Tag Archives: Simon Stevens

The views we question

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

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

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

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

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

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

 

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Where the Wild Geese go!

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

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

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

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

These clear thoughts give us two dangers

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

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

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

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

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

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

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

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

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

 

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