A Quick Journey into the State of the National Health System

For those of you not aware there is an attempt by the current Conservative government to change the terms and conditions of Junior Doctors working for the National Health Service (NHS). 


Broadly speaking the Health Secretary, Mr Jeremy Hunt would like to make the NHS a 24/7 enterprise without paying any more to achieve this- or at least that is his stated claim. 


Firstly however I should bring to your attention that the definition "Junior Doctor" is a bit misleading.  In the NHS once you have passed your final exams you are a qualified Medical Doctor but are defined as a Junior Doctor until you become a Consultant.  This process could take 10-15 years with many "Junior Doctors" being in their 30's with families and mortgages. 


It is these Junior Doctors who are the engine room of the NHS.  For the most recently qualified junior doctors, basic pay is around £23,000 a year. There is a 50% annual top up for those who work one weekend in six but that applies both to those who are on call at home and those who spend both Saturdays and Sundays at work. This top up, known as banding, also involves an obligation to work unsocial hours at other times of the week.


Social hours are currently 7-19h00 Monday through Friday.   Some junior doctors are required to work one weekend in four to qualify for the 50% banding with a number even having to do one in two or three. Others receive a 20% banding payment, again, depending on their working hours schedule.
The net result of this is that their current average work week is 48 hours.  The current top limit that they work is 91 hours.


Mr Hunt would like to extend the definition of social hours to include 7-22h00  Monday to Friday and to be extended to Saturday as well.


The British Medical Association (BMA) calculated that these changes will result in decreases for Junior Doctor incomes from 15-30%. 


Mr Hunt's response to this claim is that no Doctor will earn less than they currently earn as long as they work the maximum hours available.


This seems disingenuous to me.  I think he has a broader strategy.  Mr Hunt was co-author of a book in 2009 claiming the NHS was no longer relevant and that it should be dismantled.  This is indeed his goal.


Create enough strife in the system and then bring in private sector alternatives.  But he is overlooking certain figures.  Current health expenditure in the UK was 8.46 per cent of GDP in 2013. This compares to 16.43 per cent in the USA, 11.12 per cent in the Netherlands, 10.98 per cent in Germany, 10.95 per cent in France, 10.40 per cent in Denmark, 10.16 per cent in Canada and 8.77 per cent in Italy.
Current expenditure per capita (using the purchasing power parity) for the UK was $3,235 in 2013. This can be compared to $8,713 in the USA, $5,131 in the Netherlands, $4,819 in Germany, $4,553 in Denmark, $4,351 in Canada, $4,124 in France and $3,077 in Italy.

In the USA, despite the current health expenditure figures there were some 45 million Americans without healthcare. 
These figures were the driving force behind Obamacare  which has brought health insurance to approximately 16 million Americans who were previously uninsured.


Looking at the figures it must be that the UK government's desire to dismantle/privatise the NHS is on ideological grounds because by most accounts the NHS ranks very high when compared internationally.
So the Conservatives point to the fact that the NHS is around £750 million in debt.  They wheel out this number to show that it is inefficient, and then wheel out the old chestnut that the private sector is more efficient than the public sector, as so adequately demonstrated by the privatisation of the Rail and Prison sectors.


Of course it could be more efficient- what couldn't?  But that should not be used to suggest that the solution is to cut costs to try and balance its budget.  That would only accelerate its demise.


The truth is that it is underfunded.  That means it is understaffed.  That means that it is constantly being jerry rigged as opposed to being properly funded, and managed. 


Fund it properly.  Staff it properly.  But stop asking for it, a health system, to generate profits.
We don't ask the Police.  We don't ask the Fire Service to be profitable. 
We do ask that they are well run.


I am not convinced that Jeremy Hunt is the right man to oversee that undertaking.

Putin's Strategy

I had dinner the other night with Americans visiting London.  I will preface this note with the information that they are Republicans, primarily driven by their interpretation of President Obama's handling of Israel.
The conversation started with a discussion of the quality of the presidential candidates. Their view is that after 8 years of "no foreign policy" they were very concerned that there was no viable candidate to lead us looking forward.
Now I don't think that Obama has not had a foreign policy but I do think that he is finding it difficult to present his vision to the American public in a fashion that wins him the respect of those who would rather have a more robust, visible military presence.
Instead I think his foreign policy is almost a form of intelligence agency "operation" which is actually quite effective and yet it doesn't require "boots on the ground" nor does it result (generally) in American casualties.
Mr Putin on the other hand is very happy to march onto the big stage and make aggressive, visible moves forcing President Obama onto what would appear to be the back foot.
I have written a number of times recently about my concern that the Putin's of the world are very willing to risk conflict predicated on the belief that most Western nations are not interested in yet another (Middle Eastern) conflict.
Putin plays this very well.  He has no Congress to heed.  Russian rules of engagement don't require its Armed Forces to actively minimise civilian casualties.  And his brazen actions would suggest that he doesn't care about world opinion.
Witness his attacks in Syria on government opposition forces as opposed to IS targets which to date has been met with much hand wringing by the West, but nothing more.  He is now suggesting that he will start an air campaign against IS positions in Iraq.
 I don't know but my concerns about Russian military creep seem to be being realised as I write.
But this time the Russians would be operating in an American sphere of influence.  The risk of "friendly fire" incidents would go up geometrically.  And Mr Putin would be forcing the Iraqi government to deal with Russia at the risk of upsetting the Americans.
Now everyone tells me that Putin's plan is to force the Americans to engage in high-level negotiations with the Russians to work out a Syrian/IS plan that gives the Russians an equal say.
My friends appear to be suggesting that they don't trust the Russians-indeed they have no love lost for them. They don't see them as valid negotiating partners.  And frankly at this point they think the only response is for the USA to fight fire with fire.  And yet I can guarantee that they are not warmongers.
I think they feel trapped and somewhere humiliated by Russia. 
This is not good.
I don't know what is going on behind the scenes and can only hope that we are on top of our game but it looks to me that a day of reckoning is bearing down on us, and that is frankly frightening.



Mr Trump and Syria

I have been following the circus that is the primaries to the USA presidential election.
I am not impressed.
But one of the things that most worries me is one of the apparent front runners in the mess that is the Republican Party,  Donald Trump and his comments about Syria.
In an article about a recent Washington Post interview they mentioned that the strife in Syria has become a staple of Trump's stump speech.  It was highlighted as an area where he has begun to differentiate himself by positioning himself as a much more cautious voice.
I know generally my fear of him is that he would threaten to nuke anyone who annoys him.
But in this instance my fear is a different one.  His response to those who are advocating direct military intervention by the USA is: “They basically want to start World War 3 over Syria....If we’re going to have World War 3, it’s not going to be over Syria. . . . I won’t even call them hawks. I call them the fools.”
That's exactly what Putin wants him to say.
Now I don't want to rush into World War 3, indeed I don't want to rush into any war.  But I fear that until someone stands up to Mr Putin he will continue to march through whatever country he deems imperative to his geopolitical view of the world.  So Mr Trump crowing that Syria isn't important misses a number of points.
It makes sense on the surface.  But it shows no depth of understanding as regards geopolitics and history.  Where do we draw the line?  Those Syrians are the modern day version of Pomeranian Grenadiers. 
Bismarck was quick to say that the Balkans weren't worth the bones of a Pomeranian Grenadier.
It was the cause of the First World War, which I would maintain was the cause of the Second World War.  In between the mess that is the Middle East was created.
Maybe Mr Trump is correct not to want to dive into Syria.  But maybe he should be forced to say what would deserve American intervention at this point, and why.
But then again he is looking for sound bites.

The Power of Thanksgiving and Speaking English

My grandfather came to the United States as a 13 year old in June, 1914.  He was definitely a stranger in a strange land.  And yet when I reflect on my memories of him, heavy as his accent was, there was no question that he was American, and certainly that all his children were Americans.

Speaking English.

I also remember that his favourite holiday was Thanksgiving.

With the exception of the turkey, which would cause trouble if you were a vegetarian, the entire menu could be adapted to whatever your religious/ethnic/cultural bias might require, and yet there you were at the table celebrating the pilgrim fathers.

Despite all the baggage surrounding the Indians and the Puritans and that the Pilgrims survival was the beginning of the end for the Native Americans Thanksgiving still sets the stage for the development of the United States and is an entry point for almost every immigrant.

For despite the deeply religious fervour of the Pilgrim Fathers, the celebration itself became a non-denominational if not outright secular event, which allowed my grandfather to be enamoured with it although he was an orthodox Jew.

I would maintain that one of the most important keys to his integration was language.

Not far behind was the need to adapt to a secular society, outside, if not inside the house.

It is the only way forward and the sooner the nations of Europe, and the immigrants, face up to these requirements, the better.

Syria, Again.

So the Russians have bombed quite a bit in Syria, almost none of which has been Islamic State positions but rather have focused on Free Syrian Army rebels and other groups.


Russia is trying to force a peace convention through its military intervention, and of course would like to ensure that when the various parties come to the table that events on the ground have evolved to putting Assad in a stronger negotiating position.


Following on from my previous note on Putin I draw your attention to the 2 incursions into Turkish airspace by Russian aircraft.


Turkey is a member of NATO and an "attack" on one member of NATO is an attack on NATO as a whole.  The European member states of NATO already have a lot on their plate dealing with the economic and political fallout of the Great Recession.  This has been amplified by the wave of Immigrants emanating from the instability in the Middle East and other flash points in the world.


The Russians would like nothing better than to push NATO to the point that NATO should respond, militarily, but won't, putting the organisation under even more stress.


It could be said that these incursions should bring a response beyond terse words and the scrambling of Turkish interceptors.  Some might say that response should be robust certainly firing upon if not shooting down the Russian aircraft in question.


That would of course bring a Russian response, the nature of which under Mr Putin is quite difficult to predict.  But that uncertainty is exactly what he is counting on.


I believe he will continue to push until someone pushes back.  The way things are going it is becoming a question of not "if" but rather when it will happen,

Peace in Our Time....

I have been worried that Mr Putin's manoeuvrings kept smelling like Hitler's antics regarding the Rhineland, Austria, the Sudetenland and Czechoslovakia only for Poland to be the straw that broke the camel's back.


For like Hitler, Putin is playing on the fact that the West has demonstrated that it doesn't really have the stomach for war and so Putin has continuously pushed allowing each fait accompli to create a new reality.


And so we sat and watched as he stockpiled tanks, airplanes and other military hardware in Assad's piece of Syria, just as the West saw Hitler do the same thing time and time again.


Now he has again demonstrated that he has no intention of respecting agreements or understandings and that he is willing to do whatever he thinks is necessary to further his goals.


The ball is in our court. 


But Putin is playing on many courts. 


He is determined to maintain a deep-water port in the Mediterranean and the path to that end is through Assad.


He is annoyed that he was cut out of the USA/Iran deal, and this gives him some weight with Iran in that they are both interested in supporting Assad, though for different reasons.


And he was out to demonstrate that his Russia can match if not outdo the USA on the world stage as he certainly showed no compunction in blatantly bombing anti-Assad militias under the cover that he was acting to join the anti IS-coalition.


Lastly, over the past few weeks Putin been the good guy in reining in the Ukrainian separatists on the battlefield and in negotiations. 


I would venture to say that his actions in Syria were designed to rope the US into Russian led diplomacy in the Middle East, and get the US to engage in the Ukraine.


The US didn't play ball. 


They have not yet really responded to Putin's actions in Syria, and they did not engage in the Ukraine regarding a discussion on sanctions or a reduction in military and political aid to Kiev.


For me the question is where are we in the "run-up" to WWII with regards to Putin?  Hitler had actually hoped that the West would not come to Poland's defence in September 1939.  It was a colossal bet, that went badly wrong in the end.


At the loss of some 40 million lives.


But that's what Putin is counting on.  He just might be waking a dragon.


 

What Was VW Thinking?

In my years on Wall Street it was always said that Fear and Greed were the driving forces which led to the massive excesses which occur with disturbing regularity.

That they would drive the management of VW to the same excesses was something that was not supposed to happen.  Manufacturing industries still make things and the quality, and the nature of the products were there for all to see. 

There were no structured products; no sub-prime mortgages; no power caps; no inverse floaters; in short no financial engineering to create opaque financings where the bank was always the house and the clients always the mugs.

And then VW decided that engineering is engineering and if a financial construct could be used to circumvent regulations then an engineering construct could do the same.

Create a bit of kit that initiates emission controls when required, and turns them off under normal driving conditions.  (Criminally) Brilliant!

This is an intelligent bit of software.  It bypassed regulatory emissions tests for years.  No one believed the figures as everyone knew that the test results were done under circumstances far and away from actual driving conditions.

But I don't think anyone in their wildest imagination ever considered that the test results were achieved by a piece of software that would  turn on the "cleaning" equipment thus complying with the emission standards, and then automatically turn them off  allowing the engines to run without any emission controls at all.

It's not fudging.  It's not exaggerating.  It is pure and simple actively and consciously contravening the regulations. 

It is criminal.

And the fallout could have global repercussions. 

I can only hope that this actually is the first nail in the coffin of the internal combustion engine. 

Electric cars will remove a significant amount of pollution.  Of course we still need to deal with how that electricity is generated, but that is a discussion for another blog.