Archive for the ‘Discussion’ Category

skeletal-debate

Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.

Aneurin Bevin

The ability to provide safe, cost effective health and social care, across the National Health Service (NHS) England, and other recognised agencies, is continually being driven further into an abyss.  Contribution to this situation is seen through numerous factors: the change in societal expectations of what treatments should be available on the NHS; the historic failing of successive governments to create mechanisms within general taxation, and additional charging to facilitate the continuing demands on these services; poor leadership by the Department of Health-a direct result of short-termism and political ideology-cascading down to hospital management teams.  The private funding initiative (PFI) projects that have been demonstrated have a phenomenally catastrophic impact on patient care.  Outsourcing of services to the private sector which are integral to patient care, for example portering, and domestic services.  And more recently a drive, initiated through a shared myopia of government, and hospital managers, to blindly follow a culture of “more for less”, to name but a few.

Making savings ad infinitum with the objective of maintaining the same standards, is detrimental to an organisations ability to be efficient and sustainable.  Savings are a tool used by accountants to achieve short-term gains.  Whilst “Lean” working is a viable proposition in health care “lean” is not anorexic.  The long term effects of short term savings are to drive down standards, to force errors through the cutting of corners, and to cost the organisation dearly in the future.  “Speculate, you can’t accumulate, if you don’t”: true leaders in the NHS will see the value in this proverbial saying.

Hospitals are finding themselves in such financial dire straits, that with no apparent means of raising capital for investment, in the very basic infrastructure to make them viable propositions, under any  other circumstance they would be bankrupt.  It is possible to put a plug in the bath, even if it is a round(ish) plug in a square hole; and to at least turn the flow of the, money, taps down so they are running at a steady flow and not gushing.  But this requires long term policies, more freedom from government control, and leadership: not crisis managers.

It is time for hospitals to look at becoming shrewd financial investors; to speculate wisely.  If £25million in the red, to continue saving will only drive debt.  Speculate and invest to drive productivity over the long term, bringing the debt down.  If it is a system allegedly good enough for the government to implement, then why not Hospitals?

The role of an agency has historically been to provide a source of labour to bridge short term vacancies, through sickness or maternity leave etc., within permanent establishment numbers.  Naturally, due to the nature of the short notice required to fill these vacancies, the cost to the Hospital, and the remuneration to the agency staff, is higher than a basic payment.  However, more so now-a-days, agency staff are found to be in post, in the same hospital, for years, enjoying higher rates of pay than their permanent colleagues; having to add here with less security and benefits.  But is this their fault; that agency staff can find themselves in such a position?  The answer is a resounding no.

There are reasons as to why agency staff, from all professions, find themselves in long term posts.  These reasons have remained unchanged over the years and include, but are not limited to:

  • High turn over of permanent staff – either out of health care completely, or on to the agency; tempted by the flexibility brought about through agency work.
  • Stagnation in the employment market – unless there are substantial benefits to moving, most staff remain at the same place of employment for considerable periods of time.
  • Inability to recruit experienced staff into permanent positions
  • Develop good working rapport with department – flexibility

On the 23rd November 2015 Monitor and the NHS Trust Development Authority (TDA) introduced price caps relating to the total amount Trusts can pay per hour, across all professional groups of agency staff.  The reason being that due to the existing pressures on health care budgets managing agency costs could allegedly save considerable sums.

Jeremy Hunt had indicated that such an action could save approximately £1 billion over a three year period.  A secondary, less publicised objective of the price caps being the eventual forced migration of agency staff  back in to permanent posts within the health service.

Introducing capping of the gross amount payable to an agency provider, thus in effect capping the remuneration of agency staff, at a time of year when people are at their most vulnerable, is a deliberate crass act by Jeremy Hunt.  Obviously a sanction timed with deliberate intention; reducing the potential risk of rebellion by the agency staff, withdrawing their labour.  Moreover, the timing of such an act would appear to be a deliberate attack on Junior Doctors in retaliation to their planned industrial action.

For clarity, the how and why of capping:

4. How have the proposed price caps been calculated?
4.1 The caps would determine the maximum total hourly rate trusts can pay an agency for an agency worker.  The cap would apply to the total charge and therefore would include:
 worker pay
 worker holiday pay
 employer national insurance
 employer pension contribution
 administration fee/agency charge
 any other fixed or variable fees or payments to the worker or agency or bank (e.g. travel, accommodation, finder’s fee, bonuses)

http://bit.ly/1LS1Nvo

1.10 The price caps are intended to support trusts when they procure from agencies and to encourage staff to return to permanent and bank working.  They should enable trusts to manage their workforce in a more sustainable way, reduce reliance and expenditure on agency staffing, raise quality and improve the working environment for their staff.

The effect of the capping for Band 5 and Band 6 on maximum AfC rate, most typical of Nursing and Operating Department Practitioners (ODP) can be seen here (on page 17).  An agency shift rate calculator can be found here.

This is not the first time there has been an attempt to address the high cost of agency expenditure, with the introduction of NHS Professionals.  An agency provider, owned by Government.  Professing to be the primary provider of healthcare professionals in the country, NHS Professionals does not appear to achieve the objective of having a positive impact on overall agency expenditure.

The continuing use of agency staff will inevitably remain a thorn in the side of NHS expenditure, as safe and effective health care provision is a catch twenty-two situation. The provision safe and effective health care is man power dependent.  If the provision of health care has to be pared-down to a minimal work-force in order to save money, to re-invest in other area’s, then the money saved will never reach those other areas: it will be needed to pay for mistakes made.  Invest in a work-force and whilst it will cost more to get the provision of health care right the first time, the savings made in the future will be rewarding and significant.

Effective work-force planning in health care, as with education is compounded by the lack of fluidity within the professions.  It is difficult to plan ahead for recruitment and retention in these areas and therefore there is, and will continue to be, a need for agency staff. And the capping of agency rates, to draw staff away from agencies into permanent positions is not the resolve.  It will only serve to move experienced health care professionals away from the NHS.

Dear Mr Hunt

Let us not beat about the bush.

Your attempt to save the National Health Service (NHS) £1 billion over three years, by way of capping agency spending bills, to re-invest in frontline patient care, is nothing but bravado in the face of a public who knows no better; and intimidation of hard working professionals who have to tread daily through sludge of government induced bureaucracy in order to deliver high levels of patient care.  To implement this aggressive policy at a time of year when individuals are at their most vulnerable clearly demonstrates the disdain this government has toward public sector workers.

Jeremy, the ignorance to the true potential of damage to health care demonstrated through your action is incomprehensible.  It is evident that there is already considerable loss of income across the NHS through the inability of hospitals to meet, in a timely manner, contracts with commissioning trusts.  On-the-day cancellations attributable in part to the inability of NHS hospitals to staff substantive vacancies with permanent staff; and a reluctance to employ short term agency staff, compound loss of income with the addition of  fines imposed by the commissioning trusts for failing to meet standards.  The perceived cost to prevent the cancellations, through the employment of short term agency, is an additional expenditure of small significance in the grand scheme of overall patient experience and outcome.

It must be asked Jeremy whether National Health Service Professionals (NHSP) ltd, an agency for healthcare professions set up by the Secretary of State for Health Alan Milburn in 2001; which was still owned in whole (all though not centrally funded) by the Secretary of State for Health in 2011, is included in your harsh opinion of, “agencies ripping off the NHS“?  In the very own words of NHSP:

We typically recruit more than 1,000 flexible workers every month, making NHS Professionals the largest recruiter in the NHS. http://www.nhsprofessionals.nhs.uk/nhsp/Pages/default.aspx

Is NHSP Ltd going to flourish through your anti-competitive attack on the private companies supplying agency staff?

Based purely on empirical data there is sufficient, substantive, evidence to be able to be explicit in saying the ratio of permanent staff (doctors, nurses, Operating Department Practitioners (ODP)) in post, on any one day, is far greater than that of agency.

Jeremy, if you are serious about making substantive savings in the NHS, remove the barriers of the internal market implemented by Thatcher post the Griffith Report.  Healthcare in silo’s creates financial waste.  Put some meat back on the carcass of a health care system made too lean by the blind followings of an inappropriate management system.

Regards

Richard

 

141f3438758a52b854f3e2219e2c8f1bFollowing the atrocities of Friday 13th November, witnessed on the streets of Paris, during which, through coordinated suicide attacks and shootings, one hundred and twenty-nine innocent victims lost their lives, there has been a collective outcry on social media to “Pray for Paris”.  Praying will not bring back loved ones: will not lead to justice, what justice is there to be had?  However praying may very well be the only path to solace people know to take.

There have been two particular comments which have appeared on social media, that have stood out for me, which  could have much further reaching influence; and which can direct us toward the path to peace.

The first, “When the power of love is greater than the love of power, the world will know peace.”  Whilst there is religion, countries will know no peace.  Religion is the politicisation of  faith and with politics the love of power will always prevail.  Rabbi Jonathan Sacks, Baron Sacks, makes a suggestion in his book, “Not in Gods Name: confronting religious violence”, that the God of Abraham was a God without faith: that Judaism, Christianity and Islam compartmentalized faith through interpretations of the word of God by man.  Compartmentalization creates a “them and us” situation, that in turn leads to the power struggles, the dehumanization of the believers of one faith by others, and the violence allegedly perpetrated in the name of God.  Lose religion, keep faith in humanity, nurture peace.  God is faith in humanity: not religion.

The second has come from the Dialama,

“We cannot solve this problem only through prayers,” the spiritual leader said. “I am a Buddhist and I believe in praying. But humans have created this problem, and now we are asking God to solve it. It is illogical. God would say, solve it yourself because you created it in the first place.” http://www.rawstory.com/2015/11/dalai-lama-stop-praying-for-paris-humans-created-this-problem-and-humans-must-solve-it/

We can solve it, we must stand side by side in solidarity and say, “NO MORE!”

We need strength to have that faith in our neighbour as he has in us.

skeletal-debateIt is ironic that despite all the negative press given to the abuse of controlled substances, illegal or not, figures produced by the Office of National Statistics (ONS) suggest drug poisoning involving both illegal and legal drugs is on the increase.

Misuse of illicit drugs is not a new phenomena, we just have to listen to the tales from those who were present at Woodstock and the “Summer of Love”. The question that needs asking in relation to that era is, were the drugs cleaner in those days? How many celebrities from the music world have appeared to defy death through substance abuse. In fact, how many bankers, stockbrokers, and barristers partake in illegal drug use ( as reported in the press) and manage to lead relatively normal lives? Is it always the base drug which kills or the additives used to make it go further, and make the drug dealers richer.

Referencing data from the ONS (acknowledging their disclaimers), whilst drug related deaths in the UK are on rise in both male and female populations, the deaths represent an insignificant percentage on a whole. Though the loss of life is not insignificant.

Unlike the change in law to make not wearing of seat belts illegal, changing the law and misuse of drugs act will not, I believe, save lives.

It is long over due that society must take a step back, draw a deep breath, and ask where the heck are we going?
And for the time being we have to accept that people are not averse to risk taking. Children and adults today have enough information and sources of reference to make informed decisions; we should accept that is life.

skeletal-debateIt would appear that in your article entitled, “Why I call Myself an Atheist Muslim”; Huffington Post, 05/13/2014, you, despite attempting to argue against the point, clearly contradict yourself.

For want of no other reason, than that of a comprehensive article, “Atheism – Wikipedia” clarifies the point that, as an atheist, one would have no belief in a deity. Monotheism — a belief in one God — in which Islam, Judaism and Christianity are the main players; and which are recognised as believing in the same God, evidently precludes the use of atheist in the same title.

It is intrinsic to human nature, across the spectrum of the socio-economic rainbow, that as soon as one compartmentalise’s a subject bigotry develops. Therefore, it is my opinion, the origins of religious bigotry, as it is not just directed at Islam, is borne by the politics within monotheistic religion.

Religion is synonymous with politics. Unfortunately “politics” in my opinion is synonymous to “terrorism”, but that is another story.

Politics (from Greek: πολιτικός politikos, meaning “of, for, or relating to citizens”) is the practice and theory of influencing other people on a global, civic or individual level. More narrowly, it refers to achieving and exercising positions of governance — organized control over a human community, particularly a state. Furthermore, politics is the study or practice of the distribution of power and resources within a given community (a hierarchically organized population) as well as the interrelationship(s) between communities.
http://en.wikipedia.org/wiki/Politics

The texts of the Torah, the Bible and the Qur’an can be seen as continuations of the “Old Testament”, and could be viewed as political texts setting out the direction of each party or religion. My point is that in religion, as with politics, there will be individuals with moderate opinion; those with extreme opinion; and those with no real opinion per se, those who have an ethical non-religious outlook on life.

I am an Agnostic. I stopped calling myself a Christian because I believe I do not need to compartmentalise myself to be a better person. Personally, I believe you seek a more believable expression than “atheist Muslim”, if you wish your opinions “on the “Root Causes” of Islamist Jihadism and politics of Islamophobia” to carry more authority.

skeletal-debateI really do not know what all the fuss is about…

Edward Snowden has confirmed what many of us already believed happens on a daily basis; by bringing PRISM to the forefront of media.

A self-confessed believer in conspiracy theories, I have embraced the digital age including mobile technology, and every risk associated with using it. Every day I run the risk of having my social media accounts hacked, virus’ covertly inserted my hard-drive and worst of all my wife finding out I have more than two email accounts.

We are already aware of the personal information that Google and Yahoo collect on users to target advertising; why not extrapolate this example to Governments. The activity of Google and Yahoo in my eyes is just as intolerable as alleged actions of the National Security Agency (NSA) in the United States, or the Government Communications Headquarters the United Kingdom (UK). But it is the price we must pay for advancing technologies: someone somewhere will find the technology to get what they want, when they want.

How do the allegations put forward by Snowden differ from intercepted letters, written by soldiers fighting on the front, were censured; or the interception of wireless transmissions? Okay, instead of discriminating against the few it is alleged Government agencies are indiscriminating against the many.

“Even if you are not doing anything wrong you are being watched and recorded”, suggests Snowden. Go to the garage and fill up, your car registration will be scanned and checked, to see if you have tax and insurance. Use your super-market loyalty card and they will know more about your shopping interests then you. My journey to work is 21 miles and I wouldn’t be surprised if the entire journey could be tracked. All this information can easily be manipulated to benefit the end users purpose.

Yes Snowden could have done something wrong, in as much as being in breach of the terms of his contract of employment. Whether this his actions are morally or ethically acceptable is not for me to say. But I suspect when the dust has settled there will be a T-shirt, a book and then a film.

For what else is there for us to do if we don’t like what we have heard about the alleged actions of these Government agencies? Quit the world-wide web…?