Tag Archives: NHS

July 19, 2015 · 12:17

A political minefield

If there is one place where politics have bungled the ball on near titanic proportions, than it would be healthcare. The UK with the NHS issues, Australia with Medicare, the Netherlands with Gezondsheidszorg and the less we say about Obamacare, the better it is for all of us. They all made massive errors which changed the game for any nation that needs to take care of healthcare.

The UK has had its own issues for some time, yet now we see a new event coming up. Let’s take a look at ‘Cancer diagnosis ‘within four weeks’ under new care plan‘ (at http://www.bbc.com/news/health-33574233). First off, it is a good article by Nick Triggle, he looks at it from a decent viewpoint, but is there an issue?

The first part is “The five-year plan will cost £400m a year but experts say earlier treatment will result in similar savings. They say the plan could help an extra 30,000 patients survive for 10 years“, so basically there is no additional cost, which sounds good, let’s face it, in the increasing pull of funds, breaking even over the next 5 years does sound awesome, the people get to live up to another decade, which is just a bonus.

My initial issue is with the quote “Harpal Kumar, chief executive of Cancer Research UK and chairman of NHS England’s task force, said the changes could help create a “world class” service over the coming years“, the term ‘world class‘ seems a little out of bounds and that also sets the tone, let me go on so that it will all make sense.

The second quote is “We have an opportunity to save many thousands of lives from cancer“, which in light of all this does not make sense, especially when we see “But Mr Kumar believes another 30,000 people a year could end up surviving that long once the changes have been put in place – a third of them simply through diagnosing the disease earlier”

I admit that I am splitting hairs, because giving them an additional 10 years is not saving a life, it is prolonging it. Apart from that, is there an objection? You see, healthcare is about keeping people healthy (and saving lives whenever possible) so there is no real objection is there? Giving a person up to 10 years more is a noble goal, especially when 130,000 people die each year, letting them enjoy life a little longer is not wrong at all. So why am I looking at this article?

For that we need to look at the steps. These 7 steps is what brought the light in

  • The creation of a four-week target for diagnosis from GP referral. Currently patients are meant to see a specialist within two weeks of a GP referral but can then face weeks of waiting for tests, meaning a growing number of patients do not get their treatment started within 62 days as they should
  • An 80% increase in the number of tests being carried out, including increasing the ability of GPs to order tests directly – for many they have to go through a hospital specialist
  • Replacing more than 100 radiotherapy machines – half of England’s stock – with new, better models
  • Recruiting extra staff in areas such as specialist nurses and radiologists, with the latter needing to nearly double in number
  • Cancer patients to get online access to all their test results and a specialist nurse or other key worker to co-ordinate their care
  • A call for action on smoking and obesity – four in 10 cancers could be prevented through lifestyle improvements
  • All cancer survivors to be given a recovery package so they get the support they need to recover from their treatment and stay cancer-free

The first premise is shown in dots 3 and 4. Replacing 100 radio therapy machines with newer ones and recruiting extra staff (especially radiologists). The fact that the article implies that there are 200 radiotherapy machines is equally disturbing. You see, 280,000 diagnosed people implies 4 people a day and that is if every machine is properly managed, monitored and staffed. The issue is not complete and facts are missing.

For this we take a look at breast cancer. The site Jezebel had an interesting article linking to all this. ‘Can You Be Diagnosed With Breast Cancer In Just One Day?‘ (at http://jezebel.com/5865123/can-you-be-diagnosed-with-breast-cancer-in-just-one-day), where we read “I wrote to Dr. Karla Kerlikowske, professor of medicine and epidemiology/biostatistics at USCF’s Helen Diller Family Comprehensive Cancer Center. She explained: Mammograms can identify a site likely to be cancer, but it requires taking a sample of breast tissue and looking at it under a microscope to know a person has breast cancer. Rarely, less than 1% of the time a radiologist can look at a mammogram and based on the mammogram know a woman has breast cancer, even then it requires a tissue diagnosis for confirmation“. This seems to be a universal truth. In (as I see it) nearly all forms of cancer, confirmation is needed), which is part of the entire issue.

This does not change one essential truth “simply through diagnosing the disease earlier“, that is again a universal truth, so even for that mere fact this project should go on. The issue is not with the idea, or the plan or what we read, but by what we are not reading here.

Part 5 is the first real kicker, giving online to test results is a dangerous step, often cancer will hit the elderly, who do not comprehend the need for proper approach to common cyber sense and as such too many medical details will ends up in the open air, a place where medical details should not be allowed. Now, issue number 2 is one that can be handled, there is no reason why not to do this, yet we must acknowledge that specialists are there for a reason, as such, we can accept that GP’s could call for the test yet, here is also the danger that a GP will act under the ‘better be safe than sorry premise‘ which will now give the situation that 80% more tests are being made, yet it will also include the stronger increase of false alarm results, even under an issue of the best intentions. A mere consequence of people doing the best possible for the patient, an anticipated side effect of ‘world class cancer care‘. I do not object to these parts (or fight the approach here), but it calls into question the given budget already from this point on. So what is expected to be £400m a year, could end up being £520m a year. In addition to issue 4 where we see the need for specialist nurses and radiologists, there will also be the need for additional technicians and re-schooling of technicians and upgrading other peripheral devices. It is possible that these parts had been added to the cart of costs, yet the fact that they are not mentioned, the fact that some parts might not have been looked at yet makes the anticipated £400m a year incorrect and dangerous. The Labour party made a 12 billion IT fiasco, let’s not add to that, shall we?

You see, the cancer confirmation part is not always possible on the spot. So when we accept that ‘Most incisional and excisional biopsies are performed by surgeons‘, we see that additional costs and additional resources will be required. This means that there will be additional pressure on surgeons, was that factored in? You see, there is already a massive backlog. The Guardian reported on July 4th 2014 in the article ‘NHS patients waiting longer for routine operations under coalition‘ (at http://www.theguardian.com/society/2014/jul/04/nhs-patients-waiting-longer-for-routine-operations-under-coalition), that delays had been reported of up to 215 days.

So the entire ‘speed need’ in cancer diagnoses is going to take another matter of growth entirely.

So as I give you these facts and the thoughts around this, you might get a first idea what was wrong with the article by Nick Triggle. I am an ample Medici, but I never studied medicine and it took me roughly 17 seconds to get my question marks up, so why did Nick Triggle not voice these concerns?

The quote by Dr Maureen Baker, of the Royal College of GPs, who welcomed the plans was “The system is already overloaded and we must ensure that there is sufficient imaging and specialist capacity to cope with the increased number of referrals before promises are made to patients that cannot be delivered“. Yet her quote is equally incomplete. I would have expected the quote to be “The system is already overloaded and radiology is only one step in determining the path for a cancer patient. We must ensure that there is growth in several ways in several divisions of hospitals to cope with the increased number of referrals before promises are made to patients that cannot be delivered“, which would have been more correct and as lacking as the quote seems to be from my point of view, I personally would acknowledge that the BBC article could have been used to emphasize on how much work the NHS needs and how much more needs to be done.

None of that can be seen in the article.

It seems to be that the response from Lynda Thomas, chief executive at Macmillan Cancer Support is more on point. Even though it is ambitious, she states “This report has to be more than a set of recommendations on paper. It has to inspire action and lead to meaningful improvements for the lives of people with cancer“. I think that she is playing the game carefully as she wants to get whatever she can for people with cancer, yet the though in my mind is (based on the BBC article) that I would have phrased “This report has to be more than just a set of incomplete recommendations on paper“. That will lead to questions and that will lead to proper dimensioning of a massive problem. I agree that this needs to be done, but without the fact that the pressure for surgeons is already beyond believe (not just in the UK), not addressing this part will lead to another fiasco for NHS, which is what we need to avoid at all costs.

So we are facing a political minefield, one that Labour did not survive, I hope that the conservatives and especially the Rt Hon Jeremy Hunt MP takes more than just a few additional looks at it. And even though he might dread sitting down with a collection of ‘funny and entertaining people’ (like hospital administrators), he will do so and get a proper scope of what will be impacted, because spending another 2 billion only to learn that the term ‘similar savings‘ will never be an option is one he must be willing to accept having to deal with.

There is nothing against spending it on treatment and diagnoses of cancer patients, I just want to make certain that they do not end up becoming the group who ends up with the short straw, a draw they never got a choice in voted for.

 

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June 22, 2015 · 23:57

The News shows its limit of English

It was Sky News that showed a dangerous escalation as per next year if the Conservatives do not change certain parts of their immigration plan. Even though this is now all over the news, the BBC reported this in Feb 2012, it is only that this administration will now be confronted with it. So could this government have made such a blunder?

It is the Guardian that produced the most disturbing quote (at http://www.theguardian.com/society/2015/jun/22/new-immigration-rules-cost-nhs-millions-nursing), stating “Employers have had since 2011 to prepare for the possibility their non-EEA workers may not meet the required salary threshold to remain in the UK permanently.”, as I see it, that quote boils down to “You have 4 years to get rid of them, or get them nationalised“, which is saying a bit much!

Yet, when I look at the immigration rules appendix i (final) i see the following at section 245HF

At (d)(ii)(1) it states:

(1) At or above the appropriate rate for the job, as stated in the Codes of Practice in Appendix J, or

After which we get the 35,000 pound issue, so when we look at appendix J (at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/420539/20150406_immigration_rules_appendix_j_final.pdf) we see the following: on page 18 and 19 we see category 2231 Nurses (the appendices are attached to the story).

So the question becomes, what were the papers making noise about? Sky News, the Guardian, Daily Mail, et al. Is it me, or are they just starting a needless panic?

Section I (at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/420536/20150406_immigration_rules_appendix_i_final.pdf) states: “Pay requirements which the Secretary of State intends to apply to applications for indefinite leave to remain from Tier 2 (General) and Tier 2 (Sportspersons) migrants made on or after 6 April 2016”

Then on page 2 we clearly see the issues reported.

Let’s go by the booklet:

  • First (a) no unspent convictions (so no criminals, makes sense….yes?)
  • Second (b) no general grounds for refusal and no illegal entrant (again, makes perfect sense)
  • Third (c) have spent 5 years lawfully in the UK, which was always a requirement, and in any combination of the following:
    As a tier one migrant, excluding the Post Study work, or the Graduate entrepreneur.
    As a tier 2 migrant (general migrant); the bulk of all nurses will be a tier 2 migrant.
  • Then this person also needs a letter from the sponsor (their boss) that they still require the applicant (basically that this person has a job, which as a nurse is pretty much a given).
  • In addition to this that the applying migrant is paid at or above the Codes of Practice in Appendix J, which gets us to the other appendix (J) which clearly states that a nurse does not need to make 35,000 pounds.

So can anyone tell me why these papers were not read correctly by the writers of the stories (or their editors for that matter)?

The paper clearly indicates that this is the situation with all nurses for 2016. So why are these publications stirring panic amongst the nurses?

Perhaps the journalists are not British citizens and they failed provision 245HF (f), where it states: “The applicant must have sufficient knowledge of the English language”

OK, that was a mean statement to make, but in this day and age where doctors and nurses are nervous enough, adding silly levels of stress are just a little bit too silly for words in my slightly less humble opinion (just for today).

On the other hand, if there are new revisions and I was unaware of them (basically I had not found them at the GOV.UK site), I will be eating humble pie and upgrading this story as soon as I am aware of it.

20150406_immigration_rules_appendix_i_final

20150406_immigration_rules_appendix_j_final

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June 3, 2015 · 19:18

Dr Temp MD

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

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

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

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

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

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

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

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

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

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

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

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

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

Back to the NHS issue we go!

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

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

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

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

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

 

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May 2, 2015 · 00:03

Oops we’ll do it again

That is the image the British Labour Party is handing down to the people, via the Guardian I might add (at http://www.theguardian.com/technology/2015/may/01/labour-nhs-health-data-liz-kendall-election). You see, the article gave the view of a politician, which is fair enough, which it all seems to be, a tech driven article (it was in the tech section, so that makes sense).

The issue here is not that this Labour lady with the name Liz Kendall for Leicester West is all pro data for the people, she seems abundantly ignorant of the complex nature of this dimensional behemoth called data, which is very much an issue. So as we take a look at certain statements let us also look at the other side of them. “Citizens should have control of their own health data“, really? Health data is there to help physicians and health centres to get aid the most efficient way to the people they need to care for. Then we see an introduction of two paragraphs where she whinges on parliament and how things are outdated. Then we get the quote “Technology has been neglected by every party in this election. Even the Conservatives, who published a simple but compelling technology manifesto in 2010, have failed to follow up for 2015. And Labour, which has been working with some respected UK technologists for months, developed a slate of compelling ideas that failed to make it into its manifesto“.

Well, let me help you here Liz! Your own party wasted well over 11 billion pounds (yes billions, not millions) on an IT system that never worked and never went anywhere. This administration is trying to clean up a mess and get rid of a 1.7 trillion pound debt, pushing more billions into any place that is not carefully thought through in this day and age is a really bad idea. Did I mention that is was British Labour spending those many billions on something that did not work?

Then we get a real beauty (after more generic information) “Tech is crucial to tackling inequality and giving people life chances, as well as getting the best value for public money. We should be open about how the government works and every department should be thinking about how it can use technology. We have to take technology into politics“. Here she misses the ball on several attempts by a massive margin I might add. Inequality is only tackled if people are properly trained, if the HR departments of those places are properly dealt with. Tech is not key here, data to monitor inequality is, but that is a sub article for another time. Taking technology into politics is debatable, first of all many politicians are not that tech savvy, so getting them automated might ruin more things, behind that there is the quashed reality is that tech is nothing more than a tool. It is a tool we use, not a golden calf we worship. Tech is not a solution, it is a mere means to get the place we used to go, but more efficient (we hope).

Then we get the ‘outlier’ in all this: “She is more animated about the potential of technology in the NHS. Kendall talks about visiting a constituent who suffered with the lung condition COPD that was significantly improved by a trial of tele-nursing. Rather than hospital visits and being on oxygen 19 hours a day, Clive Callow was monitored in his own home with data sent back to a team of specialist nurses who advise on adjustments in his treatment or visit him at home“, Yes Miss Kendall, you found an application, so how many patients per hospital need to be in a hospital on oxygen 19 hours a day? Without needing any other treatments or care? You are promoting tele-nursing on an outlier. This is really not that bright.

Let’s be fair, for this one person it is a nice thing, but if there are any complications, a doctor would be needed really fast, then how good was the solution? Then we get the Kidney dialysis ‘scheme’ as Liz Kendall points out. She has a decent point, yet when we see the information from britishrenal.org we get: “The number of patients on home haemodialysis is slowly starting to increase as the hospital kidney centres become more able to provide and support home haemodialysis and kidney patients are choosing to do their own dialysis at home. However there is large variation across the country“. It is the large variation that is the issue! Now, in all fairness, she is targeting a group that is set at 41%, which makes for well over 21,000 people, so it is not a small group and in that she has a case, but there is a long stretch of ‘teching’ things and ‘series of successful digital skills training courses’. These are all different sides of different coins and they are not the same currency either. So, the Dialysis option is fair enough and giving the hospitals options here is all good and fine, but this means more technical staff (high educated ones) medical technical staff and implementers. This will drain the NHS of other staff members. So the logic is missing here. I a world where the UK does not have a debt, is not in ‘near’ recession mode that idea is fine, but the NHS has massive issues, adding to them will not help.

How could I agree?

Well, for the options where there is a much higher renal issue, I would state, have 5-10 extra machines and 5 extra nurses and one extra doctor for THAT specific department. Guess what! Her tech people will not get a job and there could be other resource draining too, but it would secure a better position for 22,000 patients that is a real number we can deal with. But what is the price tag at this point? The NHS has the need for massive funds and tagging certain amounts for dialysis alone might not be fair (not stating that it is or is not, I just do not have all the numbers to make that call).

Now we get the next bit “And the CLASH project in Leicester helped an arthritis group learn how to use digital communication tools like Skype, which, says Kendall, helped to tackle the related depression and isolation that often affects sufferers“. Again a nice part, but that is not for the NHS. Getting locals with arthritis on a communication streak is not one I oppose but it should be with the responsible place, not the NHS. Yes, there is an NHS benefit (fighting depression) but we need to be clear about what can go where and how it can be implemented to work, not to cost money and to be forgotten 14 months later because of a costing error. She ends that part with “NHS has a huge incentive because treatment costs a fortune“, Yes Miss Kendall, it might cost the NHS, but so was the 11 billion for a non-working IT system which Labour fumbled.

Now we get to the ‘initial’ issue on health data. If you look at the possibilities of monitoring data about genetics and susceptibility to diseases, then there’s an even stronger argument for a national health service, because the principle of owning and controlling your own data, for example, is really important, this is the stuff of ‘legends’. Actually it is not, this has all the makings of a tech consultant speech, which comes with commission for him/her and massive costs for the NHS. When I read tech, monitoring and ‘susceptibility to diseases‘, my initial response is, ‘Are you for freaking real?’ The statistics, the data collection and the comparison is way outside of any budget, especially when you start collecting up to 65 million records. You see, there is a low tech solution that has worked. It is called Triage which has been around since World War 1. There is also Reverse Triage, these two require two elements and they require doctors and nurses (and equipment as the third element). We are for now in an age of debts, in here ‘susceptibility’ is a nice concept but let us focus on the ACTUAL sick, getting them better and making sure the NHS has a decent system to keep track on the actual events, not the forecasting of the possible but improbable. There we see the issue, what other ‘concepts’ would Liz Kendall like to waste money on?

I’ll be frank, the concept is not bad, it would not be a wasted effort under different conditions, but in this time and age and under the austerity we still face, giving it to some tech savvy scheme that is supported from a consultancy field is a really bad idea, I would rather see more doctors and nurses and less wasting billions for now.

She basically ends with having a go at the conservatives, which, as a Labour person she should be allowed to do (fair is fair), but she needs to realise that Labour has zero credibility when it comes to ‘tech’ projects in health care. The NHS needs change, it must evolve and as we see the claim “We have an ageing population, elderly people ending up stuck in hospital because we don’t have community nurses and social care to look after them at home“. This is a fair claim, but guess what! These people will end up being dead at some point! It is not a wish, just a simple reality. Yes, there should be more community nurses (not just in England), but the politicians have wasted tonnes of money, the Labour party being one of the better wasters of resources in that regard. Change must come, we all agree there, but without funds and trained staff that solution will not be easily solved. The only thing that Liz Kendall achieved as I see it, is to give chunks of fuel to Stuart Young, the UKIP member in her electorate. I would hope that the conservatives would make it a real battle, yet at present, I am not impressed with Paul Bessant. The generic information of a ‘successful businessman’ just does not cut it nowadays (as I see it). Stuart Young, a bookkeeper and as he states, devoted to Leicester, a Westcott’s man. with his one line “Westminster’s politics and economics are fundamentally flawed and they need a complete overhaul” he does two things, one he speaks a given truth to which pretty much every British person can relate, in the second, he blows the entire Liz Kendall element of ‘Technology can stave off the crisis in the NHS‘ out of the water. The title is not only realistic, the elements that need fixing will take 3-4 years and can only be done one step at a time, more important the second step is not even an option until the first step is successfully completed, the NHS is THAT limited on resources. I cannot claim that either Stuart Young or Paul Bessant would be a good choice, but the article gives proper weight to how bad Liz Kendall would be.

However, that is just my view on the matter, so feel free to disagree!

 

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April 19, 2015 · 10:47

The economy of change

It is now three months to the day that I wrote ‘A seesaw for three‘, in there I spoke about the Swiss Franc and the changes they decided on. In that article you can read: “So the SNB decided to abandon the ceiling on the franc, in response, the spring-loaded franc shot higher“, makes perfect sense. Why should a nation with a relative low debt hold this much in risk? So now we get a new dance! “The SNB’s decision to suddenly go back on a previous policy it had claimed to be committed to will make markets think twice before taking the bank at its word“.

This was always the issue, why should nations with relative low debt pay for the short sightedness of the incapable? In addition, the claim ‘The SNB’s decision to suddenly go back on a previous policy‘ is also a loaded part, you see, as we see with Greece at present, it seems that policies are not being kept all over the field, even now there is an implied orchestration to let Greece ‘kinda’ of the hook. The words of Christine Lagarde for creditors to go ‘soft’ on Greece is not helping. Then there is the thought I offered with: “Perhaps the question that Katherine Burton (the writer) at Bloomberg should be asking is “How come such managed levels of foreign currency holdings were left out in the open to this extend, especially after the Cyprus issue”“.

The day before that one, I wrote ‘Year of the last Euro?‘ (17th January 2015), there I stated “previous administrations lived under some umbrella with the picture of a sun, which they took as an eternal summer! Instead of caution, they ignored basic rules and just went all out on a spending spree. Now that all the money is gone, the coffers are instead filled with ‘I OWE U’ notes. When every nation spends more than they are receiving, no one will have any money left, yet governments started to borrow to one another. So, those in debt were borrowing massive amounts to one another, even though no one had any money, is no one catching on?”

I saw the writing months ago, which is why I have been hammering on the Greek issue, it should not be prolonged, and there should be no ‘alternative‘ or a ‘continuation‘. Now we get the Guardian (at http://www.theguardian.com/business/2015/apr/18/us-interest-rates-rise-federal-reserve-market-crash), the subtitle ‘Janet Yellen’s decision will have global consequences – and the end of ultra-low rates could mean meltdown for indebted countries‘, whatever are you saying Mr Bond?

I have stated again and again that those in severe debt will feel the consequence at some point. Now we see the increased risk that interest rates will rise. Yet again we see dismissals, now from Olivier Blanchard. Was he not the one who came up with “Rethinking Macroeconomic Policy” (at http://www.imf.org/external/pubs/ft/spn/2010/spn1003.pdf)?

So are we witnessing the start of targeted inflation? The quote that Olivier makes “companies may have hedged their position, while investors and finance ministers were well prepared“, well, in that regard, my response is: ‘companies that are credit maxed are never hedging positions, an elemental truth at times and as for the preparation of investors we can argue that they are usually geared towards greed (relying on a 15% turnover in a 3% world) whilst in addition, finance ministers on a global scale have been pushing things forwards for a long time, relying on the sun returning the next morning. This approach works for a week, but after 157 weeks of clouds, those finance ministers tend to project sunshine from memory, forgetting the reality of the sun’. If you doubt this then consider the list of finance ministers who correctly kept their budget. I tell you now that this list has diminished to zero for some time now. Some even exceeded their budget shortage through managed bad news, a growing trend all over Europe.

In illustration the IMF wrote in regards to the possible financial crash “It highlighted how any shock can send investors fleeing; with only sellers in the market, the price keeps plunging until someone believes it has gone far enough and starts buying“, yes this is how the rich get to be even richer, my immediate concern is the dangers that superfunds and retirement funds are sitting as they might be facing another 15%-30% write off. I wonder how people feel about the consequence of their retirement funds collapsing again and now they will have to work until they are 75-80.

So, is this realistic? Am I in an evangelising ‘panic’ mode?

One might think this, but if you have followed my blog, I have consistently written over a period exceeding a year that the first need was to diminish government debts. It was the number one issue that had to be dealt with, nothing else mattered, because those without debt would get by and those in debt will get a massive invoice. Now we see that danger. So the initial quote that the Guardian had “higher interest rates in the world’s largest economy could come this year” is not just a fab, it is a reality that will push interest payments to new heights. Did Switzerland foresee this, or were they just too unhappy with the risk the Euro had? No matter what, their act seems to have been a good one and releasing the debts they were holding onto is now a second need.

There is a side that seems slightly offensive to me. When we consider “But while it is almost certain Turkey, Brazil, Russia and many others that have seen their businesses and governments borrow heavily in dollars to maintain their spending will suffer higher borrowing costs courtesy of Yellen“, is that true? Is it due to the courtesy of Yellen, or is it because the bulk of politicians cannot get a grasp on their spending spree?

Let’s face it, rates would never remain low and many are following the good news cycle that it will remain, that change is not good and as such, they forget that in their eyes rate rises are not realistic, but they do not control the algorithm. So here we all are, in a place where change is about to befall many, the outcome largely relies on your personal stability, which is a lot easier when your debts are down.

So where lies the economy of change in our favour? That is the true question that matter and I am not sure if I can answer that. I believe it to be dependent on corporations having a balanced realistic long term view. I am however uncertain to predict who those players are. Yet, if we take a look at British politics, we should consider the following; Ed Miliband states “Labour leader tells ‘one nation’ Conservatives he’s on the centre ground and will keep Britain at heart of EU”, how is that a reality? Then there is the quote “Miliband says the past 10 days of the campaign have seen the Tories become the “incredible party”, whose unfunded promises on everything from the NHS to transport and housing have turned them into the party of ‘funny money’“, so how does this relate to the economy of change?

Well, the simple matter is that Labour decided to spend 11.2 billion on an NHS IT system, that system never came, the money is gone and the NHS is weaker still. These are simple facts that you the reader can Google in any browser. There is housing progress, but not as much as many would like. In this time of change, Labour wants to spend more money, get the UK in deeper debt, now consider the US raising the interest by 0.5%, in regards to the 1.7 trillion in debt, that change could cost the tax payer an additional 8.5 billion, considering that the IMF claimed that the UK will be short 14 billion, adding to that will be a very dangerous act.

So will the economy of change require us to throw Greece out of the Euro? Will the change of interest topple France and Italy? There are too many factors, but there is certainty that the markets will be massively impacted once the percentage changes. Andy Burnham, the shadow health secretary, will come ‘He will cite figures in Health Education England’s (HEE) Workforce Plan for England 2015/16, which he says shows the service will be employing nearly 2,000 fewer nurses over the next four years – for reasons “mainly driven by affordability”’ This is a fact we cannot ignore, yet the fact that many sides are not willing to make the hard calls on certain NHS issues, does have an impact in all other quadrants, this includes nursing staff. So before Andy Burnham comes with the alleged plan that the NHS cannot survive another 5 years of David Cameron, perhaps Andy would like to look into his own party and find the plus 11 billion that they had spent on something that never came to be. I am certain that the cutting of nurses would not have been a reality if the 11 billion had not been lost to virtual plans that never became a reality.

The last of the pork pies can be found here: “Labour has set out a better plan to invest £2.5bn extra each year, on top of Tory spending plans, paid for by a mansion tax on homes worth £2m, to fund 20,000 more nurses and 8,000 more GPs.”, the current UK plan is at a deficit, so where is the 2.5 billion coming from? Mansion tax sounds nice in theory, but those places need maintenance too, which means plumbers, electricians and so on. Also, why keep on pounding the ‘wealthy’ places again and again? It is like the wealth tax. Stating on how the rich can afford more tax. The simple reality is, is that those making more than 1 million is only 6,000 people and roughly another 16,000 make £500,000 to £1 million. So how will you tax them? 60% addition? Where will you get the money to fund 28,000 health care workers? The idiocy of Labour as they make these claims is just too unwarranted. Now add to that the news from 7 hours ago that the interest rates could rise. Once they do, the deficit will grow even more.

So as we see these interactions of change, many of them not realistic, we need to realise that Austerity is here to stay for at least two more administrations, not because we want to, but because the increase of a mere 0.5% amounts to the bulk of all NHS costs, we might not survive a third increase, so we must fight now, so that we can all move forward sooner instead of never.

 

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April 5, 2015 · 20:29

The Labour Manifesto

Ed Miliband presented his Manifesto Res Rei. In light of what we here in Australia laughingly refer to as ‘the Labour party’, it seemed like a good idea to take a closer look at the speech. The full speech can be seen here http://labourlist.org/2015/03/miliband-launches-labours-business-manifesto-full-speech-text/.

So let’s take a dip into the claims pool.

‘Playing by the rules and paying the taxes that support our public services’, Really Mr. Miliband? So how will you solve the issues involving Apple, Google, Amazon et al? What measures are currently in play, what measures did Labour in its previous governing term put into play. I say naught!

The second part is found soon thereafter ‘With a government that balances the books, invests in infrastructure and works with you to improve skills and open up more competitive markets‘. The Tories are trying to get the books balanced, which means austerity. Labour had a massive hand in giving the UK that debt, so we can offer that Labour has no ability to balance books and the investment that they talk about will drive the UK into deeper debt.

Then the story changes a little and Ed Miliband goes into waffle mode. We see ‘despite the odds‘, ‘too many obstacles‘, ‘the lack of certainty about the long term‘ and my favourite: ‘Our productivity gap is at its highest level for nearly a quarter of a century‘. That last one is full of fun, because what is it based on? Weighted numbers, a lack of insight or the added anchor of virtual corporations?

Now he gets to the promise: “So we’ll balance the books and cut the deficit every year“, yes, how will you do that by investing and balancing the books at the same time? The current debt spring is loaded, because the UK has to come up 23 billion every year to pay the interest of the current deficit, so good luck with that statement, you do remember that your predecessor was cause to a massive slide in debt Mr. Miliband?

‘The struggle to find the workforce they need‘, which sounds nice in theory, but many corporations hire young unexperienced people to get away with what some want to slide under that table, when we see the issue where Ross Etherson, who admitted 21 counts of making or supplying articles for use in fraud, cost the NHS more than £37,000, Isleworth Crown Court heard, we clearly see that there are other issues at play, when we take the info from the BBC at http://www.bbc.com/news/10604117, we see that unemployment has steadily dropped under the Tory government. Now, I will in all fairness state that labour was confronted with the 2008 problems, but that mess was not properly dealt with under labour either. The mess left from their debacle 1997-2010 is still getting cleaned up half a decade later.

Now we get to the fishy side of it all: ‘It is a partnership for a purpose. We will give you control of the money for apprenticeships and in exchange we will say that any firm that gets a major government contract will have to provide apprenticeships to the next generation‘. How is this even realistic? Giving control of the money means that all kinds of accounting irregularities are likely to surface, then what? And in regards to ‘major government contract‘ and ‘provide apprenticeships to the next generation‘, how is that not discrimination towards the current aging workforce? In addition, we see that there are situations where apprenticeships are not a solution in the first place, which is just the reality. Consider a new frigate that is getting build with 500 engineers and 10 apprentices on the job, how many delays and what security breaches could the new frigate face? So not apply this rule to all fields? That is just a mess waiting to explode in the faces of those proclaiming it to be a solution.

Then we get (after another wave of waffling by Ed Miliband) ‘the priority for business tax cuts‘, yes, that has always been a good idea, especially as Google and Apple seem to pay 0.1% in taxation. How about infrastructure? Ah, that is next, where we see: ‘That’s why we’ll follow the recommendation of Sir John Armitt and set up a new independent National Infrastructure Commission‘, yes, spending more money on something that will not prove to be a solution, whilst the UK is down a trillion, so at this point, after we saw tax cut and infrastructure and invest, let us remember the earlier promise “So we’ll balance the books and cut the deficit every year“, which I see as:

  1. No balancing the books
  2. Increasing, not decreasing the deficit.

Now we get to the ideological part, which Ed Miliband is of course entitled to: “There could be nothing worse for our country or for our great exporting businesses than playing political games with our membership of the EU“. that is partially true, yet as the EU is unable to muzzle Greece with their flim flam rock band approach of not dealing with their debt and whilst several players are now willing to push Greece into deeper debt, both the UK and Germany need to realise that Greece is getting their credit for nothing and their luxuries at the expense of the other EU nations. How long until it is just safer to let the rest of the EU drown in their inactions against Greece? Which by the way has every likelihood of pushing both Italy and France over their maximum debt threshold, which has massive implications for any member remaining within the EU, all because no one was willing or able to stop Greece?

Now we get back to part of the speech that is an issue ‘Two years of uncertainty in which businesses will not be able to plan for the future‘, how about the fact that most of Europe in a denied recession, due to massive debt dealing is not the way to get any level of certainty? In the Netherlands, unemployment is at 7.2%, In Belgium it is 8.5% and in France it is at 10.4%, so when we look at what business options there are in Europe, we will see a cold turkey that comes home to voluntarily roost in the oven at 190 degrees, because the crispy warmth is loads better than the cold outside, even if the turkey is about to get eaten in the process.

If there is ONE business plan, that that would be the one, where the UK gets by for now, trying to grow, but most importantly is reducing the debt it has, so it does not have to fork out +20 billion in interest to banks for money the Labour party had spent.

So as he goes on reminding us on ‘We need to be a country that rescues our NHS with more doctors and nurses‘, yes, we all remember the NHS 12 billion computer scheme, that did not go too well for all parties involved, perhaps listening to others would have helped the Labour party heaps, but that was in those days never an option, so why trust them now? so the phrase ‘Not what we have seen over the last five years where the NHS slides into crisis‘ is a little misplaced as it was Labour who did messed up 12 billion, an amount that could have kept loads of nurses into jobs and grown the NHS. It was not meant to be!

So when we see the following quote: ‘To carry on with a Conservative plan based on the idea that as long as the richest and most powerful succeed, everyone else will be OK, or a Labour plan, a better plan, that says it is only when working people succeed that Britain succeeds‘

We ought to consider another option. To cut drastically on medical services for those on drug and alcohol based events. These people only get treatment if they can pay in advance for treatment.

Let’s take on the binge drinking issue heads on!

Those who fail the first two parts are thrown into a drunk tank like in the old days. If they die, well that is just too bad, we can blame the parents, we can rejoice on a growing number of available housing (the deceased do not need them) and the nations has even more jobs available and the cost of the NHS goes down.

Now, it will be fair if you disagree with me on this and I admit that this step is hugely inhumane, but consider: these people cost the society 21 billion on an annual base, which includes the 3.5 billion to the NHS. To protect the victims of their crime and violence, they will be remanded into prisons/work houses. So, you see, production will be better off if we change that workforce too!

Yes, I agree it is inhumane, but why must the people at large suffer for those who think that the rules do not apply to them? I have no issue with these people receiving treatment, however, if you are so willing to binge yourself for £39-£69, you can either fork out the £78 for treatment, or sleep it of in a drunk tank, either way, we reduce spending on NHS, which helps towards the actual spending balance Labour is actively ignoring.

So as I ended the look at the Speech of Ed Miliband, I must conclude that it reads political and in addition, decently devoid of realism. Which is a shame, because UK Business is in dire need of realism, which means the solution will come from somewhere else.

Which now gets us to part two of this event. It seems that Nicola Sturgeon is all about getting Labour into No10. It sounds nice, but how is the Scottish National Party any help there? Now, it is fair that they feel a lot more comfortable with their future if Labour is in charge. It is a valid call to make and it is theirs to make it to begin with. Yet, we must not forget the issues that Scotland is already short 11% on their budgets and with oil prices the way they are, their independent future is a lot less certain. This is a shame and I mean that. I was all in favour of Scotland attracting all kinds of Businesses from all over the Commonwealth to grow their economic footprint. I am still reasonably certain that Indian generic medication could grow all over Europe if they have a foothold in Scotland, which allows easy access to places all over Europe. With Oil being a problem and not a solution, other fields must be tackled to grow Scottish interest and the Labour party is nowhere near able to help Scotland there. If we revisit the issue of balancing the books, it will take less than 6 months for Ed Miliband to find way to move business out of Scotland, just to make his side look better, I wonder if Nicola Sturgeon is realising the trap she is setting herself up for.

So if we look at the Guardian article, which is less than 24 hours old, we see ‘Scotland’s SNP revolution terrifies the main parties’ (at http://www.theguardian.com/commentisfree/2015/apr/05/scotland-snp-revolution-terrifies-main-parties), which is an interesting light to see after the Labour-SNP link. There is one debatable quote that caught my eyes was: “Underpinning these analyses is a barely concealed narrative of contempt, which says they will all come to their senses when they realise there will be no land of milk and honey in a Scotland under the absolute control of the SNP“, this is fair enough, but I do not think that this is due to the SNP, I firmly believe that independence too late saved Scotland, if Scotland had been independent whilst the oil prices went into the basement, the damage would have been unimaginable. I remain in faith that growing business in England and Scotland is the only solution, it will be important for both (mostly Scotland) to look at fields they had not considered before. The Indian generic medicine growth is only one branch. The open remoteness (hence securable locations) Scotland has to offer, could spell interesting times for any manufacturing option that does not require the pressure of London, with added benefit of the lower costs that Scotland brings. Consider the Ferry from Scotland to the Netherlands, opening additional paths of revenue. Scotland can grow options, it is just the question whether the Labour party is truly a solution here.

So as we all get to ponder the choices the voters face for England and Scotland, I do hope that they will all look seriously at these flimsy speeches that rattle on all sides. This applies to all parties, not just Labour!

 

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January 2, 2015 · 10:54

Misrepresentation

That was the first word in my mind when I looked into the Guardian seeing the following headline ‘NHS cancels 3,000 operations in two December weeks‘ (at http://www.theguardian.com/society/2014/dec/28/nhs-cancels-3000-operations-in-two-december-weeks), it is not the only NHS story in the Guardian and to be fair, there has been an awful lot of bashing of the NHS, not entirely in an unfair way, but it has been in a very misrepresented way.

I have written about the NHS a few times, with the main reason that whatever hits the UK, will hit Canada, Australia and perhaps even New Zealand, later if not sooner. The small inserted text “The figures, highlighted by Labour” is entirely an issue too. Perhaps the Guardian might also want to illuminate that part of all this is DUE TO the actions of Labour, not just illustrated now by Labour. It all starred in the age of Blair, perhaps not the most unknown Prime Minister of the UK (1997-2007), followed up by former Prime Minister Gordon Brown who continued the mess from 2007 to 2010.

So why blame them?

Even though the project started in 2002, during these three administration cycles, that project was blown in access of well beyond 10 billion with nothing to show for it. 10% of that fund could have prevented well over 80% of all current NHS issues. So, I will state that Labour might not have started this mess; they definitely were in the midst as it got bungled again and again. When we consider the September 2013 article (at http://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn), where we read “CSC’s contracts could not be cancelled because a legal challenge by the company may well have succeeded, the report claimed“, we can see that this issue was bungled in several departments, the IT branch not being the smallest one.

Yes, we know, we see and we all feel that any NHS system costs us, but this fiasco is beyond the entire budget of the Ministry of Transport for 2015, so we can say that there are issues. Whatever we will hear in defense regarding how things must move forward, the current administration is still cleaning up the mess of Labour, best way they can (with emptied coffers), so the sanctimonious highlighting by Labour (not unlike the current acts of Labour in Australia), should be looked at with some contempt. When the previous landlord sells the garage, he does not get to remark on how less ‘clean’ the car is, when he had removed the shelter in the first place.

When we see the quote ““To reduce pressures on hospitals and to keep a flow of patients coming in and leaving hospital, we need to manage the number of available beds more efficiently. To achieve this, we need to reduce unnecessary admissions and visits to A&E and improve community care.”“, we should add to that that the system was meant to be better by having an actual system. When we consider a previous made quote “Dr Mark Porter, chairman of the BMA, says £20bn savings drive to blame, as doctors and nurses are made redundant“, we must now remember that wasting in access of £10bn for a non-working IT system has everything to do with that part. But that is only one factor.

For the next part I need to refer to a decent article in the Independent (at http://www.independent.co.uk/voices/comment/the-myth-excessive-government-borrowing-got-us-into-this-mess-8601390.html). There we see the following: “In fact, government borrowing did not get us into this mess. As we shall see, the last government did not borrow excessively, whilst the recession was a consequence of overleveraged banks and the collapse of the US housing market. The banks overextended themselves in poorly regulated financial markets, indulging in high-risk lending in the belief that a housing bubble would never burst“, this is absolutely true, yet not entirely correct. consider in 2008, Gordon Brown was handed a lemon for sure, yet, the strong measures that should have been taken, like cutting back hard, especially in late 2009 onwards, were also absent. The article has a few other ‘represented’ events that are true, yet incomplete, you see, no one will deny that the banks were all at fault for the bulk of the mess, yet harsh acts afterwards were mostly none existent, moreover, many of these big wigs went home with a golden handshake a fat donation to their bank account and enough to buy a ‘St James Hamper’ for all the members of their family (Catalogue Code: 2099429 at http://www.fortnumandmason.com).

So when we see the current Labour highlights, we need to take a few more details into consideration and can we agree that those issues were absent in this article?

So when we see the very premature promise of “He pledged Labour would invest an extra £2.5bn in the NHS each year, resulting in 20,000 more nurses and 8,000 GPs“, we need to consider that the bungles under labour had costed many of them their jobs in the first place. The NHS still needs a much better IT system then it has for now and until this is completed these issues will remain, trusting labour to get the job done is really not a good idea. We could misrepresent that we currently have well over 10 billion pieces of evidence to make that case. I will let you mull over any contemplation in that direction of financial deficit.

By the way, when considering that part, we must also consider Wednesday’s article (at http://www.theguardian.com/society/2014/dec/31/sexual-violence-soars-uk-hospitals), there we see security issues of several levels in the Guardian, now reread the issue from December 28th, at that point, these issues would have been clearly know. There is no mention of security or upgraded HR needs; just nurses and GP’s, so how out of touch is a three day old statement that did not consider known details at that very moment?

I see this as an out of touch Labour government that is highlighting and promising, yet the highlight is incorrect, the promise in inaccurate, perhaps even insincere and all of this in completely unrealistic (personal note: it sucks to be Labour at present). This is the view from Labour, whilst only looking at the issues that are touching the NHS, one of the most important issues that will remain around in the coming decade. I hope that the siblings of the UK (Read: Australia, Canada and New Zealand) take these thoughts into consideration, because if we ‘the Commonwealth’ in the upcoming age of IP want to survive, we need to up the game in several areas buy a lot! In this regard IP is not just a piece of software; our Intellectual Property is not just software (even though it is largely regarded as such). If we consider that the mind is the software of the brain, we need to rethink the premise that Big Business has forced us to make in the age where ‘they’ had set the target, the premise and the consequence. If we take the basic approach where ‘the Turing test is a test of a machine’s ability to conclusively show intelligent behaviour that is indistinguishable from a human being’, can we make a similar statement that ‘a system’s adherency to set and cater to a rule of definitions, which in turn allows servicing the need of a community’?

 

So what if we invert the current situation as we might see in the paper by Alan Turing ‘Computing Machinery and Intelligence‘ around 1950. Our systems have been exceeding the ability of those computers for a long time, yet as technologists have been greed driven into a iterative release of hardware (and software), we ignored use of innovation in UNIX (or LINUX or SE-LINUX), to truly drive productivity as large players like Microsoft, to cater to profits forced business to take a step back, to be the sheep carrying the pay checks for these large corporations. So as we stare at the words of Alan Turing and as we look at the words of cognitive scientist Stevan Robert Harnad, where we wonder whether a machine can act indistinguishably, we all forgot (an implied assumption by me) about the part, ‘can a system truly cater and flexibly work under a premise of security as it caters to the need of health officials’, so that they can focus on treating and curing. A system bogged down by consultants and speculators on how it ‘must’ be, whilst ignoring the small academic innovators on how it actually could be.

Whilst dishing billions to a company with a legal challenge, we all should have looked at the future of IT as these minds were shaped at universities. The technologies required were never with the people in office now, they learned the previous iteration of technologies, the actual innovators are at university now and catering into that direction at 1% of the cost is more likely a solution then the one not delivered at present. Consider for a moment the PDF (at http://www.england.nhs.uk/wp-content/uploads/2014/02/rec-man-pol.pdf). Now, there is nothing wrong with the entire approach to the document, yet at 5.9.12 we suddenly see “Be aware when redacting Microsoft Word documents electronically by using the black highlight text tool as this process is reversible. A Microsoft Word file converted into PDF can be easily read merely by copying if from PDF back into Word” suddenly we see that Microsoft is just part of all this, a ‘simple’ formatting is now a Microsoft based guideline. Why?

At 5.18.1 we see: “A secure drive (S:drive) has been created to hold such data and staff should contact openservice@atos.net to request a secure folder“, so this goes via a French multinational IT services corporation headquartered in Bezons, France, making 10 billion in 2013? How much of that revenue is coming from the NHS, and why is this cost not going through a British company (seems like an awfully simple question to pose). By the way, one other thing to notice is that the Glossary after page 27 shows the term ‘metadata’, yet the document itself leaves the term metadata unused, which refers to Protective marking, only discussed in Appendix D, where it is mentioned to the minimised extent. Although this document should not be seen as any representation of NHS IT (the document is actually a very decent piece of work), it should leave us with several questions, we might not get an answer to, if not for the now, then definitely towards the goal the NHS must steer to if it wants to survive beyond 2015, just adding funds will not do, and the funds Labour offers are those they have no access to until after an election, which will then be the funds that are non-existent as the present shows.

So where should we look when we are confronted with these misrepresentations (as I see them)?

I am not telling, just asking!

 

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October 28, 2014 · 22:36

They don’t know what they do!

The article started funny enough. The headline ‘Leaked universal credit memo shows jobcentre staff struggling with rollout’ gave me a clear indication that this is another one of these, let’s get into a world we do not understand (at http://www.theguardian.com/uk-news/2014/oct/27/universal-credit-leaked-memo-scheme-rollout).

I admit that my words here are presumptuous, but I have seen this before, to be honest many of us have seen this before. There was the NHS with 14 billion plus wasted and there were a few other projects, all gone down the drain. So, why can’t some people get their act together?

The first quote is likely the most offensive one, especially in my eyes: “The DWP had promised to have 1 million people on the scheme by April 2014 but, dogged by delays and tens of millions of pounds of IT write-downs and write-offs, the original timetable has been scrapped. Just 15,000 people are on the system“, you think what is wrong with this picture. Consider a $389 notebook, not a great piece of equipment, but I can install a variety of SQL products and have these filled with a database containing the population data of Poland in about an hour, so why do we see a system with only 15,000 records? (intentional trivialisation was used here)

When we get to the timeline (which by the way was not chronological), we see several issues. Let us take a look at them.

28th April 2013 – Trial begins for Universal credit (UC), which is covered in the Welfare Reform Act 2012 (at http://www.theguardian.com/politics/2013/mar/31/liberal-conservative-coalition-conservatives)

Universal credit introduced.
The new in- and out-of-work credit, which integrates six of the main out-of-work benefits, will start to be implemented this April in one jobcentre in Ashton-under-Lyne, Greater Manchester. The aim is to increase incentives to work for the unemployed and to encourage longer hours for those working part-time. It had been intended that four jobcentres would start the trial in April, but this has been delayed until July, and a national programme will start in September for new claimants. They will test the new sanctions regime and a new fortnightly job search trial, which aims to ensure all jobseeker’s allowance and unemployment claimants are automatically signed onto Job Match, an internet-based job-search mechanism. Suspicion remains that the software is not ready.

The issues are as follows:

  1. ‘Will start to be implemented this April‘, this means that the system had been prototyped, this means that the software has been tested and that the interface has been tested by users, so that a nearly clean version goes online.
  2. The information ‘Suspicion remains that the software is not ready‘, should have been a very clear indication that the brakes had to be applied and at this point, investigations on the entire track should have commenced.

24th May 2013 The Major Projects Authority review expresses serious concerns about the department having no detailed “blueprint” and transition plan for UC (at http://www.theguardian.com/society/2013/may/24/universal-credit-danger-failing-whitehall-review)

Universal credit in danger of failing, official Whitehall review says
The first official government admission that Iain Duncan Smith’s flagship plans to remake the welfare state has hit trouble emerged on Friday night when the Cabinet Office’s review of all major Whitehall projects branded the universal credit programme as having fallen into “amber-red” status, a category designating a project in danger of failing.

You think? How about, the issues shown after a month when there were already doubts we see an utter lack of commitment, there is no other way to describe it. When I see the quote “Francis Maude, the Cabinet Office minister, hailed the publication: ‘Major projects need scrutiny and support if we are to succeed in the global race’“, which in my book comes across as ‘only silent scrutiny is allowed. This project is too big‘, which in my eyes is nothing less than a joke, one the taxpayer is paying for by the way. I must also clarify that this is how I initially read it, not how Francis Maude stated it, he seems to want accountability, so do I, it is just too convenient that many involved are not named at all.

In addition we see “An MPA rating of amber-red will anger the DWP, which has insisted that universal credit is on time and on budget” furthermore we see “Data has been exempted from only 21 projects in the review by the Major Projects Authority (MPA), where disclosure would damage commercial interests or national security“.

So now we get the following:

  1. Who at the DWP had made that statement? We want to see his name and his dismissal; I say again dismissal, not his resignation.
  2. Was the same person making the claims in regards to October 2013? This means that we were at that point faced with two delays on a pretty expensive endeavour. More important, until now, there has been a slacking handle on this project, which is likely to be only one of many.

Now we look at two events:

5th September 2013 A National Audit Office report reveals ministers have written off £34m on failed IT programmes and the launch may be delayed beyond 2017 (at http://www.theguardian.com/politics/2013/sep/05/david-cameron-24bn-universal-credit-problems), where we see ‘David Cameron’s £2.4bn universal credit project riddled with problems‘, so the entire UC is more than just a few pennies and we are not seeing any accountability, no criminal charges and no product. We can look at the quote, which is “The National Audit Office said universal credit, the £2.4bn project meant to consolidate six welfare payments into one, has been beset by ‘weak management, ineffective control and poor governance’“, I am about to call it something else entirely.

31st October 2013 The Guardian reveals ministers have been presented with a radical plan to restart UC and write off £119m of work over the past three years (at http://www.theguardian.com/politics/2013/oct/31/universal)

Now we see the following additional quotes “Ministers attempting to put the troubled universal credit welfare reform programme back on track have been presented with a radical plan to restart the scheme and write off £119m of work over the past three years” and “The risk assessment warns that the plan to start again, the ‘design and build’ web-based scheme, is ‘unproven … at this scale’“. It says the plan to fix three years of work on universal credit is still “not achievable within the preferred timescales“, describing it as unrealistic”

These two give us the following:

  1. If we revisit “In March 2013 Duncan Smith told parliament that universal credit ‘is proceeding exactly in accordance with plans’“, then why on earth is Duncan Smith in any government building? If we look at statements from Margaret Hodge and the NAO, there is a clear indication that extreme sanitisation is needed at the DWP, the fact that this multi-billion pound fiasco is still around at that time should give cause to many serious questions.

Just to make sure the reader understands the gravity of this situation, the bungling and wasting of resources at that point could have given nearly every current university student a FREE University degree, which is saying a lot, in addition, those studying IT, might have completed the project for the price of their education, which is saying a lot!

  1. Writing off 119 million of work delivered. A failure is not work delivered, who was minding the stores, the contracts as well as the targets that had to be met? The fact that the amount in the database at present (15,000 people) could have been achieved with a $99 program called Microsoft Access, so can we have the 118,999,901 back please?

When we revisit the September quote “The DWP said the department would continue with the planned reform and was committed to delivering it on time by 2017 and within budget“, we can clearly see that either the DWP has no clue what it was doing, or we have another echelon of people and their ‘goals‘ messing things up.

Are my assumptions valid? Well, so far I did not waste billions, so I am inclined to say yes!

By the way, who did the original costing, who presented the plan and what remains of the initial plan? Because a blowout of these proportions should be regarded as clear evidence that the thought might have been nice, but none of the deciding parties had any clue on what was being decided on (my evidence here are the squandered billions as we see them melting away).

You see, in the old days, in my life, designing a database system was relatively simple. It took 5 weeks and a few iterations of tweaking to get the customer this container system. It worked like a charm! That is what is needed here. People have been overcomplicating things by massive portions.

  1. Web based solution.
    Really? With all the intrusions, phishing and other forms of malignant issues, you are going to a web based option? Let’s be clear, this system is all about letters and numbers, so an ASCII based system, which in the old days it was called a DOS program. In this situation a UNIX solution should be sought, but the overall idea is clear. In addition, UNIX is much safer, better protected and scripting allows for evolution when needed. I knew a guy once, who created a scripted solution for product distribution for a global Fortune 500 company, it was one of the few innovative software solutions that actually worked and worked when most systems had to be upgraded, it worked on a Pentium 1 with 90 MHz, a system we now buy for $49 (if even for that much), It conversed with several dozens of locations.

Now, today, when we look at the UC, something bigger is needed, but the systems of yesterday are already 2000 times stronger than the initial system it was designed on, so we can clearly see that the spending of a few billion require a deeper digging, as well as a serious interview by the members of the House of Commons towards the involved members of the DWP.

  1. more web-based system
    “The risk assessment, dated 11th October, says the plan for a faster, more web-based system would involve writing off £119m of previous work, and cost the DWP £96m to develop. However, it warns ministers that they will have no idea if the web-based system will work until the summer of 2014 ‘when it is live for 100 claimants’“

And the laughter just does not stop here, ‘more’ web based system? The people here did not learn the first time? If you want speed, consider simple ASCII, with perhaps local formatted XML. You see, you get loads of characters across in mere milliseconds (36 characters including 10 numbers tends to be fast), and let us not forget, this is all set towards 6 systems, so you need speed. So only this summer was there any chance of knowing anything, so can we wonder again where the money went, because someone is getting pretty rich here and it is not me (alas).

In these two issues we see a reiterated failure, which gives a clear signal that the original design, which would have been BEFORE money was spend, should not have passed any hurdles as I see it.

When I think ANY project I see the following

  1. request
  2. design
  3. prototype
  4. finalise
  5. test
  6. implement

Now, I will admit that a large project needs a lot more, but these 6 steps for the initial trial should have been done in 90 days for 7 tests. One test of each system and the 7th to see one person collected on all 6 systems. Now we have a master that gets us trials where this simple program could be used to star testing everywhere and see if data comes across, yes, this is nowhere near finished, but in the foundation we see what happens if the data of 150,000 people gets requested, so now we know that data can be obtained and we see a timeline of speed and more important bandwidth, because that will be the killer. If we revisit the original time line where the plan was offered in October 2010, which means that this test could have been done before Christmas, so how was time and money wasted, because as we see the Multi Billion pound bill that would be the direct question evolving from this.

The complications
Yes, I am not ignoring this. A system with this much data access will need all levels of security and encryption, there is no denying this, yet using a ‘web-based’ approach seems to me that we might as well give a copy of all this data to the cyber criminals. There are always suite options of security, and yes that needs work, yet some local test could have been made, in addition, a system this vast will need all kind of implementation servers and trained support staff, steps that were not even anywhere near implementing, were they costed for?

When we see the timeline and the involvement from ‘interested’ parties, I cannot stop but wonder what could have been if the right people had sat down, because those involved screwed the pooch big time and the taxpayer can see the billions they have to cough up for a system that never worked.

We will end with three quotes all from the October 27th 2014 article.

  1. leaked Whitehall documents warned of a failing IT system, more than £1m in wasted expenditure, and how only 25,000 claimants would likely to be served by the system by the general election next year.
  2. The government has written off or written down £130m on the project, which is designed to revolutionise the culture around claiming benefits. It now expects 100,000 people to be on the system by May 2015 and for 100 centres to be involved in its delivery by the end of this year.
  3. When fully rolled out, UC will make 3 million families better off by £177 a month and lift up to 300,000 children out of poverty.”

From the three points we get the following, if the system is turning nuts and bolts at present when there are between 25,000 and 100,000, what complications will we see when the other 2.95 million are added, if we see the issues with less than 4% populated, what happens when the other 96% is added?

When we see the quote in regards to a couple not getting paid, whilst in addition changing their details took three months, we can conclude form the quote “The DWP said the couple’s claim had been delayed because the pair had failed to complete the correct forms. Responding to Dispatches’ findings, a spokesman told the Guardian: ‘Universal credit’s IT system is robust and effective, and we have trained 26,300 work coaches who are successfully providing new support to claimants to help them better prepare for work’“, well if there are 26,300 work coaches and there are currently 25,000 in the system, why did it take three months to correct this? In addition, how come the wrong forms were filled in, what was the cause of that? Should the system not have reported (almost immediately) that the forms did not constitute their current social status/predicament?

This is more than a simple failing; this system seems to lack basic foundations, especially with three months delays.

The sad part is that this is not the first issue we see, when we consider the NHS debacle which I discussed in ‘the second exploitation‘ on August 10th, how the NHS options resulted in a wasted 15 billion, whilst no one seems to take a deeper look at how such large amounts get wasted. Now with the UC we see a similar development, it would be so nice for someone in Whitehall to recognise the need for actual change so that squandering might be minimised be a lot more then it currently is.

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October 24, 2014 · 21:04

Where the Wild Geese go!

It is so nice to read about how the EU migration is a fact that is here to stay. The subtitle containing ‘56% support in Britain for remaining in union‘ gives a pause for thought, yet what pause should there be and who should be pausing (at http://www.theguardian.com/world/2014/oct/23/juncker-tells-cameron-cant-destroy-eu-migration-rules)?

Party 1, Jean-Claude Juncker on free movement of people and how this is not to be destroyed! Well, Mr Junker, that sounds like a nice option, but when the population of Poland, Bulgaria and Romania moves into the UK, the UK ends up having a massive problem, which is what it boils down to. When we see “three million people from Bulgaria and Romania living in other European Union member states“, we do have an issue to deal with. Then we see the quote “more than 60 MPs are backing a campaign to extend the restrictions for a further five years, saying the British economy has not sufficiently recovered from the 2008 recession to cope with the change and that it will put pressure on public services and reduce job opportunities for British workers” (at http://www.bbc.com/news/uk-politics-25549715), these two facts seem to be ignored by many parties. We see some papers on the let them in side and some opposing that view, yet none of them give us a clear number of who is coming from where and how many from all over are arriving in the UK. Let’s not forget that London is still the place to be (I know, because I still miss it). What the Guardian article only casually reports is the fact that the 56% comes from an Ipsos Mori poll. Now for the good stuff, this comes from 1002 respondents, whilst the UK counts 64 million. So which person signed off on that little part? Perhaps some should consider that anything like this requires a few thousand responses, like, more then at least 5000, not 1002!

Party 2, Alisdair McIntosh, director of Business for New Europe. Many seem to see the benefit of staying within the EU, well nobody is debating that, but you see, Mr McIntosh is speaking for ‘his’ lobby and those people need a level of non-accountability, people in movement are in many ways interesting for exploitation, this has been seen in the Netherlands where immigrants hoping for a new future, willing to work hard are exploited in most inhumane ways. In addition there are also the views on how the influx of immigrants also came with a large influx of smaller crimes (theft and pick-pocketing). The good and the bad is a given fact, yet business is above such accountability, not stating that they are accountable! So yes, Alisdair McIntosh likes the borders to remain open.

Party 3, José Manuel Barroso stated “What I can tell you is that any kind of arbitrary cap seems to be not in conformity with Europeans laws. For us it is very important – the principle of non-discrimination“, but is that really correct? (at http://www.theguardian.com/uk-news/2014/oct/19/jose-manuel-barroso-david-cameron-eu-migration), “the number of Portuguese looking to settle in Britain was up by almost ten thousand people last year, climbing to 30,120 official arrivals who were recorded at British national insurance offices“, which comes form http://theportugalnews.com/news/portuguese-workers-flood-britain/30837. So as we see, the Portuguese unemployment rates are going down, but how many from leaving Portugal and where else are they going to? So, we see that José Manuel Barroso has two hats on, one is still all about Portugal, which we cannot fault him for, but the information is unclear as many ‘hide’ behind percentages, when we see the mentioning of numbers the face changes, like 560 Britons willing to stay in the EU, but what do the other 63,999,440 want? You see, 1002 weighted is in no way a real usable number, not when it is compared to the size of a nation.

These clear thoughts give us two dangers

  1. What is ACTUALLY the best for the United Kingdom?
  2. These simple realities only enable the growth of UKIP (which is not really good for the UK).

Some numbers consider the NHS the most important issue, yet consider what the influx does to an already stumbling NHS, when this falls over, there will not be any support remaining, with all the consequences of those trying to stay healthy when the doctor is not available and those who need help will only get it for a fee, which gives us a clear view on the dangers for the future. David Cameron needs to stop the massive influx that the current infrastructure is less and less able to deal with.

A weakness that gets pressed forward by the UKIP engine, which seems to be driving the people in an incorrect direction. In the end, I feel that there is no way that UKIP is a force for good, but the other parties have been stumbling all over the field trying to statistically trivialise and ignore the issues as reports are posted left right and centre. I truly hope that Scotland was not an empty lesson for the parties at large.

If we are not careful about the game some play and many observe, we will see that soon after the stumbling becomes irrecoverable we will see the people leave for other shores, then what will happen? Because when the system collapses we will soon see that the ‘The Best Exotic Marigold Hotel’ was not just an imagination, consider the cost of living in India and what will happen when a million retirees take their money and move to sunny shores with living expenses at 18% of what it is now. So, what else are some ignoring? Let’s not forget that these people will also cause the brain drain that will hamper growth down the track. Those who ‘rely’ on cheap youthful labour will soon learn that there is a downside to that. In addition, a million retirees spending THEIR money out of the UK is also a coffer drain the treasurer has not fully considered, or the consequence of such a shift.

Well, personally I see an issue that some seem to ignore, but it is the most dangerous one that many face. You see, several politicians, especially in the labour side, will get these scientists to make economic predictions, after which the analysts will get a go to agree with. Yet, all is not clear here, the politician (the absolute worst of referees) will decide, what information the two parties will receive and as such we get skewed results, moreover, there will not be an open debate and we see reusing of certain ‘weighted’ metrics, which will make too many people walk too close to the edge and as such the damage will be done and the politician will start to emotionally scream and hover BEHIND the ‘miscommunication’ sign. The approach of ‘if the result does not fit, change the initial question‘. There is only one problem, the damage will be lasting and debilitating and whilst Mr Politician has a nice dry income with zero risk to him/her self.

All this comes to fruition when we take a look at the NHS issues. You only have to look at the BBC News and look for NHS articles on the site and you are treated to a myriad of voices all with their own street in the passing of the voice. If we go back to 2013, whether it is just NHS, code 111 or GP, there are all kinds of thoughts, each with their own percentage of validity, but in what regard?

When we look at the Article by Hugh Pym, where he talks about punch packing documents (at http://www.bbc.com/news/health-29731646), we see the following: “He is signalling a big shift in the way the NHS in England is managed and organised, in some ways the most radical since the service was born in 1948“, “There should, in his view, be no more top-down reorganisations, but instead the development of new models to suit local needs” and “For Westminster and the political parties, there is one key message – you have to find more money. Blanket demands for cash at a time of government austerity were never going to cut much ice. But Mr Stevens, with the support of the health regulator Monitor, has done some careful financial modelling“.

Of course it is about the money as the NHS costs more than just two bundles of cash, but when we consider terms like ‘careful financial monitoring‘ and ‘no more top-down reorganisations‘ we see a jump in the width with a financial picture that is nowhere close to be estimated. In addition, if we regard my article ‘Concerning the Commonwealth!‘ on June 19th 2014, where we see several options, take especially my quote ‘the Labour IT systems of the NHS have proven that ten billion pound invoice, and yet doing nothing is another non-option‘ to heart! So as we change an NHS model, how much more will it cost and how is IT not ready to deal with that part?

Yet, is Simon Stevens wrong? No! In the foundations of it all he is correct, the NHS needs a massive overhaul, but here we see that part of the politician, the economist and the analyst. It takes but a whiff of ‘miscommunication’ and the UK is down a few more billion, whilst it is dealing with 1000 billion pound overdraft. So, here we see the reason to change the NHS, but not in drastic ways, yet in ways where we see the successful dealings with basic errors which will cost the NHS hundreds of millions a year. the expression ‘he that cannot keep a penny shall never have many‘, comes to mind, we need to make massive changes, but we need to close holes too, If we can save first, we get change to implement iterated evolution, one that does not cost the taxpayer. The problem for Simon Stevens is that this is not sexy and that is not good for (his) image. This is why I have been in favour of a stronger evolution involving Indian generic medicines, it will not help GlaxoSmithKline and its 14 members of the board, but it will make a massive impact on the 12 billion pound bill the NHS is getting and the kickback that is called quality of life for tens of millions of patients. We can never get around loads of medications, but if we get a cheaper generic option for an increasing number of them, the NHS might end up with a much lower bill, yet that part is often not shown in clarity, I wonder why?

 

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August 10, 2014 · 18:42

The second exploitation

It is always nice to see business to take a look at others and see how they can profit. As The US had to increase its Intelligence spending from 2004 onwards, many of us saw the outrageous amounts that the taxpayer had to dish out for intelligence resources. The biggest drain was not the need for more men, but the simple fact that much of the Intelligence community went private and those intelligence officers who were making on average $72333 year, suddenly in the private sector were asking for $172333. It was a simple ask and demand issue. This has gone on for some time and now we see how others are picking up the idea.

It is Sky News who informed us (at http://news.sky.com/story/1310468/nhs-hospital-paid-1800-a-day-for-nurse) on something so outrageous, that for a moment I thought they had just copied and pasted news from the Telegraph (the truth is far more shocking).

The first quote should be a massive wakeup call “On May Day Bank Holiday this year a locum agency was paid more than £1,800 to supply a nurse for a 12-hour shift, new figures show“, so a group that does not get anywhere near such an income supplies more funds for one day then most nurses will ever make in a week. Can anyone please explain that to me?

I know that I had given the answer in the beginning of this blog, yet in my blog of June 19th ‘Concerning the Commonwealth‘ I wrote “if we look at the NHS, then staffing and expertise are also a worry, which is by the way a worry in many Commonwealth Nations. Most of these nations have well over 5% unemployed; can some not be re-schooled in the healthcare sector?” Of course, that was after the event and long before Sky News wrote their article, yet overall, just as we saw on the mismanaged 111 helpline; it seems that hospital resources are not budgeted correctly either. You see, when we look at budgets, we think of coin and cost. It seems that most people think in that same way. Yet, hours and staffing is also a budget we must keep. The fact that we for some reason suddenly need to pay 1800 pound for a 12 hour shift comes down to the cost of a full day plumber (or the equivalent of two QC’s).

Yet the article is also lacking, WHY was this action taken? Perhaps there were valid (or better stated a host of) actions that resulted towards this choice. So, not unlike the Telegraph, we should ask the questions in regards to these events as they are told to us. This is why I decided to hold on to this, as it was clear that there was more to this than meets the eye. My initial response: ‘Bad Sky News, bad!‘ (Especially as the health strikes were already going on).

It is now, today August 10th that I see an article of the Guardian that does more than just put the Sky News article to shame. I am not debating whether the article was true, but it seems that there are sides that certain people are never happy to inform the others about.

This part is now seen (at http://www.theguardian.com/society/2014/aug/09/former-nhs-carers-intensify-strike-over-pay). If I read this correctly then these people are making just above minimum wage, yet these people are doing intense work, needing to keep a mind of everything (especially physicians at times), whilst making no more than the brain dead fast food counter staff tends to make. How is this even close to acceptable?

Perhaps Sky News did stumble upon something, but they ignored the other side. So at 7 pounds, a nurse makes 280 pounds pre taxation. If that person was staying at a homeless hostel, she would lose out on 105, which gives her 175 to live on for a week, which is 25 pounds a day, take in consideration underground, busses and such, which makes for another fiver down the sewage (as they would rightfully see it). So how can ANYONE live on less than 20 pounds a day? Remember, this still needs to account for food, clothing and a few other items.

There is no denying that leaving the NHS in private hands is worse than just a bad idea. It could be the first onset of death for healthcare in the UK. As politicians have wasted in excess of 15 billion pounds on failed approaches to healthcare, why think that the private sector (a greed and profit driven entity) would do better to the cost and even more disgraceful, better to the people it is supposed to take care of?

The article has a clear quote that shows the danger people face: “Once they have squeezed out the state sector, and the third sector, we will then see prices rise; then we will see profits; then we will see these tax-efficient structures working.” This is a clear ‘divide and conquer’ approach, a method, might I remind the reader of that has been around Julius Caesar, so long before Nicola Machiavelli decided to become devious. Attached to this is that as more and more cost cutting solutions are born, ‘surviving’ on tax shelter operations, then the treasury coffers will miss out on a lot more, which will just force a system of checks and balances which is no longer depending on any balance, it makes for a massively unbalanced future for both the people and the state.

The part that gets me is the people behind the strike “Fifty carers for the disabled are staging one of the longest strikes in the history of the health service to secure a living wage for staff working in privatised services formerly run by the NHS“. Have these people on minimum wage figured out what politicians, who make a lot more than that are ignoring?

The danger is that when (not if) the healthcare sector collapses, the fallout will be unimaginable. Those deciding on cutting costs (which by itself is not a bad idea), should also consider the dangers that follows. Government has health and medical options because (for now) it is not driven from a profit point of view, which is at the heart of this situation, this is not about cutting cost or making profit, this is about breaking even or losing an essential part of support for the living. When we are left to the devices of that what brings profit, we see the first steps into culling a population. It will not happen because they are killed, it will happen because services are no longer available. Then what will the government do, and who will they have to pay, or more interestingly, how much will it cost the government then?

Is that in any way a lesser form of murder?

The question becomes: ‘If a Service Level Agreement is set between government and the private sector, can any of these parties be prosecuted for murder?‘

You the reader will laugh now, which is fine, but when we see the first casualty because of these changes consider my words and consider how that person would still be alive if certain steps had not been taken.

 

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