Tag Archives: NHS

When they are merely numbers

What if lives are not set in souls, but in numbers, simple numbers? That is the setting we see ourselves in today. A special shout out to Karl Stefanovic who rightfully backed the police and launched a scathing attack on their “timid” critics. Although I would rephrase from ‘timid critics‘ and merely categorise them as ‘fear mongering scaredy cats with a lack of knowledge‘, yet that would be merely my personal choice in the freedom of classification.

Karl is correct in a few ways, yet to see that. We need to look at the other side. My training comes from NATO and I mastered several weapons, to give you a specific setting here, which with the Remington Model 700 is really simple. The drift on 300 meters is optionally no more than 1.1936″ in a nominal setting, so if I aim for the head the brain is gone, if I aim for the chest the damage is worse as that person will not be instantly dead, but they will feel the pinch of a .308 slug and at that point, most Kevlar is useless. You see at 300 Yds the bullet impacts with 1950 lbs on roughly a square inch, in an oversimplified example a 1000 Kg hammer hits a square inch of your chest at a speed of 671 metres per second, good luck getting past that feeling! The Kevlar might slow it down but the impact will be enough to turn ribs to shrapnel and cleave its way through your chest, if the bullet gets through, it will still be mostly slim and nail shaped, leaving the recipient with plenty of optionally fatal damage. A Kevlar vest (if the person has one) might stop a pistol 9mm, even a .357, but with a .308 or .338 rifle, nope, that person becomes a write off. This is how a soldier thinks, it is them/him or me/us, we do not want to die for our country we merely make the other one die for their country/cause.

The police is a different slice of cake. They are trying to protect people from harm of self and/or protect them from harm by others. The police are there as protection for civilians, innocent or not. They have a duty to arrest and Karl is right in backing the police. The News from News.com.au is giving us “They do it sometimes with the public hating them. But they’re the first you call when you need them and they were the first to respond. I salute them this morning“, he is correct! The news also gives us: “The call comes in response to a deadly attack in Melbourne’s Bourke Street on Friday by Hassan Khalif Shire Ali — a Muslim refugee from Somalia. Ali crashed his car full of gas cylinders before stabbing three people, killing prominent Italian restaurateur Sisto Malaspina“, and at this point, the question from me is ‘At what stage was the police to assume that this was a terrorist?‘ You see ‘his car full of gas cylinders‘ was after the fact, yet when did the police know exactly what was going on? The police had a direct need to incapacitate to a degree, not to kill. It is that plain and simple! Their job is to evangelise and support the law, not enforce it through violence, even as that will be essential at that point. So the call ‘Shoot him, shoot him’ might come from outsiders, yet to shoot is not an easy task for them. Let’s not forget that the public has been willing to lynch a policeman using his firearm in the past, so the police is utterly willing to leave shooting as a final resort (and so for the most they should), or until there is a clear and present danger to others and even then it will be shoot to incapacitate, which with a Glock is a little harder then you think.

When we see Nine News (at https://www.9news.com.au/2018/11/11/19/18/bourke-street-terror-attack-family-say-hassan-khalif-shire-ali-was-mentally-ill), we see: “The family of the man responsible for Friday’s attack on Bourke Street insist he was not a terrorist but a mentally ill man “crying for help”“. This is optionally true and it also gives rise to the police and the caution used. They might have noticed symptoms that clearly called for caution and refrain from lethal force. Let’s not forget that the entire Martin Place event was a clear case of mental illness, so there is a precedent in all this. It merely makes the entire event sadder on more than one level. It will undoubtedly give false feelings of guilt to the police officer who discharged the lethal shot, it will give feelings of guilt to all the police and carers on the sidelines, and they should not feel guilt in any way. This man, no matter how we slice it has taken three lives, it comes with consequences.

We might even overreact when we see: “Islamic State claimed the attack but today Home Affairs Minister Peter Dutton said there was no confirmed link to the terror group.” Yet the truth is that until people like ASIO give clear evidence that this was the case, we are merely getting an emotional push from a terrorist organisation seeking the limelight in any way they can, it will merely complicate matters in the short term and leave us with a bitter feeling in the long run. Yet we also see that Nine News is optionally wrong. As we see: “The terrorist has been named as 30-year-old Somali-born Hassan Khalif Shire Ali“, this is optionally wrong if any clear evidence of mental health is shown to be true. There is a call in the News.com.au article (at https://www.news.com.au/news/national/security-expert-says-were-feeding-the-beasts-of-terror-with-shoottokill-policy/news-story/59f2162b3427c2e2f5d0a3e6fe1babd1) with ‘Australia is “feeding the beasts” of terror and failing to prevent future attacks‘, in this Dr Allan Orr could be correct. there is no issue labeling the right person a lone wolf, or a terrorist, yet how was it done, what was planned and what was set in an emotional stage. It is order versus chaos. In addition is the man merely a terrorist because he is Muslim? Is he not merely a murderer at this point? These what I would call intentional misclassifications are also a larger problem, the media loves it to use the terrorist tag in all the wrong places and even as it is too soon to clearly determine this, we see that a police officer was used deadly force against an alleged murderer, alleged because intent needs to be shown in court, were these three people intended victims, or where they there and the man would be clearly guilty of manslaughter. In any case the police officer would be absolved of any guilt, especially if he/she had tried to resolve the issue in a non-lethal way.

There will be a political debate that is already raging on, yet the stage is larger than merely “I’ve been very open about the cancellation of visas, the numbers have ramped up, because there are some people who should not go on to become Australian citizens,” the setting of this might not be incorrect, yet when we know that ‘Permanent residency may be revoked at the discretion of the responsible Minister, for example in cases of criminal misconduct‘, if that is correct, then why would there be a political debate? It would be merely enforcing what is stated in policy, is it not?

It gets to be even more complicated when we see: “Ali was known to federal police and had his passport cancelled in 2015 amid fears the Somali-born man would travel to Syria“, the question becomes who was he going to support? Assad, Assad opposition, perhaps the direction does not matter, yet the direction does incline towards extremism, as such it cannot be ignored. It is an issue as we see that there are more sides to all this. The fact that no action was taken (apart from removing the passport) might have sufficed to some degree, his active interest to go to Syria was never explained (needed or not), if there would have been an assessment, even a mere interview and conversation on the consequence of doing that as a non-citizen might have optionally resolved the issue to some degree (highly speculative on my side). Even a limited monitoring on media and activities might have dampened the danger (or not). If these are all acts of a mental health issue, then the entire terrorist issue falls in the water and other activities might not have helped, but the knowledge of where this person was might have optionally aided the police in a few ways, and is that not important too? To give the members of the police every inch that they can use to resolve without being force to employ deadly force? It might not have been an option here, but the lack of indicators (as presently known) seems a little too staggering at present giving us the handle that not only was Karl Stefanovic correct, the officers subjected to this ordeal might be due a commendation or two (or three).

The last part is also the biggest issue. when we see both “Prime Minister Scott Morrison said he backs religious freedoms but has also called on Islamic leaders to call out the attack“, and “Those remarks that have in turn been labelled divisive by Muslim groups who say their community is not to blame for the actions of an individual and fear it could stoke Islamophobia“. It is the partial failure of Prime Minister Scott Morrison that his call, outside if the mental health scope was plain wrong. He can make that assessment after we know enough that mental health was not the stage here, and that part is still largely in question. You see, to require any religious group to lash out at mental health issues is the larger wrong and that is not seen here. Should I be wrong and the mental health part fails, then we have another issue, yet at present there has been no clear evidence to set that and whilst we accept: “Home Affairs Minister Peter Dutton said there was no confirmed link to the terror group“, yet this is very specific, was there any other data making any extremist link likely? I get the impression that this is not the case, giving us a much larger overreaction, just like the Martin Place incident of 2014.

From my point of view, we have become Muslim polarised to a much too large extent. Consider that every religion has its mental health cases. Consider (the Times, Oct 2017) ‘Mental patient murdered neighbour hours after hospital discharged him‘, also we have ‘How 18 psychiatric patients freed by one NHS Trust ALL went on to kill‘ (Daily Mail, Jan 2018), 19 people said to have killed someone, but not terrorists as they were allegedly not Muslim. Two filters of classification in a group of people that would have been a dangerous stage in any foundation, so we need to be extra careful who gets the ‘terrorist label’ as the impact is a lot larger and the negation that actual terrorists are could also endanger a lot more lives in the future.

The victims and perpetrators might merely be numbers, yet when the numbers are wrongly stacked, the people who are forced to act might wrongly do so making matters worse for everyone around and that needs to be clearly stated, as well as the fact that Karl Stefanovic made the right call in this case and that should be recognised on a national level as well.

 

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Goodness redirected

Even as I got shocked to the core yesterday with news on how certain Biological Agent accusations are going in the wrong direction (turning my paranoid into overdrive in 7.2 seconds flat), I was also slightly bewildered a few hours later on how a greed driven industry is now getting a rather large shake up. It was the Washington Post that treated us to ‘Hospitals are fed up with drug companies, so they’re starting their own‘ (at https://www.washingtonpost.com/national/health-science/hospitals-are-fed-up-with-drug-companies-so-theyre-starting-their-own/2018/09/05/61c27ec4-b111-11e8-9a6a-565d92a3585d_story.html?utm_term=.8362898ab1fe). It is a not for profit pharmaceutical company that works exclusively for hospitals. That is the first really good unbiased news of 2018. I truly wish I was part of that place. The report by Carolyn Y. Johnson gives us “A group of major American hospitals, battered by price spikes on old drugs and long-lasting shortages of critical medicines, has launched a mission-driven, not-for-profit generic drug company, Civica Rx, to take some control over the drug supply“. And even as it is for now merely the generic side of it all. We need to realise that in the UK, the NHS gives us (at https://www.nao.org.uk/wp-content/uploads/2018/06/Investigation-into-NHS-spending-on-generic-medicines-in-primary-care.pdf) and that they spend £3.5B in 2016-2017. I am using that data for the mere reason that it is more up to date and more reliable at present. Consider that an ‘island’ with only 20% of the population of the US has that bill, yet to a larger extent, they have a similar aging issue and several similarities in health care. Now consider that this is a NFP situation, so basically, we see the optional saving of close to a billion pounds a year, implying that the savings for the US should increase drastically. It is also important to see that this is merely the beginning.

So as the too laid back greed driven US pharmaceutical industry is confronted with two nightmares, the first is not merely the current generic medication part, it is that if the US and UK unite the damage increases for the pharmaceuticals. In addition to that, the Pharmaceutical industry is confronted with well over a hundred patents maturing over the next 5 years, so the generic part is increasing with leaps before 2023 and so far a lot of them cannot be ‘reset’ by altering the patent slightly and forcing exclusivity for another 15-20 years.

So there is light at the end of the tunnel, it will not happen overnight, but there is a setting that the US could remove medicine cost pressures by a much larger amount then even before. So even as we are given “Backed by seven large health systems and three philanthropic groups, the new venture will be led by an industry insider who refuses to draw a salary. The company will focus initially on establishing price transparency and stable supplies for 14 generic drugs used in hospitals, without pressure from shareholders to issue dividends or push a stock price higher“, we need to realise that this is merely the start of something much better in two directions. The first is that if the costs go down, there is more money for other hospital needs and also in the other direction, when people get affordable medication more will work on healing and in addition with added funds, the chance increases that they will adopt a healthier lifestyle and actually get better and more energised in their old age, which might change a few other things too.

Civica Rx

Yes, that will be a name to remember for a long time, especially when they start showing the results that their goals are set for. Yet this is merely the beginning. Let’s not forget that given a set of greedy hungry swine’s, when they get hungry they tend to let go of ‘morals’ and limitations, so unless severe warnings and protection is given to Civica Rx, they still have an uphill battle to fight. Forbes gives us (at https://www.forbes.com/sites/elliekincaid/2018/09/05/that-nonprofit-generic-firm-has-a-name-100-million-and-a-ceo-who-will-work-for-free/#38015e44ce06), gives us the name of the CEO Martin VanTrieste, he was also quoted with: “has agreed to work without compensation“. Now, I could never do that (due rent and such), but that shows a system where we would love to be a part of, does it not?

So when I see: “The healthcare systems involved: Catholic Health Initiatives, HCA Healthcare, Intermountain Healthcare, Mayo Clinic, Providence St. Joseph Health, SSM Health, and Trinity Health. The philanthropies: the Laura and John Arnold Foundation, the Peterson Center on Healthcare, and the Gary and Mary West Foundation“, I am actually surprised that the Bill Gates foundation has not (yet) knocked on that door offering a nice 8 figure amount, but you know, 2018 is not over yet.

So even as they start with 14 generic drugs, there is every indication that this can evolve to a number in the triple digits in the next 3-4 years making life a lot more affordable fast.

So what is the setting? Why is this given so important? Well, again we need to the UK numbers (as they are more reliable). It is not merely the setting of ‘cheaper’ that we need to realise, it is the attached setting of ‘proportion of spending on generic medicines that is in primary care, 2016-17’, which was 81% at that point. The second part is the logistics, a number that is even scarier than the margins and the exploded prices involved. You see there were 3,000 concessionary pricing requests made by pharmacists in November 2017, a few months earlier, basically before May 2017 the amount of requests made were less than 150, so an increase of 2000% of concessionary pricing requests. The impact of diminished budgets had that much a drain on logistical support for hospitals and NHS departments. When that pressure falls away, so much more can be done and that part is not visible to a much larger extent. there will remain a much larger issue when we look at the branded versus generic setting in both primary and secondary care, no one doubts that and that setting will remain, but over time that equation will change as well as speed up as the life cycle of branded patents end.

It becomes a little scarier when you consider that in the UK, Ten medicines accounted for £134 million of the net spend on price concessions. Topping this is Amlodipine 5mg, a medication for high blood pressure. This becomes important when we translate that to US numbers we can use. You see, in the United States, about 77.9 million, almost 1 out of every 3 adults have high blood pressure. Now consider when that becomes affordable and less of a drain for any health facility, the savings on this one drug could change the game for hospitals all over the US and at the same time prolong life for Americans. When we see that 18 out of 134 million is for that one prescription drug only, we start seeing the essential needs that Civica Rx is bringing to the table, and it has a much a much better impact than a salad (especially when reading about the McDonald Salads this morning).

SO what will come next? Well, they are off to a start, but I never trust anyone merely giving up their golden parachutes (referring to the current pharmaceuticals having to spread the negative news to their shareholders) and in light of the pharmaceutical patent escalations in India, I feel certain that Civica Rx is likely to face dozens of injunction meetings before the end of this year alone. After that the political engine will be turned against them as much as possible. I think it is important at that point to make sure that EVERY senator and congressman (m/f), will get the limelight set upon them to make the people aware of the elected officials that will make their lives more expensive.

Yet that is not the only part, the NHS report gives us the part that Civica Rx is trying to address as well, when the reporters investigated the underlying causes of pricing, the following parts were given on that report (attached here) on page 21.

The immediate cause of concessionary pricing is pharmacies being unable to purchase a generic medicine at, or below, the Drug Tariff price“, as well as “The Department identified three main underlying causes of the 2017-18 increase in concessionary pricing, and those three causes were:

  • The Medicines and Healthcare products Regulatory Agency and European regulators partially suspending the licences of three manufacturers of generic medicines;
  • A fall in the value of sterling; and
  • Governments and insurers in other countries putting downward pressure on the price of generic medicines, resulting in lower returns and manufacturers withdrawing from some markets or medicines: the reduced capacity and competition then increased prices within the UK market.

Now, the first is only an issue when it keeps on occurring and until more evidence is seen, the solution is not easy in this, the second is an impact, yet short lives and the US might not face that issue as it produced its own need, the UK is much more reliant on American pharmaceuticals. The setting of Civica Rx would when effective take away the cause of that element, making that a non-issue over time, it might initially still be a short term factor for Civica Rx to consider.

And it must also be stated that the elements could not be verified or quantified. There were too many elements in play in all this, but the significance on the factors seemed to clearly shown, but to the extent of how much remains a question that can only be proven over time (and with a lot more precise data).

It is my personal view that the report by Sir Amyas Morse KCB is quite extraordinary and even as it leaves us with questions (as any report does), it also raised the curtain on several issues, not merely showing the essential need of Civica Rx in any nation that is getting drained by healthcare costs, it sets the stage that the report empowers the existence of Civica Rx as well as the essential need for their sponsoring and protection ‘against’ some of the pharmaceutical companies, because generic medication or not, you introduce me to a commercial board of directors who do not care about lessened profits and I will introduce you to a group of people lying to you, it is basically that simple.

So we enter Friday with goodness form another direction, today brought to you by the Washington Post, a paper that still states that ‘Democracy dies in Darkness‘, I say that this is not entirely true, it is currently actively getting smothered with a pillow by the needy for greed and those who get their coins from a similar direction, but again, that is just me thinking with temporarily a few paranoid clouds overhead.

#MondayMorningIsOnly60HoursAway

#HappyFriday

 

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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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Data illusions

Yesterday was an interesting day for a few reasons; one of the primary reasons was an opinion piece in the Guardian by Jay Watts (@Shrink_at_Large). Like many article I considered to be in opposition, yet when I reread it, this piece has all kinds of hidden gems and I had to ponder a few items for an hour or so. I love that! Any piece, article or opinion that makes me rethink my position is a piece well worth reading. So this piece called ‘Supermarkets spy on them now‘ (at https://www.theguardian.com/commentisfree/2018/may/31/benefits-claimants-fear-supermarkets-spy-poor-disabled) has several sides that require us to think and rethink issues. As we see a quote like “some are happy to brush this off as no big deal” we identify with too many parts; to me and to many it is just that, no big deal, but behind the issues are secondary issues that are ignored by the masses (en mass as we might giggle), yet the truth is far from nice.

So what do we see in the first as primary and what is behind it as secondary? In the first we see the premise “if a patient with a diagnosis of paranoid schizophrenia told you that they were being watched by the Department for Work and Pensions (DWP), most mental health practitioners would presume this to be a sign of illness. This is not the case today.” It is not whether this is true or not, it is not a case of watching, being a watcher or even watching the watcher. It is what happens behind it all. So, when we recollect that dead dropped donkey called Cambridge Analytics, which was all based on interacting and engaging on fear. Consider what IBM and Google are able to do now through machine learning. This we see in an addition to a book from O’Reilly called ‘The Evolution of Analytics‘ by Patrick Hall, Wen Phan, and Katie Whitson. Here we see the direct impact of programs like SAS (Statistical Analysis System) in the application of machine learning, we see this on page 3 of Machine Learning in the Analytic Landscape (not a page 3 of the Sun by the way). Here we see for the government “Pattern recognition in images and videos enhance security and threat detection while the examination of transactions can spot healthcare fraud“, you might think it is no big deal. Yet you are forgetting that it is more than the so called implied ‘healthcare fraud‘. It is the abused setting of fraud in general and the eagerly awaited setting for ‘miscommunication’ whilst the people en mass are now set in a wrongly categorised world, a world where assumption takes control and scores of people are now pushed into the defence of their actions, an optional change towards ‘guilty until proven innocent’ whilst those making assumptions are clueless on many occasions, now are in an additional setting where they believe that they know exactly what they are doing. We have seen these kinds of bungles that impacted thousands of people in the UK and Australia. It seems that Canada has a better system where every letter with the content: ‘I am sorry to inform you, but it seems that your system made an error‘ tends to overthrow such assumptions (Yay for Canada today). So when we are confronted with: “The level of scrutiny all benefits claimants feel under is so brutal that it is no surprise that supermarket giant Sainsbury’s has a policy to share CCTV “where we are asked to do so by a public or regulatory authority such as the police or the Department for Work and Pensions”“, it is not merely the policy of Sainsbury, it is what places like the Department for Work and Pensions are going to do with machine learning and their version of classifications, whilst the foundation of true fraud is often not clear to them, so you want to set a system without clarity and hope that the machine will constitute learning through machine learning? It can never work, that evidence is seen as the initial classification of any person in a fluidic setting is altering on the best of conditions. Such systems are not able to deal with the chaotic life of any person not in a clear lifestyle cycle and people on pensions (trying to merely get by) as well as those who are physically or mentally unhealthy. These are merely three categories where all kind of cycles of chaos tend to intervene with their daily life. Those are now shown to be optionally targeted with not just a flawed system, but with a system where the transient workforce using those methods are unclear on what needs to be done as the need changes with every political administration. A system under such levels of basic change is too dangerous to get linked to any kind of machine learning. I believe that Jay Watts is not misinforming us; I feel that even the writer here has not yet touched on many unspoken dangers. There is no fault here by the one who gave us the opinion piece, I personally believe that the quote “they become imprisoned in their homes or in a mental state wherein they feel they are constantly being accused of being fraudulent or worthless” is incomplete, yet the setting I refer to is mentioned at the very end. You see, I believe that such systems will push suicide rates to an all-time high. I do not agree with “be too kind a phrase to describe what the Tories have done and are doing to claimants. It is worse than that: it is the post-apocalyptic bleakness of poverty combined with the persecution and terror of constantly feeling watched and accused“. I believe it to be wrong because this is a flaw on both sides of the political aisle. Their state of inaction for decades forced the issue out and as the NHS is out of money and is not getting any money the current administration is trying to find cash in any way that they can, because the coffers are empty, which now gets us to a BBC article from last year.

At http://www.bbc.com/news/election-2017-39980793, we saw “A survey in 2013 by Ipsos Mori suggested people believed that £24 out of every £100 spent on benefits was fraudulently claimed. What do you think – too high, too low?
Want to know the real answer? It is £1.10 for every £100
“. That is the dangerous political setting as we should see it; the assumption and believe that 24% is set to fraud when it is more realistic that 1% might be the actual figure. Let’s not be coy about it, because out of £172.3bn a 1% amount still remains a serious amount of cash, yet when you set it against the percentage of the UK population the amount becomes a mere £25 per person, it merely takes one prescription to get to that amount, one missed on the government side and one wrongly entered on the patients side and we are there. Yet in all that, how many prescriptions did you the reader require in the last year alone? When we get to that nitty gritty level we are confronted with the task where machine learning will not offer anything but additional resources to double check every claimant and offense. Now, we should all agree that machine learning and analyses will help in many ways, yet when it comes to ‘Claimants often feel unable to go out, attempt voluntary work or enjoy time with family for fear this will be used against them‘ we are confronted with a new level of data and when we merely look at the fear of voluntary work or being with family we need to consider what we have become. So in all this we see a rightful investment into a system that in the long run will help automate all kinds of things and help us to see where governments failed their social systems, we see a system that costs hundreds of millions, to look into an optional 1% loss, which at 10% of the losses might make perfect sense. Yet these systems are flawed from the very moment they are implemented because the setting is not rational, not realistic and in the end will bring more costs than any have considered from day one. So in the setting of finding ways to justify a 2015 ‘The Tories’ £12bn of welfare cuts could come back to haunt them‘, will not merely fail, it will add a £1 billion in costs of hardware, software and resources, whilst not getting the £12 billion in workable cutbacks, where exactly was the logic in that?

So when we are looking at the George Orwell edition of edition of ‘Twenty Eighteen‘, we all laugh and think it is no great deal, but the danger is actually two fold. The first I used and taught to students which gets us the loss of choice.

The setting is that a supermarket needs to satisfy the need of the customers and the survey they have they will keep items in a category (lollies for example) that are rated ‘fantastic value for money‘ and ‘great value for money‘, or the top 25th percentile of the products, whatever is the largest. So in the setting with 5,000 responses, the issue was that the 25th percentile now also included ‘decent value for money‘. So we get a setting where an additional 35 articles were kept in stock for the lollies category. This was the setting where I showed the value of what is known as User Missing Values. There were 423 people who had no opinion on lollies, who for whatever reason never bought those articles, This led to removing them from consideration, a choice merely based on actual responses; now the same situation gave us the 4,577 people gave us that the top 25th percentile only had ‘fantastic value for money‘ and ‘great value for money‘ and within that setting 35 articles were removed from that supermarket. Here we see the danger! What about those people who really loved one of those 35 articles, yet were not interviewed? The average supermarket does not have 5,000 visitors, it has depending on the location up to a thousand a day, more important, when we add a few elements and it is no longer about supermarkets, but government institutions and in addition it is not about lollies but Fraud classification? When we are set in a category of ‘Most likely to commit Fraud‘ and ‘Very likely to commit Fraud‘, whilst those people with a job and bankers are not included into the equation? So we get a diminished setting of Fraud from the very beginning.

Hold Stop!

What did I just say? Well, there is method to my madness. Two sources, the first called Slashdot.org (no idea who they were), gave us a reference to a 2009 book called ‘Insidious: How Trusted Employees Steal Millions and Why It’s So Hard for Banks to Stop Them‘ by B. C. Krishna and Shirley Inscoe (ISBN-13: 978-0982527207). Here we see “The financial crisis appears to be exacerbating fraud by bank employees: a new survey found that 72 percent of financial institutions say that in the last 12 months they have experienced a case of data theft by one of their workers“. Now, it is important to realise that I have no idea how reliable these numbers are, yet the book was published, so there will be a political player using this at some stage. This already tumbles to academic reliability of Fraud in general, now for an actual reliable source we see KPMG, who gave us last year “KPMG survey reveals surge in fraud in Australia“, with “For the period April 2016 to September 2016, the total value of frauds rose by 16 percent to a total of $442m, from $381m in the previous six month period” we see number, yet it is based on a survey and how reliable were those giving their view? How much was assumption, unrecognised numbers and based on ‘forecasted increases‘ that were not met? That issue was clearly brought to light by the Sydney Morning Herald in 2011 (at https://www.smh.com.au/technology/piracy-are-we-being-conned-20110322-1c4cs.html), where we see: “the Australian Content Industry Group (ACIG), released new statistics to The Age, which claimed piracy was costing Australian content industries $900 million a year and 8000 jobs“, yet the issue is not merely the numbers given, the larger issue is “the report, which is just 12 pages long, is fundamentally flawed. It takes a model provided by an earlier European piracy study (which itself has been thoroughly debunked) and attempts to shoe-horn in extrapolated Australian figures that are at best highly questionable and at worst just made up“, so the claim “4.7 million Australian internet users engaged in illegal downloading and this was set to increase to 8 million by 2016. By that time, the claimed losses to piracy would jump to $5.2 billion a year and 40,000 jobs” was a joke to say the least. There we see the issue of Fraud in another light, based on a different setting, the same model was used, and that is whilst I am more and more convinced that the European model was likely to be flawed as well (a small reference to the Dutch Buma/Stemra setting of 2007-2010). So not only are the models wrong, the entire exercise gives us something that was never going to be reliable in any way shape or form (personal speculation), so in this we now have the entire Machine learning, the political setting of Fraud as well as the speculated numbers involved, and what is ‘disregarded’ as Fraud. We will end up with a scenario where we get 70% false positives (a pure rough assumption on my side) in a collective where checking those numbers will never be realistic, and the moment the parameters are ‘leaked’ the actual fraudulent people will change their settings making detection of Fraud less and less likely.

How will this fix anything other than the revenue need of those selling machine learning? So when we look back at the chapter of Modern Applications of Machine Learning we see “Deploying machine learning models in real-time opens up opportunities to tackle safety issues, security threats, and financial risk immediately. Making these decisions usually involves embedding trained machine learning models into a streaming engine“, that is actually true, yet when we also consider “review some of the key organizational, data, infrastructure, modelling, and operational and production challenges that organizations must address to successfully incorporate machine learning into their analytic strategy“, the element of data and data quality is overlooked on several levels, making the entire setting, especially in light of the piece by Jay Watts a very dangerous one. So the full title, which is intentionally did not use in the beginning ‘No wonder people on benefits live in fear. Supermarkets spy on them now‘, is set wholly on the known and almost guaranteed premise that data quality and knowing that the players in this field are slightly too happy to generalise and trivialise the issue of data quality. The moment that comes to light and the implementers are held accountable for data quality is when all those now hyping machine learning, will change their tune instantly and give us all kinds of ‘party line‘ issues that they are not responsible for. Issues that I personally expect they did not really highlight when they were all about selling that system.

Until data cleaning and data vetting gets a much higher position in the analyses ladder, we are confronted with aggregated, weighted and ‘expected likelihood‘ generalisations and those who are ‘flagged’ via such systems will live in constant fear that their shallow way of life stops because a too high paid analyst stuffed up a weighting factor, condemning a few thousand people set to be tagged for all kind of reasons, not merely because they could be optionally part of a 1% that the government is trying to clamp down on, or was that 24%? We can believe the BBC, but can we believe their sources?

And if there is even a partial doubt on the BBC data, how unreliable are the aggregated government numbers?

Did I oversimplify the issue a little?

 

 

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The truth that kills you

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

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

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

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

List of UK comparator countries in this report

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

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

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

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

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

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

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

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

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

How speculative can we get?

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

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

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

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

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

 

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Num, Num, Num

There is a large following that is very appreciative of Jamie Oliver. I was for a long time unsure about the man. I do not mean that in any negative way, I just didn’t know the guy. Literally, my only knowledge of him in the beginning was this ad (at https://www.youtube.com/watch?v=gPiNeIV_WY8). I thought it was funny, I was doing consultancy in the UK for a while and that is what I saw, I would remain unaware of his actions for a few more years until I saw one of his cooking shows. It looked nice, and tended to make me hungry watching it. So I reverted to my famous Bambiburger (whilst watching Bambi, because that’s how I roll) and switched to another movie afterwards. I had noticed a few of his cooking books and they looked OK, but beyond that I moved on, no negativity implied here.

My first real exposure to the man was when I was introduced to his McDonald crusade, or perhaps better stated the fast food crusade. A sample is shown in the Rubin Report (at https://www.youtube.com/watch?v=nSoJzuUgO6c, as well as CBS at https://www.youtube.com/watch?v=YC0jMeGTJmA), so when I was aware of just how bad it was I stopped going there, I haven’t set foot into Macca’s for a long time, I might get a lemonade on a hot Sunday morning, yet that is as much as I got. I stopped going to Macca’s. He showed a part I never stopped to ponder. He became a silent hero, like my University friend and fellow student Jerome Doraisamy, how started the Wellness Doctrines and showed to be a true visionary. With his second book The Wellness Doctrines for High School Students, he is showing the younger students the path that every young person should read. With “self-help guide for secondary students struggling with academic rigours, vocational concerns and teenage issues“, we see a path that allows those who had given up, that there is a path, there are options and they can make it, there can be success. As Jerome attends to the mind of the younger person, Jamie Oliver has the physical side in mind. In the Guardian we see the goods (at https://www.theguardian.com/lifeandstyle/2018/apr/29/jamie-oliver-criticism-affect-me-childhood-obesity), with “His transformation from cheeky-chappy Essex boy chef to single-issue crusader, facts and figures to hand, about to appear in front of a select committee, is complete. You would think he would have enough going on – he closed several of his restaurants recently and restructured his business“, in all this Jamie Oliver is focused on the issue of childhood obesity. Two silent hero’s making the world a better place, because if they can tend to the upcoming generation, we would as a humanity move forward too. Now even as we, at times might question “It is not only the food industry that Oliver has targeted. He also champions better nutritional training for GPs and other health professionals“, there is a spoken truth that we ignore, we seem to go to the GP for every useless flu shot, and really useful vaccines, but the setting is that the GP has a narrow focus, he needs to be, he might tell us to see a dietician, yet will we? I know that I eat reasonable healthy, less and less Bambiburgers (the price of venison is near murder nowadays), yet I have my decent mixes of greens, pasta’s (with fresh greens) and the optional spinach stew with beef, all easily made and full of the good stuff. This came with the revelation that even as I am still the size of Dwayne Johnson (yet not in the chest section), I eat a lot better for a long time now and I walk nearly everything I do every day. I also noticed that I eat a lot less, so there is that benefit too, but overall, I could still eat better and that is where Jamie Oliver is making the difference “Oliver seems to be coming at obesity principally as a diet problem, rather than a social one, although it may be too much to ask even someone as energetic and ambitious as him to fix society. Obesity disproportionately affects children in deprived areas“. You see, even when we accept that the lifestyle choices in places like London for some is massively limited, where most are still relying on their daily fish and chips, of if fish is too expensive friend spam, we need to acknowledge that the two people are working pre-emptively. If the children are heating healthier, it could reduce NHS needs by at least 10%, which is a massive saving, when we consider the counselling and other issues that some children face in the light of pressure the writings (the second book) of Jerome Doraisamy could also impact the NHS in a positive way, as well as avoid a whole range of other issues, so making sure that every secondary school in the UK (Australia and Canada too), has at least a few copies of this book (as well as some of the Jamie Oliver solutions), we could set the next generation much better equipped on a future path, one that is healthier and ever so likely pointing towards personal success. In that we have seen so little for such a long time that the visibility of these two crusaders (not caped ones, because I still claim the title of Batman), is becoming more and more essential. Yet Jamie does not proclaim to have all the answers and all the solutions, one would be very unfair to demand that. When we see “he does not entirely understand what it is like to live in relentless, grinding poverty: to be unable to afford fresh vegetables (healthy food is three times more expensive, per calorie, than unhealthy food – Oliver has suggested that the government should subsidise healthy food); to be too tired to cook from scratch every night; to take the financial risk on a lentil recipe that your kids may refuse to eat“, now we can go that children who are really hungry will eat nearly anything, is only partially true, the addictiveness to some foods (read: food groups), especially sugar loaded ones is too tempting as the short term sugar rush is there, so it is like getting them to fight a sugar addiction seems to be more and more prevalent. Yet as it is not a narcotic, the large brands can push sugar onto everyone until it quite literally kills them (usually via some form of diabetes). This gets us to the timeliness of it all. You see, when I was young (I know a really long time ago), diabetes was something almost unheard of. Now in the US, the CDC reported that 9.4% has some form of diabetes. That is up from 8.3% 5 years earlier, so the statistics are screaming danger. Yet we remains unable to act and the fact that Jamie Oliver is pushing for larger changes so that the UK (actually the whole world) improves the stats so that we can avoid a nasty and expensive trap is more than just good thinking, it is the stuff of well-deserved knighthoods. It is in that same range that we should see the efforts of Jerome Doraisamy. The body and the mind are two parts of us, needing equal attention and the fact that we get the next generation on top of it all is massively needed, because the mind can too often work out that the rope to hang yourself with versus the rope that will snap under the weight of the 17 year old as he/she weighs 17 stones takes a mere 25 neurons (speculative), me making fun of this is how it needs to be seen, but in a very deadly serious way. Some issues we can avoid, but if healthy food elevates your mood, makes you feel more energised, and thus empowers that person, making changes to your lifestyle on both the physical and mental front become increasingly important. Not because you are saving the NHS thousands of pounds, but because the next generation could suddenly end up having worked and lived for decades in a healthy and happy way only to receive a letter, to which that person asks “What on earth is the NHS?” They didn’t know, because they were never sick. That is what we hope we could strife for and these two crusaders are making it an optional future. So even when we see in the Guardian “he will be accused on Twitter of being the “fun police”; a column in the Sun will call it a nanny-state initiative that penalises poor people“, even as we see the taken step “It calls on the government to ban junk food advertising before 9pm and unhealthy buy-one-get-one-free offers, among other things. Oliver is proud of it. He looks relaxed, sitting on one of the sofas in his industrial, vintage-styled head office – although he knows the attacks will come“, we see that there is a lot to be done, but he has started the path, and even when we recognise that “addressed to the prime minister and signed by Jeremy Corbyn, Nicola Sturgeon and other party leaders” those undersigning is are not in government, yet when we look back to 2005, we see “In a response to the plea from TV chef Jamie Oliver for a ‘school dinner revolution’, the Prime Minister will say that school kitchens will be rebuilt and equipped so dishes can be cooked from scratch, while dinner ladies are given ‘culinary skills’ to help them create appetising menus“, it was a success as the Telegraph reported “A £280 million initiative to improve the nation’s school dinners was unveiled by Tony Blair yesterday following a campaign by Jamie Oliver, the celebrity chef. Mr Blair and Ruth Kelly, the Education Secretary, produced the money just as Oliver arrived at Downing Street with a 271,000-signature petition demanding better meals“, so what happened to that initiative, the fact that there is a second round, how much success did the £280 million get the UK schools, what was achieved and what was not is also equally a question. You see throwing money at a problem does not make it go away, it merely gets the front page for a week at the most, So when we look at briefing paper 3336, Obesity Statistics called SN03336, attached, we see that the increase from 53% to 61%, and from 15% to 26% is shown on page 3, yet it also shows that the curve on overweight or obese is also leveling from 2005 onward, so there is a shown success, what is less shown is the improvement rate among the young population, we see the statistics and total statistics, but as we cannot see if the those obese have become less obese cannot be determined in such an aggregated state.

Another path shown is that when we compare to the mindset in Japan, where only 4% has obesity, we see that studying the Japanese culture on healthy foods is becoming a lot more interesting. I did see an excellent video by Joanne Lumley on Japan, where we actually get to see two culinary sides, the first is that Japanese prison food is better looking and healthier than anything we can get in any fast food place, second was a visit to a primary school having lunch. They were eye openers, so there is still much to be learned for all the dietary players in the world. The one fact that we do clearly see is on page 12 with “obesity rates in the most deprived areas have risen by almost five percentage points but were unchanged in the least deprived areas“, we could go by the need of income, but more importantly we need to find other ways to solve the food system on a parental level, because giving in the screaming kids demanding sugar and chips will not work. Some might want to give in, but the price down the line will be extremely high. Some have no means to afford decent food and when we see that £36 a day is needed when you are on the basic standard, yet this includes rent, utilities, food and clothing. So when we consider that number, we get a lot less to live on, so when we consider rent increase, energy price hikes and other elements not much is left and that amount is actually decreasing. That is part of the ballgame and even as Jamie does not have all the answers, he is giving us a path to consider. If the school kitchens become better equipped and gives better food, the health risks will decrease as they decrease and the children’s physique improves through sports and actual activities (we don’t all like sports), we get to consider a lot more options and now we merely have the mental option remaining, but that is part of Jerome Doraisamy’s The Wellness Doctrines for High School Students, which is not part of this discussion today.

We can argue on how good or how bad Jamie Oliver is doing it, but the one part that no one can deny is that he is actually doing something and that he is at least on the right path and trying to work on the solutions that could work is why he is one of several silent heroes of choice. A crusader who is not playing Don Quixote, he is trying to do good, not chasing windmills. when I see the Guardian article, I see there is plenty of mentions of failure, his failures, yet in all that there was not one mention of greed, or of some basic exploitation setting, merely, as I personally saw it, he tried too much in too many directions and seemingly all at nearly the same time, I am partially amazed that he was able to avoid a heart attack and a stroke in the process. So when it comes to trusting the health of your children, would you listen to Jamie Oliver or to the Marketing CEO of a fast food chain? Now consider that one of the two will get your child killed 20 years earlier, now who do you trust? Are you scared yet, you actually should be!

That is becoming the ballgame, because when there is no NHS, which with the current crises is not merely a speculative possibility, how will you get treatment for your child when diabetes becomes a fact of life? Oh, and in addition, when you are still on that £36 a day (if you are that lucky), how will you afford the medication and other needs?

These few steps alone show that not only is Jamie Oliver on the right path, we need to think the long term impact that are limiting the options we remain to keep, because the list of those options are falling faster than you think. When we accept that in the most deprived areas where child obesity went from 27% at the age of 5 to 41% at the age of 10, when you consider that danger for a mere 2 generations, how will you see the economy where part of the labour is no longer being done because those jobs can no longer be done in 3 generations because the health of that workforce will not allow that to be done, so who will do those jobs? Perhaps the kids who are currently growing up in Beaconsfield, Buckinghamshire or Ascot, Berkshire? You have got to be joking!

We must accept that the previous labour did make steps and we need to see what was not done, why it was not done and what needs to be done, not just done as a mere ‘because we have to‘, but because we desperately need to move away from the downward spiral that too many nations are currently on in the first place.

 

 

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Vestal Virgins of Health

We tend to get nervous whenever Richard Branson gets mentioned. I am not sure why. You see (at https://www.theguardian.com/society/2017/dec/29/richard-branson-virgin-scoops-1bn-pounds-of-nhs-contracts), we see two parts. The first is “Richard Branson’s Virgin Care won a record £1bn of NHS contracts last year, as £3.1bn of health services were privatised“, the second is “Its growing role has prompted particular anger among anti-privatisation groups. It pays no tax in the UK and its ultimate parent company, Virgin Group Holdings Ltd, is based in the British Virgin Islands, a tax haven“, my two issues here are ‘So what?‘ and ‘What did you expect would happen?‘ You see, the solution I had in mind is still not in the roll out and as such Richard has a few issues to deal with soon enough, but the larger extent is not the solution to get it on the rails, it is that both sides of the political isle have been sitting on their hands for over two years and the previous labour administration wasted 11 billion with no results to show. I have shown over half a dozen times in the last year alone that actions were needed and Richard saw options to fulfil the need, so as we read: “Privateers continue to win huge new NHS contracts“, we need to realise that the NHS can no longer make it happen and that the health care costs in the UK will go up, all largely due to politicians not seeing eye to eye on the solutions needed.

So when we now look at the need for the people we see that not only is the interpretation of the mess wrong, the issues that we saw last February (at https://www.theguardian.com/commentisfree/2017/feb/28/labour-nhs-jeremy-corbyn-hospital-theresa-may) is still not improving. With “Labour’s failure to counter the right’s message has left more people blaming the NHS crisis on migrants and patients’ bad lifestyles than Tory underfunding or rising numbers of older people“, this too requires scrutiny, because the coffers are empty, all sides in the UK were impacted, so that includes the NHS. In addition, when we see “Whoever follows Corbyn will now find it ferociously hard to regain that lost NHS ground” we see that the message got lost in many ways, because it is about owning the issue and resolving it, not to win lost NHS grounds, because that is merely a conversation on things that are nice to have and the patients will still die as the ‘conversation‘ continues. It is largely too late for conversations, it is time for actual solutions. I am not of mind whether Virgin Care UK is the right step or not, but it is an ACTUAL step being made, which is every time better than merely talking to the press on how hard things are. The people in the UK have had a few years of that with no resolution into any real solution. So as the papers go on regarding the death of a bullied girl and eating disorder services, we seem to forget that the two extreme (yet not ignorable issues) are not the centre piece, it is brought as the outliers in the game that is actually larger and has a few other problems that are digging itself to the surface. So as we see the blame of neglect, we forget to ask the question in regard to “Becky Romero, 15, was let down by ‘gross NHS failures’ an inquest heard“, yet where were the parents? Where were HIS/HER responsibilities? And when we see “The troubled school girl was victim to more than a decade of bullying before her death earlier this year“, what EXACTLY did the school do in the end? It is not a secret that the service is massively underfunded, it is not an excuse, it does not clear the NHS of any blame, but it seems to me that the school had already massively failed this student, and where are they in the dock? Where are the parents in all this?

It seems to me that there is plenty of blame to go around and the NHS has been given the black card for a few times too many. If anything, we could state that Parliament itself might be seen as the guilty party as they had no funds available. The buck gets passed around and around and there has been way too much of that.

In my view it is time that the parents themselves are getting the responsibility to some degree. Now, this is not fair and there should be a better way, but should child care and child wellbeing not be with the parent? I know that there are exceptions, but it seems to me that there have been too many exceptions in too many places and ways and the NHS is no longer able to meet the challenges it faces. Changes will be needed in the immediate and even to the longer extent for now.

So is Virgin Care the solution?

As I stated before, there is no way to tell, but it is an active step in resolving issues, which is better than looking at it and whining about shortages to the media whilst no actual actions are taken, except for planning stages that cost thousands of pounds and merely result in a report. You see, it was only 2 weeks ago that we saw “One CCG – NHS Surrey Downs – accidentally disclosed in its October public finance papers that its liability over the case was £328,000“, in my view it was not an accident, or the mere fact that it might have been shows not merely a flaw, but a larger lack of competence in this regard. Like any firm it went to court after the firm was confronted with “a “serious flaws” in the way the contract was awarded“, yet the petition was all about Branson being rich and not bout the NHS chapters screwing up AGAIN, whilst also dragging its feet regarding confidential issues. So as we get misinformed on 2 million versus the Branson estimated wealth of 3.5 billion, whilst in the same setting forgets that the NHS bungled issues for a decade and as such they can no longer get things done and private options are all that remains, that is a business decision and as such, business decisions are a game that come with rules and regulations.

In all this there is a side that people seem to ignore. You see, if Virgin Care UK gets even as little as 10% of their contracts done, with passing grades, we see that a for profit organisation has been able to do what the NHS no longer could, showing that a harsh overhaul had been overdue for well over a decade. I showed part of that earlier this year in both ‘Choosing an inability‘ (at https://lawlordtobe.com/2017/02/09/choosing-an-inability/) and ‘Healthy or Smart?‘ (at https://lawlordtobe.com/2017/02/10/healthy-or-smart/), two moments where we see the usage of funds that are debatable. Now, whether it should have been done is not the question, what is shown is that the NHS is so short of cash whilst the privatised versions are optionally now making a profit. Considering that Richard Branson is in it for the cash (to some extent), showing that it can be done is merely meat for the grinder showing that the NHS has a few more logistical flaws than any of us are realising. As such there is a clear chance that we need to ask a multitude of serious questions at the address of the NHS and not at the setting of Branson incorporated, that is the evidence we might be harshly confronted with at the end of 2018.

The fact that the people at large are starting to realise that harsher acts are needed are an initial first in resolving the issue. The fact that the Daily Mail reported on Drunk Tanks, an issue I raised in 2014 shows the additional part that the actions by the NHS have been too lacks and too slow, it could be the evidence that drove Richard Branson in entering the UK care field more energetically over the last 5 years.

 

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