Tag Archives: NHS

As an election looms

Finally, we get some words on the Labour manifesto, the Guardian has been on top of it and whilst they are presenting a good part, I have a few issues as they went a little light on labour as I personally see it. Again, it is a personal side and as a conservative you should take into consideration that the flaw is on my side, and I would accept it, but let me give you the goods.

The entire review is at https://www.theguardian.com/politics/2017/may/16/labour-manifesto-analysis-key-points-pledges, so you have the option to completely disagree and seek your own version of their vision. The first part “a short note on a new £250bn “national transformation fund” implies that these costs will be funded through capital borrowing” shows their intent on rail, which is a quarter of a trillion through borrowing. So off the bat we are considering electing someone who wants to add a quarter of a trillion to a debt that went off the handles due to the Labour party in two previous administrations. How is that ever a good idea? a chunk of all the other parts is supposedly coming by adding a new tax group of 50% for those earning above £123K. A marginal addition for the ‘fat cat’ group. So those making more than that will be charged for the amount above and I have a hard time accepting and believing that this will get them the ‘speculated‘ £6.4 billion. It reads more like wishful thinking in an age where rationalism will not ever get you that amount. Consider, as mentioned before, something that any excel user can check with the numbers the UK tax office (HMRC) offers, the super wealthy, those making well over a million is limited to less than 5000 people. So how is this billion pound extra achieved? Let’s not forget they only get the 5% extra over the amount over £123K, as such the income will not get close, yet after the election they will come with excuses, whilst we already knew that this was never realistic. In addition, how many are close to the threshold? In this those making £123K – £199K, they might feel safer setting apart certain investment reserves into retirement, if they get that done, the £6.4B will drop fast by a lot. In addition, the Guardian gives us: “But recent evidence from the imposition of a 50p rate in 2010 shows that the measure could spark mass avoidance by the individuals affected and raise no extra funds for the exchequer“, so there is that part too! Remember Jeremy Corbyn and his nurses? The 10,000 nurses pledge? When we consider the already announced part “Health and social care reform at a cost of £7.7bn, as part of a package that includes a guarantee of A&E treatment within four hours and the end of the NHS pay cap“, and the “Free lunches for pupils as part of £6.3bn school package“, that’s another 14 billion, where is that coming from? Remember the tax increase part? When we tally, we see that the NHS part is already leaving the tax increase at minus a billion, all the other multi billion pound parts are not even close to being addressed. This is simple tally stuff that many in their final year in primary school can achieve from their calculus lessons and Jeremy Corbyn and his ‘raunchettes’ cannot deliver, a mere exercise in lewd offensive spending. Choices without proper merit and ignoring the consequences of the deep debt they got the UK in in the first place. I am all for some level of social levy, yet any social act requires to consider the impact, something that UK Labour is clearly not doing. It is even more upsetting that simple calculus gets us to a place where this would never have been a reality to begin with. Are you seriously considering voting for such a failed attempt?

When we consider the added Cyber security, and the promise to the security agencies, we see items that are promised without any claim to the cost. Now we might accept that part, yet their own £11.2 NHS IT fiasco should clearly show that they haven’t got a clue on how to tackle it because the limitations they imposed through failed IT is part of the reason that NHS IT is not up to date in the most meagre of ways which is also exactly part of the reason that the NHS hacks were successful in the first place. In addition the entire pension part is flawed, that is a given not because of what it states, but when you compare it against the Australian need to already up the retirement point to 67, with a population of 20 million, that is a retirement change already needed now, the fact that the age wave will hit with almost 4 times the intensity in the UK and the retirement age will not significantly up for another 6 years is delusional and as I see it set so that the current Labour electorate can ignore the issue until the next election, at that point it will be way too late and they will offer some diluted solutions using capital borrowing adding another . I see it as we now need an estimated £75bn a year, it is anticipated a near doubling before 2025. You see, some of the statistics have been placing comparison of life expectancy and percentage of retirement, yet as I see it, the quality of life for those born in the 30’s and those born in the 60’s is vastly different. the difference of those two groups is that maximum life is more likely to be in excess of 20 years, so those born in the 60’s and onward have a much higher chance of requiring a pension for close to 20 years longer, on a population of millions, that would equate to an additional pile of billions that would be required. In this the setbacks that the financial meltdowns gave all the people and government institutions, it shows that the shortage will increase and the pension deficit will increase annually by a lot over the next 5 years alone, so not seeing any repair actions is just weird. So as labour proclaims to be ‘social‘ their social unawareness and unpreparedness is just a little too upsetting. Now, the Tories are not innocent either. There is a given shortage and getting rid of the debt is a first step in solving it, so as we see that Labour is now willing to add close to half a trillion to the total shortage and that is just the added shortage of what they want to do to look cool. The added deficit will go straight through the roof adding overall a lot more debt than anyone is willing to consider.

And it is Labour of all others who have no welfare support. they promise a future policy paper, but the overall issue is not that paper (it will be though), it is “There are no spare funds in Labour’s calculations for extra welfare spending. To counteract the effects of planned cuts, under Labour’s current plans it would need to increase borrowing“, so that implies even more borrowing, whilst they amount needed is already through the roof. I did voice a change, I offered a view where there might be some additional ‘fat cat’ costs, even though that is not what I call it, it was a need to increase the second tax tier by 2% and the third one by 1%, whilst increasing the 0% tax group. so basically the lowest people get £100 a month more and the highest (45% tier) loses about £150 a month (as they also have the higher 0% part, they lose a little in the end), around £100 for tier 2 and £50 on the tier 3 part which I saw as a very social thing to do. And all that without burdening towards extra debt. I am not stating that the lowest group did not deserve more, I was working from a 0 balance difference for taxation, so that the coffer would not be denied more coins to address the massive debts it has now. It was a simple exercise in Excel and perhaps my method is flawed, my intention was pure, that is a lot more than I can state for the McDonnell-Corbyn group who will happily max out the UK credit card and leave others to solve the matter after they leave office, just like the two previous labour governments did.

Yet in all this it is not just the Labour party that needs a look, the Lib Dems are also due a little concern. In that I actually like the entire ‘rent to buy‘ pledge. I cannot say if it would work because the ground materials are not a given at present. What homes would be offered? Consider what the foundation is. New houses, would b great, but when we see where, there will be an optional issue. It is of course a way to get the younger generation out of London and perhaps towards other places where a younger population would be a good thing. However, would they embrace life in Essex, Suffolk, Norfolk, Lincolnshire or Kent? What happens when that is not an option, what if the social houses in London does not get resolved? Those elements make the Lib Dems an issue that might not come to pass, yet for every person accepting a place outside of the greater London area, the pressure will go down a little, enough little’s will make for a moment of relief, yet will it work, time will tell. In all this I personally found the second ‘referendum’ offensive. So, because people did not like the outcome, because some didn’t bother voting, the people in the UK get to vote again? I wonder how the Lib Dems will be seen when the EU gets the bill of what Wall Street does, when the UK gets the pounding because the US could not get their house in order, I wonder how those second referendum people will be seen. Even as the US is ‘suddenly’ doing great again, whilst their debt is increasing by trillions of dollars a year, as well as their inability of dealing with their deficit, how will that push others? The US now with almost 20 trillion in national debt, they stated the 1st half of 2016 a collected taxation of 1.48 trillion. now, if we do something not entirely valid, but what if we double it? (the second half is never as much as the first half, yet for argument sake), this now implies that the US would collect a maximum of $3 trillion for 2016, that whilst at present, federal spending is at almost $4 trillion and the deficit is now approaching $600 billion for this year. The deficit, no matter what they report is not getting properly addressed and has not been or over a decade. What do you think will happen when that well ends? Do you think that export to the US will continue? At that point, who would be the trade partner that remains? I do not proclaim to have then answer, yet when we see that at present US total Interest paid is set at $2.5 trillion, where do you think that goes? Who is paid interest on debts that seem to be mainly virtual? Do not think it is a simple picture, because this part is as complex as anything could ever get. Machiavelli could not design something this complex. Yet at the end of the day, the taxpayer is left with the invoice. As such lowering debt is the only safety net that would allow the people in general to have any life. I have always stated and truly believed that once it collapses, it will hit whomever is in debt. I still believe that Japan is the first domino to fall, yet that also means that the US dollar gets a hit that will be a terminal one and Wall Street will falter almost immediately after that, after which the Euro will go straight out of the window, its value less than the German Deutschmark in 1923. Japan has a debt that is close to 240% of GDP, a group of nations that includes the US, Japan, the UK and several other European nations have a budget deficit that is surpassing $9 trillion, how is that allowed to continue? This is not me, this comes from Martin Weiss, PhD. Although his PhD is in cultural anthropology from Columbia University, not in economics. Yet we can agree that at least he has a few degrees which includes degrees from Columbia and NYU, so he is not the most uneducated tool we know, unlike some in politics nowadays. The problem is not the total deficit or the total debt. It is the fact that some players like the Rothschild’s, Wall Street and even the IMF are wanting this game to continue. A push it forward game that benefits the political and financial engine operators and 0.1% of the population. Would it be fair to call this a legalised form of slavery? Is the one option allowed to have the same as a freedom of choice? That is what is more and more at stake. When the people in the UK were allowed this freedom, they chose Brexit, now we see all these players trying to undo that one part, because it is the fear of the players with too much to lose. We get more and more weighted information from the press and that engine is less and less reliable. So what remains? Well, the people in the UK are about to make their selection, whilst we see certain manifesto’s that are debatable to say the least. Some parts are just not realistic at all, yet the people must elect someone. I will not tell you who to vote for, I am merely wondering if the people will ever be properly informed.

This is mainly because there is an election looming and those not governing will make whatever promise they can just to get into office. So what will happen after that? Remember Emmanuel Macron? Making all those statements on how Europe must reform, or else there would be a referendum? Well, merely an hour ago we see: “Both pro-Europe leaders were keen to show solidarity concerning the Eurozone and have broken with previous statements by discussing potential changes to EU treaties. The move is seen by both nations as a way of healing ongoing EU upheaval, combating the rise of the far right and showing a united front in the wake of Brexit negotiations” healing whom? the ECB spending spree recipients? When we see “Visiting Berlin on Monday, Macron ‘did not push for major, ambitious reforms (of the EU) because he knows the chancellor cannot deliver until the elections in September’“, I merely see the fact that the French people have been lied to again, and those people voting have elected a new Wall Street tool (as I personally see it), and the fact that he was a former investment banker was pretty much a clear giveaway. I expect to see some kind of ‘compromise’ that gets no one anywhere any time soon around the end of August or early September, implying that the European gravy train will move along with full speed ahead for another 4-5 years. When you realise this, do you still think my Brexit support was weird? If someone had effectively muzzled Mario Draghi, that might have been a first piece of evidence that reform of the Eurozone would have been a far fetched optional reality, yet so far, that has not and is unlikely to happen.

 

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As the UK changes

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

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

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

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

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

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

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

 

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The light of exposure

In France everything is going topsy turvy, we see people who claim to have no gains in any of it make certain that anybody is elected, except for Marine Le Pen, even the current President of France is on that boat, which is interesting as he is at present regarded as the biggest political failure since WW2. I myself would like to remain neutral, which is almost not possible as out of nowhere a former investment banker is suddenly the favourite runner with no real main political experience. The political marketing department might like the fact that he will be the youngest French President, which makes almost as much sense as it would be for me to take over the clandestine department of the CIA, with all those Korean challenges? I’m game!

Yet as I see it, Emmanuel Macron made a large blunder on LinkedIn as he wanted France to head all kinds of environmental and climate research, which sounds nice as the population at large is all about climate, but he seems to forget that France has a 2.25 trillion Euro debt to deal with and the current French President is leaving France in a dire, weakened and unhealthy state. Something that can not now, and not ever be cured by throwing money in anything but a growing economy move. Even I could have done better than that. Both players for the hefty seat will need to consider that a true quality investigation in the French healthcare system will be next on the list. It is at present regarded as one of the best, yet by 2019 their numbers will drastically change as France has one contributing element. As the retirement age has shifted by 2 years, there will be a spike in both physical and mental health care that will at that moment spike to different levels. France has the benefit of seeing how wrong inaction has left the British NHS close to death, and this is whilst the retirement age was at present not affected, so in France a think-tank will need to convene on a structured overhaul that does not leave a non working system in hands of consultants for 11 billion and at that point be a non-working system. The British Labour party left them with this example. If met with the proper adjustment, Huawei Technologies and Google could have optional solutions in theory before the end of 2018 and implemented 2 years later. The question becomes who will be the player and how will it be implemented. Questions that require serious consideration and in my view the youthful investment banker might not have the solution, in equal measure I am not certain whether Marine Le Pen will fit that bill either. Yet what has been shown is that the current president has made little effort towards that growing dilemma.

So why is Macron the bad choice? I am not sure he is, but the issues we have seen with investment bankers do not make me confident. Even as we should agree that he married the love of his life even though she is a few decades older, which implies that he does not care about the opinion of others gives the vibes that he is made of stern stuff, something the French people desperately need after one tour of Francois ‘the paperback’ Hollande (as I personally see it). Yet, what wrong has Emmanuel Macron done? That is the issue, for the mere reason that there is nothing that shows he had done anything but bend the law without breaking it in the Nestle acquisition deal. So basically, this proclaimed Mozart of Finance is getting soiled in soot for the mere title of being a former investment banker. That is as far as I can take it with reliable information. The Rothschild bank empire keeps it laundry hidden and dry, neither the NSA or the CIA has anything on them (FBI has nothing either). Whatever others can find is either hear say of overextended triviality. Again, as I personally see it the entire board of commissioners of PwC will be in jail long before Rothschild bankers get into the dock in court. I am happy, but unlikely to be wrong here.

Yet these elements are not the only ones in play. During the next French administration banks are moving their interests and their work environment all over the globe, France will see its share of new challenges. As the UK is dealing with Brexit and their set of new challenges, France will also deal with other issues. Even as both are not looking towards the frontiers of what will be possible with 5G, we will see new views on security and cyber issues, not just in the WiMAX and 5G environment, there will be additional dangers and risks with the new IBM hype word! As blockchain is heralded as a new solution, there are inherent risks with a system that has these abilities. Not just in managing the data, the attached data goes much further, there is the risk that any system has more than a mere ‘massive disintermediation of the financial system’. There is the risk that a hiatus in ‘non-repudiation’ could leave a dangerous leap in the ‘who done it’ realm where nobody can be held to account. The fact that blockchain has no form of regulations whatsoever will give French banking laws additional headaches down the line. This is not just assumption (well, it is a little), the Washington Post was all about ‘Russian hackers‘ in French elections. That does not prove that it is not so, there is merely a lack of concrete data evidence and the quote “the front-runner in France’s presidential race carried digital “fingerprints” similar to the suspected Russian hacking of the Democratic National Committee and others in the 2016 U.S. election” give food for thought. As present the cyber units cannot even get on par with the criminals, as blockchain evolves in all kinds of ‘personal’ dialects in every nation, we will witness a new level of data adjustment. This does not mean that blackchains are evil or that they are instigate criminal activities, the timing that blockchains bring just as the data traffic from 5G could sent a 500% data traffic spike from 2020 onwards through the global online cloud community leaves us with a boatload of issues and in that, France will have its share of issues to deal with, so as there might be opportunity, there is a more than equal risk of harmful dangers. Europe at large is not ready and in a lack of checks and balances, the dangers of another 2004 and 2008 investment collapse is not out of the question, especially as the laws are still not ready to deal with the recurring danger of a 2008 finance event. In this France is in too weak a condition (as is the UK by the way). So consider that if we relate this to the Bitcoin, its volatility is in its foundation the same volatility that blockchain could face, with a truckload of return on investment risks. In this we might consider that Macron is the better candidate, but I am not convinced, in this both are not great options, yet still better than the others. It almost a Churchill moment “Democracy is the worst form of government, except for all those other forms that have been tried“, we could replace the word Democracy with either ‘Blockchain’ ‘Emmanuel Macron’ and ‘Marine Le Pen’. Although in the first example, we would need to exchange ‘government’ with ‘data system’ as well. In this day and age governments can no longer keep up and until the spirit of the law gets clearly enforced the population of any nation is in trouble. In this danger is too harsh a word but there is a risk and the press at large has proven to be little or no help (apart from some actual newspapers, who are some help).

As France goes to vote there is little that I can offer to the voters, only that they need to know who and what they are voting for. They need to realise that their immediate choice is for themselves and their family. For some it is one candidate for others there is the other candidate. With France having an explosive growth in poverty, the social element seems the most pressing one, but its solution is in other elements not in solving poverty but in growing a dire economy, a dire situation grown by what I regard to be outsourcing and the bottom Euro of getting things done cheaply. It is that proper reform that herald change and options, which puts the initial premise in the hands of Marine Le Pen, yet no matter how her national pride is set, if she cannot build solutions she would be a one term president too. For Macron it seems simple in the way he talks and he talks like a salesperson, but in this he needs an engine to deliver on his promises, this is something he cannot walk away from, whether he realises it to the degree is not certain, his LinkedIn message made that clear.

So no matter where the exposure ends, there are dangers that all nations of Europe will face, the sudden ‘relaxed’ shift from Mario Draghi is making that clear (Source: Financial Times). I think that this temporary ease of situation is merely to ‘atone’ for French voters, I think that the message is a dangerous one. Several sources are talking on the dangers of joint bonds an in addition the fat that Reuters views that Mario Draghi could lose credibility is not a fab, it is a realistic danger which people seem to be dimming to low until after the French elections. This as I see it implies that there is heavy weather ahead. This is strictly my personal view, yet in that regard I have been correct a few times too many. See my other blog articles to compare on that regard. In this there is partial data, there is the claim that the IMF has dropped the pledge to resist all forms of protectionism. For me the issue whether they dropped it, or merely did not make mention of it. The result is very different and in this it is not just about clarity, it is about changing channels of commerce. It is more than a mere view of ‘good business is where you find it’ versus ‘we all should be allowed to do business’, which is the more direct issue that will impact France too. Even as I have an issue with the President Trump’s tax breaks, there is one sight that is adamant. The economies are now no longer in the hands of the fat cats of Wal-Mart and corporations alike, it is in the hands of small businesses and families in stores. They will reduce tensions on infrastructure pressures and make combined ripples in a starting wave of commerce. France is one of the more likely places to get that going, much more so that the UK at present. In this France’s biggest enemy is the French language.

When it overcomes that barrier, it could start a wave of trendsetting businesses from local to global, how it is done remains open to the people deciding walking that path, it will be a personal choice for all who endeavour that step, but they can get there, they just need the proper exposure and support.

 

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The spotlight on ‘exploiters’

The Mobile World Congress finished on March 2nd. These places are always a little weird. It is often about concepts and about desires, but for the most we see some new stuff and some that was released in the last few months. It is loaded with exhibitors, the list is 72 pages, so you better believe that there is close to no way to see it all. If you are in apps, smart cards, tags or smartphones, you are either there or you do not count. Now, that is not really a true given, if you are really small, or truly enormous you might want to give it a pass. Apple can because they have nothing to add (at present), but at that point they give ground to Google (Google Pixel) and Huawei (Mate9). It is a choice and as being in the place is plenty super expensive, so whatever you bring, better be an important game changer, because the large players can drown you out.

So as the Guardian (at https://www.theguardian.com/technology/2017/mar/11/is-5g-the-future-robots-delivering-pizza-house-viewing-vr) gave us ‘Robots delivering pizza and house viewing by VR: is 5G really the future?‘ last Saturday, the question became, what is this really about?

However, 5G, which is set to be rolled out in the UK next decade, also has its critics. They argue consumers don’t need the superfast speeds the upgrade from current 4G technology promises, and many in the industry believe that logistical issues mean that 5G may not be properly rolled out in the UK for decades“, this is an interesting statement, because I heard a similar thing when 3G was to be replaced by 4G. Some claimed it was not needed, mainly those having the 3G equipment and not the funds to go to 4G. So I saw this as a repetition of that. An opinion piece in the Computer World 2 years ago gave us ‘Tony Milbourn, vice president of strategy at u-blox‘ who questioned it, as did the Cambridge Wireless Network. We can question party one (as well as party two), yet we must admit that Cambridge Wireless is at least a techno savvy industry group. So dismissing them out of hand is not the wisest of choices.

To me, the 5G jump is essential. It is not just about speed. I see that 5G can be the cornerstone to fix some of the NHS UK issues. From there it can be an optional solution to a host of International Health Systems. 5G brings a lot more than just speed, it brings optional innovations that some are unwilling to consider (Larry Page can buy the solution for 15 million pounds up front price is post taxation).

As many sources in short minded ways hide behind “When the 5G wireless standard hits the mainstream, our home internet speeds have the potential to be so fast that we’ll be downloading 4K movies, games, software, and any other large form of content at a fraction of the time we’re used to“, the truth goes a hell of a lot further. 5G can be the cornerstone of non-repudiation, which has been a mobile flaw for the longest of times. In addition, the new connecting devices can change in many ways facilitate interlocked solutions as well as managing a host of non-considered options for systems already rolled out.

In addition, 5G could initially allow for a much better solution towards scaling the performance of short TCP connections on multicore systems. Which will also evolve the smartphone in several new directions. In addition, the Tablet would grow into a new level interactive system, I reckon that Google would need to evolve Android into something like Cyborg, which basically is Android plus, the plus is for the libraries and functionality that would slow down the average phone by way too much, but under 5G, the upgraded system would allow for authentication and new ways of privacy driven encryption that 4G cannot allow for, mainly because it is just too impractical.

The Guardian article also correctly identifies: “The mass connectivity it allows will also help expand the so-called internet of things (IoT), in which everyday appliances and devices wirelessly connect to the internet and each other. “IoT technology is being used in everything from smart homes to wearables,” says Ofcom. “5G should help the evolution of IoT“, which clearly shows that those against ‘advancing’ are either not in this field, or merely unaware of what they are missing (that is some of the critics, not all of them). The one prediction I do not completely agree with is “Analysts Gartner estimate that by 2020 there will be 20 billion IoT-connected devices“, if the 5G preparation goes correctly, there are opportunities to get that to 25 million devices easily, I reckon that 30 million is possible, but only if all elements work favourably to all and that is just not entirely realistic. The next part is one of caution, because blindly going for something is just not cricket. “The report by Lord Adonis, who heads the National Infrastructure Commission, found that the UK’s 4G network ranked only 54th in terms of coverage, behind countries such as Albania, Panama and Peru“, now we can argue that two of the places are merely two villages, a cafe and a cemetery is not entirely accurate. Yet, the idea comes across. Panama has over 50% of its population in the capital, so that is not a fair comparison, yet there are plenty of players (read: Scandinavian nations), who are doing plenty better, we know that it is a small population 3 times the size of panama, but stretched over a massive amount of miles, so things are not entirely great for the UK. Improvements are essential and perhaps considering 5G as the main drive to get to a much higher coverage rating might not be the worst idea.

In light of some responses we also need to look at “Professor William Webb, an academic and former Ofcom director, has been outspoken in warning that 5G could be a case of the “emperor and his supposed new clothes”. Webb is not convinced that the industry obsession with faster speeds is matched by consumer demand“. In this that the professor might talk a decent pitch, but the issue as stated before is not just about speed. 5G will allow for avenues that are currently under 4G not practical, which is partially about speed, but also partially about the options to connectivity currently not possible. Yet in the next part we see the exploitation part “mobile operators may be in danger of investing billions in 5G networks that they may struggle to recoup their costs from. Telecoms companies forked out £2.3bn in Ofcom’s auction of 4G spectrum just a few years ago in 2013“. So as we see the £2.3bn auction, we see that Orange (at https://www.orange.com/en/Press-Room/press-releases-2017/press-releases-2016/2015-full-year-results) gives us “Restated EBITDA was 12.426 billion euros in 2015, ahead of the 2015 target“, so basically in one year they got 12 billion Euros (approx. £10.778 billion in 2015). So I reckon that the 2.3 billion on all players was not that much of an issue to begin with and this is just ONE player and not even the biggest one, so as such (even as we understand that there are always more cost), Professor William Webb should reconsider his position before we put a massive spreadsheet showing just how much the mobile providers are driving you for. You will not be happy or impressed to realise what better a deal you could have gotten whilst they would still end up with a massive profit.

Now there is a lot more going on and this path will not be a smooth sailing one, yet when we realise that 5G will offer support and solutions in directions that some seem to be craving, the news (at https://www.digitalhealth.net/2017/03/nhs-england-working-with-us-internet-giants-to-promote-digital-tools/), give us more shallow parts. It seems that everyone wants to drive some digital solution, that is tool based and has heavy dangers when it comes to cyber security. That was clearly shown by the Financial Times on February 3rd (at https://www.ft.com/content/b9abf11e-e945-11e6-967b-c88452263daf). So as there is too much fidgeting and some giving in to these criminals instead of hunting them down and injecting their children with Ebola (just to give clear indication that health care data is essential and should not be messed with, EVER). The fact is shown that cybercrimes is still too open a field, with many criminals not ending up getting prosecuted and/or incarcerated gives view to the essential need to change thinking and not like a collection of Emu’s run to what seems to be the next (easy) solution in postponing the essential changes the NHS and healthcare in general needs. The Financial Times has actually one additional gem. The quote “According to data from Intel Security, ransomware is growing at an alarming rate across all industries: total ransomware incidents grew by 128 per cent in the 12 months to September 2016“, gives a much needed light on the dangers that “NHS England is working with Google and Bing to increase the visibility of NHS content online and the forthcoming NHS app store” is bringing the people and the next release of ransomware. There is currently too much dangers and the 5G gives a first optional approach to non-repudiation as well as the option to block several similar dangers to health care data. I feel rather confident that Juliet Bauer, director of digital experience at NHS England could end up having to send out all kinds of statements on unauthorised accessed data. I hope to be wrong, yet the statements in the Financial Times, gives us that Jason Allaway, vice-president of UK & Ireland from cyber security firm RES. In that light, Juliet Bauer has every reason to become massively cautious. Any MP that is pushing for some Mobile app solution could find themselves into the limelight explaining how they could have pushed for such a change endangering the lives of many. It could also immediately spark a by election replacing that person pushing for cyber changes whilst the NHS and many health care trusts and providers are nowhere near ready at present. To give but the shortest of lists, you need to consider Healthcare.GOV, Pathology servers (blood tests), Radiological Patient data and images, Ultrasounds imaging systems, Magnetic resonance imaging data, images and reports and the list goes on (each category with a long list of providers). In all this there is still the GP, the specialist and the NHS staff to consider, so in the end, the digital paths some are taking are limited, inferior and no release of pressures to the NHS, so where is the benefit? I went over all that before I made certain designs. There needs to be a massive shift and the first time around the politicians had this utterly disgustingly dangerous idea that it was a great idea to put it in one place. I reckon that there is enough data to not ever consider that. The solution is on the other side of the spectrum, yet there needs to be a shift on the other side of the players too. There needs to be Common Cyber Sense and there needs to be accountability which non repudiation is a first step in, because there will be no more, my ‘device’ was on the fritz. Now there will be a clear digital path, which in health care is essential before considering the digital path in the more serious sides of healthcare.

 

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Healthy or Smart?

Earlier (16.4 hours ago roughly) I talked about the NHS, more important about an article in the Guardian about the NHS. An article that I considered to be a sales pitch, and not a very good one. Today I am taking a look at the ‘Smarter Health: boosting analytical capacity at NHS‘ pdf. First we need to take a look at the players, you see when we read a story we need to know what the story is about, the first step here is to take a look at who is telling us the story, because that matters, especially in the world we see today. The front page gives us the people involved:

Beth Simone Noveck – a Professor at NYU, director and co-founder.
Stefaan Verhulst – Chief Research and Development Officer of the Governance Laboratory at New York University.
Andrew Young – Associate Director of Research at The GovLab, and in addition, he is NOT the Managing Director of APY Consulting Ltd, who has the same name, but looks a few decades older.
Maria Hermosilla and Anirudh Dinesh are also directly linked to Govlab and it is Juliet McMurren who is a bit of a mystery. Perhaps she is merely a minion in that digital publishing machine, but her name pops up in a few papers, but only at the introduction, perhaps she is the one putting the reports together.

You see, if the story is everything, we need to see the storytellers in their environment, because they are setting the stage on how we should see the information given to us. This is given to us from the very beginning as the headline in the executive summary tells us: “It would be impractical and prohibitively expensive to fulfill all of NHS’s analytical needs through more hiring“, which is exactly what I raised yesterday, in addition, I did mention that part as well, just the pathway that follows is not the pathway I trust. I believe that some skills should be managed inside the NHS. I do not trust the outsider telling me how it is, especially after consultants walked off with a large slice of £11.2 billion whilst the NHS has nothing to show for it. In addition, having outsiders access to NHS data is even scarier to me than losing those billions. You see, once the data is out there, the people whose data is out there get to be the victims of dangers they never signed up for. As I see it, once copied the NHS becomes useless to them and whomever walks away with that ends up diminishing the value of the NHS and those people even more. That is in my view a big no-no! (I am not accusing Govlab of having done anything immoral or questionable), I am merely raising the issue.

I notice that part of the paper is what we read yesterday in the Guardian. It makes it easier for me as I had already crossed off several issues on my list and I stand by these elements. Yet, the report is not all bad, it is illustrative in parts, but also suggestive and that lack of clarity is never part of a good paper.  The reader tends to go from assumptions and that goes to either too positive or too negative, there is never ever a balanced in-between there.

When they give us: “The NHS should also create a variety of online knowledge networks of those inside and outside of NHS, especially in UK universities, who possess the skills and willingness to help the NHS with their data analytical questions. For example, last week the Rockefeller Foundation launched the Zilient platform to connect resilience practitioners, and the GovLab and Justice Management Institute launched DataJustice. Both are designed to connect networks of professionals for mutual learning“, which could be novel, were it not that I actually gave a similar (less eloquent) idea on June 29th 2014 in my article ‘What’s in a health system?‘ (at https://lawlordtobe.com/2014/06/29/whats-in-a-health-system/), where I state: “What if we take the next generation in solutions and take away 30% of that workload? When people ask which company will do this, the answer should be ‘None!’. The UK is filled with universities, some of them regarded as the most prestigious and brightest on the planet. Consider that most IT people, might claim experience, yet their drama skills are the only ones that improved for the most, is it not up to the Universities, those who are introduced to the newest ideas, design a solution that would make the work of the doctors and nurses at the NHS better, slightly more efficient and a truckload of less hassle! Is that such a tall order? We will get to the solutions if we are willing to navigate other options. We have seen that the current path is not a success; new methods might not be a failure. It is a road that politicians should be willing to go, if only to make sure that a possible solution was not overlooked“, I admit, not as eloquent, but pretty much the same story and it came whilst the NHS was 2.5 years further away from the ‘Abyss of non-existence’ it finds itself in front of at present.

So let’s take a look at the recommendations, and the first one gives us: “The NHS should build a Project Marketplace like the environmental protection agency’s one EPA Skills Marketplace and help supply find the demand“, so how do these outside talents not cost the NHS? Even as it hides behind ‘help with specific assignments, the skills marketplace helps to match talent to those opportunities to use it‘, you see, the more specific a need is, the more expensive such an expertise tends to get. The more generic and shallow, the less need for such a marketplace, more important, as a little more is asked on what needs to be done, the costs of these people will rise substantially and it tends to rise fast.

The second recommendation gives us “The NHS should construct an NHS Data Lab modelled on the Ministry of Justice Data Lab to make better use of sensitive administrative data“, which also sounds nice, but data labs cost, there is hardware, there is software and hiding it all in some cloud with questionable security will not be a solution, in addition, IT gets stretched even further and there is a difference between ‘better use of sensitive administrative data‘ and ‘safe and responsible use of sensitive administrative data‘, they are not the same, not by a long shot. In addition, I already made that point effective enough in the previous blog. The third one counts “The NHS should build an employee expert network like health and human services’ HHS Profiles and help the demand find the supply across the NHS“, which is what I partially raised when I opted for ‘low level‘ people in my previous blog. Yet this issue is correctly raised and if recommendation is started on yesterday by the NHS HR, than that would be an excellent idea as well. Adding a training path where some can learn skills like Q-Software, data cleaning skills and data capture skills, that might not be the worst idea either as it allows for an IT growth path. There are plenty of NHS volunteers, who are now retired, but still desire to be engaged, not everyone is doing that holding a set of people skills, some are happy to do other tasks. In addition there is the Employer-supported volunteering path, where Market Research and Data employees could spend a few hours a week working on the NHS systems, helping and teaching to create dashboards. In that HQIP Director Dr Danny Keenan might hold his hand up as high as possible to get started on the communication issues he currently states to have. Recommendations 4, 5 and 6 are basically skill finders in another dimension, so having that crossed off with HR to set a proper visibility path should solve all these issues. Option 7 gets us “bring in more talent from outside, including from the private sector“, which is a cost and not a small one either, that is depending on the needs there are. Recommendation 8 is the one that stopped me. You see ‘Open Data Learning Hub‘ I almost like I mentioned earlier, but here we see ‘data scientists to grow its data science community‘ with the added quote “Each toolkit includes the original data and step-by-step instructions for using the data to conduct sample analyses, create visualisations from the data and connect interested data scientists“, which makes me wonder, have they considered that the cost here will increase dramatically fast? In addition, how many data scientists are there now? If there are a few, why a training growth path was not initialised a few weeks after the first data scientist was hired. Because from some of the required trivial reports, those people are really expensive to use for making the ‘basic’ reports. Now, there is a part that I am not aware of, but recommendation 8 is leaving me with questions. If there are proper data scientists, why was growth not acted on long ago, if there are no Data scientists, that open learning hub will attract experts stating that ‘it is a complex issue‘ on too many projects, making this a marketing jump to hiring people, which is not the path we want to go through. Recommendation is just dangerous. As I stated, I have no faith in certain groups and ‘exchange data to help solve public problems. These collaborations focus both on sharing data but also on sharing talent‘, yet when certain ‘assisting‘ experts in the insurance world have been accessing the data sets, once they have the aggregated data they need, they will fall from vision like snowflakes in a summer sunshine, this recommendation is one that should be rejected as soon as the rejecter has read the words. It reads like Recommendation 10 is a potpourri of some of the previous recommendations, yet again we see “a “conversational” infrastructure to a secure physical infrastructure for managing data to tap the best know-how outside NHS on an ongoing basis“, which is pretty much an introduction towards hiring external consultants, which was a bad idea from the very beginning. The entire papers is followed by a score of issues, some I blew away in the previous blog article, some are there to (as I personally see it) illustrate fortune cookie wisdom, which is always debatable and will always be used out of context. An examples is: ‘We are achieving 1% of the potential to improve people’s lives‘. When we see ‘Healthcare data in England is collected, published and used by a variety of institutions, each of which has its own cadre of statisticians, analysts, and economists‘, there is the implied part, but the actual scope who is collecting what and who is collecting it for private organisations and insurances is equally left out there. As we see the groups we also see quotes like “Among its staff are approximately 150 people who hold the title of analyst for NHS England, including those in an operational research and evaluation unit created in 2014. NHS England publishes indicators on performance and satisfaction data about patient experience, bed availability, and wait times, and administers friends and family satisfaction testing“, yet when we see the group ‘Clinical Commissioning Groups‘, we get to see “We know there is lots of information on quality out there but don’t know if all NHS staff, such as clinicians, commissioners and service managers, are equipped to access and analyse it for both operational and improvement purposes, nor do we know if it meets people’s requirements, says one of NHS England’s clinical leads“, which beckons the question, did this clinical lead not know who to ask, what to ask and when to expect an answer? This reads like a ‘let’s set the premise of ignorance‘, whilst the systems in place would (read: should) have been there to inform the participants. This is not a paper on informing, this reads like a paper on creating doubt, preferably a paper pushing towards the recommendations regarding hiring and sharing, which is I admit is a speculation form my side. Yet it is strengthened when we read the premise with NHS Digital, where the language is phrased as “NHS Digital has a statutory monopoly over the collection of certain kinds of data, and over 300 professionals work on the collection and analysis” as well as “Of this group, approximately 250 are classified as analysts, whose work is focused on this routine and statutorily-mandated data collection and the publication of statistical reports“, whilst we get the implied accusation of “NHS Digital has not made much use of predictive modelling to evaluate innovations, conduct experiments or design new models of clinical care“. It seems that at New York University, the weight of a loss of £11.2 billion has no weight at all. That from a nation that has accumulated a debt of $20 trillion, should they be regarded as the experts? So when we read “no mandate—to translate that into policy recommendations nor to do research, according to Dr John Varlow, Director of Information Analysis at NHS Digital. In total, the organisation has 2000 professional staff, most of whom focus on information technology and the maintenance of NHS websites“, I need to wonder if that was the full part of the contribution of Dr John Varlow. Especially when we consider the work that maintenance of NHS websites requires. How many pages, what hardware infrastructure, more important, what other tasks are part of their workflow. An issue (as I personally see it) intentionally set outside of proper dimensionality. So when we consider the ‘produces over 250 annual official publications on topics from GP earnings to drug use among school children. These reports are accompanied by data in formatted Excel spreadsheets and machine-readable comma separated variable (csv) text files. Anonymised population-level data is available both on the NHS Digital website and on data.gov.uk‘. The reader should realise that this adds up to a little over 20 reports a month, that needs exporting, cleaning (personal data markers) set into final data forms and uploaded to the proper places. It should come down to one person does this full time, but the reality is that 1-2 other employees need to check this, to make sure identity sensitive data is not there.  In addition we need to consider ‘NHS Digital publishes over a thousand indicators‘, which we can accept as a given, but based on whose recommendations? When is the policy to publish set through political means and requirements?

This gets me to the subtitle ‘The current emphasis on performance analytics needs to expand to predictive analytics, simulation and modelling‘, on what premise and whose budget? Whenever we see a statistician running around with a massive erection shouting  ‘predictive analytics‘ and ‘modelling‘ it is usually because the linked implication that this additional work usually comes with a not to modest pay rise. When ‘simulation‘ is thrown into the mix, it tends to link to either resource needs, budgeting or failure analyses, which now implies that hiring becomes almost essential as these people were either hired from the start, or the skill set was not deemed essential, so raising it here raises a lot more than the reader will fathom. So when the writers decide to add Tim Kelsey on page 37, they should have considered the Guardian (at https://www.theguardian.com/society/2015/sep/17/cameron-adviser-leaves-controversial-nhs-data-scheme-private-sector), where we see: “Kelsey was appointed to the Cabinet Office in 2012 as the UK’s first transparency and open data director. However a few months later he joined the NHS, where he was the driving force behind care.data. The programme was supposed to be in place in 8,000 GP practices by 2014 but has been beset by controversies since its launch last year. It was finally put on hold after a series of blunders exposed serious problems relating to the confidentiality of patient information“, there we got the issues that the Guardian headlined with ‘NHS patient data to be made available for sale to drug and insurance firms‘ and ‘Privacy experts warn there will be no way for public to work out who has their medical records or how they are using it‘, which is actually an issue I raised more than once. So is Professor Noveck soliciting for data? Because there have been more than one marker in that paper to see as a consequence and the US in general is still massively horny for the UK NHS data sets. The report goes on for a total of 82 pages. In total it is actually a good sales pitch, but with my utterly paranoid mindset of once that data is no longer just with the NHS, the people relying on it will prefer to be dead than have to live through the aggravation that insurance companies will push them through. The page 78 mention of “the NHS could use this Brain Trust to expand its expertise outside its institutional borders. A pilot deployment would make it possible to determine empirically whether technology can bring expertise in from the outside efficiently” continues that path, because Brain Trust and expertise requires data access to set into a result. In addition ‘pilot deployment would make it possible to determine‘ tends to come with data attached, or accessible. I am not convinced that juice will be worth the squeeze and until the ghosts of data loss are set to rest (which is unlikely to ever happen), the entire sales pitch, no matter how good cloaked in 78 pages is one that the NHS needs to walk away from really fast. The PDF is at http://www.thegovlab.org/static/files/publications/nhs-health.pdf, so I will let you all decide how paranoid I am. The fact that the NHS did this with NYU and no critical report from, for example the University of Cambridge or the University of Westminster is actually an issue that a few others should make (just two of a collection of worthy investigative parties).

So is this ‘Smarter Health’ report healthy or smart? At present I fear it is neither!

 

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Choosing an inability

This all started last night when a link flashed before my eyes. It had the magical word ‘NHS’ in there and that word works on me like a red cloth on a bull. I believe that there is a lot wrong there and even more needs fixing, it needs to be done. There is no disagreement from anyone. The way to do it that is where the shoes start feeling tight. There are so many sides to fix, the side to start with is not always a given. There will be agreement and disagreement, yet overall most paths when leading to improvement should be fine. There is however one almighty agreement. You see the data analyses side of health care is not that high on the list. Most would agree that knowing certain stuff is nice, but when you have a primary shortage (nurses and doctors) the analyst does not rank that high on the equation. Although I am an analyst myself, I agree to that assessment of the NHS, my need is a lot lower than getting an extra nurse (at present). So when I see ‘Another NHS crisis looms – an inability to analyse data‘ (at https://www.theguardian.com/science/political-science/2017/feb/08/another-nhs-crisis-looms-an-inability-to-analyse-data), I start wondering what actually is going on. The first issue that rises is the author. Beth Simone Noveck is as the Guardian states “the former United States Deputy Chief Technology Officer and Director, White House Open Government Initiative. A professor at New York University“, you see, it is a given that Yanks always have an agenda. Is this about her book ‘Smart Citizens, Smarter State: The Technologies of Expertise and the Future of Governing‘? Just asking, because the by-line there is: “New tools—what Beth Simone Noveck calls technologies of expertise—are making it possible to match citizen expertise to the demand for it in government. She offers a vision of participatory democracy rooted not in voting or crowdsourcing but in people’s knowledge and know-how“, which seems to match the article. So, is this her sales pitch? You see, she must have missed the memo where the previous labour government wasted £11.2 billion on something that never worked and now as the NHS has plenty of crises moments, spending it on something that limits the growth towards nurses and doctors is a really bad idea.

Then she sets the focus on the HQIP with: “The Healthcare Quality Improvement Partnership (HQIP) conducts forty annual audits comparing hospital and physician outcomes, and the implementation of National Institute of Clinical Excellence standards across England and Wales. But, as HQIP Director Dr Danny Keenan admits, although they have the expertise to do the analysis, “we are woefully inadequate at translating such analysis into improvements. What’s the takeaway for the hospital or community provider Board or the medical director? They cannot understand what they have to do.”“, from that I get that the existence of the HQIP is under discussion because they cannot communicate. This we see in: ‘They cannot understand what they have to do‘, which means that the hospital or community provider Boards or the medical directors are either incompetent or there is a communication issue. I am willing to ‘auto-set’ to: ‘the inability to communicate’. I admit that I would have to read those reports to get a better view, but it is clear that the HQIP has a few cogs missing, which is on them and not on the NHS as such. So if the NHS needs to cut further, that’s where the cutting can start.

Am I against the HQIP? No, of course not, but the NHS has actual problems and putting more resources in communication gaps when a place is running low on gauss and staff the priority seems to be pretty clear. I also accept that if this path is taken that restoration of the NHS will take longer, I get that, but I hope you can agree with me that once the ability to properly aid patients is restored, we can look at the next stage of fixing the NHS, because aiding patients’ needs to be the primary concern for all sides of the NHS.

A second element in the given sales pitch comes from Dr Geraldine Strathdee, where we see “National Mental Health Intelligence Network, together with partners, launched the Fingertips Mental Health data dashboard of common mental health conditions in every locality. Strathdee points out there is a tremendous need for such benchmarking data: to design services based on local need, build community assets, and improve NHS services“, I have stated at a few conferences (mid 90’s) that there is an inherent need to document and create clear paths of internal knowledge retention, which included healthcare, education and government departments. I literally stated “as you grow the knowhow with your own staff members, you will increase their value, they will be better motivated and you create a moment when you become less and less reliant on outside sources, which usually cost a fair amount“, I have been proven correct in more than one way and the lack from some people who saw the gravy train benefit by being aligned with consultants is now at an end and those people tend to not have any allegiance, other than the need to grow their bank account. Creating internal knowledge points has always been a primary need and as this opportunity was wasted, we now see the plea ‘a tremendous need for such benchmarking data‘. They should have listened to some of their IT people a long time ago. The second opposition is seen in “Without it, NHS resourcing is just based on historical allocations, guesswork or the “loudest voice”“. This implies that there has been no proper data collection and reporting for well over 5 years, whilst 10 year gap would sound a little more correct (an assumption from my side). When you look at the Netherlands, there is a long list of reports that psychiatrists and psycho analysts need to adhere to and deliver towards those paying for the services. That has been the case for the longest time. What happens afterwards? Are they not properly collated and reported? In the Netherlands it was and I think it still is (a fact, not verified at present). Yet what happens in the UK? The yank might not know, but I reckon that if the MP’s ask these questions from Dr Geraldine Strathdee that we will get proper responses on what is done now, how it is recorded, reported on and considered for continued improvement. If all of that is absent, who should we talk to? Who needs to give an accountable response?

At that point the doctor becomes a little confusing to me; perhaps that is just me, because when I read “The data dictates investment in early intervention psychosis teams, which dramatically improves outcomes. Fifty per cent of patients get back to education, training or employment. However, there is a shortage of people able to draw these insights“, I just wonder what is set in reports. It is confusing because psychosis is only one of many mental health issues that are in play. When someone gets diagnosed as such a treatment plan comes into focus and as such data had no impact. The patient is either correctly treated or the patient is not. Data had no influence there, it is the carer’s report that is submitted and for that this person will either get the resources needed, or not. Data will not influence this. A report on how many are treated with psychosis is required, but as the reports are handed upwards, those numbers would be known and as such the required needs in medications, staff, treatment plans and of course the required funds to pay for all this would be known. If not, the question becomes: is Professor Noveck there to aid in obscuring events, or should we consider that the National Mental Health Intelligence Network has become redundant and is draining funds needlessly? If you think that this is an exaggerated notion, consider that when we look for the ‘National Mental Health Intelligence Network‘, we get the website (at http://mentalhealthpartnerships.com/network/mental-health-intelligence-network/), the latest thing on their website is a meeting from September 2013, in addition there is something from Professor Chris Cutts on STORM Skills Training and that is May 2014. So I think that the National Mental Health Intelligence Network did get itself involved in a sales pitch and a very poorly constructed one I might add. You see, when we go to Public Health England, we see that there are health Intelligence Networks, but the one they have is called ‘National Mental Health, Dementia and Neurology Intelligence Networks (NMHDNINs)‘, perhaps an oversight from the two sales people? You see the Mental Health Dementia and Neurology path gives us all kinds of information (shallow information I admit), but I wonder if that is wrong or just not the proper place to find it. In addition I see when I look at ‘Severe Mental Illness‘, some 2017 mentions (so it is up to date) with the Psychosis Care Pathway, where I see “The Psychosis Care Pathway provides a high level summary using 16 key indicators to help users assess and benchmark how they manage this important condition. This pathway is consistent with and linked to the Commissioning for Value Psychosis packs to be published by NHS England“, this is an interesting part isn’t it? Does this mean that this is happening, not happening, or more important, what on earth does Dr Geraldine Strathdee think she is doing? Perhaps it is an ill-conceived hostile takeover using an outsider who was published and has a name, whilst the minimum needs to be taken seriously are not even there (an up to date website perhaps). This whilst the mention ‘based at Public Health England‘ is an issue as the Public Health England (at https://www.gov.uk/government/organisations/public-health-england), has no mention at all of the ‘National Mental Health Intelligence Network‘, is that not odd? So what ill-conceived sales pitch are we reading in The Guardian?

Perhaps the quote ‘The NHS needs data analytical talent, which comes from a variety of disciplines‘ gives us that. And as the NHS has no immediate need to hire analysts, see there, the ‘National Mental Health Intelligence Network’ would come to the rescue and save the moment. Perhaps the first thing they would consider is hire a web designer and make sure that the latest INTEL is not 2+ years old (cautious advice from my side). In addition, as it seems that the NHS is likely to be pushed into a ‘we need analytics data‘ conversation (one they can go without at present), not taking the word from a professor and a doctor who dropped the ball might be a first notion to consider. Making a proper inventory of what data the NHS has and seeing if a conversation (a non-invoiced conversation) with someone from Q Research Software is likely to be a hell of a lot more productive than talking to the previous two ‘sales’ people that the Guardian article touches on. I will be honest I had a few issues with that program in the past (for specific reasons) but Q Software has never stopped improving and it has grown to the extent that it is now chiseling to the marginal groups IBM Statistics had and they are now losing those customers to Q Research, which is quite the accomplishment. In that I think it is Dr Danny Keenan who is likely to get the most out of such a meeting. From what the Guardian tells us, we get the implied understanding that he needs the solution to tell a better story. You see, translating statistical results into actions is done through stories. Not fabrications mind you, but a story that helps the receiver understand what direction would be the best to take. The listener will get a few options and each will have a plus and a minus side and usually the one with the best track movement tends to win. If that path includes successfully suppressing the negative elements even more, so much the better.

My main reason for opening this door is because there is enough low level talent in the NHS in several places that might have the ability to do this on the side, a simple path that allows additional reporting whilst not needing to drain essential resources. I call them ‘low level’ not because of anything negative. When working with proper analytics you need to have someone on your back and call with a degree in applied mathematics. Anyone claiming that this is not needed is usually lying to you. In the case of Q, a lot of the calculations have been auto completed and the numbers that are reflecting in the tables still need some level of statistics, but many with a tertiary business degree would have had exposure to a lot more stats than is needed here so as such this person would be low-level only in that regard. It is for all intent and purposes a reporting tool that goes a lot further than mere tabulation and significance levels. It could be the tool of choice for the NHS. Even when they start getting forward momentum, this tool would still be massively useful to them and any change might be limited to getting a dedicated person for this goal. Which with the current shortages all over the NHS is not that far a stretch anyway.

So as we realise what one program can do, we see the questionable approach that the sales person named Beth Noveck is making. The mention “the NHS should expand efforts already underway to construct an NHS Data Lab“, “Improving public institutions with data also requires strong communications, design and visualisation skills. Digital designers are needed who know how to turn raw data into dashboards and other feedback mechanisms, to support managers’ decisions” and “So the NHS needs to be able to tap into a wide range of data analytic know-how, from computer scientists, statisticians, economists, ethicists and social scientists. It is impractical and expensive to meet all of these needs through more hiring. But there are other ways that the NHS can match its demand for data expertise to the supply of knowledgeable talent both within and outside the organization

Three distinct statements which are not false, yet the first one is currently not feasible with the shortages that the NHS has the second one was debunked by me in merely 5 minutes as I introduced Q Research Software to you the reader. Anyone stating that this is not the best solution has a case, but in the shortage world the NHS lives in, with the cost of Q-Software against 93% of all other software solutions, it is the best value for money the NHS could ever lay there fingers on and the third one is even more worrying, because that expensive track of consultants is one of the ways that partially accounts for the £11.2 billion loss that the NHS already suffered. Should the esteemed professor come up with ‘additional considerations’ the NHS should become really scared, because there is a growing concern that some people want to get their fingers on the NHS data, the one treasure the bulk of ALL American healthcare insurers and provides want, because that is one data warehouse they have never been able to properly build.

She ends the article with “Whether the NHS wants to know how to spot the most high-risk patients or where to allocate beds during a particularly cold winter, it can use online networks to find the talent hiding in plain sight, inside and outside the health and social care system“, so how does that work? Where to allocate a bed in cold winter? Are they moved by truck to another location (impeding nurses and doctors as more aid needs to be given at that location), will it require the patient to move, which is actually simply done by finding out where a bed is available. The article is a worrying one, in that light that the article was published and I wonder if it was properly vetted, because there is a difference of many miles between a political science piece and an opinionated sales pitch. So my next step is to take a very critical look at “Smarter Health: Boosting Analytical Capacity at NHS England“, because my spidey sense is tingling and I might find more worrying ammunition in that piece.

 

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The rights of one person

Where does the rights of a person stand? Where do we draw the line of reason? These two questions came to mind when I saw the partial readable news in The Times with ‘Asbo woman fears eviction for moving bins‘ It could be seen that there is something amiss, but where does the problem lie? You see, when I was looking into Brexit dangers, the quote “A 61-year-old woman who has been warned about antisocial behaviour claims that she is facing eviction after neighbours made 15 complaints about her for “offences” including moving bins and supporting Brexit“, in addition we see:

  • Over the past seven years, Anne Maple has been sent eight antisocial behaviour notices by Lewisham council.
  • Three ordered her to stop interfering with dustbins.
  • She was warned against displaying “inflammatory” notices after putting pro-Brexit and Conservative election posters in her window.

In this my first response would be that Jim Dowd, the MP there wakes up and takes a personal look at this very case. In the first, is there a law against putting a conservative poster in her window? What kind of people are there in Lewisham to take such offense, Labour minded people perhaps? That is off course as long as there is no housing law against it, which would actually be a breach of the freedom of speech! Now, there is no case I can make against the dustbin issue as I have no idea what actually happened and to what degree. Yet the fact that this is about a 61 year old woman, who is actually making these complaints? In addition the fact that more than 3 anti-social notices were given by the council themselves, I think it is time for Jim Dowd to do a little less posturing, especially when sauce bottles are looking very distinctively different! Mr Dowd should actually take the morning to visit Ms Maple and have an actual conversation. That is, unless he is too busy posturing towards his next election. And the threat of eviction because a person was in favour of Brexit? Is that area filled with sore losers perhaps?

It is nice that The Times is stating that there have not been any conviction, yet these acts against Ms Maple could be seen as Psychic Assault. Perhaps the people making the registration, should inform those complaining that in light of the number of instances, that they could face the consequences of Psychic Assault (although the UK doesn’t really have proper protection in place), which is for now a little bit of an issue. Still the situation remains that the Lewisham Council seems to be no more than a convenient portal for harassment. (Read: taking offense to Brexit and Conservative posters pretty much qualifies), in addition, if no offense was given to Labour Posters in windows anywhere in Lewisham, it now becomes a council act of discrimination as I personally see it.

Yet, even as we see this, the Miss Maple case was not the one that this was going to be about, but it is actually closely related to the matter at hand. You see, the papers are full of deportation articles, it is the Barclay brothers spreading fear. Sir David Rowat Barclay and Sir Frederick Hugh Barclay own these papers, so I call them in charge, even as I know that Aidan Barclay is actually managing pretty much anything they have in the UK (several billions worth I might add). You see, Owen Bowcott at the Guardian stated it perfectly when we see “Mass deportations of the estimated 2.9 million EU nationals living in the UK would be impractical and they should not be used as a “bargaining chip” in Brexit negotiations, the government is being warned“, this is where I see this happen. Emotional reports and statements from Bremainers getting desperate that any alternative is null and void. First of all there is the Immigration Rules on Family and Private Life (HC 194), which the Home office has here: (attachment).

When we get to the best interests of the child, we see: “arrangements are in place to ensure immigration decisions are made having regard to the need to safeguard and promote the welfare of children who are in the UK“, now when I reflect that in regards to the Guardian article (at https://www.theguardian.com/politics/2016/dec/28/dutch-woman-with-two-british-children-told-to-leave-uk-after-24-years), where we see “A Dutch woman who has lived in the UK for 24 years, and has two children with her British husband, has been told by the Home Office that she should make arrangements to leave the country after she applied for citizenship after the EU referendum“, yet when we consider the Home office paper, the interest of her children and Section 55 of the Borders, Citizenship and Immigration Act 2009, where we see in section 55(6): “children means persons who are under the age of 18;“, both children fall into that category, we can argue that the Home office as presently interpreted failed in that assessment, in addition, that this family for 24 years have paid their taxation, have become a part of British society, it is there that we see the notifications from the Home Office seem to be either a careless failure or an intentional attempt to raise fear. I feel that no other direct impression remains. Even if we accept: “European citizens marrying Britons do not automatically qualify for UK citizenship under current rules“, the Borders, Citizenship and Immigration Act 2009 clearly provides in case of underage children which was applicable from the earliest moment on. We can also raise the issue that the 85-page application form for “permanent residency” will become an issue a few hundred thousand times more, so we can state that there will be a blooming business for immigration agents in the UK soon enough.

In all this the rights of one person are currently in danger because certain elements have been left out of too many media outlets for too long, we have forgotten where the media itself was. The Conversation gives us (at http://theconversation.com/hard-evidence-analysis-shows-extent-of-press-bias-towards-brexit-61106) a much clearer view, where we see the Bremain tainted side in blue and the UKF*ckOff (read: Brexit) in red. The fact that the Times is by far the most balanced one yet remains slightly Bremain is pretty awesome to some extent. In all this we all forget that as the least reputable sources (the Sun, Daily Mail and Daily Express) are more widely read and reaches a much larger audience. My view is not incorrect, yet massively incomplete. You should take a look at the Conversation article by David Deacon, Dominic Wring, Emily Harmer, James Stanyer and John Downey because it is an amazing piece of work, and nearly all of them professors (oh, whoop di do). The end result that we see is “when weightings for circulation are factored in, the fact that the highest circulating newspapers have tended to support Brexit means that the gap between the two positions widens into a substantial difference of 18% pro-Remain and 82% pro-Leave“, which is scary!

My reason for remaining ever so slightly in the Brexit field was not on any of those merits and it is perhaps the one part missing here, mainly because it is perhaps not part of the view these people looked at. My view grew based on the actions of others, the inactions of several others and the denial of even more people. The actions of Mario Draghi gave view that Bremain would be too dangerous. The invoice that he would instill on all would debilitate too many, making all mere slaves with implied false freedom. We all become the cogs of the engines of financial institutions and big business whilst the wealth is removed from the people more and more. Servitude to Wall Street! That would be the result and I never signed up for that and I know most Europeans have never signed up for that. In that regard, it is equally interesting how the spokesperson (Prime Minister Joseph Muscat of Malta) considers that “Britain should be made to answer to the European Court of Justice (ECJ) during the process in order to smooth the path for leaving“, it is my question to what regard. You see, the European Court of Justice has clearly intentionally skated away from the issue of a nation leaving for 2 decades. Mainly because no one believed it could ever happen and it is there where we see that the European Court of Justice (ECJ) has utterly failed! When we see “Any member state may decide to withdraw from the union in accordance with its own constitutional requirements”, checks and balances should have been put in place. Perhaps people remember on how ‘Grexit’ was such a big deal. Perhaps you all remember 2012 when people like Roubini stated that Grexit would be possible in 2013. So when I published the paper I found by Phoebus Athanassiou, stating that expulsion from the EU and the EMU wasn’t even legally possible (published in 2009), how betrayed did you feel? All in the media we were led like sheep, and as I saw it intentionally misinformed by those around us. Is it even a surprise that the UK wanted out? It might have started with Nigel Farage, but the issue has grown so much larger, all because the people in charge needed the gravy train to continue, the continuation of the wealthy demanding their Status Quo to remain to grow their fortunes. It is that foundation that is now very much in play. Even as this is all known, even as we have seen that the European exit must be voluntary, we see the BBC give us in June 2016 (at http://www.bbc.com/news/world-europe-36629145), the quote “the risk remains of Brexit precipitating the departure of Greece from the Eurozone and therefore possibly the EU“. At no point do I see the Greeks or the article state clearly that it must be voluntary, no legislation has been put in place ever since this started in 2012. Now we know that laws take a long time to set, but the effort regarding the trimming of the EU tree has been massively absent, why is that?

In all this we see that the rights of one person no longer seems to matter, which is weird because Common Law was clearly set to remain fair in that regard. Even for the most in Europe where civil law was key, the people had a fair amount of rights. Here now we see that the people remain uninformed, the media seems to be unable or unwilling to inform the people where their rights and what their rights are. It is my personal belief that the people are restoring a need for nationalism hoping that local laws will advocate a better level of informing the people, not tailoring to the needs of large global corporations. It sounds weird, yet this is what I believe to be the fear of many. The tax events on large corporations like Apple, Amazon, Google and IBM seem to be catalysts in all this. If you think that I am kidding in this matter, you should see “The discontent with legal tax avoidance, in the UK at least, is clear. A YouGov survey last year found that 59% of people think legally reducing your tax liability is wrong and make no distinction between evasion and avoidance“, which we got from Forbes in August last year (at http://www.forbes.com/sites/jaymcgregor/2016/08/31/apple-falls-victim-to-rapidly-changing-public-mood-around-tax-avoidance), this doesn’t just impact the branding, there are indicators that this also fueled the anger of Brexit voters. In addition, the 180 degree view that President Obama made in The Hague (2012) as he gave a speech on responsibility and then sent senior officials to oppose the tax reformation / tax accountability was no help here. So Brexiteers had a large stack of ammunition that they could hand to the people again and again. Misguiding and misinforming have been instrumental indicators in all this. There are too many sources to name, many are just mongering, yet a large amount came from reputable sources and Forbes has pointed out more than one issue in all this.

As I see it there is an abundance of work to do, some of it should have been addressed a long time ago. Even if I admit that I have not yet filled out my permanent residency papers for the UK, the fact that this is an 85 page booklet is still cause for concern. It is linked to the situation we saw earlier this week regarding the NHS, especially the Coventry ‘issue’. It has become clear that a logistical overhaul is needed in the UK. It is the hardest and most debilitating of overhauls, yet at present it could be seen as the most essential one. Consider the cost for civil servants having to get through 1,000,000 applications, which now implies that 850,000,000 pages get reviewed and decided upon. If a person is really focused and on the ball, that person will make an error once in every 50 pages, this now gives rise to the risk that every submission will have at least one error in its assessment. How efficient is that?

There are steps that can be taken to minimise this, yet it will cost in staff or technology and in both there is still the added flaw that items will be overlooked. That is the mere nature of the beast in all this. The application right of a person will be diminished, not on purpose and not with malice, but the danger is absolute and the scars that soul is left with is pretty much for a long time, perhaps even for life. How is any of it a solution?

In this we can argue that on the middle ground that automated residency is equally not an option, but the middle ground is not trotted on and that is where the solution is to be found, somewhere in the middle, which is turf that the polarised extremists (Brexiteers and Bremainers) are currently not looking, yet neither is the Home Office, or so it seems.

 

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The views we question

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

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

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

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

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

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

 

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On this Friday 13th

There have been a few events going on, with all the hustle and bustle from America we are moving towards a possible point that this nation will be officially renamed, when that happens other domino stones will be pushed into a different direction. Yet there is still time, so we can ignore it for now. What was interesting for me, was a Facebook mail that has all the elements of becoming a flame, a wave of emotions, intentionally set in that way. Yet the part that was actually interesting were the facts that it had. Those facts were indeed interesting to look into, yet not by themselves. At this very moment I am digging to confirm certain numbers and see if they hold up.

 

Income 2013 Income 2014 Change

Aetna, Mark Bertolini

$30.7M $15M -50%
Centene, Michael Neidorf $14.5M $28.1M 93%
Cigna, David Cordani $13.5M $27.2M 101%
Humana, Bruce Broussard $8.8M $13.1M 48%
United Health, Stephen Hemsley $12.1M $66.1M 546%
Wellpoint Joseph Swedish $17M $8.1M -47%

These are health insurances and their CEO’s. This group of 6 have in their hands the health options of the bulk of Americans. Now, before we act in outrage, which we might still do, we see that two of them lost half their income, which in the worst situation, that person (Joseph Swedish) makes in 2 days the same I make in a year. In opposition, there is Stephen Hemsley, who makes in a day, the same I would make in 6 years. Now, we can make this about the imbalance, yet that is not what this is about.

Let’s not forget that these are manages health carers. In September 2016 we saw CNN report “A recent report by Kaiser/HRET Employer Health Benefits forecasts that the average family health care plan will cost $18,142, up 3.4% from 2015. That’s faster than wage growth in America“, and “Premiums on the Obamacare exchanges are expected to rise by double-digits this year“. Now, we need to tread carefully here, health care systems require more work and they need to look to what happens in the future, not just what happens now, So when we see Aetna report in 2016 a total revenue of 60 billion, yet an operating earnings of 2.7 billion, we see that there is a margin, yet not an overly exaggerated one. This is part of a system for 23.5 million members. In this on page 7 we see that the revenue is comprised of commercial and governmental premiums totalling 51.5 billion. Yet it goes further, when we see the growth that Aetna has had, the merger deal with Humana, which is interesting as it is set as a 37 billion merger, yet when we see the quarter of quarter growth of 3 years at least, does it make sense to see this as a mere 37 billion dollar merger when the operating revenue has been in excess of 58 billion for well over 3 years? In addition, Aetna reported an operating gain against costs of over 30%, so when we see the CNBC quote on November 10th 2016: “The Affordable Care Act was built on a flawed model that required getting as many people as possible into the insurance system, Bertolini said. And he said he thinks the Republican Party will make good on its promise to repeal it“, we wonder with their operating profits, a managed health care system no less, what are we not seeing? As stated, compared to the revenue, the profits are not outlandish, yet the entire Obamacare issue seems to give another view, one that clashes with the view that we see at Aetna. Now consider another quote, one we see on December 13th 2016, in bizjournals.com. Here we see: “As one of its arguments against the acquisition, the U.S. Justice Department says the deal would drive up prices on health insurance exchanges in 17 counties where Aetna (NYSE: AET) and Louisville-based Humana (NYSE: HUM) now compete“, you see where there is competition, prices are pushed down, so how come I suddenly see an increase in health insurance exchanges? The final part is one that strikes a sting on the violin of chaos too. Consider the quote: “Bertolini also testified that Molina Healthcare Inc., which has agreed to buy Medicare assets from Aetna and Humana for $117 million if the merger is approved“, now let’s be honest that $117 million is nothing to sneer at, yet what are these Medicare assets exactly? Where is the write-off? You see, two companies with a total revenue exceeding $100 billion annually over the last 3 years, in that light $117 million is close to no blip on the radar (0.11%). So why was it mentioned, why put Molina Healthcare Inc. in the picture? Well, like the other two players, they have had quarter on quarter growth for 3 years too, more important, even as their revenue is not as impressive of the two others, we see that annual on quarter, 2015 brought close to 50% growth, whilst 2016 is expected to surpass the 30% mark, those are operating revenue growths nearly unheard of in this day and age. And this is not the adult media sales, this is healthcare, so as we expect that there will always be growth, we need to see where the interests are of these players. Let’s not forget that the picture is changing. Humana Inc. is a for-profit American health insurance company, they clearly state this, so what will become of Aetna when that merger goes through? How will the picture change and how will that impact the members? They are both Managed health care, yet Aetna is not outspoken ‘for profit’, the numbers do bear this out to some degree. Yet in all this is not about the members or patients. This is about the shareholders and both have plenty, the question becomes what direction will Aetna take? Will we see a board of directors that find themselves in agreement with the senate under Emperor Tiberius Claudius Nero, when in 19 AD they proclaimed: ‘Puer Pauper‘ (fuck the poor), which by the way coincided with the expulsion of the Jews from Rome, life is full of irony at times. The reason to make mention of this is because Israel has a health care system not unlike the Netherlands. A compulsory plan where all Israeli citizens are entitled to basic health care as a fundamental right. There a person can sign up with one of four official health insurance organizations which are run as not-for-profit organizations, this is where we see the massive difference. ‘run-for-profit‘ comes at a price and that price is the additional dividends that the members must pay the shareholders. It is not that simple, but you get the idea. In all this the fact that this approach made Israel 4th in terms of efficiency and Israel was ranked 6th healthiest country in the world by Bloomberg rankings. These are numbers any government could be proud of. Neither the US nor the UK make that top 10, according to the article in Bloomberg, the UK doesn’t even make the Top20. So as we realise a few numbers and this all leads to a lot of questions, we can agree that there is nothing against ‘for-profit’, yet who remains in the US with the option to afford this? Perhaps that is why the link to Molina Healthcare Inc., just a small token proclaiming to remain ‘for the people‘, whilst relying on tax deductions and write offs to remain ‘for the shareholders‘. However, let’s face it, these two (Mark Bertolini and Bruce Broussard) are almost the lowest ones on the Health Care CEO list of incomes, still making per day about what I make per year. Yet even as their incomes drew the attention, it is the coverage, the operating profits and the for-profit sides in some of these Managed Health Care groups, whilst we see places like fortune.com inform its upcoming ‘victims’ that the costs will go up: “costs are expected to grow 6.5% through next year. While costs have finally reached a point of equilibrium after years of double-digit growth” as well as “36% of employers are even considering a defined contribution strategy where they would provide a set sum of money to each employee to pay for health care, and if a health care plan exceeds that sum, the employee is on the hook for the remainder of the cost“, so whatever increased quality of life the Americans did not get, there is information that well over 10% of the employers have adopted this strategy. Such plans, especially with the for-profit health care managers will see a shift in costs, from employer to employee. Fortune.com gives as reason: “There’s two primary factors that affect health care costs: how much is being consumed and the price for services and drugs. As it turns out, prices aren’t what’s primarily adding to the rising trend. It comes down to more people consuming more care“. I personally believe that the truth is somewhere in the middle lane. Both the needs of an aging population and the pharmaceutical patents driving up prices as pharmaceutical patents are chomping down on maximised profit per pill. In this Forbes reported two days ago that the pharmaceuticals are not happy. Here we see the quote “Much of Medicare is now run by private sector insurers like Humana or Aetna, who already bid on drugs to get lower prices (this is known as Medicare Advantage)“, Yet President elect Donald Trump stated: “I worry today that the pharmaceutical industry has a very false sense of relief or security because of a Trump administration and a Republican Congress. I think we should recognize that the drug pricing issue is a populist issue. Americans are rightfully angry. The fault is not, surely, on the pharmaceutical industry’s shoulders, but we bear that because we make the drugs. We innovate the drugs, and as a result of that, whether we like it or not, or we want to try to explain it or not, we have to deal with it.” As stated more than once in the past, I do believe in capitalism, yet at what point does capitalism become plain greed? When we look at the top 20 pharmaceuticals, they are hiding behind a 2% growth, yet these 20 companies which include Novartis, Pfizer and Johnson & Johnson were making 547 billion in 2014, whilst we see that 13 of them are turning a profit with one of them 127%, these are only the 2014 numbers, the profits have been steadily increasing, at the expense of those requiring medication, at the expense of a health care system that can afford less and less. In all this we see that places like Pfizer kept a gross profit of well above 38 billion and they weren’t even the best scoring one. Yet, the connection go on a lot further. You see, with Pfizer we see James C. Smith who is also on the public board of Thomson Reuters, Suzanne Nora Johnson is also on the board of American International Group, Inc. (insurances). James M. Kilts serves on the board of MetLife Inc. as well as Nielsen Holdings N.V. The list goes on. A group of board members already on a massive income, adding the incomes from other boards where they serve with incomes most people dare not dream of. What is more interesting is how we see an almost illuminati sized cloud of interaction with media, insurances and other interactions. All essential and profitable for Pfizer. When we look at Novartis that list of directors takes an even more interesting turn. Ann Fudge who also serves on the board of the US Council on Foreign Relations, with additional functions at Unilever as well as the Northrop Grumman Corporation. Pierre Landolt, Ph.D. who is also the chairman of the Swiss private bank Landolt & Cie SA, a Financial Institution in Brazil and a few other enterprises. Andreas von Planta, Ph.D, linked to HSBC, Moller Finance, and the regulation board of the Swiss stock exchange and finally Srikant Datar, Ph.D., who goes beyond mere Novartis, with additional board placement with ICF International Inc., Stryker Corp. and T-Mobile US. The pharmaceutical boards read like a weave of corporate interaction with links all over the Fortune 500. A conspiracy theorists wet dream.

For us it is not about who they are connected to, but how such links could be used to maximise profits. The idea that the Pharmaceutical industry has its representation, and on the other side we see an optional Novartis with its board member Ann Fudge who also serves on the board of the US Council on Foreign Relations, how is that for hedging your bets on both sides of the profit sandwich?

On this Friday 13th we see news in the Guardian mention of the NHS winter crisis, we have been seeing from all directions the Obamacare and how Obamacare Premiums are expected to Increase by ‘Double Digits‘ in 2017, one can only hope that the first digit is a ‘1’. With pharmaceuticals and insurances both on the maximisation of profit, the people in several places are pushed in a corner with no place to go see about any options.

Only the superstitious will think that the health care news will be better tomorrow, it is Friday 13th after all.

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No Health Statements

This is not the first time that we see a level of anger non-management in regards to the NHS and the medical staff. The proclaimed shortages and a government in denial over these elements. Whilst the DMG Media papers (among others) have had their fun day. The messages concerning the NHS are increasing all over the place and when we start reading about the  ‘The worst conditions in memory’, we know that we have come to that place also known as rock bottom.

This in contrast of messages like: ‘Hospital pays £1,800 for an agency nurse to work a single shift‘, April 5th 2014 (at Read more: http://www.dailymail.co.uk/news/article-2597442/Hospital-pays-1-800-agency-nurse-work-single-shift-thats-163-hour.html), Paul Dacre and ‘his’ DMG media. It is not the only case, there was a similar story on July 30th of that same year. The Telegraph gives us a similar story on January 19th 2013. This in contrast with real newspapers, namely the Guardian who voices (at https://www.theguardian.com/society/2014/nov/01/nhs-spending-agency-nurses-cuts) ‘NHS spending on agency nurses soars past £5.5bn‘, with the second line giving us ‘Government accused of ‘truly incompetent planning’ after years of training cuts push cost of temporary staff way over budget‘, this is a situation that affects both sides of the isle as it wasn’t started by this conservative government, it started before 2010. Neither side of the political isle has given proper vision to the pressures building, and this current government is now watching from the sides as they need to find £25bn. That number is actually pretty easy to see.

Staff shortage, overhaul of equipment, shortage of infrastructure and an overhaul of the infrastructure to protect it from this ever happening again. In this we have two elements. The first is that the press is partial to blame in all this. Consider the speech by Paul Dacre “a kind of show trial in which the industry was judged guilty and had to prove its innocence” (source: betterratailing.com). I like the news in the Spectator even better with “unremitting pressure of fighting what I have no doubt was a concerted attempt by the Liberal Establishment, in cahoots with Whitehall and the Judiciary, to break the only institution in Britain that is genuinely free of Government control – the commercially viable free press“. Yet, Paul Dacre sold out his readers in an instant as he kept quiet on the changed user agreements PSN users were forced to agree to, just a mere 10 days before the release of the Sony PlayStation 4. In that, as I personally see it, he kept the people out of the loop. So as the commercially viable free press is betraying its readers. Possible because he had to orally please the ears of Sony? How can we have any faith on anything we read regarding the NHS, especially when it is coming from DMG Media? You see, the issues are very much linked. The people have been made aware again and again that people like this cannot be trusted. It is Stephen Fry who brings the best definition of the Daily Mail “the only good thing to be said about his Mail is that no one decent or educated believes in it“, which is pretty much spot on, and the news the Guardian gives us regarding: “Paul Dacre steps down from the post of Chairman of the Editors’ Code of Practice Committee, which he had held since 2008” (at https://www.theguardian.com/media/2016/dec/01/paul-dacre-to-step-down-as-chair-of-journalists-code-of-practice-committee) is only the smallest of positive messages, even as he attacks it on the way out. Yet the Mail Online, which is owned by the mother company DMG media has had a long line of issues, among others with Tom Cruise as he was identified in a relationship between ‘Tom Cruise and the head of the church of scientology, David Miscavige‘, which might or might not be a big thing, what was the issue that the publishers were unable to defend themselves and even as we see ‘diplomatic’ responses like ‘Mail Online had failed to demonstrate that it had complied with its obligations under the first clause of the editors’ code on accuracy’, and as Editors’ Code of Practice Committee is part of IPSO, and they administered ‘penalties’ on a DMG Media sibling, the news that the Guardian gave “Regulator to reconsider whether the editors’ code, and its rules, can apply to a global digital publisher” (at https://www.theguardian.com/media/greenslade/2016/jul/19/ipso-review-after-mail-online-fails-to-defend-tom-cruise-story), so at this level of ‘contemplation’, something I personally tend to see as ‘inbreeding’, they are contemplating ‘a commercially viable free press‘. Are you freaking kidding me?

This sidestep is essential, because if it does not come from the Guardian, the Independent or the Times, we cannot be certain of anything nowadays, so as we lash out against the NHS, its governance and the consequences its patients face, we seem to be spurred into a false sense of righteousness as we kept on reading regarding those £225 an hour nursing jobs, which should be seen as misrepresentation of the highest order! The Telegraph isn’t helping any as they publish that the NHS now has access to Artificial Intelligence (at http://www.telegraph.co.uk/technology/2017/01/05/nhs-trials-artificial-intelligence-app-place-111-helpline/).

The part that the Telegraph does show that is important is “Joyce Robins, from Patient Concern, said: “I find this quite frightening. People who are ill want a person they can speak to. Typing in your own symptoms and waiting for a result is just ridiculous – what happens if you make a mistake?”“, which is just the tip of the iceberg.

The issues seem to escalate and there are a few players in this dramatic comedy that have to explain their reasoning. I am clear in ‘explain’ because there are sides that I am unaware of, to boast not being unaware of anything is utterly irresponsible. Before I go into the separate points. I did make a case on several levels with ‘The UK NHS is fine‘ (at https://lawlordtobe.com/2016/09/20/the-uk-nhs-is-fine/), and an even stronger case with ‘Is there a doctor on this budget?‘ (at https://lawlordtobe.com/2016/02/15/is-there-a-doctor-on-this-budget/).

Staff shortage.
It is the easiest one to solve, but cannot be solved overnight. Yet the shortages have been known for close to 4 years, so what has been done over the last 4 years to address these shortages?

Overhaul of equipment, Professor Angus Dalgleish has been outspoken in the past in several ways, mentioning the budget of the NHS not in the smallest way. We know that George Osborne had cut the budget by 1 billion, which in light of the shortages was a bad idea, the question is, was it avoidable, if not, how can the NHS move forward? With the current unemployment levels, how come it is still so hard to recruit nurses and doctors? I myself have had a lifelong interest in Radiology and Anaesthesiology. I am not alone in this, although in the 70’s when I was initially studying, getting into law or medicine was only possible if your parents were wealthy or if they were in law or medicine (meaning that they were wealthy). Now consider what the governments have done over the last 2 decades. I am giving that frame because we have known for at least 20 years that there was an aging generation coming up. Now the press at large seems to be blaming the immigrants, they might be as factor, yet they are not the main cause. A UK parliament going all the way back to Tony Blair should be seen as responsible for this. Those words are very specific. You see, when we look at the NHS expenditure history (at http://www.nhshistory.net/parlymoney.pdf), we see that in 2004/5 and 2006/7, Under Labour Tony Blair, the expenditure takes a massive hit, it is after that during Conservative David Cameron that expenditure goes straight into the basement, both sides fell short whilst both groups knew that the increased pressure from 2013 onwards would be strangling any budget as the NHS gets to deal with an aging population moving into retirement and an increased need for health care. None of it got properly dealt with by any parliament. In this, a rough estimate would be that the UK needs to hire no less than an additional 2,000 students a year for no less than 7 years to get anywhere near the numbers we will need in 8 years’ time, because the current shortage will increase. Perhaps parliament should take additional looks at places like the Royal College of Physicians (https://www.rcplondon.ac.uk/), we can agree that quality needs to be high, Yet when your annual tuition fee is set at £23,190 with an additional college Fee of £7,350 there will not be much appreciation on an international level, unless it is for private practice and that is where the NHS luck runs out, in addition, for the ‘locals’, £9,250 annually is still a big ticket, especially in today’s financial uncertainty. Consider the fact that this goes on for 4 years (the NHS is mentioned in several places to cover years 5 and 6), still, the average student will end up owning over £37,000 before they are actually earning anything and by the time they start earning enough to pay some back, the houses and their prices come across the corner, so these people too will try to find a commercially viable place. Perhaps they will go into journalism? Which is an issue as Paul Dacre of the Daily Mail (read: DMG Media) and Jane Dacre (President of the Royal College of Physicians) are related to one another, so I can only speculate with the question whether the Daily Mail news and Mail Online and others are setting a stage that is leaving a foul taste in my mouth. Now we all know that there are plenty of other sources making statements in the open, yet I cannot wonder if there is a sorted wave of misrepresentation of information is going on. We all know that there is an issue and that the NHS is in serious trouble, yet it requires drastic changes and a vocation that attracts many yet nearly null can afford is still a vocation with no staff.

Shortage of infrastructure.
This is seen in two sections, the people and the technology. Both are in a failed state. Even as plenty of people are looking for jobs, it seems that the infrastructure is under pressure as well. A cut budget as George Osborne had put in place is in addition incrementally debilitating to the NHS infrastructure shortage. Now in this I am not placing blame on George Osborne. The UK got themselves into a £1.7 trillion debt, the NHS is only one side of a national infrastructure that needs a budget, whilst the previous administrations have been burning their budgets like there is no tomorrow, the point has been reached where government credit cards are all maxed out, so finally budgets get cut hard all over the place. The NHS was not the first and will not be the last to suffer near death symptoms for some time to come. Unless parliament takes drastic steps and starts to change the way things are done and perceived there won’t be anything left.

Overhaul of the infrastructure.
The NHS infrastructure requires a massive overhaul, the NHS has to some degree failed itself. This isn’t just about cut budgets, this is about the essential need for hospitals to be lean and mean (read: not average). Processes need to change, the objectives of hospitals need to change. Larger implementations are required that deals a blow to the posts that have too large a cost. One if the implementations would be that alcohol and/or drug related injuries are no longer treated unpaid and only treatment when upfront payments are placed. It will be the first harsh response to binge drinking. It was stated a year ago that binge drinking is costing UK taxpayers £4.9 billion a year, which boiled down to almost £13.5 million a day. Now the researcher set that it equates to £77 per person, so in my view, any alcohol and drug related treatment will be set at £60 per treatment up front. Those who cannot afford it (spent their money on booze and drugs) simply get to wait outside until that bad feeling is gone (or they can die and decrease the surplus population, source: Charles Dickens). It is my personal view that it will take no more than 1000 deaths for people to realise that binge drinking needs to get to an end. This is actually small fry compared to Australia where the annual tally of costing is set to $36 billion and when we accept that the currency is only slightly below 2:1, whilst the population is set to 1:3 (only 23 million in Australia) we can honestly state that Australia is in a much bigger mess than the UK and if the UK adopts certain policies, Australia is likely to follow quite quickly.

If these three parts can be addressed, there will still be a dangerous time for the NHS, but there is also the option that the NHS will move away from near death to extremely sick and hopefully the death of the NHS will be averted. The alternative is to put faith in the aging population to throw their numbers in another direction. You see, at present, the death rate is down. Over the last 10 years it went down on average by almost 14%, so if the elderly could be so nice to do an about face and start dying more increasingly (like an annual average of 2,500 elderly per year), we would see a diminished drain on the NHS, housing prices more affordable, you see the benefit, right? Now, if you feel that this is so inhumane, than this is the lesson you now get to face.

To have a social civil society, or a civil social society, you need to be certain that you can afford to maintain it. As the political parties gave the keys of non-taxability to large corporations, the first step in having no budget was reached, as these players had no taxation, they still would try to find every corner to cut costs. So the car industry moved, fashion production went to places like Malaysia and Indonesia and sales went online via places like Ireland. It does not take a rocket scientist to work out that jobs would decrease and governments would no longer have a budget to play with, this is what we see in nearly EVERY nation on the planet, whilst the senior management places in corporations on a global scale left those few with more money than ever before and they do not need health statements, their incomes allow for their private physician with a nurse for the happy ending.

In all this, is this a story of hope? I am not certain, you see, unless draconian drastic changes come along, it might actually be too late for the NHS, merely because of the oldest triangle in existence. I am referring to the triangle of Places, Provisions and People. Any government and corporation can undercut one element for a longer time without consequence, for a short time you can undercut two elements with minimum consequences, yet there is no chance for survival when you undermine all three for anything longer than a really short amount of time. This is what has been done to the NHS for no less than 10 years, that whilst all the players knew that the pressure and needs of the NHS would increase and will continue to do so for no less than 10-20 years. What did you expect would happen to the NHS under those conditions?

 

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