Wednesday, 30 November 2011

Guide dogs for the blind and my shameful past

I have struggled to find a topic for discussion today. I didn’t want to write about the public sector strike – it’s just too depressing. Insults are being traded, distorted facts and biased opinions spouted by both sides, and even Prime Ministers question time in parliament today was described as ‘silly comments flying about, lots of noise, just childish’  by Tory MP Andrew Percy on Twitter.

So instead I shall write about one of my favourite charities, Guide Dogs for the Blind. A story featured in the Sunday Times recently warned that this 80 year old Charity may be forced to stop offering dogs to the newly blind because of a £15.6m deficit. This would be a tragedy and I truly hope that fundraising campaigns will reap sufficient rewards to save this amazing organisation, which enables thousands of blind and partially sighted individuals to lead independent lives.

The reason I list this charity among my beneficiaries is because of a very embarrassing incident that occurred a few years ago. I was waiting at a traffic light controlled crossing, and noticed a lady with a guide dog standing next to me, also waiting to cross. Being one who is quick to interfere, often when not needed, but always with good intentions, I decided to ‘help’. When the little man turned green, alerting us to the fact that it was safe to cross, I took it upon myself to grab the harness of the dog and lead him and his owner safely to the other side. Except I didn’t. I ended up half way across the road, with a confused looking dog - without his owner who was left stranded, looking bemused, at the side of the road. I panicked and really didn’t know what to do next especially as the little man started flashing warning me that it would no longer be safe to cross very soon. I somehow ended up on the pavement, plus dog, minus owner, on the other side of the road. Acutely embarrassed, especially as several of my work colleagues witnessed the whole incident, I had to wait, red-faced until it was safe for me and my four legged companion to return to the original side of the road and back to his owner.

The woman was now clearly angry and as I blurted out my apologies I realised she was looking straight at me. ‘You stupid woman’ she shrieked ‘I’m not blind, I’m a trainer and your actions have probably set the progress of this dog back by weeks!’

At this point, my colleagues were in paroxysms of laughter and mirth at my total humiliation and the ludicracy of the situation! Needless to say, I went straight back to my office and made a donation to this worthy cause.

Moral of this story? Not all dumb animals have four legs..

Please give generously.

Saturday, 26 November 2011

Please don’t strike….

I had hoped to dodge this particular bullet, but alas it just won’t go away. I’m talking about the upcoming public sector strike on Wednesday. As a commentator about all things health and especially the NHS – I can bury my head in the sand  no longer and have to face my fears and put in print how I really feel.

I am really, really sad that health workers and other public sector employees plan to strike. While I absolutely support the right of anyone in this country to withdraw their labour if they feel strongly about an issue, I am at a loss to see how this action is going to help anyone – least of all the public sector community.

I am not going to go into the rights and wrongs of the government’s recent pensions offer and neither will I pontificate at length about what it’s like to work in the private sector compared with state funded employment as both arenas are fraught with challenges. Instead I shall just make a few points for consideration by anyone involved with healthcare who is contemplating strike action.

·        Please consider the devastating effect on individual patients if an estimated 28,000 non urgent operations, 38,000 non-emergency ambulance journeys and 200,000 outpatient appointments are cancelled.
·        Please understand that working in the public sector no longer means a job for life, and neither should it.
·        Please note that private sector pay is, on average, lower and pensions in the private sector are, apart from the most senior of managers, nowhere near as generous as in the public sector.
·        Please understand that the country currently faces a significant deficit, which, however it was created, must be addressed.
·        Please remember that the general public really do appreciate all the work you do although they may not have a clear understanding of the pressures you face in your day to day roles.
·        Please consider that every time you take extreme action, the support from the public could be eroded. There are 2.5 million people in this country living without jobs, on the breadline and without the benefits of employment open to you who would welcome the opportunity to have the relative security of your positions.
·        Please consider the fact that there seems to be a growing emotional divide between public and private sector workers, which is a real shame as we are all in the same boat. Apart from the very wealthy we all have mortgages or rent to pay, food to buy and futures to plan in the context of the real threat of double dip recession.
·        Please remember that is the most vulnerable who will suffer from your actions.

I think it’s highly regrettable that strong arm tactics appear to be in play. Danny Alexander, Chief Secretary to the Treasury is insisting that the offer made to unions earlier this month cannot be improved and Schools Minister Nick Gibb has repeated warnings to unions that the current offer on public sector pensions may be withdrawn if no deal is reached.

I have great sympathy with my friends and colleagues facing an erosion of their pension rights. I also have great sympathy for several of my friends from the private sector who have been made redundant or face reduction in hours with no opportunity for redress. But it’s a tough world out there, and the relatively soft bosom of the public sector can continue to be a good place to nestle.

The general public is in no doubt about how strongly you feel and your point has been made well by your representatives. So keep talking but be realistic, and please, please maintain the vital services that you normally provide with such dedication.

Wednesday, 23 November 2011

Caesareans on demand. ‘Nice’ to have but not need to have?

The National Institute of Health and Clinical excellence (NICE) has issued some new guidelines advising that pregnant women should be allowed  to choose caesarean delivery, paid for the NHS, even if there ‘is no medical need’

As always, I am writing this post with all hats on – mother, clinically trained, healthcare manager and commentator. Let’s start with the mother bit first. Childbirth, like so many other experiences, can be dramatically influenced by perception. My mother, bless her, told me that giving birth was ‘easy as falling off a log’. A strange saying as I don’t know anyone who has actually fallen off a log, but I guess that if you chose to do such a foolish thing – it would be easy. I was very fortunate to produce a tiny baby who was in a hurry to be born so it was just as dear Mama said – a doddle. But I won’t deny that it was a painful doddle.

I would not for one moment belittle anyone who has fears or concerns about natural labour. Neither would I dispute that C sections can be life saving and vital in some cases. But to choose to have surgery simply because you can, really isn’t good enough. Pregnancy is usually an active choice. Even unplanned reproduction is often a result of a choice not to be more careful! With choice comes responsibility. We are already very fortunate in the UK to have access to free maternity services. Those free services, up till now, included the reassurance that either a planned, medically necessary or unplanned emergency Caesarean would be offered. So prior to these new guidelines, mothers being cared for within the NHS would expect to have to go through natural labour unless sound medical reasons existed.

NICE recommends that mother’s considering to opt for a C section should receive counselling from a midwife. That seems sensible until you look at resources currently available. Just two months ago, the Royal College of Midwives warned that some areas of the country face ‘dangerous shortages’ as the number of trained professionals has not kept pace with the rising birth rate.

This is where all my other hats kick in. Yes – in a perfect world patient choice would be absolute, although the wisdom of choosing major abdominal surgery when not essential could be questioned.  But we don’t live in a perfect world. Especially in the land of healthcare. Midwifery resources are already stretched, so how can this counselling realistically be offered? NHS Hospitals are severely stretched so how can it be sensible to offer a potentially huge number of extra surgical interventions with the resulting increase in bed occupancy and procedural   costs?

Every treatment option must be considered in the context of medical inflation and the dire financial straits of the NHS. It isn’t helpful to those trying to balance the books when an official body eases open a potential floodgate of cost and resource pressure.

As the NHS faces it’s most drastic reform and cost cutting measures, all agencies must try to work within the context of this reality.

We don’t just need joined up care – we need joined up thinking.

Sunday, 20 November 2011

A pharmacist is not just for handing out pills – the need to understand each other’s roles

I’ve just been ‘eavesdropping’ a conversation on Twitter regarding a recent, but not original, news event about a pharmacist refusing a patient the ‘morning after pill’  (also known as PCC - post coital contraception) due to religious reasons.

The gist of some of the comments were that the patient had been unnecessarily inconvenienced and embarrassed and pharmacists simply need to take the packet of pills off the shelf – no big deal.  I quote one doctor ‘It’s in a packet. Instructions are inside. Px (prescription) has been given. It’s easy- just give the meds surely’. The same, highly respected (by many in healthcare, including me) and influential doctor goes on to tweet ‘maybe the third way is to have a vending machine dispensing ‘off limits’ medicines such as PCC

To try to give a balanced view (I aim not to subscribe to the Daily Mail method of health reporting) I should point out that the same doctor went on to say, wisely, that she wasn’t singling out pharmacists – ‘we all need to reflect’ and another tweeter (or is it tweep?) commented ‘…we all need to understand each other’s roles better’

I trained and practiced as a pharmacist for a decade before moving into healthcare administration. I must confess that I am old enough to remember mixing potions (I’m a great cook thanks to the rigorous discipline required in following formulae) - even making ointments and suppositories from scratch and when I first qualified very few medications were in premeasured packs. But then, like now, a pharmacy degree and post graduate training was in-depth, comprehensive and vital in producing highly knowledgeable and skilled specialists.

One of the aspects of my profession that often saddened me was not only the lack of understanding between doctors, nurses and pharmacists, but also the thinly veiled contempt that was held between different branches of the profession. I have worked as a pharmacist in hospital, retail and pharmaceutical research establishments and can personally vouch for the validity and complexity of each role.

I think, and hope, that things have come a long way since the 70s when pharmacists first started to play an active role in dispensing on patient wards and actively counselling patients in a retail setting. I also think there is more mutual respect across all branches of healthcare. But not enough.

I’m not brave (or even foolish) enough to get embroiled in the pros and cons of conscience of dispensing certain types of contraception, but one point that will always engage me is the value of each professional branch of delivery of healthcare services and the integration of that delivery.

Yes – that old chestnut. As a facilitator of clinical pathway mapping exercises, I often have to remind the organisers to include representatives from the entire patient pathway. Pharmacists included. Understanding and appreciation of the vital role that all of those associated with professional patient care should start in the classroom or lecture theatre and continue through induction and on-going development.

That is the only way we can provide truly integrated patient care – and enjoy multidisciplinary harmony along the way.

Thursday, 17 November 2011

How to win a healthcare argument – The British Medical Association vs. the pro-smoking lobby

The British press was awash yesterday with commentary about the British Medical Association (BMA) suggestion that smoking should be banned in cars.

The main thrust of the BMA argument is a recent study which suggests that the levels of toxins from smoking cigarettes are 23 times higher in a car than in a smoky bar. The ‘smoking in vehicles’ briefing paper says children are particularly vulnerable to second-hand smoke, as they absorb more pollutants because of their size and have underdeveloped immune systems. BMA director of professional activities Vivienne Nathanson, BMA Director of professional activities said: ‘…We are calling on UK governments to take the bold and courageous step of banning smoking in private vehicles. The evidence for extending the smoke free legislation is compelling’

Up steps Forest (Freedom organisation for the right to enjoy smoking) - with their counter-argument coming head to head with the BMA spokespersons both on TV and radio. The discussions that ensued provide me with an excellent framework on how to win and argument (or not as the case may be)

Make sure that your factual case is strong:
The BMA have over half a century of proven studies that smoking causes life -threatening and life-limiting disease. A variety of scientific studies have also confirmed the effects of passive or secondary smoking for at least three decades. The study quoting the toxicity of smoke filled cars was undertaken by the British Lung Foundation. The Director of Forest, Simon Clarke’s ‘factual case’ is ‘The evidence is flimsy…. There is not a serious health risk to children’
BMA:1 Forest: 0

Pick your argument and make sure it’s winnable:
This is where I believe the BMA got it wrong yesterday. Children and pets – always a winner. Legislation to protect the vulnerable – can’t lose. Remove ‘civil liberties’ – much tougher game altogether. Forest were able to extrapolate the BMA’s suggestion about banning all smoking in cars, whether children are present or not and question how far the legislation would reach – suggesting that the government could then ban smoking in homes as well.
BMA:1 Forest:1

Stay calm and courteous:
The two BMA spokespeople remained professional and calm throughout. Simon Clarke from Forest often bordered on a rant.
BMA:2 Forest: 1

Never, ever say ‘with the greatest of respect’
A personal dislike of mine. Whenever that phrase is used, it means the exact opposite. If one of the opponents doesn’t agree with the other’s argument – say so. Alas, Mr Clarke – you committed this faux pas
BMA: 3 Forest: 1

Be careful not to counteract your own argument:
The BMA has a ream of strong factual evidence on the dangers of secondary smoking and the enhanced effect of smoke in an enclosed space such as a car. It is estimated that in the UK 4000 adults and 23 children a year die from the effects of secondary smoking. Forest used the statistic that there are 21% of the population and 8% of those smoked in cars with children present. In other words there are at least 1 million children currently at the enhanced risk of passive smoking in cars. Shocking figure – worthy of legislation surely. Own goal
BMA: 4 Forest: 1

Prepare for possible counter attack:
As Simon Clarke made the valid counter argument that the UK police have more than enough to do without trying to arrest smokers in their cars, the BMA countered with the fact that seat belt legislation was unpopular at the time of introduction but now is pretty much universally accepted in the UK with a resultant significant saving of lives. A draw on that point – one all.
BMA: 5 Forest: 2

Try not to let it get personal:
Forest are taking any attack on the right to smoke personally on behalf of the 12 million smokers in the UK, but in this argument – they managed to avoid attacking the doctors personally.
The BMA spokespeople were positively saintly in not criticising smokers directly.
BMA: 6 Forest: 3

Put your argument in context – always looking at the bigger picture:
Particularly important for healthcare issues. This is easy for the BMA – the good of the nation etc etc. Not so easy for Forest – sorry – no beneficial big picture argument available.
BMA: 7 Forest: 3

And finally…

Try to get the last word in:
I suspect that both Dr Vivienne Nathanson and Dr Dean Marshall have had excellent media training. In both the TV interview and radio debate – their final words were… ‘we are just trying to save lives’

Slam dunk, home run, century, win on penalties, serve an ace, whatever sporting metaphor you choose – that has to be the most powerful healthcare argument winner there is.

We are just trying to save lives

Monday, 14 November 2011

Is sentimentality getting in the way of progress for the NHS?

As predicted – there has been much ruffling of feathers and beating of breasts following the coalition’s announcement that a private health partnership Circle, will take over the running of the failing NHS Hinchingbrooke Hospital, near Cambridge.

‘No-one should make profit from health’ said Terry Christian, TV presenter on a daytime chat show. Liz Kendall, shadow health minister is ‘deeply worried’. ‘An accident waiting to happen’ warns Christina McAnea, from the union Unison.

In a £1bn deal, Circle has 10 years to run the hospital, which is currently £40m in debt. This debt has been accepted by Circle as part of the deal.

Perhaps the nay-sayers to this franchise agreement should hold their horses for one cott’n pickin’ moment. Let’s look at the facts…

Hinchingbrooke Hospital serves a community of over 150,000 people. A community who vehemently want their hospital to remain open, delivering care ‘free at the point of delivery’ as per the NHS founding values. Hinchingbrooke Hospital has been ‘failing’ for years. Failing to reach minimum standards in quality, safety and financial control. The hospital has floundered under a succession of NHS management teams who failed to take control of the escalating debt, poor morale and falling standards.

My grandmother had a saying ‘never throw good money after bad’. There was a growing pit of debt at this hospital. Something had to give and there were three options. Try yet another NHS management team, close the hospital, or put the management of this wounded beast up for tender. The third option had to be the best choice, although in true NHS fashion – the tender process took over 18 months, as money and quality dripped away in Cambridgeshire.

The appointment of Circle health partnership is, I think, courageous and worthy. Their track record in running hospitals is good so far. Their approach of partnerships – so effective in organisations such as the retail giant John Lewis, sits comfortably with NHS principles. And I think they have a very good chance of turning the hospital into an efficient, high quality care provider. Yes services may need to be rationalised – but show me an NHS hospital that isn’t going through rationalisation.

What are the real dangers of this decision? Not many in my opinion. There is an opt-out clause so the government can pull the contract if sufficient progress isn’t made. There must be regular and effective lines of communication between the NHS and its franchisee.

‘No front line jobs will be lost’ according to Simon Burns, health minister. I see that as a potential negative rather than a positive. One of the biggest problems with the NHS is the lack of performance management in some areas. I would like to think that Circle will ensure that staff perform to the standards required and poor attitude or performance is not rewarded with continued tenure.

The main ‘danger’ I perceive? Sentimentality. Speaking as one who is dreadfully sentimental (bereavement, age, parenthood are my excuses) – I feel we really must put sentimentality aside in this case. ‘Save our NHS’ is a popular Twitter hashtag, and I don’t think anyone would argue with that particular sentiment. But trusting the management of a failing hospital to an existing failing system for sentimental reasons just isn’t good enough.

Yes – I do get very sentimental about the NHS, especially when I comment on the Health and Social Care Bill, which I believe will do harm to the state funded care system in general. But when bits are broken and need fixing – sometimes you need to look further afield for the best organisation to do the job. And if Circle make some profit AND save a hospital, turn around £40m debt while providing cost effective high quality care and keep good staff in their NHS jobs - good luck to them.

Thursday, 10 November 2011

How do you treat a bully like Sepp Blatter?

Sepp Blatter really doesn’t like the FA (English football Association) does he?

The President of FIFA, the international ruling body, has insisted that English football players cannot wear the poppy, a sign of remembrance, on their shirts for the friendly match at Wembley on Saturday.

Hiding behind the ‘rules’, I absolutely believe that Blatter is delighted to have yet another opportunity to have a dig at the Brits.

My daughter – who is my voice of reason, censor and editor, tells me that I really can’t voice my true feelings for Mr Blatter in this blog. ‘Incitement to violence’ was the warning phrase she shot across my bows when I blogged about the world cup bid fiasco.

Suffice to say – Mr Blatter is one of my least favourite people on this planet. In terms of my absolute contempt, he ranks only slightly below healthcare assistants, nurses and doctors who are mean to patients and anyone who hurts a helpless animal.

FIFA is a shambles. The world cup last year was a shambles. (South Africa put on a great show but FIFA failed its worldwide audience badly) The bidding process for the world cup 2018 and 2022 was a shambles.

So Mr Blatter – rather than bother about the English team paying their respects to generations of young men and women who gave their lives for their country – I would like you to address the following:

Corruption in FIFA: now proven
Bad refereeing: The brilliant Brazilian player Kaka was sent off after an Ivory Coast player, Keita, feigned an attack to his face, and even though this injustice was clearly viewed in TV replays, the one match ban remained.
Bad sportsmanship: As above – plus the pathetic diving, writhing in agony and clutching various parts of the body in mock anguish that cheating footballers use to illicit unwarranted red and yellow cards for their opponents.
Corruption: Yes – it is worthy of two mentions. 2018 World Cup – Russia, 2022 World Cup – Qatar. I rest my case.

Prince William, Duke of Cambridge has had the courage to write to FIFA telling them that he is ‘dismayed’ at their decision.  A quote from his representatives goes on ‘The Duke’s strong view is the poppy is a universal symbol of remembrance, which has no political, religious or commercial connotations’. His Highness is currently top of my list of favourite people…

Well done Prince William!

But back to Sepp Blatter. He is a bully. (At this point you will understand why I haven’t shown this blog to my daughter before posting).

So how do you deal with bullies? There are several options for the FA:
1)     Do nothing and suffer in silence - Please let it not be this option
2)     Take your concerns to a higher authority in the hope that they can sort it out - Prince William and David Cameron have tried but FIFA have shown previously their contempt for such worthy advocates.
3)     Reach  a compromise to co-exist - This is the FA’s current stand. They are suggesting measures that are almost laughable – filming the training sessions on 11/11 to show the players wearing poppies/black armbands on the day/wreath in the middle of the pitch before play/bla bla
4)     Walk away - we really don’t want to see the end of an English football team do we?
5)     Confront the bully – they are usually cowards and often back down. My preferred option, wear the poppies – what can FIFA do?

So I’m off the fence on this one. Come on England and the FA – take a stand and let the team wear their poppies with pride.

This blog is dedicated to all servicemen and women, all over the world, who lost their lives fighting for their countries with a special mention for submariner Daniel Craig Reid, NBC, who survived his war, but who carried his memories of the conflict for a lifetime.

Tuesday, 8 November 2011

Some myths surrounding bullying and harassment in the workplace

Bullying and harassment in the workplace can have a significant negative impact on employee wellbeing and corporate morale and productivity. The effects can be as far reaching as stress related absence, long term sickness, loss of talent and potentially expensive and damaging legal claims.

In the UK, a survey of 7000 HR professionals noted that every single one believed that bullying was ‘embedded in workplace culture’. It is estimated that employers’ failure to tackle the root cause of bullying costs in excess of £13 billion a year (Unite Union)

There continue to be many misconceptions regarding this emotive subject and this article debunks some of the myths surrounding bullying and harassment.

Bullying and harassment are the same thing:
Not exactly. Bullying and harassment are separate concepts but they can have the same effect on an individual – summarised as unwelcome, unwanted and unwarranted.

It is acceptable to adopt one corporate policy to deal with both bullying and harassment. The main issue is not to label the unwelcomed behaviour, but to provide a robust framework to deal with complaints and to educate employees and managers.

For the rest of this article I shall call the ‘perpetrator’ the ‘bully’ but you could equally substitute this with ‘harasser’

Victims are weak:
Not true. It is more appropriate to refer to a ‘victim’ of bullying or harassment as the ‘target’. The archetypal vision of a bullying situation in school is a big, strong bully beating up (physically or verbally) a diminutive, weak or vulnerable victim. This tends not to be the case in the workplace. Bullying can happen to anyone, from senior directors to new recruits. Targets may have some form of vulnerability such as a difficult family situation or financial reliance on the job, but that doesn’t mean they are weak. Targets are often popular, capable, socially adept and expert. This can cause great difficulties for targets as when they instigate a complaint procedure, often the first reaction is ‘but you are always so upbeat/cheerful/on top of things’.

Most bullies are male:
Again not true. Yes, the stereotypical bully is the male boss who either behaves as a sexual predator or intimidates his female target or subordinate male target. Bullying in the workplace can be insidious, psychological and emotional, with no physical strength required. The ‘Queen Bee Syndrome’ is a well known obstacle for women to succeed with a female boss. Surprisingly, ‘the sisterhood’ is not a positive force when it comes to career progression and promotion.

Most bullies are managers:
Not always. Yes – bullying bosses are more common, but bullies can operate upwards and along as well as down.  Managers subjected to bullying are usually particularly loathe to admit this perceived weakness.

Poor management is responsible for bullying:
Yes and no. Poor management doesn’t create a bully but can enable a bullying environment to exist. A poor manager may bully or harass staff members due to his own inadequacy. A UK survey by Ban Bullying at Work found that two thirds of 500 managers quizzed believed that their own behaviour was a major contributing factor to a bullying problem. The culture of an organisation is also key, especially in allowing sexist or racist views to go uncensored.

If you downplay a bullying situation, the problem will go away:
A foolish dream. Uncontrolled bullying or harassment will either lead to an expensive and damaging lawsuit or the loss of talent.

Bullies are born, not made:
Tricky one. Does someone start life with a bullying streak? Have all bullies been bullied themselves? Probably not. The one common link that all bullies seem to display is a sense of inadequacy and fail to accept responsibility for their behaviour. A boss who knows that his subordinate is wiser, more experienced or more popular may use that as an excuse to harass or bully. Individual members of peer groups are particularly susceptible to bullying due to jealousy. Events that can trigger bullying of a target include departure of a previous target, reorganisation, the target being a focus of praise due to exceptional achievement or sticking to a rule which the bully wants to break.

Bullies work alone:
Not always true. Bullying can be undertaken by groups of people, working together to isolate their target.

Bullying and harassment will get worse in this economic climate:
Entirely possible. As workplace pressure increases the environment is more conducive to bullying. It is estimated that in excess of 200,000 bullied employees in the UK leave their jobs every year rather than go down the complaint route. As jobs become harder to find, targets are more likely to take leave of absence due to stress or suffer in silence.  This form of presenteeism (working while under par, stressed or ill) will have a detrimental effect on their wellbeing with a resultant loss of productivity.

A final indisputable truth:
There has never been a more crucial time to adopt a robust, workable and well publicised bullying and harassment policy. Tailored training and awareness can be highly effective in minimising the occurrence of harassment and bullying and can protect both the individual and the organisation from the effects of such behaviour.

This article was written by me on behalf of the Institute of Welfare and appears in the Autumn edition of their journal, Welfare World

Sunday, 6 November 2011

Employer Healthcare Congress (5) The final night (Medieval Times) and post script.

In my self appointed role as roving reporter for last week’s Employer healthcare Congress in Chicago, I could not let final evening’s entertainment go without comment.

An epic adventure awaits’…the publicity promised .. ‘Be swept away to an age of bravery and honor and witness epic battles of steel and steed’… This was all due to take place in the ‘ The gorgeous, expansive Schaumburg Castle … one of Medieval Times' most memorable, due to its colossal stone tower and emerald lawn’.

Admittedly, on the final night of the conference, I was already feeling a little jaded as I boarded the coach en route to the castle. Too many (well two, anyway) late nights in the bar (as my father would say – ‘of course I was in the pub – it was open’) so maybe my sense of humour was doomed to failure from the outset.

Sitting at the front of the coach was a lady dressed in full medieval regalia. As she sat there in silence, briefly nodding (was that in welcome?) to each delegate, I couldn’t help wondering if she was a member of the ‘cast’ aboard to jolly us along or a delegate who hadn’t noticed the ‘business casual’ instruction on the invitation. Awkward.

Call me an snob (feel free) but I am fortunate to have been brought up just a few miles from King Arthur’s round table in a magnificent 13th Century Hall in Winchester, England, so the ‘Legoland’ plastic looking castle set in a parking lot failed to impress. We were greeted with gushings of welcoming jollity by knights and pages who put me in mind of a children’s entertainer called Rainbow Bigbottom (this is true), who I once hired for my daughter’s birthday party. No the ‘actors’ didn’t all have big bottoms, but they spoke with multiple exclamation marks throughout!!!!

I decided to stop being grumpy and embrace the fantasy so partook of some medieval wine (I think it really was fermented – is that the right word? centuries ago) out of a plastic cup. I did consider the cocktails but they seemed to glow with so many colouring additives that I didn’t want to risk being hyper for the rest of the week. We were then ushered into predetermined, colour coded sections of the arena. On a serious note – this was a real shame. The main point, I believe, of the final hurrah of a conference should be an opportunity to network, hopefully chiefly on a social basis with new friends and colleagues whom you have met along the way. Alas, as this was a spectator event, akin to going to the cinema, sitting in the dark in rows, the only conversation possible was with the delegates either side of you. I’m glad to report I was fortunate enough to be sitting next to two delightful people.

As we awaited the main event we were served surprisingly delicious food as the serving wench (who looked remarkably like a standard bearer in the arena later) dutifully went through her script – suggesting that the potato wedges were dragon fingers etc etc.

Our allotted area was colour coded, and we were each given the appropriate coloured paper crown, linking to the knight we were supposed to support. Great for a hen party, but not so great for the row of business men sitting next to us. I think they were from the Philippine Tourist Board, attending the Medical Tourism conference and they were clearly separated into two groups. Those who slept throughout the whole performance, (while still wearing their crowns - bless), and those who sat bolt upright for 90 minutes, looking petrified!

The show that followed was as spectacular as it was confusing. There were horses, swords, knights, pages, a king, a damsel in distress (or was she a princess?) some baddies, some goodies. There was impressive horsemanship, scary sword fights (with real sparks flying as metal clashed), jousting and plenty of posturing, I had absolutely no idea of what was going on at any time. The actors delivered lengthy speeches, I guess in English, but either my hearing or the dodgy sound system or both meant that I didn’t catch a single word. It was a bit like watching a medieval sci fi with a complex plot (I never did really understand the Matrix) but everyone seemed to be having a good time and I think the goody won in the end.

There we upsides of course. Some of the knights were quite cute. Some of the audience – especially a few girls who I think were confused and believed they were, after all, at a hen party, had a ball. I was presented with a carnation (without the stalk for health and safety purposes) by the red knight. I would like to think that the handsome young man picked me for my obvious beauty, wit and intelligence, but I suspect he noticed my look of utter bemusement and felt sorry for me….

In summary, the evening was an eclectic mix of confusing activity, good intentions and a bit of argy bargy - the perfect metaphor for healthcare reform (both sides of the Atlantic).

Post script…
Back to the business of the Employer Healthcare Congress. Was it useful? Absolutely. It was great to catch up with old friends and make some new ones, to share fascinating views on corporate wellness and receive highly informative updates on healthcare reform. I really appreciated the added bonus of presentations on marketing and brand development. Was it better than last year? Yes it was. The multi-stream options continue to be beneficial and this year’s format and agenda were much easier to follow.

Will I attend next year’s congress? Of course. The conference is going to be ‘on the beach’ in Florida – it would be rude not to….

Thursday, 3 November 2011

Employer Healthcare Congress (4). Things you need to know about US healthcare reform but were afraid to ask..

Or maybe the subtitle should be – a layman’s summary of notable facts about the Patient Protection and Affordable Care Act (PPACA)

A fairly large chunk of my time at the Employer healthcare Congress was spent updating myself on the PPACA. A hot topic at last year’s conference, Obama’s controversial reforms are still occupying a great deal of energy, time and money for providers and employers. These are some of my jottings following two excellent sessions run by an impressive team of experts:
Anne Wilde, Attorney and Principal, The HR and Benefits adviser PLLC
Ben Conley, Attorney, Seyfarth Shaw LLP
Michelle Hicks, Director, Communications Buck Consultants

The pearls of wisdom below are all credited to these three experts and the reason they win my prize for ‘most informed presentation’ is not only due to their clear explanations of a complex subject but because they were the only team to provide handouts. This considerably eased the pain for all concerned.

The aim of the PPACA:
To ensure that an additional 32 million Americans will receive healthcare cover. By 2014 the structure of US healthcare will have changed to offer three options:
·      State funded health exchanges (comparing different rates from different insurers and qualifying for tax credits) and taken out by individuals who ‘opt out’ or are ineligible for employer co-funded cover.
·      Individual mandate – an individual must purchase health insurance or face penalties
·      Employers are ‘mandated’ to offer ‘minimum essential coverage’ (applies to all organisations employing 50 or more full time equivalent staff). They will be fined for non-compliance ‘play or pay’

It is highly likely that the PPACA is here to stay:
Challenges to this act will face the Supreme Court within the next 12 months to decide if any element of the legislation is unconstitutional within the next 12 months. For now – it is the law of the land and the smart money is that if it gets repealed, this will be a political, not constitutional decision. With elections next year – this reform could become an interesting political pawn. (Very similar to the way that NHS reforms in the UK are becoming more political by the minute)

Deadlines count:
By December 23rd every self funded group plan MUST have two IRO’s (independent review organisation) contracted to review claims.
Modifications to rules and regulations MUST be communicated to members 60 days in advance.
Initial Benefit determination for a claim on a group plan MUST be completed within 72 hours.
There are many other deadlines written into the Bill.

Grandfathering status is key:
Full comprehension of your Grandfathering status is vital. My English and European readers will think I’m talking about extended families, but no, as those of you in the know are aware – a Grandfathered plan can be described as follows:
A Grandfathered plan is a group plan that provides medical care to employees or their dependants directly or through reimbursement or otherwise, in place on March 23rd 2010. These plans must still comply with minimum cover requirements. These requirements include cover for ‘adult child’ coverage, no lifetime limits, no pre-existing condition exclusions for children under 19 etc etc)

However, if your plan is ‘grandfathered’, then other mandates imposed by the PPACA do not apply. Changes in regulations, cover levels or other aspects of your plan could lead to loss of grandfathered status and exposure to the new regulations.

Still with me?

Fines will be applicable for non-compliance but no-one is sure how these will be monitored and administered.
If an employer fails to over health cover to staff they will be subjected to fines of up to $3000 per employee.(less the first 30) It is expected that some organisations may decide to take this risk – after all – standard cover can run to at least $5000 per year per employee.
Cover offered by employers must be deemed as ‘affordable’. (‘not exceed 9.5% household income) It has not been agreed yet how ‘affordable will be decided’. Means tests will be invasive and impractical and it’s expected that base salary will be used as a measure.
Providing cover levels or elements of a plan that do not comply with the PPACA will result in a fine of $100 per employee per day.
It is therefore cheaper (penalty wise) to fail to offer cover than to provide non compliant cover.

Confused? I am. Which leads to the most important nugget of all..

Appoint an expert!:
Legal counsel is highly recommended (two fantastic attorneys listed above). This law is complex and at times ambiguous. Large penalties may apply for non-compliance, even if your non-compliance is unintentional. The reforms are restrictive, prescriptive and unforgiving in many aspects.

If I had the time – or inclination – it would be interesting to see how many times the words ‘MUST’ or ‘Mandatory’ appear in the PPACA. Instead – I am happy to leave the legal interpretation to the experts…. And thank my lucky stars that the the UK state funded NHS is quite simply ‘free at the point of delivery’.

For now……