it? I reckon that when the NHS actually starts getting healthier, they will live with the loss of £1 each person, each payslip. It might have been pennies, initially, but that was 2 years ago, now we either act or lose a lot more and this is with VirginCare in place. Without it, and with the lack of restructuring the losses will be close to monumental, the simple impact of inaction, we can argue that the Conservative government is taking the easy way out, but is there any alternative? You merely need to look at what we can call a hijack by both Couns Ali and Fillis to realise that there are two in a setting that is much larger and those loses and those legal ramifications as well as the actions that followed is more than a sign of the times, it is a sign of high cost and zero impact desperation, that whilst actual working actions to get the NHS in a better place was ignored to one side and mismanaged on the other side by Labour in the 1997–2007 frame.

At present for Virgin, VirginCare is merely a starting point that can go a much larger route within the next 4 years, in the end, without an NHS, what will people do? I wonder how many remain in denial of that setting, yet it has been a more and more realistic setting. The simple setting is that almost two trillion in debt means that annually at present £68 billion is required for interest alone. Even as Net borrowing is down to almost 28% of what is was in 2010, the setting is that there is a massive debt and it is impacting everything (and the NHS not in the smallest setting). Only be diminishing that part can the UK move forward, which is a lot better than the EU is seeing at present, their debt will make them slaves to the banks for decades. You see, linked to all this is not merely what the government has, but the fact that “The 28 member states of the European Union (EU) have a total debt burden of €12.5 trillion, which could be even bigger, according to the latest figures from the EU statistics office, Eurostat“, in light of the UK being one of the big four, it implies that the rest of the EU will have to deal with the €10.7 trillion debt. How quick do you think they will be able to deal with that? That is why Brexit mattered, in light of the NHS being cut to a bare minimum, it is more and more a setting that Europe could more likely than not end up with not having any healthcare at all, so where would you prefer to be? In light of all that, Virgin might end up with a large gain, but at least there will be some healthcare, a part that too many are ignoring. Would it have been better to keep it all in the NHS? No doubt, but if you want to eat at the Ritz, you better have a fat wallet and the governments from 1997 onwards have all been part of blunders that ended the UK at minus 2 trillion, did you think that was going to go away because the news did not make mention of it? Consider Forbes who gave us not only that French and Italian health care is really good under normal conditions, in Italy (regarding the article), “I have never heard of a child waiting for surgery on his arm.  He would have been placed on the operating room list and he would have been fixed as soon as feasible. There are plenty of more serious surgeries, like cancer cases or even cardiac care, that are put on hold for months in these types of healthcare systems“, the article (at https://www.forbes.com/sites/benjamindavies/2018/08/05/a-broken-arm-in-italy-waiting-for-surgery/#20de8a1f29b6) shows the setting in Italy, in addition, in France we have a similar setting and all over Europe there are similar pressures.

Getting back to the corporation in question, is VirginCare a force for good, or the opposite? I believe that it can be a force for good, but we need to realise that the people can only be treated when we consider that flexibility is required. The lack of resources that is already in play is one part, the political games that we see, whilst relying on the emotion of others is the second part and when the people realise that they have been had by the likes of ‘both Couns Ali and Fillis‘, and many others like them, when it comes out on the waste of resources that they enabled for, will these angry people picket at the front doors of these politicians, or is that not sexy enough?

So when we see the Virgin setting with: “We welcomed inspectors back on 4 July and they were very positive at the further progress we’d made since January in implementing our improvement plan, and gave us positive feedback about the improvements to the practice. We are awaiting the publication of an updated report in the coming months which will reflect this most recent visit“, we see that there is positive change, that there is progress. It will take time, because those expecting this change to be overnight, they are truly looney tunes. If you wanted immediate change, you should have gone after certain politicians as early as 2013, so don’t cry now, not when the choice is now limited between a crewcut and decapitation. The NHS setting is close to that extreme, and has been for some time.

 

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The views we question

This is not a piece of me knowing, this is not a piece of me telling how it is. This is me questioning certain choices and certain actions. When we now see the actions as displayed by the press, is the press correct, was the press played or is the press playing us? To help to you in this, let’s start with two articles, both in the Guardian. The first (at https://www.theguardian.com/society/2017/jan/14/nhs-crisis-my-frail-mum-was-forced-to-wait-on-the-floor-for-eight-hours), where we see the emotional start ‘My frail mum was forced to wait on the floor for eight hours‘, I myself have had to wait in triage twice. This happens. There is only so much a hospital can do, as for the wait on the floor? When we see the first story appear we see “It was another seven hours before he went upstairs for an angioplasty and a stent. The A&E staff were under immense pressure, having to deal with far too many patients, but they did an amazing job“, now this person was from Worcestershire, famous for its Lea and Perrin’s sauce. In another case we see “It took 30 minutes for the paramedics to get there but when they arrived they were brilliant“, as well as “I don’t want to blame the paramedics or any staff at the NHS. They do a wonderful job and do their best to take care of patients when they arrive. But the issue is with the government and the lack of funding to our healthcare services” from that same person. Finally the one that is important here is “Dr Liam Brennan, president, Royal College of Anaesthetists: ‘These are no longer winter pressures, but perennial pressures’” with the added quote “In my 34 years as a frontline doctor I have never seen the breadth and scale of the relentless demands across the whole health and social care system that I see today“, in all this, this is the part that is in the eye of the hurricane, because, when we look back to Baron Kerslake, or as he is called in the House of Lords ‘bobby’ (assumption from my side). You see, he came up in an earlier blog, appointed as the Chair of King’s College Hospital NHS Foundation Trust. On February 17th 2016, in my blog article ‘Behind the smiling numbers‘, I wrote (at https://lawlordtobe.com/2016/02/17/behind-the-smiling-numbers/), “The title ‘Income tax must rise 3p to stop NHS ‘staggering from year to year’‘, which implies initially that the NHS needs £1.95m, which might be OK. Yet the truth is far from that, the text gives us that Lord Kerslake stated “Income tax will have to increase by at least 3p in the pound….”“, which is another story entirely (and first evidence that members of the House of Lords are gifted with a decent sense of humour)”, which came from a February article in the Guardian. Now when we consider The Royal College of Anaesthetists (www.rcoa.ac.uk), we see “Anaesthetists are qualified doctors who are registered with the General Medical Council (GMC). The first step towards a career as an anaesthetist is medical school. Undergraduate medical training normally lasts for five years and medical students normally graduate with a bachelor’s degree. After graduating, the newly qualified doctor enters foundation training in hospitals around the UK. Foundation training lasts two years and after the first year, trainees become fully registered medical practitioners. Through the second year of foundation year training, trainees apply for postgraduate training in one of the specialties, of which anaesthesia is one. Trainees can apply for the seven years anaesthesia programme or the eight years anaesthesia programme which includes two years of the Acute Care Common Stem (ACCS) programme. Trainees also have the option of completing dual Certificates of Completion of training (CCT) in anaesthesia and intensive care medicine. The dual CCT is similar in principle to achieving dual degrees and will normally take 8.5 years to complete“, so as we see staff shortages, as we see resource shortages, we also see something else, do we not? The quote from Lord Bobby, my apologies for this error, I meant Lord Kerslake, Baron Kerslake no less, it is my personal believe that harsher calls should have been made near a decade ago. In this former Prime Ministers Tony Blair, Gordon Brown and David Cameron should have made larger adjustments towards the NHS. Yes, we know that the Labour party bungled 11.2 billion pounds in that regard, but that was IT, staff is another matter and adjusting for those needs should have been done a long time ago. I have had an interest in becoming an anaesthetist a long time ago, if I had known the dire shortage then, I would have appealed and applied to Professor Peter Hutton in person in 2001. I might not have made it and unlikely I would have been able to do this, but I would have made the effort, a part I now see a failing Lord Kerslake with Lord Kerslake stated “Income tax will have to increase by at least 3p in the pound….“, I believe that if this is going to get saved, Prime Minister Theresa May will have to increase taxation to all working people by £1 every month as per January 1st 2016 and all pensions by £0.50 as per that same date. The treasury coffers will need to make a larger change, yet if anyone in House of Commons, the House of Lords or Parliament has any serious consideration to keep the NHS alive, that action is now needed. It is not unlikely that we will see a 2018 judicial public inquiry regarding the actions, practices, responsibilities and funding of the NHS. There is no telling which Lord Justice would be chosen, yet in these levels of failure, in these levels of events and the inhumane pressures that the medical profession is now under, brings a pain to my heart a lot more severe than a heart attack (I had more than one of those, so I know). The reason for all this is that there is a similar atmosphere all over the Commonwealth and if we want to prevent such a disaster in Australia, Canada and New Zealand, something needs to be done now.

The second article I mentioned was ‘NHS in crisis as cancer operations cancelled due to lack of beds‘ (at https://www.theguardian.com/society/2017/jan/14/health-service-in-crisis-cancer-ops-cancelled-nhs). The second line is the one that brings the beef to the table: ‘Hospital chief warns government must face the truth, as patients lose surgery dates with some only receiving one day’s notice‘, the question becomes how could this have come to such a dire place? You see, this is not just some refugee or illegal immigrant thing, this is what I personally see a categorical undermining of an essential support system. This is a basic view, but is my view incorrect? It can only be seen as such if there is a visible spike of 30%-45% of Cancer patients and I am fairly certain that actually newspapers did not make such a report. In this the quote “Today, writing for this newspaper, the chair of King’s College Hospital, London, Lord Kerslake, a former head of the civil service, suggests Theresa May’s government is not sufficiently in touch with the reality facing NHS hospitals and staff to appreciate the severity of the crisis“, in this I would respond is that Lord Kerslake left the needs of the NHS too shallow in his 3 pence required statement, perhaps I just got that wrong, but if I misread it, than who else did that very same thing? Yet there is another gem in this article and it is shown a little further down that piece. The quotes “Kerslake also sides with Simon Stevens, chief executive of NHS England, who last week questioned the prime minister’s claim about NHS funding“, “Dr Sarah Wollaston, chair of the Commons health select committee, criticised the government for blaming GPs for the crisis” as well as “She said in a tweet: “Pretty dismal stuff for govt to scapegoat GPs for very serious NHS pressures. Failure to understand the complexity or own responsibility.”“. So we have a few political fires going on and the fact that Prime Minister May reacted poorly is just one facet. The one that does matter is “failure to understand the complexity“, you see, it seemed to me for the longest of time that there was too much politicisation with the NHS, which is why I am referring to the essential need of a judicial public inquiry of the NHS. Why on earth has the NHS become so complex? Is that not a valid question too? In this world, is medical care and health care the one item on everyone’s agenda to keep that as simple as possible? In that, we see another part, in advance I will apologise for the upcoming ‘less’ civil words, but why the fuck is anyone handing over £340,000 to PwC? The headline from the Coventry Telegraph ‘Coventry and Warwickshire NHS chiefs fork out £340,000 for advice on how to SAVE money‘ (at http://www.coventrytelegraph.net/news/coventry-warwickshire-nhs-chiefs-fork-12436466), there is in addition a small part if each forked that over, or if this was a total amount. The fact that PwC, you know the ‘idiots’ involved in fallen places like Tesco and BHS, now they are advising the NHS? How much is that going to cost the tax payers after the initial fee that equals 13 annual incomes for most UK working citizens? The quote “The document, released in December, aims to address the need to bridge the local NHS funding gap of £267 million which will exist by 2020 if services stay the same in the region” gives rise to even more worry. Not only is the NHS a quarter of a billion short in roughly 1080 days in Coventry and Warwickshire, to survive they have to move? How will that aid the people in Coventry and Warwickshire? Will they end up with any health care at all, or will the local Romani Gypsies with oils and herbals need to be relied on? You think that I am exaggerating? If so, please feel free to inform me on how those two places Coventry and Warwickshire, with 340,000 and 550,000 people end up coming up short by £267,000,000 in three years? Well if advice comes at £343,000 on private consultants, that shortage might be reached rather quickly, but that is not the story is it? The story is how funding has failed and how much more it will fail over the next three years. So, as such, is my view as I personally see it of an essential judicial public inquiry that far-fetched?

In that part, the PwC will have more to explain. When we see: “The sum cannot be broken down as you request as the work was undertaken on a fixed fee basis but please note that the work was commissioned in line with government framework rates.”, what else was done, how many hours and what data was the advice based on? In addition we see that the payment to PWC LLP, who were commissioned by the STP member bodies to help to develop the STP between July and September 2016 (as quoted), so this Sustainability and Transformation Plan (STP) gives a solution, which involves:

  • University Hospitals Coventry and Warwickshire NHS Trust
  • South Warwickshire NHS Foundation Trust
  • George Eliot Hospital NHS Trust
  • Coventry and Warwickshire Partnership NHS Trust
  • NHS Coventry and Rugby Clinical Commissioning Group
  • NHS Warwickshire North Clinical Commissioning Group
  • NHS South Warwickshire Clinical Commissioning Group

It now becomes a question on where the trimming would need to be, more important if there is an upcoming shortage of a quarter of a billion, is there an oversight of what has been billed, what has been received and with three commissioning groups, should we fear what kind of a gravy train is running here. How many clinical commissioning groups are there in the West Midlands? If every county has one, how much in payments go into those clinical commissioning groups? These are all questions that are not heard by too many places. I think that there is an issue, I am not sure if what I am raising is an issue, but with only part of West Midlands, if they are short by a quarter of a billion, what shortages can we expect to see in Herefordshire, Shropshire and Staffordshire? Consider that the West-Midlands is around 5.8 million at present. Implying a lot, that part you should realise when 15% of a West Midlands is cause for a quarter of a billion in shortage, where is the rest of West Midlands at? Is that such a weird question? Even as there is absolutely no fault to the medical practitioners themselves, there is a fair bit of uncertainty regarding the governance of the medical profession and the governance of the NHS trusts. It is the scent of silence. In this I equally blame the Labour party as they did not change direction funding the NHS as it should have. Now, we know that the financial crises has hit everyone, this is a fact of life, yet the issue we see when the Guardian quote “saying that the real amount of extra cash being given to the NHS in England between 2014-15 and 2020-21 is only £6bn and even that much smaller sum has only come from cutting spending on public health programmes and medical education and training by £3.5bn” was given on October 31st 2016 also implies the partial pressure we see mounting. by cutting £3.5bn on medical education and training, we can see one headline, namely ‘NHS in crisis as cancer operations cancelled due to lack of beds‘ as it changes into ‘NHS in crisis as cancer operations cancelled due to lack of qualified surgical staff‘, when some of these specialists require 8 years of training, that view is not overly pessimistic, it is an actual reality that the UK could be facing from 2019 onwards, yet for how long cannot be predicted because the changes in policy are unknown and they will largely influence for how long this problem will continue, as well as it will continue to grow as a problem.

In light of this, perhaps a light hearted alternative? When we see the BBC (at http://www.bbc.com/news/uk-england-35121632), how long until politicians will consider: “Nearly 1,500,000 people were killed this year as part of the government’s NHS sustainability cull“. You see, if we do it to the badgers, how long until people are on a similar list to create convenience?

 

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Behind the smiling numbers

An interesting story got to see the internet light by Nicholas Watt (at http://www.theguardian.com/society/2016/feb/16/income-tax-must-rise-3p-to-stop-nhs-staggering-from-year-to-year). The title ‘Income tax must rise 3p to stop NHS ‘staggering from year to year’‘, which implies initially that the NHS needs £1.95m, which might be OK. Yet the truth is far from that, the text gives us that Lord Kerslake stated “Income tax will have to increase by at least 3p in the pound…. “, which is another story entirely (and first evidence that members of the House of Lords are gifted with a decent sense of humour).

His lordship is quite correct when he states: “big questions needed to be asked to ensure that spending kept up with medical advances, an ageing population and the need to invest in hospitals“, yet these are mere facts that should have been asked almost a decade ago, there was a clear and near immediate danger to the health of the NHS. The logic we see after that becomes an issue (read: worry, concern, and both are debatable) “Health spending needs to rise at least in line with GDP. Arguably, we may need to go faster if we want to match European funding. You might argue there is a discount there because we have a more efficient system. But it’s got to be at least GDP-linked otherwise I don’t think we’ll get there“. So let’s take a look. First the Dutch version (at http://www.rijksbegroting.nl/2015/voorbereiding/begroting,kst199401_25.html) gives us two issues should we be willing to ignore language barrier. The BZK gets €71.3b, which is divided in €7.5b called budget financed expenditure and €63.8b from premium financed expenditures. So for argument sake, let’s take the total and divide that on a population of 17 million, this now implies that there is almost €4200 per person (remember that this is a terribly rough estimate).

Now for Belgium we get the VBO with €23.85b. Now we all know that Belgium is a much smaller nation (not that much smaller than the Netherlands in size) and with 11.5 million calling the Belgium nation their homestead we now see that they end up with €2075 per person (Rounded upwards). Perhaps his Lordship could give a slightly more detailed explanation for the remark “Health spending needs to rise at least in line with GDP. Arguably, we may need to go faster if we want to match European funding“. Considering that the Netherlands and Belgium are next to one another and their budgets per person are apart by a mere 49.404%.

This gets me to the core of the proclaimed matter, can anyone explain why we are linking healthcare to GDP? Perhaps, and this is merely a lose speculation, some people in the House of Lords had the time to read a paper by Santiago Lago Peñas (added at the end) called ‘On the relationship between GDP and Health Care expenditure; A new perspective‘, now that might be a good thing, there is nothing wrong with Spain taking the lead in matters (especially if it is a good idea). Santiago Lago Peñas as well as David Cantarero Prieto and Carla Blázquez Fernández have written an interesting paper.

First let’s take a look at part of the abstract, which states “Econometric results show that the long-run multiplier is close to unity, that health expenditure is more sensitive to per capita income cyclical movements than to trend movements, and that those countries with a higher share of private health expenditure fit faster and following a different pattern“. Now, I am not going to take a deep dive into this one (it is after all an abstract), but it gave me a few ideas on where to dig.

Next are a few quotes: “Attention is paid to several usually neglected dimensions of this link. With this aim, four different specifications are presented, with the logarithm of per capital total health care expenditure as the dependent variable in all cases” this doesn’t seem to be more than just a quote, but it will have impact down the track.

It is part 2 called previous evidence that is a first issue. When we accept the initial statement “the debate on this link has moved on whether the income elasticity of health expenditure is greater or less than 1 (Bac and Le Pen, 2002). An income elasticity less than 1 classified health expenditure and income inelastic, therefore, as a “necessary” good. On the other hand, if the elasticity is higher than 1, health will be classified as a “luxury” good“, which will do for now. You see, my issue is when we see the part that follows:

  • The seminal paper by Newhouse (1977)
  • An earlier study by Kleiman (1974) for a different set of countries
  • Leu (1986) using cross-sectional data for 19 OECD countries in 1974
  • Parkin et al. (1987) using similar methods and data from 1980
  • Brown (1987) using a sample of 20 OECD countries

Here we have the first issue. You see, this is not regarding the methodology, it is about the data, methods of data collection, usage of weights (if done), these numbers regarded in contrast towards those temporary populations in reflection to the whole. Health expenditure is one part, but based against which healthy part. Now consider the initial reflection I had on the Netherlands and Belgium. They have very different norms in respect to mental health care. Now consider the statements ‘19 OECD countries in 1974‘ and ‘20 OECD countries in 1987‘ I will again make a clear speculative declaration that the mental health norms are not equal, especially when considering economic differences, which gives my first thought, how useful is the paper on a whole (I am not attacking it) and how applicable this would be (read: could be) in reflection towards the whole.

You only need to scan for ‘psychology, psychiatry and mental health’ to see that the paper does not take this into consideration. As we know that the EEC nations have had their own approach to mental health in the past, is not a statement that they did anything wrong, but if this is the first element that does not align, what else will not align (there are a few). One that shines directly behind the ‘previous evidence‘. You see in my head the question comes to mind when I see “The econometric analysis relies on annual data for 31 OECD countries from 1970 to 2009 gathered from the OECD Health Data Set 2011“, so is this aggregated data or raw data. if it is aggregated data the foundation might not align giving an unbalanced and invalid view (in my personal opinion), if it is raw data, what ground line data (the full population) is added so that the individual record compares towards the national whole, if that is missing how can any calculation be truly reflective of what was, especially taking into account the data is reflective over different time zones with very different social pressures. In that case I wonder if I can get a similar result by calculating Z-scores and run a Crosstabs in IBM Statistics #JustSaying!

Now we get back to the article which comes with the image of a smiling Lord Kerslake. Does this paper validate or invalidate the idea? No it does not, but it leads to questions, serious ones.

The quote “John Appleby, the chief economist at the King’s Fund, has estimated that NHS spending is due to fall from 7.3% of GDP to 6.6% in 2020-21. If health spending were to keep pace with economic growth, Appleby estimates an extra £16bn would have to be found every year by 2020-21 to take the NHS budget to £158bn. This works out at 3p on all rates of income tax, according to the IFS” is next!

The term ‘NHS spending is due to fall‘ reads like an event Baron Munchausen could have come up with (the character from Raspe’s book in 1785, not the syndrome). Of course the prediction is 5 years away, which makes it speculative. Now we know that John Appleby is more than the Chief economist for The King’s fund. He is also a Visiting Professor at the Department of Economics at City University and he has a whole range of publications to his name, so why am I opposed?

Well, part of this starts with his own article ‘Social care: a future we don’t yet know‘ (at http://www.kingsfund.org.uk/blog/2015/11/social-care-future), the two quotes that get the foreground are “In our submission to the Spending Review we called for social care to be protected from further cuts and for the money previously agreed for the postponed Care Act funding reforms to be retained and invested in social care. But non-protected departments have been asked by HM Treasury to model cuts of 25 and 40 per cent – so further cuts seem inevitable“, as well as “What would happen if the spending cuts applied to social care over the past five years continue over the next five? Spending on social care for people of all ages as a share of GDP has already begun to fall. It was roughly 1.2 per cent in 2009 but if cuts continue at the same rate it will have halved by the end of this parliament to barely more than a half of one per cent of GDP“. Now there is nothing wrong with any of the texts, John Appleby is not where he is because he is silly, he is very (read: extremely) clued in. I am stating that the environment has changed, it has changed drastically from 2011 onwards and in addition; the changes the UK faces over the next three years will take some of these prediction to town in not so nice a manner.

You will now ask why, which is the question you should ask!

We get part of this from the London School of Economics and Political science (at http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf), the initial answer is given on page 13. Where we see “To summarise, treatments for the “common mental disorders” of depression and anxiety can be self-financing within the NHS. By spending more, we save even more. This is different from much of NHS expenditure. At the same time we relieve one of the main sources of suffering in our community“, in addition page 15 gives us “According to the 2007 survey, which covered a random sample of households, only 24% of people with depression and anxiety disorders were in any form of treatment“. This now gives us the first part in all this. The overall costs are not in league of the budgets because there is a missing foundations of equality on what falls ‘within’ the NHS. There is no option for the NHS other than to evolve into something ‘more’ complete. The UK is about to get 20,000 refugees from war torn Syria (over several years), the initial approved £1b seems to be nothing more than a drop of water on a hot plate, the ‘why’ will be clear shortly.

The UK has seen a massive rise in mental health issues in the last year alone. Depression and anxiety mainly due to economic events (cost of living) is now a serious concern, especially as the pressures of the economy are likely to continue a few more years. Consider my article two days ago (at https://lawlordtobe.com/2016/02/15/is-there-a-doctor-on-this-budget/) called ‘Is there a doctor on this budget?‘ where we saw the link to ‘Health Care for Undocumented Migrants: European Approaches‘. The graph shown on page 3 is the charm. If we consider the cube, we see that on the X-axis we see subcategories of undocumented migrants, yet the same expenditure would apply to refugees (or the population for that matter). Now consider the Y-axis which is about the type of services and the Z-axis are the funding arrangements. Now this can be treated like a glass with liquid. If we increase the base (X or Y) the funding arrangements go down, it is the simplest of physics, a bigger glass requires more fluid to fill, so we have a population with more health care needs, mental health care in this case and the types of services is not just against depression or anxiety, it will require the coverage of war trauma and shell shock. This will impact refugees of all ages. So the glass gets bigger and bigger and more and more funding will be required to keep funding arrangements on an equal level, this is merely the application of logic.

This is why I opposed John Appleby’s approach, it shows little application of a changing population, merely a greying one (which is a form of change), but it does not hold water against the massive change the UK has faced since 2013 and will face until 2019. This is why I am not in agreement with the statements of John Appleby. Now we get back to Lord Kerslake. You see, the paper I mentioned is an example. It might not even be the foundation of Lord Kerslake’s approach. Yet a multitude of papers clearly show that there seems to be no real no equality in the setting of healthcare (read: cost of health care). It seems to be wearing a different hat in nearly every European nation, it would already be a great leap forward if they all had the same colour, which does not seem to be the case either.

Now we get the quote that wakes us all up “Appleby estimates that NHS spending would have to increase by 30% or £43bn a year to take NHS total spending to the EU-15 average by 2020-21. The IFS estimates that this would involve an 8p increase on all rates of income tax“, which is one side of the option. How about the other side? When we see that AstraZeneca has been able to avoid corporation tax on a massive scale, which dwarves when we compare it to the mergers Pfizer and Allergan have achieved. Is it perhaps possible that his lordship looks at another solution like closing that tax abyss? Might I suggest an idea where any corporation involved in tax avoidance gets its medication ‘grey’ listed? Which means that any drug that could be begotten in a generic form from a place like India will be selected as a first solution? It could even result in India starting businesses in the UK (with the economic benefits that those places will give). It would also send a clear signal that if corporations would like to avoid taxation, which in legal correct way is just fine, but at that point other distributors of pharmaceuticals will be found. I reckon that between that announcement and the offer of reduced medications (read: less costs for the NHS) from pharmaceutical firms would be forthcoming within 24 hours of making the announcement.

Yet, this was not about the costing, it was about the increase and setting against the GDP. The fact that health spending and economic spending are on par reads more like an option for deferred payments to big pharma and medical supplier than anything else. In case of doctors it would mean that their incomes would go through the roof (which might be a deserved reality), but it is one that the coffers under the care of George Osborne cannot afford.

There is wisdom in his lordship stating that “a royal commission should be established to build a national consensus on NHS funding“, which sounds a lot more ‘reliable’ (read: acceptable) than the Labour party giving way by letting a banker (Sir Derek Wanless) set the NHS spending levels. It is of course desirable to go with the people and keep the directly funded NHS free at the point of use, yet that comes with a price tag that is no longer realistic in this day and age of deficit, in addition harder times are coming for a while longer, making the price tag we already have a non-linear shifting one. Yet I feel adamant to speak that mental health must be fully accepted as part of the NHS (for all people, anywhere in the UK), which slides the scales of budget by a lot. A reality many papers (as I expect it to be) did not take into account. Raising income taxation as implied could equally be an issue as that could potentially drive depression and suicide statistics overnight (the latter would lower rents but that seems just too harsh a solution).

What is a given is that Lord Kerslake is the catalyst that is making us ask several serious questions.

I am however not entirely convinced that his lordship took the best path in getting these issues out into the open.

On the relationship between GDP and Health Care expenditure; A new perspective

 

 

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