Tag Archives: Sarah Wollaston

Merely a starting point

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

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

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

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

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

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

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

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

 

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Thomas the Tank wreck

Parents will have seen a program if they have kids, they all love to see that cheeky tank engine. The simple life in the town of Knapfort, or is that Nap Forth? The complication of not getting uncoupled, and even as it was merely an episode one, the not so young population might remember the rap edition of this Thomas (at https://www.youtube.com/watch?v=ETfiUYij5UE), so in all this. Is it about the music or the story? Consider that, when we see the Guardian claim ‘Revealed: NHS cuts could target heart attack patients in Surrey and Sussex‘ (at https://www.theguardian.com/politics/2017/jul/14/revealed-nhs-cuts-could-target-heart-attack-patients-in-surrey-and-sussex). So when we see “Organisations in the area are considering limiting angiogram and angioplasty despite positive evidence for procedures” should we be surprised? You see, I have had one, I understand that it is at times essential and that it is needed to assess the situation. We might see: “Hospitals routinely use an angiogram to assess the health of a patient’s heart“, so there is not surprise here. Yet when we see “Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under NHS plans to make £55m of budget cuts in Surrey and Sussex, the Guardian can reveal“. Why is anyone surprised? You remember that vague promise from some politician named, I think it was Jeremy Carbonite? Labour was going to hire a thousand nurses. So with what money were they going to do that? The NHS is out of cash and out of options. Whilst we see the NHS being politicised, everyone forgot that whilst those optional solution bringers remain talking, not much gets done whilst they talk and whilst they contemplate the decisions that need to be made; no resolutions and the money kept on draining for another 5 months. So we might feel sorry to the smallest degree for Tory MP Sarah Wollaston, with the mention of “the secretive cost-cutting regime which the NHS is imposing on 14 areas of England in an attempt to save £500m – because it involves “draconian” cuts to services that will hit patient care“, which is fair, it is Draconian and nobody wants it, but as the politicians were shouting at each other time went on and nothing was done, the changes for long term gain were all not done, pretty much none of them. Perhaps Labour can help? Do they not have a leader named Jeremy Carbonite? Is Carbonite not a backup program? Perhaps he has a backup option? He was so ‘speechy’, so clear on what needed to be done. So, Jeremy, what would you do next? Spend more money? It’s gone, your Labour predecessors took care of that, to have an NHS, you need an actual economy, if your side had not wasted the massive chunk of a £trillion in total, there would be options to move the track. Did you think of that as you paraded your addition of 4 figure amounts of nurses, police officers and others?

Did you think that the governing party was not aware of the issues? Did you think that those who are governing are not aware of the fact that the NHS is ending far below the line of zero before the end of quarter three? When we see the quote “Hospitals routinely use an angiogram to assess the health of a patient’s heart. The number of people in the UK undergoing angioplasty has risen eightfold since the early 1990s to almost 100,000 a year, reflecting its growing popularity as a non-invasive alternative to a heart bypass“, we understand that it is routinely done (I had one), oh wait! I never had an angioplasty, I had an angiogram. So why is the Guardian just shovelling two issues together on a pile making it seem as one? Perhaps it is done to make it all a little more trivial? When we consider that an angioplasty is set at roughly £17,500, we see that this procedure alone would cost £1,750,000,000 annually, that is a lot of fish and chips repair, or am I trivialising here? So how much are the costs of an angiogram? One source gave me £5,529, so how many a year operations are needed of those and why was there one number, but not the other? It should be a larger number of ‘operations’ needed, but with the cost being merely a third, the impact is less severe. None of that part matters when it is needed, yet what does matter was given to us in 2010 by USA today. Here (at http://usatoday30.usatoday.com/news/health/2010-03-10-heart-angiograms_N.htm) we see a point that matters. With “A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests. The researchers said the findings suggest doctors must do better in determining which patients should be subjected to the cost and risks of an angiogram. The test carries a small but real risk — less than 1% — of causing a stroke or heart attack, and also entails radiation exposure“. Now, we get that it is an American source on US patients, and not on UK patients, yet there have been correlations in health care in many nations, so it is not without merit to state that there is the chance that the same issue to some extent in the UK is taking place. Now, in the NHS age where £500 million in cost cutting, is it such a stretch to cut the one procedure that is seemingly only actually required in 1% of the cases? I am not stating that it is a great idea, yet if we accept that we need to get £500 million down, going after the 1% group might be one of the better ideas. In all this Labour should not object, a truckload of their politicians have made a career out of going after the 1% group their entire life, so there should be a consensus on both sides on the isle on this subject! The quote that is hugely helpful is ““We have to rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals. We’re looking into why that is. Who in future won’t get an angiogram? That’ll be up to cardiologists,” said one senior doctor“, which makes perfect sense and as we accept that there will be a group of people that goes through one way of treatment, some of this will be done because a doctor had a certain education from a certain medical school, another takes route 2. I am largely convinced that both paths have merit and are in the best interest of the patient. In addition, when we see the 60%-70% variation, what happens when we drill down deeper and set it against the years of practice of the cardiologist. Will there be clustering? I am not stating that any of them are wrong. Yet, is there a chance that a junior cardiologist would see a few more (perfectly valid) reasons to do the cardiogram? I am not stating, not judging, I am merely asking. You see, as stated by: ‘the Guardian can reveal‘, yet that part they did not reveal. Why not? Perhaps the data was missing, yet the article on how “NHS organisations in Surrey and Sussex are considering restricting the number of patients who have an angiogram or an angioplasty” it would have been nice to see more than merely quoting “I don’t think that these extra cuts are reasonable. You can’t justify £500m to the DUP while taking another £500m out of the English NHS“. When we see the numbers I see that £500 million can be cut from one side where the costs are implied to be £1.75 BILLION, meaning that here we see that cost cutting is met whilst that budget remains to get 72% and none of the other parts are affected.

So cutting 28% from a program, whilst one of the other considerations is ‘Shut beds or even whole wards in community hospitals‘. It is merely a good idea to contemplate what could be cancelled, postponed of even considered in other ways. Another part that is true, yet limited to merely a small paragraph is “Saving the £55m this year will prove to be a false economy that costs the NHS more money in the long term, warned Nigel Edwards, chief executive of the Nuffield Trust health think-tank” Now, we might think that Nigel Edward is talking politics to the people that hire his consultancy (which is fair enough), yet he has a point and the point he is trying to make has been proven again and again. Yet, the NHS needs a massive overhaul and for the longest of times, people seemed to have been merely talking about it. Is it mere complacency or is there more? Consider the American source 17 years old gave us a 99% not needed rate. There is no evidence (at present) that this is as high in the UK, yet when we see “rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals“. In an age of cost cutting that 60-70% is an enormous amount of variation and until properly looked at that data there is no way to tell how valid it is in the end.

The article merely gives us a lot more questions than they answer. That is gotten from the final part with “A Department of Health spokesperson said only that “Given the NHS budget has gone up by £6 billion in the last two years in real terms NHS England and NHS Improvement are ensuring that local areas spend their increasing share equally based on best clinical practice.”“, and in addition we see the mention of Tory MP Sarah Wollaston and “while taking another £500m out of the English NHS“, whilst at the end we see “Jeremy Hunt, the health secretary, declined to comment on the £55m cuts“. In addition there is “under NHS plans to make £55m of budget cuts in Surrey and Sussex“, so the article does not give us many things. Like why these two counties have to cut a little over 10%, the final part is given in the weirdest of ways. Now, it could be merely the reporter having a creative thought. If that is not the case, the entire issue in the NHS is a lot weirder and even more problematic than the Guardian could have revealed. The issue “The bodies made clear that they have to contemplate such controversial measures because NHSE and NHSI have told them to save the £55m. Despite already having “ambitious financial plans for 2017-18”“, so here we see part of a larger problem. We have seen for the longest time that the NHS over overspending, that the cash is gone and that cuts were needed, we have all seen that news for about 2-3 years and here we see “ambitious financial plans for 2017-18“. So based on what budget were those ambitious plans conceived, perhaps on a gurney with a few nurses (a somewhat speculative imaginative thought)?

The clarity of the problem has been there for the longest of times, the governing bodies need to take several matters a lot more serious, and in all this the shifting numbers, the mentioning of the blended events and numbers give rise to several other questions too. All this because certain numbers were thrown at the readers, yet the overall numbers called in questions from the very first moment and as such the article (in my humble opinion) merely stats that there is a lot more wrong at the NHS than most people realise, with all that, caught in the middle are the doctors and nurses. None are getting hired in addition and there are issues for the doctors two, so when they rightfully demand that these ‘ambitious financial plans for 2017-18‘ are being made public, what kind of a story will they receive? The tension should be an interesting one as the pay rise for health care workers was capped at 1%.

So as we conclude today’s event, we all need to take a long hard look at the decision makers in the UK NHS, they are seemingly wasting too much time of the preferential prospect of presentation, whilst the reality was never a given element of that presentation at all. The fact that there are actual issues rising to the surface of the NHS, whether already looked at or not, when we see the amount of issues linked to high variations, in an age where costs are cut to the extent they need to be, is it not weird that those numbers had not be properly looked at and reported on at least 2 years ago? The 2010 article is indicative of that to at least some degree. You see, if it had been, that that would have been evidence that could have been added to this article. The fact that it was not gives rise to the questions I added and in all this it took not that much time. Now in all fairness, to add 30% on a £105M cut. Yet in all this, there is still the issue with the £1.75 billion of angioplasty in the UK.

In addition, to add the amounts that are added, how was it decided where they would fall?

Now we get that there are issues in several places and some would state ‘It will be alright‘, and ‘things will get fixed‘. Yet from my point of view and from the issues presented there are merely more and more questions coming up and it seems to me that the growing issues with the NHS is due to inaction, not merely through cut backs. That is one actual clear given, the issue at that point is not how we can solve the NHS issues, it becomes how can we temper towards zero the amount of idle time and inaction, not in the staff, but in the governing and infrastructural sides.

The additional part that was not seen at present is the realisation that the NHS issue will tighten, and get worse for the next foreseeable future (up to 5 years), you see, the turnaround will take longer with every delay and the recovery from any delay will take longer with every delay we see. The second part that we will be shown with the time to come is that there is a growing concern that the UK aging part has been shelved with the NHS for too long, so in about three years we will see that the NHS geriatric division is not up to scrap and there will be additional increasing pressures on the NHS soon thereafter.

 

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