Monday, December 17, 2012

Foreclosures Can Be Cheap Investment Properties - Lake county, FL

It may not be the happiest situation, but the reality is that banks, State, Federal and private organizations seize thousands of properties every month because of various bankruptcy and seizure laws. These properties are generally auctioned off after seizure, and can be purchased for as little as 10% of the market value of the property. Although various types of seizures exist, when a property is repossessed because the owner failed to pay the mortgage, this is specifically known as a foreclosure. Many lenders handle hundreds of these properties every month, and the cost of holding and managing them is exorbitant. So they auction them off as fast as possible to recover as much of their loss as they can. You can search the Internet and find foreclosure properties that are listed for sale. If you're looking to build an investment property portfolio, foreclosures can be a great way to grow it more quickly. Because you're buying the property so cheaply, you automatically have some equity. That means you can either borrow against that equity to help buy your next property, or you can sell the property in the normal way for market value, and pocket the difference. Naturally it would be nice if you could buy every property at 10% of its real value, but of course this doesn't happen every day. But if you do your homework and keep a close watch on the foreclosure listings, it's easy to buy properties at substantial discounts. In fact, it's likely that there will be more than you could ever manage to buy. If the homes in your own area are rather expensive, or you can't find anything that's cheap, widen your horizons and look in another city or even another state. Depending on what you plan to do with the property once you've bought it, you can find agents who are local to look after the rental or sale of it for you. If you're uncomfortable about owning property that you can't drive past once in a while, then sell off any cheap deals you find interstate, and only keep and rent out the ones that are local. The main things is to find yourself a reputable source of listings, so that you can be confident you're genuinely pursuing a good deal. Once you have a steady supply of potential purchases available to you, then it's just a question of working out a strategy for benefiting that suits your time availability, money resources and personal preference. No matter which way you choose to make money from foreclosures, there's no doubt it's there to be made. More information, visit : Lake County Investment Properties Lake County Investment Properties buys and sells houses in Lake county, FL. We have cheap investment properties. We help homeowners sell distressed properties. Lake County Investment Properties handles short sales, foreclosures, bankruptcy, probate, and just need to sell.


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Saturday, December 15, 2012

The Best Portable Accommodation Product

So many business sites that exist in the cyberspace, but only our business site is very extraordinary in the field of portable cabins, Modular Building Industry, Supplying All Types Of Portable Cabins, Anti Vandal Site Accommodation, Modular Buildings And Storage Containers. we applied prices were very competitive and affordable.

Tuesday, December 11, 2012

Telling an American You Love Them is a Turn Off

So against my better judgment I decided to enter (well tiptoe) into the world of dating in South Africa.* I arrived in South Africa with the intention of not dating anyone during my time here and using this as a period to “cleanse.” Repeated conversations with South African women about the infidelity of South African men, coupled with the fact that the average marrying age here is (I am guessing) 25 so there is a lack of eligible bachelors over 30 and the popularity of beer being apparent in the vast array of male protruding bellies, all served as a confirmation for me to stay far away from dating. However, after repeated prodding from my coworkers to be more open minded I decided to at least give one of my would be suitors a chance. I actually enjoyed myself on both of the dates I went on and thoroughly appreciated how chivalrous they both were. It’s the aftermath of those dates that has me retreating for the hills. One of my dates, repeatedly told me how much he loved me and was going to marry me at the end of our date. Following my other date, my would be suitor emailed me once, SMS me three times, and called me 5 times all in the next day. I did speak to my “I love you” date and tried to explain to him that he doesn’t know me so he can’t possibly love me. He is francophone and explained that in French there isn’t a word for “like” just “love.” That there are varying degrees of love and his love for me was small but growing every second. Needless to say this didn’t change my perspective. So being the cultural ambassador that I am, I then proceeded to try and explain my culture, particularly in regards to dating, to him. One of the great things about living in another culture is it gives you the unique opportunity to externally view your own culture. I was quite taking aback as I listened to my description of dating in America. Here is some of what I shared: Telling an American when you first meet them and don’t know them that you love them is a turn off. Americans are naturally distrustful. We believe that trust is earned not given. As such, we are guarded in our interactions and relationships until we feel that someone is trustworthy. In dating, this also manifests itself by not initially divulging your feelings, and most of the times not fully sharing your feelings until you know that the other person shares similar feelings. We are an individualistic society so we like personal space figuratively and literally. Dating in the U.S. is a game. Sort of like “cat and mouse.”

Wednesday, November 28, 2012

Sunday Post #2: Richmond realtor proclaims real estate market in process of a dramatic crash

Richmond realtor ri James Wong takes a look at the evolving market conditions and comes to the stunning conclusion (for a realtor) that there are "strong signs for a prolonged market downturn." It has Wong asking, Are We Headed For a Housing Market Downturn?

Wednesday, November 14, 2012

Rent Portable Accommodation

We have a wide range of mobile and portable accommodation units for hire that will suit a variety of needs including use on building sites as well as: Offices Canteens Toilet Blocks Farm Shops There are too many options to list individually but hiring portable accommodation provides a cost-effective, easy way of meeting your needs. Since these units are portable this type of accommodation does not generally require planning permission. Please give us a call to discuss your exact requirements - we usually find no two needs are the same - and we'll find a unit to suit you.

Tuesday, November 6, 2012

Kitchen Countertops Santa Cruz

Did you know that by adding Kitchen countertops santa cruz can make your kitchen has the feel of a new, full of spirit. The kitchen is often forgotten, or rather not be noticed. The kitchen is also one of the 'dirty' in between the spaces in the house. This was caused by the habit of leaving the kitchen after cooking in a dirty state. By doing a rearrangement of your kitchen, you can raise the spirit to make the kitchen is always clean and no longer a dirty place. Add some new accessories, some colored pots, glass vases, and holders can be sure the kitchen cooking utensils you coined a new look. Immediately replace the kitchen utensils that are not feasible, and save a few plates, bowls, and trays are worn only on certain days. The most important think to make the kitchen more functionalist, one of them by adding a kitchen table, Kitchen Countertops of Santa Cruz. If the narrow kitchen to reconsider this idea unless you want to expand the kitchen or combine two rooms into a kitchen.

Monday, November 5, 2012

5 Ways to Sell Your House Fast

Looking to relocate to another place? Are instant cash needs worrying you? Are you thinking of sell your house fast quickly and worried for the same reason? Well, to be much of a relief a fast house sale can be a lot more than a myth that all sellers had once eyed on. Bringing the buyers to your doorstep is very easy and simple in the present days. But evoking in them the intention to make a purchase soon from you is not all that simple by its nature. Yet, in just a matter of 5 strategic steps, you can be sure of selling the house fast. The primary concern should be given to the aspect of pricing. A low pricing can fetch you a loss in the deal. A high pricing can have the very adverse effect of making the buyer rethink on their decision to buy the house from you. Such hurdles can be shadowed over by means of an appropriate pricing based on a property valuation, usually done by estate agents. So, the first but the most crucial step while you attempt to sell your house fast, lies in selling it at the right price. Secondly, you should find time to get the necessary repair works done. It is a very often witnessed scene where the buyer back out seeing that the house to be sold requires a lot of repairs to be done, before actually moving into the house. Therefore, it is quite vital to make a check that you have done all essential though minor repairs before trying to sell it out to someone. The very appearance of your house can decide whether you can sell your home quickly or not. Appearance pertains to both the exteriors as well as the interiors. The exteriors have the power both to attract the prospective buyers and also to make the buyer reluctant to even enter your house. A well maintained external appearance grabs the attention of the buyers. But a poorly maintained one can easily drive away the buyers. Mowing of the lawn, trimming of shrubs, repairing of gutters can all aid you to sell your house fast. The interiors of the house give the homely touch to your house. The interiors when well maintained suggest the buyer that the house is ready to accommodate new inhabitants. Thus, the third step is to make your house look attractive and homely. Financing is something that several buyer have trouble with. Being adamant in such issues can shoo away the buyers. Therefore, rendering flexibility in financing options forms the fourth step. Depersonalizing can add more value to the house and can help you in selling the fast. Depersonalizing refers to the packing off of such personal items like family photos, and other collections. This fifth step can very well enhance your chances of making a very fast house sale.

Sunday, November 4, 2012

Modular buildings the benefits

Modular Buildings create space within the premises as well as in your budget because they are less expensive than fixed buildings and serve exactly the same purposes. The multiple prefabricated wall sections are known as modules along with the area of the modular building is decided through the number and dimensions of the modules. These modules allow easy assembly and quick installation for the novice along with a professional. These structures became popular as schools expanded and required space for laboratories sewing classes woodwork rooms and after-school care. The pre-engineered buildings could not anymore accommodate the masses and individuals were seeking a less expensive method to expand than fixed buildings that will be costly and take too much time to create. The structure sounds of hammers and drilling would disrupt the peace and distract students so these modular relocatable buildings were constructed off-site and brought to the institution or assembled within the car park. Aside from the noise building also causes mess plus the labourers are noisy when they're in group and there's inadequate supervision. The majority of the construction occurs in the factory this also makes deadlines simpler to stick to and it is far more convenient for the client with no noise and hassle. Buildings can also be customised plus the floor plan is agreed by the client and designer. When the modular building has actually been ordered to specification and delivered it's safe for habitation.

Tuesday, October 9, 2012

Private Health Insurance Exchanges––Will They Save Money? Will the Idea Grow?

Private health insurance exchanges will save employers money but not make health insurance cheaper.

Because private health insurance will save employers money, they will grow.

Will Private Insurance Exchanges Reduce Health Insurance Costs?

There's lots of buzz these days about private insurance exchanges. The idea is to give employees more choice in purchasing their own individual coverage

Tuesday, October 2, 2012

Will Many of the Smallest Employers Circumvent the Affordable Care Act by Using Self-Insurance?

Not surprisingly, only about 10% of firms with fewer than 200 workers take advantage of self-insurance––and almost no very small groups (fewer than 50 workers) use the product. It just isn't worth it for these small employer groups to take the risk that they will either have too many claims or very big claims from their workers––that is what insurance companies are for.

Already, 96% of workers

Friday, September 21, 2012

The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up

Indiana, New Mexico, and Wisconsin are asking the federal government
to exempt people making between 100% and 133% of the poverty level from
the upcoming Medicaid expansion.

These Republican governors need to put up or shut up.

Ever since the passage of the Affordable Care Act (ACA), Republican governors have been clamoring for block granting Medicaid.

The Supreme Court ruled that a state

Thursday, September 13, 2012

Romney Intends to Repeal “Obamacare” in 2013—Has He Thought Through the Unintended Consequences If He Does?

Romney says he will repeal “Obamacare” if he is elected. Given that this has been part of his platform from the beginning of the campaign he is entitled to do that if he wins.

I did not support passage of the Affordable Care Act (ACA) in 2010 because I saw it as an unaffordable entitlement expansion with no real hope of containing costs.

But the practical reality of killing the Affordable Care

Monday, September 10, 2012

Obama vs. Romney: A Detailed Analysis of Mitt Romney’s Health Care Reform Plan

Let’s take a look at Mitt Romney’s Health Care plan using his own outline ("Mitt’s Plan") on his website.

Romney's approach to health care reform summarized:

"Kill Obamacare" - There seems to be no chance Romney would try to fix the Affordable Care Act––he would repeal all of it.
No new federal health insurance reform law - There is no indication from his policy outline that he would try to

Monday, August 20, 2012

Romney vs. Obama: The Romney-Ryan Medicare Plan Compared to the Obama Medicare Plan—Who’s Telling the Truth on Medicare?

They both are and they both aren’t.

I’ve never seen a week in health care policy like last week. The media reports have to be in the thousands, all trying to make sense of the furious debate between Obama and Romney over Medicare.

As someone who has studied this issue for more than 20 years, it has also been more than exasperating for me to watch each side trade claims and for the press to try

Monday, August 13, 2012

Wyden and Ryan—One is Up and the Other is Down—and They Are Both Telling the Truth

Republican Vice Presidential pick Paul Ryan isn’t the only one Democrats are piling on this week. The knives have come out for Senator Ron Wyden, the Oregon Democrat.

I guess that isn’t a surprise. If Ron Wyden is right on Medicare then so are Paul Ryan and Mitt Romney.

The fundamental problem here is that the Democrats have decided that their best path to victory in the November elections is

Tuesday, July 3, 2012

The Game’s Not Over, and It May Not Even Be The Real Game

by Brian Klepper

Like most health law watchers, I was surprised by the recent Supreme Court decision. I'm sure that on this issue, as with everything else, zealous responses rationalize the result and split the country down the middle.

I expected the Court to be purely partisan, but apparently Chief Justice John Roberts, acknowledging the gravity of his role, saw his way clear to support the

Thursday, June 28, 2012

Do You Have Any Idea How Close the Affordable Care Act Came to Being Toast?

I expected Supreme Court Justice Anthony Kennedy to vote to toss the individual mandate. I had no doubt the other three conservative justices would want the whole of the Affordable Care Act thrown out.

I also expected the four liberal justices to support both the individual mandate as well as the entire law.

About everyone expected Roberts and Kennedy to vote alike.

If Roberts had gone with

The Supreme Court Ruling on Health Care, Its Impact on Medicaid, and 29 Republican Governors--Be Careful You Might Get What You Wish For

Conservatives wanted the Supreme Court to do the work of killing the Affordable Care Act (ACA) for them. They didn’t get their wish but the Court may have put conservatives into a political corner they will find very uncomfortable.

Under the new health law, the Medicaid program will be substantially expanded. Those making up to 133% of the federal poverty level (about $30,000 in annual income

The Supreme Court's Decision on the Affordable Care Act

In the immortal words of Rosane Rosana Dana, "Never mind."From the SCOTUS blog live in the court room: "Chief Justice Roberts' vote saved the ACA."On to the elections.

Monday, June 25, 2012

What Would Health Insurance Cost if the Supreme Court Overturns the Individual Mandate But Leaves the Insurance Reforms in Place?

That will be the big question on Thursday if the Court throws out the mandate and the parallel insurance reforms that would require health plans to take all comers without regard to their health status and require insurers to cover pre-existing conditions.

But before we get to that scenario, let’s look at another possibility.

The Court Overturns Both the Individual Mandate and the Insurance

Sunday, June 24, 2012

AMIA Board: specification of core competencies in Biomedical Informatics

In 1998 I launched a website called "Medical Informatics and Leadership of Clinical Computing" (now entitled "Contemporary Issues in Medical Informatics- Common Examples of Healthcare Information Technology Difficulties" at this link).

Its theme was that leadership of IT in healthcare was severely lacking in the formal competencies needed to reach any measure of success, and in fact the lack of informatics competencies in the usual IT actors was causing wasted resources and patient harm.

I had also commented that the term "Medical Informatics" itself was being misappropriated by anyone claiming to do anything with computers in medicine, even the creation of trivial and/or low-value programs.

Sadly, little has changed in that regard since 1998; in fact things are much worse.  The meaning of the term "Medical Informatics" itself has become severely blurred, and job listings that use the term are largely misguided.  They often seek a nurse (most common) or doctor (less common) without formal education in the domain, who's dabbled with hospital IT systems, to lead clinical IT projects.  This is a totally inappropriate and even dangerous approach (example here).

The American Medical Informatics Association has released a paper "AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline" that is long, long overdue.  As of this writing, full text is available a this link:

This paper certainly provides a robust affirmation of ONC's recommendations on healthcare IT leadership roles that I wrote of in my Oct. 2009 post "ONC Defines a Taxonomy of Robust Healthcare IT Leadership."

Some highlights of the new AMIA paper:


The AMIA biomedical informatics (BMI) core competencies have been designed to support and guide graduate education in BMI, the core scientific discipline underlying the breadth of the field's research, practice, and education. The core definition of BMI adopted by AMIA specifies that BMI is ‘the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health.’ Application areas range from bioinformatics to clinical and public health informatics and span the spectrum from the molecular to population levels of health and biomedicine. The shared core inform`tics competencies of BMI draw on the practical experience of many specific informatics sub-disciplines. The AMIA BMI analysis highlights the central shared set of competencies that should guide curriculum design and that graduate students should be expected to master.

Note that Biomedical Informatics, which the Board feels is a broader term encompassing all of the information-science disciplines in healthcare and biomedical research, is defined as "a core scientific discipline underlying the breadth of the field's research, practice, and education."  One does not acquire expertise in a scientific discipline without first rigorously studying that discipline, e.g., as is done in medical school to gain optimal understanding of clinical medicine.

... The present articulation of BMI core competencies is intended to support AMIA and its members in promoting the discipline as a career choice, and to provide guidance to students and curriculum developers when choosing, designing (and implementing), or re-designing graduate-level academic BMI programs.

(Who needs graduate education in Biomedical Informatics when all that seems to be needed is a little on-the-job dabbling?)

... Defining BMI as the scientific core of a discipline that has broad applications across health and biomedicine highlights its foundational role and refutes the kind of reductionism that superficially explains BMI simply as the application of information technology (IT) to biomedical and health problems.

I termed that phenomenon "Medical Instamatics" on that late 1990's site.  Unfortunately, the "reductionism" is all too prevalent today.  People whose BMI education and skill levels (which I define as the ability to apply deep knowledge and experience to successfully manage the unexpected, not just manage traditional activities via a book of "process"), are often at the amateur level -- in the same sense that I am a radio amateur, not a telecommunications/engineering professional -- or worse.  This wreaks havoc (as here) in health IT, especially when led by senior management also incognizant of the issues.

Definition: Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, driven by efforts to improve human health.
Scope and breadth of discipline: BMI investigates and supports reasoning, modeling, simulation, experimentation, and translation across the spectrum from molecules to individuals and to populations, from biological to social systems, bridging basic and clinical research and practice and the healthcare enterprise.
Theory and methodology: BMI develops, studies, and applies theories, methods, and processes for the generation, storage, retrieval, use, management, and sharing of biomedical data, information, and knowledge.
Technological approach: BMI builds on and contributes to computer, telecommunication, and information sciences and technologies, emphasizing their application in biomedicine.
Human and social context: BMI, recognizing that people are the ultimate users of biomedical information, draws upon the social and behavioral sciences to inform the design and evaluation of technical solutions, policies, and the evolution of economic, ethical, social, educational, and organizational systems.

There is also a call for experts to:

  • Acquire professional perspective: Understand and analyze the history and values of the discipline and its relationship to other fields while demonstrating an ability to read, interpret, and critique the core literature.

In effect, health IT amateurs, including those in traditional business computing, have little to no formal education or experience in reasoning, modeling, simulation, experimentation, and translation; developing, studying, and applying theories; building on and contributing to computer, telecommunication, and information sciences and technologies; and drawing upon the social and behavioral sciences to inform design of these complex systems.

BMI is the core scientific discipline that supports applied research and practice in several biomedical disciplines, including health informatics, which is composed of clinical informatics (including subfields such as medical, nursing, and dental informatics) and public health informatics (sometimes referred to more broadly as population informatics to capture its inclusion of global health informatics). There are related notions, such as consumer health informatics, which involves elements of both clinical and public health informatics. BMI in turn draws on the practical experience of the applied subspecialties, and works in the context of clinical and public health systems and organizations to develop experiments, interventions, and approaches that will have scalable impact in solving health informatics problems. However, it is the depth of informatics methods, shared across the spectrum from the molecular to the population levels that defines the core discipline of BMI and provides its coherence and its professional foundation for defining a common set of core competencies.

Here is the diagrammatic represention of the above in the full article:

Biomedical informatics and its areas of application and practice, spanning the range from molecules to populations and society

Finally, excerpts from the meat of the article on Prerequisite knowledge and skills.  This depth and breadth of knowledge does not come from studying business computing, dabbling with systems by nurses or physicians lacking formal domain education at the graduate level or beyond, or by guessing by the seat of one's pants:
    • Fundamental knowledge: Understand the fundamentals of the field in the context of the effective use of biomedical data, information, and knowledge. For example:
      • ... Healthcare: screening, diagnosis (diagnoses, test results), prognosis, treatment (medications, procedures), prevention, billing, healthcare teams, quality assurance, safety, error reduction, comparative effectiveness, medical records, personalized medicine, health economics, information security and privacy.
    • Procedural knowledge and skills: For substantive problems related to scientific inquiry, problem solving, and decision making, apply, analyze, evaluate, and create solutions based on biomedical informatics approaches.
      • Understand and analyze complex biomedical informatics problems in terms of data, information, and knowledge.
      • Apply, analyze, evaluate, and create biomedical informatics methods that solve substantive problems within and across biomedical domains.
      • Relate such knowledge and methods to other problems within and across levels of the biomedical spectrum.
  • Theory and methodology: BMI develops, studies, and applies theories, methods, and processes for the generation, storage, retrieval, use, management, and sharing of biomedical data, information, and knowledge. All involve the ability to reason and relate to biomedical information, concepts, and models spanning molecules to individuals to populations:
    • Theories: Understand and apply syntactic, semantic, cognitive, social, and pragmatic theories as they are used in biomedical informatics.
    • Typology: Understand, and analyze the types and nature of biomedical data, information, and knowledge.
    • Frameworks: Understand, and apply the common conceptual frameworks that are used in biomedical informatics.
      • A framework is a modeling approach (eg, belief networks), programming approach (eg, object-oriented programming), representational scheme (eg, problem space models), or an architectural design (eg, web services).
    • Knowledge representation: Understand and apply representations and models that are applicable to biomedical data, information, and knowledge.
      • A knowledge representation is a method of encoding concepts and relationships in a domain using definitions that are computable (eg, first order logics).
    • Methods and processes: Understand and apply existing methods (eg, simulated annealing) and processes (eg, goal-oriented reasoning) used in different contexts of biomedical informatics.
  • Technological approach: BMI builds on and contributes to computer, telecommunication, and information sciences and technologies, emphasizing their application in biomedicine.
    • Prerequisite knowledge and skills: Assumes familiarity with data structures, algorithms, programming, mathematics, statistics.
    • Fundamental knowledge: Understand and apply technological approaches in the context of biomedical problems. For example:
      • Imaging and signal analysis.
      • Information documentation, storage, and retrieval.
      • Machine learning, including data mining.
      • Networking, security, databases.
      • Natural language processing, semantic technologies.
      • Representation of logical and probabilistic knowledge and reasoning.
      • Simulation and modeling.
      • Software engineering.
    • Procedural knowledge and skills: For substantive problems, understand and apply methods of inquiry and criteria for selecting and utilizing algorithms, techniques, and methods.
  • Human and social context: BMI, recognizing that people are the ultimate users of biomedical information, draws upon the social and behavioral sciences to inform the design and evaluation of technical solutions, policies, and the evolution of economic, ethical, social, educational, and organizational systems.
    • Prerequisite knowledge and skills: Familiarity with fundamentals of social, organizational, cognitive, and decision sciences.
    • Fundamental knowledge: Understand and apply knowledge in the following areas:
      • Design: for example, human-centered design, usability, human factors, cognitive and ergonomic sciences and engineering.
      • Evaluation: for example, study design, controlled trials, observational studies, hypothesis testing, ethnographic methods, field observational methods, qualitative methods, mixed methods.
      • Social, behavioral, communication, and organizational sciences: for example, computer supported cooperative work, social networks, change management, human factors engineering, cognitive task analysis, project management.
      • Ethical, legal, social issues: for example, human subjects, HIPAA, informed consent, secondary use of data, confidentiality, privacy.
      • Economic, social and organizational context of biomedical research, pharmaceutical and biotechnology industries, medical instrumentation, healthcare, and public health.

While nobody is an expert in all of these areas, skills in many of them are essential for successful and safety-promoting leadership in the health IT domain.

I repeat, this depth and breadth of knowledge does not come from studying business computing, dabbling with health IT, or by guessing by the seat of one's pants.  It comes about from rigorous education and experience in the appropriate domains at the graduate and (especially) post-doctoral levels.

Amateurs mistakenly put in leadership positions, and their organizations, are going to increasingly find themselves in legal hot water over mistakes in design and implementation that result in patient harm, security breaches, overbilling and other issues.

That is probably what it will take to have hospitals manage health IT talent more appropriately.

Finally, I plead guilty to tooting my own profession's horn.

Somebody needs to when the stakes are so high for patients.

-- SS

Monday, June 18, 2012

Administrators at Pepper Spray U Found to Have Violated Medical Professor's Academic Freedom

There they, the management of University of California - Davis, go again.

The Wilkes and Hoffman Op-Ed Questioning A University Sponsored Aggressive Prostate Cancer Screening Program

According to the Los Angeles Times, and a post in Inside Higher Ed, the trouble began when Dr Michael Wilkes, a professor of medicine at University of California - Davis, and Jerome Hoffman, a professor of emergency medicine, wrote an op-ed in the San Francisco Chronicle in 2010 questioning the wisdom of a program run by UC-Davis promoting aggressive screening for prostate cancer with the PSA test.  They brought up problems with using PSA for screeninf that have been known for a while, including the poor ability of the test to detect cancer, the inability of the test or of prostate biopsy performed in response to the test to differentiate aggressive prostate cancer from cancer that will not progress, which is more common, the risks of such biopsies, and the poor effectiveness of available prostate cancer treatments, compared with the frequency with which they produce harms.  All these issues have again been brought to the fore by US Preventive Services Taskforce's latest recommendations not to screen for prostate cancer, based on similar concerns.

Not only did Wilkes and Hoffman question the basis for the university sponsored program's aggressiveness, they speculated that it might have to do with money.  The program was sponsored not only by UC-Davis but by the American Urological Association Foundation.  In fact, that foundation's current corporate sponsors include:  Astellas Pharma, Inc., Endo Pharmaceuticals, Ferring Pharmaceuticals, Intuitive Surgical, Inc., Pfizer, Inc., and Qualigen, Inc., although the op-ed did not specifically list its commercial support.

The University Slap(p?)s Back

Nonetheless, per the Inside Higher Ed post,
Michael Wilkes received an e-mail from an administrator at the University of California at Davis. Wilkes, a professor at the medical school, was told that he would no longer lead a program sequence that taught better patient care, and support for a Hungarian student exchange program he headed would be withdrawn.

Within weeks, Wilkes was told that he would be removed as director of global health for the UC Davis Health System. He also received letters from the university’s health system counsel suggesting that the university could potentially sue him for defamation over the op-ed.

Again, this occurred despite the facts that many distinguished people have questioned the wisdom of aggressive prostate cancer screening, and that this particular prostate cancer program was supported by an organization that in turn is supported by money from pharmaceutical devices and drug companies that may stand to gain from selling drugs and devices related to screening for prostate cancer, and the diagnosis and treatment of such cancer. Wilkes and Hoffman were raising valid clinical and policy concerns about the public actions of a government-supported university, in my humble opinion.

Thus the university lawyer's apparent threat of defamation suits thus appears to be a SLAPP, a threat of strategic litigation against public participation. In California, a 1993 law provides recourse for people who have been threatened with SLAPPs (look here).

The Faculty Committee Responds

Regardless, Prof Wilkes filed an internal complaint, and again, per Inside Higher Ed,
Now, a committee on academic freedom at the university that investigated allegations of intimidation and harassment against Wilkes has found them to be true. The faculty committee said in its report, a copy of which was obtained by Inside Higher Ed, that the actions of the university administrators cast doubt on its ability to be a 'truthful and accountable purveyor of knowledge and services.'

The group has asked the dean and other top officials at the university’s school of medicine to write letters of apology to the professor, admit to errors of judgment, stop proposed disciplinary actions against him and take steps to prevent future violations of academic freedom. This week, representatives of the university’s Academic Senate are expected to vote on similar resolutions against the administrators.

Now, according to the LA Times,
The next step is up to campus Executive Vice Chancellor Ralph Hexter, who in consultation with Chancellor Linda P.B. Katehi is expected to decide by fall whether to impose any discipline on the medical school executives, campus officials said.

Good luck with that.

The Context at UC-Davis

I would be surprised if any such punishment occurs. After all, UC-Davis has a record of not tolerating dissent, but tolerating administrators who suppress such dissent.  We have previously discussed:
- How the UC-Davis police infamously pepper sprayed peaceful student demonstrators, apparently at least partially in response to Chancellor Katehi's vague orders to clear the campus (see post here).
- A subsequent report blamed this incident on incompetent, or worse leadership by Katehi's administration, but so far it is not obvious that this has lead to any changes (see post here).
- How UC-Davis adminstrators tried to punish a medical student who got in a dispute with an overly officious student who apparently was "monitoring" his actions on an email list server, apparently on behalf of the administration, invoking "professionalism" as if that meant blind obedience to academic administrators (see post here).

Furthemore, Chancellor Katehi has a record of her own relationships to industry.  Here we noted that she sits on the board of a large publishing conglomerate that includes a medical education and communication company (a MECC) as a subsidy.  So I suspect she may not rush to punish subordinate executives because they suppressed criticism of the role of commercial money in medical academics.


So UC-Davis seems to be another academic medical institution run by people more interested in bringing in commercial support than the academic medical mission, including the support of free speech and academic freedom.  Its case is another example of how leadership that seems hostile to the mission in one instance is likely to be hostile to the mission in other instances.

Here I summarized what I believe to be the real threats against professionalism in the academic medical context.  As we have said again and again, true health care reform would encourage leadership who understand the mission and will put its support ahead of financial concerns and ahead of their own self-interest.

See also posts in the Health News Review blog, and the University Diaries blog.

Thursday, June 14, 2012

Ellmers Calls on Sebelius to Address Health IT Safety Concerns: A Responsible Voice in Government on Health IT and HIT Safety

The following press release is very welcome, and speaks for itself.  There is a responsible voice in the government wilderness.  It is perhaps no surprise it comes from a Congresswoman who is also a registered nurse:

Ellmers Calls on Sebelius to Address Health IT Safety Concerns

Safety Risks and Health IT-Related Errors Cited in IOM Recommendations

WASHINGTON – House Small Business Subcommittee on Healthcare and Technology Chairwoman Renee Ellmers (R-NC) today sent a letter to Kathleen Sebelius, Secretary of Health and Human Services (HHS), inquiring about whether the Department has adopted the Institute of Medicine’s (IOM) recommendations for improving the safety of health information technology (IT).
The report, issued in November, recommended several steps to be taken by HHS and called for greater oversight by the public and private sectors. The Secretary was called upon by the IOM to issue a plan within 12 months to minimize patient safety risks associated with health IT and report annually on the progress being made.  The report further recommended that the plan should include a schedule for working with the private sector to assess the impact of health IT on patient safety, and recommended several other steps to help improve the safety of health IT.

Specifically, Chairwoman Ellmers has requested a copy of the Secretary’s plan to minimize patient safety risks, a description of health IT-related errors that have resulted in patient risks, injuries and deaths, and the status of the development of a mechanism for health IT vendors and users to report health IT-related deaths.  She said that because health IT has the promise to improve health care delivery for patients, physicians and other medical professionals, she remains eager to work with the Secretary to ensure that health IT is safe, effective and affordable.

In an August 11, 2011 letter to Secretary Sebelius, Chairwoman Ellmers said that a modern, well-equipped office is critical to the practice of medicine, and asked the Secretary to undertake a study of health IT’s adoption, benefits and cost effectiveness, including medical error rates.

On June 2, 2011, Chairwoman Ellmers’ Subcommittee held a hearing on the barriers to health IT that are encountered by physicians and other health professionals in small and solo practices.   At the hearing, physicians expressed strong concerns about the cost of purchasing and maintaining health IT systems, as well as the staff training and downtime necessary to implement such a system.  Chairwoman Ellmers noted health IT’s great potential to improve health care delivery, decrease medical errors, increase clinical and administrative efficiency and reduce paperwork.

For more than twenty-one years before being elected to Congress, Chairwoman Ellmers served as a registered nurse, focusing on surgical care as Clinical Director of the Trinity Wound Care Center and later helping to manage the family's small medical practice with her husband, Dr. Brent Ellmers, a licensed surgeon. As a registered nurse and the wife of a surgeon, Ellmers understands that a modern, efficient and well-equipped office is critical to the practice of medicine.    

This voice of sanity is quite welcome.  I've spoken with Rep. Ellmers' office, pointing them to my Drexel Univ. writings and materials and recommending Sebelius' reply be gone over with a fine-toothed comb, from the perspective of health IT realities, not merely from the perspective of the Ddulite's good intentions.  (I also introduced her staffer to the concept of the Ddulite, the HIT hyper-enthusiast who ignores all downsides and ethical concerns.)

I also pointed out the ethical lapse in IOM's position of "wait and see" while HIT is pushed nationally under penalty of law, at the cost of hundreds of billions of dollars, when their own report (along with reports from FDA here, JC here and others) admits they don't know the mafnitude of benefits, risks and harms:

... While some studies suggest improvements in patient safety can be made, others have found no effect. Instances of health IT–associated harm have been reported. However, little published evidence could be found quantifying the magnitude of the risk.

Several reasons health IT–related safety data are lacking include the absence of measures and a central repository (or linkages among decentralized repositories) to collect, analyze, and act on information related to safety of this technology. Another impediment to gathering safety data is contractual barriers (e.g., nondisclosure, confidentiality clauses) that can prevent users from sharing information about health IT–related adverse events. These barriers limit users’ abilities to share knowledge of risk-prone user interfaces, for instance through screenshots and descriptions of potentially unsafe processes. In addition, some vendors include language in their sales contracts and escape responsibility for errors or defects in their software (i.e., “hold harmless clauses”). The committee believes these types of contractual restrictions limit transparency, which significantly contributes to the gaps in knowledge of health IT–related patient safety risks. These barriers to generating evidence pose unacceptable risks to safety.
[IOM (Institute of Medicine). 2012. Health IT and Patient Safety: Building Safer Systems for Better Care (PDF). Washington, DC: The National Academies Press, pg. S-2.]

As I wrote in my Nov. 2011 post "IOM Report - 'Health IT and Patient Safety: Building Safer Systems for Better Care' - Nix the FDA; Create a New Toothless Agency", the IOM's response to their own study was reckless and unethical (at best):

... The panel also recommends that the HHS secretary publicly report on the progress of health IT safety each year, beginning in 2012. If the secretary determines at any time that adequate safety progress has not been made, only then should the FDA take the regulatory lead and be given the resources to do so, the report recommends, adding that the agency should be developing a framework now to be prepared.

In the meantime, during each year of "watching for safety progress", innumerable patients are exposed to HIT's hazards and costs.  Pharma and other medical device industries are afforded no such special accommodation.

-- SS

Wednesday, June 6, 2012

University of Miami Lays Off 800, Cuts Research Funding, Builds New Presidential Mansion

Despite the trillions of dollars flowing through the US health care systems, prominent not-for-profit health care organizations seem to be complaining more often that the money going to them is not enough. 

The Lay-Offs and Research Cutbacks

Recently, for example, the University of Miami announced that its medical center would have to tighten its belt.  In April, according to the Miami Herald,
University of Miami President Donna Shalala announced Tuesday that the medical school will take 'difficult and painful but necessary steps' next month to reduce costs, including staff cuts.In a letter to employees, she called the cuts 'significant' but provided no details about how many employees might be laid off.

'The process will take place in stages, and affected employees will be notified during the month of May,' Shalala wrote. 'Reductions will not impact clinical care or our patients and will primarily focus on unfunded research and administrative areas.'

Shalala said the cuts were necessary because of 'unprecedented factors' including the global downturn of 2008, decreased funding for research and clinical care, plus cutbacks in payments from Jackson Health System. The Jackson reductions 'have had a profound effect on our finances,' she wrote.

Placing the blame for the medical school's financial problems on Jackson Health System, the local safety-net health system, did not sit well with that organization's leadership. In another Miami Herald story, its chairman stated that the real problem might be:
'investments that they have made that may or may not have panned out,' including the purchase in 2007 of Cedars Medical Center, across the street from Jackson Memorial, for a price that several experts say was far too high.

In fact, we discussed here allegations that the University of Miami Medical School's purchase of a facility that was renamed the University of Miami Hospital adjacent to Jackson was meant to take insured patients from that already struggling facility.

Nonetheless, the Medical School proceeded with its cuts, which resulted in 800 layoffs (see Miami Herald story here.) The next Miami Herald story suggested that the cuts would disproportionately impact worthy researchers, for example,
When Nobel Laureate Andrew Schally arrived in South Florida six years ago, he was greeted with great fanfare and named a distinguished professor of pathology at the University of Miami medical school. Now he says his work is one of the many casualties of the school’s budget slashing.

Schally says UM told him several weeks ago that his annual funding of $150,000 for research would end May 31, part of widespread cuts in the medical school that could eliminate up to 800 jobs this month and trigger major reductions in research.

'I was shocked... We developed so many drugs for the university,' Schally says. 'They are killing the goose that laid the golden egg.'
The President's New House
The headline of another Miami Herald story last week suggested that things had gotten so bad that the cuts were even going to affect top university leadership's lifestyle:
UM president’s house sells for $9 million

We had posted about University of Miami President Donna Shalala's lavish university funded living conditions a while ago. Now it seems she would be giving up
'tropical ambiance,' 4.6 acres of lush gardens, and a prestigious Gables Estates address.

This "rare piece of Florida history" also had
a guest room created specifically to host the Dalai Lama during His Holiness’ visits to South Florida.

So can we conclude that the University is really tightening its belt when its President is forced to move out of such a lush environment? Not really.

In fact, Ms Shalala may be moving to even more plush surroundings, courtesy the university's supposedly challenged budget:
The 32-acre Pinecrest development, built on land donated to the university by UM law grad-turned-philanthropist Frank Smathers Jr., exclusively houses UM faculty. Shalala will now join their ranks as both boss and neighbor.

Decades ago, the grounds were home to Smathers’ Arabian horses and world-renowned mango collection. The UM-built homes are clustered in the center one-third of the acreage 'to safeguard the botanical integrity of the estate,' according to the university’s website. The remaining land is dominated by lush plants and fruit groves, and is maintained by Fairchild Tropical Botanical Gardens.

In particular,
It’s a very bold house,” Taylor said of Shalala’s new digs. “It’s a dominant house in the neighborhood.”

Taylor said the all-white exterior of the new home is a noticeable contrast to the more-earthy tones of other houses nearby. The university is calling it the 'Ibis House' after UM’s beloved (and also all-white) mascot.

Shalala’s new home will sit on a quarter-acre of land — dramatically less property than she enjoyed before. On the plus side, Shalala, just as in her old home, will enjoy about 9,000 or so square feet of interior space, and an in-home elevator connecting the first and second floors.

The new home is also situated in a unique gated community that offers a community clubhouse, tennis courts and pool, and meticulously landscaped gardens.

Was anyone really expecting that Ms Shalala would have to find her own housing, like the 99 percent have to?

So here we have another example of how the notion of CEO exceptionalism has filtered down from large for-profit corporations to even non-profit, ostensibly mission-oriented health care institutions. Leaders of health care organizations are now deemed to be so important, at least in the eyes of their hired public relations staff, that they must be given every luxury. Perhaps if housed in any space smaller than 9000 feet, Ms Shalala would be so confined as not be able to think great thoughts anymore, like how many layoffs would be needed to sufficiently cut costs. Worse, maybe without such free housing, she would just decide that the institution would not be showing enough gratitude, and so her amazingly brilliant leadership would have to seek new pastures.

Maybe, on the other hand, Ms Shalala's new house is just another demonstration how health care has become dominated by leadership whose own compensation and privilege seems to come before the mission., and sees no problem in asking for "difficult and painful" cuts from those who do the real work on the ground while building itself new mansions.

So as usual, it is time to say that true health care reform would foster leadership  that upholds the core values of health care, and focuses on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research.

Tuesday, May 29, 2012

Cyberknives: Our campaign to make sure your NHS has one.

This cyberknife shown above should be available to you and and your family if you need radiotherapy treatment to treat a cancer. It is 8 times more successful than chemotherapy. Currently, only 5 places in the UK have them. This one above is at Harley Street Private Clinic in London. Areas such as the North East, North West, South West, Midlands and Yorkshire & Humberside do not have access to this treatment. Update: NHS Sussex this morning have announced they are to buy 5 machines for their PCT. Great news for the people of Sussex (here).

What makes this even more galling is that there is currently a £169,000,000 underspend in the Cancer Drugs Fund for this year. This wasted millions should be used to buy the equipment above so that you and your loved ones can have access to this cutting edge treatment. We in Labour Left  have used the one click gadget below to tweet Health Ministers Paul Burstow and Anne Milton to ask them to use the Cancer Drugs Fund underspend to buy cyberknives. Please give your consideration to doing likewise. Many thanks.


5 NHS staffs whose morale is at an all time low

1. Derriford Hospital, Plymouth

The hospital is being asked to find £54m savings in two years. The workforce's morale is at an all time low as Serco who run the cleaning & catering contract in the hospital arbitrarily cut staff's hours by 17 leading to an annual lost of more than £7,000 a year for some staff. Hospital bosses for months refused to meet Trade Union officials until strike action was threatened. In the latest twist, just today two non-executive directors have resigned their posts at the hospital in protest at the poor running. The new chair for the hospital has just been appointed from outside the hospital with no appreciation or understanding for how hard things have been for the staff.

2. Great Royal Western, Swindon

Staff that this hospital are among the most deflated in the country. Wards have been shut down, staff have been asked to re-apply for their posts (in some cases unsuccessfully). Staff have been disciplined for their social media usage and Multi-National Corporation, Carillion, admit to bullying and shaking down the staff. The cleaning and catering staff have been on strike at the hospital for weeks now as they protest against the sacking and black listing of staff members through the courts. 

3. Robert Jones & Agnes Hunt Orthopaedic Hospital, Shropshire

The Keynon Ward was shut down over Easter and has not opened since. The staff were not informed of any decision. The budgetary pressures and staff cuts at the hospital have led to staff operating a "Work to Rule" strike. This means they only fulfill their contractual obligations at the hospital and refuse to do the normal 1000s of hours of overtime they put in without pay per month. There is a serious de-skilling programme under way at the hospital, where staff being asked to perform duties above their pay grade. Health Care Assistants are being sent on courses and asked to operate machines that a really the duties of a nurse. 

4. NHS Direct Staff, Devon

NHS Direct staff throughout the UK live in uncertain times. The 111 pilots are scary for three main reasons. Experienced staff are being replaced by telephonists with much less medical training. Staff numbers are being cut and private corporations are being invited to tender for the contracts. This led 600 staff across South Devon staging a work in protest, where they all worked free of charge for 24 hours to draw attention to the importance of their cause. Just yesterday, Serco pulled out of several 111 contracts they were bidding for after it emerged they were to be prevented from out sourcing the jobs. Serco claimed they only wanted to outsource the jobs to other NHS areas of England but ultimately the true profits would have been in using their Indian Call Centres. I hope the nurses pick up this piece of good news.

5. Springfield University Hospital, London

It might seem trivial to include these mental health nurses on the list, but please let me explain why I have done so. Nurses pay have been frozen for two years, their registration fees have climbed. Many are facing the prospect of being downbanded and as staff shortages bite they are being asked to do more. As well as this Andrew Lansley is currently waging a pensions war with NHS staff. All things considered, the prospect of £450 car parking charges being introduced at the South London hospitals represents an annual 2.5% tax for the nurses. On top of everything else, this is a cost they cannot afford. Some nurses have got in touch to say that the charges they have been asked to pay for parking their car at their hospital have topped £600 a year. The commodification of staff who do such a crucial job is a moral wrong and for all the collective funds raised, think what a boost to their morale it would be if the Health Secretary were to announce nation wide that charges were to be scrapped. After all, NHS car parks are free in Scotland.

(I was tempted to include other staffs such as the Royal Victoria Hospital in Belfast who have had to absorb an A & E Closure in the city's other main hospital. The extra patients combined with no corresponding increase in staff numbers has crippled a once great hospital. In addition, the spread of the Noro-virus throughout Scotland's hospitals especially the Royal Alexandria has placed immense strain on the workforces in Scottish Hospitals).

Monday, May 28, 2012

"It is essentially Skype messaging"

Virgin are in my bad books. First they take the NHS in York to the CCP accusing them of predatory pricing because York NHS beat Virgin to a contract by charging lower prices. Then Virgin gain 18 contracts throughout the UK to run anything from community care to sexual services. Worse still, this week, the story broke of their 5 year ill treatment of Virgin Media customers who suffer death. Instead of showing compassion Virgin go on to threaten and abuse the family members left behind to settle unpaid bills.
Associate Professor Bernard Yan using the Telestroke Service.

Now Virgin have teamed up with 7 PCTs in the NHS Lancashire area to help deliver "virtual" or "video" diagnosis. It works as follows. You switch on your camera on your computer, give me a peek & I'll tell you if your gonna have a stroke or not. Well, it is not quite like that since I am not qualified to diagnose, and they'll probably have a proper camera (or a "telekart" as they're calling it) but the basics are the same. A dude will now diagnose you down a camera. This paves the way to reduce expertise on site, to cease the employment of surgeons and simply perform diagnosis remotely. If this technology is beneficial, and it might be, use it on-site. Give the surgeon a hand held interactive device that he can carry whilst moving about the ward. The danger is the off site provision and those occasions when things go wrong.

Now here's the nitty gritty. The cameras will be placed in emergency wards of Lancashire hospitals and used in out of hours services. The whole sheebang comes complete with a help desk. The people behind this project say that its unique selling point is that if the nurse on site cannot use equipment because she has "forgotten" how to use it that this remote video conferencing will be able to help. One might be inclined to ask why there cannot be a doctor on site, and whether the nurse will not so much forget but more be a Health Care Assistant who is not trained or qualified to use the equipment. Either way, the growing use of virtual technology be it virtual wards, or video conferencing should concern us all. As the expert involved explains (I quote) "It is essentially Skype messaging" (see more here).

17,000,000 voters think Tony Blair should be tried for war crimes


In February 2010, just after Tony Blair appeared at the Chilcot Inquiry, ComRes published a poll for the Independent that asked voters if they think Tony Blair should be tried for war crimes.  37% voters thought he should, whilst 57% of voters thought he should not. 

As a percentage of voters on the electoral roll in 2010, this means that 17 million voters wanted Tony Blair placed on trial for war crimes. Those in favour were predominantly the young (those under 35) and those from northern or poorer parts of the UK.  Those who were of mind not to put him on trial were mostly the elderly, southern wealthy types. You can see the data for yourself (here).

If you want to geek out on why polling is a science not an art, and how we are able to recalibrate the polling %s into numbers of actual voters, then please follow this link (here).

3 NHS policies that should be included in Labour's 2015 Manifesto

On 24 separate occasions since the NHS Bill became law, Andy Burnham and Ed Miliband have said that they will repeal the NHS Bill. Upon closer examination of their detailed comments about what form this will take, we can say that they include:

1. Awarding the NHS Preferred Bidder Status in the tendering process. 
2. Repealing the 49% Cap of Private Sector Involvement in the NHS.
3. Preventing CCGs commissioning to themselves.
4. Reforming MONITOR but in a way that is unclear.

None of this goes far enough and to me it is no wonder that an NHS party has been formed with a view to contesting seats at the next election. Below, I outline the policies Labour should be embracing on the NHS if we are to present ourselves as a radical alternative to the Tories on Health.

1. We need to support Fran├žois Hollande's attempts to enshrine in EU Law the right of all EU citizens to have access to a publicly funded healthcare system. This important principle, if agreed, would have the added benefit of reducing health tourism as well as extending the rights we have enjoyed since 1948 to other EU citizens including those in our neighbouring Irish Republic.

2. We need to seek opt outs of EU regulations 103 & 104 that open up the NHS to EU Competition Law. This can be done by legislation in the sovereign parliament exempting our healthcare from these elements of EU. It could also be further secured by coordinating Hollande's planned EU law to include protection from public health systems from competition law.

3. A De-Marketisation Act: We need to commit to de-marketising our health service. The crude image of a la carte menus of operations offered, and their prices, runs alien to the ethos of our healthcare. I should not know that £107 will get my partner a pregnancy scan. I should not know that £199 gets me an MRI scan. I should not receive brochures and pamphlets inviting me to book special rooms at a NHS Hospital or NHS Hospital Hotel for the duration of my operation. A complete an utter de-marketisation of our public healthcare is required, perhaps through a de-marketisation bill. NHS Hospitals should be cashless societies. 

It might also be necessary to explore all of the structures that Lansley's bill has created. If the CCGs were to remain then the Senate should be given teeth. Monitor could be dramatically downgraded and its powers dispersed to regional NHS Senates. Healthwatch pending its effective functioning should also potentially be retained and given powers to refer matters to the judiciary if need be.

Sick, grotesque & cynical: The spectacle of Government Ministers campaigning to save NHS hospitals in their own seats.

The government is currently engaged in rank hypocrisy throughout the UK. They have conspired to pass an unwanted NHS Bill, force £20bn of NHS cuts through and shut down many wards, hospitals and units all in the name of cost savings exercises. The spectacle of government ministers leading the campaign to save NHS Hospitals ONLY in their own constituencies will sicken many NHS activists to their very core. If these ministers really cared about the NHS, then they would have done something to prevent cuts, closures and carve ups throughout the UK, not just the areas where they seek votes.

What sickens me the most is that Government Ministers are using their own special influence within the government to cherry pick which hospitals must go, and which ones are given special consideration. So, the Trafford A & E in Greater Manchester is to be shown no mercy because it has no government minister that could save it.  Wards have been shut at The Great Royal Western, Shropshire & Hinchingbrooke. In some cases even sitting Tory MPs have joined in the fight to save their wards & hospitals but their please have fallen on deaf ears.

Yet Health Minister Paul Burstow is using the privilege of his Ministerial position to lobby for St Helier Hospital in his constituency. Many readers will feel bitter that the Lib Dem health spokesperson has brutally ignored the millions of voices who cried out to protect NHS services, yet he wishes to preserve his political future by saving the hospital in his constituency (see here).

Likewise, William Hague has been foremost among the Tory voices who showed impunity for the pleas to halt the passing of the Health & Social Care Bill and yet he has the cheek to attend and address a 4,200 strong NHS march in North Allerton at the weekend to save his local Maternity Ward (see here). Hague's posturing in terms of detaching himself from government decisions is laughable. What will concern many is that has had 4 separate meetings with Lansley to lobby for the non-closure of the Ward. The activists of Royston, Heatherwood or Trafford might rightly enquire what it is that they have to do in order to earn the same audience with Lansley? This is a classic case of one rule for all of us, and special privilege for government chums. 

70% of Homeless patients are discharged from the NHS onto the street.

The Department of Health commissioned this report (link here) into Homelessness's link with NHS Discharges. The report produced by St Mungo's and Homeless Link found that 70% of homeless people who are discharged from NHS hospitals are actually discharged onto the street. No attempt is being made to safeguard the recovering health of homeless patients. Homeless people die much younger than you and I and often carry serious illness related to dirty needle usage or alcoholism. These people need our compassion, love and support if they are to get better and get their lives on track. Research shows that family breakdown on abuse during their adolescence are key factors in their declining health.

As I have shown from other research, homelessness has risen 14% under this Tory government with more than 45,000 households being declared statutorily homeless per year. Given that the average household is 2.3 per home, we can be sure that the true figure of actual homeless people is much higher than 45,000. The figures also exclude those living in emergency accommodation,  the standard of which would actually worsen a patient's health.

What concerns me about this report is that coverage of it includes an immediate response from the government Minister (Paul Burstow). This is a cynical attempt to mitigate the fall out from the article and is a ploy that should concern all democrats. I have not included the government's response here because I think it appropriate that those interested get to read the report first.

The truth is that the government have oversaw the building of just 454 affordable homes for the last 6 months on record. They have commenced the building of just 100 Council Homes. And they are in the process of selling 591 Hectares of NHS land off to private developers. Homelessness is one statistic that this government are impervious to.

See the report (here).

Sunday, May 27, 2012

Cancer Drugs Fund under spend is costing lives

Radiopharmaceuticals more commonly known as radiotherapy is a precise/localised way of targeting cancer. It causes less damage to the tissues around the cancer area than chemotherapy because it is so precise/localised. Results show it is 8 times more successful than Chemotherapy. If you wish to geek out on original EU guidelines on the storage and safe usage of radiopharmaceuticals then please follow this link (here).

In October 2010, the Tories announced a cancer drugs fund of up to £200,000,000. This was a good decision and one which should have led to 1000s of lives throughout the 28 Cancer Network areas of England being saved. Conceivably, the £200m could have paid for this radiotherapy treatment. 

The sad fact is that there is currently a severe under spend in the Cancer Drugs Fund. Only £71,000,000 has been spent so far this year. Even the Tory newspapers accept that this is potentially costing thousands of lives per year (here). What's more, the Cancer Drug Networks of the North East, North West, Yorks & Humberside, South West and Midlands are missing out on this radiotherapy treatment. Instead patients in those regions are either being offered chemotherapy treatment, or are too ill to undergo that treatment. Especially for the latter category of patients, it is imperative that they have the radiotherapy treatment made available. Thus far, the only sites offering the treatment are 2 private clinics and three southern hospitals.

Tonight, we in Labour Left are launching a campaign to a) ensure all of the Cancer Drugs Fund is spent and that b) The spending is allocated fairly throughout the 28 Cancer Networks. This will allow local areas to decide if they wish to avail of this radiotherapy treatment. Our Chairperson, and Health Select Committee Member, Grahame Morris MP (Easington), has been making the case on the Committee and in lobbying the government for some time. Grahame argues, "It makes no sense for the Cancer Drugs Fund to under spend in this way and relinquish resources back to the central NHS pot". He also warned, "People are dying on Lansley's watch because they are not being offered treatments that could save their lives. It is an insult to their families to deny them this avenue especially when the funds are there". 

Thus far the government have shown flashes of willingness to engage on the issue. Unfortunately, of the £200m fund, the government retain £60m locally and decide how it should be spent. In addition, there is no requirement that the £140m is evenly spread, or that there is guidance given on the radiotherapy treatment. Paul Burstow claims that he is willing to set aside an additional £150m over 3 years but this has not materialized in DoH guidance on resources available for the Cancer Drugs Fun (see here).

Saturday, May 26, 2012

Tories ring fence Fat Cat NHS bosses salaries while launching a war on Nurses' wages.

These 80 fat cat jobs in the NHS earn a combined salary of almost £10,000,000 a year. They average at nearly £120,000 per post annually. This excludes pension relief, company car and bonuses. In evidence submitted to the local pay & senior salaries review, it was yesterday recommended that regional NHS bosses earning a fortune in salaries should be exempted from the regional pay review. This advice was given at the same time as plans are underway to cut the wages nurses, Health Care Assistants, porters, auxiliaries and other cleaning staff receive in the North East, North West, Midlands, South West and Yorks & Humber. This is black and white hypocrisy, inequality and double standards at its very worst. The justification for protecting high paid fat cat NHS bosses from regional pay cuts was that the roles they held were national posts not really reflective of local market conditions. Why should ordinary NHS staff lose up to 30% of the wages because they live in poorer parts of England? This could amount to a wage cut of £6,000. As I have argued many times, it is perhaps justifiable to pay those staff more, given that the need they are tending is much more acute as a result of generational inequalities.

Access the full list of high paid NHS bosses (here).

See below for a comparison in the salaries of NHS bosses in comparison to a band 5 nurse.

A step by step guide as to how Lansley is set to privatise our NHS

Every NHS Trust in England is now legally obliged to either seek Foundation Trust status or merge with another NHS Trust by 2014.  This is part of the regulations to emerge from private consultancy firm McKinsey during the drafting of the Tory Health Bill.

The problem is that 50% of NHS Trusts are failing in their application for Foundation Trust status. This is causing them as a secondary option to seek a merger. A merger, if achieved, is by no means a disaster because at least it gives the trust a chance of remain in public control. So Trafford, Northumbria, St Hellier and Cumbria are all seeking a merger with a more financially healthy NHS Trust close by.

Even if mergers are achieved, however, very often the larger Trust in the merger seeks to offload the less financially viable parts of the supposedly failing trust. For example, Trafford A & E is at severe risk of closure. It is just one of a long list of places under threat that I could bore you with. But there are other problems besides.

Even by joining another Trust to achieve Foundation Trust status, the NHS Trusts enter into a precarious standalone existence where they are expected to balance budgets year on year. These prescribed budgets are subject to annual change (often reductions) and any improvements in infrastructure must be met out of the budget. This is the reason a very many Foundation Trusts have struggled and had to be bailed out already to the tune of hundreds of millions of pounds. The government are in the midst of £20,000,000,000 cuts in our NHS, and the same figure will be applied again once those rounds of cuts have been achieved.

In addition, the government are reviewing Public Borrowing Controls. They have placed McKinsey once more in charge of deciding if NHS Foundation Trusts should be allowed to borrow less as a % of their budget. Currently the limit is 40% but a further reduction would enshrine infrastructural stagnation for NHS Hospitals and mean that all new innovations are likely to come from private investors. A NHS Trust's ability to compete for a host of NHS contracts would be severely weakened. Even more dangerously, if the new NHS Foundation Trusts find themselves unable to stick to the new tight budgetary framework, then they would be legally open to being placed into administration, declared insolvent, carved up and handed out to private investors.

If, as is likely, some NHS Trusts fail to achieve Foundation Trust status & fail to achieve a merger with a NHS Trust locally, then they will be deemed financially insolvent or quality compromised and could (most likely would) be taken into central control pending a sell off to private investors. 

On top of all of the financial risks I have just outlined there are also new developments in the expectations of standards that are sure to place hospitals under threat of takeover. Cameron yesterday boasted that his new patient surveys would be used to name and shame failing hospitals. Not to mention that previous NHS Patient Services delivered the highest satisfaction ratings in the NHS's history, Cameron is designing new criteria and formatted questionnaires that he will use to hold individual hospitals to account. 'Failing' hospitals will be taken over, and sold off. 

So you can see that NHS Trusts, Foundation Trusts and Hospitals are now under a much greater risk of private takeover than ever before. The government have the means to tighten the budgetary controls and raise the care standards/expectations and then pounce accordingly. In short, the most successful, profitable, and hospital with the highest standard care could be at risk of take over if the government tighten the budget or raise the bar in terms of service expectations. We now live in an NHS world governed by annually fluctuating whims of Tory health bosses who have only one goal in mind. to paint our NHS as failing so that private profiteers can ride in on white horses and save our ailing public health system by privatising in. There is not a single Trust in England, no matter how financially healthy and well performing it is, that could not be painted as failing with a manipulation of their budget or quality surveys.