Tag Archives: NHS

June 29, 2014 · 11:05

What’s in a health system?

Another day, another view on the failings of an NHS system in the UK is presented through the newspapers. The interesting part is not that we read it or that we know about it, for the most it seems to be about a level of blind acceptance that the NHS system might soon be no more. We see more discussions (at http://www.theguardian.com/society/2014/jun/28/cameron-warned-nhs-in-danger-of-collapse). One quote is “the NHS needed an extra £15bn from the Treasury over the next five years ‘if you don’t want the system to collapse during the course of the next parliament’“. Now, that comes down to an additional 220 pounds for every person in the UK. The additional quote “The grim analysis is backed by some of the country’s top health experts“, Really? Is that the actual solution? Perhaps the UK has the ‘wrong’ experts in the field. First we see a 10 billion pound IT system that never works, then we get another failed infusion of 3 billion pounds. Could the issue perhaps be that throwing money at it is no longer a solution? In addition, in a greying economy, healthcare will be the most important thing over the next 10-15 years, so perhaps sitting down and designing a completely new NHS, then seeing how the old system could be migrated might be a much better idea (especially as the other ideas are not working).

“The quality of patient care will be compromised by not having enough doctors and nurses on the wards and in surgeries and clinics. The well-publicised failures of care at Mid Staffordshire NHS Foundation were caused by precisely this kind of cost cutting, with tragic consequences for the families concerned.” Is a quote that is in the article and I have a few issues with it. First of all, let’s take a look at the issue (at http://www.theguardian.com/society/2014/apr/28/mid-staffordshire-nhs-trust-fined-gillian-astbury), it is without any doubt a terrible event for the family. The quote “Mistakes were made as her ward underwent as many as eight shift changes and 11 drugs rounds per day. The system for handovers, when nurses arriving for the next shift should be informed of the needs of the patients, was ’inconsistent and sometimes non-existent’, the trust admitted.” So we can agree that there was a shortage, the point is, was it avoidable? This is where the issue starts. Throwing more money at it is NOT a solution, having 1 nurse per 5 patients is also a non-workable solution. The more people go into all this, the more time we see spend on handovers, with two sets of nurses getting/giving updates, not to mention the absolute fortune this setup will cost. I found the following (at http://straightstatistics.org/article/alcohol-related-hospital-admissions-set-tumble), it is about ‘Alcohol-related hospital admissions‘, the quote “If we limit the numbers to admissions wholly attributable to alcohol, the numbers have risen from 45,000 to 68,500, an increase of 52.2 per cent“. Really? Is that what doctors and nurses spend their time on? How about we change the approach to alcohol (and drugs for that matter) and take a page from the quotes of Ebenezer Scrooge “‘If they would rather die,’ said Scrooge, ‘they had better do it, and decrease the surplus population.’”

It seems harsh doesn’t it? Does it? Now consider the possibility that Gillian Astbury aged 66, might be alive if something is actually dome about the alcohol cases. We see a little more clarity (at http://www.staffordshire.gov.uk/Resources/Documents/s/ss/SSPCTAlcoholneedsassessmentforStaffscountyJan08.pdf), where we find the quote “Trend data published by the West Midlands Public Health Observatory for selected alcohol admissions show that between 1999/00 and 2004/05 there was an increase in hospital admission rates by 40% for men and 30% for women across Staffordshire County“.

 

How about actually change people? So let’s do the following, a drunk in need is no longer given medical aid. If some youngling wants to be heroic and binge drink himself into a coma, then let his body fight it off in some cage (of course if they have money for private care, then that will be OK). If the body is unsuccessful, it will die. Plain and simple! We will call their mother telling them they should have raised them better and the case is closed. Consider the benefit of lower costs to the NHS, unemployment numbers will go down and we might even see an increase in rental options.

I know this is not a pretty picture, but these so called health experts need to see that the current course is no longer an option. We could do the same for the drug addicted population and get an even healthier commonwealth. The issue is not just the approach of certain people; it is the entire look that non-action gives all. Consider the PDF I added the linked to, in Table 9 (on page 26), we see a changed trend of 272%. So, almost three times as many go for the bottle in a group? The fact that this is not dealt with is a plain joke, especially as the NHS gets to clean up that mess in addition to dealing with the ‘actual‘ sick. There are alternatives! One is that all alcoholic beverages are raised by 23% taxation, which all goes to the NHS, which seems unfair to the population that can actually temper their alcohol use. The UK could instigate a Swedish approach to alcohol (also expensive), but you can only get hard liquor on an identity card, which gets registered and you cannot buy more than 2 bottles a month. Or we let the alcohol abusers die. You see, we can go in all directions, but most people, weak as they are, are unable to make the hard decisions and will force a situation where more money is given. This is fair enough, but then we add taxation, including to the lowest income bracket, to get more money for the NHS. Now, these same experts will tell you that this is not a solution either.

There is no choice; hard options will have to be selected in one way or another. It seems that steering clear of some zero tolerance options have been ignored for too long and those who are actually trying to get healthy so that they can contribute to family and society are dying, like Gillian Astbury. This part is however not shown to such a degree by the journalists at large. There is one more table to consider in that PDF. In table 19 we see that the total of the alcohol misusers cause a massive £1,701,900,000 to the UK health economy. So if we need cut backs, then here is one point seven billion in savings. Mr Prime minister! (I think I just earned my knighthood and a small cottage in saffron Walden) I think that the total savings in damages that these drinkers are causing is considerable larger than just to the health economy.

I am all for a better NHS, I am all for giving doctors and nurses a better tomorrow and if just throwing money at it would make that difference, then I would be all in favour of it, but there is almost 10 years of data disproving that, we see an NHS system that is rattled by big business (pharmacy and IT for example) and politicians and the approach as it is at present can no longer be maintained. Perhaps we need to make additional changes to the patients as well. The healthcare is all about keeping track of data and details, what if the patient becomes the data carrier? What if the nurse has a tablet with details and patient numbers, which is transferred to the new nurse and as they go over it, they can verify with the patient chip? When I go into ANY hospital, I see a multitude of papers, folders and more papers and people entering reports in computers and then printing it all. What if we take the next generation in solutions and take away 30% of that workload?

When people ask which company will do this, the answer should be ‘None!’. The UK is filled with universities, some of them regarded as the most prestigious and brightest on the planet. Consider that most IT people, might claim experience, yet their drama skills are the only ones that improved for the most, is it not up to the Universities, those who are introduced to the newest ideas, design a solution that would make the work of the doctors and nurses at the NHS better, slightly more efficient and a truckload of less hassle! Is that such a tall order?

We will get to the solutions if we are willing to navigate other options. We have seen that the current path is not a success; new methods might not be a failure. It is a road that politicians should be willing to go, if only to make sure that a possible solution was not overlooked.

 

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June 22, 2014 · 20:00

The Illusion of control

It is three days after writing ‘Concerning the Commonwealth!‘, I stand by my piece. I think that the Commonwealth is facing increasing issues all over the field and as the numbers go up and up and up, healthcare will take a centre seat in a diminishing population of workers, which by the way include issues that will hit Australian shores too. Today (at http://news.sky.com/story/1287088/government-has-lost-control-of-the-nhs) we get to see more about the NHS, the mention of a 3 billion pound fiasco, which gets attached to the name Andrew Lansley, who is currently Leader of the House of Commons. He is also behind the Health and Social Care Act 2012, which is regarded to be highly controversial. However, before we go into any controversial parts, try finding a document called ‘ABPI UK NHS medicines bill projection 2012 – 2015‘, it is a PDF file (the Google link was too messy). There is a massive revelation on page 5, which diminishes a bible chapter with a similar name to a mere Paddington bear story.

As we ignore earlier mentions of a shake-up gone awry at 3 billion and mentions of an IT structure at the price of 10 billion that never worked, here we see that over the term 2013-2015 the use of brands go up from 14.2 to 15.5 billion, yet generic medication needs only rises from 3.2 to 3.9 billion. The interesting part is that even though there is still a brand growth, the bio-similar mention (generics) go up from 134 to 328, so there is more than 100% growth in change to generic medication, whilst the cost is still growing steadily on both sides (generic versus brands), what would the brand side have done if the generic side did not exist?

Three days ago I was extremely outspoken in regards to the need to get the NHS costs down. It seems that the search for generic alternatives is taking a backseat to other options. In an age of finding ways to make ends meet, the Health and Social Care Act 2012 has no space reserved in regards to the need for a stronger presence of generic medication.

When we look at:

233 General duties
(1) In exercising its functions NICE must have regard to—
               (a) the broad balance between the benefits and costs of the provision of health services or of social care in
               England,
               (b) the degree of need of persons for health services or social care in England, and
               (c) the desirability of promoting innovation in the provision of health services or of social care in England.

Why was the following not added?

                (d) the choice of generic medication where possibility for a responsible health care alternative warrants it.

Now, I will be the first one to admit that my choice of words is not the best one, but it seems where it is known that generic medication is such an important part for the survival of the NHS, that no mention at all (as far as I could tell) seems to raise a few more questions. Key message 4 on page 11 of the PDF shows exactly the part that matters: “Nine of the current top 20 selling brands lose patent exclusivity between 2012 and 2015” and when we consider the growth through bio-similars, we see that the right path seems to be taken as we read the numbers from the office of health economics. So, there is a path to better growth through managed costs (to some degree), the question becomes, why is this report quoting Jane Ellison as secretly taped? More important, why is Sky News not giving proper light to the NHS issues as they are (to a small extent) resolved? Why are they not taking a look a Professor Adrian Towse, Jon Sussex, Lesley Cockcroft or Martina Garau. I would think that the latter two as statistician and economist might be able to light a candle in the tunnel of ambiguous ‘tell tailing’ darkness ‘some’ are sailing.

None of these matters are coming to light at any stage. Even the Guardian on April fool’s day, did little more then http://www.theguardian.com/society/2014/apr/01/health-service-biggest-challenge-history-nhs-boss. I will admit that the article of the Guardian was decent, yet the quote “the NHS is facing a perfect storm of rising demand, funding pressures and worryingly low staff morale“, no matter how true, seems to be about the hardships (which remain true). Yet the information that the Office of health economics seem to have is escaping these Journo’s of bad news writings. Slide 13 of the initial PDF shows an even stronger view on how the UK is getting by, whilst the US is facing an overall hike from 176% to 281% compared to the UK index, Only Spain, Finland and France were barely better off. That part remains in question when we consider their population, if the results was correctly weighted (small oops on that slide), then the pressures for patent change from American shows just how desperate the American position is, which is shown even stronger on slide 6 when we see just how hard medication hits both Japan and USA as they spend well over 2% of GDP there, whilst the population of Japan is twice that of UK and the population of the USA is set at well over 400%. These slides will also leave is with other questions in several regards, yet the initial positive view is not reverberated over the press sites, or by the UK journalists. It seems to me that the information by certain newsgroups, especially in the LACKING sight on the importance of generic medication leaves us with questions. However, the Guardian was all over the business side of Pfizer trying to take over AstraZeneca. Did no one properly wonder why they were willing to dish over 69 billion? When did a US company EVER spend such an amount unless they knew that they would end up with double the amount? When we consider those events, we should wonder why the papers aren’t a lot more outspoken in regards to informing the public.

Even if this was all not true, don’t you think that the press would (should is a better word) have been all over the members of the Office of health economics I mentioned asking them the questions I am voicing and a few more after that? Is the silence of the press not deafening? The late April article in regards to Pfizer – Astranezeca headlines as ‘Pfizer refuses to guarantee UK jobs if AstraZeneca takeover goes through‘, which should make us wonder whether this is about income, jobs or patents. Would that takeover stopped any patents, or at least delayed them? If many patents have 1-2 years left, why pay that many billions, which information was kept hidden from us? It is the quote from Pfizer CEO Ian Read that states “The combination of Pfizer and AstraZeneca could further enhance the ability to create value for shareholders of both companies and bring an expanded portfolio of important treatments to patients.” This is a fair, honest (to some degree) and clear message. It is about the shareholders and the message that these billion will come back to ‘us’ and then some. This is clear business, I do not object, yet the overview for the UK? What will it cost them besides jobs? We saw little of that and the NHS has been played like a piñata donkey for a little too long. This is not me stating that the NHS is okay. Actually it is far from that, it is about getting the proper illumination on events, which does not seem to be happening either.

In the end, the quote in the Sky News article “A spokesman for the Department of Health told Sky News: ‘Giving operational control for the day-to-day running of services to doctors was the right decision but we’ve always been clear that ministers are responsible for the NHS’” might have been a correct one, the added information could have been a lot more insightful. When you Google ‘Office of health economics‘ you will not find any links to any newspaper, which is puzzling when you go to the Office of health economics and look at some of their publications. If I would add one more ‘light‘ remark then it would be that the members of the editorial and the policy board of the Office of health economics seem to have more degrees then a Kelvin scale, making them in my mind an essential source of health information for any journalist.

So where are these articles informing the public?

 

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June 19, 2014 · 21:22

Concerning the Commonwealth!

There is no easy news. The Commonwealth is having several issues that are not easily solved. There is always blame, but who to blame and more important, will it get us anywhere to begin with? I also believe that the Commonwealth has its share of solutions, but in that regard we will have to make some drastic changes. Some will be good, many will not be good and a lot of them will have to be different.

It is the last one that is likely the strongest salvation we might hope for, but we can no longer think the way we are, as we currently end up planning to go nowhere.

First of all, one member will need to step up to the plate and the others must protect this part. They started being regarded as a simple land, this land became a colony and later part of what would be known as the British Empire. It became independent and it is now a Commonwealth nation. Now, India must step up to the plate and become a Commonwealth leader. We (Australia, Canada, New Zealand and United Kingdom) must stand firmly and strongly next to India.

India has basically become the world leader in generic pharmacy and many are so eager to take up the Trans Pacific Partnership that we ignore the part that this US and Japanese conclave is not just about ‘trade‘ or ‘fairness‘, the indications are that it will give even more power to the US companies. A level of power they should not have to this degree.

They were complacent; they were lazy and became the facilitator for flaccid economists (yes, that was a Viagra joke).

If we accept a Canadian source, we see the following: “One proposed TPP provision would require governments to grant new 20-year patents for modifications of existing medicines, such as a new forms, uses or methods, even without improvement of therapeutic efficacy for patients. Another provision would make it more expensive and cumbersome to challenge undeserved or invalid patents; and yet another would add additional years to a patent term to compensate for administrative processes. Taken together, these and other provisions will add up to more years of high-priced medicines at the expense of people needing treatment, who then must wait longer for access to affordable generics. Meanwhile, provisions in the proposed investment chapter would give pharmaceutical companies the right to sue governments for instituting any regulation that reduces their expected profits, using private tribunals that circumvent a country’s judicial process.” (at http://www.msf.ca/en/article/negotiators-must-fix-most-harmful-trade-pact-ever-access-medicines).

This is not what we signed up for in any way shape or form (nor should we ever). It had been stated in several sources that Australia was one of the least objecting partners. The fact that this would be done and through this ensure the consequence that a large part of the Commonwealth will then have another decade of expensive medication to look forward to is just too absurd. when we read the additional quote “U.S. pharmaceutical company Eli Lilly is using similar provisions in NAFTA to demand $100 million from the Canadian government for invalidating one of its patents, claiming, among other things, that the company’s expected profits were “expropriated” when the patent was overturned“, we see a pattern where the use of such a partnership is not a partnership at all, it feels more that America is applying republican dictatorship, through arranged courts in order to thwart almost two decades of laziness and stupidity. Them overspending their treasury by well over 17 trillion is not helping them either and is at the centre of the current push we see.

India is proving slowly to be the leading authority on generic medication, even now in the last two years we see players like Kroger, Axium, Pfizer and Wyeth in multi-billion dollar mergers. They are setting up shop to have their own corners, which will grant them stability and income for the next decade. Guess what! We cannot afford that. The UK NHS is in shambles, healthcare all over Europe is unaffordable and the other Commonwealth nations see the cost of medication go up and up and up. These costs forced upon governments are the new way to get the maximum revenue, whilst in the end not being taxed on it (or for the ultimate minimum). India as a Commonwealth leader in generic medication can step up to the plate. We will not go to India, no, it seems that under these conditions India comes to the UK, Australia and Canada to build their places for generic medication to be produced. India would become a leader here. I wonder if President Pranab Mukherjee had ever envisioned that, to visit the other nations, including the UK as a leader, paving the way for a solution to the other heads of states of the Commonwealth.

If you think that this is ludicrous, then think again. In the Independent we see at http://www.independent.co.uk/news/uk/politics/government-accused-of-losing-grip-on-nhs-as-58-failing-trusts-now-have-241m-debt-9544181.html the following headline “Government accused of ‘losing grip on NHS’ as 58 failing trusts now have £241m debt“. Australia is feeling the pinch of healthcare hard and Canadian healthcare will soon be a sizeable chunk of a 2.2 trillion dollar debt. This must change!

We need to pull our resources. We need to think of other ways. Medication from India is only a first step. How about the option for healthcare graduates to work off their debts in a few years overseas in the UK or Canada? They’ll have a place to live, some income and over a period of 5-10 years (depending on the degree) their debt is settled. These are but a few of the options we can resort to. The old ways are not working and the few that do are drowned into costs of a faltering IT system. We need to group ourselves together and build a new system on different scopes. The old way has not worked and the more we delay the deeper the debt becomes and the less solvable the problem becomes.

This is no longer Labour versus Conservatives; this is now finding a way to avoid deaths through inaction. I agree that simply starting something new is not the way to go, the Labour IT systems of the NHS have proven that ten billion pound invoice, and yet doing nothing is another non-option. The heads of the Commonwealth must come together and find surpluses on one side to stop drainage in other sides. We are one commonwealth and we must save us! From there we will have the stability to come to the European aide, especially with affordable medication.

This side was ignored by the USA as the cash was flowing so nicely. Guess what, we are all broke and we need to find WORKABLE alternatives. The ones we claim to have at present do not work!

Let me also take a step back. This is not an anti-American thing, they are welcome to be part of this (even as a non-Commonwealth nation) and the issue is that they have been blocking affordable solutions through the FDA for a long time. What was good for Canadian was apparently not good enough for Americans and cheaper medication. The information from RxRights.org stated: “Threats to Economic Creativity and Theft of Intellectual Property Act of 2011 (PROTECT IP Act). This new act moves far beyond COICA’s blacklist of pharmacy websites. It would categorize all non-U.S. based online pharmacies as a risk to public health. It would require that Internet service providers and search engines block these sites that credit card companies stop their payments. Even worse, under this new law, Canadian and international pharmacies would be prohibited from defending themselves against those who shut them down“. This situation is even more ridiculous as this is instigated by a president claiming to bring ‘affordable‘ healthcare. If that were true, then why not let people find the cheapest option? Is a Canadian less than an American? No, it is all about a Democratic party with minus 17 trillion and they are firmly in the pockets of big pharmacy! That is the part and the Commonwealth cannot afford this shallow minded greed based approach. We must entertain the best option for the Commonwealth. As General Motors left Australia for cheaper options in China, so we must find our cheaper options in India and the TPP will not help us here. Signing it would be a massive mistake. By the way, all them Americans spamming my email for cheap Viagra was legal? Interesting double standard the FDA has.

We can see more in regards to Indian patents (at http://timesofindia.indiatimes.com/home/stoi/all-that-matters/Changes-to-Indias-patent-law-will-impact-prices-of-life-saving-drugs/articleshow/32519848.cms), of course, as it is the Indian Times, it would be all in favour of India, but are the facts incorrect? That part is in debate on several issues. One question that has not been answered over a term of at least two years is “Access to Medicines – Will the Trans-Pacific Partnership FTA allow governments to produce and/or obtain affordable, generic medications for sick people?”

That is not just the question which is not answered; it is one if the questions that seem to be actively avoided whilst the TPP is continued behind closed doors. The response from Doctors without borders is “Governments have a responsibility to ensure that public health interests are not trampled by commercial interests, and must resist pressures to erode hard-fought legal safeguards for public health that represent a lifeline for people in developing countries.”

This is at the heart of the issues for the Commonwealth, because if these steps stop affordable medication, then there will be no healthcare at all, the Commonwealth nations will be broke as they are decimated through age and sickness, after that what will be left of Western Europe?

It is only a first step; 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? In the UK many IT trained staff are without a job, can they not help rebuild the NHS IT systems? Too many issues that are overlapping and someone threw away 10 billion. It is time to rewrite the tactical guide and start building a solution that will work. Sitting at home will not help anyone, not even one’s self.

 

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April 7, 2014 · 20:06

Should governments provide?

This is the question I had after watching the Dutch newscast at the NOS. The issue is that the Dutch are lagging more and more behind the Germans (except for soccer). Now part of that statement is a joke as Germany is 850% the size of the Netherlands. In addition, Germany has large deposits of ores. They are regarded as one of the world’s foremost producers of iron, steel, coal, cement, chemicals, machinery, vehicles, machine tools, electronics, food and beverages, shipbuilding and textiles. So why is this comparison even an issue?

Ineke Dezentjé Hamming, president of the FME (an organisation for the Dutch technological industry) stated “Wij verliezen onze positie als exportland als we niet snel vernieuwen en mee-ontwikkelen met de Duitsers” (translated as) “We are losing our position as an export nation if we do not renew and develop our technologies with the Germans“. In addition there is the statement that Germany is now in its fourth cycle of industries, where factories and ICT are completely integrated (at http://nos.nl/artikel/632638-nl-raakt-achter-op-duitsland.html).

An example could be the New VDL Nedcar factory, which allows for 24 hours a day production. The NOS newscast implies in my view (they did not state) that the approach of the FME is that the government should be handing over the funds to allow for this. In opposition of my own words, I must state that her statement in the Hannover Messe does not imply that at all (at http://www.hannovermesse.de/en/exhibition/partner-country/ineke-dezentje-hammink-blue.xhtml). Yet, the changes in infrastructure will require massive funds and there is plenty of clarity that the industry corners do not seem to have it.

I am still in awe that the Dutch want to get on equal footing with the Germans on an industrial ground. It almost reads like David stating towards Goliath ‘where are the other eleven?‘ which make me wonder, why is this even an issue?

Yes, as the article stated, the Dutch have for too long relied on services, which was not the best choice, yet, what are the options? The Dutch have no mining options, they have an excellence in ship building, yet that market is not doing too well. Let us not forget that the Dutch did have an excellence in services too. They had the East India Company, which should be regarded as the first and largest multinational ever, starting in 1602 lasting almost 200 years, which is a much better track record then IBM can proud itself on.

But in this day and age, after a multiple joke echelon of services based organisations (from the late 90’s), relying on selling concepts, the age of services is dwindling down. Even now, when we see the Business Industry relying on services and selling them, we see a decline as many customers selected (sometimes forced) to find internal solutions. Many corporations had to wise up fast. This is at the heart of the issue I have with the thoughts of Ineke Dezentjé Hamming-Bluemink. She is correct in the thoughts she phrases, yet again, when compared to the Germans, the Dutch had let these options slide for too long. An integrated ICT means that ICT skills are essential to these companies. If not, then those services will explode in costing’s as the ICT will suddenly rise in value, in an unbalanced way, which created a news hype bubble and there is no way that this is a good thing. This is where the shoes become too tight for the dance of industry. To get this all in motion, training and adaptation should have started two years ago. If the entire track is started now, we will see a wildfire of services and needs, which will drown common sense and pragmatism, which in turn will only hurt industries further.

So, why am I writing this?

The issue is that Ineke Dezentjé Hamming-Bluemink brings up an issue that is at the centre for not just the Netherlands, but the situation also applies to the United Kingdom and Australia. This industry 4.0 as they call it might be needed, but that need goes far beyond just high tech industry. The NHS is just one of many service based organisations where the need for strong and correct integration is required (which seems to be a mess). The ICT integration has been a requirement since the late 90’s. Yet, greed got in the way and as these firms all hunkered down on selling concepts and ‘solutions’, the ICT developers got lazy and many decided to forsake on created products and they all walked down to the path of some 80% readied toolbox with additional training and consultancy.

It was extremely counterproductive.

The Dutch have seen in the last three years how ‘Deutche Grundligkeit’ has taken foothold and it gives way to additional growth in Germany. So, the Dutch want to get on this 4.0 horse as some might see it, but why and for whom? The Netherlands does have an industry, however when we get past the breweries and Nutricia, what is left? Unilever, Akzo-Nobel and perhaps Philips? So, in this smaller list, why is industry 4.0 such a story?

That is the puzzling part, which gets me to the (by me) implied need for government ‘subsidies’. This I see as another approach to overspending, by those who should be keeping their wallets closed (the unfortunate consequence of being in debt for almost 500 billion dollars).

Is industry 4.0 anymore then the latest hype?

This is a question that is a lot harder to answer. Yes, it is hype, but the issue with ‘hype’ that this word also implies that its need tends to be overstated to some degree. This is where I tend to side with the need for it. If all parties need to cut costs, then Industry 4.0 is a definite need, but getting there will require spending and is this truly an option for some?

Here we need to see the words of Journalist Frank Gersdorf from the ‘Financieele Dagblad’ (Financial Paper) “De toekomstvisie wordt in Duitsland met zoveel geweld gepusht, zoals met een overheidstoelage van € 200 mln en promotiefilmpjes, dat je bijna gelooft dat dit echt de toekomst is en dat wij in Nederland de boot missen“, translated it states “The futuristic vision is getting pushed in Germany with such ferocity, like with the subsidy of € 200 million and promotion films, that it is implied that this is the real future and that the Dutch are missing the opportunity” (at http://duitslandnieuws.nl/archief/2014/02/frank-gersdorf-industrie-4-0-misschien-een-hype-maar-heeft-wel-toekomst/)

These words give strength to my implied acts from Ineke Dezentjé Hamming-Bluemink seeing them as an attempt to shake the governmental money tree to see what might drop down. it makes perfect sense that she was doing this as it is her job to get what she can to work for and fight for her interest group. This is all fair enough and we cannot fault her for that. I just wonder if the Dutch and several other groups are even ready for this. Germany has always believed in unity (their version of it) and as such, they had set out a path, which has been in motion since 2004 (at http://www.din.de/sixcms_upload/media/2896/DNS_english%5B1%5D.pdf).

This shows that Germany has been on the industrial choices for a decade; the Dutch cannot just step in and ‘proclaim’ that we should get there too just overnight. This I can proclaim as I was there in the late 70’s and 80’s as the Rotterdam harbours were in a transitional need for upgrading. Take 3 large harbour barons and you got 7 opinions, 14 options and no solution. I reckon that Anthony Veder was the last of the true famous harbour barons. As I witnessed the sales fight between IBM, Hewlett Packard (mainframes) and Digital Equipment Corporation (DEC), things were never standard in any way. For the record, my voice was always with DEC with VAX/VMS, which showed true paths of open standardisation. There is only so many times you can stomach the ‘answer‘ “we are IBM” as it was an actual answer to a question. This is however not about IBM, this is about the needs for industry 4.0 and as such a new form of true standard ‘plug and produce’ solutions. There is no commitment to a path, too many players want the door to remain open so that they might get a shot at this and at the same instance, nothing gets done and no one will decide. So it is not just about the advantage Germany is building, it is about the increased distance it is creating by actually going for any solution.

The Germans do have a massive advantage. When the need was there almost 5 years ago, Germany did tighten the belt, the rest (Netherlands, UK, France and Italy) played their ‘fair weather’ games and as such they are now in additional hardships, which is likely disabling that money tree to be shaken. At least, until there is a clear shown path for an ROI for the Dutch taxpayer. This is however not just about the Dutch; the Commonwealth is in a similar situation. In the magazine Industrial Technology of January 2014 (at http://www.gambica.org.uk/app/images/documents/articles/Industrial_Technology_Jan2014.pdf) where we see the following quote at the end: “Industry 4.0 could be the reason why the UK is ultimately successful in redefining itself as a manufacturing economy“. This I can agree with, just as I did not disagree with the statements given by Ineke Dezentjé Hamming-Bluemink. The issue of funds will remain, no matter how needed it might be and if this is good for business, why should the government fund it? Consider the statement “we could be profitable if the tax office foots the bill“. That is what this current Industry 4.0 situation amounts to. This does not mean that it should not happen, but what is the Return On Investment? If it takes longer than that, is it a good deal to put money in something whilst the main objective for the Netherlands and the UK should be to lower their debts.

The issue is already getting the consultants to crawl out of the woodwork (like Roland Berger), where we can read (at http://www.rolandberger.com/press_releases/Industry_4_0_opportunities_for_European_industry.html)

“The Roland Berger experts explain what companies and politics should do to support the development of Industry 4.0 and leverage this opportunity for Europe“. It seems to me that this is another one sided step to get the cards shoved into the hands of politics to spend, spend, spend. They also illuminated a second side to this all. The second quote gives us the cake with toppings “This is where politics needs to support the process by initiating research and development programs at the European level“. Why? Why can this not be instigated by IBM, Oracle or by Hewlett Packard? If it makes business sense, then these three will hop on that horse right quick. Why must tax Euros be used one way or another? They made billions, which means that sponsoring should not really be a prerequisite.

In my view, I find that new technologies are usually a step forward, yet when we consider on how people jump on and off funding horses with the greatest of easy within their political terms, should we allow certain corporate evolutions at the expense of the government coffers?

 

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January 9, 2014 · 12:45

A healthier population

The Guardian notified me of another issue ‘rising’ in the UK (at http://www.theguardian.com/society/2014/jan/08/government-dancing-tune-drinks-industry-doctors). It is a nice article on setting the minimum price of alcohol. Is it a bad idea? Nah, I do not think so, there is ample believe that setting a higher minimum price might (I state might) dissuade a few people from drinking alcohol, but the amount of people that alcohol abuse is impacted will for the most not be hit by such changes.

I found the issue that lobbyists were meeting with politicians a little laughable. Is that not their function? In the end, the fact that these lobbyists had such easy access is noticeable. Is it about the 130 meetings, or perhaps the implied 130 free lunches these politicians might have had?

The one passage that did get my attention was “In an open letter, 21 senior doctors and campaigners, including Prof Sir Ian Gilmore, special adviser on alcohol for the Royal College of Physicians, raised fears that ‘big business is trumping public health concerns in Westminster’.”

This is a matter of concern. The question becomes on what might be a solution that would actually work? I do not pretend to have the answer, or the wisdom to answer the issue as it could be resolved. The Daily Mail (at http://www.dailymail.co.uk/news/article-19699/Alcohol-abuse-costing-Britain-6bn-year.html, not the best source of academic like information) stated that it costs the government 6 million pounds (the BBC stated much higher numbers in Feb 2013), as well as a cost to the NHS of 207 million pounds.

Perhaps we should consider another method. Something more like the subtle message we see on cigarette packages in Australia. How about these people get a standard letter as their details are recorded? The letter should go something like this.

Dear drinker,

Thank you for soon drinking yourself to death. Even though you are (for now) still alive, the pressing shortage of houses and jobs will be slowly resolved as you die from alcohol abuse. At present, as the damage is voluntarily self-inflicted, you have no right to any medical support other than the one you can pay for through the use of cash or credit card, which must be paid for before you receive this aid.

Should these events result in your death, then your belongings must be collected from your apartment within 48 hours, or they are regarded as forfeit! We, the government are grateful that you vacated your job and housing for a person who wants to make life better for themselves and those around them.

Kind regards,

Your local politician (insert name here).

That letter might actually have two interesting effects. The first would be that the person scares him/herself into a state of perpetual soberness. The second one is that his/her direct family might also deal with this situation, which could help the drinker get a hold of him/her self.

Why this way?

Consider when we see the damage of alcohol and we keep on having this ‘soft’ approach on a group that will continuously binge drink themselves. The BBC in February 2013 (at http://www.bbc.co.uk/news/health-21586566) stated an even grimmer picture, so clearly something is not working. Consider how much a person pays to drink and the additional damage a country receives. Why must this go to the taxpayer?

The current drop in legal aid funds in several nations (most notably in the UK). The drops in assigned budgets which are currently stopping mental health workers to continue do their job. It is also notable that people with a mental health issue (the non-alcoholics) are cut twice. On one side they lose out on legal aid, the other side they get cut on mental health assistance. The third side is added as the NHS has no money left.

I personally do not see the levels of alcohol abuse as a mental health issue. (Alcoholism is without question a mental health issue). The people who drink more because they can’t get laid, they are ignoring their temporary issues or they are just in a party race of who can drink the most are a massive part of the current cost of alcohol abuse as we see it happen. So, if they are left to die, less are there to compete in fast drinking, which solves that part. Less are alive to get noticed, so those alive might get laid (resolving the second issue) and when many people see that an issue gets them killed they work it out themselves which takes care of item three.

Seems like a nice simple package!

The reality is that this issue is not that simple, but the crux is that these money costing issues have to be resolved. The treasury coffers are empty and these transgressors need to be made aware that when you get in a state such as they get in, they might no longer get any support getting over it.

The time of ‘Whatever! Have another drink‘ is gone, not only do we need to be held accountable for our actions, a change is needed on the levels of support that is given to some as they abuse themselves and others. Consider that a refugee cannot get any legal aid when it has to deal with what is now known as a ‘rogue landlord’, then consider that the same landlord drinking his kidney using rogue rent cash into failure gets all the assistance he/she needs to do it again.

We as a population and politicians as a deciding group have been focusing on the wrong sides of the equation. With coffers empty, economy at long time low and groups of people burdening a system that can no longer support it, we must look into new directions.

They might work, they might not, but not changing anything is no solution, that part has clearly been proven.

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September 18, 2013 · 21:13

Bankrupt or failed? It’s all the same!

This topic applies to two events that are hitting two groups. The first one is about one of the final nails that are getting hammered into the coffin that is laughingly called the US economy.

Yet, what is actually in play? On one hand there are the mentions that the US economy is on the rise, so why is the debt limit such a strong issue?

The second issue is one that is playing in the UK, but about that later.

For these issues we need to consider a few chess pieces, that had been ignored in the past and there is only so much you can do before those ‘forgotten’ pieces rear their ugly head. Yes, I agree that there are signs that the US economy is again slightly on the rise. More jobs are offered, people are getting back onto the horse of labouring enterprises. There is however the other side. The government seems to ignore the need to get their budget in order, they ignore that there is a consequence to non-stop borrowing. Excuse upon excuse, story upon story and where does this lead?

The issues got visibility after Sky News reported on a story that involved the interview with Treasury Secretary Jack Lew. Reuters quoted him stating “We cannot afford for Congress to gamble with the full faith and credit of the United States,” Lew told the Economic Club of Washington, a business forum. Yes, he is correct in that, yet the strong story to hunker down on excessive spending is not loudly voiced. That same situation is what the Dutch government is currently facing. The story there was that it will never be like is was ever again is the story in the Dutch case. The pre 2008 life style is gone and likely gone forever. It will take a small nation like the Netherlands 5-10 years to get their spending under control, but it will never be as good as it was before. Why mention the Netherlands? With 16 million people they are at 5% of the American population. Their debt is around 430 billion. This is less than 2% of the national debt the US has and they have now announced austerity measures to reduce their deficit. The measures will be a helping of bitter fruit to nearly all Dutch. The total US debt is said to be around 60 trillion dollars, which boils down to $9000 for every person on the planet.  Basically, the annual US Currency degradation is larger than the total debt of the Netherlands and the Dutch are looking at the next 10-15 years of financial hardship, and then only if the economy has picked up to the smallest extent by the end of 2015. If not, then those 15 years might not be enough. So the summary ‘the good times are gone forever’ seems amply put. More important, as the US debt devaluates quicker than the annual interest payments, is there any way out left for the US but bankruptcy?

The RABO bank director had made a comment that ‘all will have to tighten the belt’. Sounds nice, but let’s not forget that financial institutions playing fast and loose with other people’s money was cause to most of these issues. The second link is that he is not just mentioning the massive debt, yet a small mention on how the Dutch have such a good retirement treasury. It is another first attempt to get their fingers on the one place that was supposed to keep a population safe. (at http://nos.nl/audio/552545-directeur-rabobank-we-moeten-met-zn-allen-de-broekriem-aanhalen.html)

The US seems to ignore again and again that there is a limit to spending, so the lesson the Dutch are learning the hard way is one that American is currently not ready to face. They might say yes, there is a limit, but then state that they are nowhere near these limits. I disagree! I reckon that the point of no return was reached in 2011. The outstanding debts are now a matter of more than just multiple generations. The fact that we are given stories about returning economies are one thing, the part on how taxation must be paid (and is not) is silenced again and again. the rich move away their fortunes to the Bahamas or other places that will keep it ‘safe’, in addition corporate America is doing the very same thing by moving their ventures to places like Ireland, which allowed several corporations to pay less than 0.2% in taxation. How can the US survive when people without jobs cannot pay taxation and the super-rich move outside of the reach of the US treasury so they do not have to? These steps are socially undesirable and in my mind it is a form of treason. How can a company hide behind the US as a shield stating they have rights and then move away as they shun their own duties? These ignored elements are part of the problem that is likely to soon leave the US in a state of bankruptcy.

The US claims to be a nation of laws, which is fair enough. I think that they forgot that when greed calls the shots, the law becomes a shield for criminals, whilst becoming an anchor for those they are supposed to protect. It is a topsy-turvy world indeed.

So as we move towards the next 8 weeks of uncertainty, as the Democrats and Republicans are moved into a space that is more polarised then sunglasses, we will see that some will get a few coins from the jittery movement of the markets. Also take notice on how some of these people proclaim on how this is all so much unfair and how spending just a little more will save the people. No! It will not. It has not been a solution for almost 2 administrations. It is time to look for an actual solution, instead of prolonging an absolute failure.

So time to take a look at the UK now!

They have their own deficit, but more importantly, they do have a different set of problems. The NHS was at some point to have some kind of system that would record some forms of information. (Or so it would seem).

The NHS IT system is a failure. So much so, that it is the biggest failure in UK history. I reckon it is big enough to be the biggest failure in European history, but that seems too much like splitting hairs. The program had cost 10 billion pound, which makes it a 0.5% of the total British debt. That takes some doing to be such a failure.

Why are these two events connected?

Apart from the usual suspect that both involved politicians, it seems to me that both situations require a clear vision of what needs to be done. In both places they are lacking. It actually goes further than that, however for that part, let us take a look at the NHS laptop.

The Guardian is giving it some attention at (http://www.theguardian.com/society/2013/sep/18/nhs-records-system-10bn)

To do this, we will need to look at a few quotes that were made in this regard.

“MPs on the public accounts committee said final costs are expected to increase beyond the existing £9.8bn because new regional IT systems for the NHS, introduced to replace the National Programme for IT, are also being poorly managed and are riven with their own contractual wrangles.” This is one of the stronger quotes. We are looking at three distinct parts.

1. ‘Own contractual wrangles’ looks to me that the wrong people were involved in the contractual parts. Too much baggage or too little know-how, no matter how you twist this, when the contract is about ‘disputes‘ the people are not linked to a contract, but driven apart though paper (not unlike less successful marriages). This all makes for a nasty ‘separation’.

2. ‘new regional IT systems‘ and ‘being poorly managed‘ means that this is again a track of issues that are set to how good one’s PowerPoint presentation looks, not on how well an infrastructure can be managed. It is a fatal flaw in any IT project.

3. ‘Final costs are expected to increase beyond the existing £9.8bn‘ Like that is a surprise? This means that the costing’s were never properly done. Even in an age where the UK had a 3 year bad run with the economy, it seems to me that proper setting out a charter was never done. No charter, no limits and no results. It is again the same story we see too often when interested parties see the government not as a customer, but as a gravy train with no end in sight.

The IT is no different from any other business, when they see a governmental place where the gravy train just runs through it and they hope they are the station the train will stop. In my mind I see these places as a spot with too many managers and not enough workers. This is often the situation in many organisations. When it is in a commercial organisation it is a nuisance, and if they do not bring home the bacon, they are often let go at some point. With governmental organisations it is a different thing, more important, when it is done on regional area’s where they all want to be ‘in charge’ it adds up to nothing less than a death sentence to any structure that does not have commercial goals. It will collapse onto itself.

Here is the comparison with the US government. Like the NHS both are spending huge amounts they do not have to reflect upon. Not unlike the US their incomes are going down fast as tax havens take away the annual incomes the UK/US used to have. So in all, we are a looking at an engine that is supposed to run whilst we allowed the fuel tank to be external and no longer attached to the car. How stupid is that approach?

Richard Bacon, who had co-written a book on failing government projects, said that the NHS’s particular problems stem from the original contracts signed before 2002.  It comes from a book he wrote with Christopher Hope called Conundrum. I am not disputing his view; it does however show that 10 years later a situation is holding the UK back. Perhaps a better contract team is/was needed? This all reads like my first item I mentioned. Nice that someone from Norfolk can see the issue that the London bigwig’s can’t be bothered to identify on a good day.

The issue I see is that the contracts might have been OK or acceptable at that time, but government situations require a different scope, and signing something that is holding back the UK 10 years later is really a bad contract (from the NHS point of view). So people were hired who lacked that same insight. It is not just on what they were instructed to do, I am questioning whether the right people were ever asked to question the outstanding approach to the long term extent it was needed to be looked at.

Too many are trying the same approach to other scenario’s, which is fair enough, yet those who should be in charge are NOT thinking this through. The mind is lazy, when something works, use it again, I get that! In this case it was not a solution and neither is it when it comes down to spending again and again to shove forward an economy that requires $10 for a return of $0.10. It is bad business through and through.

The one quote from the Guardian article is the crux ‘The government was keen to distance itself from the problem.‘

That is just not an option. Moreover, if it wanted that, it should have never gone near this issue to begin with. If we look at the BBC in 2011 (http://www.bbc.co.uk/news/uk-15014288) the following quote comes forward “Health Secretary Andrew Lansley will say: “Labour’s IT programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs. We will be moving to an innovative new system driven by local decision-making.”

Whilst in July 2010 the issue stated by the BBC (at http://www.bbc.co.uk/news/10557996) was: “Mr Lansley also announced he expected all NHS trusts, which run hospitals and mental health units, to get foundation status by 2013.” So what did get done? More important, it states nothing about abandoning this ‘new’ system at the moment of release.

It all gets a little more hairy when you consider the quote in that very same article ‘Professor Chris Ham, chief executive of the King’s Fund think-tank, said: “It is a very radical programme. We have never seen anything like this since the inception of the NHS in 1948.“‘

It seems to me that this was another PowerPoint approach by those who talk nice but have no idea where the keyboard is stored. Certain quality questions should be asked from those who can only think in election terms. These systems are supposed to outlast them all. This is an issue which has, not once been properly dealt with in either the US or the UK.

How much more tax money will be spent on trains that lead to a place called nowhere?

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July 30, 2013 · 14:21

A call centre heart attack

The news has been visible and intense. For the last month the news, to some extent internationally is growing stronger and stronger into the crashed and clashed NHS. The National Health Service is as seems to be described, as a system that has buckled. It is an infrastructure that can no longer deal with the population size of the UK, where more people and less money are two direct causes of collapse to a system that cannot sustain itself.

In this regard I will only look at the 111 helpline. I am not an MD or a member of the Medici family; I do however have the knowledge of call centres and technology. So, I will go with my strengths.

If you want to read some additional material (quality information), then take a look at http://www.guardian.co.uk/society/2013/jul/29/nhs-direct-pullout-111-helpline, where most information is available. There was additional information on TV; however as Channel 4 chose not to transmit their service to Sydney, I cannot tell the content of that special.

When we look at another Guardian article we read “Channel 4’s Dispatches programme, NHS Undercover, found the non-emergency 111 system had staff shortages, long waits for callers, and in some cases ambulances were being called out unnecessarily.”

The second quoted from the initial mentioned article is “NHS Direct had worked on the assumption that it would cost on average £13 per call to cover salaries and other expenses for employees, but then found the actual payment it was receiving for its services was closer to £8, leaving it far short.”

The last quote comes from the NHS site itself (at http://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspx)

You should use the NHS 111 service if you urgently need medical help or advice but it’s not a life-threatening situation.
Call 111 if:
you need medical help fast but it’s not a 999 emergency
you think you need to go to A&E or need another NHS urgent care service
you don’t know who to call or you don’t have a GP to call
you need health information or reassurance about what to do next
For less urgent health needs, contact your GP or local pharmacist in the usual way.

When we look at this in a clinical way, then we should look at this with the cold IT heart we need to have when running a call centre.

1. Staff shortages.
This is plain and simple a management issue. How many calls were expected, how many came, what staff is available and what needs to be added. This in the best of terms is nothing less than a mere exercise in Excel. Even if there was a shortage, then we see there are two sides. On one side we need more people which mean there is a budget part; on the other side we see the expectation of quicker times, again all part of a budget.

2. Long waiting time.
When you go to the hospital, when you are NOT in a life threatening situation, then how long until you receive medical assistance? Would more staff solve this (would that actually solve it)?

There is a Dutch expression which boils down to mopping the floor next to a running tap. Basically it means that the floor will never get dry. That seems to apply to the situation people face with the 111 helpline.

In addition, this quote “its reporters found many patients were left waiting for longer than the 10-minute target for a call-back from a clinician”. Is that truly a bad thing? Let us not forget that this line was not for REAL emergencies. I have been to a hospital after a heart attack, and even though I got excellent care and they saved my life, the doctor was more than 10 minutes away. It happens! I am not the only one in need, and the hospital has excellent nurses. I wonder whether some expectations, as set for the 111 helpline, really are realistic.

3. Time and money.
When looking at the second quote earlier, we see that between £13 and £8, there is a definite discrepancy. When you get the needed and actual target wrong by 40%, management either did not do their homework, or they have not ample dealt with all the elements in play.

One of the clear signs as was mentioned by Sky News is that calls took much longer. When we consider call centre etiquette, not unlike what physicians do, we need to get to the crux of things. We need structured questions and we need to keep control of the conversation. This all leads to reduced times. Letting the patient (or customer) ‘waffle on’ is just a waste of time for all parties. So it boiled down to asking the right open and then closed questions to get the show on the high speed road. Here there is a slight problem. Nurses (Doctors too) rely on what they see and what they smell, these factors are now lost to them. This means that any assessment will take longer then they think, yet call centre protocol approach would limit these losses to some extent. This is a skill that nurses might not have. They can get trained in this and over time they will get good at it, but are they given the time needed? In the end this could also reduce the amount of ambulances getting called out unnecessarily.

The last part in this matter comes from the 111 site itself. “You don’t know who to call or you don’t have a GP to call” & “you need health information or reassurance about what to do next“.

Are those truly the right expressions? In that regard the 17 year old girl dealing with the statements to tell her dad “I had sex” and “you’re going to be a grandfather“. They fit the description, yet, let us be fair whether this is an emergency? (To the girl it really is!)

The generic description gives way that all in need of more than a band aid might call. This even includes mental health issues. Is that what the 111 number is for? If so, was the budget aim correct? These are all raised issues that I could have told them before the service launched. So the question becomes were they raised at all? Perhaps they were which takes us right back to the issue of 40% budget offset. What was missed?

In addition the following quote gives way to another question in the Guardian article “was replaced by a new system in which private providers and NHS Direct bid against each other to win regional contracts“. Really? So the cheapest won? Perhaps the indication is there on how the 40% difference of income is set. How is that a solution? I get the idea behind it. The NHS must find a cheaper solution to get part of their pressure removed and as such the solution of a call-centre makes sense. However, as the human element will remain in the system, we see the need that the problem could be managerial not systematic. In addition, we need to realise that coaching the health care teams is a necessity that usually takes 20% longer than most expect. That is not bad expectations, but when those in their field move to other mediums, they need to reset the scope of their skills. (Like the loss of information by not being face to face with the patient in person). That is just a reality.

This all is visible before additional factors are added. If you think work in a hospital is intense, wait until these people get to the patients who will scream into a phone because they feel that the connection is too un personal. It will happen. Take a person under pressure and a situation where that person cannot vent, then your goose is cooked. This will result in burnouts and spiking stress levels. Were these factors included in the costs of this project? If not, then you will see further escalations of costs and shortages.

The Chief Operations Officer Dame Barbara Hakin has her work cut out for her. I reckon that this is a system that could work. I personally belief that it has a future, yet, a system that is spread over a large area, with 45-50 contractors involved means that there are additional issues to content with. Is it true that this is just about taking over and restoring confidence (as Sky News reported)? I think it needs to be about communicating realistic goals (not the golden cost reduction some politicians claimed it might be) and attending to these needs and fighting towards those goals.

It is also about looking at all of the contractors and aligning views, requirements and systems. There is for example the NHS phone App. (or website), which could help a person in determining where they need to go to, or who to call. It could be that they need to call 111, yet these few seconds of going through that path, if that is an option, might even reduce pressure to the 111 service for up to 10%. That would be a big relief for both patient and service!

 

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March 3, 2013 · 16:51

March Hare of Government

Most of us have seen the news and heard the messages of the sequester cuts for the US of 85 billion dollars. How so many are now up in arms.
Let us be honest! This is all a load of rubbish (imho)! The deficit is 16+ trillion dollars. At 0.5% interest annual interest should be well over 80 billion a year, so they are still skating backwards if only 0.5% interest was due. In reality, as we doubt whether the US will EVER correctly deal with their debts we could consider the fact that it should be a lot higher than that. Also, important that even at 0% interest, it will take 200 years to get rid of a deficit this high. Are you awake yet?
I already mentioned it in 2011 that America was joining the 3G nations (nations that will need 3 generations to get rid of their debt). I was not alone in these thoughts; people like Glenn Beck, Bill O’Reilly and others were on THAT bandwagon as early as 2010. No one listened, all claimed it was not that bad, and it is now shown more clearly on a daily basis that it is getting worse. Yes, a March Hare is in charge of US Government. Oh Boy! The US is not alone in this situation, that same Looney Tunes character, created by Lewis Carroll seems to be in charge all over the commonwealth too. You know, those smaller world leading countries like UK, Australia and to some extent even in Canada. Lewis would be so delighted that he could have added in the cover of his book “These characters are based on leading individuals of the British Empire and those bloody colonials” (sorry US, I could not resist this).
First of all, for the next part, you must realise something first: “I AM NOT A RICH MAN!”
All capitals, I insist! The issue is that I am on the Republican side in this. It is also why I am so angry in regards of the (imho) the statement, which i consider to be BS, voiced by President Obama all over the news. He states “This was not necessary”, I say yes it is. He has overspent to such a degree that these cuts are essential for that nation to NOT go bankrupt. It is also linked to my life philosophy. I have always believed in being a Return on Investment. I get a job and that boss makes a profit by having me. I have worked on dozens of projects every quarter for over 20 years, and my bosses made more than just a small profit. This is how it should go. A company makes profit and that company continues and its staff members have a job. I believe in this simple premise with all my being.
You might think it is a simple and naive approach, but consider to alternative from the financial industry. They play markets on assumptions and reap benefits on image and commissions on a premise, not a given, and not on an actual creation of wealth. That was shown by Goldman Sachs in the 2008 issue where they banked on bad credit and foreclosures to make quick cash. All legal, but that should never have been allowed. This part now reflects back to the US government as these loop holes are still NOT stopped, and they just keep on grabbing from the wealthy and not from the immoral. These two groups are not the same.
This is however, not just about the US. the UK, Australia, the Netherlands, Italy and even France are going in EXACTLY the same direction. In the Netherlands on March 1st their Easter Bunny surprise is about to show the nasty side as it might go into a burnout as they are trying to find 4.3 Billion Euro in cut backs. Not unlike the US, they have been overspending for almost a decade and instead of taking heed then, they left it until they were no longer in office. You just need to check the Dutch newscasts between 2009 and 2011 to see dozens of articles “GroenLinks: bezuinigen is helemaal niet nodig” (the Greens state that cutbacks are not needed). These were often specific issues; however, the overall clear issue is that cutbacks were left too late. Any doubts? Consider that 250 million Euro annual cutbacks in 2008 onwards could have prevented a 4 billion cutback almost essential now. I use the word ‘almost’ as the method of cut backs is nearly always a debatable thing. All parties are passionate on protecting THEIR groups, but some must give in to the needs of cut backs. The CDA (Christian Democrats) are actually voicing a lot like the Republicans. It cannot remain about cutbacks; it must be about proper spending of what is available. So here we have our first direct link.
Two parties who I personally never really agreed with are voicing a solution that is simple and clear. I am NOT against taxing the rich to a certain degree (I am not rich, so fair enough). But NO nation can continue when the rich are taxed to such a degree they move away to other liveable lands. And in all fairness, that group is small. So small that taking them another 1% will NOT EVER get the government the money mountain they need. Should you doubt this, and that is fair enough, one must always question things, consider 1% to make 85 billion needs an Income group of billionaires making a sum of 8.5 trillion dollars. The US, UK and Australia combined do not have that amount of billionaires. This is the empty cloud that Democrats are offering. Which is why I oppose this mindless action. Spending needs to be put under control for a long time, long before 2011. I will state that this is not all President Obama’s fault. He did inherit a bad situation and that must be stated if we look at this honestly. I believe he truly thought that his approach to the bad economy was the best solution. I cannot fault or blame ideology. Yet, 4 years in office showed so clearly that this was NEVER a solution. So why he is continuing that method in his second term is in all honesty beyond me.

So, now let us add the next shackle in this chain. The UK and Australia are already feeling the weights of healthcare. In 2011 the UK had a population of 60 million people. For the period 2010-2011 the NHS had spent 51 billion pounds (as mentioned by the UK department of health). That almost equates to 1000 pounds per person (roughly $1500). A large slice of the UK population never gets sick or treated, yet the group that needs healthcare therefore required more than the 1000 pounds. This figure will shift as the population is growing old and grey. It is clear that the NHS will need more and more money, which is a clear reality many nations face. That links back to US healthcare. Whether it is labelled as Obamacare, as Healthcare or whatever coat of labelling it needs. Forbes reported in 2012 that US healthcare was set around 3 Trillion dollars. Now take a population of 325 Million in the US. Then we see that 1500 dollars do not get us anywhere near the needs of the UK. We can make two conclusions. Either the average American is very unhealthy, or that Medicare in the US is vastly overpriced.
OK, I admit that this equation is very simple and there are more factors at work. However, I hope that it is clear to most that something is wrong. I have stated before that the US seems to be a greed driven society (even though it is mostly visible in Banking and Financial Institutions), Shakespeare would state that there seems to be a stench coming from the state of budgeting (Hamlet banking association, 2008). Just to be certain you do not get the wrong impression, oddly enough Nurses seem to get the smallest part from that barrel, so they are constantly being underpaid (a global truth), so where does all the money go?

The next is generic and not just connected to healthcare. There seems to be too many managers in a company. If America is a ship, then the President is its captain. That is simple and clear. It is however an issue that this administration could be regarded as a badly stocked Titanic with 132 Pursers, 373 stewards, 83 cooks, 227 barkeepers, 93 janitors and the odd Marshall. The issue is that the paying crew is roughly 2000. This could never continue. When the servicing crew is at almost 50% of the paying customers, then either this population starts paying a hell of a lot more, or the ship sinks. I hope that this comparison is a lot clearer. It is actually close to the comparison as the RMS Titanic was populated. Yet, that ship was mostly designed for the indulgent and the wealthy. I hope that some will remember what happened. 1502 people died there. The numbers almost equates that one crew member saves one passenger, the rest is out of luck (I am NOT stating that this is what happened on the RMS Titanic). That is however how the US economy is seen by many. The numbers are a little harder. They are unclear on how many people lost their homes and never got another home. The numbers add up into the millions, and it seems to be around that one in six lost a home forever. So one government worker saves one citizen, the rest is out of luck. This seems to be the Nanny state as some call it. Funds for all! Yet, when no money is coming in, that nation gets shut down real fast. All nations depend on actual money making contribution to survive.

This is how 2013 is starting for the US. The bad issues coming is NOT because of some sequester. It is NOT because someone reports moderate growth. There is a collection of machines left, right and liberal trying to get what they can secure. We can look at Heidi Moore of the Guardian or Maxwell Strachan of the Huffington post. There is long term of financial pain coming and no one is safe. Yet, in all this, it is interesting how some ‘experts’ like Agentschap NL and NABE seem to predict a +2% growth in 2014. What is this? The land of the Umpa Lumpa’s?

I would love those numbers to be realistic. It seems however that those ‘experts’ are more and more moving to the mindset of market research where they seem to present what a government would like to reflect then to the area of research where we reflect the actual facts. Neither is a lie, but one is very very incorrect. All governments want to see nice indications, so they can forward the invoice. That time is gone; we have overspent for too long. Unless spending is reduced greatly, and fat is cut all over we will not see any good growth. If you doubt that, then look at the issues now going on all over Europe as horse meat is added to ‘expensive’ beef. When the daily issues of life are frauded on, then they have met rock bottom. There is no way you can ignore that (as far as I know it takes twice the time to grow a horse to adulthood, compared to a cow, which makes me wonder what on earth is ACTUALLY going on).
So let us get back on that horse steak and drive back to the so called ‘financial growth’. The seen level of misrepresentation is exactly how we move towards the Abyss. Some of those ‘experts’ might point to such good profitable places like China and India where things are currently so prosperous and how we all could be this successful. They are deceiving YOU and delusional towards themselves. You see, YES, Those two places are going forward, and 10,000 new millionaires seem to pop up. Yet, this is due to them voicing the need of outsourcing. WE lost those jobs (perhaps forever). They were cheap, and like on any ‘slave’ farm, there are guards and overseers getting a fair wage for every 10000 workers who are getting mere pennies (in comparison). Now consider that one third of the global population lives in those two nations. So that number of 10000 millionaires seems ‘fair’. Now add to this, a consumer market that could be slowly collapsing. We now have the means for that iPad, Ultrabook or iPhone, but is that still possible in January 2014? Soon this curve will level and then I expect it to decrease. Whether the decrease is short term, or long term I cannot foresee at present (there is no way to tell). But from my point of view it seems that America with their 200 years of debt would be living on slim margins for a very long time to come. If the Commonwealth and the EEC do NOT severely change their budgeting habits we will end in a similar predicament. Make no mistake; America will happily push US over the edge to survive a little longer. Then what?

We need to get a lot better and clever on how we do business and how we govern. My worry is that too many politicians on a global scale are not willing to consider that, especially if they and their constituents have to cut back.

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