Items filtered by date: June 2017

The answer is “Yes” but what needs to happen is a step change in the provision of services and embracing technology. 

We do not advocate removal of human intervention but enhancing it.  Technology should be used to remove paperwork and form filling at the nurse’s station.  Admissions on electronic forms that are extracted from a central database which then means it is a checking and correcting process not a completion task.  These are maybe minor activities but when you reflect these across a major hospital it very soon will save days if not weeks of activities across the year.

What happens with saved time?

Waiting lists are always positioned as targets either met or not, changed interpretation or figures reset.  Waiting lists are not the problem! The problem is the capacity of the hospital and its process management to churn more people in and more procedures carried out.

What about operations and the lack of consultants? 

The requirement to maximise theatre time is fundamental to the success of the hospital and what needs to happen in every hospital is the requirement to understand, plan and schedule procedures.  Operations should be carried out throughout the week and even at the weekends.  This means that the specialist consultants required would be 3 or 4 if one procedure could be carried out continually on a known demand basis.

The business analysis of the processes is fundamental and targets defined as to what is realistic and achievable.  Management must support this process of change and identify contingency.  The movement of staff utilising expensive equipment and procedures is important and joined up and partnering agreements with the neighbouring hospitals.

So, in summary the NHS is a massive company with complex processes and is often dragged down by the paper chase that is happening in the background.  Technology can remove most of this and free resources. The processes need to be reengineered, per hospital and then collectively across the sector.  Cash resources thrown into a pot which is funding the wrong areas is worrying as the return is never going to be achieved.

In a recent conversation referenced with a senior consultant over the question of Brexit and the impact of numbers coming in to the UK.  The answer was the issue is not the resources but the level of knowledge and command of English.  Assuming the numbers decrease from the EU it will allow the correct people to be screened and employed coming from non-EU countries.  The main consideration on this point is the terms trained and their command of English thus reducing management intervention and supervision.

Finally revisiting the initial question, hospitals need to change using technology to release staff resources and all this underpinned with processes to improve the throughput of people with hospital procedures carried out.  The right resources are needed but the processes need to be defined properly to identify the gaps. 

A hospital is a manufacturing, care and repair company and should operate as such!

Published in Hospitals
Monday, 26 June 2017 08:20

The Truth about the SNP

It is fantastic when you are a party in opposition, you can sling mud from a distance and hope that some of it sticks on the incumbent party.  As you are not in power nobody really challenges your ability, your messages or your actual policies with a fine-tooth comb.

Problem for the SNP is the whole issue of serving MP’s in Westminster but they are in power in Scotland and have been for the last 10-years.

So, let’s look at some of the things that are going on and when questioned the SNP will not answer or will answer by stating party soundbites and spin.

Starting with small but significant areas where the SNP make significant noise about the fact the Conservatives are doing it wrong but when exploring their devolved powers, you actually start to see things differently.

Legislation

The SNP Government has in a year introduced no major legislation.  If you watch First Ministers questions in Holyrood it is not about delivering new legislation it is more about independence.  You would not expect change all the time but to manage a country you need to change the way things are delivered. This just is not happening!

Fox Hunting

The SNP are vocal about the vote in England on whether the ban should remain in place for fox hunting.  Yet in Scotland it is still not banned and the SNP continue to fail to bring legislation to ban it and instead would prefer to resolve to bring in unworkable monitoring and controls.

Named Person

The proposed legislation of appointing a named person for all children is the sledge hammer to crack a nut approach to ensure young people are protected.  If anything, those that are identified at considerable risk are now more likely to be lost in the system and the parents coming to terms with the state questioning their abilities as a parent.  Ill thought out and over cumbersome to protect those few that are in most need of support. Criticised by parents, schools, councils and the police.  A back down and fundamental changes in the details around information sharing. It has still not been introduced due to areas missed in terms of the initial draft.

Land and Buildings Transaction Tax 

This is a Scottish Tax that was introduced to target those in more expensive houses.  What the SNP have failed to understand is how it impacts the housing market.  The reform to Stamp Duty was probably necessary but as average house prices in cities and some towns have increased this tax has increased the tax to a point people are struggling to sell.  This is another SNP policy ill thought out and that does not provide the revenue stream the SNP government desire. Wider it has an impact on the economy and firms establishing in Scotland.

So, what about some of the bigger matters!

The Barnet Formula

This has been castigated over the years as being unfair and has an England bias.  Looking at the figures it tells a different story and with the cyclic decline in the oil industry, or maybe permanent decline scrapping it would be catastrophic for Scotland.  Per person Scotland gets around £1,500 more per head of population than England and Wales.  Remove that and the public services across Scotland would lose £7.5 Billion in funding.  The Scottish Government with devolved powers can spend their allocation on what they want.

Further Education

Scotland attracts students from all over the world to its first class University system.  This is correct, but the SNP claim “Free Tuition Fees” for all and as a result further education is available to all. Wrong and this is another smoke screen.  Consider you have 50 seats on a bus and there are 100 people want to get on that bus.  The only way to provide this is to buy another bus.  So how do you afford it if you cannot charge fees to the people wanting to get on the bus.  You find 100 people that are willing to pay or are forced to pay.  I appreciate that this is a yes or no example but looking at the figures.  The fee in Scotland is £1,820 and if you come from the other parts of the UK the University will charge you this sum.  If you come from Scotland you will not be charged this sum, equally if you come from an EU country you will not be charged. The allocation from the Government to compensate the Scottish students and EU students is somewhat short of the £1,820.  Therefore, the reality is Scotland is funding Europeans to attend and this is funded by the rest of the UK.  So how does it work?  The reality is the SNP impose a cap on the number of Scottish and European students based on their designated budget so when the University considers applicants they will consider applicants from England, Wales and Northern Ireland as they know they can secure uncapped fees.  They can flex numbers for rest of the UK applicants to get students through the door.  Scottish students will get squeezed and many will not get that free further education place, and many are not based on this process.

Recently the phrase used has been “positive destinations” but if Universities are limited what about colleges?  Well the latest figures published by Audit Scotland show a decline in the numbers attending college.  So where are these positive destinations?  Also are Scottish schools preparing our young people for these positive destinations?

School Education

School education is failing and amongst the reasons are funding, subject focus and recruitment into the profession.  There are many people employed on salaries a lot less than those in teaching, with worse holidays and poorer pensions.  So, what is wrong? Why can’t they recruit into the profession and why can’t the retain good qualified teachers?  The squeeze is from all sides and as teachers enter the profession senior teachers are squeezed out from the top. Lower grades equals lower pay, removing higher grades on higher pay. Solutions a budget saving! 

Curriculum for Excellence is a disaster in choice provision, designed to give wider choice it is in fact reducing choice. So why is literacy and numeracy surrendered at the expense of providing a broad range of social subjects that once at University continuation of study requires a standard in either or both to be able to progress.  A recent SNP politician (Mr Mason) defended the decline by justification on breadth of knowledge and a surgeon not being able to spell is that a problem?  I would not want to be treated by someone who then wrote prescribed after care and got that wrong!  The Universities are looking for students with attainment at Advanced Highers to then be comparable with the English students who do 3 subjects to an advanced level (A-Level).  What has been delivered is broken and with failure to rectify the failing trend in attainment as per the benchmark statistics now means 5 – 10 years to deviate, improve and deliver an effective education system.  It is not just one generation that has been failed but potentially two.

Compounding this is the proposed reform and more devolvement of powers and budget to the head teachers away from the Council’s. The regulatory controls and accountability will be lost.  One reason this is viewed as favourable is that the private fee-paying schools have this autonomy and in the main results are better.  The reality is that the school is better resourced and the fees are the control.  If a private school does not get the pupils attaining high standards then the numbers fall and the number of parents sending their children to the establishment declines.  In a state school, the budget is set on school size not attainment.  The headteachers will also protect their underperforming staff if no controls are in place.

Energy, Oil and Gas

This may not be the fault of the SNP party but more the consequence of world markets and the requirement for energy.  The USA has gone from a net importer to a net exporter with their “fracking” strategies and more recently the reopening of open cast coal mining.  The Middle East is now producing high grade crude oil which is flooding the market and the roll out of renewable energy schemes in the developed countries is decreasing the demand.  North Sea oil is high quality but with high extraction costs in comparison.  The market needs to have a demand first and then secondly the investment to open-up new fields probably to the west of Scotland.   The problem when it comes to the SNP is that reliance on oil was communicated as a buoyant sector which it can be, but equally it is cyclic and for the periods of boom there are often significant periods of bust. 

The economy must be able to smooth the peaks and troughs and does require other business sectors to take up the strain when prices drop.  There are significant energy infrastructure projects that could be invested in but do not have the same employment requirements and therefore can plug the energy gap or provide export opportunities but does not employ thousands or people as it has done in the past.

Care Costs branded as the Dementia Tax

The dementia tax as branded is the care provision in the Conservative manifesto (2017) where the value of £100,000 is protected in the value of your estate where anything above is payable towards the care provision.  As an example, if your house is valued at £500,000 there would be a liability of up to £400,000.  If your care cost £500,000 the maximum recovered from your estate would be the full £400,000.  If the care cost £100,000 then this would be recovered from your estate, leaving your family to inherit £400,000.  Two key factors are, firstly, that the house is not sold whilst you are alive and the sum recovered is after you die.  This means that you would still be able to reside in the house with care provided in the house. The second factor is an increase in the current levels.  Scotland under SNP has the system where your house can be sold and funds used to cover your care costs when you are still alive and the threshold is only £26,250.  Scotland has a deferred payment scheme which must be agreed with the local authority, so imagine someone with dementia negotiating with the Council to defer the sale of their house and equally the threshold remains low!

Going back to the example of the rest of the UK the next thing to understand is there will be a cap in place.  This means you will pay the annual fee less the benefits you are entitled to. If the cap was £70,000 then it might equate to £10,000 to £15,000 per annum as a contribution from savings the rest from benefits and pensions. Taking the lower figure after 7 years you will have spent £70,000 from your estate.  Once the Cap is reached the contribution significantly reduces so costs may be £5,000 per year.   In Scotland, there is no Cap so the same example means if you are in care for a long period the costs continue at the higher rate.  So overall the costs can be significantly higher for early dementia sufferers!

Police Scotland and claiming back VAT

A business case was made to save monies and improve efficiencies by consolidating to one Scottish police force and it would be assumed that the business case was agreed by the SNP government.  With any business case of this nature and size it would be expected a cost benefit analysis was conducted and should have indicated the move from local to central government was more cost effective.  Demanding VAT to be paid back is SNP trying to cover up a failing in their decision process.  Blaming a Westminster government to change VAT conditions is wrong on so many levels.  What if companies start demanding that the rules are changed so they do not pay tax when they are liable!  Or you as a member of the public knocking 1/6th off your purchases when you hand over money. 

NHS

Where to start on this.  If Scotland has managed this service for the past 10 years then you cannot blame others for your issues.  If you are saying that the allocation to Scotland is wrong and more money is needed then understanding the allocation is £1,500 per person greater north of the border but also the extra £7.5Bn could be spent on the NHS. If you look at the decisions taken by the SNP on free prescription charges it would be a consideration that to reverse back to a set fee for all repeat prescriptions.  Another consideration is the cuts in nurse training numbers and now the gap in qualified staffing.  The out of hours service and the inflated rates for GP cover.  Salaries across the grades and progression of staff.  There is a pay discrepancy, the SNP Government has managed the discrepancy or not as is the case.  In addition, the failure to deliver results on multiple projects results in massive overspends.  These overspends are moving resources away from patient service delivery.  The NHS is a massive company and the management is complex and challenging but culture and service are areas that cannot be ignored.

Exports

Currently Scotland exports 4 times as much to England, Wales and Northern Ireland than it does to all other EU states.  It is appreciated that independence would not wipe out all this trade but for goods and services that can be sourced elsewhere it would be a significant risk.  The other consideration is the cost of exports.  At present the goods to the rest of the word go via container ports in England and the transport to and from these ports is via road and rail.  Scotland does not have a suitable container port so would be subject to infrastructure or trade costs to ship.  The UK is a service based economy and not manufacturing.  The EU Common Market does not cover services but products.  This is appoint missed by all parties in the debates.

Currency

Scotland does not have an issuing bank so the continued use of sterling is subject to agreement by the rest of the UK government.  If via independence the objective is to use the Euro then the terms of entry are to run your own currency for a minimum of 2-years.  If this ruling is removed the issue of moving from sterling to the Euro has costs associated with it.  There are many reasons why the rest of the UK will not agree to the use of sterling but Scotland would also have no control of setting its value and would be subject to market influences out-with Scotland’s control. It just would not work without agreement and entertained with significant economic risks for both parties.  The SNP would need to be clear on how and what agreements are in place to protect its economy.  The divorce is initiated by Scotland and they would therefore need to have contingency plans agreed in advance.

Nationalism

Purposely leaving this to last having covered all the areas where devolved government failures have happened it does indicate that the SNP are not fit to govern the Country.  Excuses that “we would do it differently” if everything was devolved the Barnet Formula would immediately give a £7.5bn funding gap.  With this funding gap, you would need an economy that is growing significantly greater than the 0.2% compared to the 2.2% of England. 

Honesty is “the SNP want an independent Country”, what is missing is that with independence comes significant challenges and the potential to impact the economy significantly.  What maybe should be the SNP statement

“The SNP strive for an independent Country who will face significant issues and challenges but in the long-term the SNP believe independence is our right to self-govern.”  If you support this vision, accept the risks and are prepared to live in a Country that potentially will be bankrupt within a couple of years it is your choice.  Scotland was bankrupt prior to the Act of Union in 1707.  

Bankrupt means no public services, an inability to trade and rationed services and food.

Published in Scottish
Wednesday, 07 June 2017 16:58

Rugby Rugby Rugby

After dinner speeches, songs and banter on the coach trip, the end of season tour, or, just that post-match banter are all sources of anecdotes where some will be told for years to come and often be the source of the odd free pint along the way.

So, a few stories from one aging ex rugby player.

The Presidents Order

On a distant rugby 7’s tournament the decision was made to look after the club president who had not been able to make the 6-hour trip.  At our hotel, a decision was made whilst eating our sustenance prior to hitting the towns bars and nightclub (there was just the one) we would phone the president and let him know how we got on. It was then suggested as he had missed out we would order him some food, home delivered and he would enjoy it having missed out on the rugby and beers.   In principle, a nice gesture but it was taken to the next level, that for the next 6 hours at hourly intervals a delivery was organised from a different eating establishment or carryout restaurant.  None of these were paid for in advance and he probably saw the funny side for the first two but at 1am in the morning having an irate delivery driver demanding money for a meal he did not want did wear a bit thin.

The France Tour

On a hot night in Orleans and after copious amounts of French lager (drunk out of vases but that is another story) the three who had stayed out past the curfew decided they knew the way back to the hotel and started walking in what they believed to be the right direction. After 45 minutes of brisk walking it was obvious that the city district entered was not right one and the buildings and streets where more like a ghetto.  Solution appeared coming towards us, a taxi, although the “for hire” light was not on, driving down the empty main street.  Three drunk rugby players stepped into the road and waved furiously.  As the taxi approached it was not a taxi but a police car with a collar in the back; handcuffs on!  The gendarmes were more than helpful and started trying to locate a taxi for us. Then with the pending wait for the taxi and the area we had walked into they decided to give us a lift across the city to the hotel (opposite direction to that which we had walked).  Got the picture? Three drunk rugby players crammed into the back of the police car with a less than happy restrained criminal seated in the middle.  I am sure the gendarme had a story to tell at shift handover as did we over croissants at breakfast.

The Club Dinner

 After an early start the drinks had been flowing for quite some time before we were respectively escorted to the function suite to take our seats.  One of the coaches, a rotund and bearded chap had the pleasure of sitting at the top table and assigned the task of providing the opening address.  Well getting back to the drinks in the bar beforehand and this stalwart of the club had maybe had one or two too many.  When ushered to his seat he had poured himself a large glass of wine and before the scotch broth arrived he had consumed a bottle or two.  Although he finished his soup he decided to get forty winks and had faced planted into his bowl.   Subsequent courses arrived and were consumed, laughter and jollity across the assembled and yet this rugby stalwart was left to his slumbers.  Time for the speeches. Opening address? A prompt elbow to the ribs and a startled rabbit in the headlamps arousal and rising to his feet! What followed from the mouth of barley laden beard was, and is still, the best rugby speech I have ever heard…… RUGBY RUGBY RUGBY!!!  He sat down to applause and faceplanted the soup bowl again. 

Published in Rugby
Wednesday, 07 June 2017 10:27

How do you cut through political spin?

With great difficulty is the easy answer!

Also has politics been dumbed down for the masses? This is another dilemma which with run up to the General Election in 2017 is obviously apparent.

The media is driving this and with social media fuelling these flames, where debate and canvassing become soundbites, slogans become hollow promises and politicians are more likely to do a U-turn than justify areas of their manifesto.

We recently wrote an article that asked about the state of UK politics over the last 40-years which focussed on the ground political parties looked to occupy.  Still worth a ride. When the UK was a manufacturing centre of excellence the class system would typically dictate your political allegiances.  Now with the call centre culture, financial sector dominance and the service orientated economy it will have a group of co-workers with all political parties supported by the small group.

So, if employment, heritage, history and loyalty of the voter has changed is it not the reason why the parties have changed? No.

The addition at the last hour before publication of a manifesto pledge will typically be the one that causes the party to come unstuck, equally, a significant deviation from the past should raise alarm bells of “are these just vote winning soundbites?”  Equally if a politician believes it is in the best interest of the country they should be able to justify and standby their political policies even when independntly scrutinised.

Consider also, televised debates are now as much forums for audience members to take the spotlight just as much as for the politicians to be held to account.  How many that come to take part are undecided voters that want to have questions answered to help in their deliberations? We would suggest very few!

Getting back to the spin element what we as citizens of this great country need to do is demand better from our politicians. Manifesto words are justified by advisers and their calculations should be in the public domain too and easily accessible.  Our democratic duty is to analyse thoroughly and make an informed choice.

We would recommend the following for the voter, media and the politician.

  1. Voters need to change how they plan to vote, anyone who turns up at the polling booth and votes without doing their research are accountable and actually promote second rate politicians who have little or no respect for their constituents once in power.  It is harder to remove someone than not to elect them in the first place. 
  2. Politicians must publish all supporting information to the public and these facts and figures should be independently audited and rated as “sound”, “concern”, or, “unjustified” when we are in a general election campaign.  The audited manifesto can be updated throughout as scrutiny identifies gaps or justifications.
  3. The media should report on campaign activity, challenge unjustified figures and drive for the politicians to substantiate their overall policies.  With published justifications it becomes easier and journalists should report and not create the news!
  4. Political impropriety addressed as a priority, so any politician under investigation externally should be suspended until the investigation concludes.  These elected representatives should be role models not objects of ridicule. A party losing one seat should not be put above the party delivering a sound, professional, honest and ethical campaign.

Will it happen is the big question? As politicians and media are more focused on their image and self than doing what we should demand from them.  It is our responsible to demand the change in our political system and those that are veted in!

Published in British

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